Heme Lymphoid (Reviewed 2024)

Term for high lymphocytes?

Lymphocytosis

Term for low lymphocytes?

Lymphocytopenia

High or low lymphocytes is determined by the ________ lymphocyte count

absolute (ALC)

What causes reactive lymphocytosis?

viruses!

What causes clonal lymphocytosis?

cancers!

marked lymphocytosis

Will mononucleosis cause high or low monocytes and lymphocytes?

high!

MONO is a benign infection of _____ lymphocytes

B

MONO is associated with which types of CA?

lymphoma (hodgkins/burkitts)

MONO: incubation period

4-6 weeks

MONO: population

young adults, 15-25 (can be any age)

MONO: tranmission

close contact, saliva*

MONO: symptoms

• Fatigue - weeks to months

• Fever

• Pharyngitis c palatal petechiae

• Periorbital edema

• Posterior cervical lymphadenopathy

• Hepatitis, splenomegaly (jaundice 5%)

Describe the rash associated c MONO

• Morbiliform rash worse with ampicillin

What is rapid test for MONO?

monospot (Heterophile Ab)

When does the monospot test become positive?

4 weeks

CBC of MONO

Inc monocytes + atypical lymphocytes

+/- thrombocytopenia

Which mono titer do you think would be positive 6 months after diagnosis?

A. IgM

B. IgG

B. IgG

When does VCA IgG for mono become negative?

never, it persists for life

Precautions for MONO during acute phase

No work or school

No contact sports

Life threatening ABDOMINAL complication of MONO

splenic rupture

CBC c splenic rupture

falling H/H

CXR c splenic rupture

elevated L hemidiaphragm

Tx of splenic rupture

monitor vs splenectomy

Tx of MONO

Supportive

When to give steroids for MONO

airway obstruction

or thrombocytopenia

• Most common leukemia in childhood

ALL

Best cytologic type of ALL

L1

ALL: peripheral smear

immature blast cells

ALL: special test

periodic acid schiff test

Test to r/o CNS involvement of ALL

LP

GS test for leukemias

flow cytometry

Indicators of good prognosis for ALL

Younger (3-7)

Lower WBC (<25K)

L1 morphology

Does ALL generally have a good prognosis?

yes

• MC leukemia in west

CLL

MC presentation of CLL

ASYMPTOMATIC

Peripheral smear of CLL

Small mature lymphocytes that SMUDGE

Do you always have to treat CLL ?

No

MC presentation of hairy cell leukemia

MASSIVE SPLENOMEGALY

CBC of hairy cell leukemia

pancytopenia

Smear of hairy cell leukemia

normal WBCs c hair like projections of cytoplasm

Special tests: hairy cell leukemia

TRAP stain

MC feature of lymphoma

painless lymphadenopathy

Which has a better prognosis, Hodgkins or non-Hodgkins?

Hodgkins

How does Hodgkin's lymphoma spread?

node to node

How does non Hodgkin's lymphoma spread?

by blood

3 Bs of HODGKINS LYMPHOMA

B cell

Bimodal

EBV

Which virus is implicated in 50-75% of HODGKINS LYMPHOMA cases

EBV

Bimodal distribution of HODGKINS LYMPHOMA

15-35

>50

MC presentation of HODGKINS LYMPHOMA

painless asymmetric LAD

MC site of LAD in HODGKINS LYMPHOMA

upper body

L ant cervical

Sxs of HODGKINS LYMPHOMA

LAD

Systemic

Frequent infxn

Pel Ebstein fever ******

Pruritis

Describe Pel Ebstein fever of HODGKINS LYMPHOMA

FLUCTUATING FEVER!!!!

high-grade (105-106°F) rises abruptly, stays high for a week, then falls close to normal abruptly again, staying low for a week

Is pruritis a B cell symptom ?

no, no, and NO

Cells of HODGKINS LYMPHOMA

Reed-Sternberg cells

Appearance of Reed-Sternberg cells

owls eyes

CXR of HODGKINS LYMPHOMA

mediastinal LAD

Chemo tx of HODGKINS LYMPHOMA

MOPP

ABVD

HODGKINS LYMPHOMA: chemo tx

ABVD

Classic presentation of sporadic BURKITT'S LYMPHOMA

• GI - LBO, GI bleed, mimic appendicitis, ascites

BM biopsy of BURKITT'S LYMPHOMA

starry sky

MC Ig of MM

IgG

MC Ig of Waldenstroms

IgM

MC presentation of MM

asymptomatic

Skeletal manifestations of MM

Lytic lesions

Arthralgias

Fractures

Osteoporosis

Cord compression

Dx of MM

SPEP

UPEP

CBC

CBC of MM

Rouleaux

Urine finding of MM

bence jones

HYPERVISCOSITY SYNDROME triad

Bleeding

Visual

Neuro

• Cutaneous T cell lymphoma

MYCOSIS FUNGOIDES