WBC Disorders and Normal Smears Overview
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Questions and Answers

Which acute myeloid leukemia type is associated with translocation t(8:21)?

  • AML M2 (correct)
  • AML M6
  • AML M3
  • AML M4

What is the associated condition with acute megakaryocytic leukemia (AML M7)?

  • Acute lymphoblastic leukemia
  • Down's syndrome (correct)
  • Leukemia cutis
  • Chronic myeloid leukemia

Which acute myeloid leukemia type is characterized by the presence of maximum Auer rods?

  • AML M1
  • AML M4
  • AML M5
  • AML M3 (correct)

Which cytogenetic abnormality is specifically associated with acute myeloid leukemia type M4?

<p>Inv 16 (B)</p> Signup and view all the answers

What is the best prognostic factor for acute myeloid leukemia type M3?

<p>Use of arsenic trioxide treatment (B)</p> Signup and view all the answers

Which age group is associated with a better prognosis in Acute Lymphoblastic Leukemia (ALL)?

<p>2-9 years (D)</p> Signup and view all the answers

What classification is associated with a worse prognosis in B-ALL?

<p>FAB L2 (C), FAB L3 (D)</p> Signup and view all the answers

Which cytogenetic abnormality is most common in Acute Lymphoblastic Leukemia (ALL)?

<p>Trisomy 4, 7, 10 (C)</p> Signup and view all the answers

Which of the following is NOT associated with a good prognosis in Acute Lymphoblastic Leukemia?

<p>Age over 10 years (B)</p> Signup and view all the answers

What marker is associated with T-ALL?

<p>t(9;22) (C)</p> Signup and view all the answers

Which feature is typically observed in Acute Myeloid Leukemia (AML)?

<p>Gum bleeding/hyperplasia (D)</p> Signup and view all the answers

Which FAB classification indicates Acute Promyelocytic Leukemia?

<p>M3 (A)</p> Signup and view all the answers

Which population is associated with a worse prognosis in ALL?

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

Which cytogenetic abnormality can lead to a diagnosis of leukemia even when the blast count is less than 20%?

<p>Inv 16 (A), t(8:21) (B), t(15:17) (C)</p> Signup and view all the answers

What characteristic distinguishes myeloblasts from lymphoblasts?

<p>Granules in cytoplasm (A), Size of cell (C), Presence of Auer rods (D)</p> Signup and view all the answers

Which of the following markers is associated with myeloblasts?

<p>CD 117 (A)</p> Signup and view all the answers

What is a common clinical feature observed in Acute Lymphoblastic Leukemia (ALL)?

<p>Increased risk of bleeding (B)</p> Signup and view all the answers

Which staining technique is typically positive in lymphoblasts?

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

Which chromatin feature helps differentiate myeloblasts from lymphoblasts?

<p>Coarse chromatin in myeloblasts (D)</p> Signup and view all the answers

In Acute Myeloid Leukemia, what morphological features might be present?

<p>Prominent nucleoli (A), Large cell size (D)</p> Signup and view all the answers

What age group is most commonly affected by Acute Lymphoblastic Leukemia?

<p>Children aged 2-9 years (D)</p> Signup and view all the answers

Flashcards

Good Prognosis in ALL (Acute Lymphoblastic Leukemia)

Features like age 2-9, female sex, white race, L1 FAB type, B-ALL type, and no CNS involvement. are associated with a higher chance of recovery

Bad Prognosis in ALL

Features like age 10, male sex, black race, L2/L3 FAB type, T-ALL type and CNS involvement, suggest a lower chance of recovery from ALL.

AML (Acute Myeloid Leukemia) Age Range

The average age of AML diagnosis is between 15 and 39 years.

AML Feature: Gum Bleeding/Hyperplasia

A symptom where gum bleeding or hyperplasia (overgrowth) can be present in patients with AML.

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Chloroma in AML

A greenish mass of cells that might appear in certain cases of AML. Commonly found around the eyes.

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FAB Classification in Leukemia

A system that categorizes leukemias based on the type and degree of differentiation of the abnormal blood cells.

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Hyperdiploidy in ALL

An abnormal number of chromosomes is a factor associated with ALL and better than Hypodiploidy, which is also a type of chromosomal abnormality (and more serious in ALL).

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Common Cytogenetic Abnormalities in ALL

The most common abnormalities, including Trisomy 4, 7, 10, and t(12;21), along with t(9;22).

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M7 AML

A type of acute myeloid leukemia associated with Down's syndrome, myelofibrosis, and a "dry tap" during bone marrow aspiration.

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Auer Rods

Abnormal rod-shaped structures found in the cytoplasm of myeloblasts, often seen in acute myeloid leukemia.

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Faggot Cell

A descriptive term for a myeloblast with a characteristic criss-cross pattern of Auer rods.

