Lesson 60 - Bone Marrow and Leukemia

pluripotent stem cells

Which cells are associated with undifferentiated leukemia?

1. B-lymphocytes

2. T-lymphocytes

3. NK-lymphocytes

Which cells are associated with lymphoproliferative disease?

1. platelets

2. erythrocytes

3. neutrophils

4. monocytes

5. eosinophils

6. basophils

7. mast cells

Which cells are associated with myoproliferative disease?

1. persistent, unexplained cytopenia

2. persistent, unexplained cytosis

3. atypical or immature cells in blood (blasts)

4. >1 cytopenia especially

What are the indications to perform a bone marrow aspirate?

there is a marrow response like a regenerative anemia

What is a reason to NOT perform a bone marrow aspirate?

1. Hunting for neoplasia/infectious organisms

2. Staging of lymphoma

3. Check iron stores (uncommon, Prussian blue dye)

What are some other reasons to perform a bone marrow aspirate?

1. Iliac crest

2. Proximal humerus

3. Proximal femur

4. Sternum or rib in large animals

Where are bone marrow needle aspirates/core biopsies taken from?

aspirates

What kind of bone marrow sample is better for cell lines?

cores

What kind of bone marrow sample is better for cellularity?

CBC

What do you need to submit at the same time as your bone marrow aspirate or biopsy for the most accurate interpretation?

erythroid, myeloid, and megakaryocytic cell lines

What do you evaluate in context of the CBC results?

clues to why cells are decreased, increased or atypical cells are present in the blood

What information can bone marrow aspirates provide to CBC interpretations?

stained spicules

What is being shown on this slide?

normal calf bone marrow

normal adult bone marrow

fat

What is the white arrow pointing to?

spicule

What is being shown here?

1. Cellularity of ratio of hematopoietic cells to fat (need bone spicules)

2. Maturation and morphology of all cell lines

What is being assessed in bone marrow aspirates?

age

What can cause variation of cellularity ratio of hematopoietic cells to fat?

inadequate sample of myelofibrosis

What does it mean if there are no spicules in a sample?

regenerative

What does it mean when there are more segs than bands in a left shift?

degenerative

What does it mean when there are more bands than segs in a left shift?

group of neoplastic diseases with a clonal proliferation of hematopoietic cells in marrow

What is leukemia?

immature precursor cells found in the bone marrow capable of maturing into specific types of blood cells such as red blood cells, white blood cells, or platelets

What are blast cells?

bone marrow

Where are blast cells found while differentiating before entering the bloodstream?

What percentage of blast cells are found in the bone marrow under normal conditions?

acute leukemia

What can an increased number of blast cells in the blood or bone marrow indicate?

bone marrow produces excessive blast cells that fail to mature

What happens to blast cells in acute leukemia?

>20%

What percentage of blast cells in the blood or bone marrow indicates a potential acute leukemia?

1. Infections/inflammatory diseases

2. Myeloid hyperplasia

3. Lymphoproliferative diseases

4. Myeloproliferative diseases

What can cause increased cell concentrations and/or atypical cells?

1. orderly maturation or left shift

2. megakaryocytic hyperplasia

3. non-regenerative anemia

What is observed with myeloid hyperplasia?

1. Stage V lymphoma

2. Lymphocytic Leukemia

What are some lymphoproliferative diseases?

1. Erythroid leukemia

2. Myeloid leukemia

3. Megakaryocytic leukemia

What are some myeloproliferative diseases?

1. Erythroid, myeloid, megakaryocytic

2. Aplastic anemia/Pancytopenia

3. Replacement of bone marrow with neoplasia or fibrosis

4. Severe inflammatory diseases

What can cause decreased cell concentrations?

1. Lack of or decreased precursors

2. Maturation arrest

3. Viral infections

4. Immune mediated disease

What causes erythroid, myeloid, or megakaryocytic aplasia or hypoplasia?

decrease

What happens to all bone marrow cell lines in aplastic anemia/pancyopenia?

lymphoid neoplasia

What is an example of replacement of bone marrow with neoplasia?

demand out strips the bone marrow's ability to respond

How do severe inflammatory diseases decrease cell concentrations?

1. Gram negative bacterial infections

2. Parvovirus virus

What are some severe inflammatory diseases that can decrease cell concentrations?

1. microscopic exam of Wright-stained blood and marrow by clinical pathologist

2. Immunophenotyping or immunochemistry

3. PCR

What are some methods to determine lineage of leukemia?

B-cell typically has better prognosis than T-cell

What kind of lymphoid leukemia/lymphoma has a better prognosis?

clonality of lymphoid cells

What does PCR determine in leukemia?

originating from a single cell source

What is monoclonal?

originating from multiple cell sources

What is polyclonal?

antigens are foreign molecules that bind to pre-existing antigen receptors on lymphocytes, triggering an immune response

What statement best describes the relationship between antigens and antigen receptors on lymphocytes?

PCR for Antigen Receptor Rearrangements

What is PARR?

determines if a lymphoid population is polyclonal or monoclonal

What is the purpose of PARR?

normal response to infection/inflammation

What does it mean if a PARR test determines that the lymphoid population is polyclonal?

rogue cell/clonal proliferation indicative of lymphoma

What does it mean if a PARR test determines that the lymphoid population is monoclonal?

identify clones for B and T cells

What is the purpose of PARR for the monoclonal population?

smear

What testing should you do before PARR?

CD34

What CD molecule is used as a marker for acute leukemia?

fat cells because there is not a lot of bone marrow architecture (pancytopenia)

What is the predominant cell in this bone marrow aspirate and why?

1. myeloid

2. erythroid

3. lymphoid and megakaryocytic

What are the bone marrow hematopoietic lineages?

granulocytes like neutrophils, eosinophils, basophils as well as monocytes

What are the myeloid cells?

precursors to red blood cells

What are erythroid cells?

immunophenotyping using CD markers

What is used to distinguish acute from chronic leukemia?

arrested cell lines

What does the presence of rubricytes indicate?

bone marrow aspirate

What test would you run if a dog that had previously been treated for parvo still has a pancytopenia two weeks later?

1. marked leukocytosis

2. blastic cells in blood

How is leukemia diagnosed?

immature cell lines

What cell lines are observed in acute leukemia?

mature cell lines

What cell lines are observed in chronic leukemia?

1. lymphoma

2. lymphoid leukemia

What is lymphoproliferative disease of lymphocytes?

final stage of leukemia that goes to blood

What is lymphoid leukemia?

1. multiple myeloma

2. extramedullary plasmacytoma

What is lymphoproliferative disease of plasma cells?

blastic cell

What is the red arrow?

normal lymphocyte

What is the blue arrow?