Leukemias Flashcards
name 4 examples of WBC disorders
leukopenia
leukocytosis
leukemia
lymphoma
White blood cell disorders form solid masses (TRUE/FALSE)?
FALSE
What is leukopenia?
Low WBC count due to reduced production or accelerated destruction of WBCs
leukopenia is associated with increased ____
infections
what is the most common cause of leukopenia?
chemotherapeutics (all cells affected = Aplastic anemia)
what are the symptoms of leukopenia?
malaise
chill
fever
What is leukocytosis?
High WBC count of mature non-neoplastic WBCs
What infection presents as a leukemoid reaction which may be confused with leukemias?
Acute appendicitis
Patient presents with lower right quadrant pain, nausea, vomiting, and pinpoint tenderness. CBC count shows 38,000 WBC and 80% neutrophils. What is a likely diagnosis?
Acute appendicitis
What is polymorphonucleocytosis indicative of?
Bacterial infection
(increased neutrophils)
What is eosinophilic leukocytosis indicative of?
Parasitic infection
(increased eosinophils)
What is lymphocytosis indicative of?
Viral infection
(increased lymphocytes)
What do lymphoid progenitor cells give rise to?
Lymphocytes (Agranulocytes)
What do myeloid progenitor cells give rise to?
Granulocytes (Neutrophil, Basophils, Eosinophil)
What form of leukemia is derived from lymphoid stem cells?
Lymphocytic leukemia
What form of leukemia is derived from myeloid stem cells?
Myeloid (Granulocytic) leukemia
What is lymphadenitis?
Inflammation of the lymph nodes presenting with enlarged, PAINFUL lymph nodes
Lymphadenitis will almost always present with…
pain and enlargement (lymphadenopathy) of lymph nodes (cardinal signs of inflammation)
What is lymphadenopathy?
Enraged lymph nodes with NO PAIN
(Lymphadenitis/Lymphadenopathy) is often the more serious condition?
Lymphadenopathy (independent of lymphadenitis)
What is leukemia?
Neoplastic disorder of uncontrolled proliferation of hematopoietic stem cells characterized by replacement of bone marrow with malignant cells
Leukemia’s are always (Benign/Malignant)?
Malignant
What is lymphocytic leukemia?
Leukemia derived from lymphoid stem cells including B and T cells
Lymphocytic leukemia affects primarily __________ cells?
B
What is myelogenous leukemia?
Leukemia derived from myeloid stem cells including granulocytes, monocytes, and megakaryocytes
Myelogenous leukemia affects primarily _____________________?
Granulocytes
What are histological characteristics of acute leukemia?
- immature neoplastic cells, larger and less differentiated
What are histological characteristics of chronic leukemia?
well differentiated cells that are mature, smaller and more compact
describe the clinical presentation of acute leukemias
- abrupt, stormy onset
- symptoms related to depression of normal marrow: fatigue, fever, bleeding, bone pain, organomegaly, CNS involvement
describe the clinical presentation of chronic leukemias
- insidious onset, rather slow, indolent clinical course
- elevated WBC count
- no/vague symptomology: anemia, fatigue & weakness, weight loss, organomegaly
(Chronic/Acute) leukemia is more severe if left untreated?
Acute
If a patient has bone pain the diagnosis is more likely to be (Leukemia/Lymphoma)?
Leukemia
If a patient has lymphadenopathy the diagnosis is more likely to be (Leukemia/Lymphoma)?
Lymphoma
If a neoplasm is of bone marrow origin it is (Leukemia/Lymphoma)?
Leukemia
If a neoplasm is of nodal origin it is (Leukemia/Lymphoma)?
Lymphoma
What is the most common childhood leukemia?
Acute lymphocytic leukemia (ALL)
Where does acute lymphocytic leukemia (ALL) originate in the body?
Bone marrow
What is myeloperoxidase?
