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Hematology > Introduction to Leukemia (Exam III) > Flashcards

Introduction to Leukemia (Exam III) Flashcards

1
Q

Definition of leukemia

A

malignant disease of hematopoietic tissue that is characterized by replacement of normal BM elements with abnormal (neoplastic) blood cells

  • leukemic cells are frequently (NOT always) present in the peripheral blood
  • Commonly invade reticuloendothelial tissue (spleen, liver, and lymph nodes) and can invade other organs
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2
Q

Etiology

A

Mutation or altered expression of oncogenes or tumor suppressor genes
- regulate cell proliferation and differentiation

Abnormal oncogene or tumor suppressor gene expression -> unregulated cellular proliferation

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3
Q

First) BM becomes crowded

A

Neoplastic cells proliferate

(need to identify)

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4
Q

Second) Normal hematopoiesis hindered

A

Anemia and Thrombocytopenia

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5
Q

Third) Extramedullary hematopoiesis

A

Hepatosplenomegaly

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6
Q

Myeloid lineage

A

Related to cell lineages from Myeloid Stem Cell
- includes cell lines that divide and mature iN BM
- Granulocytic (neutrophils, basophils, eosinophils), Erythrocytic (RBCs), megakaryocytic (platelets), monocytic (monocytes/macrophages) and all of their precursors

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7
Q

Lymphoid lineage

A

Relating to cell lineages from lymphoid stem cell
- includes cell lines that mature in the lymphatic system (spleen, thymus, lymph nodes)
- B&T lymphocytes and their precursors

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8
Q

Acute Leukemia

A

Rapidly progressive disease characterized by an abnormal expansion of immature cells or blasts

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9
Q

Chronic leukemia

A

Slowly progressive disorder characterized by an abnormal expansion of mature cells

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10
Q

Acute Leukemia
Age
Clinical Onset
Course (untreated)
Leukemic Cells
Anemia
Thrombocytopenia
Organomegaly

A
  • All ages
  • Sudden
  • Months
  • Immature
  • Mild-Severe
  • Mild-Severe
  • Mild
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11
Q

Chronic Leukemia
Age
Clinical Onset
Course (untreated)
Leukemic Cells
Anemia
Thrombocytopenia
Organomegaly

A
  • Adults
  • Insidious
  • Years
  • Mature
  • Mild
  • Mild
  • Prominent
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12
Q

Leukemia Broad Groups

A
  • Acute Myeloid Leukemia
  • Acute Lymphoblastic Leukemia
  • Chronic Myeloid Leukemia
  • Chronic Lymphocytic Leukemia
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13
Q

Cytogenetics

A

detects # and structural variations in chromosomes

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14
Q

karyotyping

A

stained metaphase chromsomes

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15
Q

FISH

A

Fluorescent in Situ Hybdridization - detects smaller genetic abnormalities

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16
Q

Molecular Genetics

A

Detcts changes at the DNA level in a single gene

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17
Q

Genetics nomenclature

A

Ex: Philadelphia chromosome - CML
- t(9;22)(q34;q11)(BCR-ABL)
- t = trnaslocation (transfer of one portion of a chromosome to another)
- inversion = breaks off and reattaches upside down
- () surrounds structurally altered chromosomes and breakpoints

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18
Q

Q arm

A

long arm

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19
Q

P arm

A

Short arm

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20
Q

BCR-ABL

A

gene product from abnormality

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21
Q

Cell surface markers

A

Proteins on the cell membrane

22
Q

Cytoplasmic markers

A

proteins in the cytoplasm

23
Q

Cell surface markers and cytoplasmic markers

A

can be detected using flow cytometry or immunohistochemistry

24
Q

cytoplasmic markers

A

Quantity of antigen on the cell surface and in cytoplasm varies

Some antigens are exclusively cytoplasmic

When using flow cytometry for detection, we have to add a step
- Permeabilize cells - allows antibody being used for detection to enter the cytoplasm

25
Q

Flow cytometry

A

Requires a cell suspension
- Typically bone marrow aspirate or peripheral blood

Want fresh speciment with viable cells

Uses immunoflorescence to stain the cells
- Fluorochrome (antibody conjugated to fluorescent dye) binds to a specific antigen

Cells then flow in a single file line through detector
- detects fluorescence of fluorochrome
- Can also measure size (FSC) and granularity (SSC) of cell from light scatter

26
Q

Immunohistochemistry

A

Performed on paraffin sections of the core biopsy, BM clot, or other biposy material
- specimen must be fized

Antibodies conjugated to an enzyme (or fluorescent dye) bind to specific antigens
- a substrate is added that is catalyzed by the bount enzymes producing a color reaction

27
Q

Age ALL

A

more common in children

28
Q

Age AML

A

more common in adults

29
Q

Age CLL and CML

A

more common in adults

30
Q

Onset

Abrupt, more common in acute leukemia

A

ALL and AML

31
Q

Onset

Gradual, more common in chronic leukemia

A

CML and CLL

32
Q

Auer Rods

A
  • Needle like bodies in Myeloblast or Promyelocyte
  • Cause = fusion of primary granules
  • Acute Myelogenous leukemia (AML)
  • Acut Monocytic Leukemia
33
Q

Leukemoid reaction

A

High LAP score

34
Q

Chronic myelogenous leukemia (CML)

A

Low LAP score

35
Q

LAP positive staining

A

Blue intensified granules

36
Q

LAP stains neutrophilic granules

A

present in segmented neutrophils, bands, metamyelocytes

37
Q

Cytogenetics

A

number and structural variations in chromosomes

38
Q

molecular genetics

A

identify translocations, inversions, mutations

39
Q

immunophenotype

A

cell marker expression (flow cytometry or immunohistochemistry)

40
Q

Clinical features

A

Symptoms, onset etc.

41
Q

Microscopic morphology

A

identifiable cellular details

42
Q

Cytochemistry

A

Special stains to identify enzymes or lipids specific to certain blast populations

43
Q

French-American-British (FAB)

A

Microscipic morphology
- identifiable cellular details

Cytochemistry
- special stains to identify enzymes or lipids specific to certain blast populations

Requires >30% blasts in blood or MB = Acute leukemia

44
Q

WHO system

A

Requires >20% myeloblasts in blood or BM = Acute Myeloid Leukemia

Requires >25% lymphoblasts in BM = Acute Lymphoblastic/cytic Leukemia

45
Q

ALL/Lymohoma ->

A

B cells
- B cell lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities
- B cell lymphoblastic leukemia/lymphoma, not otherwise specified

T cells
- Early T cell precursors lymphoblastic leukemia
- Natural Killer (NK) cell lymphoblastic leukemia/lymphoma

46
Q

WHO genetics

A

AML withh recurent genetic abnormalities

47
Q

WHO secondary/history

A
  • AML with myelodysplasia related changes
  • Therapy related myeloid neoplasms
  • Myeloid proliferations realted to downs syndrome
48
Q

WHO morphology/cytochemistry/Immunophenotype

A
  • AML not otherwise specified (NOS)
  • Blastic Plasmacytoid dendritic cell neoplasm
49
Q

WHO Immunophenotype Undifferentiated or mixed

A

Acute leukemias of ambigious lineage

50
Q

WHO myeloid neoplasms outside of BM

A

Myeloid sarcoma

51
Q

WHO Myeloid neoplasm in background

A

Myeloid neoplasms with germline predisposition

Hematology (36 decks)

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