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Hematology 2 Lec > INTRO TO LEUKEMIA > Flashcards

INTRO TO LEUKEMIA Flashcards

1
Q

▪ a disease of the blood-forming tissues, predominantly the bone marrow

A

LEUKEMIA

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2
Q

• adults:

A

bone marrow

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3
Q

• children or newborns who develop early leukemic stages:

A

liver and spleen

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4
Q

▪ a malignant neoplasm characterized by disorderly (different maturation stages affected or arrested), purposeless (unwanted/unneeded response), and uncontrolled proliferation of one or more of the hematopoietic cells (due to gene mutation/oncogene activation and other factors affecting uncontrolled wbc production)

A

LEUKEMIA

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5
Q

▪ mutation of gene at a certain stage of [?] in a cell cycle

A

DNA encoding

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6
Q

▪ also caused by [?] in a cell cycle

A

low or inhibition or regulatory cells/substances

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7
Q

: regulates or suppresses activity of mutated gene/s or cells

A

▪ regulatory substances

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8
Q

: key regulators for cell proliferation

A

• p27 and p53

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9
Q
  • very low levels or defective: mutated gene are allowed to proliferate
A

• p27 and p53

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10
Q
  • leads to genetic mutation leading to leukemia
A

• p27 and p53

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11
Q

: master control during the transition stage of a primitive precursor cell until maturation

A

▪ GATA2

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12
Q

: arrests/halts cell maturation on a blast stage

A

• GATA2 mutation

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13
Q

: • causes the normal cells to be cancerous when mutated

A

Proto-oncogenes

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14
Q

Proto-oncogenes
• functions to encode proteins which stimulates:

A
  • cell division
  • cell differentiation
  • cell death (minimized or inhibit if unnecessary)
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15
Q

• normal gene controlling essential cell functions such as signaling pathways, cell proliferation, differentiation, and apoptosis that, on mutation, may become an oncogene

A

Proto-oncogenes

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16
Q

• group of genes that causes the normal cells to become cancerous when mutated

A

Proto-oncogenes

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17
Q

Oncogene

• upon activation: exhibits increased production of an encoded protein which causes

A
  • increased cell division
  • decreased cell differentiation
  • inhibition of cell death (apoptosis)
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18
Q

No cell death occurs with blast cells, allowing proliferation; no elimination of abnormal cells

A

Oncogene

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19
Q

Oncogene e.g.,

A

DNMT3A

MEIS1

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20
Q

(proto-oncogene; caused by viral infection)

A

DNMT3A

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21
Q

(oncogene; triggers leukemia)

A

MEIS1

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22
Q

• viruses have the capability to carry their own oncogene and mutating it to an individual’s proto-oncogene to their oncogenes with the use of triggers

A

MEIS1

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23
Q
  • viruses integrate their RNA to our cells (nucleus) and their oncogene causes our proto-oncogene to become oncogene
A

MEIS1

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24
Q

IMPLICATED/ASSOCIATED CONDITIONS

A
  1. HEREDITY/GENETIC
  2. CHROMOSOMAL ABNORMALITY/CONGENITAL FACTORS
  3. CHEMICAL AGENTS
  4. IONIZING RADIATION ]
  5. VIRUSES
  6. IMMUNOLOGICAL DEFECTS
  7. NEOPLASIA
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25
Q

▪ All lines of the offspring may inherit the gene and demonstrate leukemia decelopment

A
  1. HEREDITY/GENETIC
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26
Q
  1. CHROMOSOMAL ABNORMALITY/CONGENITAL FACTORS Examples:
A

• Trisomy 21
• Philadelphia (Ph) chromosome
• Chromosome 8 and 14 arm defects

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27
Q

: most popular

A
  • Ph1 chromosome
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28
Q

ch22 abnormality

A
  • Ph1 chromosome
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29
Q

some part of ch9 is transferred to ch22 (modification)

A
  • Ph1 chromosome
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30
Q

usually seen mostly in CML and sometimes in ALL

A
  • Ph1 chromosome
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31
Q
  1. CHEMICAL AGENTS
A

benzene

chloramphenicol

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32
Q

most widely known to depress bone marrow

A

benzene

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33
Q

antibiotic with major side effects or reversible bone marrow depression, aplastic anemia, and leukemia

