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Heme Week 2 > Pathoma Chapter 6: Part 1 > Flashcards

Pathoma Chapter 6: Part 1 Flashcards

1
Q

Myeloid stem cells give rise to what?

A
  • Erythroblasts (RBCs)
  • Myeloblasts (neutrophils, basophils, eosinophils)
  • Monoblasts (monocytes)
  • Megakaryoblasts (Megakaryocytes)
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2
Q

What is a normal white cell count?

A

4.4-11.3 K/ul

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3
Q

What are some causes of neutropenia?

A
  • drug toxicity (chemo with alkylating agents)

- severe infection (gram- species)

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4
Q

How do chemo alkylating agents cause neutropenia?

A

they damage stem cells resulting in decreased production

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5
Q

How do severe infections cause neutropenia?

A

increased movement of neutrophils into tissue results in decreased circulating neutrophils

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6
Q

What are some causes of lymphopenia?

A
  • immunodeficiency (DiGeorge or HIV)
  • High cortisol state (Cushing’s of exogenous corticosteroids)
  • Autoimmune destruction (SLE)
  • Whole body radiation
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7
Q

How does a high cortisol state cause lymphopenia?

A

it induces apoptosis of lymphocytes

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8
Q

What are some causes of eosinophilia?

A
  • type I hypersensitivity
  • parasitic infections
  • Hodgkin lymphoma
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9
Q

What are some causes of basophilia?

A
  • acute myeloid leukemia
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10
Q

What are some causes of lymphocytosis?

A
  • viral infections
  • Bordetella pertussis infection (via lymphocytosis promoting factor secreted by the bacteria which prevents them from leaving blood to enter lymph)
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11
Q

What is acute leukemia?

A

neoplastic proliferation of blasts; defined as an accumulation of 20+% of blasts in the bone marrow or peripheral blood

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12
Q

Why is it called “acute” leukemia?

A

increased blasts crowd-out normal hematopoiesis, resulting in an acute presentation

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13
Q

Clinical presentation of acute leukemia?

A
  • anemia (fatigue)
  • thrombocytopenia (bleeding)
  • possible neutropenia (infection)
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14
Q

T or F. WBC is usually elevated in acute leukemia

A

T. due to blasts entering the blood stream

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15
Q

What is acute lymphoblastic leukemia defined as?

A

accumulation of 20+ % of lymphocytes in the bone marrow

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16
Q

How are lymphoblasts identified?

A

via positive nuclear staining for TdT, a DNA polymerase

TdT is absent in myeloid blasts and mature lymphocytes

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17
Q

ALL is common in what patient population?

A 
usually kids (associated with down syndrome)
presents after 5 y/o typically
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18
Q

Subclasses of ALL?

A

B-ALL (most common) and T-ALL based on surface markers

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19
Q

How is B-ALL identified?

A

usually characterized by lymphoblasts (TdT) that express CD10, CD19, and CD20.

20
Q

Clinical course for B-ALL?

A

requires prophylaxis to scrotum and CSF- great response

21
Q

Prognosis of B-ALL?

A

based on cytogenetic abnormalities

i. t(12,21)-kids- has a good prognosis
ii. t(9,22)-adults- has a poor prognosis (philadelphia)

22
Q

What is T-ALL characterized by?

A

lymphoblasts (TdT+) that express markers ranging from CD2 to CD8 (e.g. CD3/4/7).

don’t express CD10

23
Q

What patient population is common for T-ALL?

A

usually presents in teenagers as a mediastinal (thymic) mass (called acute lymphoblastic lymphoma because the malignant cells form a mass)

24
Q

What is acute myeloid leukemia defined as?

A

20+% of immature myeloid precursors (myeloblasts) in the bone marrow

25
How are myeloblasts identified?
positive cytoplasmic staining for MPO (crystals of MPO commonly seen as Auer rods)
26
Patient population for AMLs?
older adults (avg 50-60 y/o)
27
High-yield subtypes of AML (based on cytogenetics, lineage of immature myeloid cells, and surface markers):
- Acute promyelocytic leukemia (APL) - Acute monocytic leukemia - Acute megakaryoblastic leukemia
28
What causes APL?
t(15,17) PML-RARa. The fusion protein causes enhancement of RARa function, which is to disrupt myeloid differentiation, but proliferation is unaffected so promyeloblasts accumulate
29
What is a common risk associated with APL?
DIC
30
What is the treatment for APL?
ATRA (vitamin A derivative) which binds the receptor and causes the blasts to mature (and eventually die)
31
What causes acute monocytic leukemia?
- proliferation of mono blasts that usually lack MPO | - these blasts characteristically infiltrate gums
32
What causes acute megakaryocytic leukemia?
-proliferation of megakaryoblasts that usually lack MPO
33
What is acute megakaryocytic leukemia associated with? When does it present?
Down syndrome (usually arise BEFORE age 5)
34
What else can AML arise from?
-pre-existing dysplasia (myelodysplastic syndromes)
35
How does myelodysplastic syndromes usually present?
- cytopenias - hyper cellular bone marrow - increased blasts (but less than 20%)
36
Outcome of myelodysplastic syndrome patients?
most die from infection or bleeding, though some progress to acute leukemia
37
What causes chronic leukemia?
neoplastic proliferation of mature circulating lymphocytes (high WBC count)
38
Patient population for chronic leukemia?
insidious onset in older adults
39
What causes chronic lymphocytic leukemia (CLL)?
neoplastic proliferation of naive B cells that co-express CD5 and CD20 (most common leukemia overall)
40
What are some complications with CLL?
- hypogammaglobinemia - autoimmune hemolytic anemia - Transformation to diffuse large B-cell lymphoma (Richter transformation)
41
Hairy cell leukemia (HCL) patients are positive for what?
TRAP (tartrate-resistant acid phosphatase)
42
Clinical features of HCL?
- splenomegaly due to accumulation of hairy cells in red pulp - dry tap on bone marrow aspiration (due to marrow fibrosis) - no lymphadenopathy
43
How is HCL treated?
excellent response to 2-CDA (Cladribine), an adenosine deaminase inhibitor
44
What is adult T-cell leukemia/lymphoma (ATLL) caused by?
neoplastic proliferation of mature CD4+ T cells associated with HTLV-1
45
Clinical presentation of ATLL?
- rash (skin infiltration) - generalized lymphadenopathy with hepatosplenomegaly - lytic (punched out) bone lesions with hypercalcemia
46
Normal counterpart in mycosis fungicides (chronic leukemia type)?
mature CD4 T cells
47
When MF spreads to include peripheral blood it is called _____.
Sezary syndrome

Heme Week 2 (18 decks)

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