Heme Flashcards
t(8;14)
c-myc + heavy chain of Ig
*Burkitt Lymphoma
t(12;21)
ALL w/ good prognosis
t(9;22)
aka Philadelphia chromosome, BCR-abl
*CML and ALL
t(14;18)
BCL-2 activation
*Follicular lymphoma
t(15;17)
Retinoic acid receptor shut off
*APL (M3 type of AML)
Aplastic anemia
Cause: viral, radiation, drugs
BM: (dry tap) hypocellular, just lymphoid and fat cells
Labs: low reticulocyte count
Infectious Mononucleosis
Cause: EBV or CMV
Complication: splenic rupture (and Burkitt’s Lymphoma)
PB: Downey cell (reactive T lymphocyte)
LN: paracortical hyperplasia (bc T cells proliferating)
Serology: Monospot (heterophile Ab) test +ve for EBV (will be -ve for CMV)
Burkitt’s Lymphoma
Cause: c-Myc translocation (EBV assoc.)
Markers: CD19, CD20, CD10 and surface Ig
Follicular Lymphoma
Cause: BCL2 t(14;18)
Morphology: B cell tumor arising from germinal center w/ small or large cells and nodular or diffuse pattern
Markers: CD19, CD20, CD10
Complications: progression to DLBL (large diffuse is worst prognosis)
HL (nodular sclerosis)
RS cell: lacunar
Most common HL (classical type)
Markers: CD15, CD30
HL (lymphocyte predominant)
RS cell: popcorn
Variant HL
Markers: CD20, CD45
HL (mixed cellular)
Cause: EBV assoc.
PB: eosinophils bc IL-5 secretion by RS cells
Classic type
Markers: CD15, CD30
HL (lymphocyte depleted)
RS cell: bizarre
Elderly or HIV+ pt
Classic type
Markers: CD15, CD30
Lymphoma Staging
- Single LN
- 2 LNs on same side of diaphragm
- LNs on both sides of diaphragm
- Disseminated to organs
Hairy Cell Leukemia
TRAP +ve
Markers: CD11c, CD103
BM aspirate: dry tap (hypocellular BM)
Biopsy: fried egg appearance, cells in reticulin
Spleen: red pulp infiltration = beefy red appearance
CLL
PB: smudge cells (crushed little lymphocytes)
Markers: CD19, CD20, CD23, CD43, CD5 (normally on T cells)
Complication: warm autoimmune hemolytic anemia, AML/ALL, or DLBL (Richter transformation)
Multiple Myeloma
Pathogenesis: cells producing cytokines that activate osteoclasts and inhibit osteoblasts = pathological fx’s
Electrophoresis: monoclonal IgG spike
BM: hypercellular (lymphocytes take over) = pancytopenia
Urine: Bence-Jones proteins (AL amyloid)
PB smear: rouleaux formation (IgG changes charge of RBCs)
Complication: infection, renal failure, restrictive cardiomyopathy
CML
Cause: BCR-abl (Philadelphia chromosome) t(9;22)
ROS: itching after warm shower (bc of basophils)
PB: neutrophils, bands, basophils, metamyelocytes = left shift (low LAP score)
BM: hypercellular
Tx: Imatinib (Gleevec)
Primary Myelofibrosis
Cause: JAK2 or MPL point mutation
Pathogenesis: megakaryocytes produce TGF-β and PDGF causing reticiulin fibers in BM
PB: poikilocyte, leukoerythroblasts (from spleen)
ALL
Assoc. w/ Trisomy 21
Cause: t(12;21) and t(9;22)
BM: hypercellular, primitive cells w/ Lg nuclei, prominent nucleoli, and scanty cytoplasm
BALL: CD19, CD20, CD10; younger pt
TALL: CD2-8; adolescent boys (mediastinum)
Dx: TdT positive, PAS+
Bad ALL prognosis
<2yo, teenager, males, Philadelphia chromosome, T-ALL, aneupoloidy, high WBC
Good ALL prognosis
2-10yo, females, t(12;21), B-ALL, multipoloidy, low WBC
AML
Cause: M3 type is t(15;17) - turns off retinoic acid receptor, t(8;21), and t(16;16) which has best prognosis
PB: Auer rods (MPO crystals), punched out nuclei
Complication: DIC
Tx: ATRA for M3 APL type
Dx: Sudan Black +ve and MPO+
Dry taps
(Dry HAM)
- Hairy cell
- Aplastic anemia
- Myelofibrosis
Vitamin rule of 6’s
6 wks folate
6 months iron and iodine
6 years B12
Normal MCV
80-100
Normal MCHC
31-36%
Normal Platelet count
150,000 - 400,000
