Disease State- Leukocytes
Classification of acute leukemia in the United States relies on two main systems, the FAB (French American British) and the WHO (World Health Organization) classifications. In order to diagnose acute leukemia, the FAB system requires ______% of non-erythroid blasts to be present in the bone marrow/peripheral blood, while the WHO system requires the presence of ________% non-erythroid blasts.
30%, 20%
A 76-year-old patient experiences frequent infections and bleeding episodes. She is also complaining of pain in her bones and joints. Upon routine exam, her physician orders a complete blood count and differential. The hematology technologist notices many cells appearing similar to the cell in the image to the right. Which condition is this patient most likely suffering from?
Acute Myeloid Leukemia (AML)
A 27-year-old man with Down syndrome has the following CBC results which are MOST suggestive of what condition? WBC: 27 x 103/µL HGB: 8.5 g/dl HCT: 25.0%PLT: 30 x 109/L Differential blood smear results:8% segmented neutrophils25% lymphocytes67% TdT-positive blasts
Acute lymphocytic leukemia
Which one of the following is the most common form of childhood leukemia?
Acute lymphocytic leukemia (ALL)
Auer rods are most commonly present in which of the following conditions?
Acute myelocytic leukemia (AML)
Fifty percent blasts are found on a peripheral blood smear. The cells are large (3-5x the size of a lymphocyte) with a nucleus that contains homogeneous fine chromatin and two to three nucleoli. There is moderate blue-grey cytoplasm with Auer rods. What leukemia is most likely?
Acute myelogenous leukemia (AML)
Which morphologic term describes this slide?
Alder-Reilly neutrophils
Alder-Reilly inclusions may be found in which cell type(s)?
All types of mature white blood cells
The causative agent of infectious mononucleosis attaches to a receptor on which of the following cells?
B lymphocyte
Toxic granulation is seen most frequently in:
Bacterial infections
Select from the choices below the best report that reflects this pleural fluid cytospin image from a patient with refractory Non-Hodgkin lymphoma.
Bilobed or round nuclei in neutrophils (hyposegmented)
Prominent vacuolation involving the cytoplasm of abnormal lymphoblast-like cells seen in the peritoneal body fluid preparation shown is a distinctive feature of which disease?
Burkitt Lymphoma
Which of the following conditions is associated with the Epstein-Barr Virus?
Burkitt's lymphoma
Abnormal granulation can be seen in the cytoplasm of leukocytes in which of the following conditions?
Chediak-Higashi syndrome
This autosomal recessive disorder is associated with recurrent bacterial infections and cells consistent with the cell in the image.
Chediak-Higashi syndrome
Which disease/condition can be indicated by the morphology displayed in the white blood cell to the right?
Chediak-Higashi syndrome
A 68 year old woman presents with pressure under the lower left ribs from a swollen spleen, but is not complaining of any other symptoms. Her laboratory data showed the following: Hgb = 13.5 g/dL Hct = 40% Platelets = 240 x 109/L WBC count = 46 x 109/L Differential: 45% Neutrophils, 2% Lymphocytes, 6% Eosinophils, 2% Basophils, 35% myelocytes, 10% metamyelocytes LAP score: 11 What is a potiential diagnosis?
Chronic Myelogenous Leukemia
A patient that has 2% peripheral blood blasts, absolute monocytosis, and 10% bone marrow blasts would be classified as which Myelodysplastic Syndrome?
Chronic Myelomonocytic Leukemia
A 72 year old patient has a routine check-up and CBC. The CBC shows a high absolute neutrophil count of 28,000/µl, with slightly elevated bands, a few immature myeloid cells, and slight toxic granulation. Upon further examination of the patient, hepatomegaly and splenomegaly are noted. Because of the splenomegaly and the lack of obvious infection, a bone marrow exam is performed which shows hypercellularity of the granulocytes. Molecular testing yields a CSF3R mutation. The most likely diagnosis is:
Chronic Neutrophilic Leukemia (CNL)
What condition would be suspected in an asymptomatic patient with greater than 20% atypical (reactive) lymphocytes on their peripheral blood smear?
