Midterm WBC Review Flashcards by Rob Nicholas

What cause flow cytometry to be used

AIDS

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T-cell CD markers
B-Cell
NK cell
All cells

T: 1-8
B: 19,20
NK: 15, 56
All: 45

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Use of flow cytometry?

COnfirm diagnoses

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Most common form of leukopenia

Neutropenia

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Neutropenia neutrophil count?
3 causes
Which most common

Less than a 1000/ul

Inadequate granulopoiesis
Accelerated removal
Drug toxicity (most common)

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Drug responsible for neutropenia usually

Chemo

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Major problem with leukopenia

Infections

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Reactive leukocytosis
Reaction to what?
Mimics what?
Lab count definition

Infection or inflammatory stimuli
Mimics leukemia (leukemoid reaction)
WBC greater than 50,000

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Define leukoerythroblastosis?

Presence of nucleated RBC’s and left shift of neutrophils

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Three toxic changes in neutrophilia (3)

Toxic degranualation
Dohle bodies
Cytoplasmic vacuoles

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Infectious mono
Main blood manifestation (primary histo finding)
3 other symptoms

Reactive lymphocytosis

Sore throat, lymphadenitis, splenomegaly

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Infectious mono cause

How to detect (2)

EBV

Monospot test or Specific EBV Ab’s in blood

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Acute nonspecific lymphadenitis
Two location types
Two specific types

Localized or generalized
Bubos: yersinia pestis
Scrofula: mycobacteria

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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

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Cat scratch fever
Cause
2 results

Bartonella henselae

Regional lymphadenopathy
Stellate necrotizing granulomas

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Leukemias are only found where? 2

Peripheral blood

Bone marrow

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Main finding in Hodgkin lymphoma

Reed-sternberg cell

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Main cell-origin of most lymph neoplasms

B-cell

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Effaced lymph node means you can exclude what?

Lymphoma

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Acute leukemias
How it presents
Lab findings (3)

Abrupt stormy onset

Anemia, Thrombocytopenia, >20% blasts

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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

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Special title of ALL?

Most common cancer of children

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Pre-B CD markers? (2)

CD19 and CD20

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Pre-T CD marker?

CD1, CD2, CD5, CD7, and later CD3, CD4, CD8

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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)

1. Sjogren 2. Hashimoto 3. 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