Test 2- Leukemia

Question 1

What are your relative causes of increased red cell concentration?

Answer 1

Hemoconcentration:! dehydration (water loss) and fluid shifts
• Redistribution- excitement and exercise (more amounts of blood
in the vessels)

Question 2

What are absolute causes of increased red cell concentration?

Answer 2

Increased EPO- due to appropriate causes (chronic hypoxia- ex. Higher elevation, infarction) and inappropriate EPO secretion- renal cysts, tumors
• Primary- polycythemia vera (myeloproliferative disorder)- unlike a red cell leukemia- w/ primary polycythemia vera, the red cells maturing normally (MAJOR DIFFERENCE) and morphologically normal in bone marrow as well.

Question 3

What occurs w/ antifreeze ingestion?

Answer 3

Calcium oxalte crystals. Metabolites of ethylene glycol toxic to renal
epithelium cells and you have interference of glucose metabolism so you may see high glucose levels w/ antifreeze. – binds calcium and forms cytstals. Make kidney inable to concentrate urine. Results w/ extreme dehydration.

Question 4

What can cause increase PCV and protein?

Answer 4

Dehydration

Question 5

After ruling out dehydration what other test can you perform w/ an animal that is PU/PD?

Answer 5

Arterial oxygen (if hypoxemic- would show appropriate increase in EPO) also check lung function, heart function.

Question 6

A dog presents w/ elevated PCV, increased reticulocytes, and normal total protein. Animal is lethargic and PU/PD. Arterial oxygen is normal, EPO is increased. What is your ddx?

Answer 6

The arterial oxygen will show you if animal is hypoxic. The test comes back normal. The EPO test demonstrated an elevated EPO. b/c animal is not hypoxic, this is an inappropriate increase in EPO (an absolute cause)- perform a kidney function test and imaging- mass or cysts interfering w/ cells making EPO. EPO is the least common cause of polycythemia

Question 7

A dog presents w/ elevated PCV, increased reticulocytes, normal total protein presenting w/ PU/PD. Both arterial oxygen and EPO are normal. what is your dx?

Answer 7

Dx of exclusion. Not hypoxic, not an increase in EPO. look at the animal- if Animal not excited/excercised- not a redistribution, animal is also not dehydrated Based on the PCV and protein not being elevated together. Animal can only have polycythemia vera.
o Shown increased red cells- clin sins include high PCV w/ sludging of the small vessels so you can see neurologic abnormalities from brain not getting appropriate blood. Mucous membranes quite red. Not a precursor for leukemia in animals

Question 8

You have a dog present w/ lethargy, dyspnea, increased PCV, increased reticulocytes, normal total protein. Arterial oxygen is decreased, EPO is increased. Whats your dx. What other test would you might want?

Answer 8

• EPO increase is appropriate w/ hypoxia. Try to figure out why the animal is hypoxic.
• do not stop there- look further- Is it a lung or heart issue- perform imaging. w/ heart problems- valve defects in older dogs you can see the PCV above the reference interval.

Question 9

What cells are involved in lymph proliferative disorders and myeloid neoplasms

Answer 9

What cells are involved in lymph proliferative disorders and myeloid neoplasms (lymphocytes and plasma cells) (red cells, neutros, megakaryocytes, eosinophils, basophils,)

Question 10

Define leukemia? How do you diagnose?

Answer 10

• Presence of neoplastic cells in peripheral blood and or bone marrow
or spleen
• Finding characteristic cells in blood/bone marrow/ other organs and
or associated hematologic abnormalities.

Question 11

ways to classify leukemia:

Answer 11

Cell type, number of circulating cells in periphery, and acute vs chronic are ways to classify leukemias

Question 12

What are traditional ID of cell types?

Answer 12

Morphologic appearance, cytochemical staining properties, electron
microscopic appearance, monoclonal antibody binding to antigens.

Question 13

How do you classify leukemias based on circulating neoplastic cells?

Answer 13

Leukemic leukemia (abundant abnormal cells), subleukemic leukemia (number in reference interval w/ some blasts) aleukemic
leukemia (full of neoplastic cells but nto releasing them from bone
marrow)

Question 14

What is acute vs chronic leukemia?

