Practical 6: Leukaemia Investigations

Question 1

Define leukaemia

Answer 1

A cancer that affects the blood and blood forming organs

Question 2

How many type of leukaemia are there?

Answer 2

Four types

Question 3

What are the four types of leukaemia?

Answer 3

Acute lymphoblastic leukaemia

Acute myeloid leukaemia

Chronic lymphocytic leaukaemia

Chronic myeloid leukaemia

Question 4

What are acute leukaemias

Answer 4

Leukaemias which develop quickly and need to be treated urgently

Question 5

What are chronic leukaemias

Answer 5

Leukaemias which develop slowly and may not need to be treated for some time after they are diagnosed

Some forms may not require any treatment

Question 6

What are myeloid leukaemias

Answer 6

leukaemia that arises from myeloid stem cells and are characterised by the accumulation of cancerous myeloid cells

Question 7

What are lymphoid leukaemias?

Answer 7

leukaemia that arises from lymphoid stem cells and are characterised by the accumulation of cancerous lymphoid cells such as B-cells and T-cells

Question 8

What are the most common forms of leukaemia in adults

Answer 8

Chronic lymphocytic

Acute myeloid

Question 9

What are the most common forms of leukaemia in children

Answer 9

Acute lymphoblastic

Question 10

What is the basis by which leukaemias are classified

Answer 10

Based on the stage of development at which they occur

Question 11

How can you determine if a cell is mature or immature
(6)

Answer 11

Mature are smaller

Mature have a smaller nucleus

Immature have a very blue nucleus

Immature nucleus is reddish

Immature chromatin is fine and lacy

Mature chromatin is coarse and clumped

Question 12

What are the two types of neoplasms chronic myeloid leukaemia can lead to

Answer 12

Myeloproliferative neoplasm

Myelodysplastic neoplasm

Question 13

What is the main difference between myeloproliferative and myelodysplastic neoplasm?

Answer 13

Normal differentiation is seen in myeloproliferative neoplasm

Abnormal differentiation is seen in myelodysplastic neoplasm

Question 14

What are the five main stages to the development of a granulocyte

Answer 14

Myeloblast

Pro-myelocyte

myelocyte

Meta-myelocyte

Granulocyte

Question 15

How can you identify an acute leukaemia

Answer 15

If the majority of cells are blast cell

Question 16

How do you differentiate between an acute myeloid and an acute lymphoid leukaemia
(3)

Answer 16

It’s not always possible to tell the difference

Flow cytometry is the best way to find out

Sometimes “auer rods” can be seen in myeloblasts -> these aren’t seen in lymphoblasts

Question 17

How can you identify a chronic leukaemia

Answer 17

If the predominant cell type is a more mature cell than a blast

Question 18

What are the three stages in the development of a lymphocyte

Answer 18

Lymphoblast

Pro lymphocyte

Lymphocyte

Question 19

How do you diagnose leukaemia in the lab?

Answer 19

Performance of a white cell differential count

Combined with other laboratory tests

Question 20

How would you describe a myeloblast
(6)

Answer 20

The youngest cell in the myeloid lineage

It is approximately 12-18 microns in size with very basophilic cytoplasm

The cytoplasmic membrane tends to be regular without much denting, bumps, pseudopods or shredding

Its cytoplasm is basophilic and can have a hint of background “ground glass” graininess

The nucleus takes up around 2/3 of the total cell volume with a soft, finely stranded chromatin with very little clumping

The nucleus is eccentrically placed and ovoid, but can also be slightly flattened. The will typically have two or more nucleoli with well defined nucleolar granules

Question 21

How would you describe a pro-myelocyte
(4)

Answer 21

These are generally larger than myeloblasts, measuring approximately 12 to 20 microns

The nucleus is similar in size to the myeloblast but the cytoplasm is more abundant at this stage

The cytoplasm will have a gritty basophilic colour and texture, however there will also be prominent primary granules which will look like red/purple grains of sand

The nucleoli will begin to close and become less prominent than in the blast stage. The chromatin strand texture tends to become slightly more coarse and clumped

Question 22

How would you describe a myelocyte
(3)

Answer 22

The cytoplasm of this cell begins to produce specific, secondary granules

The nucleoli close and disappear, the chromatin gets coarser/denser and more clumped and the chromatin gets tighter darker and more compact

The cytoplasm appears more light blue and no longer has the darker basophilic colour

Question 23

How would you describe a meta-myelocyte
(3)

Answer 23

The cytoplasm achieves full secondary granule content

At this stage, the cytoplasm and nucleus continue to decrease in size and nuclear indentation starts

The chromatin becomes more dense, knotted and compact, while the nucleus begins to acquire a kidney bean shape

Question 24

How would you describe a granulocyte
(4)

Answer 24

The condensation and identification of the nucleus reaches the point where all parts of the nucleus are of uniform width

At this stage the cytoplasm is normally fully granulated and should be identical to its fully mature segmented neutrophil counterpart

U-shaped nucleus is the most classic shape but the band nucleus can be curled or coiled as well

The chromatin has continued to condense and should appear as knotted and clumped as a mature neutrophil

Question 25

What is an indicator of CLL on a blood film

Answer 25

Smudged cells

Question 26

Why does CML have such a good survival rate

Answer 26

Gleevac

A tyrosine kinase inhibitor used to treat the philadelphia chromosome