Acute Myeloid Leukemia Quiz

Bone Marrow Cell Morphology

• The presentation covers the morphology of bone marrow cells, focusing on red blood cells (RBCs) and identifying abnormalities.
• Blood smears analyze RBC morphology, including features like agglutination, hypochromia, schistocytes, spherocytes, and teardrop cells.
• Bone marrow smears examine BM cellularity (bone marrow proliferation) and specific blood cell types (AA, APL, CML, CLL, MM, MA).

Staining Techniques

• Wright's and Giemsa stains are used to visualize bone marrow cells.
• Eosin (acidic dye) stains cells red.
• Azure dyes (basic dyes) stain cell nuclei blue.

Red Blood Cell (RBC) Morphology

• Normal red blood cells appear as circular, biconcave discs.
• Images presented depict healthy RBCs in a blood smear under a microscope and their microscopic healthy form.
• Irregular RBC distributions in blood films can indicate conditions like cold agglutination and rouleaux formation.
• Hypochromia (pale color) in RBCs signifies iron deficiency.
• Dimorphism involves variations in appearance, linked to iron deficiency anemia before and after treatment.
• Macrocytes are larger RBCs often associated with B12/folate deficiencies, liver disease, or MDS.

Red Blood Cell Shape Abnormalities

• Schistocytes are fragmented RBCs resulting from mechanical damage within circulation, commonly associated with MAHA.
• Spherocytes are small, spherical RBCs, often associated with hereditary spherocytosis or autoimmune hemolytic anemia (AIHA).
• Elliptocytes (ovalocytes) are oval-shaped RBCs, often linked to hereditary elliptocytosis or iron deficiency.
• Acanthocytes exhibit irregular, thorny projections, often associated with liver diseases, vitamin E deficiency, or abetalipoproteinemia.
• Echinocytes are characterized by evenly spaced projections, linked to liver/kidney diseases, or pyruvate kinase deficiency.
• Bite cells are characterized by scooped-out areas on their surface; linked to G6PD deficiency.
• Blister cells are bubble-shaped cells; often linked to oxidative haemolysis and G6PD deficiency.
• Target cells have a central area with outward projections, and are linked to liver diseases, hemoglobinopathies, or thalassemia.
• Stomatocytes show a slit-like central area, associated with liver disease or hereditary stomatocytosis.

Inclusions in RBCs

• Basophilic stippling, which shows abnormally aggregated ribosomal inclusions linked to lead poisoning, hemoglobinopathies, or thalassemia.
• Howell-Jolly bodies, nuclear remnants, linked to hyposplenism, post-splenectomy, haemolytic anemia, or megaloblastic anemia.
• Heinz bodies, denatured hemoglobin precipitates, linked to G6PD deficiency.
• Intracellular haemoglobin crystals, linked to hemoglobinopathies (HbC and HbSC).

Sickle Cells and Teardrop Cells

• Sickle cells are associated with sickle cell anemia.
• Teardrop cells are observed in myelofibrosis.

Bone Marrow Preparation and Examination

• Bone marrow aspiration is a technique to collect bone marrow for analysis.
• Bone marrow biopsy is another technique to examine bone marrow to diagnose different diseases.
• Different materials like diluted bone marrow, dry tap in which the bone marrow is directly on the slide, and coagulation need to be properly prepared.
• Bone marrow evaluation includes assessing cellularity (degree of marrow proliferation), looking at myeloid to erythroid ratio (M:E), and examining cell morphology and types.

Blood Disorders Diagnosed Using Bone Marrow Examinations

• Hematologic diseases, including nutritional anemia (IDA, MA), aplastic anemia, leukemia (AML, CML, ALL, CLL, HCL), myelodysplastic syndrome (MDS), multiple myeloma (MM), myeloproliferative neoplasms (CML, PV, ET, PMF), lymphoma, hemolytic anemia (HS, SCA), thalassemia, and immune thrombocytopenia (ITP).
• Non-hematologic disorders requiring bone marrow examination include Gaucher disease, Niemann-Pick disease, infectious diseases (malaria, kala azar), and metastatic carcinoma.

Specific Types of Leukemia

• Acute leukemia (AL) is characterized by a high percentage of blasts.
• Classification of AML involves a further breakdown in subtypes (M1-M7), with criteria for distinguishing these subtypes involving certain features (e.g. presence of Auer rods, specific cell counts).
• Chronic myeloid leukemia (CML) involves a Philadelphia chromosome and BCR::ABL1 fusion.
• Chronic myelomonocytic leukemia (CMML) features monocytosis.

Lymphocytes and Monocytes

• Reactive lymphocytosis is linked to viral infections.
• Relative lymphocytosis and Absolute lymphocytosis are specific abnormal percentages.
• Lymphocyte morphology includes size (7–18µm), shape (round to oval, indented), cytoplasm (scant to moderate, may have vacuoles), and presence of nucleoli.
• Monocyte morphology includes size (12–20µm), possible shapes (various), presence of cytoplasm lobes in the nucleus & vacuoles.

Bone Marrow Aspiration and Biopsy

• Proper technique for bone marrow aspiration and biopsy is necessary to avoid complications such as dry tap and coagulation.
• Various procedures are also included with different types of leukemia.

Dysgranulopoiesis or Dysmegakaryopoiesis

• Indicates specific abnormalities in granulocyte or megakaryocyte development, often seen in certain types of leukemia or MDS.
• Features to look for include unusual sizes and shape of cells, multinucleated granulocytes, reduced or unusual granules.

Plasma Cells and Myeloma (PCM)

• Peripheral blood plasma cells are typically very low in number.
• Clonal plasma cells have unique characteristics and are measured with CRAB and SLIM criteria.

Macrophagocyte

• Presence of macrophages and phagocytosis is linked to chronic disease states.

Other Information

• Detailed tables providing specific criteria (e.g., percentages of cells, specific chromosomal markers) for diagnosing various hematological cancers and disorders are included.
• Images and diagrams support the descriptions of cells and abnormalities.
• Additional abnormalities and their causes are further analyzed.

Test your knowledge on acute myeloid leukemia (AML) and related hematological diseases. This quiz covers key aspects such as diagnostics, mutations, and associated conditions like Gaucher and Niemann-Pick diseases. Dive into the intricacies of bone marrow morphology and its implications for various syndromes.