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clinical lab > lab diagnosis of neoplastic and non neoplastic leukocytes > Flashcards

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
Q

when is basophilia seen ?

A

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

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26
Q

the earliest recognisable cell of monocytes are ?

A

promonocytes

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27
Q

what is the function of monocytes ?

A

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

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28
Q

what is the reason for monocytosis ?

A

infections - tuberculosis , subacute bacterial endocarditis , syphilus
recovery from neutropnea
leukemia , myeloproliferative disorders , lymphoma , multiple myeloma
inflammtory - ulcerative colitis , sprue , polyarteritis , temporal arteritis

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29
Q

what is the cause for monocytopnea ?

A

therapy with prednisone
hairy cell leukaemia
uncommon as an isolated finding

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30
Q

B cell differentiation can be divided into what ?

A

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

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31
Q

what is the staging diffrentiation of t cell lymphocytes

A

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
Q

In late fetal and postnatal life, lymphocytes are produced where ?

A

secondary lymphoid tissue: spleen, lymph nodes, and intestine

Lymphopoiesis in secondary lymphoid organs depends solely on antigenic stimulation

33
Q

function of t cell?

A

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
Q

majority of circulating lymphocytes

A

T cells

35
Q

life span of t cells ?

A

months to years

36
Q

the absolute numbers of lymphocytes and T cells are highest in?

A

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
Q

The absolute number of B lymphocytes is higher or lower between adolesence and child ?

A

remains stable during all stages of life

38
Q

Relative lymphocytosis is caused by ?

A

disorders with neutropenia

39
Q

what is the cause of absolute lymphocytosis

A

acute lymphocytic leukaemia
chronic lymphocytic meukemia
lymphoma
viral - EBV and hepatitis

40
Q

acute infectious lymphocytosis usually occurs in whom?

A

children and it is contagious

41
Q

what is the incubation period of acute infectious lymphocytosis ?

A

12-21 days

42
Q

what causes ACUTE infectious lymphocytosis ?

what are the symtpoms ?

A

coxsackievirus
echovirus
adenovirus type 12

not noted with - EBV , CYTOMEGALOVIRUS , HERPES

vomitting , fever , diarrhea ,discomfort , rashes

leukocytosis precedes clinical manifestations

43
Q

acute infectious lymphocytosis dimer from other leukaemia because ?

A

blood leukocytes are small and mature and are most probably t cell origin

44
Q

what are the biological signs for acute infectious lymphocytosis ?

A

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
Q

what are the signs of CHRONIC infectious lymphocytosis in children ?

A

enlargement of tonsils, lymph nodes , and spleen
history of reoccurring upper respiratory tract infections
marrow shows no abnormality

46
Q

what causes infectious mononucleosis ?

A

secondary to infection with EBV - occurs in children but goes unnoticed

when occurring to equally healthy adults - results in syndrome

47
Q

what is the physical characteristics of infectious mononucleosis ?

A

self limited disease

lymphadenopathy most common in posterior cervical , splenomegaly

48
Q

what are the clinical symptoms of infectious mononucleosis ?

A

sore throat

prolonged maliase

49
Q

what are the biological characteristics of infectious mononucleosis ?

A 
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
Q

what is the pathophysiology of EBV ?

A

enters through orophargeal epithelium and lymphoid cells
attaches to b cells
elicit antibody reaction

51
Q

what type t cells are majorly in the blood ?

A

CD3 T CELLs

then CD4 T CELLS

52
Q

what causes lymphocytopnea ?

A

increased level of adrenocortical hormones
chemotherapeutic drugs
irradiation
advanced cases of hodgkin and non hodgkin lymphomas and terminal carcinoma

53
Q

chronic myelogenous leukemia occurs in who?

A

increases markedly after 50 years

54
Q

what is the symptoms of chronic myelogenous leukaemia ?

A 
anemia 
wieght loss 
maliase 
fever 
night sweats 
infracted spleen - left upper quadrant pain
55
Q

what is the physical findings of chronic myelgenus leukaemia ?

A

splenomegaly
infracts in spleen
excessive bleeding and bruising in later stages
lymphadenopathy present but not prominent
marrow hypercellular - myeloid to erythroid increase

56
Q

what is the characteristics found on the blood test of chronic myelogenous leukaemia ?

A

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
Q

what are other diagnostic markers for chronic myelogenous leukaemia ?

A

neutrophil alkaline phosphatase is reduced or absent

58
Q

neutrophil alkaline phsophatase is elevated when ?

A

in polycethmia vera

59
Q

what is the neutrophil alkaline phosphates in idiopathic myeofibrosis ?

A

elevated , normal or low

60
Q

what is the cytogenic abnormality of chronic myelogenous leukaemia ?

A

involving ABL1 gener in chromosome 9

and BCR gene in chromosome 22 - philadelphia chromsome

61
Q

when does acute myeloid leukaemia occur ?

A

in the first few months of life , but affects all ages more likely above 60 swell

62
Q

what are the clinical signs of acute myeloid leukaemia ?

A

resemble acute infections
granulocytic insufficeincy - ulceration sof mucous membanes
fever

63
Q

what are the physical findings in acute myeloid leukaemia ?

A

prominent enlargement of lymph nodes

spleen

64
Q

how can we make the diagnosis of acute meylogenous leukaemia ?

A

20 percent blast cells in marrow or blood

65
Q

i acute myeloid leukaemia how can we differentiate the mature to the immature myeloid cells ?

A

mature myeloblast identified with MPO , sudan black B and chloroaxetate estuaries assays

cytogenetics

air flow cytometry

cytochemistry

66
Q

who does acute lymphoblastic leukaemia most affects ?

A

children and then adolescents

67
Q

what are the clinical symptoms of acute lymphoblastic leukaemia ?

A

fever and bleeding

68
Q

what are the biological findings of acute lymphoblastic leukaemia ?

A

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
Q

what is the diagnostic rule to diagnose this as acute lymphoblastic leukaemia ?

A

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
Q

in acute lymphoblastic leukaemia what can be the diagnostic test to differentiate it from other blast cells ?

A

negative for SBB , peroxidase , naphthol ASD , CAE

air flow symmetry

71
Q

acute lymphoblastic leukaemia among adults have a worst prognosis than children why?

A

Among adults, only 30%–40% are cured, in part because of the higher frequency of adverse genetic abnormalities

72
Q

what are the characteristics to each type of leukemia in air flow symmetry ?

A

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
Q

chronic lymphocytic leukemia and small cell lymphocytic lymphoma is what ?

A

clonal proliferation of small b lymphocytes involving the blood , bone marrow and

monotonous and usually look normal lymph nodes

74
Q

when does chronic lymphocytic leukaemia and small lymphocytic lymphoma occur

A

above 60

75
Q

what are other haematological associations with chronic lymphocytic leukaemia/ small lymphocytic lymphoma ?

A

nieither anemia or thrombocytopnea

clinical lab (9 decks)

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