Leukemia and Hematopoiesis Overview
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Questions and Answers

What specific chromosome aberration is commonly found in 95% of chronic myeloid leukemia cases?

  • Turner syndrome chromosome
  • Down syndrome chromosome
  • Williams syndrome chromosome
  • Philadelphia chromosome (correct)

    • In distinguishing between ALL blasts and small-cell non-Hodgkin lymphoma, what analysis is crucial?

  • DNA sequencing
  • Protein electrophoresis
  • Cytogenetic analysis
  • Cell surface marker analysis (correct)

    • What is one characteristic morphological finding in the peripheral blood smear of someone with chronic myeloid leukemia?

  • Vacuolated erythrocytes
  • Decreased eosinophils
  • Increased plasma cells
  • Increased immature and mature blast cells (correct)

    • Which of the following indicates a left shift in chronic myeloid leukemia?

    <p>Increased myeloblasts (A)</p> Signup and view all the answers

    What is typically observed in a bone marrow smear of a patient with chronic lymphocytic leukemia?

    <p>Uniform population of lymphocytes (C)</p> Signup and view all the answers

    How is the myeloid:erythroid ratio typically characterized in chronic myeloid leukemia?

    <p>10:1 (B)</p> Signup and view all the answers

    What may occasionally manifest as rouleaux formation of erythrocytes in cases of chronic lymphocytic leukemia?

    <p>Monoclonal gammopathy (C)</p> Signup and view all the answers

    Which morphological feature is associated with the blasts in B-cell acute lymphoblastic leukemia (ALL)?

    <p>Dense, irregular nuclear structure (D)</p> Signup and view all the answers

    What characterizes smudge cells in the context of chronic lymphocytic leukemia (CLL)?

    <p>Remnants of cells lacking identifiable nuclear structures. (A)</p> Signup and view all the answers

    Which of the following indicates poor prognosis in patients with chronic lymphocytic leukemia?

    <p>Presence of a large number of smudge cells. (C)</p> Signup and view all the answers

    In acute myeloid leukemia (AML), what distinguishes M1 cells from M0 cells?

    <p>Presence of granules and positive peroxidase. (A)</p> Signup and view all the answers

    Which classification of AML involves a mixture of myeloblasts and promonocytes?

    <p>M4: myelomonocyte. (C)</p> Signup and view all the answers

    What type of cells are characterized by a positive peroxidase reaction and Auer rods in AML?

    <p>M2: differentiated myeloblasts. (B)</p> Signup and view all the answers

    Which statement about basket cells is true?

    <p>They are remnants of cells seen primarily in CLL. (C)</p> Signup and view all the answers

    What does the presence of fibrous tissue in bone marrow indicate?

    <p>Myelofibrosis. (B)</p> Signup and view all the answers

    Which marker is typically used to confirm the diagnosis in suspected cases of AML?

    <p>Immunological marker studies. (C)</p> Signup and view all the answers

    In the FAB classification, what morphological characteristic distinguishes acute myeloblastic leukemia (AML) cells from lymphocytes?

    <p>AML cells display prominently defined nucleoli and a larger size. (C)</p> Signup and view all the answers

    What is a defining feature of Auer bodies in the context of acute myeloblastic leukemia?

    <p>They are primary granules shaped like needles. (B)</p> Signup and view all the answers

    Which stage of acute myeloblastic leukemia first shows positive peroxidase reaction?

    <p>M1 (C)</p> Signup and view all the answers

    What characteristic differentiates acute lymphoblastic leukemia (ALL) from acute myeloblastic leukemia (AML)?

    <p>ALL cells have a denser chromatin structure and are usually smaller. (C)</p> Signup and view all the answers

    In promyelocytic leukemia (M3), what unique feature is often observed in the presence of Auer bodies?

    <p>Multiple Auer bodies are frequently arranged like firewood. (D)</p> Signup and view all the answers

    What approach should be taken to differentiate between acute lymphoblastic leukemia and chronic lymphocytic leukemia?

    <p>Cell surface marker analysis is necessary. (A)</p> Signup and view all the answers

    Which of these cytochemical tests is commonly initiated for diagnosing acute leukemias?

    <p>Peroxidase and esterase tests (C)</p> Signup and view all the answers

    What is the typical appearance of cells in the early stages of myeloid leukemia (M0–M1)?

    <p>Undifferentiated blasts with dense fine chromatin and narrow basophilic cytoplasm. (A)</p> Signup and view all the answers

    Which type of cells are classified as agranulocytes?

    <p>Lymphocytes and Monocytes (C)</p> Signup and view all the answers

    What is indicated by the blue cytoplasm in hematopoietic blast cells when stained with H&E?

    <p>The cell is basophilic (B)</p> Signup and view all the answers

    What type of leukemia is classified as peroxidase-negative?

    <p>Lymphoblastic leukemia (A)</p> Signup and view all the answers

    Which of the following accurately describes the phenotypic classification of acute leukemias?

    <p>Combined approach involving immunophenotyping (B)</p> Signup and view all the answers

    Which cells are primarily involved in acute myeloid leukemia (AML)?

    <p>Myeloblasts, promyeloblasts, and monoblasts (B)</p> Signup and view all the answers

    What is the primary purpose of performing cytochemical testing in acute leukemia diagnosis?

    <p>To refine the initial diagnosis based on morphology (B)</p> Signup and view all the answers

    In what way does the morphological analysis contribute to the classification of leukemic cells?

    <p>It groups leukemic cells based on specific cell types (B)</p> Signup and view all the answers

    Which type of staining is required to visually differentiate B- and T-cells?

    <p>Immunohistochemical staining (D)</p> Signup and view all the answers

    Flashcards

    Agranulocytes

    White blood cells without granules, including monocytes and lymphocytes.

    Granulocytes

    White blood cells with granules, including basophils, neutrophils, and eosinophils.

    B-Cell

    A type of lymphocyte that produces antibodies; it matures into plasma cells.

    T-Cell

    A type of lymphocyte involved in cell-mediated immunity; recognizes and responds to pathogens.

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    Cytochemical Testing

    Tests that identify cellular characteristics for leukemia diagnosis, such as peroxidase testing.

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    Acute Myeloid Leukemia (AML)

    A fast-growing cancer of the blood and bone marrow characterized by myeloblasts.

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    Immunophenotyping

    Method to classify cells based on specific markers on their surface, for accurate leukemia diagnosis.

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    Blast Cells

    Immature cells in the bone marrow that develop into mature blood cells, identifiable via histology.

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    FAB classification

    Morphological subclassification of leukemia types proposed by French-American-British collaboration.

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    Acute Myeloblastic Leukemia

    Leukemia with myeloblasts showing coarse chromatin and prominent nucleoli, with large cell sizes compared to lymphocytes.

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    Auer bodies

    Needle-shaped primary granules found in myeloblasts, associated with acute myeloblastic leukemia.

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    Peroxidase-positive blasts

    Blasts that show a positive reaction to peroxidase staining, characteristic of myeloid lineage.

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    Acute Lymphoblastic Leukemia (ALL)

    Leukemia where cells do not resemble myeloblasts; typically smaller nuclei and denser chromatin.

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    Chronic Lymphocytic Leukemia (CLL) confusion

    Morphological analysis of ALL can be confused with CLL but can be clarified with cell surface marker analysis.

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    Esterase tests

    Diagnostic tests used alongside peroxidase tests to analyze fresh blood smears in hematology.

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    Promyelocytic leukemia (M3)

    Type of acute myeloid leukemia characterized by multiple Auer bodies, often stacked.

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    Smudge Cells

    Remnants of non-identifiable cells lacking nuclear structure, seen in CLL.

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    Basket Cells

    Another name for smudge cells; non-functional remnants in blood smears.

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    Chronic Lymphocytic Leukemia (CLL)

    A type of cancer affecting lymphocytes, marked by the presence of smudge cells.

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    Prognosis Indicator

    Higher smudge cell percentages indicate a poorer prognosis in CLL.

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    Peroxidase Positive

    Characteristic of myeloid cells, indicating the presence of granules in cell types like AML.

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    Monoclonal Gammopathy

    Abnormal protein production in some CLL cases, manifesting as rouleaux formation.

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    Bone Marrow Aspiration

    A procedure to collect bone marrow for diagnosing various blood disorders, including leukemia.

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    Blasts

    Immature cells that proliferate in certain leukemias, such as ALL.

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    Philadelphia Chromosome

    A specific chromosome abnormality found in 95% of Chronic Myeloid Leukemia (CML) cases.

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    Blast Crisis in CML

    A transformation in CML where the disease behaves like acute leukemia with increased blasts.

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    Left Shift

    Refers to the presence of immature cells in the blood as seen in CML, including myeloblasts.

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    Rouleaux Formation

    The stacking of red blood cells which can occur in some cases of CLL due to increased proteins.

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    Myeloid:Erythroid Ratio

    A measurement in the bone marrow indicating the number of myeloid cells compared to erythroid cells, typically >10:1 in CML.

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    Study Notes

    Leukemia Overview

    • Leukemia is a cancer of the blood and bone marrow.
    • It involves the abnormal production of white blood cells, often called blasts.
    • Various types exist, differing in the cell type affected.

    Hematopoiesis

    • Hematopoiesis is the process of blood cell production in the bone marrow.
    • It involves a series of progenitor and mature cell stages.
    • Different lineages of blood cells arise from distinct progenitor cells.
    • Granulocytes, including neutrophils, eosinophils, and basophils, are produced via granulopoiesis.
    • Monocytes and macrophages are part of the monocytopoiesis pathway.
    • Lymphocytes are produced through lymphopoiesis, which further differentiates into B and T cells.
    • Erythrocytes are produced during erythropoiesis.

    Acute Leukemia (AML and ALL)

    • Acute leukemia is characterized by rapidly dividing immature blood cells (blasts).
    • Acute Myeloid Leukemia (AML): Blast cells of the myeloid lineage dominate.
      • Cell morphology varies depending on subtype.
      • Cytochemical tests (e.g., peroxidase) are used for classification.
      • Immunological testing (immunophenotyping) refines the diagnosis.
      • Auer Rods, specific to some subtypes, are a distinctive feature.
    • Acute Lymphoblastic Leukemia (ALL): Blast cells of the lymphoid lineage are predominant.
      • Cells do not typically resemble other lineages.
      • Cytochemical testing often doesn't match myeloid patterns.
      • Cell surface markers and analysis are crucial for definitive diagnosis.

    Chronic Leukemia (CML and CLL)

    • Chronic leukemia involves relatively mature but abnormal blood cells.
    • Chronic Myeloid Leukemia (CML):
      • Characterized by a chromosomal translocation (Philadelphia chromosome).
      • Includes an increase in immature myeloblasts and other myeloid cells.
    • Chronic Lymphocytic Leukemia (CLL):
      • A uniform lymphocyte population dominates.
      • Bone marrow cells often show smudge cells or "basket cells".

    Additional Information

    • Smudge cells, also called basket cells, are remnants of lymphocytes.
    • They are frequently associated with CLL, where an increased percentage often indicates a poor prognosis.
    • Differential diagnosis of leukemia may be challenging. Various analyses, including morphology, cytochemistry, and immunophenotyping can help discern the specific subtype.
    • Bone marrow biopsies and peripheral blood smears are diagnostic tools.

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    Lab Manual Leukemia PDF

    Description

    This quiz explores the essential concepts of leukemia, a type of cancer affecting blood and bone marrow, along with the processes of hematopoiesis. Understand different types of leukemia, their characteristics, and the stages of blood cell production. Test your knowledge on acute leukemia, including AML and ALL, and the nuances of blood cell differentiation.

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