Hematopathology
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- What disease is characterized by absolute basophilia?
- CML
- What cells are likely to be found in the peripheral blood of a CML patient?
- immature granulocytes at various stages
- What are the blast %s that differentiate the phases of CML?
- <5 = chronic; 5-19 = accelerated; >20 = blast
- All CMPD have an excess of what cell type in the bone marrow?
- Megakaryocytes, which produce growth factors for fibros -> fibrosis
- What is typical bone marrow appearance for a patient with PV?
- Excess of RBC precurors and megakaryocytes; lack of iron stores,
- What are physical findings with nodular sclerosing Hodgkin lymphoma?
- effaced lymph node with lots of fibrosis and slightly nodular appearance; RSC surrounded by mileau (lymph, plasma, eos)
- What antigens are expressed by cells in nodular sclerosing Hodgkin lymphoma?
- CD15, CD30, no CD45, no CD20
- What are some typical findings in a patient with plasma cell myeloma?
- High lymphs; RBC rouleaux in smear; high protein, low albumin levels (suggest abnormal protein); hypercalcemia; SPEP = monoclonal spike; odd Ig levels; hypercellular marrow w/ lots of plasma cells
- SLL is the nodal based disease comparative to ________
- B-CLL (SLL = small lymphocytic lymphoma) cells =small, mature, express CD19, 20, light chain
- With low grade lymphoma, what are common lab findings?
- Nothing - usually pretty normal, just find messed up things in biopsy
- In promyelocytic leukemia (a AML variant), what are some typical findings?
- Lots of promyelocytes in marrow + blood; often have hypo or hyper granules, odd nuclei; maybe thromboses or hemorrhage. Treat w/ ATRA
- What indicates AML?
- Auer rods; MPO +; cells having antigen for CD13, 34, HLA-DR
- + NSE in cells indicates which disease?
- Chronic myelomonocytic leukemia; a CMPD (monocytes) + MDS (other cells lines) Must have >1000 monos
- Hodgkin's and non-Hodgkin's lymphomas are often described in term of what?
- Hodgkins: lymphocyte morphology +/or phenotype; NH: morphology +/or phenotype, + overall pattern (diffuse vs follicular)
- What is the most common type of chronic lymphoid leukemia?
- B - CLL
- What are peripheral blood and bone marrow findings for a patient w/ B-CLL?
- Small, mature, round lymphocytes; express B cell antigens, some Ig; >30% of cells in marrow
- What are typical findings for a patient w/ plasma cell myeloma?
- moderate to severe normochromic normocytic anemia; maybe neutro + thrombocytopenia; monoclonal protein in serum +/or urine; Bence Jones, inc calcium, renal abnormalities
- How do plasma cell myelomas lead to bone lesions?
- PCM cells secrete osteoclast activating factor, which includes several substances like TNF-B + IL-1.
- What does a PCM cell look like? How does the bone marrow look?
- Cell: varying degrees of atypia; maybe multinucleated, or anaplastic. BM: may be patchy; see nodules or infiltrate of pc, trabeculae look thin + sparse
- What is smoldering myeloma?
- A more indolent form when findings are not sufficient for outright PCM diagnosis. Pt often asymptomatic, may be stable for years
- What is MGUS?
- Dx for an asymptomatic patient w/ a monoclonal protein, but you can't find the cells that are making it. 20-30% later develop PCM (no bone lysis)
- Is nodular lymphocyte predominant HL a form of classical? Is nodular sclerosis HL?
- Nodular lymphocyte is not: expresses CD45 + CD20, + cell = H+L (popcorn); nodular sclerosis: CD15 + 30+, no B or T , lots of collagen. Main difference: the classicals have HRS, non doesn't
- What are the malignant cells in NHL?
- T or B cells that were screwed up at a certain developmental point so they recapitulate morph + immunology of some cell precursor (from lymph node stage)
- What is the bad cell in Burkitt lymphoma? What pattern does it present with?
- small non cleaved lymphocyte or follicular B-blast. Rarely has follicular pattern
- What are the most common types of NHL? What are the most aggressive?
- B cell (except in kids); aggressive: precursor B or T cell lymphoblastic leukemia/lymphoma, and Burkitt's
- What are the differences between sporadic and endemic Burkitt's?
- Sporadic: in US, mostly in Peyer's patches, rarely have EBV; endemic = Africa, in jaw + abdomen, most have EBV