Stains, Malignant disorders of leukocytes: AML Flashcards
What %age of circulating blasts establishes diagnosis of AML?
>/=20%
What cytochemical stains can be useful in initial eval of a suspected AML?
MPO, specific esterase usually positive in granulocytic cells and negative in lymphoid/monocytic
What is NONspecific esterase usually positive in? what is the stain composed of?
nonspecific esterase usually positive in monoblasts and megakaryoblasts; Stain is alpha-naphthyl acetate or butyrate
what is the specific esterase stain also referred to as?
chloroacetate
what does the PAS stain, and what is it helpful to daignose?
intracellular glycoge stains bright pink; it is not used much anymore but cells of erythroleukemia will stain (normal RBCs won’t) and Accute lymphoblastic leukemia. Myeloblasts and normal erythro cells don’t stain
what does the LAP stain and what will be high or low, condition-wise?
it stains the primary granules of neutrophils that have alkaline phosphatase activity; In CML it will be a lower score; will be higher in a leukemoid reaction, or CML in blast crisis
What does the TRAP stain identify and how?
Hairy cell leukemia; It continues to stain positive whereas normal cells will be inhibited once tartrate is added
what are iron inclusions named depending on the stain used?
With Perl’s Prussian blue they are called siderotic granules; with Wright’s stain just Pappenheimer bodies
What conditions are ringed sideroblasts potentially a sign of?
could be sideroblastic anemia, or refractory anemia with ringed sideroblasts (RARS)
what translocation is associated with a FAB morphology like M2, myelogenous with some maturation: blasts with sometimes large azurophilic granules, some auer rods; CD13, CD34, HLA-DR and especially CD19 & CD56 positive?
t(8;21)
What genetic abnormality may be associated with an AML of M4eo (has dysplastic eosinophils, and myelomonocytic differentiation); pos for CD14, CD64, CD11b…..
inv 16 or t(16;16)
t(15;17) is associated with what type of AML? how does it often present?
APL, M3;
often presents with DIC; can be hypergranular or hypogranular.
Hypergranular is typical and has bundles of auer rods and intense granules (remember these are PROmyelocytes).
Agranular is just that, and may have kidney shaped nuclei in the promyelocytes.
In leukemia with t(15;17)/ M3, what promyelocytic CD marker is unusually weak (normal pros it is veyr bright?)
CD15
what is the usual agent used to treat AML w/ t(15;17)/ M3?
ATRA, all trans retinoic acid
what FAB classification may include t(9;11) and is common in children; and what particular section of the gene is found in many leukemias and has poor prognosis?
M4 or M5, having monoblastic maturation (CD14, CD64); gene 11 arm q loci 23…..11q23 aberrations
quick associations: give the genetic abnormality and/or FAB associated with:
Promyelocytic differentiation of abnormal cells, hypergranular with auer rods or hypogranular and kidney-shaped nuclei; Often presents with DIC
FAB M3, APL; t(15;17)
quick association: genetic trnslctn and FAB associated with:
an acute myelogenous leukemia with some differentiation, auer rods present, most common CD13 and CD33 positive;
t(8;21)/ M2
what would be the origin of a leukemic cell if it is MPO, SBB, and specific (chloroacetate) esterase positive?
myeloid precursor
the CD markers associated with myeloid cells (pan) are:
CD13 and CD33
what does CD34 signify and how is it used to evaluate WBCs?
It is a stem cell/ hematopoietic cell marker, used to identify them for stem cell transplant cell dosing
what translocation should you think of : AML FAB M4Eo (increased dysplastic eosinophils)
t(16;16) or inv16
quick association: t(9;11), CD34 negative
M4 or M5, monoblastic differentiation, common in children
11q23
poor prognosis, M5 monocytic precursors
t(9;22)
CML, philadelphia chromosome
what are these cell markers indicative of and in what leukemia would you find?
CD41, 42, AND 61
PLATELETS; FAB M7, acute megakaryocytic, very rare
the WHO classification of AMLs all have what percentage of blasts?
>/= 20% in bone marrow
(FAB was 30%)
what type of differentiation/ leukemia is FAB M6?
erythroleukemia aka DiGuglielmo syndrome.
How is DiGuglielomo syndrome/ Erythroleukemia characterized and what stains are positive?
>20% (WHO) marrow myeloblasts and >50% dysplastic normoblasts (erythrocytic!)
malignant normoblasts are PAS +
malignant myelos are MPO and SBB +
FAB M1 & M2 account for what %age of the AMLs?
50%
what FAB classification has blasts with myeloid markers of CD13, 33 and 34 (HSC) but stains negatively with MPO, SBB….
M0
CD 45 is a cell marker for what group?
all leukocytes/WBCs. Used in flow
differentiate monocytic vs myelocytic/granulocyte cells based on esterase staining
the specific esterase stain, (naphthol AS-D chloroacetate esterase) is positive in granulocytic but not cells with monocytic cells;
the nonspecific esterase stain is only positive in monocytic cells
