Glossary of Purely objective
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- Common bone marrow aspirate sites:
- Adults/kids: iliac crest, sternum, vertebral spines.
- What type of needle used for:
- Aspirate: 16 guage
Biopsy: 8 or 11 guage, with Jamshidi-stylet, cutting edge, and tapered end.
- How much specimen is drawn in an aspirate?
- 1 ml
- How do you determine which area of aspirate smear to use for evaluating cellularity/morpholog and counting the diff?
- Near Particle; no fibrin, intact stells, good staining, not in the sinusoidal blood area.
- What steps are taken to count the diff?
- 1. Estimate Megakaryocyte number
2. Look for abnormal cells
3. Count 200-1000 cells and calculate percentage of each.
- How do you calculate the M:E ratio?
- Quantify Myeloid;
- What are Myeloid cells?
What are Erythroid cells?
- What are 4 reasons for doing a bone marrow exam?
- 1. Investigate nonresponsive anemia or pancytopenia
2. If blasts in peripheral blood
3. Investigate abnormal lymphs
4. To evaluate leukemic therapy and how well it worked
- What are the referance ranges for bone marrow cells?
- myeloid:erythroid Ratio = 3:1
-myeloid: mostly metas/myelos
-erythr: should see rubricytes
- Why would an M:E ratio be increased?
- Due to Myeloid hyperplasia or erythroid hypoplasia
- Why would an M:E ratio be decreased?
- Due to myeloid hypoplasia or erythroid hyperplasia.
- What is the purpose of
-Prussian Blue stain?
- Prussian: to evaluate bone marrow iron stores.
Silver: to evaluate reticulin.
- What is the definition of a stem cell?
- A stem cell has the capacity for continuous self-replication.
- What factors affect the production and differentiation of cells?
- CSFs - hematopoeitic growth factors.
- What are 2 types of CSFs?
- 1. Pluripotent - affect the stem cell which is completely undifferentiated
2. Lineage-restricted - affects cells that have begun to differentiate.
- What are the pluripotent growth factors?
- Interleukin 1,3,6
- What are the lineage-restricted growth factors?
- What are the production sites of blood cells?
- Medullary: bone marrow.
Extramedullary: liver, spleen, only during fetal development and BM disease.
- What does MYELODYSPLASTIC SYNDROME mean?
- A Pre-leukemia proliferation of an abnormal stem cell.
- What is characteristic feature of ALL MDS cases?
- Dyspoeisis and Progressive Cytopenia of at least one cell type.
- What are some erythroid morphologic alterations seen in MDS?
- -Megaloblastoid cells
- what are some general presenting features of myelodysplastic syndrome?
-Neutropenia - infection prone
-Thrombocytopenia - bleeding tendencies
- What type of progression does MDS have?
- Is the bone marrow infiltrated in MDS?
- not totally; it has increased cellularity though.
- How do you know MDS is not vitamin b12/folate deficiency if seeing megaloblastoid cells?
- Doesn't respond to that therapy.
- What types of inclusions are common to see in MDS?
-Ringed sideroblasts *prussian*
- What is nuclear bridging
- When daughter cells of dividing progenitors are connected by their nuclei instead of cytoplasm.
- What hemoglobin abnormalities can pop up in MDS?
- -Acquired HbH
- What are 4 signs of dysgranulopoeisis seen in MDS?
- 1. Pelgeroid PMNs
2. Mixed eos/basos granules
4. Monocytosis unexplained
- What is the name for the odd granulocytes in MDS?
- Stoddmeister - looks like a monocyte b/c it is hypogranular but it's a pmn!
- What are 4 metabolic abnormalities in grans in MDS?
- 1. Decreased myeloperoxidase
2. Decreased LAP
3. Defective chemotaxis
4. Decr. bacteriocidal activity
- What are 4 thrombocytic abnormalities in MDS?
- 1. Giant platelets
2. Abnormal granulation
3. Circulating micromegakaryos
- Because of MDS's abnormal thrombocytes, what results?
- Abnormal bleeding disorders.
- What are 4 chromosomal abnormalities associated with MDS?
- 1. 5q- (50-80%)
2. 5q-, +8, 20q- (advanced stg)
3. t(5:12) (assoc. w/ CMML)
4. -7 (assoc. w/ transit to AL)
- Based on number of blasts, what distinguishes MDS for FAB? WHO?
- FAB: Less than/equal to 30% of all nucleated cells are blasts.
