WBCs Disorders and Leukemias

Question 1

What are the two common features of leukemias?

Answer 1

1. WBC precursors in the bone marrow

2. Increased malignant WBCs in peripheral blood

Question 2

What are the two major classes of leukemias?

Answer 2

1. Myeloid (granulocyteic-monocytic)

2. Lymphoid (lymphocytic)

Question 3

Which type of leukemia are children more commonly affected by?

Answer 3

Children = acute

Question 4

Which type of leukemia are adults more likely to have?

Answer 4

Adults = chronic

Question 5

What virus has implicated as a cause of Burkitt Lymphoma?

Answer 5

EBV

Question 6

Name 3 complications common to all leukemias

Answer 6

1. Anemia
2. Recurrent infection
3. Uncontrolled bleeding

*Pancytopenia

Question 7

What is the most common cause of death in leukemia?

Answer 7

overwhelming infection, ie sepsis

Question 8

Immature B-cell leukemia with lymph node involvement

Answer 8

Acute Lymphoblastic leukemia (ALL)

Question 9

What is the most common form of leukemia in children <5?

Answer 9

Acute lymphoblastic leukemia

Question 10

Describe the clinical features of acute lymphoblastic leukemia

Answer 10

• Bone pain and arthralgia
• Pancytopenia
  
  • bleeding into skin and internal organs
• Enlarged lymph nodes
• Mild splenomegaly

Question 11

In the FAB- French American British classifications of acute leukemias who are L1 and L2 distinguished?

Answer 11

L1 Acute Lymphoblastic is principally pediatric and has a uniform nucleus

L2 Lymphoblastic has irregular nucleus

Question 12

What is the prognosis for Acute Lymphoblastic leukemia?

Answer 12

No treatment = dead in 3-5 months

Treatment =>90% cure

–prognosis better in children

Question 13

What is the most common acute leukemia?

Answer 13

Acute myeloid leukemia

Question 14

Who is most commonly affected by acute myeloid leukemia?

Answer 14

older people

Question 15

How is acute myeloid leukemia diagnosed?

Answer 15

Bone marrow biopsy showingn >20% myyeloblasts

Question 16

Which leukemia is associated with radiation (ex. atomic bombs), cytoxic chemotherapy, benzene exposure, cigarette smoke

Answer 16

Acute myeloid leukemia

Question 17

Which type of leukemia is associated with Auer rods?

Answer 17

Acute Myeloid Leukemia

Question 18

What are the two cytochemical markers used for diagnosis of AML?

Answer 18

1. Myeloperoxidase

2. Nonspecific Esterase (NSE)

Question 19

Are cytoplasmic granules associated with AML or ALL?

Answer 19

AML

Question 20

Which type of infection is especially seen in AML?

Answer 20

fungal

Question 21

Clinical features of AML?

Answer 21

• Splenomegaly
• Lymphadenopathy
• Testicular enlargement
• Infiltrates into the retina and choroid
• CNS may be involved with infiltrates

Question 22

Prognosis of AML?

Answer 22

Most die within 6 months

Chemo can induce remission, but almost all will relapse. 30% 5 year survival

Question 23

What is a key clinical feature of chronic lymphocytic leukemia

Answer 23

bilateral axillary

Question 24

Chronic lymphocytic leukemia shares many of the same features as ________

Answer 24

small cell lymphocytic lymphoma

Question 25

What should be expected in patient with histological finding of lymphocytes >15,000 in peripheral blood

Answer 25

Chronic lymphocytic leukemia

Question 26

Which condition will show show many abnormal looking lymphocytes called smudge cells on a peripheral smear?

Answer 26

Chronic lymphocytic leukemia

Question 27

Which is the most common form of myeloproliferative syndrome? (Chronic or acute)

Answer 27

Chronic

Question 28

What is the difference in cell maturity between chronic myelogenous leukemia and chronic lymphocytic leukemia?

Answer 28

Chronic myelogenous leukemia is a maligant disease with granulocytes in all stages of maturation chronic lymphocytic leukemia is a malignant disease of adult lymphoid cells (indistinguishable from mature lymphocytes)

Question 29

What specific chromosomal abnormality is associated with 95% of patients with Chronic myelogenous leukemia?

Answer 29

Philadelphia chromosome - reciprocal translocation between chromosome 9 and 22 -->produces uncontrolled tyrosine kinase.

Question 30

How is chronic myelogenous leukemia diagnosed?

Answer 30

1. High WBC count | 2. FISH (fluorescence in-situ hybridization)

Question 31

Is there a better prognosis or worse prognosis if you are in the 95% of people who have the reciprocal translocation for chronic myelogenous leukemia?

Answer 31

better prognosis with it

Question 32

The presence of _______ in CML cells is strong evidence of its disease causing role

Answer 32

tyrosine kinase

Question 33

Which chromosome is technically the philadelphia chromosome?

Answer 33

22

Question 34

What might you suspect if a bone marrow smear and peripheral blood smear showed granulocytes in all stages of maturation and rouleux formation (ex. metamyelocytes, myelocytes)?

Answer 34

Chronic myelogenous leukemia

Question 35

What two clinical findings are a result of accelerated clotting found in Chronic Myelogenous Leukemia?

Answer 35

1. Splenomegaly | 2. Thrombosis

Question 36

After 2-3 years of chronic phase in CML, 50% of the time it will progress to an accelerated phase which usually ends in a ___________ that resembles acute leukemia

Answer 36

"blast crisis"

Question 37

Does chemotherapy work well for CML patients?

Answer 37

chemo yields unsatisfactory results and most will die in 3-5 years. 70% 3 year survival with BM + radiation + chemo