Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Blood and Lymph > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Severe Combined Immunodeficiency Disease (SCID)

A

Low T AND B cells

  • block in development of lymphoid stem cell or its maturation
  • Children rarely survive past 1 year
  • Different variations but is a group of diseases with a similar phenotype
  • Most are XR, some are AR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SCID-X1

A

defect in gene for gamma chain for IL-2 receptor and other cytokines necessary for lymphoid development and signaling (XR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Adenosine deaminase enzyme deficiency

A

type of SCID

-adenosine accumulates in all cells, and impairs lymphocyte development selectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatment of ADA enzyme deficiency in some SCID cases (3)

A

-Irradiated red cells (very high concentration of ADA in RBCs)
(Irradiation kills lymphocytes, but not RBCs)

  • Purified ADA stabilized by polyethylene glycol
  • Replacement gene therapy (still under research)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pure B cell Deficiencies include…(4)

A

X-Linked (Bruton) Agammaglobulinemia

X-linked hyperIgM Syndrome

Common Variable Immunodeficiency (CVID)

Transient Hypogammaglobulinemia of Infancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Infections commonly associated with pure B cell deficiencies

A

high-grade (extracellular, pyogenic) bacterial pathogens

Including:
Staphylococcus aureus
Haemophilus influenzae
Streptococcus pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

X-Linked (Bruton) Agammaglobulinemia

where is the block?
Where is the defect?
What kinds of infections are associated?

A

developmental block between pre-B cell and B cell → normal pre-B in marrow, NO B cells or antibody

Defect in tyrosine kinase gene

BACTERIAL infections (pneumonia, chronic diarrhea), ENTEROVIRUS infections (enter through mucous membranes - no IgA there) e.g. polio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

X-linked hyperIgM Syndrome

A

high IgM, low IgG and IgA = defect in IgM-to-IgG switch mechanism

CD40 not on B cell or no CD40 ligand on Tfh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common Variable Immunodeficiency (CVID)

where is the block?
what kinds of infections?
treatments?

A

Normal # of pre-B cells and B cells, but B cells difficult to trigger to make specific antibody (very low serum IgG)

Recurrent BACTERIAL infections

Treat with IVIG or SCIG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Transient Hypogammaglobulinemia of Infancy

A
  • lasts from 6-18 months
  • Slow to get IgG production going
  • Recurrent, persistent, Gram-positive bacterial infections
  • 15% of al chronic diarrhea in infants due to this condition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Embryology of the thymus (2)

A

Stroma + Lymphoid

Stroma of thymus comes from endoderm and ectoderm of the 3rd and 4th pharyngeal pouches

Lymphoid part comes from bone marrow precursors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DiGeorge Syndrome

A

Abnormal development of 3rd/4th pharyngeal pouches → stroma does not support thymic lymphoid development → No T cells, normal B cells (but no Tfh cells)

45 gene deletion on chr 22

Associated with parathyroid problem (same embryological origin)

Common VIRAL and FUNGAL infections

CATCH-22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CATCH-22

A

Massive defect on chromosome 22 (de novo mutation)

Calcium (calcium convulsions)

Appearance (wide set eyes, low set ears)

Thymus

Clefts (palate)

Heart (big vessel abnormalities)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Selective IgA Deficiency

A
  • can’t make IgA, but make all other Igs
  • Most common immunodeficiency disease
  • Usually asymptomatic - diarrhea, sinopulmonary infections, more allergies
  • Associated with Celiac Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nude Mouse

A

Fail to make thymic stroma (and hair) → no T cells

Immunologically similar to DiGeorge kids (different gene defect though)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of immunodeficiency

A

1) Isolation (bubbles)
2) Prophylactic abx
3) Transplantation
4) IVIG, SCIG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

IVIG and SCIG

A

IVIG:
Given monthly, effective, expensive, short supply
99% IgG, half life of 3 weeks

SCIG:
slow subcutaneous infusions recently approved, done at home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

B cell immunodeficiency work up

A
  • Serum protein electrophoresis
  • Quantitative Ig (G,A,M) levels
  • Specific Abs prior to immunizations
  • ABO isohemagglutinins
  • Ab responses to novel Ags
  • Sequence suspect genes
  • lymph node biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

T cell immunodeficiency work up

A
  • Skin tests with recall Ag panel
  • Total lymphocyte count
  • CD3, CD4, CD8 counts
  • Mitogen responses (MLR, cytokine measurements)
  • Sequence suspect genes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Phagocytic immunodeficiency work up