WHO: less than/equal to 20%
- What's the definition of "Myeloproliferative Disorder"?
- -A clonal neoplastic disease of pluripotent hematopoeitic stem cells.
- How does a Myeloproliferative disease differ from a reactive leukemoid rxtn?
- Myeloprolif is monoclonal;
Leukemoid is polyclonal, in response to infectn/inflamm.
- Which myeloprolif disorder especially causes splenomegaly?
- IMF - Agnogenic myeloid metaplasia.
- Which myeloprolif disorder is associated with Chromosomal abnormality? What is it?
- CML - Philadelphia chromosome, t(9,22)
- Which myeloprolif disorders do you see megakaryocytes in?
- All of them.
- What is Polycythemia by itself?
- Increased RBCs only
- What is Polycythemia vera?
- PANmyelosis - increased RBCs, WBC, and Platelet count!!
- What is a relative polycythemia?
- A RELATIVE RBC increase due to decreased plasma volume
- What 2 things can cause relative polycythemia?
What confirms Relative polycythemia?
- 1. Dehydration
2. Stress erythrocytosis.
Blood volume studies.
- What are the 2 forms of Absolute polycythemia?
- 1. secondary polycythemia
2. Polycythemia vera
- What is 2' polycythm?
- An increase in marrow erythroid precursors due to increased erythropoeitin.
- What causes the increase in EPO in 2' polycyth?
- DECREASED O2 SUPPLY
- What 2 mechanisms decrease the o2 supply to stim EPO productn?
- 1. Hypoxia -> 5 causes.
2. Disease state -> 5 causes
- What 5 things cause hypoxia?
- 1. Cardiopulmonary dysfunction
2. Decreased blood volume
3. high altitude
4. Decreased Hb
5. Decreased O2 affinity
- What 5 disease states cause hypoxia?
- 1. Renal ischemia
2. Renal artery stenosis
3. Renal casts
5. Tumors on kidney/liver - produce EPO active substances.
- What are major diffncs btwn 2' and 1' Polycythemia?
- -Primary doesn't have increased EPO levels, 2' does.
-Primary has normal O2 saturatn, it is decreased in 2'.
-All cells are increased in 1', only RBCs in 2'.
- What are similarities btwn 1' and 2' polycythemia?
- -Both have increased RBC mass
- What additional findings show up in polycyth vera and not 2'?
- -Increased LAP
- What additional lab findings show up in progressed polycythemia vera?
- PB: increases in young cells, dacrocytes, anemia, leukopenia and thrombocytopenia.
BM: increased myelofibrosis, reticulin/collagen fibers.
-Develops into ANLL.
- What 3 major findings diagnosie polycythemia vera?
- 1. Splenomegaly
2. Increased cell mass
3. Normal O2 saturation
- What 4 minor things can diagnose Polycythemia vera (if you have 2, plus 2 major)
- 1. Plt count over 450,000/uL
2. WBC count over 12,000/uL
3. Increased LAP
5. Increased B12
- What causes the symptoms seen in polycythemia vera?
- Sluggish blood - so many platelets, increased viscosity and blood volume.
- How is polycythemia vera treated?
P32 + phlebotomy
Hydroxyurea to suppress myelos.
- What can polycythemia vera turn into?
- 1. Idiopathic myelofibrosis
2. Idiopathic thrombocythemia
- How can you best differentiate between a leukemoid and a chronic myeloprolif disorder?
- 1. Leukemoid has high LAP and limited young cell forms.
2. leukemia has LOW LAP, more immature forms, and unexplained baso/eosinophilia.
- Between an acute and chronic leukemia, which has increased platelets? which has low plts?
- Chronic has normal to increased.
Acute has low platelets.
- What cell structure do Myeloperoxidase, SBB, NCE, and NSE all stain?
- Primary granules - myeloblasts and beyond, except NSE which is monoblasts and beyond.
- If NaF is negative after a positive NSE, what does it tell you?
- It's definitely a monoblastic leukemia.
- What does TdT stain?
- the nuclei of lymphoblasts
- What does PAS stain?
- Glycogen in everything; useful in M6 b/c it stains the cytoplasms.
- What are the key morphological characteristics of ALL?
- No granules; No auer rods; Small sized cells; denser chromatin; small, fewer nucleoli.
- What symptoms can be seen in all of the acute leukemias?
- -Bleeding b/c of decr. platelets
-Anemia b/c of decr. RBCs
-Increased infections b/c of decreased PMNs.
- What symptoms are characteristic of monocytic leukemia?