A

chloramphenicol

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34
Q

▪ used in chemotherapies to kill cancer cells

A
  1. IONIZING RADIATION
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35
Q

• not specific (usually systemic) and kills healthy cells thus aggravating the leukemic condition of a patient

A
  1. IONIZING RADIATION
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36
Q

▪ implicate the leukemic condition of a patient due to their mode of replication

A
  1. VIRUSES
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37
Q

• integrates their viral RNA causing the mutation or activation of proto-oncogene into oncogene in an infected individual

A
  1. VIRUSES
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38
Q

▪ most known virus to trigger leukemia

A

• Epstein-Barr virus (EBV)
• Human T-lymphotropic virus (HTLV) - HTLV-I - HTLV-II

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39
Q

▪ breakdown (decreased capacity) of the immunosurveillance that normally keeps neoplastic growths, aggravating the leukemic condition

A
  1. IMMUNOLOGICAL DEFECTS
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40
Q

▪ usually seen in acute lymphocytic leukemia (ALL = prone to viral infections) and lymphoma

A
  1. IMMUNOLOGICAL DEFECTS
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41
Q

arise from the hematopoietic cells of bone marrow and usually spread first to peripheral blood

42
Q

▪ cancerous cell clone will grow rapidly and at the expense of

A

normal hematopoietic cells

43
Q

CONSEQUENCES

A

▪ decreased RBC and platelet production (suppressed once there is a proliferation in 1 or 2 cell lines)
▪ deceased (blast cell are present in the circulation) to normal WBC production in peripheral blood (proliferation or increased production)

44
Q

OTHER SINGS AND SYMPTOMS

A

Anemia: fatigue, headache, dizziness

Neutropenia: fever, increased sweating

Thrombocytopenia: bleeding and clotting problems

Hypermetabolism

Organ Failure

45
Q

Anemia:

A

fatigue, headache, dizziness

46
Q

Neutropenia:

A

fever, increased sweating

47
Q

Thrombocytopenia:

A

bleeding and clotting problems

48
Q

▪ sign of bone marrow failure

49
Q

▪ decreased RBC survival

50
Q

▪ dyserythropoiesis (abnormal RBC production/structure/count)

51
Q

dyserythropoiesis characterized by:

A

multinuclearity, gigantism (giant RBCs), pyknosis

52
Q

: hyperlobulated or hypolobulated nucleus with nuclear fragmentation

A

• multinuclearity

53
Q

: shrinkage or condensation in the size of a cell or cell nucleus (nucleus disappears)

A

• pyknosis

54
Q

▪ less delivery of oxygen and nutrient transport thus cause weakness and headaches

55
Q

▪ treatment: transfusion of red cell concentrates (red cell transfusion)

56
Q

subject to infections; sign of bone marrow failure

A

Neutropenia

57
Q

exhibits dysmyelopoiesis

A

Neutropenia

58
Q

dysmyelopoiesis characterized by:

A

Pseudo-Pelger-Huet, Auer rods, N:C ratio asynchrony

59
Q

: abnormal nuclear condition of WBC (hypersegmentation)

A

• Pseudo-Pelger-Huet

60
Q

: fused primary granules

A

• presence of Auer rods

61
Q
  • asynchronous maturation of nucleus and cytoplasm
A

N:C ratio asynchrony

62
Q
  • (normal) as the cell ages: ↓ cytoplasm size, segmentation of nucleus
A

N:C ratio asynchrony

63
Q
  • cytoplasmic size ↓ without nuclear segmentation or lobulation
A

N:C ratio asynchrony

64
Q
  • nuclear hypersegmentation (mature) with large cytoplasmic size (immature)
A

N:C ratio asynchrony

65
Q

treatment: transfusion of granulocyte concentrates (granulocyte transfusion)

A

Neutropenia

66
Q

▪ involves platelet and coagulation factors

A

Thrombocytopenia:

67
Q

: low platelet count

A

▪ bleeding

68
Q

: liver and other organs are affected as bm fail = coag factor defects and qualitative plt abnormalities

A

▪ clotting problems

69
Q

treatment: transfusion of platelet concentrates (platelet transfusion)

A

Thrombocytopenia:

70
Q

dysmegakaryopoiesis

A

Thrombocytopenia:

71
Q

dysmegakaryopoiesis characterized by:

A

• giant platelet
• hypolobulation/hyperlobulation of megakaryocytes
• micromegakaryocyte (product)

72
Q

 (normal) man nucleus to signify maturation
 Abnormal: hypolobulation (N:C ratio asynchrony)

A

hypolobulation/hyperlobulation of megakaryocytes

73
Q

▪ elevated resting energy expenditure accompanied by extreme weight loss (thin leukemic patients)

A

Hypermetabolism

74
Q

▪ ↓nutrient intake, ↑metabolism = nutrients are immediately metabolized (not absorbed) in ≤1 hr instead of 2 hrs (normal)

A

Hypermetabolism

75
Q

▪due to bone marrow failure

A

Organ Failure

76
Q

• treated by:
- radiotherapy or chemotherapy (Steininger)
- bone marrow transplant: least recommended due to many complications (allogeneic transplant) such as Graft versus host disease (GVHD)

A

Organ Failure

77
Q

CLASSIFICATIONS OF LEUKEMIAS Criteria

A

I. Cell Line

78
Q

I. Cell Line

A
  1. Myeloid/Myelocytic/Myelogenous Leukemia/ Non-Lymphocytic Leukemia
  2. Lymphoid/Lymphocytic/Lymphogenous Leukemia/Lymphoblastic
79
Q

II. % of Blasts in the PB and BM

A
  1. Acute Leukemia
  2. Chronic Leukemia
  3. Sub-acute Leukemia
80
Q

III. Number of WBCs in the peripheral blood

A
  1. Leukemic Leukemia
  2. Sub-leukemic Leukemia
  3. Aleukemic Leukemia
81
Q
  1. Myeloid/Myelocytic/Myelogenous Leukemia/ Non-Lymphocytic Leukemia ▪ affected cells:
A

RBCs, BEN, monocytes, platelets (except lymphocyte)

82
Q
  1. Lymphoid/Lymphocytic/Lymphogenous Leukemia/Lymphoblastic ▪ affected cells:
A

lymphocyte

83
Q

▪ with increased blast cells in the bone marrow and peripheral blood

A
  1. Acute Leukemia
84
Q

• FAB criteria: > 30% bone marrow blasts

A
  1. Acute Leukemia
85
Q

• WHO criteria: ≥ 20% bone marrow blasts

A
  1. Acute Leukemia
86
Q

▪ Prognosis: rapidly progressive, with a shorter prognosis (poor) of days to 6 months

A
  1. Acute Leukemia
87
Q

▪ < 10% blasts in PB

A
  1. Chronic Leukemia
88
Q

▪ with better and longer prognosis (slower progression and proliferation; not responsive to treatment)

A
  1. Chronic Leukemia
89
Q

▪ transitional stage between acute to chronic

A
  1. Sub-acute Leukemia
90
Q

▪ 10-30 % blast in the PB plus other symptoms

A
  1. Sub-acute Leukemia
91
Q

▪ Prognosis: at least 2-6 months

A
  1. Sub-acute Leukemia
92
Q

:▪ WBC count: more than 15, 000/uL

A
  1. Leukemic Leukemia
93
Q

▪ WBC count: less than 15, 000/uL

A
  1. Sub-leukemic Leukemia
94
Q

▪ presence of immature or abnormal cells in the PB

A
  1. Sub-leukemic Leukemia
95
Q

▪ WBC count: less than 15, 000 /uL

A
  1. Aleukemic Leukemia
96
Q

▪ no immature nor abnormal cells in the PB

A
  1. Aleukemic Leukemia
97
Q

FAB basis in classification of leukemia:

A

morphological appearance of cells in a Romanowsky stain

98
Q
  1. AML/ANLL =
A

M1, M2, M3, M4, M5, M6, M7 (myeloid)

99
Q
  1. ALL =
A

L1, L2, L3 (lympoid)

100
Q

WHO basis in classification of leukemia:

A

▪ morphology
▪ cytochemical stain
▪ immunologic markers/probes (antibodies produced): cluster of differentiation (CD)
▪ cytogenetics: chromosomal markers of leukemic cells

Hematology 2 Lec (29 decks)

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