Haematology Study PDF

**[ALL]** **My identification technique:** Crap ton of blasts don't stress about type, just write acute leukemia **Differentials:** AML, Non-Hodgkins Lymphoma, Burkitt's Lymphoma, Aplastic Anaemia, IM, Viral **Tests and expectations:** Cytogenetics: - T(9:22) -- Philadelphia chromosome (BCR...

**[ALL]** **My identification technique:** Crap ton of blasts don't stress about type, just write acute leukemia **Differentials:** AML, Non-Hodgkins Lymphoma, Burkitt's Lymphoma, Aplastic Anaemia, IM, Viral **Tests and expectations:** Cytogenetics: - T(9:22) -- Philadelphia chromosome (BCR-ABL) - T(1:19) -- PBX-E2A - T(12:21) -- TEL-AML1 - T(v:11) -- v:MLL - Hyperdiploid - Hypodiploid Immunophenotyping: Positive: - Blast Markers -- 34, TdT - T-Cell Markers -- 2, 3, 5, 7 - B-Cell Markers -- 10, 19, 20 Cytochemistry: **Positive:** PAS, TdT, HLA-DR, Acid Phosphate **Negative:** MPO, SBB **[CLL]** **My identification technique:** Crap ton of lymphocytes and smear cells **Differentials:** AML, ALL, CML, HCL, Lymphomas, Bacterial Infection, AIHA, post splenectomy lymphocytosis, stress induced lymphocytosis, MDS, MF, Prolymphocytic Leukemia, IM, Viral **Tests and expectations:** Cytogenetics: - Del(13q.14.3) - Trisomy 12 - Del(11q) Immunophenotyping: Positive: - T-Cell Markers -- 2, 3, 5, 7 (rare) - B-Cell Markers -- 19, 20, 23, 79 Negative: - FMC7, 10, 38 Microbiology -- Bacterial infection DAT -- AIHA BM **[AML]** **My identification technique:** Crap ton of blasts don't stress about type, just write acute leukemia. Should see left shift though. **Differentials:** ALL, APML, AMML, MDS Transformation, Leukemoid Reaction, Aplastic Anaemia. **Tests and expectations:** Cytogenetics: - T(16:16) -- CBFB-MYH11 - T(9:11) -- MLLT3-MLL - T(6:9) -- DEK-NUP214 - T(3:3) - RPN1-EV11 - T(1:22) - RBM15-MKL1 - T(8:21) - RUNX1-RUNX1T1 - T(15:17) - PML-RARA for APML Immunophenotyping: Positive: - Myeloid Markers -- 13, 33, 117 - Blast Markers - 34 Negative: - T-Cell Markers -- 2, 3, 5, 7 - B-Cell Markers -- 10, 20 - Monocytic -- 14, 64 Cytochemistry: **Positive:** MPO, SBB, Chloroacetate Esterase **Negative:** PAS, Acid Phosphate, a-naphthylacetate esterase BM **[CML]** **My identification technique:** Crap ton of left shift and basophils **Differentials:** AML, CMML, Reactive neutrophilia, Leukemoid Reaction, PCV, ET, MF. **Tests and expectations:** Cytogenetics: - T(9:22) - BCR-ABL - Negative JAK mutation rules out PCV, ET + MF. Immunophenotyping: Positive: - Myeloid Markers -- 13, 33, 117 Negative: - T-Cell Markers -- 2, 3, 5, 7 - B-Cell Markers -- 10, 20 - Monocytic -- 14, 64 - Blast Markers - 34 Biochemistry: Increased -- LDH, ALP, Uric Acid, VB12, Cytochemistry: Negative a-naphthylacetate esterase rules out CMML. BM -- Hyper granular, granulocytic proliferation\ LOW NAP score **[APML]** **My identification technique:** Crap ton of promyelocytes and blasts **Differentials:** AML, ALL, AMML, MDS Transformation, Leukemoid Reaction, Aplastic Anaemia. **Tests and expectations:** Cytogenetics: - T(15:17) PML-RARA Immunophenotyping: Positive: - Myeloid Markers -- 13, 33, 117 Negative: - T-Cell Markers -- 2, 3, 5, 7 - B-Cell Markers -- 10, 19, 22 - Monocytic -- 14, 64 Cytochemistry: **Positive:** MPO, SBB, Chloroacetate esterase **Negative:** PAS, Acid Phosphatase, a-naphthylacetate esterase **[CMML]** **My identification technique:** Crap ton of dysplastic monocytes and