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RUSVM Clin Path > Polycythemia and Leukemia > Flashcards

Polycythemia and Leukemia Flashcards

1
Q

What is polycythemia

A

Increased red cell concentration (increased PCV)

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2
Q

Relative polycythemia

A
  • not an absolute increase

- not that the red cell mass has increased but that the water portion/ plasma has decreased for some reason

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3
Q

types of relative polycythemia

A
  • Hemoconcentration (dehydration and fluid shifts)

- Redistribution (excitement, exercise)

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4
Q

Absolute polycythemia

A

There is an actual increase in red cell production

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5
Q

types of absolute polycythemia

A
  • increased erythropoietin
    • appropriate (chronic hypoxia)
    • inappropriate (renal cysts, tumors)
  • primary (polycythemia vera)
    • myeloproliferative disorders
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6
Q

an increased PCV and TP are indicative of…

A

dehydration (relative polycythemia)

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7
Q

Possible Dx for macrocytic polycythemia, normal TP, EPO and arterial O2 Normal

A

polycythemia vera

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8
Q

DDx for decreased arterial oxygen and increased EPO

PCV usually isn’t sky high

A

Dx: Hypoxemia

Heart function vs Lung Function (Imaging to differentiate)

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9
Q

Leukemia

A

neoplastic cells in blood or bone marrow (spleen should also be included-some forms of lymphoid leukemia and T cell leukemia cells are produced solely in the spleen)

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10
Q

types of leukemia

A
  • Lymphoproliferative Disorders

- Myeloid neoplasms (Myeloproliferative disorders)

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11
Q

lymphoma

A

Starts in the tissue can ultimately get a leukemia

with lymphoma

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12
Q

Ways leukemias are classified

A
  • Lymphoid vs myeloid
  • Immunophenotype
  • Acute vs chronic
  • Cell morphology (small, large, LGL, etc)
  • By number of circulating cells (aleukemic, subleukemic, leukemic)
  • Leukemias may arise in bone marrow or spleen, but Stage V lymphomas are leukemic and these may be difficult to distinguish if they present late in disease
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13
Q

Immunophenotyping Leukemias

A

The kinds of antigens the cells have on their membrane, recognized by antibodies against those antigens. The kinds of cell markers are very important for prognosis

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14
Q

Acute vs Chronic Leukemia refers to

A

patient survival time

  • Acute- effects immature cells (bone marrow and peripheral blood- blasts, lymphoblasts/myeloblasts)
  • Chronic- typical cells look mature
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15
Q

Acute Leukemia types

A
  • Acute Lymphoblastic Leukemia (almost always this when acute)
  • Acute Myelogenous Leukemia
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16
Q

Chronic Leukemia types

A
  • Chronic lymphocytic leukemia
    • B-cell
    • T-cell
  • Chronic myeloproliferative
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17
Q

Chronic Myeloproliferative leukemia

A

Common in people rare in dogs and cats
Can be difficult to distinguish from inflammatory leukograms: neutrophils are maturing and they can be orderly, become suspicious when neutrophil count is greater than 100,000

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18
Q

Identification of cell types to classify lymphoid vs myeloid

A
  • Morphologic appearance
  • Cytochemical staining properties
  • Electron microscopic appearance
  • Monoclonal antibody binding to antigens
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19
Q

CD 3, 4, 5, 8

A

T cells leukemias

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20
Q

CD 21, 79a

A

B cell leukemias

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21
Q

Simple Classification: Lymphoproliferative

A
  • Lymphoblastic leukemia
  • Lymphocytic leukemia
  • Plasma cell leukemia (multiple myeloma)
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22
Q

Simple Classification: Myeloproliferative

A
  • Undifferentiated leukemia
  • Granulocytic leukemia
  • Monocytic leukemia
  • Myelomonocytic leukemia
  • Erythroid leukemia (erythremic myelosis)
  • Megakaryocytic leukemia
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23
Q

PCR detects

A
  • antigen receptor rearrangements
  • used to identify a clonal, neoplastic population of cells
  • referred to as “PARR”
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24
Q

PCR/ PARR differentiates

A

non neoplastic lymphoproliferative disorders from those that are neoplastic
Ehrlichia*

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25
Q

Acute leukemia

A
  • neoplastic cells immature

- Survival time is usually very short: MST – 9 days for ALL and AML (range, 1-120 days)

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26
Q

Chronic leukemia

A
  • “mature” well-differentiated cells predominate

- patient survival time is usually long

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27
Q

Acute Lymphoblastic Leukemia (ALL)

A
  • Need to differentiate from Stage V lymphoma
  • “65% of dogs presenting with multicentric lymphoma are leukemic.”
  • 50% of dogs with ALL have lymphadenopathy
28
Q

how to determine if lymphoblastic leukemia on cytology

A
  • Use neutrophil for size comparison ( should be around the same size)
  • Larger size and presence of nucleoli tells us they are immature cells or lymphoblast
  • Cytoplasm will break off and get cytoplasmic fragments (almost look like platelets) - lymphoglandular bodies- Help to distinguish in cytology
    Lymphoid cells rupture easily
29
Q

T/F in cases of leukemia, animals can present with anemia, neutropenia, and thrombocytopenia

A

True: more prevalent in animals with acute leukemias

30
Q

clinical signs of acute leukemia

A

Due to lack of normal hematopoietic cells or to infiltration of organs.

