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Neoplasm
abnormal formation of new tissue that serves no useful purpose
leukemia
generalized abnormal neoplastic proliferation and diff arrest of immature hematopoietic cells which lead to accumulation in BM and peripheral
Oncogenes
mutated genes that lead to the transformation of a normal cell to a cancer
Proto-oncogne
normal counterpart of oncogene
tumor suppressor gene
hereditary unit whose protein products function to inhibit the growth of normal cells
what are the 2 major cytological classifications
lymphocytic (lymphoid progenitor) and non-lymphocytic (myeloid progenitor)
Acute leukemia
- precursor neoplasm
- refractory to remission
- fatal in 3 months
- > 20% blasts in BM
Chronic leukemia
- mature neoplasm
- longer prognosis
- < 10% blasts in BM
- wider variety of cells
What are some non-specific symptoms (seen in other diseases) for leukemia?
fatigue, low grade fever, N/V, anemia, infection, bleeding episodes (thrombocytopenia)
What are more specific symptoms for leukemia?
- enlargement of lymph nodes, liver, and spleen
- bone pain (sternum)
- chronic headache
What are common lab findings for leukemia?
anemia (n/n), leukocytosis, thrombocytopenia, basophilia, blasts in BM, NRBCs in peripheral blood
What are non-hematological clues for leukemia?
Inc in Uric acid, LDH, vitamin B12 and binding capacity, muramidase (greatly inc in monocytic leukemias)
What happens after the activation of a proto-oncogene?
stimulates proliferation and inhibits apoptosis
The inactivation of tumor suppressor genes leads to what?
loss of proliferation control, block of maturation and differentiation
Cytogenetic Analysis
- analyzing cells in a sample to look for changes in chromosomes (translocations most common)
- during metaphase
- help monitor therapy, survival, remission, relapse
Philadelphia Chromosome (Ph1)
- >90% CML
- t(9;22)
- makes BCR-ABL gene and protein
What does the BCR-ABL protein do?
provides kinase activity which stimulates CML cell proliferation
Immunophenotyping by Flow
- CD markers used to ID and investigate hematopoietic cells
- used to ID leukemic cells, predict prognosis, predict treatment response, monitor progression/relapse
What is the CD marker for Hematopoietic Stem cells?
CD34
All differentiated WBCs have which CD marker?
CD45