Module 2 ICA original order Flashcards
What is the typical immunophenotype of AML?
CD13+, CD33+, CD117+, -CD 34+ (if immature cells)
What is the typical immunophenotype of AML M0?
CD13+, CD33+, CD117+, CD34+, HLA-DR+, CD7-, CD19-
The white cell shown is:
A normal large granular lymphocyte.
What disease does the following immunophenotype suggest? CD13+, CD33+, CD117+, CD7-, CD2- CD34-, CD41+, CD42+, CD61+.
- AML M7. Acute myeloid megakaryoblastic leukaemia
- CD41+, CD42+, CD61+ are platelet antigens.
What is the normal range of haemoglobin?
- Male: 130-180 g/L
- Female: 115-165 g/L
Describe the myeloid maturation sequence
Myeloblast, Promyelocyte, Myelocyte, Metamyelocyte, Band, granulocyte (e.g Neutrophil)
What is the normal range of white cell count?
3.6-11.0 109/L
What is the normal range of platelet count?
140-400 109/L
What is the normal range of red cell count?
- Male: 4.5-6.5 1012/L
- Female: 3.8-4.8 1012/L
What disease does the following immunophenotype suggest? CD13+, CD33+, CD117+, CD15+, CD11c+, CD14+, CD64+, CD34-, CD19-, CD22-, Tdt-
- AML M5 acute myeloid monocytic leukaemia
- CD15, CD11c, CD14, CD64 are monocyte markers
What disease does the following immunophenotype suggest? CD45+, CD34-, CD2-, CD13+, CD33+, CD117+, CD235a/Glycophorin+, CD19-
- AML M6 acute erythroid leukaemia
- CD235a/Glycophorin (erythroid marker)
What disease does the following immunophenotype suggest? CD45+, CD13+, CD33+, CD117+, CD34+, HLA-DR+, CD19-, Tdt-
- AML M0/M1/M2
- CD34+, HLA-DR+, (Both markers of immaturity)
What disease does the following immunophenotype suggest? CD7-, CD13-, CD19-, CD33+, HLA-DR-, CD117+, CD15-, CD34+
- AML M3 (APML)
- Could also be AML M0, M1, M2
Outline the symptoms of acute lymphoblastic/Myeloid leukaemia.
Fever, sweats, weight loss
- Caused by Bone marrow failure:
- tiredness, bruising and bleeding, infections/sepsis
- Caused by tissue infiltration
- Pulmonary infiltrates -> Shortness of breath, hepatomegaly, splenomegaly, gum hypertrophy
-
What diseases are caused by Epstein-Barr Virus?
- Burkitt’s lymphoma
- Hodgkin lymphoma
What haematological malignancy can coeliacs lead to?
-(non-hodgkin), of M.A.L.T lymphoma,
What haematologial malignancy is Coxiella Burnetti linked to?
Diffuse large B-cell lymphoma (Non-Hodgkin)
What are the viruses that can contribute to lymphoma?
EBV (Burkitt, Hodgkin)
HHV8 (ATLL)
Hep C (Marginal zone lymphoma)
HIV (Hodgkin, High grade B-cell lymphoma)
Hep B
What bacteria can contribute to the development of lymphoma?
Helicobacter pylori (MALT lymphoma)
Campylobacter jejuni
Mycobacterium tuberculosis
Borrelia burdorferi
Chlamydophila psittaci
What is the main translocation associated with Burkitt lymphoma?
t(8;14) MYC and IgH locus (90%)
(Or others involving chromosome 8)
What is the main translocation associated with CML?
t(9;22)/BCR-ABL1/Philadelphia chromosome
The white cell shown is:
An eosinophil
This white cell shows what?
Toxic granulation and vacuolisation.
What kind of white cell is this?
Atypical lymphocyte
- Minimal chromatin condensation, lots of cytoplasm
- Large cell with no granulation
What disease does this blood film suggest?
- CLL
- Lymphocytosis, smear cells, thrombocytopenia
What are the nucleated cells here?
Nucleated red cells/erythroblasts
What disease does this blood film suggest?
Multiple myeloma
- Plasma cell. Paler area is golgi zone.
- Roleux formation
What disease does this blood film suggest?
- One of the myelodysplastic syndromes
- Hypogranular neutrophil
- blast cell
- stomatocytes
What disease does this blood film suggest?
AML
-M2. 1 Aur rod present
What disease does this blood film suggest
- Large cell lymphoma
- large and pleomorphic cell
Outline the pathophysiology of CML
- Translocation occurs between chromosome 9 and 22, forming BCR-ABL1 fusion gene
- BCR-ABL1 molecule is a constitutively active tyrosine kinase
- Causes downstream activation of oncogenes, such as JAK, PI3K and RAS
- Leading to increased proliferation, survival and clonal expansion of cells with the initial t(9;22) mutation.
What is the clinical presentation of CML (symptoms and signs)?
- Fatigue
- Night sweats
- Malaise and weight loss
- Left upper quadrant pain
- Splenomegaly
- Less common (in advanced diseas)
- Bone pain
- Lymphadenopathy
- Skin infiltration
- Extra medullary mass
What blood parameters are associated with CML?
- High white cell count
- Anaemia (Sometimes)
- platelets can be either high or low (Mostly high)
- Basophiliia
What disease does this blood film show?
CML, in chronic phase
Myelocytes and basophils can be prewent
What is the mechanism of action of Imatinib?
- Imatinib is a tyrosine kinase inhibitor
- It binds to the ATP binding site of BCR-ABL1, preventing ATP from binding and donating it’s phosphate.
- Therefore no activation of oncogenic proteins
What complications can arise from TKI therapy?
- Renal impairment
- Nausea and vomiting
- Pancytopenia
- Pleural effusion (From dasatinib)
What disease does this blood film show?
CML
(Left shift)
Myelocyte > promyelocyte > metamyelocyte > Band forms
What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10+, CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m-
B-ALL
What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10-, CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m-
B-ALL, specifically ProB-ALL
What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20+, CD22+, CD10(+/-), CD19+, CD7-, CD3-, CD13-, CD33-, cytoplasmic m+.
B-ALL, specifically PreB-ALL
What disease does the following immunophenotype suggest? CD45+, CD34+, Tdt+, CD20-, CD22-, CD10-, CD19-, CD7+, CD3+, CD2+, CD13-, CD33-, cytoplasmic m-.
T-ALL (T acute lymphoblastic leukaemia)
Describe how t(12;21) leads to ALL
- RUNX1 encodes CBFalpha, which binds to HAT (Activating transcription)
- In ETV6-RUNX1 fusion, the protein cannot bind to HAT.
- Therefore transcription is not activated
What disease does this blood film suggest?
- ALL
- Could also possibly be AML M0-1
What disease does this blood film suggest?
ALL
-Could also possibly be AML M0-1
What are the most common cytogenetic abnormalities associated with ALL?
- High hyperdiploidy (good prognosis)
- t(12;21)/ETV6-RUNX1 (Childhood, Good prognosis)
- t(9;22)/BCR-ABL1/Ph (older adults, bad prognosis)
- 11q23 rearrangements/KMT2A (infants, bad prognosis)
- t(1;19)/TCF-PBX1
- T-ALL: t(10;14)
Describe the typical blood count of a patient with ALL
- Anaemia
- Thrombocytopenia
- Neutropenia
Which is the most common haematological malignancy in children?
ALL
What are the clinical signs and symptoms of CLL?
- Lymphadenopathy
- features of anaemia (fatigue, pallor)
- Bruising/purpura from thrombocytopenia
- rarely hepatosplenomegaly
- Features of immune suppression (Infection)