A
  • WBC count, differential, morphology
  • NBT test, oxidative burst
  • Assay for phagocytosis, chemotaxis
  • Sequence suspect genes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complement immunodeficiency work up

A
  • CH50
  • Assay for C1 inhibitor
  • Individual complement levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Viruses associated with secondary immunodeficiencies include… (4)

A

Measles
Epstein Barr virus
Mononucleosis
Cytomegalovirus (CMV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Secondary Immunodeficiencies

A
  • Many viral illnesses are immunosuppressive, secondary infection common
  • Drugs used in therapy of autoimmune/inflammatory conditions immunosuppressive (corticosteroids, antibodies)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hematologic Malignancies

A

CLONAL malignant population of cells derived from transformed cell of marrow derivation

  • all are inherently malignant
  • can contain both leukemic and lymphoma component
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Leukemia

A
  • malignancy of hematopoietic cells - chief involvement is blood and marrow
  • Can include lymphoid and myeloid cells, both mature and immature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Lymphoma

A

malignancy of hematopoietic cells derived from lymphocytes or their precursors

Presents as a solid mass

Nodal = presenting as enlarged lymph nodes
Extranodal = present at sites such as skin, brain, GI tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Extramedullary myeloid tumor (aka granulocytic sarcoma

A

Malignancy of hematopoietic cells derived from myeloid cells or their precursors (granulocytes, monocytes, etc.)

Presents as a solid mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

High Grade Lymphoma

A

more aggressive, more rapidly growing

Lymphoma = rapidly enlarging mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Low grade Lymphoma

A

Lymphoma = mildly enlarged neck lymph node (present for years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Acute leukemia

A

Rapidly progressive course, rapidly fatal without treatment

-Failed production of normal marrow cells due to predominance of leukemic cells (leukemic cells usually blasts)
→ low platelets, low neutrophils, low RBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Chronic Leukemia

A

CLL or CML

Subtle symptoms, noticed incidentally on CBC performed for another reason

Increased WBC count - accumulation of normal-appearing (but clonal) mature blood cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

_________ are common in immunoglobulin and T cell receptor genes in lymphomas because…

A

balanced translocations

During initial Ig/T cell receptor rearrangement during maturation of B and T cells there is normal (but high) levels of genomic instability

EX) Class recombination, somatic hypermutation for B cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Importance of specific recurrent translocations (one EX)

A

EX) t(9;22) = Chronic Myelogenous Leukemia (CML)

  • Important as diagnostic markers in hematologic malignancies
  • Their persistence suggests critical role in development of hematologic malignancy they are associated with
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

3 oncogenic viruses in lymphoma

A

1) Epstein-Barr Virus
2) Human T cell Leukemia Virus-1 (HTLK-1)
3) Kaposi Sarcoma Herpesvirus / Human Herpesvirus-8 (KSV / HHV-8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Epstein-Barr Virus (EBV) implicated in the development of _______, _________ and _______

A

implicated in development of classical Hodgkin Lymphoma, Burkit Lymphoma and some other B cell non-Hodgkin lymphomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Human T cell Leukemia Virus-1 (HTLV-1) implicated in the development of __________

A

adult T cell leukemia/lymphoma (ATLL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Kaposi Sarcoma Herpesvirus / Human Herpesvirus-8 (KSV / HHV-8) implicated in ____________

A

primary effusion lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Frequency In Children of…

Leukemia
Lymphoma

A

Leukemia = most common childhood cancer (37%)

Lymphoma = 3rd most common childhood cancer (24%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Frequency and death in adults of…

Leukemia
Non-Hodgkin Lymphoma

A

Non-Hodgkin Lymphoma = 7th most frequent, 7th most deadly

Leukemia = 10th most frequent, not very deadly anymore because of good treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Classification of hematologic malignancies (6)

A

1) Myeloid vs. Lymphoid vs. other
2) Microscopic appearance of malignant cells

3) Histologic growth pattern of malignant cells in marrow, lymph node, or other tissue
4) Presence / absence of specific cytogenetic findings or molecular findings
5) Relative amount of malignant cells present in the blood or marrow
6) Presence or absence of certain cell surface markers / cytoplasmic markers / nuclear markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Myeloid vs. Lymphoid vs. Other

A

Myeloid: resemble cells of granulocytic, monocytic, erythroid, megakaryocytic, and/or mast cell lineages

Lymphoid: resemble cells of the B cell, T cell and NK cell lineages

Other: resemble histiocytes, dendritic cells, Langerhans cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Acute Leukemia:

