UAMS Hematology Exam 4 Review

Where are granulocytes produced?

Granulocytes are produced in the Bone Marrow.

What stimulates the maturation of granulocytes?

Colony Stimulating Factors.

How long does it take for granulocytes to mature before entering circulation?

Maturation takes 5 days.

What are the two pools of granulocytes?

Circulating Pool and Marginating Pool.

What is contained in primary granules of granulocytes?

Myeloperoxidase.

In which stage are secondary granules first observed?

Secondary granules are first observed in the Myelocyte stage.

Explain the process of granulocyte killing of organisms in order.

Chemotaxis, Opsonization, Phagocytosis, Degranulation, Oxidative burst, Killing bacteria, Inflammation.

What is a relative white cell count based on?

Percentage based on a total of 100 WBC.

How do you calculate absolute neutrophil count (ANC)?

Relative Percentage X WBC count = # cells in 1 µL of blood.

What indicates neutrophilia?

An absolute neutrophil count (ANC) greater than the normal range.

What causes neutropenia?

Leukemia, chemotherapy, or other blood disorders.

How do relative lymphocyte counts change with age at birth?

At birth, the relative lymphocyte count is 30%.

What is the role of eosinophils in the body?

Eosinophils are seen in allergies and parasitic infections.

Which WBC is often increased in chronic myeloid leukemia (CML)?

Basophils.

What is a sign of Chediak-Higashi syndrome?

Giant, fused lysosome granules.

What is the NitroBlue Tetrazolium Reduction Test used for?

To test for chronic granulomatous disorder.

What characterizes Alder-Reilly anomaly?

Dark, coarse granules in all WBC.

What changes occur in the bone marrow in myelofibrosis?

Hypercellular marrow with various cells and increased reticular fibers.

What is the Philadelphia chromosome associated with?

Chronic Myelogenous Leukemia (CML).

What is polycythemia vera associated with?

An unregulated increase in RBC production.

What is essential thrombocythemia?

A condition with a platelet count greater than 1,000,000/µL.

List major leukemias associated with acute myeloid leukemia (AML).

M0, M1, M2, M3, M4, M5, M6, M7.

What laboratory results are used in the cytochemical staining of acute leukemia?

Results from stains such as Peroxidase and Sudan Black.

What defines lymphocytosis?

An increase in lymphocytes with an absolute value >4,000/μL.

Which virus causes infectious mononucleosis?

Epstein Barr Virus.

What features define hairy cell leukemia?

Pancytopenia with hairy cells and TRAP positivity.

What is observed in multiple myeloma?

Malignant plasma cells with increased serum immunoglobins and bone lesions.

What is the main concern with Waldenstrom's macroglobulinemia?

Hyperviscosity due to primary IgM.

What is the main cellular feature of Hodgkin’s Lymphoma?

Reed-Sternberg cells.

What defines non-Hodgkin’s lymphoma?

An abnormal blood count only with abnormal bone marrow.

What are Sezary cells?

Circulating lymphoma cells associated with cutaneous lymphoma.

What causes lipid storage disorders like Gaucher's disease?

A defect in the enzyme β-glucocerebrosidase.

What are the normal values for newborn hemoglobin?

16.5-21.5 gm/dL.

What should you expect the platelet count to be after chemotherapy?

Approximately 10,000/µL.

What is the prognosis for acute lymphoblastic leukemia (ALL)?

Best chance for survival among acute leukemias.

What distinguishes M3 acute myeloid leukemia?

Presence of bundles of Auer Rods.

What are Dohle bodies associated with?

Inclusions seen in all granulocytes, indicating May-Hegglin anomaly.

How many blasts are considered abnormal in peripheral blood of an adult?

More than 3% blasts are considered abnormal.

What signifies an increase in reticulin fibers in myelofibrosis?

Support cells become bone.

What characterizes chronic lymphocytic leukemia (CLL)?

Small, mature lymphocytes with smudge cells and a high WBC count.

What does reactive lymphocytosis often present with?

Atypical lymphocytes with stretched nuclei.

What cell type would you expect in a patient with a bacterial infection?

Neutrophils.

What happens to hematocrit in dehydration?

Hematocrit increases.

Are myelocytes normally present in adult peripheral smears?

No, they are not typically found.

What signifies leukocytosis in peripheral blood?

High WBC count indicating potential infection or disorder.

What is the defining feature of Eosinophils?

High numbers in allergies and parasitic infections.

What are the symptoms related to myeloproliferative disorders?

Fatigue, malaise, bone pain, splenomegaly.

How are blasts differentiated from lymphs?

Nuclear chromatin clumping.

What is the expected differential with high eosinophils?

Parasite infections.

How is absolute neutrophilia defined?

ANC > 14,000 cells/µL.

What cell morphology is observed in AML M6?

Large, bizarre, multi-nucleated dysplastic RBCs.

What is found in peripheral blood of patients with multiple myeloma?

Rouleaux formation and abnormal plasma cells.

What is the genetic mutation associated with CLL?

Mutation in tumor suppressor genes.

In which syndrome are giant fused lysosomes found?

Chediak-Higashi syndrome.

What are we looking for in the NitroBlue Tetrazolium Reduction Test?

Ability to produce an oxidative burst.

What condition features tear drop RBCs?

Myelofibrosis.

What is the main clinical feature of essential thrombocythemia?

High platelet counts leading to stroke risk.

What does an increased WBC count typically indicate?

Infection, inflammation, or malignancy.

What becomes of hematocrit after hydration post-dehydration?

Hematocrit will decrease.

What does TRAP stand for in hairy cell leukemia?

Tartrate Resistant Acid Phosphatase.

What is characteristic of Pelger-Huet anomaly?

Neutrophils with two lobes.

What does an increase in lymphocytes in a peripheral blood smear indicate?

Lymphocytosis.

Describe the features of atypical lymphocytes in reactive lymphocytosis.

Nucleus pushed against RBCs, stretched out appearance.

What is a common presentation of lymphadenopathy?

Enlarged lymph nodes.

When is it considered absolute neutropenia?

Absolute neutrophil count < 1,500 cells/µL.

What characterizes the cytochemical stain results of AML M4?

Positive for specific and non-specific esterase.

What indicates an abnormal count of NRBCs in adults?

Three or more NRBCs present.

What is it called when you see intracellular homogenous material observed in segs?

LE Cells

What myeloproliferative disorder will you see a low LAP score?

CML

What AML classification is acute myeloblastic leukemia without maturation?

M1

What AML classification is Acute myeloid leukemia with maturation?

M2

What AML classification is Acute promyelocytic leukemia?

M3

What AML classification is Acute myelomonocytic leukemia?

M4

What AML classification is Acute monocytic leukemia?

M5

What AML classification is Acute erythroid leukemia?

M6

A patient has a platelet count of 700 × 10³ per microliter, with abnormalities in size, shape, granularity of platelets; a WBC count of 12 × 10³ per microliter, and hemoglobin of 11g/dL. The Philadelphia chromosome is not present. What is the likely diagnosis?

Essential Thrombocytopenia

What AML classification is Acute megakaryoblastic leukemia?

M7

What AML is associated with the following results?

Sudan black; peroxide -, non specific esterase +, specific esterase -, PAS -

M5

What AML is associated with the following results?

Sudan black; peroxide -, non specific esterase +, specific esterase -, PAS +

M6 and M7

What AML is associated with the following results?

Sudan black; peroxide -, non specific esterase -, specific esterase -, PAS +

Acute lymphocytic

In most cases, the diagnosis of lymphoma relies on all of the following except:

A. Microscopic examination of affected lymph nodes

B. Immunophenotyping using immunohistochemistry or flow cytometry

C. Molecular and cytogenetic analysis

D. Peripheral blood examination and a complete blood count

D. Peripheral blood examination and a complete blood count

What condition is associated with an accumulation of malignant plasma cells in the bone marrow presenting as lytic bone lesions, and is also associated with excess production of immunoglobulins, which can be detected in the urine and serum (monoclonal gammopathy)?

Multiple myeloma

Which condition presents as a disseminated disease with widespread skin involvement associated with Mycosis Fungiodes, lymphadenopathy, and circulating lymphoma cells with characteristic cerebriform nuclei?

Sezary Syndrome

What AML classifications are associated with the following results?

Sudan black; peroxide +, non specific esterase -, specific esterase +, PAS -

M1, M2, M3

What AML is associated with the following results?

Sudan black; peroxide +, non specific esterase +, specific esterase +, PAS -

M4

What condition will you see the Philadelphia chromosome?

CML

What is a normal LAP score?

20-100

A patient has a WBC count of 30 × 10³ per microliter with the following differential results:

Bands: 17%

Metamyelocytes: 7%

Myelocytes: 20%

Promyelocytes: 10%

Basophils: 5%

What test result will be helpful in determining whether the patient has CML?

Positive for BCR/ABL 1 Fusion

Based on the following results, what is the most likely myeloproliferative disorder?

Dry tap on BM

+ reticulin, silver stain

Myelofibrosis

The most common mutation found in patients with polycythemia Vera is what?

JAK2 V617F

What chromosome abnormality is associated with CML?

t(9;22)

The cytochemical stain alpha napthol butyrate is a nonspecific esterase stain that shows diffuse positivity in cells of which lineage?

Monocytic

Which classification of AML would have diffuse positive staining patterns in myeloperoxidase, Sudan black B, specific esterase and non specific esterase?

M4

What AML classification is acute myeloblastic leukemia with minimal differentiation?

M0

How can a blast be differentiated from a lymph?

Nuclear chromatic clumping

Which cell is usually seen in viral infections?

Reactive lymphocyte

Are 60% lymphs found on a 6 month old peripheral smear considered normal?

Yes

Are 3% blasts found in the peripheral blood of a newborn normal?

Abnormal

What may be seen in the blasts of AML?

Auer Rods