Myeloid Leukemia Clinical Flashcards
If a patient is found to have leukemoid reaction with elevated leukocytes with a specific increase of lymphocytes, what is likely non-neoplastic condiction?
Bordetella Pertussis
If a patient has a neutrophil prominent leukemoid reaction, what is most common cause?
Infection of bacteria/virus
What is a common mutation similar between Polycythemia Vera and Essential Thrombocytosis?
JAK2 Mutation V617F – over-activation
What is “toxic change” seen histologically?
An increase in primary granules, compared to secondary. This is a nonspecific finding indicating neutrophil production could be occurring.
What is most common associated with nonspecific leukocytosis of all myelocytes?
Chronic Myelogenous Leukemia (CML)
What lab findings would be consistent with polycythemia vera and leukocytosis?
Increased RBC and Hemaglobin (18g+)
What myelocyte condition is associated with hyperplastic bone marrow with pancytopenia?
Myelodysplastic Syndrome
What myelocyte condition is usually found to have hyperplasia and leukocytosis?
CML, PV, PMF, and ET
What would be the chromosomal abnormality associated with CML?
Leukocytes positive for Philadelphia Chromosome
— t(9;22)
If a patient becomes diagnosed with CML with a Philadelphia chromosome, what would be the first treatment?
Tyrosine Kinase inhibitors!
– BCR-ABL Fusion – Use Imatinib or Dasatinib
Causes inactivation of tyrosine kinase, resulting in cell death. (Forever Treatment)
What kind of myeloproliferative disease would you use an alkylating agent?
Essential Thrombocytosis
If an acute myeloproliferative leukemia is found with a t(15,17) what should be done first?
All-trans retinoic acid – ATRA
What are the common clinical symptoms of polycythemia vera?
- *Hepatic Venous Thrombosis
- Pruritus after showering
- Peptic Ulcer disease
If a patient is have bleeding disorder and found to have disseminated intravascular coagulation, what might be a key finding on histology for diagnosis?
Multiple Auer Rods – AML – t(15,17)
What are the the common chromosomal abnormalities in AML for good prognosis?
- t(8,21) AML1/ETO
- inv(16) CBFbeta/MYH11
- t(15,17) PML/RARalpha
What kind of leukocytic disorder is associated with hypogranular neutrophils, hypolobulated megakaryocytes, with hypercellular marrow?
Myelodysplastic Syndrome (if less than 20% blasts)
- Typically older aged patient
- Pre-leukemia disease
What is a leading cytogenetic abnormality of Myelodysplastic Syndrome?
Monosomy 7 (or Monosomy 5)
What treatment is most common employed to treat myelodysplastic syndrome?
Hypomethylating Drugs (Inhibits DNMT) – Decitabine –
– In theory, allows increased expression of genes allowing more cells to differentiate.
BM Transplant – can cure, but patients are usually old and high risk for them.
What is a major risk factor for acquiring MDS later in life?
If the patient had undergone radiation or chemotherapy earlier in life. Can cause long term dysfunction of stem cells leading to MDS.
What would the surface markers common seen on MDS blast cells be?
CD34
CD117
CD13 - nonspecific myeloid / monocyte
CD33 - nonspecific myeloid
If a patient is found to have highly elevated WBCs with 20%+ blasts, how can you determine if AML or ALL?
Size of Cells / Amount of Cytoplasm
Auer Rods
MPO stain
CD13 Marker
What is a common chromosomal abnormality in primary myelofibrosis?
JAK2 V617F Mutation
–treat with JAK2 inhibitor
Why is splenomegaly common in primary myelofibrosis?
Since the bone marrow is fibrotic and not able to produce as many cells the spleen tries to help with production.