Most common cell type
Morphology

A

Rapid accumulation of immature cells in marrow, replace normal marrow cells, accumulate in blood → other cytopenias

Cell Type: almost always BLASTS (myeloid or lymphoid)

Morphology: certain line of differentiation (monocytic, megakaryocytic, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Immunophenotyping

A

abs used to detect certain substances being expressed by cells (flow cytometry and immunohistochemistry) → morphologically identical cells put into definite lineage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Myelodysplastic Syndrome (MDS) (3)

A

Neoplastic clone stem cell takes over marrow → can’t make normal blood cells in one or more lineages (dysplasia)

May progress to AML

Persistently low blood counts in one or more lineages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Myeloproliferative Neoplasms (MPNs) (3)

A

Neoplastic clonal proliferations of marrow - clone makes normal functioning blood cells, but makes too many of them in one or more lineages

Subsequent increased blood counts

Can progress to acute leukemia (less than for MDS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Classical Hodgkin Lymphoma (CHL)

A

Driven by Hodgkin-Reed-Sternberg (HRS) cells derived from B cells

-old school classification still used even though its from B cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Non-Hodgkin Lymphoma (2)

A

Any malignancy derived from mature B cells (excluding CHL or plasma cells neoplasms), T cells, or NK cells

Large majority derived from B cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Plasma Cell Neoplasms: includes _______, ________ and _________

A

Includes MGUS, plasmacytoma, and multiple myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

AML diagnosis age

A

avg age at diagnosis is 65 years old

1.Rare in children and young adults (only 10% of childhood leukemias)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

ALL diagnosis age

A

75% of cases occur in children under 6 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Prognosis of ALL

A

generally good prognosis in children (95% complete remission following chemotherapy, 80% cure rates)

1.Worse in adults - complete remission 60-80%, cure rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Leukemic Stem Cell:

A

Potential for self renewal → Inexhaustible source of leukemic cells that replace the bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Risk factors for acute leukemia (6)

A

i. Majority of ALs occur in absence of risk factors
ii. Previous chemo, esp. DNA alkylating agents and topoisomerase-II inhibitors
iii. Tobacco smoke
iv. Ionizing radiation
v. Benzene exposure
vi. Genetic syndromes including Down syndrome, Bloom syndrome, Fanconi anemia, and ataxia-telangiectasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Signs/symptoms of acute leukemia die to

A

decreased # of normal peripheral blood cells due to marrow infiltration by leukemic cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Symptoms of acute leukemia

A

Fatigue, malaise, dyspnea, easy bruising, weight loss, bone pain, abdominal pain, neurologic symptoms (rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Signs of acute leukemia

A

anemia, pallor, thrombocytopenia, hemorrhage, ecchymoses, petechiae, fundal hemorrhage

  1. Fever, infection
  2. Adenopathy, hepatosplenomegaly, mediastinal mass
  3. Gum or skin infiltration, renal enlargement and insufficiency, cranial neuropathy (all rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

ALL diagnostic markers:

A
  1. CD34 → myeloblasts (generic marker of immaturity)
  2. TdT → NOT myeloblast, NOT mature lymphocyte
    a. Nuclear enzyme specific to lymphoblasts
  3. B-lymphoblasts express B-lineage antigens (CD19, CD22)
    a. do NOT express markers of mature B cells (CD20) or surface Ig
  4. T-Lymphoblasts express T-lineage antigens (CD3, CD7)
    a. May express CD4 and CD8 concurrently (or just one, or neither)
    b. Express T-lineage antigens ONLY seen in mature T cells (CD99, CD1a)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

CD34

A

myeloblasts and lymphoblasts (generic marker of immaturity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

TdT

A

marker of immature T-lymphoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

CD19 and CD22

A

B lymphoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

CD3 and CD7

A

T lymphoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

AML Diagnostic markers

A
  1. CD34 - generic marker of immaturity → myeloblasts and lymphoblasts
  2. CD117 (C-Kit), myeloperoxidase - myeloid antigens → myeloblasts
  3. CD64, CD14 - monocytic antigens → Monocyte differentiation
  4. CD41, CD61 - megakaryocytic antigens → megakaryoblast differentiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

CD117 (C-Kit), myeloperoxidase

A

myeloblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

CD64, CD14

A

Monocyte differentiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

CD41, CD61

A

Megakaryoblast differentiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Most prevalent ALL

A

B-ALL (80-85% of all cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

B-ALL present at what age?