Answer 14

• Determine the degree of differentiation or maturity of the cells. Often will tell you the clinical course of the disease.
• Acute- worse than a chronic leukemia (short life span)- neoplastic cells are immature (blasts)
• Chronic- mature well differentiated cells predominate patients survive longer time

Question 15

where can neoplastic cells be found?

Answer 15

blood, usually bone marrow- can maybe in the spleen, liver, lymph
nodes

Question 16

what are your two types of proliferative disorders

Answer 16

proliferative disorders usually imply there being a neoplasm.
• lymphoproliferative disorder! neoplasms of lymphocytes and
plasma cells.
• Myeloproliferative disorder-s neoplasms arising from bone
marrow, stem cells and involve neutrophils, monocytes,
erythrocytes, rarely eosinophil’s and basophils.

Question 17

How can lymphoproliferative disorders be further classififed?

Answer 17

• B or T or other cell neoplastic process can lead to lymphoma (lymphosarcoma) confined to solid tissues or lymphocytic leukemia (neoplastic process involving either marrow and or blood)
• Specific B cell neoplastic process plasma cell differentiation can lead to multiple myeloma (usually functional and producing immunoglobulin- can see high globulin of 1 type (monoclonal gammopathy. – multiple usually indicates that there are many sites the cells are found at time of diagnosis

Question 18

In dogs what is a lymphocytosis indicative of?

Answer 18

• Lymphocyte concentration that is greater than 35,000/ul
can be classified as a leukemia.
• If greater than 15,000/ul and Erlichia negative, it is a
leukemia

Question 19

What is acute lymphoblastic leukemia(ALL)?

Answer 19

• Needs to be distinguished from stage V lymphoma. 65% of dogs
presenting w/ multicentric lymphoma are leukemic. Question
if there is lymphandopathy. 50% of dogs w/ ALL have
lymphadenopathy
• clinical sings- pale m.m, splenomegaly, hepatomegaly, lethargy,
weight loss

Question 20

What occurs w/ CBC and ALL?

Answer 20

You can have anemia, thrombocytopenia, lymphocytosis usually, and lympoblasts in blood

Question 21

What is the prognosis of ALL?

Answer 21

Poor, cinical course is rapid and progressive and responds poorly to
therapy. Cats are usually younger and FeLV positive.

Question 22

What is chornic lymphocyctic leukemia?

Answer 22

• Lymphocytes are small and appear well differentiated. It is more common in dogs, must be differentiated from other causes of lymphocytosis. If greater than 35,000 lymphocytes it is leukemic (but can be lower and still be leukemic)
o Lymphocytes are often normal. Longer course of dz than acute

Question 23

What is the DDX for CLL in cats?

Answer 23

• Excitement lymphocytosis- but not greater than 20,000/ul and
Bartonella henselae (cat scratch fever)

Question 24

What are your DDx for CCL in dogs?

Answer 24

• Chronic erlichiosis (usually will see lager granular lymphocytes), other antigenic stimulation rarely cause an increase in lymphocytes greater than 10,000/ul , excitement lymphoyctosis rare in dogs, and rarely is it caused by hypoadrenocrticsm

Question 25

What are clinical signs of CLL?

Answer 25

• Can be asymptomatic, dx during wellness exam. If ill, the animal
can show lethargy, anorexia, pale mucous membranes,
lymphadenopathy, splenomegaly, hepatomegaly possible

Question 26

What are laboratory findings of CLL?

Answer 26

Lymphocytosis, (ranging from greater than 300,000/ul),
may be anemic, thrmocytopenic, increased small lymphocytes in bone marrow (25-100%), rarely monoclonal gammoapthy, cats usually FeLV Negative!!

Question 27

What are phenotypic classifications of CLL?

Answer 27

• CD34- expression predicts poor outcome
• CD8- and lymphocyte concentration greater than 30,00- shorter survival then if less 30,000/ul
• Similar outcome w/ CD4-8-5+ and CD8+ T cell leukemias
• CD21+ B cell patients w/ large lymphocytes survive less time than
patients w/ small cells
• Old dos w / B cell leukemia survive longer than young dogs
• Dogs w/ T cell CLL and no anemia survive longer

Question 28

What can PCR detect?

