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Blood and lymph test 2 > Leukemias > Flashcards

Leukemias Flashcards

1
Q

Leukemoid rxn

A 
Left shift (Increase in band cells)
Alk phos would be increased but not in CML!!!
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2
Q

Leukemia

A

Low leukocyte alk phos

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3
Q

Hodgkin’s lymphoma characteristics

A 
Reed-sternberg cells
Local lymph nodes 
B symptoms
May be associated with EBV
Less reed cells, better outcome
PET scan best for staging

Brentaximab also used for advanced

Early- ABVD- Adriamycin, Bleomycin, Vinblastine and Dacarbazinefor all stages

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4
Q

Non hodgkins lymphoma characteristics

A

Widespread lymph nodes
B symptoms not as common
May be associated with HIV
Prognosis varies widely

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5
Q

Reed sternberg cell

A 
Owl eyes
CD30/CD15 positive
CD45 negatve, only lymphoprolifrative disorder that is negative.
Lymphomas always do an excisional biopsy
Under somatic hypermutation
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6
Q

Hodgkin lymphoma types

A

Nodular sclerosis
Mixed cellularity
Lymphocyte depletion
Lymphocyte predominance (CD 20+)

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7
Q

Nodular sclerosis

A

Most common in women
Mediastinal, supraclavicular, and lower cervical nodes
Good prognosis (low reed sternberg count)
Can see collagen banding on biopsy

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8
Q

Mixed cellularity

A

Intermediate prognosis
Is associated with EBV
Lymphocytes and reed sternberg about equal

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9
Q

Lymphocyte predominance

A

Mostly men, lots of lymphocytes, good prognosis

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10
Q

Lymphocyte depletion

A

EBV associated

Poor prognosis

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11
Q

Hodgkins lymphoma staging

A

1) 1 LN
2) More than one LN, same side as diaphragm
3) More than one LN, both sides of diaphragm
4) Outside of LN system

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12
Q

Burkitt lymphoma

A 
B- cell
Africa- Jaw
US- abd
(8:14  2:8  8:22) c-myc translocation
Starry sky pattern
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13
Q

Diffuse large well differentiated lymphocytic lymphoma

A

Older Patients (Most common non hodgkins)
Lymph/hepatosplenomegaly
Bone marrow almost always involved
5-7 year survival

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14
Q

Mantle cell lymphoma

A

t(11;14) IgH to bcl-1
Lymph/hepatospleenomegaly with fever and night sweats
Poor prognosis—3 years
CD5+

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15
Q

Follicular lymphoma

A

Slower growing
t(14;18) IgH to bcl2 so less apoptosis
May be associated with immunodificiency states

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16
Q

Adult t-cell leukemia/lymphoma

A

Mosly japan, some africa
Lymph/hepatospleenomgaly, skin lesion, and hypercalcemia
Cause: HTLV1

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17
Q

Cutaneous T-cell lymphomas

A

Mycosis fungoides- Inflammation, plaque, tumor

Sezary syndrome- Once its in the bloodstream.

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18
Q

Multiple myeloma

A

Plasma cell neoplasm
CRAB- Calcium, Renal, Anemia, Bone lysis

Test: serum protein electrophoresis shows a large spike of serum or urine of monoclonal IgG or IgA

Over production of light chain gets stuck in distal renal tubule (kappa bence jones proteins) and causes necroses.
Marrow cells have Russell bodes
X-rays show punched out defects (can produce hyper calcemia because they secrete osteoclast activating factor)
Rouleaux formation shows stacked RBC’s

Staging based on serum albumin levels and B-2 microgloblulin

19
Q

Waldenstrom macroglobulinemia

A

Like multiple myeloma only monoclonal IgM
Get thick blood, clotting
NO BONE LYSIS

20
Q

Monoclonal gammopathy of undetermed significance

A

Also get a M spike electrophoresis without symptoms associated with waldenstrom and multiple myelomas