A

childhood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

B-ALL lack markers for ____ and ____

A

mature B calls (CD20)

Surface Ig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

T-ALL present at what age?

A

Teenagers

70
Q

T-ALL present with component of ___ that manifests as large ____

A 
Lymphoblastic lymphoma (T-LBL)
mediastinal mass
71
Q

Which has higher WBC count, T-ALL or B-ALL

A

T-ALL

72
Q

T-ALL favors males or females

A

Males

73
Q

3 commonly observed cytogenetic abnormalities in B-ALL

A
  1. t(9;22); BCR-ABL1
  2. 11q23; MLL
  3. t(12;21); ETV-RUNX1
74
Q

B-ALL with t(9;22); BCR-ABL1:

A
  1. 25% of adult B-ALL (only 2% of childhood B-ALL)
  2. Philadelphia Chromosome (chr22)
  3. BCR-ABL fusion 190kd (different than CML) due to different breakpoint in BCR gene
  4. Unfavorable prognostic factor
75
Q

B-ALL with translocations of 11q23; MLL:

A
  1. Can have MLL rearranged with multiple possible partner genes
  2. Seen in B-ALL in neonates and young infants
  3. POOR prognosis
76
Q

B-ALL with t(12;21); ETV6-RUNX1:

A
  1. 25% of childhood B-ALL cases

2. Very GOOD prognosis

77
Q

7 factors leading to worse prognosis in ALL

A 
Infants (less than 1yo)
Teens, adults (>10yo)
Very high WBC count
T-lymphoblastic
Hypodiploidy (less than 46)
Slow Response to Rx
Min. Residual Disease
78
Q

3 factors leading to favorable prognosis in ALL

A
  1. 1-10 years old
  2. B-lymphoblastic
  3. Hyperdiploidy (51-65)
79
Q

Two diagnostic feactures of AML

A
  1. Myeloblasts > 20% of nucleated cells in marrow and/or peripheral blood
    - CD34 (generic marker of immaturity) and CD117 (C-KIT), and Myeloperoxidase seen (markers on myeloids)
    - NEGATIVE for markers of lymphoid differentiation
  2. Presence of certain recurrent cytogenetic abnormalities → diagnosis of AML regardless of blast count
80
Q

Auer Rods

A

i. Fused azurophilic granules forming small stick-like structure in the cytoplasm
ii. Presence of auer rods allows identification of a blast as a myeloblast
iii. ONLY seen in abnormal myeloblasts

SUGGESTS AML

81
Q

2 methods to detect AML cytogenetics

A
  1. Cytogenetic analysis (FISH, karyotyping)

2. Molecular analysis (PCR)

82
Q

AML with t(8;21); RUNX1-RUNX1T1:
__% of AML cases
Patients are typically ____

A

5%

younger

83
Q

AML with t(8;21); RUNX1-RUNX1T1 is associate with “_______”

A

AML with maturation

- Some neut production still at diagnosis

84
Q

RUNX1 encodes ____ which does what?

A

encodes alpha unit of core binding factor (CBF), a TF needed for hematopoiesis-> fusion-> blocks transcription of CBF-> block differentiation

85
Q

Prognosis of AML with t(8;21); RUNX1-RUNX1T1

A

GOOD

86
Q

AML with inv(16) or t(16;16); CBFB-MYH11:
___% of AML cases
patients are typically ____

A

5-10%

younger

87
Q

In the marrow of AML with inv (16) or t(16;16)->

A

frequent presence of immature eosinophils with abnormal basophilic granules = “baso eos”

88
Q

in AML with inv(16) or t(16;16), there is an increase of ___ and _____

A

myeloblasts and monocytes= “myelomonnocytic leukemia”

89
Q

CBFB

A

beta subunit of core binding factor (CBF)

90
Q

Prognosis of ML with inv(16) or t(16;16)

A

good

91
Q

APL with t(15;17); PML-RARa:

A

APL = Acute Promyelocytic Leukemia

Distinct subtype - abnormal promyelocytes predominate instead of blasts (5-10% of cases of AML)

92
Q

Histology of

APL

A

Hypergranular (obscure nucleus), multiple Auer rods (“faggot cells”)

93
Q

Translocation associated with APL

A

t(15;17)

94
Q

AML with t(1;22); RBM15-MKL1

A
  1. Megakaryoblastic differentiation
  2. Most often see in infants with Down Syndrome
  3. Good prognosis with intensive chemo
95
Q