Answer 28

• Major antigen receptor rearrangements. Used to identify a clonal,
neoplastic population of cells. It differentiates non neoplastic lymph
proliferative disorders from those that are neoplastic

Question 29

What is multiple myeloma?

Answer 29

Proliferation of plasma cells at various sits in the bone
marrow. And eventually other tissues. Release into peripheral blood occurs occasionally but small in numbers (survival time less if leukemia present)

Question 30

What are flame cells?

Answer 30

Round nucleus, immunoglobulin is not getting released out of the
cell efficiently- have a lot of pink Ig in cytoplasm

Question 31

What are clinical signs and lab findings w/ multiple myeloma?

Answer 31

• Clinical signs are related to the presence of neoplastic plasma cells in bone marrow and other tissues. And related to immunoglobulins they produce( can increase viscosity of the blood)
o Lethargy, anorexia, lameness, bleeding from nares, PU/PD, fundoscopic changes (retinal hemorrhage, and engorged retinal blood vessels, renal dz sometimes (bence jones proteins, and sometimes 2ndary hypercalcemia w/ mineralization, and sometimes central nervous system signs (hyper viscosity)
“ Bleeding disorders in 1/3 of all dogs
• Lab findings- 20% plasma cells in bone marrow in aggregates
usually. Must be differentiated from chronic antigenic stimulation o Can se monoclonal or biclonal gammaopathy. Usually IgG or
igA, sometimes igM (referred to as paraproteins) sometimes paraproteins can stick to platelets and cause thrombocytopenia.
o Other sings! lytic lesions common in bones!! Platelet function abnormality due to presence of protein.

Question 32

What are Bence Jones proteins in urine?

Answer 32

Immunoglobulin light chains separated from heavy chains in
circulation. Light chains small enough they pass through glomerulus. Not picked up by dipstick (only pick up albumin)
o If peak is 4x as high as it is wide, probably a monoclonal gammpoathy.

Question 33

How does multiple myeloma present in cats?

Answer 33

Atypical plasma cell morphology, anemia, bone lesions, organ

involvement (very common in cats)

Question 34

you are presented w/ a older dog w/ anorexia, lethargy and nose bleeds. Decreased PCV, non regen anemia, increased total protein, increase bands, decreased lymphocytes, and 60,000/ul platelet s(low). What can you say?

Answer 34

• You have a non regenerative anemia, increase total protein likely b/c of increase in globulin rather than dehydration. Perform a protein electrophreisis.
• Inflammatory and stress leukogram.
• You have thrombocytopenia (not enough to cause the nose bleed)!
possible DIC, immune mediated or lack of platelet production.
Combination of non regenerative anemia and thrombocytopenia should cause you to do a bone marrow aspirate. ! discovered monoclonal gammopathy (increased in your gel eletctro ) w/ normal albumin. (have increase plasma cells in bone marrow, demonstrating bence jones protein in urine, lytic lesions of the bone noted as well.

Question 35

How do myeloid neoplastic cells manifest?

Answer 35

• As either lack of normal cells in blood, or presence of neoplastic
cells (of your hematopoetic cells)
Include cancers w/ both rapid and gradual progression. Percentage of blast cells in marrow is used to distinguish acute from chronic

Question 36

What are myelodysplastic syndrome?

Answer 36

Variable manifestations w/ subtle morphologic abnormalities. Usually some form of cytopenia may be single or in combination. Including non regen. Anemia, neutropenia, and or thrombocytopenia. Marrow may be hypocellular, normal cellular or hypercellular. It is often pre leukemic, reported in dogs, cats, rarely horses, usually FeLV induced in cats.

Question 37

What are morphological abnormalities associated w/ meylodysplatic syndromes?

Answer 37

RBC and RBC precursors are usually abnormally large and very variable in size leading to macrocytosis and anisocytosis (which will widen the histogram); while platelets and neutorphils may also be abnormally large. In addition you can have dysinchonry of nuclear and cytoplasmic matruation events. S

Question 38

What are clinical signs of MDS?