Epstein-Barr virus infection
A 90-year-old patient is admitted to the hospital with the following laboratory data: WBC: 9,000/mm3 PLT: 190,000/mm3 Hgb: 6.1 g/dL Differential:11% Neutrophils40% Lymphocytes4% Monocytes45% Myeloblasts45 NRBC's / 100 WBCBone Marrow: 45% Myeloblasts & 55% Megaloblastoid Erythroblasts Serum Vitamin B12 and Folic Acid: Normal The MOST likely diagnosis is:
Erythroleukemia
A CBC is done on a patient admitted for a severe hemorrhage. The patient has a high platelet count and the blood smear can be seen on the right. A bone marrow exam is performed and a proliferation of megakaryocytes is noted. Molecular analysis shows a JAK 2 mutation. This patient most likely has:
Essential Thrombocythemia
In which of the following situations would a bone marrow aspirate and biopsy be MOST LIKELY recommended to aid in diagnosis?
Evaluation of unexplained cytopenias
Which of the following is the cause of cytopenia in Myelodysplastic syndromes (MDS)?
Excess apoptosis
Which FAB designation is called the "true" monocytic leukemia and is characterized by monoblasts, promonocytes, and monocytes?
FAB M5
Diseases associated with a dysfunction of polymorphonuclear neutrophils (PMNs) include all of the following with the exception of:
Gaucher 's Disease
A representative congenital monocyte-macrophage functional disorder is:
Gaucher's disease
Which of the following morphologic characteristics is associated with the Chédiak-Higashi syndrome?
Giant lysosomal granules in granulocytes
Which of the following characteristics are found within May Hegglin Anomaly?
Giant platelets
Cells that stain positive with acid phosphatase, and are NOT inhibited with tartrate, are characteristically seen in:
Hairy cell leukemia
Laboratory tests which distinguish Polycythemia Vera (PV) from Chronic Myelogenous Leukemia (CML) include all of the following EXCEPT:
Hypercellular bone marrow
What morphological change is present in the image indicated by the arrow?
Hypersegmented nucleus
Which of the following are seen in Pelger-Huet anomaly?
Hyposegmented neutrophils
The large blue staining cells represented in the photomicrographs comprise 50% of the total white blood cell count. Which of the following conditions is this peripheral blood picture most consistent with?
Infectious mononucleosis
In almost all cases of polycythemia vera, which of the following genetic abnormalities is present?
JAK2 mutation
Which abnormal gene is inherited within Chediak Higashi resulting in dysfunctional cells and susceptible to infections consequently?
LYST
The cells included in the composite image were found in the peripheral blood smear of a patient with the following results: total WBC of 21.5 x 109/L. Differential count: metamyelocytes 4 band neutrophils 16 segmented neutrophils 48 monocytes 6 eosinophils 1 basophils 1 lymphocytes 24
Left shift
Bone marrow examination may be used to aid in the diagnosis of which of the following?
Leukemia
Bone marrow examinations may aid in the diagnosis of:
Leukemia
A patient admitted to the hospital for ongoing fever produces the following laboratory results: RBC count: 3.56 x 1012/L WBC count: 57.5 x 109/L Platelet count: 375,000/uL Differential count: 3 blasts, 10 myelocytes, 6 metamyelocytes, 12 bands, 64 segs, 4 lymphocytes, and 1 monocyte LAP score = 155. Which of the following conditions correlates closely with this patient's results?
Leukemoid Reaction
The analysis of a differential blood smear and laboratory results produced the following results: WBC: 47,000/µLHgb: 10.9 g/dLHct: 34%Differential:4% Monocytes20% Lymphocytes4% Myelocytes2% Promyelocytes15% Metamyelocytes25% Segmented Neutrophils30% BandsLeukocyte Alkaline Phosphatase (LAP) - increased What is the MOST likely disease/condition associated with these results?
Leukemoid reaction
If a patient has a white blood count of 40,000/µL, what would be the MOST useful staining procedure to distinguish between bacterial infection and chronic myelogenous leukemia (CML)?
Leukocyte alkaline phosphatase (LAP)
Which of the following stains is used to differentiate a neutrophilic leukemoid reaction from chronic myelogenous leukemia (CML)?
Leukocyte alkaline phosphatase (LAP)
If a patient's WBC is 50,000/mm3, what test should be ordered to determine if this is a leukemoid reaction or a chronic myelocytic leukemia?
Leukocyte alkaline phosphatase stain
Which of the following terms could be used to describe this picture?
Lymphocytosis
The WBC anomaly indicated by the arrow in this illustration is:
May-Hegglin anomaly
The structure that is indicated by the arrow in this image, along with giant platelets (also present in the image), is characteristic of which of the following conditions?
May-Hegglin anomaly
This image is of a peripheral blood smear from a patient with what condition?
May-Hegglin anomaly
An accumulation of this results in a heavily granulated appearance in Alder Reilly Anomaly?
Mucopolysaccharide
An example of a neoplastic proliferative disease of the plasma cells is:
Multiple Myeloma
The upper image of a peripheral blood smear reveals RBC rouleaux formation. Several blood cells that are similar in appearance to the one indicated by the arrow in the bottom image are also seen on the smear. Which of the following conditions is associated with both of these findings?
Multiple myeloma
A patient has a high absolute eosinophil count of 2000/µl; organ biopsies show infiltration of eosinophils. The patient is diagnosed as having Chronic Eosinophilic Leukemia. Other causes for high eosinophil counts include all of the following EXCEPT:
Mycosis Fungoides
"Refractory Anemia with Excess Blasts" (RAEB) is classified under which category?
Myelodysplastic Syndromes
In which stain will auer rods have the most intense reaction?
Myeloperoxidase
If greater than 50% lymphocytes were found on the peripheral blood smear of a 5 month old child you would suspect which of the following conditions?
Normal finding
Which of the following statements is FALSE?
Nucleated red blood cells can cause a falsely decreased white blood count
Which of the following is a sign of dyserythropoiesis that occurs in Myelodysplastic Syndromes?
Oval macrocytes
Approximately 80 - 90% of the neutrophils on the peripheral blood smear of a young man are similar to those in the image. This peripheral smear most likely represents which condition?
Pelger-Huet anomaly
The cell in this image is known as a MOTT cell. What is the condition in which these cells are associated?
Plasma cell myeloma
The most striking laboratory finding of this myeloproliferative neoplasms is an absolute erythrocytosis and hemoglobin concentrations of greater than 18.5 g/dL?
Polycythemia vera (PV)
A patient has a hypercellular bone marrow and is suspected of having a myeloproliferative disorder. Laboratory features include: excess megakaryocyte proliferation and atypia, marked marrow fibrosis, and the JAK2 mutation. The most likely diagnosis is:
Primary Myelofibrosis (PMF)
In which Myelodysplastic Syndrome classification would a patient having <5% blasts and <15% ringed sideroblasts belong?
RA
A patient that has >15% ringed sideroblasts present would be categorized as which Myelodysplastic Syndrome?
RARS
What is the most common early abnormality observed in the lymph nodes of AIDS patients?
Reactive lymphadenopathy
Which of the following abnormal white blood cells is most commonly found in a peripheral smear of a patient with infectious mononucleosis?
Reactive lymphocytes
Which of the following cells is indicative of Hodgkin's disease?
Reed-Sternberg (RS) cells
Which of the following is NOT classified as a Myelodysplastic Syndrome?
Refractory Lymphopenia
All of the following methods are used in the diagnosis and classification of acute leukemia, EXCEPT?
Reticulocyte count
What is the cell that is indicated by the arrow in this Prussian-blue stained bone marrow smear?
Ringed sideroblast
Which of the following blood smear observations would support the diagnosis of Multiple Myeloma if a patient demonstrated plasma cells in his bone marrow and had an elevated serum IgG?
Rouleaux formation
What are the globular inclusions in this cell?
Russell bodies
Which one of the following is a useful chemical test for the diagnosis of hairy cell leukemia?
Tartrate-resistant acid phosphatase test
An adult patient presents with a temperature of 103°F (39.4°C). A CBC is ordered and the white blood cell (WBC) count is 15.0 x 109/L (reference interval= 4.0 -11.0 x 109/L) with 10% band neutrophils and 2% metamyelocytes. What can be concluded at this point with these clinical and laboratory results?
This is most likely a bacterial infection or inflammatory response.
Eosinophils are increased in all of the following conditions EXCEPT?
Viral infections
Increased numbers of the cells indicated by the arrows can be associated with which of these conditions?
Viral meningitis
Which chromosome abnormality is most commonly associated with CML?
t(9;22)
Which of the following gene translocations is associated with Acute Promyelocytic Leukemia (APL)?
t(15;17)
What is the most likely clinical condition in which the cell in the image A would be present in increased numbers?
Chediak-Higashi
Which of the following best describes Myelodysplastic syndromes?
A qualitative disorder of erythroid, myeloid and/or megakaryocytic cell series
A 41-year-old male arrived at the clinic with complaints of fatigue, malaise, and overall discomfort. Upon testing, the patient's CBC results were notably abnormal with 30% blasts present along with anemia and thrombocytopenia. Bone marrow and cytochemical staining were subsequently performed. The cytochemical stains noted negative reactions to Myeloperoxidase and Sudan Black B but a positive reaction to alpha-naphthyl acetate. Which of the following conditions is most likely seen?
Acute Monocytic Leukemia
The following stain reactions were resulted on a suspected case of leukemia: Myeloperoxidase + Sudan Black B + Chloroacetate Esterase + Nonspecific Esterases - Which of the following is the correct interpretation?
Acute Myelocytic Leukemia
An 8-year-old boy presents with a 2 week history of high fevers and lethargy. He has shown petechiae and bleeding gums for approximately 3 weeks. Upon physical examination, the following was noted: Enlarged cervical lymph nodes, Pale and febrile, Enlarged spleen His laboratory results were the following: Hgb = 6.3g/dLHct = 18.9% RBC count = 2.89 x 109/L WBC Count = 96 x 109/L Platelet count = 23 x 109/L Differential: 90% blasts, 5% bands, 5% neutrophils BM aspirate > 90% blasts What is this patient most likely suffering from? Please select the single best answer
Acute leukemia
Which of the following leukemias can be excluded as a possible diagnosis if Auer rods are seen in blasts on the peripheral blood smear?
Acute lymphoblastic leukemia
A small child has albino characteristics, photophobia, frequent pyogenic infections, and her blood smear shows giant dark granules in her monocytes and granulocytes. What is the probable diagnosis?
Chediak-Hegashi syndrome
A monoclonal B-cell population (Kappa or Lambda predominant) with expression of CD19, CD20, CD23, and co-expression of CD5 is consistent with which of the following?
Chronic lymphocytic leukemia
The Philadelphia chromosome is consistently associated with which of the following blood disorders?
Chronic myelocytic leukemia (CML)
A representative congenital neutrophil functional disorder is:
Chédiak-Higashi syndrome
What is the name of the cells that are indicated by the arrows on this slide?
Dacrocytes (teardrop cells)
Cytomegalovirus (CMV) appears to suppress cell-mediated immune functions. Which of the following is a characteristic finding in persons infected with CMV?
Decreased CD4+ cells; increased CD8+ cells
Myelodysplastic Syndromes are characterized by cytopenias with at least one cell line decreased as well as this:
Dyspoiesis
Which of the following would be true of the myeloid to erythroid (M:E) ratio in a case of chronic myelocytic leukemia (CML)?
High (>4:1)
A 36-year-old woman visits her physician after experiencing fevers, night sweats, and overall fatigue over the past 3 months. Upon physical examination she displays lymphadenopathy. When a lymph node biopsy is performed, Reed-Sternberg cells, bands of fibrosis, and various-sized lymphocytes are noted.
Hodgkin lymphoma
What is the cell indicated by the arrow in this illustration?
smudge cell
