Bone Marrow, Leukocytes & Neoplasms

What is a normal myeloid-to-erythroid (M:E) ratio in adult bone marrow?

1.5:1 to 3.3:1

What does a "dry tap" during bone marrow aspiration suggest?

Fibrosis (e.g., Primary Myelofibrosis) or cellular infiltration (e.g., Hairy Cell Leukemia)

What is the diagnostic cell in Hodgkin's Lymphoma?

Reed-Sternberg cell

What mutation is found in >95% of Polycythemia Vera (PV) cases?

JAK2 V617F mutation

What genetic abnormality is the Philadelphia chromosome?

Translocation t(9;22) forming the BCR::ABL1 fusion gene

Which leukemia is commonly associated with the Philadelphia chromosome?

Chronic Myeloid Leukemia (CML) and some Acute Lymphoblastic Leukemia (ALL)

What are Auer rods, and in which disease are they seen?

Rod-shaped cytoplasmic inclusions seen in Acute Myeloid Leukemia (AML)

What is "toxic granulation" in neutrophils?

Abnormally large, dark primary granules due to severe infection or inflammation

What is Pelger-Huët anomaly?

Inherited disorder causing hypolobulated neutrophils with bilobed "pince-nez" nuclei

Which condition is associated with hypersegmented neutrophils?

Megaloblastic anemia (Vitamin B12 or folate deficiency)

What are Döhle bodies?

Pale blue cytoplasmic inclusions in neutrophils seen in infections, burns, or pregnancy

What is "rouleaux" formation in red blood cells (RBCs)?

Stacking of RBCs due to high plasma proteins (fibrinogen or globulins)

What is a leukemoid reaction?

a dramatic increase in white blood cells (WBCs) that mimics leukemia often featuring immature neutrophils in the blood

What is leukocytosis?

a condition with a higher-than-normal number of white blood cells (leukocytes) in your blood

What is the most common acute leukemia in adults?

Acute Myeloid Leukemia (AML)

What is the most common acute leukemia in children?

Acute Lymphoblastic Leukemia (ALL)

What lymphoma shows a "starry sky" appearance under the microscope?

Burkitt Lymphoma

What are key features of Hairy Cell Leukemia (HCL)?

"Fried egg" appearance, TRAP (Tartrate-Resistant Acid Phosphatase) positive, dry tap

What is a hallmark peripheral blood finding in Chronic Myeloid Leukemia (CML)?

Marked leukocytosis with full spectrum of granulocytic maturation

What mutation is commonly found in Essential Thrombocythemia (ET)?

JAK2 V617F (also CALR and MPL mutations)

What is the main feature of Myelodysplastic Syndromes (MDS)?

Dysplasia in one or more myeloid cell lines with associated cytopenias

What are Hematologic neoplasms?

abnormal growth of cells of the hematopoietic system

What is the predominant cell type in acute leukemias?

Precursor cell or blast

What is the predominant cell type in chronic leukemias?

Mature cells

What is the onset of acute leukemias vs chronic leukemias?

Acute is onset while chronic is insidious (slower progression)

What are the symptoms of acute leukemias?

Fever, fatigue and Mucocutaneous bleeding

What are the symptoms of chronic leukemias?

Variable, nonspecific; some asymptomatic

Compare white blood cell count in acute and chronic leukemia

Acute: WBCs count are variable Chronic: WBC count increase

What is Acute Myelogenous Leukemia?

Infiltration of malignant cells into gums and mucous membranes

What is a symptom that most patients present with Acute Myelogenous Leukemia?

Bone and joint pain

What is the mechanism of action of Gleevec® (Imatinib) in treating Chronic Myeloid Leukemia (CML)?

Binds to the ATP-binding site of the BCR-ABL tyrosine kinase, blocking ATP and stopping abnormal phosphorylation → halts leukemia cell growth.

What do alkylation agents do in chemotherapy?

Damage DNA using free radicals.

What is the source of antitumor antibiotics like daunorubicin?

Microorganisms (bacteria/fungi).

How do antitumor antibiotics work?

Inhibit DNA/RNA synthesis.

What are antimetabolites?

Drugs that mimic metabolites

How do steroids help treat leukemias?

Kill lymphocytes (lympholytic) and affect mitosis/protein synthesis.

What does radiotherapy do to cancer cells?

Damages DNA using ionizing radiation.

Which body systems are most affected by radiotherapy?

Blood cells, GI tract, skin.

What are Biological Response Modifiers (BRMs)?

Immune-boosting drugs like G-CSF, interferon-α, IL-2.

What does G-CSF do?

Stimulates neutrophil growth after chemo.

What is Rituximab, and what does it target?

Anti-CD20 monoclonal antibody; treats B-cell Acute Lymphoblastic Leukemia.

What are the two main types of bone marrow transplant?

Allogeneic (donor) and autologous (self)

What is the main risk of allogeneic transplant?

Graft-versus-Host Disease (GVHD).

What is the main risk of autologous transplant?

Higher relapse risk (own cells may contain cancer).

What do interferon-α and IL-2 do?

Activate cytotoxic T cells to attack cancer.

Why are Biological Response Modifiers (BRMs) sometimes “not toxic enough” alone?

They boost immunity but may not kill cancer directly; often used with chemo.

What are Myeloproliferative Neoplasms (MPNs)?

Blood cancers where mutated stem cells make too many normal-looking blood cells.

What are the main signs of Chronic Myeloid Leukemia (CML)?

Infections, anemia, bleeding, and enlarged spleen due to too many immature white cells everywhere.

What white blood cells are elevated in Chronic Myeloid Leukemia?

Neutrophils, basophils, eosinophils

What is Polycythemia Vera (PV)?

A blood cancer where the bone marrow overproduces all three blood cell types (red cells, white cells, and platelets)

How is Polycythemia Vera (PV) diagnosed according to WHO?

High red blood cell count, bone marrow making too many cells, and a JAK2 gene mutation.

What is Essential Thrombocythemia (ET)?

A blood cancer with very high platelets (often >1 million) and crowded, large megakaryocytes in the bone marrow.

What is Primary Myelofibrosis (PMF)?

A bone marrow cancer that starts with high blood counts but turns into low blood counts as the marrow gets scarred.

What is Dyserythropoiesis?

Abnormal red blood cell production (two sizes of RBCs, ringed sideroblasts).

What is Dysmyelopoiesis?

Abnormal white blood cell development (weird nuclei, missing granules).

How does Reactive Adenopathy feel?

Movable, tender, softer, and comes/goes.

How does Malignant Adenopathy feel?

Matted, hard, painless, and keeps growing.

What is a key difference in growth pattern?

Reactive nodes shrink over time; malignant nodes grow steadily.

What is the classic diagnostic cell in Hodgkin Lymphoma?

Reed-Sternberg cell.

Which type of Hodgkin Lymphoma has lacunar cells?

Nodular Sclerosis HD.

Which type of Hodgkin Lymphoma has popcorn cells?

Nodular Lymphocyte Predominance HD.

What cells are seen in Lymphocyte Depletion HD?

Atypical Reed-Sternberg cells, few lymphocytes.

What Hodgkin type is linked to Epstein Barr virus infection?

Mixed Cellularity HD.

What is a long-term risk of Hodgkin Lymphoma treatment?

Secondary cancers (e.g., breast, lung, leukemia).

Which Hodgkin Lymphoma type has the best prognosis?

Nodular Lymphocyte Predominance HD (popcorn cells).

Which is the most common Hodgkin Lymphoma type?

Nodular Sclerosis HD (lacunar cells, fibrosis).

Which Hodgkin type has the worst prognosis?

Lymphocyte Depletion HD (often in older or HIV+ patients).

What type of cell is characteristic of Nodular Sclerosis Hodgkin Lymphoma?

Lacunar Reed-Sternberg cells.

What is Small Lymphocytic Lymphoma (SLL)?

Low-grade B-cell lymphoma (like CLL); CD5+, CD19+, CD20+, CD10-.

Which lymphoma is linked to t(11;14) and cyclin D1?

Mantle Cell Lymphoma.

Which lymphoma has t(14;18) and Bcl-2 overexpression?

Follicular Lymphoma.

Which lymphoma is often linked to H. pylori infection in the stomach?

MALT lymphoma (Marginal Zone B-cell Lymphoma).

What is rouleaux formation and what causes it?

RBCs stacking like coins due to high fibrinogen/globulins; which makes sedimentation rate rise in inflammation.

What is Diffuse Large B-cell Lymphoma (DLBCL)?

The most common Non-Hodgkin's Lymphoma is aggressive, treatable, large B-cells with multiple nucleoli.

What is Burkitt Lymphoma?

A fast-growing B-cell lymphoma with starry sky appearance, t(8;14), often in kids; linked to EBV and malaria.