Midterm WBC Review Flashcards
What cause flow cytometry to be used
AIDS
T-cell CD markers
B-Cell
NK cell
All cells
T: 1-8
B: 19,20
NK: 15, 56
All: 45
Use of flow cytometry?
COnfirm diagnoses
Most common form of leukopenia
Neutropenia
Neutropenia neutrophil count?
3 causes
Which most common
Less than a 1000/ul
- Inadequate granulopoiesis
- Accelerated removal
- Drug toxicity (most common)
Drug responsible for neutropenia usually
Chemo
Major problem with leukopenia
Infections
Reactive leukocytosis
Reaction to what?
Mimics what?
Lab count definition
Infection or inflammatory stimuli
Mimics leukemia (leukemoid reaction)
WBC greater than 50,000
Define leukoerythroblastosis?
Presence of nucleated RBC’s and left shift of neutrophils
Three toxic changes in neutrophilia (3)
- Toxic degranualation
- Dohle bodies
- Cytoplasmic vacuoles
Infectious mono
Main blood manifestation (primary histo finding)
3 other symptoms
Reactive lymphocytosis
Sore throat, lymphadenitis, splenomegaly
Infectious mono cause
How to detect (2)
EBV
Monospot test or Specific EBV Ab’s in blood
Acute nonspecific lymphadenitis
Two location types
Two specific types
Localized or generalized
Bubos: yersinia pestis
Scrofula: mycobacteria
Chronic nonspecific lymphadenitis
Three causes
Common finding in cancer lymph nodes
Two lymph node locations
Viral infection, Post-vaccination, Dilantin
Sinus histiocytosis in lymph nodes draining cancers
Inguinal and axillary lymph nodes
Cat scratch fever
Cause
2 results
Bartonella henselae
- Regional lymphadenopathy
- Stellate necrotizing granulomas
Leukemias are only found where? 2
Peripheral blood
Bone marrow
Main finding in Hodgkin lymphoma
Reed-sternberg cell
Main cell-origin of most lymph neoplasms
B-cell
Effaced lymph node means you can exclude what?
Lymphoma
Acute leukemias
How it presents
Lab findings (3)
Abrupt stormy onset
Anemia, Thrombocytopenia, >20% blasts
Precursor B and T cell leukemia/lymphoma Age of patients Pre-B present how? Involvement of what Pre-T present how? Involvement of what WIll both appear how at some point? Pre-B age Pre-T age?
Children/young adults Leukemia with BM and PB involement Mediastinal mass involving thymus ALL Child Teenager
Special title of ALL?
Most common cancer of children
Pre-B CD markers? (2)
CD19 and CD20
Pre-T CD marker?
CD1, CD2, CD5, CD7, and later CD3, CD4, CD8
Enzyme found in both Pre-B and Pre-T?
TdT
Which is best prognosis, PreB or Pre-T?
Pre-B better
Small lymphocytic lymphoma/CLL Special title Age Histo finding Two special markers Two complications
Most common leukemia in Western world 60 Smudge cells CD23 and CD5 along with pan-B Autoimmune hemolytic anemia and thrombocytopenia
Follicluar lymphoma 3 special markers How to stage Major mutation Result of mutation
CD10, BCL6, BCL2
Bone marrow part of staging
14:18 translocation
Overexpress BCL2
Diffuse Large B-cell lymphoma
Title
Age
Growth pattern
Most common form of NHL
60
Aggressive and diffuse
Burkitt lymphoma Histo pattern Age Main manifestation in US Main manifestation in Africa Main translocation Gene involved Gene on what chromosome What is on other chromosome
Starry sky Young Visceral Jaw involvement 8:14 translocation c-MYC gene Chromosome 8 Ch 14 has Ig Heavy chain
Mantle cell lymphoma Age and sex Two markers positive One marker negative Most translocation Gene involved
Old males CD5 and BCL1/Cyclin D1 positive Negative for CD23 11:14 translocation Cyclin D1/BCL1
Marginal zone lymphoma is commonly found where?
Marginal Zone Lymphoma (extranodal)
Marginal zone lymphoma MALT is associated with what? (3)
- Sjogren
- Hashimoto
- H. pylori
Hairy Cell Leukemia Age/Sex/Ethnic Histo finding 3 special CD markers Triad of symptoms Major stain for this type
Middle-aged Caucasian males Hair-like cytoplasmic projections CD11c, CD25, CD103 Splenomegaly, Pancytopenia, Dry Tap TRAP stain
Plasma Cell neoplasms/Dyscrasias
Cell type
Has what diagnostic feature
Common urine finding
IG-secreting B Cells
Monoclonal spike = M Component
Bence Jones proteins (light chains)
Plasma cell myeloma Title Primary clinical finding Blood level finding M component is mainly what Urine finding Complication of urine finding Blood histo finding (2)
Most common plasma cell dyscrasia
Multifocal lytic lesions of axial skeleton
Hypercalcemia
IgG
Bence Jones proteins
Amyloidosis
Rouleaux formation and Mott Cells with Russell bodies
Solitary plasmocytoma
Presentation
Usually develop what after time
Solitary bony lesion in skeleton or soft tissues
Disseminated disease like myeloma after time
Monoclonal Gammopathy of Undetermined Significance
Seen in who?
Severity
M component spike in healthy elderly patients
Not severe, but should monitor
Lymphoplasmacytic Lymphoma
M component Ig?
Can progress to what syndrome?
What makes this syndrome special?
IgM
Waldenstrom Macroglobulinemia
Hyperviscosity syndrome
Peripheral T cell neoplasms have what markers?
How do they respond to therapy
2, 3, 5
Respond poorly to therapy
Anaplastic large Cell lymphoma Rearrangement of what gene Chromosome Main cell Age Best prognosis
ALK gene 2p23 Anaplastic cells Children and young adults ALK+ tumors best prognosis
Adult-T cell leukemia
Cause:
4 clinical findings
HTLV-1
Skin lesions, hepatosplenomegaly, hypercalcemia, elevated WBC count
Mycosis FUngoides and Sezary
Cells appear how
Cerebriform
Mycosis fungioides 3 phases
Inflammatory pre-mycotic
plaque phase
tumor phase
Sezary syndrome
Main presentation
Generalized exfoliative erythroderma
Large Granular lymphocytic leukemia
Two histo findings
Which form is more aggressive
Abundant blue cytoplasm and scattered coarse azurophilic granules
NK cell
Extranodal NK/T-cell lymphoma
Presents how
Virus association
Nasopharyngeal mass
EBV
Hodgkin lymphoma Primary cell Two CD markers Origin of most Age Curable?
Reed-Sternberg cell CD15 and CD30 B cell Young adults Curable
The classic hodgkin lymphoma are positive for what two markers
Negative for what two?
Virus associated with many of these
CD15 and CD30
CD20 and CD45 negative
EBV
Nodular sclerosis lymphoma
Title
Two histo findings
Most common form of HL overall
Lacunar cells and collagen fibrosis bands
MIxed cellularity hodgkin lymphoma
Title
Sex
EBV%
Most common form of HL in elderly
Males
70%
Lymphocyte rich hodgkin lymphoma
Predominate cell
EBV association
Reactive lymphocytes
40% EBV
Lymphocyte Depletion Hodgkin Lymphoma
Title
Two patient types
EBV%
Least common form of HL
Elderly and HIV
90% EBV
Lymphocyte Predominance HOdgkin lymphoma Male/Sex Characteristic cells RS cell presence? Two positive markers Two negative markers EBV association?
Younger males Lymphohistiocytic/Popcorn cells R-S cells very rare CD20 and BCL6 positive CD15 and CD30 negative
Acute myeloid leukemia Mutation mechanism Age association Peaks when 1st order diagnosis Primary histo finding CD markers Key diagnostic finding
Acquired oncogenic blocks differentiation Increases with age Peaks after 60 Karyotypic findings Auer Rods CD13, CD14, CD15, CD33 > 20% myeloblasts
The M3 version of AML is named what?
Acute promyelocytic leukemia
APL Translocation Two genes and their chromosome Two complications Characteristic Cell
15:17
RARA gene on 17 and PML gene on 15
DIC and bleeding diatheses
Faggot cell
Myelodysplastic Mechanism Bone marrow change Age of onset Primary complication Most patients die of what
Abnormal differentiation Bone marrow hypercellular Age of onset = 70 Refractory anemia occurs Marrow failure (platelet loss/infection)
Myeloproliferative disorders Mechanism Main mutation Two specific mutations Change in marrow Change in liver/spleen
Cells capable of normal differentiation divide like crazy Mutated tyrosine kinases BCR-ABL (9/22) and JAK2 Marrow proliferates Hepatosplenomegaly
Chronic myeloid leukemia Mutation Age Organ change WBC changes (2) Bone marrow change One diagnostic test Two progressions Treatment
Adults Philadelphia chromosome 9/22 Splenomegaly WBC increase with basophil increase Panhyperplasia of marrow Decreased LAP score Accelerated phase or Blast crisis Gleevec
Relative polycythemia definition
Plasma volume decreases elevating HCT
Absolute polycythemia definition
Actual increase in total red cell mass
Difference between primary and secondary absolute polycythemias?
Primary = Low EPO levels Secondary = Increased EPO levels
Polycythemia Vera Definition Mutation Age Primary finding
Increase in RBC mass independent of EPO
JAK2 mutation
Elderly
Intense pruritis
Essential thrombocytosis
Cell type proliferating
Platelet count
Main mutation
Megakarocytes
>600,000
JAK2
Myelofibrosis
Mutation
Two characteristic cells
One WBC increase
JAK2
Leukoerythroblastosis and teardrop cells
Increased basophils
Langerhans cell histiocytosis
Specific granules
2 antigens
Birbeck granules
S-100 and CD1a antigens
Multifocal multisystem LCH
Where are lesions
Age
If untreated
Lesions of trunk and scalp
Before age 2
Unifocal and multifocal unisystem LCH
Three common bone lesions
Age
Complication
Skull, ribs, femur
Kids
Diabetes insipidus
Pulmonary LCH
Common patient type
Adult smokers
Splenic insufficiency concern
Increased chance of sepsis from encapsulated bacteria
What is hypersplenism?
Spleen overworks in removing blood cells and results in penias
Causes of congestive splenomegaly? 3
Central venous congestion
CIrrhosis of liver
Portal vein thrombosis
Hypoplasia or aplasia of spleen more common
Hypoplasia
What is common splenic congenital abnormality
Acessory spleen
DiGeorge syndrome
Path
Mechanism
Symptoms
Thymic hypoplasia/aplasia 22q11 Catch-22 Cardiac abnormality Abnormal facies THymic aplasia Cleft palate Hypocalcemia Hypoparathyroidism
Thymic hyperplasia seen in who?
Myasthenia gravis
Thymoma
Definition
Associated with what disease
Causes what RBC disorder
Thymic tumor
Myasthenia gravis
Pure red cell aplasia
