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Hematology CCMLS > Leukemia > Flashcards

Leukemia Flashcards

1
Q

leukemia etiology

A

idiopathic
drugs/chemicals
radiation
inadequate tumor suppressor gene

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2
Q

forms of leukemia

A

acute: 50%, aggressive, sudden onset, AML/ANLL- adults, ALL-kids
chronic: less aggressive, insidious onset, more mature cells, adults

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3
Q

acute leukemia clincal presentation

A

fatigue
pallor
petechiae/bleeding
fever
bonepain
neurologic abnormalities

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4
Q

acute leukemia laboratory presentation

A

n/n anemia
decreased Plt
variable wbc- dependant on stage of disease
diff: blasts (monotonous), leukemic hiatus, auer rods
bm: hypercellular, incre M:E, 1 cell line predomiinates
increas uric acid and LD

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5
Q

classification of AML

A

FAB: M0, M1, M2, M3, M4, M5, M6, M7

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6
Q

classification of ALL

A

FAB: L1, L2, L3

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7
Q

M0 leukemia- myeloblastic w/o differentiation

A

adults
>90% blasts
positive: MPO/SSB, SPECIFIC ESTERASE
negative; non specific esterase
CD34 markers

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8
Q

M1 leukemia- myeloblastic w/o differentiation

A

adults
>90% blasts
=/+ auer rods
postive: MPO/SBB, specific esterase, PAS
negative; non specific esterase

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9
Q

M2 leukemia- myeloblastic w/ differentiation

A

adults
30-89% blasts
10% promyelocytes and myelocytes
+/= auer rods
positive: MPO/SBB, specific esterase, PAS
negative: non specific esterase

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10
Q

M3 leukemia-

A

promyelocytic
adults
>30% blasts
increas. promyelocytes
auer rods
assoc. w/ DIC
hyer/micro granular variants
15/17 chromo. translocation
rx: trans-retinoic acid
positive: MPO/SBB (+++), PAS, specific esterase
negative: non speicific esterase

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11
Q

M4 leukemia-

A

myelomonocytic
adults
>30% blasts
increas. monocytes
positive: MPO/SBB, PAS, specific esterase
negative: non specific esterase
M4e variant: eosinophilic variant, inversion of chromo 16, specific esterase is + in these but = in normal eos, better prognosis than M4

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12
Q

M5 leukema-

A

monocytic
adults
>30% blast
>80% monocytes
blasts, promonocytes, monocytes
positive: MPO/SBB, PAS, specific esterase, non specific esterase (+++)
M5a: monoblasts predominate
M5b: promonocytes predominate (gums/skin, tissue infiltrates)

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13
Q

M6 leukemia-

A

erythroleukemia
Digugliemo’s syndrome
>30% blasts
>50% RBC precursors
least common leukemia
can evolve from M1/M2
PAS + (VERY)

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14
Q

M7 leukemia-

A

megakaryoblastic
>30% megakaryoblasts
increas. fibrin & reticulum in marrow
dry tap
rare
Down’s synd.
Plt blebbing
positive: PAS, acid phosphatase
negative: MPO/SBB, specific esterase
classified w/ immunophenotyping

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15
Q

immunophenotyping

A

cell markers and indicators
flow cytometry
id cell types
cluster of differentiation
CD13 & CD33- Myelocytic and monocytic cells

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16
Q

L1 ALL

A

small homogenous cells
fine chromatin
no nucleoli
scant cyto
most common in kids
best prognosis

17
Q

L2 ALL

A

large cells
fine chromatin
irr. nuclei w/ clefts
nucleoli
abundant cyto
adult
most common ALL

18
Q

classification of ALL

A

based on immunophenotyping and cell markers
common acute lymphocytic leukemia antigen (CALLA)
t cell vs. b cell
immature lymphs- tdt +
T cell: CD- 1,2,3,4,5,6,7; positive- acid phosphataste
B cell: CD- 10,19,22; slg positive

19
Q

REAL classification of leukemia

A

revised European American lymphoid neoplasm
based on morph, immunophenotyping, genetics, clinical appearance
3 groups: B cell, T/NK cell, Hodgkin’s Disease

20
Q

Chromosomal anaysis for leukemia

A

philidelphia chromo 9:22 translocation- CML
15:17 translocation- M3
8:21 translocation- AML
9:14 translocation- M4

21
Q

WHO classification of Leukemia

A

based on cell lineage
determined by morph, immunophenotype, genetic features, clinical apperance
~6 groups: ALL, AML, therapy related, not otherwise specified, myeloid syndrome, Down’s syndrome, hematopoetic, lymphopoietic, histocytic/dendritic
>20% blasts defines leukemia

22
Q

albumin smears

A

helps w/ increased smudge cells

23
Q

buffy coat smears

A

low # wbc or low #abnormal cells

24
Q

Leukemia therapy

A

goal: eliminate abnormal clone
chemo
radiation
bm transplant
supportive care

25
Q

leukemia therapy side effects

A

kills all fast growing cells
hair, skin, GI
bm suppression: infec., anemia, bleeding
increased cell turnover
increased uric acid (kidney failure)

26
Q

leukemia prognosis

A

ALL: 80% survival kids, poorer for adults
AML: 55-65% survival
chronic leukemia: generally longer survivals

Hematology CCMLS (13 decks)

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