Enzyme made in the peroxisomes of myeloid (Granulocytic) cells
What is the primarily histological indicator of a patient with acute lymphocytic leukemia (ALL)?
transformed B-cells are Myeloperoxidase negative (enzyme not present)
What system of the body will be quickly affected in a patient with acute lymphocytic leukemia (ALL)?
CNS
Male patient; 13 years of age. Presents with chronic fatigue, recurrent infections, fever, and bone pain. Biopsy of bone marrow cells shows bizarre cells that are negative for myeloperoxidase. What is the likely diagnosis?
Acute lymphocytic leukemia (ALL)
What is the most common adult acute leukemia?
Acute myelogenous leukemia (AML)
Leukemia most commonly occurs in (Children/Adults)?
Children
What are the primary histological indicators of a patient with acute myelogenous leukemia?
- Myeloperoxidase positive (present) and Auer Rod positive (present)
- Abnormal retinoic acid receptors
Male patient; 35 years of age. Presents with chronic infections, fever, fatigue, and deep, constant pain in the anterior thigh. Biopsy of the bone marrow in the anterior thigh shows large, poorly differentiated granulocytes. Granulocytic cells are positive for myeloperoxidase and Auer Rods. What is a likely diagnosis?
Acute myelogenous leukemia
What form of leukemia presents with abnormal retinoic acid receptors due to gene fusion?
Acute myelogenous leukemia
What form of leukemia can be treated with vitamin A therapy?
Acute myelogenous leukemia
how does the prognosis of ALL and AML differ?
- ALL: dramatic advances in treatment, good remission rate
- AML: difficult to treat, relapses frequent
What is the treatment protocol for a patient with chronic lymphocytic leukemia?
Difficult to treat due to maturity of neoplastic cells
Blood cell graft or bone marrow transplant
who is most affected by chronic lymphocytic leukemia?
older males
Male patient; 63 years of age. Presenting with fatigue and weakness that has been evident for almost a year. Patient reports losing 30 pounds in the last 3 months without any sort of dietary or lifestyle changes. Upon palpation, extensive bruising and tenderness is noted throughout the body. Biopsy of the bone marrow shows mature B cells that are well differentiated, small, and compact. CBC shows 96,000 white blood cells and 60% lymphocytes. What is a likely diagnosis?
Chronic lymphocytic leukemia (CLL)
what is the leukemic counterpart of small lymphocytic lymphoma (SLL)?
CLL
what are symptoms of chronic lymphocytic leukemia?
asymptomatic/vague symptoms: infection, fatigue, organomegaly
What form of leukemia presents with the Philadelphia (Ph) chromosome?
Chronic myelogenous leukemia (CML)
Chronic leukemias are more commonly seen in (Child/Adult) populations?
Adult
what is the Philadelphia (Ph) chromosome?
translocation between chromosome 9 & 22 (t(9:22)) resulting in Bcr-c-abl gene
What is the Bcr-c-abl gene? What neoplasm is it often present in?
Faulty tyrosine kinase (stuck “on”) present in patients with chronic myelogenous leukemia (CML)
What is the common name for the t(9:22) nomenclature?
Philadelphia chromosome
What chromosomes undergo chromosomal translocation to make the Philadelphia chromosome?
Chromosomes 9 and 22
What is the treatment for chronic myelogenous leukemia (CML)? What is the mechanism?
Gleevec (MAb) that shuts down the bcr-c-abl gene
Male patient; 52 years of age presents with deep pain described as being “On the bone” in the right arm that has been nagging him for the last 4 months. The patient has a diagnose of anemia three years prior before seeing you in his office today. Recently, the patient has decided to finally seek another opinion as he has been chronically fatigued at work. The patient is sent out for a full genetic testing panel. Results show chromosomal translocation of chromosomes 9 and 22 and the presence of the bcr-c-abl gene. What is the common name of the new chromosome that this patient has formed? What is the likely diagnosis for this patient? What treatment should be recommended to this patient?
Philadelphia chromosome
Chronic myelogenous leukemia
Gleevec (MAb)
