Acute Myeloid Leukemia Quiz

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Questions and Answers

Which of the following statements about acute myeloid leukemia (AML) is true?

MPO staining positive indicates a myeloid lineage. (correct)

Acute promyelocytic leukemia (APL) is classified as AML-M2.

Genetic mutations like BCR-ABL and CEBPA always require over 20% of primary cells for diagnosis.

The presence of Auer rods is not significant in M3 AML.

What percentage of myeloblasts is required in bone marrow (BM) to indicate acute leukemia in the context of AML?

Less than 20%

At least 10%

At least 20% (correct)

Over 30%

Which specific mutation is indicative of acute promyelocytic leukemia (APL) and is associated with a good prognosis?

BCR-ABL+

FLT3+

PML-RARa+ (correct)

CEBPA+

Which feature is characteristic for acute promyelocytic leukemia (APL) subtype M3?

Auer rods or Faggot cells present Signup and view all the answers

What differentiates myelodysplastic syndromes (MDS) from acute myeloid leukemia (AML)?

MDS presents with cytopenia and dysplasia. Signup and view all the answers

What is primarily responsible for the accumulation of glucocerebroside in Gaucher disease?

Deficiency of glucocerebrosidase Signup and view all the answers

Which type of cell is prominently observed in Niemann-Pick disease?

Sea blue histiocytes Signup and view all the answers

What are the two forms of Histoplasma capsulatum observed in tissue?

Mold form and yeast form Signup and view all the answers

Which parasitic disease is associated with the presence of Leishmania in phagocytes?

Kala-azar (leishmaniasis) Signup and view all the answers

What role does the morphology of bone marrow cells play in the diagnosis of diseases?

It remains a cornerstone in the diagnosis of many diseases Signup and view all the answers

What type of bone marrow cellularity is characterized by a ratio of 1:1 and a cell count greater than 200?

Extreme hypercellular Signup and view all the answers

Which condition is associated with a marrow evaluation showing a decreased myeloid to erythroid (M:E) ratio?

Hemolytic anemia Signup and view all the answers

Which type of anemia is characterized by a presence of red cell precursors in the bone marrow but low numbers of mature red blood cells?

Pure red cell aplasia Signup and view all the answers

What type of bone marrow finding is typically associated with acute leukemia?

Extreme hypercellularity Signup and view all the answers

Which of the following diseases can be recognized through a bone marrow examination?

Gaucher disease Signup and view all the answers

What is the main purpose of performing a bone marrow examination?

To diagnose hematological and non-hematological diseases Signup and view all the answers

Which of the following conditions is characterized by hypocellular bone marrow after chemotherapy?

Aplastic anemia Signup and view all the answers

Which infectious disease can be diagnosed through a bone marrow examination?

Malaria Signup and view all the answers

What percentage of monocytes is indicative of persistent peripheral blood monocytosis?

≥ 10% Signup and view all the answers

What is the normal range of megakaryocytes per blood smear?

7-35 Signup and view all the answers

Which of the following is a characteristic of plasma cells in multiple myeloma?

Monoclonal immunoglobulin (M protein) Signup and view all the answers

What condition is characterized by the presence of Mott cells?

Multiple myeloma Signup and view all the answers

What type of cell demonstrates dysmegakaryopoiesis in the megakaryocyte series?

Micromegakaryocytes Signup and view all the answers

What is the term for the phenomenon in which macrophages consume red blood cells?

Hemophagocytosis Signup and view all the answers

What kind of abnormalities are seen in clonal plasma cells during myeloma diagnosis?

Immaturity and pleomorphism Signup and view all the answers

Which of the following diseases is a non-hematologic metabolic disorder associated with macrophagic activity?

Niemann-Pick disease Signup and view all the answers

What characterizes the morphology of hairy cell leukaemia (HCL)?

Hairy projections on small mature lymphoid cells Signup and view all the answers

What is the minimum monoclonal B-cell count required for diagnosing chronic lymphocytic leukaemia (CLL)?

5 x 10^9 /L Signup and view all the answers

Which immunophenotype markers are notably bright in hairy cell leukaemia?

CD20, CD22, and CD11c Signup and view all the answers

In which type of leukaemia are the nuclei described as round or convoluted with condensed chromatin?

Acute lymphoblastic leukaemia (ALL) Signup and view all the answers

Which of the following indicates the presence of acute myeloid leukaemia (AML) M5a?

Monoblasts ≥ 80% Signup and view all the answers

What trait is associated with chronic myelomonocytic leukaemia (CMML)?

Characteristics of both myeloproliferative neoplasm and myelodysplastic syndrome Signup and view all the answers

Which finding is abnormal in AML-M4Eo?

Abnormal eosinophils ≥ 5% Signup and view all the answers

What marker is associated with the immunophenotype of chronic lymphocytic leukaemia (CLL)?

CD5 and CD23 Signup and view all the answers

Which cytogenetic abnormality is associated with AML-M4Eo?

t(16;16)(p13.1;q22) Signup and view all the answers

What shape do schistocytes typically take in microangiopathic haemolytic anaemia?

Irregular fragments Signup and view all the answers

Which type of red blood cell is associated with hereditary spherocytosis?

Spherocytes Signup and view all the answers

What is the primary cause of bite cells in red blood cell morphology?

G6PD deficiency Signup and view all the answers

Which red blood cell morphology is most commonly associated with iron-deficiency anemia?

Hypochromic cells Signup and view all the answers

In which condition are Howell-Jolly bodies commonly found?

Hyposplenism Signup and view all the answers

What is the normal myeloid to erythroid ratio in the bone marrow?

2:1 Signup and view all the answers

What characterizes acanthocytes in red blood cell morphology?

Irregularly spaced projections Signup and view all the answers

What is the primary feature of blister cells in red blood cell morphology?

Bubbles within the cell Signup and view all the answers

Which of the following is a common condition associated with echinocytes?

Pyruvate kinase deficiency Signup and view all the answers

Which red blood cell inclusion is commonly seen in cases of lead poisoning?

Basophilic stippling Signup and view all the answers

Teardrop cells are associated with which condition?

Myelofibrosis Signup and view all the answers

What does the term 'hypochromic cells' refer to in hematology?

Cells with reduced hemoglobin content Signup and view all the answers

Which of the following best describes target cells?

Red blood cells with a central area of pallor Signup and view all the answers

In a bone marrow aspiration, what does a 'dry tap' indicate?

Difficulty extracting due to fibrotic changes Signup and view all the answers

Study Notes

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.

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Description

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.