Introduction to Leukocyte Neoplasms (Part 3 AML) Flashcards
Acute Myeloid Leukemia (AML) affects elements in what cell lineages?
granulocytic, monocytic, erythroid, or megakaryocytic lineages
Acute Myeloid Leukemia (AML) affects what age group?
All ages, predominated in adults around 65 years of age
How will someone present clinically with Acute Myeloid Leukemia (AML)?
- Pallor, fatigue
- Fever/ infection
- Bruising/ bleeding
- Malignant cell infiltration into other tissues
Acute Myeloid Leukemia (AML)
- peripheral blood
- Variable leukocytosis
- variable displasia
- myeloblasts present in 95% of patients
- Leukemic hiatus
Having many myeloblasts and some segs with no intermediate stages is known as what?
Leukemic Hiatus
Acute Myeloid Leukemia (AML)
- Bone marrow findings
- Hypercellular increased blasts
- > 20% blasts with limited maturation
- variable dysplasia
Acute Myeloid Leukemia (AML)
- Immunophenotyping
CD34+, HLA-DR+, CD117+, CD13+, CD33+
the last two are very specific to AML
What six immature cells will you find in Acute Myeloid Leukemia (AML)?
- Myeloblasts
- Promyelocytes
- Monoblasts
- Promonocytes
- Erythroblasts
- Megakaryoblasts
Acute Myeloid Leukemia (AML) will have recurrent cytogenic abnormalities:
_______ - addition or deletion of part of - or entire- chromosome
_______ primarily translocations and inversions
Numerical
Structural
Acute Promyelocytic Leukemia (APL)
- cytogenetic abnormality
t(15;17)(q24;q21)
Acute Promyelocytic Leukemia (APL)
- two different types of APL
- Typical (60-70%)
- Atypical (30-40%)
Of the two types of APL…which one has hyper granular promyelocytes and nuclei are often bi-lobed or kidney shaped
Typical
Of the two types of APL…which one has micro granular promyelocytes and nuclei that are predominately deeply notched/bilobed (Butterfly)
Atypical
Will Acute Promyelocytic Leukemia (APL) have Auer rods?
YES! They will have multiple Auer Rods (faggot cells)
In Acute Promyelocytic Leukemia (APL), t(15;17) creates a fusion gene. What is it?
PML-RARA
The PML-RARA fusion gene leads to what?
Uncontrolled proliferation and inhibition of cellular differentiation
Acute Promyelocytic Leukemia (APL)
- Lab Results
- DIC/fibrinolysis coagulation
- Thrombocytopenia
- hyper or microgranular promyelocytes
When a slide from a patient with APL is stained with MPO, what will it look like?
Strongly Positive
Acute Promyelocytic Leukemia (APL)
- Treatment
- Prescribe ATRA
- manage coagulopathy
AML - With Abnormal Marrow Eosinophils
- cytogenetic abnormality
inv(16)(p13.1;q22)
t(16;16) (p13.1;q22)
AML - With Abnormal Marrow Eosinophils
- age group affected
primarily young adults
AML - With Abnormal Marrow Eosinophils
- prognosis
favorable to average risk
AML - With Abnormal Marrow Eosinophils
- Peripheral Blood findings
- myeloblasts (other immature myeloid cells)
- monocytoid cells
- thrombocytopenia
- normal eos
AML - With Abnormal Marrow Eosinophils
- Bone marrow findings
- myeloblasts and promyelocytes (30-80%)
- Monocytic component (>20%)
- > 5% eosinophils (all stages of maturation)
AML with maturation
- cytogenetic abnormality
t(8;21)(q22;q22)
AML with maturation
- fusion gene
Runx1-Runx1T1
AML with maturation
- age affected
- 25-30 years old
- predominant in children and young adults
AML with maturation
- prognosis
- good in adults but poor in children
- response well with chemotherapy
AML with maturation
- PB findings
- Blasts with numerous azurophilic granules
- Some may have very large granules (Pseudo-Chediak-Higashi)
- Auer Rods likely
AML with maturation
- BM findings
dysplasia in neutrophil line
monos, eos, and eryth, components not affected
AML with Myelodysplasia-Related Changes
- wich AMLs are in this category
- AML evolving from previous myelodysplastic syndrome
- AML with cytogenetic abnormalites that marrow those of MDS syndromes
AML with Myelodysplasia-Related Changes
- age range affected
elderly population
AML with Myelodysplasia-Related Changes
- Lab findings
presents with severe pancytopenia
AML with Myelodysplasia-Related Changes
- prognosis
poor
AML- Therapy-Related Myeloid Neoplasms
- why does it occur?
