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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