Answer 38

Lethargy, anorexia, weight loss. Die w/in week so dx- often

progress to leukemia

Question 39

What is acute myeloid leukemia’s?

Answer 39

Rapidly progressing myeloid cancer. Must have 20% or greater blasts in bone marrow. But % of blasts in blood is variable. Cytogenetic analysis routine and important in determining treatment modality and prognosis

Question 40

What is undifferentiated leukemia?

Answer 40

• All cells in bone marrow are blasts cant be classified based on
morphology, cytochemistry. Can dx based on ultra structural cytochemistry or immunophenotyping. “Reticuloendotheliosis in cats”
o Features of both erythroid and myeloid leukemias. Often the myeloid cells have cone shaped cytoplasm. pieces of the cytoplasm may break off and resemble giant platelets but really pieces of cytoplasm

Question 41

What is seen w/ myeloblastic leukemia?

Answer 41

Greater than 90% blasts in bone marrow and less than 10% more
differentiated granulocyte precursors

Question 42

What is myeloblastic leukemia w/ differentiation?

Answer 42

• 20% balsts but less than 90% blasts. Greater than 10% differentiated granulocytes.

Question 43

Often many promyelocytes

what coincides w/ a myelomonocytic leukemia?

Answer 43

Myleoblasts and monoblasts greater than 20% in bone marrow and
monocytes and granulocytes are greater than 20%

Question 44

What occurs with a monocytic leukemia?

Answer 44

Promonocytes and monoblasts are greater than 80% of non erythroid cells. (M5a)
• Greater than 20% to less than 80% promonocytes and monoblasts (M5b)

Question 45

What do you see w/ erythroleukmia?

Answer 45

Erythroid greater than 50%, myeloblastas and monoblasts less than
20%. – a red cell leukemia can have combo of immature red cells and immature neutros. Combine referred to as erythroleukemia.
o If most blasts are erythorid- called an erythmic myelosis or M6ER.

Question 46

What does a megakeryoblstic leukemia look like?

Answer 46

Greater than 20% megakaryoblssts in blood, w/ increased
megakaryocytes. May need immunocytochemistry. Can see
thrombocytopenia or thormobcytosis.

Question 47

What is chronic meyloproliferative neoplasms in animals?

Answer 47

• Rare – difficult to distinguish from hyperplasia.
• More in dogs than cats. CML (chronic granylocytic (myelogenous)
leukemia) is more like CNL (chronic neutrophilic leukemia) since rarely basophilia and eosinophilia.
o Eventually develop disorderly left shift and blast crisis. Usually more anemic than patients w/ inflame. Dz.
“ Have marked neutrophilia, left shift and monocytosis. hypersegmented nuclei, giant metamyelocytes, bands.
• Ddx: ddx from MDS by seeing a marked leukocytosis w/ CML., Inflammatory responses (lekmoid reactions; marrow exam may not be helpful w/ orderliness. May be disrupted w/ inflammation.

Question 48

What is an eosinophilic leukemia?

Answer 48

Rare primarily in FeLV negative cats. Eosinophilia, immature
eospinophils in blood predominance in marrow, eopshinophil infiltration of organs. Must differentiate from hyperesopnihpohilic syndrome.

Question 49

What are clinical signs w/ eosphinophilic leukemia?

Answer 49

Similar to other MPDs but diarrhea, thickened bowel loop, vomit, eosinophil infiltration of intestine. hydroxyrea and prednisone may prolong survival.

Question 50

What is chronic basophilic leukemia?

Answer 50

Rare- reported in dogs and cats. Basophiilia w/ orderly left shift-
may show thormocytosis, organ infiltration. Differentiate from mast cell leukemia (mast cell shave round nuclei where basophils havenucleisu tha looks like monocytes

Question 51

What is essential thrombocythemia?

Answer 51

Rare, PLT greater than 1 milllkion/ul. Giant forms. increased
megakaryocytes in marrow. Differentiate form Fe def. anemia, inflammation, antineoplstic drug therapy, corticosteroids, neoplasia, all which can cause thrombocytosis