  • Pale mucous membranes
  • Splenomegaly
  • Hepatomegaly
  • Lethargy
  • Weight loss
31
Q

CBC abnormalities – Acute leukemias

A
  • Anemia
  • Thrombocytopenia
  • Leukocytosis
    • Mean TNCC – 98,000/μl
  • Immature cells in blood
32
Q

Prognosis- ALL

A

Poor

  • Clinical course is usually rapid, progressive, and poorly responsive to therapy.
  • Cats are usually younger and Fe-LV positive.
33
Q

Acute Myeloid Leukemia

A

must have 20% or greater blast cells in the bone marrow.

But % of blasts in blood is variable

34
Q

T/F Very poorly differentiated myelogenous or myelomonocytic leukemia cannot be differentiated, based on morphology, from lymphoid leukemia

A

True

35
Q

What is undifferentiated leukemia

A

Almost all cells in bone marrow are immature cells that cannot be classified based on morphology or cytochemistry.
Has features of both erythroid and myeloid Leukemia

36
Q

how do you classify undifferentiated leukemia

A

immunophenotyping

37
Q

Myeloblastic leukemia (M1)

A

> 90% Blasts in BM;

38
Q

Myeloblastic leukemia with differentation (M2)

A

20% blasts but 10% differentiated granulocytes

Often many promyelocytes

39
Q

T/F Immune mediated neutropenia can appear similar to granulocytic leukemia

A

True! When we do a bone marrow aspirate, everything later is being destroyed by antibodies directed against its own neutrophils so what you have left are blasts. Occasionally missed diagnosed as leukemias but get better on steroids

40
Q

Myelomonocytic leukemia (M4)

A

Myeloblasts and monoblasts >20% in BM

Monocytes and granulocytes > 20%

41
Q

Monocytic leukemia (M5)

A

M5a Promonocytes and monoblasts; >80% of non erythroid cells

M5b >20% to

42
Q

Erythroleukemia (M6)

A

Erythroid > 50%, myeloblasts and monoblasts

43
Q

Megakaryoblastic leukemia (M7)

A

> 20% megakaryoblasts, also in blood

Increased megakaryocytes

May need immunocytochemistry to detect reactivity for factor VII-related antigen and platelet glycoprotein IIIa

Thrombocytopenia or thrombocytosis

44
Q

Chronic lymphocytic leukemia

A

Lymphocytes are small and appear well differentiated.

More common in dogs.

Must be differentiated from other causes of lymphocytosis.
>35,000 lymphs, it is leukemia.

45
Q

T/F: T-cell CLLs are more common in dogs and cats than B-cell CLLs

A

true

46
Q

where do T-cells tend to proliferate

A

the spleen

47
Q

DDx of CLL in cats

A

excitement lymphocytosis (usually not greater than 20,000)

Bartonella henselae (“cat scratch fever”)

48
Q

DDx of CLL in dogs

A

Chronic ehrlichiosis (often see large granular lymphocytes)

Excitement lymphocytosis rare

Rarely hypoadrenocorticism

49
Q

Clinical signs of CLL

A

May be asymptomatic (diagnose during wellness exam)

lethargy, anorexia, pale mucous membranes, lymphadenopathy, splenomegaly, hepatomegaly possible

50
Q

Laboratory Findings for CLL

A

Lymphocytosis ( slightly increased to > 300,000/μl)

Maybe anemia thrombocytopenia

Increased small lymphs in BM

Rarely monoclonal gammopathy

Cats are usually Fe-LV neg

51
Q

T/F immunophenotyping is not helpful for prognosis

A

False

52
Q

T/F Myelodysplastic syndromes have variable manifestations, usually with subtle morphologic abnormalities

A

True

53
Q

Myelodysplastic syndromes-cytopenia

A

single or in combination, including non- regeneratve anemia, neutropenia, and/or thrombocytenia.

54
Q

Myelodysplastic syndromes-marrow

A

hypocellular, of normal cellularity or hypercellular.

55
Q

Myelodysplasia

A

Often pre-leukemic

Reported in dogs, cats, rarely horses

Usually FeLV induced in cats

56
Q

Chronic myeloproliferative neoplasms

A

Rare

Difficult to distinguish from hyperplasia

57
Q

Chronic granulocytic (myelogenous) leukemia

A

More common in dogs than in cats

marked neutrophilia, left shift, and often monocytosis.

Hypersegmented nuclei, giant metamyelocytes, bands

58
Q

DDx Chronic granulocytic (myelogenous) leukemia

A

Differentiated from MDS by marked leukocytosis.

Inflammatory responses (“leukemoid reactions”)

Marrow exam may not be helpful as orderliness of maturation may appear disrupted with inflammation

59
Q

Definitive diagnosis of Chronic granulocytic (myelogenous) leukemia

A

Eventually develop disorderly left shift and “blast crisis”

Usually much more anemic than patients with inflammatory disease

60
Q

Eosinophilic leukemia

A

Rare, primarily in FeLV-negative cats

Eosinophilia, immature eosinoiphils in blood, eosinophil predominance in marrow, eosinophil infiltration of organs

61
Q

Clinical signs of Eosinophilic leukemia

A

similar to other MPDs but also include thickened bowel loops, diarrhea, vomiting due to eosinophil infiltration of intestine.

62
Q

T/F Hydroxyurea and prednisone may prolong survival of patients with eosinophilic leukemia

A

true

63
Q

Chronic basophilic leukemia

A

Very rare

Basophilia, orderly left shift, maybe thrombocytosis, organ infiltration

Differentiate from mast cell leukemia

64
Q

Essential thrombocythemia

A

Very very rare

Platelets > 1,000,000/μl. Giant forms.

Increased megakaryocytes in marrow

65
Q

DDx Essential thrombocythemia

A

iron deficiency anemia, inflammation, antineoplastic drug therapy, corticosteroids, neoplasia, all of which can cause thrombocytosis.

RUSVM Clin Path (11 decks)

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