neutrophils **Differentials:** CML, PCV, ET, MF, MDS, tuberculosis, bacterial endocarditis. **Tests and expectations:** Cytogenetics: - T(9:22) -- BCR-ABL negative -- rules out CML - MDS abnormalities negative Immunophenotyping: Positive: - Myeloid Markers -- 13, 33 - Monocytic Markers -- 14 Negative: - T-Cell Markers -- 2, 3, 5, 7 - B-Cell Markers -- 10, 19, 22 Cytochemistry: **Positive:** Chloroacetate esterase, a-naphthylacetate esterase **Negative:** PAS, Acid Phosphatase, MPO, SBB BM\ LOW NAP score for CML\ Microbiology negative for TB or other infection\ Molecular studies JAK2 mutations negative **[Myeloma]** **My identification technique:** Egg lookin plasma cells **Differentials:** Reactive Plasmacytosis, Plasma Cell Leukemia, Waldenstrom's Macroglobulinemia, Monoclonal Gammopathy **Tests and expectations:** Cytogenetics: - Del 13q - T(4:14) Immunophenotyping: Positive: - 38, 56, 58 ,138 Chemistries:\ Increased: Igs, TP, urea nitrogen, creatinine, calcium\ Decreased: albumin\ Bence Jones protein in urine BM: Marrow plasmacytosis\ Xray, CT, MRI **[Non-Hodgkins Lymphoma]** **My identification technique:** Lymphoma Cells **Differentials:** Burkitt's Lymphoma, Mantle Cell Lymphoma, Prolymphocytic Leukemia, CLL, Hairy Cell Leukemia, Diffuse Large B cell Lymphoma, Follicular Lymphoma **Tests and expectations:** **[MDS]** **My identification technique:** Dysplastic cells in either one or all cell lines -- pelger huet, hypogranulation, ovalocytes, nRBCs. Often with cytopenias. **Differentials:** AML, AMML, CML, CMML, VB12 Def, infections, toxins, drugs, congenital, PNH, aplastic, mf, ida. **Tests and expectations:** Cytogenetics: - Del 5q - Del 7q - Trisomy 8 BM: - Dysplasia - Increased Blasts AML? - Increased cellularity **[Myelofibrosis]** **My identification technique:** Tear drop cells, nRBCs **Differentials:** AML, CML, ALL, CLL, MDS, TB, SLE, Lymphoma, ET, PCV, CMML. **Tests and expectations:** Antinuclear Antibodies to exclude SLE\ BM to exclude acute leukemia and identify significant reticulin and collagen - fibrosis\ Molecular Studies + Cytogenetics to exclude CML + MDS. Should have JAK2 Mutation\ Microbiology to exclude TB\ DAT to exclude acute hemolysis **[ET]** **My identification technique:** Crap ton of platelets **Differentials:** PCV, Reactive Thrombocytosis, CML, MF, MDS, IDA **Tests and expectations:** BM -- Normocellular or slightly hypocellular, increased megakaryocytes no collagen fibrosis Molecular Tests -- Mutation of JAK2 (V617F) Cytogenetics negative for t(9:22) ESR + CRP rule out reactive thrombocytosis Iron Studies Normal **[PCV]** **My identification technique:** Crap ton of RBCs **Differentials:** Methemoglobinemia, ET, hypoxia, Renal Disease, IDA **Tests and expectations:** Molecular Studies: - JAK2 Mutation (V617F) EPO Levels Low Iron Studies -- Increased Ferritin rules out IDA BM: - Hypercellularity - Megakaryocytic proliferation and clustering Oxygen Saturation -- Differentiates hypoxia association **[PCV]** **My identification technique:** Thrombocytopenia and schistocytes **Differentials:** ITP, HUS, DIC, HELLP, malignancy, autoimmune disorders, sepsis/bacterial infection. **Tests and expectations:** RFT -- Rule out HUS\ LFT -- Rule out HELLP\ Coagulation Profile -- Rule out DIC\ DAT - Rule out Autoimmune\ Blood Culture -- Rule out Sepsis\ ADAMTS13 Decreased\ Congenital -- ADAMTS13 Mutation\ Acquired -- ADAMTS13 Antibodies