AML with abnormalities of 11q23; MLL

A
  1. MLL gene can be fused with multiple different partner genes
  2. AML with translocation involving MLL → some monocytic differentiation
96
Q

Two reasons it is important to recognize APL as subtype of AML

A
  1. Gene fusion in APL fuses retinoic acid receptor-alpha (RARa) to another gene
    - RARa needed for differentiation of promyelocytes, fused product does not work well and thus blocks differentiation
    - Can overcome block with supraphysiologic dose of all-trans retinoic acid (ATRA) in combination with arsenic salts → patients DO NOT require chemo
  2. Some cases of APL cause DIC → important to know its APL to watch out for DIC
97
Q

Two categories of therapy related AML

A
  1. t-AML secondary to alkylating agents or radiation

2. t-AML secondary to topoisomerase-II inhibitors

98
Q

t-AML secondary to alkylating agents or radiation: (3)

A
  1. Latency of 2-8 years from prior treatment
  2. Progresses through initial MDS stage before reaching AML (20% blasts)
  3. Complex karyotype that includes whole/partial loss of chr 5 and/or 7
99
Q

t-AML secondary to topoisomerase-II inhibitors: (3)

A
  1. Latency of 1-2 years from prior treatment
  2. Presents as de no novo AML with no prior MDS phase
  3. Rearrangement of MLL gene (11q23)
100
Q

Prognosis of t-AML

A

VERY BAD PROGNOSIS

101
Q

3 molecular markers for AML prognosis

A
  1. FLT3 ITD
  2. NPM1
  3. CEBPA
102
Q

FLT3 ITD

- or + prognostic factor?

A

internal tandem duplications (ITDs) in FLT3 gene

Negative prognostic factor for AML, NOS (not otherwise specified)

103
Q

NPM1

- or + prognostic factor?

A

Positivity for a mutation of the nucleophosmin-1 gene

Positive prognostic factor in AML, NOS (only if negative for FLT3 ITD)

104
Q

CEBPA

- or + prognostic factor?

A

Positivity for a mutation of the CEBPA gene

Positive prognostic factor in AML, NOS (only if negative for FLT3 ITD)Ca

105
Q

Myelodysplastic syndrome

A

condition where marrow is replaced by a malignant clone derived from a transformed stem cell/progenitor cell

106
Q

Two main features of myelodysplastic syndrome

A
  1. Clone of cells ineffective at hematopoiesis

2. Increased risk of transformation to AML

107
Q

Two clinical scenarios of MDS

A
  1. Primary (idiopathic) MDS

2. Secondary (Therapy-related) MDS (t-MDS)

108
Q

Primary idiopathic MDS age of onset/diagnosis

A

over 50 years old, insidious onset, median age of diagnosis is 70 years old

109
Q

Secondary (Therapy-Related) MDS: (3)

A
  1. Part of t-AML spectrum
  2. Occurs 2-8 years after use of alkylating agents or radiation
  3. Whole or partial deletions of chr 5 and/or 7
110
Q

Diagnosis of MDS

A

Persistent peripheral cytopenia in one or more lineages that cannot be otherwise explained

111
Q

Three tests to make a diagnosis of MDS

A
  1. Morphologic evidence of dysplastic change- in at least 10% of cells in one or more lineages
  2. Increased myeloblasts but less than 20% of blood and marrow cells
  3. Clonal cytogenetic findings typical of MDS
112
Q

Dyserythropoiesis

A

RBC precursors with nuclear budding, irregularly-shaped nuclei, lack of coordination between nuclear and cytoplasmic maturation, increased ring sideroblasts (iron backing up in cytoplasm)

113
Q

Dysgranulopoiesis

A

Nuclear hypolobation of mature neutrophils, including neutrophils with bilobed nuclei called pseudo-Pelger-Huet cells, also cytoplasmic hypogranularity of neutrophils

114
Q

Dysmegakaryopoiesis

A

Megakaryocytes with hypolobated or non-lobated nuclei, often hyperchromatic nuclei, megakaryocytes often of small size

115
Q

Clonal cytogenetic findings typical of MDS

A

Complex karyotypes (monosomy 7 or 5, deletion 7q or 5q, trisomy 8)

116
Q

Negative for elevated myeloblasts and negative for clonal cytogenetic evidence of MDS →

A

potential non-neoplastic causes of secondary myelodysplasia

117
Q

Four possible causes of secondary myelodysplasia (may mimic MDS

A
  1. Certain drugs (e.g. chemo drugs)
  2. VB12, Folic acid, essential element deficiencies
  3. Viral infections
  4. Toxin exposure (e.g. arsenic, heavy metals)
118
Q

