Wright Heme lecture Flashcards
Name the 4 main types of leukemia.
Acute Myeloid leukemia
Chronic Myeloid Leukemia
Acute Lymphoblastic Leukemia
Chronic Lymphocytic Leukemia
What are the signs and symptoms of leukemia?
Leukocytosis Pancytopenia Hypogammaglobulinemia Bone pain LAD spelnomegaly
What test should be done in all patients suspected to have leukemia
Bone marrow biopsy
What is the most common leukemia in adults?
AML
What pathologic finding is diagnostic of AML
Auer rods on biopsy
Circulating blasts >20%
First line treatment for AML
Chemo then Stem cell transplant
Prognosis for AML
not great, only 1/3 of patients are cured
What is the most common childhood malignancy?
Acute lymphoblastic leukemia
Peak incidence of ALL?
2-5 y.o.
Increased incidence of ALL with what genetic disorder?
Down Syndrome
Most common cell linages effected by ALL?
B cell lineage( 85%), then T (15%), then NK (1%)
Treatment for ALL?
Chemo
Prognosis for ALL?
Curable, with 85% 5 year survival, but high dose chemo in kids increases risk of long term complications
Good prognostic indicators in ALL?
Hyperdiploid (>50 chromosomes per cell)
2-10 y.o.
CD10 +
low WBC count
Poor prognostic indicators in ALL?
Hypodiploid
<2 or >10 y.o.
Male gender
High WBC count (>100k)
What is CAR-T therapy?
Therapy for ALL that removes T cells and trains them to attack neoplastic B cells. It is so effective that the B cells are killed so rapidly it causes cytokine storm.
What leukemia is a Philadelphia chromosome seen in?
Chronic Myeloid Leukemia
Philadelphia chromosome results from fusion of 2 genes. What are they?
ABL on chromosome 9 and BCR on chromosome 22
After what age are most CML diagnoses made?
After age 50
What are the treatment options for CML?
Stem cell transplant - risky but curative
Oral chemotherapy - low risk, can manage disease but not cure it
Chronic Lymphocytic leukemia is most often diagnosed after what age?
after age 70
CLL more common in men or women?
Men
What pathology finding on cytology is suggestive of CLL?
Gingersnap appearance of cells
What are the 2 main categories of lymphoma and how do you distinguish between them?
Hodgkin Lymphoma - presence of reed sternberg cells on biopsy
Non-Hodgkin lymphoma - absence of reed sternberg cells on biopsy.
Indolent lymphomas
Fuck My Life, Sike
follicular
marginal zone, lymphoplasmocytic,
small lymphocytic
Aggressive lymphomas
Big Deal, Many Problems Burrkitt Diffuse Large B cell Mantle Cell Peripheral T cell
What lymphoma has pain in lymph nodes with alcohol comsumption?
Hodgkin Lymphoma
What lymphoma is amenable to surgical excision?
Hodgkin Lymphoma
What is the most common lymphoma worldwide?
Diffuse Large B cell lymphoma
Common presenting symptom in Diffuse Large B cell lymphoma?
Rapidly enlarging symptomatic mass
Prognosis of Diffuse Large B cell lymphoma?
Not great, most patients present with advanced disease.
Curable in half of cases
Second most common non hodgkin lymphoma
Follicular Lymphoma
Painless peripheral adenopathy is a common symptom in what diagnosis?
Follicular lymphoma
Follicular lymphoma has a good prognosis, but it can progress to what other types of lymphoma?
Diffuse Large B cell
or
Burkitt lymphoma
What is a common location for a mass in Burkitt lymphoma?
Abdominal or retroperitoneal
What medication should be prescribed to patients with Burkitt lymphoma before treatment and why?
Alopurinol
Burkitt lymphoma can cause tumor lysis syndrome, where large amounts of potassium, phosphate, and nucleic acids are released in circulation
Nuclear staining for cyclin D1 is positive. What is the most likely diagnosis
Mantle Cell lymphoma
Where does mantle cell lymphoma occur?
Any region of the GI tract
A patient with chronic gastritis from H. pylori is most susceptible to what lymphoma?
MALT (mucosa associated lymphoid tissue) lymphoma
MALT lymphoma is what type of lymphoma?
Marginal zone lymphoma
What lymphoma is associated with an IgM monoclonal gammopathy, Raynaud phenomenon, and smudge cells?
Lymphoplasmacytic lymphoma
Why is non-hodgkin lymphoma not amenable to surgical excision?
It involves discontinuous groups of lymph nodes
What organ is often involved with non-hodgkin lymphoma?
The spleen
Multiple myeloma is a cancer of what type of cells?
Plasma cells (fully matured B cells that produce antibodies)
You should consider multiple myeloma in a patient with what lab findings?
Anemia and hypercalcemia
What labs should you order in a multiple myeloma work up? What findings indicate multiple myeloma?
SPEP - M spike
UPEP - Bence Jones proteins
What findings on x ray are concerning for multiple myeloma?
Lytic lesions
Pathologic fracture
What are the symptoms of multiple myeloma?
CRAB Hypercalcemia Renal Failure Anemia Bone (pain, lytic lesions, pathologic fx)
Prognosis for multiple myeloma?
Bad. Median survival of 6 months
Non-curable but stem cell transplant can prolong life
Signs and symptoms of immune thombocytopenic purpura
signs of capillary rupture
Define chronic, persistent, and newly diagnosed ITP
Chronic >12 months
Persistent 3-12 months
newly diagnosed <3 months
Deficiency in what enzyme can cause TTP?
ADAMTS13 protease
What happens to vWF in TTP?
vWF accumulates into long chains on endothelial surfaces capable of binding large amounts of platelets.
Triad of symptoms for TTP?
Pentad?
Triad: Thrombocytopenia, neurologic changes, microangipathic anemia
Pentad: the above triad plus fever and renal failure
Hemolytic uremic syndrome is caused by what type of infections?
GI infections
HUS should be treated with antibiotics? T/F
False - it will cause release of more toxins worsening symptoms
What does vWF do?
Carrier for factor VIII
What is the most common inherited bleeding disorder?
Von Willebrand disease
In Von Willebrand disease, what happens to PTT and PT?
PTT increases
PT normal
Hemophilia A is caused by a deficiency of factor ___
VIII
Hemophilia B is caused by a deficiency of factor ___
IX
A hypercoagulable state increases risk for _____
thromboembolism