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MPO Positivity in Myeloblasts

A test result confirming the presence of myeloperoxidase, an enzyme found in normal myeloblasts, indicating their immature nature.

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Chronic Myeloid Leukemia (CML)

A type of leukemia characterized by a slow growth of abnormal white blood cells, predominantly involving granulocytes.

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Blast Count < 20%

Diagnosis of leukemia is possible even with blast counts lower than 20% if at least one of the translocations t(15:17), t(8:21), or inv(16) is present.

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Lymphoblast vs. Myeloblast

Lymphoblasts and myeloblasts are different types of immature blood cells, distinguishable by their size, cytoplasm, granules, Auer rods, chromatin, and nucleoli.

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Lymphoblast (Size)

Small cell size in comparison with myeloblast.

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Myeloblast (Size)

Large cell size in comparison with lymphoblast.

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Lymphoblast (Cytoplasm)

Lymphoblasts have scanty cytoplasm.

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Myeloblast (Cytoplasm)

Myeloblasts have moderate cytoplasm.

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ALL (Acute Lymphoblastic Leukemia)

A type of cancer affecting blood cells commonly seen in young children, characterized by abnormally high numbers of lymphoblasts.

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ALL Symptoms

Symptoms include anemia, decreased blood platelets, organ involvement (like the liver, spleen), fatigue, and increased infection risk.

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Study Notes

Normal Smears

  • White Blood Cells (WBC) contain granulocytes (neutrophils, eosinophils, basophils) and agranulocytes (lymphocytes, monocytes).
  • Peripheral smears typically show only mature cells.
  • Red Blood Cells (RBC) are round with central pallor.
  • Monocytes are the largest white blood cell, with a horse-shoe shaped nucleus.
  • Lymphocytes are the smallest white blood cells, with a small central nucleus.
  • Neutrophils have 3-5 lobes and granules in their cytoplasm.
  • Eosinophils are binucleate and have brick red granules.
  • Basophils have granules that obscure the nucleus, which are blue in color.

Bone Marrow Examination

  • Bone marrow aspirates contain mature and immature cells.
  • Fat globules are present.

WBC Disorders - Non-Neoplastic

  • Normal white blood cell count (TLC): 4,000-11,000/mm².
  • Neutrophils (40-70%), Lymphocytes (15-40%), Monocytes (2-8%), Eosinophils (1-6%), Basophils (<1%).
  • Increased TLC (leukocytosis) indicates infection.
  • Neutrophilia: associated with acute and bacterial infections, tissue necrosis.
  • Lymphocytosis: associated with viral infection, chronic infection, tuberculosis.
  • Basophilia: associated with myeloproliferative disorders (CML).
  • Eosinophilia: associated with allergic reactions, parasitic infections, malignancies (Hodgkin's lymphoma), tropical pulmonary eosinophilia, chronic infections, inflammatory bowel disease, or malaria.
  • Monocytosis: associated with chronic infections, inflammatory bowel disease, rickettsia, or malaria.

WBC Disorders - Neoplastic

  • Leukemia: malignant cells in bone marrow or peripheral blood.
  • Lymphoma: malignant cells in lymph nodes, tissues, spleen, etc.
  • Acute Lymphocytic Leukemia (ALL) and Acute Myeloid Leukemia (AML).
    • ALL: common in younger individuals (2-9 years).
    • AML: average age of onset is 15-39 years.

Acute Leukemia

  • Diagnostic criteria:
    • WHO criteria: > 20% blasts in peripheral blood or bone marrow.
    • FAB criteria: > 30% blasts in the peripheral blood or bone marrow (exceptions apply; count can be < 20% if one of three other features is present).
  • Lymphoblast vs myeloblast: described by their cell size, cytoplasm, granules, Auer rods, and chromatin.

Additional Information

  • Bone marrow biopsy: used for diagnosis and monitoring.
  • Sites for bone marrow aspiration in adults: ASIS (anterior superior iliac spine), PSIS (posterior superior iliac spine), or iliac crest.
  • Sites for bone marrow aspiration in children: anterior surface of the tibia or shin of the tibia.
  • Dry Tap: a dry tap is when there is no marrow obtained during aspiration, which is often the case in aplastic anemia, myelofibrosis, hairy cell leukemia, or AML-M7.
  • Bone marrow examination is usually followed by dry tap aspiration and then biopsy, if necessary.
  • Chloroma: granulocytic sarcoma, found in myeloblastoma, MPO positive, associated with the orbit, is greenish in color.
  • Myeloproliferative disorders (CML, Polycythemia vera, Essential thrombocytosis, myelofibrosis) with features and diagnostic criteria.

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Description

Explore the intricacies of white blood cells and their normal smear characteristics with this informative quiz. Delve into the details of WBC disorders, including the anatomy of granulocytes and agranulocytes, as well as the significance of bone marrow examinations. Test your knowledge of leukocyte classifications and their normal ranges.

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