Diagnostic criteria of low grade MDS

A

myeloblasts NOT increased in frequency (less than 5% of marrow cells, and less than 2% peripheral blood cells)

119
Q

3 types of low grade MDS

A
  1. Refractory cytopenia with Unilineage Dysplasia (RC-UD) = good prognosis, median survival over 5 years, AML transformation rate only 2% at 5 years
    - Mostly cases of refractory anemia, rarely refractory neutropenia or refractory thrombocytopenia
  2. Refractory Cytopenia with Multilineage Dysplasia (RC-MD) = worse than RC-UD, median survival of 2.5 years, AML transformation rate 10% at 2 years
    - Low grade MDS dysplasia in 2 or more lineages
  3. MDS with isolated 5q Deletion = low grade MDS associated with anemia
120
Q

High grade MDS diagnostic criteria

A

myeloblasts are increased in frequency, but less than 20% (> 5% of marrow cells, and/or > 2% peripheral blood cells)

121
Q

2 types of high grade MDS

A
  1. Refractory Anemia with Excess Blasts-1 (RAEB-1) = 5-9% blasts in marrow, or 2-4% blasts in peripheral blood → 16 month survival, 25% transform to AML
  2. Refractory Anemia with Excess Blasts-2 (RAEB-2) = 10-19% blasts in marrow, or 5-19% blasts in peripheral blood → 9 month survival, 33% transform to AML

BAD prognosis - may or may not progress to AML, but frequently die secondary to bone marrow failure

122
Q

Myeloproliferative Neoplasms (MPNs)

A

characterized by increased numbers of NORMAL (not dysplastic) blood cells in one or more myeloid lineages (effective hematopoiesis), partially or entirely replaces normal marrow cells in multiple lineages

123
Q

MPN age

A

Disease of adults in 50s-70, rare in children

124
Q

3 Characteristics of MPNs

A
  1. Increase # of one or more blood cell type with correspondingly hypercellular marrow
  2. Splenomegaly/Hepatomegaly common
  3. Insidious onset, incidentally noticed on CBC - without treatment will progress to bad outcomes
125
Q

Why does splenomegaly and hepatomegaly occur in patients with MPN

A
  1. Sequestration of excess blood cells

2. Extramedullary hematopoiesis (body trying to make enough blood cells)

126
Q

Three Negative End Points for MPNs

A

1) Transformation to AML (sometimes ALL) - less common in MPNs than in MDS
2) Development of myelodysplasia with ineffective hematopoiesis (transform to MDS)
3) Excessive marrow fibrosis → BM failure

127
Q

4 types of MPNs

A
  1. Chronic myelogenous leukemia (CML)
  2. Polycythemia vera (PV) (“a lot of blood cells, truly”)
  3. Primary Myelofibrosis (PMF)
  4. Essential Thrombocythemia (ET)
128
Q

CML cytogenetics

A

Clonal hematopoietic stem cell disorder, BCR-ABL1 gene fusion

129
Q

CML progression

A

Chronic phase → Accelerated phase → Blast Phase

130
Q

Chronic phase of CML marrow findings

A 
Hypercellular marrow
Granulocytic hyperplasia
NORMAL blasts
NO dysplasia in marrow or blood
Neutrophil leukocytosis (also basophilia / thrombocytopenia)
131
Q

Blast phase of CML marrow findings

A

20% or more blasts in marrow/blood (myeloblasts or lymphoblasts)

132
Q

Genetics of CML

A

a. BCR-ABL1 gene fusion t(9;22)→ fusion on chr 22 (Philadelphia Chromosome) → constitutive activation of growth pathways
b. 210 kD (p210) fusion protein (190kD fusion for adult B-ALL)

133
Q

Prognosis of CML

A

Much better, used to be only 2-3 years

→ targeted therapies (PTKIs)

134
Q

Polycythemia vera

A

Erythrocytosis and can also have increased neutrophils/platelets → BM shows trilineage hyperplasia and large bizarre megakaryocytes

135
Q

Marrow of polycythemia vera

A

Polycythemic stage: increased peripheral blood counts

Spent phase: marrow shows myelofibrosis, low peripheral blood cell counts

136
Q

Genetic of polycythemia vera

A

JAK2 gene point mutation (V617F) encoding JAK2 cell signaling protein

137
Q

Key concern with polycythemia vera

A

Clotting (venous or arterial thrombosis)

138
Q

Primary myelofibrosis (PMF)