3 criteria
Monoclonal <10%
No end organ damage

Smoldering the same except with bone marrow plasma cells between 10-60g/dl

21
Q

Acute lymphoblastic leukemia/lymphoma

ALL

A 
Less than 15 y/o
Increased bone marrow lymphoblast
TdT and CALLA+
If t(12;21), better prognosis
t(8;14); t(8;22); t(2,8)
t(9;22) Philly!!! Really bad

Children- 60-80% cure
Adults- 30-60% cure

Responds to imitinib, also monitor kidney and use allopurinol

22
Q

Small lymphocytic lymphoma and Chronic lymphocytic leukemia

SLL/CLL

A

Greater than 60 y/o, Men more likely
Often asymptomatic, smudge cell in PBS
Warm Ab autoimmune hemolytic anemia
CLL has more lymphocytosis than SLL

Possible:
Autoimmune hemolytic anemia
Autoimmune Thrombocytopenia
Infections due to Hypogammaglobulinemia

Grading
0- Lymphocytosis
1- with lymphadenopathy (SLL)
2- Organomegaly
3- Anemia
4- Thrombocytopenia

Deletion 11q23 and Alteration 17p is poor prognosis

23
Q

Hairy cell leukemia

A

B cell tumor with hair like projections

Stains TRAP +

24
Q

Acute myelogenous leukemia AML

A 
Peaks at 60yo
increased myeloblasts on PBS
Auer rods present
t(15;17) 
M3 AML subtype responds to all trans retinoic acid (Vit A)
DIC common in these patients
25
Q

Chronic myelogenous leukemia CML

A 
50-60 yo
t(9;22) bcl-abl Ph
Increased (always) neutrophils, metamyelocytes, and basophils
Low leukocyte alk phos
Responds to imitinib, nilotinib, dasatib
26
Q

B cell and T cell markers

A

B- CD10/19/20

T- CD2-8

27
Q

Neutrophilic leukocytosis

A

Bacterial infection
Tissue necrosis
High cotrisol state (release cells from marginated pool)

Early left shift cells express CD16 with decreased Fc expression

28
Q

Monocytosis

A

Inflammation and malignancy

29
Q

Eosinophilia

A

HODGKINS LYMPHOMA Via IL5

Allergic/parasite

30
Q

Basophilia

A

CML

31
Q

Lymphocytic leukocytosis

A

CD8+ response
Viral and Bordetella pertusis
EBV, CMV less common

32
Q

Myeldysplastic disorder

A

Qualitative and quantitative disorder with more immature

33
Q

Myeloproliferative

A

See more mature cells

34
Q

Fanconi’s Anemia

A 
Chromosomal Breakage Syndrome
Autosomal Recessive(?)
Constitutional Aplastic Anemia with thumb & radius malformations, hyperpigmentation & hypogonadism
AMML;  ~10% incidence (No ALL reported)
1 in 12 risk before age 21 years
35
Q

Li-Fraumini Syndrome

A 
Germline p53 mutation
Autosomal Dominant
Familial clustering of certain cancers:
Acute Leukemia (usually childhood ALL)
Breast/Brain/Sarcoma
Adrenal Cortical Carcinomas
36
Q

Increased risk for ALL

A 
Downs
Blooms
Li-fraumini
Radiation 
Alkylating Agents
Topoisomerase inhibitors
37
Q

Increased risk for AML

A

Benzene
Blooms
Alkylating agents
Topoisomerase inhibitors

38
Q

Tumor lysis syndrome

A

Look it up

39
Q

CLL and MCL markers

A

CD5- T cell marker in both
CD20 B-cell marker in both

CLL also CD23 to distinguish

40
Q

Polycythemia vera

A

Increase in all cells

Can present with blurred vision, HA, flushed

41
Q

Myelofibrosis

A

Jak 2

See

42
Q

Juvenile myelomonocytic leukemia

A

Like CML but Ph chromosome negative and found in children

43
Q

Chronic myelomonocytic leukemia

A

Myelodysplastic disorder of monocytes

No Ph chromosome

44
Q

Myeloproliferative disorders

A

CML
ET
PV
Primary meylofibrosis

If untreated, can become AML

Blood and lymph test 2 (6 decks)

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