occurs as a result of therapy-related cytotoxic chemotherapy and/or radiation therapy
AML- Therapy-Related Myeloid Neoplasms
- Age affected
- Prognosis
- median age 61
- poor prognosis (<10% 5 yr survival rate)
AML not otherwise specified (NOS)
- divisions within this category are based primarily off of what?
morphological and cytochemical/immunophenotypic features
(M0) AML-NOS Minimal Differentiation
- What stains are negative?
MPO and most other stains are negative
(M0) AML-NOS Minimal Differentiation
- age affected
infants and older adults
(M0) AML-NOS Minimal Differentiation
- PB findings
Blasts: medium, round (1-2 nucleoli), fine chromatin, cytoplasm is AGRANULAR and BASOPHILIC
(M0) AML-NOS Minimal Differentiation
- MPX/SBB stains
- Auer rods?
neg/no auer rods
(M1) AML-NOS Without Maturation
- Blast percentage
- MPO/SBB stain?
- Auer rods?
- > 90% of non erythroid cells
- MPO/SBB >3% (positive)
- Auer rods (+/-)
(M2) AML-NOS With Maturation
- MPO
- Auer Rods?
- age affected
- MPO Positive
- Frequent Auer rods
- all age groups
(M4) AML -NOS Myelomonocytic
- Peripheral blood
- Auer rods?
- Myeloblasts
- Monocytoid cells
- thromobcytopenia
- Auer rods +/-
(M4) AML -NOS Myelomonocytic
- Bone marrow
- Myeloblasts >20%
- Monocyte components
(M4) AML -NOS Myelomonocytic
- stains
Blasts will be positive for both myeloid and monocytic markers
(MPO+)
(ANBE +)
(M5a) AML-NOS-Acute Monoblastic AND (M5b) Monocytic Leukemia
- problems
- bleeding problems common at presentation
- Cutaneous and gingival infiltration
- CNS involvement common
(M5a) AML-NOS-Acute Monoblastic AND (M5b) Monocytic Leukemia
- ANBE stain
ANBE- Positive
AML-NOS Acute Erythroid Leukemia
- Two subclasses
- Erythroleukemia (erythroid and myeloblasts in BM)
- Pure Erythroid leukemia (only erythroid precursors in BM)
AML-NOS Erythroleukemia (erythroid/myeloid)
- PAS stain
PAS- positive in RBC precursors, Chunky
(M7) AML-NOS- Megakaryoblastic
- PB
- Micromegakaryocytes
- pleomorphic blasts, blasts with agranular cytoplasm
(M7) AML-NOS- Megakaryoblastic
- BM and stains
- usually dry tap
- MBO/SBB- negative
- Factor VIII stain-pos
AML-NOS-Basopilic Leukemia
- increased what?
blasts and immature basos
AML-NOS Acute Panmyelosis with Myelobibrosis (APMF)
- clinical
- increase in what?
- bone pain and extensive myelofibrosis
- Increased blasts of all myeloid lines
After chemotherapy patients often develop severe leukcytopenia so what do we do to concentrate the cells for a differential?
We make a buffy coat smear by adding EDTA-anticoag blood into a WINTROBE tube