A

Granulocytic and megakaryocytic hyperplasia (but NO erythrocytosis), with eventual progression to myelofibrosis

Mutations in JAK2 in 50% of PMF cases

139
Q

PMF stages

A

Prefibrotic stage: marrow is hypercellular (mega/gran), large bizarre, megakaryocytes clustered + marked thrombocytosis/neutrophilia

a.Better survival with diagnosis at this stage

Fibrotic Stage:

a. BM significant reticulin (collagen IV) stage, loss of marrow space → intramedullary extramedullary hematopoiesis
b. Peripheral blood = leukoerythroblastosis
i. Increased immature granulocytes (myelocytes, metamyelocytes), immature nucleated RBCs
ii. Dacrocytes (tear-drop shaped RBCs)
c. Enlargement of other organs due to extramedullary hematopoiesis (spleen, liver, lymph nodes)
d. Falling WBC counts

140
Q

Essential thrombocythemia (ET)

A
  1. Sustained, marked thrombocytosis
  2. No granulocytic hyperplasia in marrow - marrow is normocellular but with atypical megakaryocytes larger and even more bizarre
  3. Mutation in JAK2 found in 50% of ET cases
  4. Symptom free for long periods with occasional severe thrombotic or hemorrhagic events
141
Q

Why do we need a second and third generation PTKIs

A

Imatinib (Gleevec) - PTKI used to treat CML

PTKIs effectively select to form new subclones against which the PTKI is not effective → second generation PTKI for CML = Dasatinib

142
Q

Death in PV patients

A

venous or arterial thrombosis (20% of patients)

Three sites of thrombosis associated with PV:

  1. Mesenteric vein
  2. Portal vein
  3. Splenic vein
143
Q

Treatment for PV

A

Serial phlebotomy (and aspirin to prevent clots)

144
Q

Type II immunopathology

A

antibody (IgG, IgM, IgA) directed against self

TISSUE specific autoimmunity - Ab directed against specific target tissue or cell

145
Q

Mechanisms of tissue damage (3)

A

1) Neutralization
2) Complement mediated damage
3) Stimulatory hypersensitivity

146
Q

Neutralization

EX)

A

protein inactivated by autoantibody

EX) IFN-y auto-antibodies → Th1 cells functionless → multiple infections - underlying pathology is autoimmunity, manifests as immunodeficiency

147
Q

Complement-Mediated Damage

A

tissues with ab against them damaged by lysis, phagocytosis, or by release of phagocyte lysosomal enzymes and ROS → inflammatory response

148
Q

Stimulatory Hypersensitivity

EX)

A

autoantibody directed against cell-receptor → mimic receptor agonist

EX) Hyperthyroidism (Graves Disease)

149
Q

Graves Disease (4)

A

Hyperthyroidism

“Stimulatory autoimmunity” to TSH receptor on thyroid cells

Thyroid cells have TSH receptor on them that recognizes TSH from pituitary and is told to make MORE thyroid hormones

Autoantibodies against TSH receptor on thyroid cells → agonist interaction → oversecretion of thyroid hormones, no normal feedback controls

150
Q

Myasthenia gravis is characterized by ________, and can be treated with ________

A

progressive muscle weakness (more common in women)

IVIG

151
Q

Myasthenia gravis mechanism

A

Antibody made to alpha subunit of acetylcholine receptor (AChR) → blocks receptor and activates complement and neutrophils → damage receptor → signal gets weaker to muscle → muscle gets weaker

Complement and neutrophil mediated damage

152
Q

AIRE gene in myasthenia gravis

A

AIRE gene → thymic expression of CHRNA1 (gene for alpha subunit of AChR)

In this disease protein NOT expressed in thymus, Th clones reactive with AChR not deleted by negative selection → B cells get help making ab to receptor

153
Q

Dressler’s Syndrome

A

immune response to pericardial or myocardial antigens

Persistent cardiac pain, fever, malaise, and pericardial effusion seen after heart attack (and heart surgery)

“Post cardiac injury syndrome”

Treat with anti-inflammatory agents

Resolves as heart heals

154
Q

Goodpasture’s Disease (5)

A

1) autoantibodies to lung and kidney basement membranes (CT framework)
2) Epitope on antigen (type IV collagen) only in lung/kidney

3) Primary symptoms is persistent glomerulonephritis
(in smokers → ab to lung → hemoptysis)

4) Ab directed against BM → staining by IF sharp and linear
5) Complement mediated destruction**

155
Q

Autoimmune thrombocytopenia purpura (ATP) (3)

A

bleeding abnormality due to destruction of platelets by autoantibody

Platelets are opsonized and their destruction (in the spleen) is rapid.

