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lab diagnosis of neoplastic and non neoplastic leukocytes Flashcards

1
Q

give the algorithm for neutrophil hematopoesis?

A

common myeloid – myeloblast – promyelocyte — n myelocyte — metamyelocyte — n band — /neutrophils /

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2
Q

the hematopoetic algorithm for macrophages ?

A

common myeloid - mono blast - promonocyte – / monocyte – macrophage /

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3
Q

what is the hematopoetic algorithm for eosinophils ?

A

common myeloid progenitor – myeloblast — e myelocyte – e metamyelocyte – e band / eosinophil/

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4
Q

what is the hematopoetic algorithm for basophils ?

A

common myeloid progenitor — myeloblast – b myelocyte –/basophil/

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5
Q

what is the hematopoetic algorithm for erythrocytes ?

A

common myeloid progenitor — pranamoblast – basophilic normoblast — polychromatophilic normoblast — orthochromatophilic normoblast — reticulocyte – / erythrocytes/

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6
Q

what is the heamtopoetic algorithm for platelets ?

A

common myeloid progenitor – megakaryoblast – promegakaryocytes –grnaular megakaryocytes –mature megakaryocytes –/platelets/

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7
Q

what t cell and b cells

A

pluripotent hematopoetic stem cell —-lymphoid progenitor — precursor t/ nk cell —-pro t cell pro nk cell

pre t cell – t cell

nk cell

precursor b cell – pro b cell — pre b cell —/b cell — plasma cell/

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8
Q

Mature neutrophils express what

A

CD13, CD15, CD16, and CD11b, but lose HLA-DR and CD33.

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9
Q

what is the function of neutrophils ?

A

bactericidalactivity

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10
Q

what is Neutrophilic leukocytosis

A

to an absolute concentration of neutrophils in the blood above normal for age

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11
Q

what are the primary factors influencing the neutrophil count

A

the rate of inflow of cells from the BM

the proportion of neutrophils in the marginal granulocyte pool and the circulating granulocyte pool

rate of outflow of neutrophils from the blood

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12
Q

Physiologic neutrophilia leukocytosis occurs when?

A

Severe exercise, hypoxia, stress, or injection of epinephrine

corticosteroids- increase release of neutrophils from marrow, decrease egression of neutrophils from blood, and increase demargination.

Neutrophilia can also be seen with gastrointestinal and hepatic tumors, HL, renal cell carcinoma, and metastatic disease.

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13
Q

in acute infection there can be neutropnea but why is there not ?

A

increased margination of neutrophils and outflow from blood to tissues would lead to neutropenia

were there not a flow of neutrophils from the marrow storage compartment into the blood.

marrow will show granulocytic hyperplasia (increased myeloid to erythroid [M : E] ratio and increased cellularity

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14
Q

in acut infection what does left shift mean ?

A

An increase in immature peripheral blood granulocytes is usually present

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15
Q

what is neutropnea ?

A

reduction in the absolute neutrophil count

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16
Q

what is a agranulocytosis ?

A

been used for severe neutropenia,
usually <0.5 × 10^9/L

can also be associated with depletion of eosinophils and basophils.

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17
Q

what is severe chronic neutropenia

A

efers to patients with ANC <0.5 × 109/L for months or years,

usually with diseases that primarily cause neutropenia in the absence of other cytopenias

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18
Q

what is the cause of neutropnea

A

inherited

acquired as part of an autoimmune disorder - AIDS , RA

intrinsic defect -
fanconi
kostman
cyclic neutropnea

acquired secondary to toxins - alcohol and benzene compounds

drug-associated - cancer chemotherapy
chloramphenicol
qunidine

radiation

hematological - megaloblastic anemia ,
myelodysplasia ,
marror failure

overwhelming infection

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19
Q

what are the morphological alterations neutrophils ?

A

band cells - called into service in times of need

Hypersegmented - slowed DNa synthesis

toxic granulation - azurophilic cytoplasma granules seen in bacterial SEPSIS

cytoplasmic vacuoles - seen in infection indicating phagocytosis - bacterial infection

dohle bodies / my hagglin -pale blue , oval cytoplasmic remnants of ribosomes seen in infection and other toxic conditions / rare autosomal dominant

alder reilly - prominent azurophilic granulation not related to infection but MUCOPOLYSACCHARIDOSIS

hypo granulated cytoplasm - myelodysplastic syndrome

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20
Q

what influences the production of eosinophils ?

A

IL-3 , IL-5 , GM -CSF produced by T LYMPHOCYTES

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21
Q

what is the life span for eosinophils ?

A

approx 18 hours half life

if they enter the tissue - survive for 6 days

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22
Q

in what conditions do eosinophils participate in ?

A

allergic reactions- asthma, urticaria

certain myocardial disease - loeffler endocarditis

infammatory - churg strauss syndrome ,
pulmonary eosinophilic syndrome - loffler

destroying parasitic - trichinosis , filariasis , helmiths

neoplastic - CML chronic myelogenous leukemia

hodgkin lymphoma

t cell lymphoma

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23
Q

are basophils found in tissues ?