- Hypertrophic gums and mucosal areas.
- What symptom is characteristic of Tcell leukemias?
- Mediastinal mass (thymic involvement)
- What cytochemical stain is positive in Megakaryocytic leukemia?
- Platelets = peroxidase positive.
- What markers identify megakaryocytic leukemia?
- CD41 and CD61
- What are the Chronic lymphoproliferative disorders?
- 1. B-CLL (and prolymph transf)
3. Prolymphoctic leukemia
4. WDLL-Leukemic phase
6. Hairy cell
7. Hodgkin's Disease
8. Plasma Cell Myeloma (mltpl)
- Describe the PB and BM findings for B-CLL:
- PB: monomorphic lymphocytosis with smudge cells
BM: slow infiltration of the same.
- Describe the PB and BM findings for T-CLL
- PB:lymphocytosis with large granular lymphs
BM: rapid infiltration of the same, as well as dissemination to the skin and CNS.
- Describe the PB and BM findings for Prolymphocytic leukemia
- PB and BM are filled with prolymphocytes.
- Describe the PB and BM findings for WDLL-Leukemic phase:
- It looks like CLL.
- Describe the PB and BM findings for Sezary syndrome:
- Convulted nuclei with pearl necklace vacuoles
- Describe the PB and BM findings for Hairy cell leukemia
- Big lymphocytes with hairy cytoplasm.
- Describe the PB and BM findings for Hodgkin's Disease
- PB = NORMAL!
BM = Reed-Sternberg cells.
- Describe the PB and BM findings for Plasma Cell (multiple) myeloma:
- PB: rouleaux
BM: nests of plasma cells
- Describe the PB and BM findings for Waldenstrom's macroglobulinemia:
- PB: rouleaux
BM: lymphocytosis, plasmacytoid and plasma cells.
- What clinical symptoms and lab test results are seen in CLL-B?
- Hypogammaglobulinemia, AIHA, autoimmune thrombocytopenia, and it is a long-term disease.
- What clinical symptoms and lab test results are seen in CLL-T?
- HYPERgammaglobulinemia, it is a short term disease.
- What clinical symptoms and lab test results are seen in Prolymphocytic leukemia?
- Marked splenomegally - very rapid progression after diagnosis, short-term.
- What clinical symptoms and lab test results are seen in Sezary?
- SKIN PROBLEMS
- What clinical symptoms and lab test results are seen in Hairy cell leukemia?
- Splenomegaly, Reticulin in the Bone Marrow
- What clinical symptoms and lab test results are seen in Plasma cell myeloma?
- IgG or IgA increase - bone pain and breaks, Bence Jones proteiurea, clonal excess of kappa or lambda.
- What tests are done for Plasma cell myeloma?
- -Serum protein electrophoresis
- What clinical symptoms and lab test results are seen in Waldenstrom's?
- IgM; tested in same way as plasma cell myeloma, look for clonal excess of kappa/lambda light chains.
- Which has it; Waldenstrom or MM?
-Lytic bone lesions
-Length of survival
- Organ: Waldenstrom's
Better survival: Waldenstrom's
- What is the TRAP stain?
- Tartrate Resistant Acid Phosphatase
- How does the TRAP stainwork?
- Only hairy cells don't lose their ability to stain for acid phosphatase in presence of tartrate - they resist it!
- What is the definition of LYMPHOMA?
- Malignancy of the lymph nodes
- How do you differentiate between Hodgkin's and Non-hodgkin's lymphoma?
- Hodgkin's: lymph node involvement follows lymphatics. Abnormal cells are Reed-sternberg, can find in BM.
NHL: lymphnode involvmnt has no set pattern; abnormal lymphs can be found in BM and PB.
- In what disorders does extramedullary hematopoeisis occur?
- Chronic myeloproliferatives.
- Which FAB AMLs are "AML not otherwise categorized"?
- M0, M1, M5, M7
- Which FAB AMLs are "AML w/ recurrent cytogenetic abnormalities?"
- M2, M3, M4eos
- Which FAB AMLs are "AML with Multilineage Dysplasia"?
- M4, M6
- Which FAB AMLs are "AML Therapy related"?
- Any secondary leukemia.
- What chromosomal abnormality is associated with:
M2? M3? M3eos? M4?
- M2: t(8;21)
M5a: t(9:11) M5b: t(8,16)
- What age popultation is assoc w/
- CLL: some kids, more older folks
CML: mid-aged to elderly
AML: older folks
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