ATP is seen in young healthy people weeks after a viral infection or in older people in association with many other autoantibodies.

156
Q

Treatment of Autoimmune thrombocytopenia purpura

A

TX: suppress immune system and/or remove the spleen

157
Q

Autoimmune hemolytic anemia (AIHA)

A

autoantibody to RBCs

  • can be induced by drugs (usually temporarily)
  • associated with other autoimmune syndromes and cancer
158
Q

Paroxysmal cold hemoglobinuria (PCH)

A

hemolysis after exposure to cold, ab binds RBCs at 15 degrees celsius

159
Q

Rheumatic heart disease

A
  • heart disease post streptococcal infection
  • Cross-reaction between strep M-protein antigen and structure on heart’s endothelial lining (lamin on heart valves)
  • Neutrophil mediated tissue destruction of valves
160
Q

Rheumatic Fever

A

same disease, more widespread manifestations (cross-reactions in skin and CNS as well)

161
Q

Incidence of rheumatic heart disease declined in the west but not developing countries. Why?

A

Antibiotics given quickly for strep treatment in west, but in developing countries strep infections allowed to last longer and occur more frequently

162
Q

Hashimoto’s thyroiditis

A

hypothyroidism

Ab to thyroid antigens (thyroglobulin, and thyroid peroxidase)

Inflammatory and destructive (NOT stimulatory)

Lots of overlap with Graves disease

163
Q

Linear vs. Lumpy-bumpy immunofluorescent patterns

A

Linear:

  • Type II immunopathology
  • indicate ab is binding to a specific structure (e.g. basement membrane)
  • Fluorescent antibody will show a clear structure that it is coating

Lumpy-bumpy:

  • type III immunopathology.
  • indicate immune complex pathologies, whereby antigen and antibody clump together and precipitate.
  • Do not line any particular structures, they just bind together in large groups
164
Q

Direct test for Goodpastures

A

use kidney tissue

1) Take patient kidney (will already have antibody on its glomerular BM)
2) Add fluorescently labeled goat antisera to human IgG.
3) Goodpasture’s (ab present on GBM)→ binding occurs along glomerulus

165
Q

Indirect test for Goodpastures

A

use serum + normal human tissue

1) Normal kidney (no Ab in it)
2) Add patient’s serum with Anti-GBM antibodies
3) Labeled anti-IgG reveals that Abs in patient’s serum bound GBM sample

Ab directed against BM, not trapped in clumps → staining is sharp and linear, not “lumpy-bumpy” (as in Type III immune complex conditions)

166
Q

Hybrid (foreign + self) antigen formation

5 steps

A

1) B cell binds self + foreign epitope - couples foreign with self protein
2) It then ingests and digests
3) Foreign epitope is presented to Th2 on Class II MHC AND self protein is presented to Th2 on Class II MHC
4) TfH → cytokines, engages coreceptors
5) B cell is activated, secretes antibody to self

167
Q

Forbidden Clone

A

clone of autoreactive T cells that escape normal thymic clonal deletion mechanisms → T cell matures so that encounters with antigen immunize it

168
Q

Cross-Reaction between foreign antigen + self antigen

A

ab produced against some infection (foreign) kills off disease, but this ab is also kind of like a self antigen, so it starts reacting with self

EX) Rheumatic Heart Disease

169
Q

Innocent Bystander

A

Damage to normal tissue infected by antigen

EX) TB - infectious bacteria localized in lungs → lung tissue damaged as body tries to rid itself of infection.

170
Q

Release of a sequestered antigen

A
  • Special case in which antigen cannot get out into general system → NOT immunogenic
  • Antigens somehow allowed to get out → immune response initiated in region where antigen is sequestered → damage to that tissue → more release of antigens → further immune response

EX) Men who get mumps becoming sterile

171
Q

Failure of regulatory mechanisms

A

Proper balance between Th1, Th17, Tfh, Th2, and Treg activity assures appropriate immune response

Disrupt this balance → immune response exaggerated, self/nonself discrimination breaks down? – still under study

172
Q

AIRE gene

A

causes thymic stromal genes to express a wide variety of “out-of-place” peptides so that reactive T cells may be removed from the repertoire.

Made in thymus to help negatively select anti-self T-cells

Aire-deficient people develop several autoimmune diseases

Blood and Lymph (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions