Hematology/Oncology: WBC Disorders
what is the diagnosis process for ALL?
- CBC - bone marrow biopsy - flow cytometry - cytogenetics
what is the process of diagnosis for AML?
- CBC - bone marrow biopsy - flow cytometry - cytogenetics
what is the diagnosis process for polycythemia vera?
- CBC - peripheral blood smear - bone marrow biopsy
what is the testing and results in plasma cell myeloma?
- CMP --> elevated total protein, maybe elevated calcium - imaging --> lytic lesions in the bone - protein electrophoresis --> * serum protein electrophoresis (SPEP) - shows M (monoclonal) band from IgG or IgA ("M" spike) * urine protein electrophoresis (UPEP) - shows free light chains (Bence Jones protein) band
what are non-specific tests for infections?
- ESR - CRP
what are specific tests for infections?
- HIV - Mono
what are the two major types of lymphomas?
- Hodgkin - Non-Hodgkin
what is lymphoma classification based on?
- cell surface markers - cytogenetics - molecular studies
explain the process of flow cytometry in WBC testing?
- cells labelled with antibodies to specific cell proteins (cell line markers) - each antibody has attached fluorescent markers that will fluoresce a specific color when activated by a laser - labelled cells passed through a laser one at a time - detectors sense multiple parameters, including color of fluorescence - if needed, cells can be sorted by fluorescence into different tubes for further testing
what is the second testing and results for CML?
- cytogenetics *Philidelphia chromosome translocation
diseases of WBC can be differentiated into what 3 categories?
- diseases of WBC function - quantitative disorders - clonal disorders (malignancies)
what kinds of questions would you be wanting to answer when using flow cytometry?
- exactly what type of cancer is it? - which drug might be the best to use?
what are the specialized testing techniques for cancers?
- flow cytometry - cytogenetics
what are the 3 types of clonal WBC disorders?
- leukemias - lymphomas - immunoproliferative
what is the first testing and results for CML?
- leukocyte alkaline phosphate (LAP) *LAP low in leukemias
what are the agranulocytes?
- lymphocytes - monocytes
if a patient has no symptoms but has leukemia, what two cell lineages will you see?
- myelocyte - metamyelocyte
quantitative (non-clonal) WBC disorders include what two things?
- neutropenia - leukemia reaction
what are the granulocytes?
- neutrophils - eosinophils - basophils
developing white blood cells are divided into what three physiologic compartments?
- proliferating or mitotic pool in bone marrow - maturation pool (post-mitotic) and storage pool in bone marrow - peripheral blood (divided into circulating pool and marginating pool)
what are the 4 types of myelodysplasia syndromes?
- refractory anemia - refractory anemia with ringed sideroblasts - refractory anemia with excess blasts - refractory anemia with excess blasts in transformation
explain the process of cytogenetics in WBC testing?
- use staining or fluorescence to identify changes in genome - metaphase analysis
what is the relative normal % of basophils?
0-1%
what is the relative normal % of eosinophils?
2-5%
what is the relative normal % of lymphocytes?
20-40%
what is the percentage of myelodysplastic syndromes progressing to leukemia?
25%
what is the relative normal % of monocytes?
3-10%
what is the relative normal % of neutrophils?
50-70%
acute leukemia is greater than what percentage of blasts in bone marrow?
> 20%
what infectious disease oddly causes a high WBC count?
C. diff
what are the specific neutrophils called that are in toxic granulation of segmented neutrophils that are a marker of severe infection?
Dole bodies
what are the specific cells called that are atypical or reactive lymphocytes in changes in WBC morphology?
Downey cells
what are the types of techniques used in cytogenetics?
FISH and spectral karyotyping
what kind of lymph node biopsy is where a needle aspirate is done?
FNA
what kind of lymphoma has Reed-sternberg cells?
Hodgkin lymphoma
what do you need in order to classify a lymphoma?
Lymph node biopsy
what kind of lymphoma has B cell lymphocytes being more dominant than T cell lymphocytes?
Non-Hodgkin lymphoma
what is seen in the peripheral blood smear in plasma cell myeloma?
Rouleaux (sticking)
what is the characteristic of WBC in the circulating pool of peripheral blood?
WBC seen on the CBC
in the cytogenetic of some cancers, especially CML, the Philadelphia chromosome is recognized and analyzed. a piece of what chromosome is broken off and put on what chromosome?
a part of chromosome 9 broken off and out on chromosome 22
what kind of leukemia has acute onset, symptomatic patient, blasts and immature cells on blood smear, variable WBC count, and anemia and thrombocytopenia may be present?
acute leukemia
what leukemia's predominant cell is a blast with no Auer rods?
acute lymphocytic leukemia
what subtype of ANLL has > 20% blasts (large, fine, chromatin, blue cytoplasm, nucleoli) in bone marrow and some have Auer rods (purple stained rods on cytoplasm of blasts)?
acute myelocytic leukemia
what is main category name for acute myeloid leukemia?
acute non-lymphocytic
what kind of biopsy looks at the the blasts but loses the bone marrow structure?
aspirate
what is another change in WBC morphology where the lymphocytes look like monocytes from a reaction and are weird shaped?
atypical or reactive lymphocytes
toxic granulation in segmented neutrophils symbolizes what present?
bad bacterial infection
what type of neutrophil will be seen in a big infection?
banded neutrophils
CML terminates in what with picture identical to AML or ALL?
blast crisis
in hematopoiesis, what are early cells in differentiation that are not normally seen in large numbers in the bone marrow and are never present usually in the peripheral blood?
blasts
leukemias are differentiated based on the percentage of what in the bone marrow?
blasts
what is usually the definitive diagnosis technique for WBC disorders?
bone marrow biopsy
what kind of leukemia has a slow onset, most patients are asymptomatic or mild symptoms, more mature cells on the smear, leukocytosis is typically seen, and anemia and thrombocytopenia show up as the disease progresses?
chronic leukemia
what leukemia has a WBC of 20,000 - 100,000+ and the perisperhal blood smear shows mature appearing, nonfunctional lymphocytes (B cells), and smudge cells on smear?
chronic lymphocyte leukemia
what leukemia is usually a disease of adults and the WBC is 50,000 - 200,000 where the neutrophils, eosinophils, and basophils are all increased?
chronic myelocytic leukemia
what is the hallmark of WBC disorders associated with disorders of function?
chronic, recurrent infections
what type of WBC disorders is characterized as unregulated and uncontrolled growth and proliferation of cells from one cell line?
clonal disorders
what kind of leukocytes disorders are derived from a single precursor cell and include leukemia, lymphomas, myelodysplastic syndromes, and myeloma?
clonal disorders (malignancies)
what kind of biopsy looks at the structure of the bone marrow?
core biopsy
what kind of lymph node biopsy is where a portion of the lymph node is taken out?
core biopsy
what WBC testing looks for chromosomal abnormalities, such as translocations or deletions?
cytogenetics
what kinds of WBC disorders are where adequate numbers of WBCs are present, but one or more cell types does not function correctly?
disorders of functions
who does the testing for primary causes of WBC disorders of function?
done by specialists
ANLL has the universal symptoms of fatigue and fever and has highly variable WBC counts on presentation. you cannot distinguish the multiple subtypes until what is obtained?
flow cytometry
what WBC testing uses fluorescence wi identify and sort cells?
flow cytometry
what type of clonal WBC disorders arise from activated B lymphocytes and include the overproduction of a monoclonal antibody?
immunoproliferative
the body cannot eradicate all of the malignant cells in CLL by the Tim the disease is found, so what is the result of WBC proliferation?
it is usually widespread and massive
describe the look of Downey cells?
larger bluer cytoplasm - radial basophilia - plasmacytoid shape (not round)
what type of quantitative (non-clonal) WBC disorder includes significantly elevated WBC count and infectious causes such as (Mononucleosis and C. diff)?
leukemia reaction
what type of clonal WBC disorders are generally arising from bone marrow and include myeloid vs. lymphocytic line, acute vs. chronic, and myelodysplasias?
leukemias
what WBC is predominant on a WBC differential in a child until about age 4?
lymphocytes
what type of WBC disorder is a milgnant proliferation of a lymphocytes that has painless lymphadenopathy?
lymphoma
what type of clonal WBC disorders generally arise from lymph nodes and lymph tissues and include B cell vs. T cell?
lymphomas
what infection is associated with Downey cells?
mononucleosis
what is the immature form of a neutrophil?
myeloblast
give the maturation order of WBC (neutrophil specifically)
myeloblast --> promyelocyte --> myelocyte --> metamyelocyte --> band --> neutrophil
what WBC disorder if classified as ineffective bone marrow production but not leukemia?
myelodysplasia syndromes
what are the earliest differentiated cells?
myeloid stem cell
what type of quantitative (non-clonal) WBC disorder includes infections, medications, and bone marrow suppression?
neutropenia
what WBC is predominant on a WBC differential in adults?
neutrophils
are myeloblasts normal in peripheral blood?
no
leukemias have an increase in what?
number of blasts
what does cytogenetics look for specifically?
oncogenes
what kind of lymph node biopsy is where they take the whole thing out?
open lymph node biopsy
what are the causes of secondary WBC disorders of function?
outside factors/conditions that reduce functioning (diabetes, CKD, immunosuppressants, stress)
what is the treatment for polycythemia vera?
phlebotomy
what is an other clonal disorder where there is uncontrolled production of monoclonal antibodies and malignant plasma cells invade the bone marrow, leading to lytic lesions in the bone?
plasma cell myeloma
what is another name for reticulocyte in hematopoiesis?
polychromatic erythrocyte
what is a myeloproliferative disorder (other clonal disorder) where there is an increase in all cell lines?
polycythemia vera
where are bone marrow core biopsies mostly done?
posterior hip
what kind of WBC disorders have abnormal counts (too high or too low)?
quantitative (non-clonal) disorders
where are aspirate biopsies mostly done?
sternum
what is the characteristic of WBC detected in the marginating pool of peripheral blood?
stuck on blood vessel walls
if a neutrophil has dark staining spots what change in WBC morphology does this characterize?
toxic granulation in segmented neutrophils
what are the causes of primary WBC disorders of function?
underlying genetic issue (rare)
