Practical 6: Leukaemia Investigations Flashcards
Define leukaemia
A cancer that affects the blood and blood forming organs
How many type of leukaemia are there?
Four types
What are the four types of leukaemia?
Acute lymphoblastic leukaemia
Acute myeloid leukaemia
Chronic lymphocytic leaukaemia
Chronic myeloid leukaemia
What are acute leukaemias
Leukaemias which develop quickly and need to be treated urgently
What are chronic leukaemias
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
What are myeloid leukaemias
leukaemia that arises from myeloid stem cells and are characterised by the accumulation of cancerous myeloid cells
What are lymphoid leukaemias?
leukaemia that arises from lymphoid stem cells and are characterised by the accumulation of cancerous lymphoid cells such as B-cells and T-cells
What are the most common forms of leukaemia in adults
Chronic lymphocytic
Acute myeloid
What are the most common forms of leukaemia in children
Acute lymphoblastic
What is the basis by which leukaemias are classified
Based on the stage of development at which they occur
How can you determine if a cell is mature or immature
(6)
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
What are the two types of neoplasms chronic myeloid leukaemia can lead to
Myeloproliferative neoplasm
Myelodysplastic neoplasm
What is the main difference between myeloproliferative and myelodysplastic neoplasm?
Normal differentiation is seen in myeloproliferative neoplasm
Abnormal differentiation is seen in myelodysplastic neoplasm
What are the five main stages to the development of a granulocyte
Myeloblast
Pro-myelocyte
myelocyte
Meta-myelocyte
Granulocyte
How can you identify an acute leukaemia
If the majority of cells are blast cell
How do you differentiate between an acute myeloid and an acute lymphoid leukaemia
(3)
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
How can you identify a chronic leukaemia
If the predominant cell type is a more mature cell than a blast
What are the three stages in the development of a lymphocyte
Lymphoblast
Pro lymphocyte
Lymphocyte
How do you diagnose leukaemia in the lab?
Performance of a white cell differential count
Combined with other laboratory tests
How would you describe a myeloblast
(6)
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
How would you describe a pro-myelocyte
(4)
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
How would you describe a myelocyte
(3)
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
How would you describe a meta-myelocyte
(3)
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
How would you describe a granulocyte
(4)
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
What is an indicator of CLL on a blood film
Smudged cells
Why does CML have such a good survival rate
Gleevac
A tyrosine kinase inhibitor used to treat the philadelphia chromosome