A

no , usually mostly found in blood

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24
Q

what is the growth factor for basophils ?

A

Il-3

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25
when is basophilia seen ?
during asthma - immediate hypersensitivity reactions delayed hypersensitivity reaction - cutaneous basophil hypersentivity chronic myelogenous leukemia ``` myeloid metaplasia (extramedually myelopoesis) / myeloproliefrative diseases ``` infections - variola , varicella poycethmia vera reactive basophilis - following irradiation inflammtory - ulcerative collitis hyperthyroidism chronic hemolytic anemia- post splenectomy
26
the earliest recognisable cell of monocytes are ?
promonocytes
27
what is the function of monocytes ?
defence against - mycobacteria , bacteria , virus , protozoa and viruses humoral and cell mediated immunity antibody dependant cellular cytotoxicity after becoming macrophage - release cytolytic proteins - TNF -a
28
what is the reason for monocytosis ?
infections - tuberculosis , subacute bacterial endocarditis , syphilus recovery from neutropnea leukemia , myeloproliferative disorders , lymphoma , multiple myeloma inflammtory - ulcerative colitis , sprue , polyarteritis , temporal arteritis
29
what is the cause for monocytopnea ?
therapy with prednisone hairy cell leukaemia uncommon as an isolated finding
30
B cell differentiation can be divided into what ?
The initial stage of B cell differentiation involves the antigen- independent generation of diversity through rearrangement of the Ig heavy and light chain genes. The second stage is regulated by antigen triggering, T cell interaction, macrophages, and various growth factors . This stage occurs predominantly in the secondary lymphoid organs
31
what is the staging diffrentiation of t cell lymphocytes
Pro-T cells from the bone marrow or fetal liver migrate to the thymus, where they undergo T cell receptor (TCR) gene rearrangement. goes from the cortex of the thymus to the medulla During this time, T cells with the ability to recognize foreign antigens are retained, and T cells with the ability to recognize self-antigens are eliminated
32
In late fetal and postnatal life, lymphocytes are produced where ?
secondary lymphoid tissue: spleen, lymph nodes, and intestine Lymphopoiesis in secondary lymphoid organs depends solely on antigenic stimulation
33
function of t cell?
cytotoxic effect cell- mediated immunity : delayed hypersensitivity, graft rejection, graft-versus-host reactions, defense against intracellular organism - tubercle bacillus , brucella organisms -such as tubercle bacillus and Brucella defense against neoplasms.
34
majority of circulating lymphocytes
T cells
35
life span of t cells ?
months to years
36
the absolute numbers of lymphocytes and T cells are highest in?
young children. percentage of lymphocytes in the blood about 50% for the first 5 years adolescence, the absolute lymphocyte count and the absolute number of T cells have leveled off
37
The absolute number of B lymphocytes is higher or lower between adolesence and child ?
remains stable during all stages of life
38
Relative lymphocytosis is caused by ?
disorders with neutropenia
39
what is the cause of absolute lymphocytosis
acute lymphocytic leukaemia chronic lymphocytic meukemia lymphoma viral - EBV and hepatitis
40
acute infectious lymphocytosis usually occurs in whom?
children and it is contagious
41
what is the incubation period of acute infectious lymphocytosis ?
12-21 days
42
what causes ACUTE infectious lymphocytosis ? what are the symtpoms ?
coxsackievirus echovirus adenovirus type 12 not noted with - EBV , CYTOMEGALOVIRUS , HERPES vomitting , fever , diarrhea ,discomfort , rashes leukocytosis precedes clinical manifestations
43
acute infectious lymphocytosis dimer from other leukaemia because ?
blood leukocytes are small and mature and are most probably t cell origin
44
what are the biological signs for acute infectious lymphocytosis ?
lymphoid biopsy - reactive follicular hyperplasia in SOME cases white cell in csf increased no spleen or liver or lymph node enlargement in contrast to infectious mononucleosis - atypical lymphocytes is UNCOMMON
45
what are the signs of CHRONIC infectious lymphocytosis in children ?
enlargement of tonsils, lymph nodes , and spleen history of reoccurring upper respiratory tract infections marrow shows no abnormality
46
what causes infectious mononucleosis ?
secondary to infection with EBV - occurs in children but goes unnoticed when occurring to equally healthy adults - results in syndrome
47
what is the physical characteristics of infectious mononucleosis ?
self limited disease lymphadenopathy most common in posterior cervical , splenomegaly
48
what are the clinical symptoms of infectious mononucleosis ?
sore throat | prolonged maliase
49
what are the biological characteristics of infectious mononucleosis ?
``` atypical lymphocytosis large transformed lymphocytes transiet monocytosis relative or absolute neutropnea early on elevated transaminases ``` in immunocompirmised patient EBV associated with : benign b cell hyperplasia malignant lymphoma post transplantation lymphoproliefrative disease
50
what is the pathophysiology of EBV ?
enters through orophargeal epithelium and lymphoid cells attaches to b cells elicit antibody reaction
51
what type t cells are majorly in the blood ?
CD3 T CELLs | then CD4 T CELLS
52
what causes lymphocytopnea ?
increased level of adrenocortical hormones chemotherapeutic drugs irradiation advanced cases of hodgkin and non hodgkin lymphomas and terminal carcinoma
53
chronic myelogenous leukemia occurs in who?
increases markedly after 50 years
54
what is the symptoms of chronic myelogenous leukaemia ?
``` anemia wieght loss maliase fever night sweats infracted spleen - left upper quadrant pain ```
55
what is the physical findings of chronic myelgenus leukaemia ?
splenomegaly infracts in spleen excessive bleeding and bruising in later stages lymphadenopathy present but not prominent marrow hypercellular - myeloid to erythroid increase
56
what is the characteristics found on the blood test of chronic myelogenous leukaemia ?
complete spectrum of granulocytes from few meyloblasts to mature neutrophils myelocytes and neutrophils are exceeding - bimodal distribution excludes anything else myeloblast less than 10 percent of cells basophilia always eosinophilia with eosinophil myelocytes absolute increase of monocytes normocytic anemia thrombocytosis or thrombocytopnea
57
what are other diagnostic markers for chronic myelogenous leukaemia ?
neutrophil alkaline phosphatase is reduced or absent
58
neutrophil alkaline phsophatase is elevated when ?
in polycethmia vera
59
what is the neutrophil alkaline phosphates in idiopathic myeofibrosis ?
elevated , normal or low
60
what is the cytogenic abnormality of chronic myelogenous leukaemia ?
involving ABL1 gener in chromosome 9 | and BCR gene in chromosome 22 - philadelphia chromsome
61
when does acute myeloid leukaemia occur ?
in the first few months of life , but affects all ages more likely above 60 swell
62
what are the clinical signs of acute myeloid leukaemia ?
resemble acute infections granulocytic insufficeincy - ulceration sof mucous membanes fever
63
what are the physical findings in acute myeloid leukaemia ?
prominent enlargement of lymph nodes | spleen
64
how can we make the diagnosis of acute meylogenous leukaemia ?
20 percent blast cells in marrow or blood
65
i acute myeloid leukaemia how can we differentiate the mature to the immature myeloid cells ?
mature myeloblast identified with MPO , sudan black B and chloroaxetate estuaries assays cytogenetics air flow cytometry cytochemistry
66
who does acute lymphoblastic leukaemia most affects ?
children and then adolescents
67
what are the clinical symptoms of acute lymphoblastic leukaemia ?
fever and bleeding
68
what are the biological findings of acute lymphoblastic leukaemia ?
in precuror b ALL - noromocytic anemia present , frequently nucleated red cells thrombocytopnea is the RULE predominant cell - lymphoblast leukocyte count occasionally very high , most free normal or decreased
69
what is the diagnostic rule to diagnose this as acute lymphoblastic leukaemia ?
blast percentage more than 50 percent predominance of small blast - highly basophilic increased nuclear to cytoplasmic ration inconspicuous nucleoli most common in childhood acute lymphoblastic leukaemia - FAB L1 FAB L2 - chromatin diffuse in some cells show variable condensation difficult to distinguish from normal lymphocytes large blasts with more ABUNDANT CYTOPLASM PROMINENT irregular NUCLEOLI IN ADULT ALL
70
in acute lymphoblastic leukaemia what can be the diagnostic test to differentiate it from other blast cells ?
negative for SBB , peroxidase , naphthol ASD , CAE air flow symmetry
71
acute lymphoblastic leukaemia among adults have a worst prognosis than children why?
Among adults, only 30%–40% are cured, in part because of the higher frequency of adverse genetic abnormalities
72
what are the characteristics to each type of leukemia in air flow symmetry ?
definative for aml - CYTOPLSMIC MPO strongly associated -CD17 moderatley - CD13 definative for ALL - b cell - None strongly assocaited -cytoplasmic cd79a cytoplasmic CD22 moderately associated - TdT definative for ALL - t cell cytoplasmic CD3 Tcell recptor strong associated - cd7 - bright moderatley assocaited - CD 5 bilinear acute leukaemia - when there is differentiation along more than one lineqage such as myeloid and b cell
73
chronic lymphocytic leukemia and small cell lymphocytic lymphoma is what ?
clonal proliferation of small b lymphocytes involving the blood , bone marrow and monotonous and usually look normal lymph nodes
74
when does chronic lymphocytic leukaemia and small lymphocytic lymphoma occur
above 60
75
what are other haematological associations with chronic lymphocytic leukaemia/ small lymphocytic lymphoma ?
nieither anemia or thrombocytopnea

clinical lab (9 decks)

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