The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except:
B) Decreased erythropoietin production.
Which of the following cells is considered pathognomonic (diagnostic) for Hodgkin's disease?
C) Reed Sternberg cells
Waldenstrom's macroglobulinemia is a malignancy of the:
B) lymphoplasmacytoid cells
Auer rods may be seen in all of the following except:
A) actue lymphoblastic leukemia (L1, L2, L3)
The following laboratory values are seen:
RBCs 1.90 x 10^6
Hgb 6.0 g/dL
WBCs 3.0 x 10^3
WBC differential: 6% PMNs, 50% lymphocytes, 4% monocytes, 40% immature cells, 8 NRBCs/100 WBCs
Bone Marrow: 50% erythroblasts, some multinucleated megaloblasts, 30% myeloblasts
Serum B12 and folic acid: low
These results are most characteristic of:
C) Erythroleukemia (M6)
In myelofibrosis, the characteristic abnormal red cell morphology is that of:
D) teardrop cells
Name 3 parameters which help distinguish CML from a leukemoid reaction. List the results of each parameter for each condition.
CML sufferers will have the "philadelphia chromosome" mutation which is not present in "normal" patients.
CML will have a high basophil count (seeing multiple basophils in one field should "make you think CML")
(T/F) Chronic lymphocytic leukemia is primarily considered to be a disease of children.
(T/F) A high beta 2 microglobulin level is considered to be predictive of a poor prognosis in a patient with CLL.
A 62 year old man with fatigue and vague abdominal pain for one month had the results shown in the accompanying table:
WBCs 21.0 x 10^9/L
Platelets 780 x 10^9/L
Hgb 9.0 g/dL
20 NRBCs/100 WBC
Cytogenetics reveals negative for Philadelphia chromosome.
Few bizarre agranular, giant platelets
These values are most suggestive of a diagnosis of:
D) Idiopathic myelofibrosis (IMF)
Polycythemia vera is characterized by:
A) absolute increase in total red cell mass
In Polycythemia vera (PV), what is characteristically seen in blood?
A striking feature of the peripheral blood of a patient with CML is:
A) profusion of granulocytes at different stages of development
(T/F) Chronic myelogenous leukemia is considered a disease of middle aged adults and is rarely found in children.Many patients carry the Philadelphia chromosome.
Which type of anemia is usually present in a patient with acute leukemia?
A) normocytic, normochromic
What is the characteristic finding seen in the peripheral smear of a patient with multiple myeloma?
All of the following are associated with the diagnosis of multiple myeloma except:
A) Philadelphia chromosome
Which of the following parameters does the WHO use for classification of myeloproliferative disorders?
B) Cytogenetics and immunophenotyping
An M:E ratio of 10:1 is most often seen in:
Which of the following studies helps distinguish AML from ALL?
C) Myeloperoxidase stain
A 22yearold male presented in the ER with lethargy and hepatosplenomegaly. His WBC count was 23,000 with the white cell differential showing 56% blasts. Cytogenetics testing was positive for the Philadelphia chromosome. Flow cytometry indicated the patient was CD10+, CD19+ an TdT+. What is the most likely diagnosis?
C) B cell ALL with t(9;22) BCR ABL1
A 17yearold male presented to the ER with a large mediastinal mass, fever, malaise and slight anemia. His white blood cell differential showed 15% blasts. Special tests were MPO negative and Philadelphia chromosome negative. Immunophenotyping revealed TdT+, CD1a+, CD3+ and CD7+. Which is the most likely diagnosis?
D) T cell ALL
A 49yearold male complained of gum bleeding and skin lesions. His differential showed 80% monoblasts. Cytochemistry was positive for Sudan Black B and nonspecific esterase. Flow cytometry results were positive for MPO, CD13, CD33, CD 17, CD14, CD4, CD11b and c, CD64, CD68, CD36, HLA DR and lysozyme. Which is the most probable diagnosis?
D) Acute monoblastic leukemia
The following are stages of chronic myelogenous leukemia EXCEPT:
D) Spent phase
Which condition involves panmyelosis in the bone marrow (up to 100% cellularity), an increased count in the peripheral blood of all cell lines (RBCs, WBCs and platelets) and stem cells with increased sensitivity to erythropoietin?
A) Polycythemia vera
Which of the following is the cytogenetic abnormality which describes the Philadelphia chromosome?
Of which category is chronic myelomonocytic leukemia?
B) Myelodysplastic disorder/myeloproliferative neoplasm
What is the difference between CML and atypical CML?
C) Absence of Philadelphia chromosome
A 70yearold woman presented with lymphadenopathy and splenomegaly. Her WBC count was 220,000. A peripheral blood smear showed numerous mature appearing lymphocytes and moderate smudge cells. What is the most likely diagnosis?
B) B cell CLL
A 65yearold woman presents with lymphadenopathy and massive splenomegaly with a WBC count of 116,000, Hct of 28% and platelet count of 70,000. A peripheral blood smear showed 60% lymphoid cells with prominent nucleoli. What is the most likely diagnosis?
B) Acute Prolymphocytic leukemia
Multiple myeloma is most difficult to distinguish from:
A) benign monoclonal gammopathy
Reactive lymphocytes may best be distinguished from blasts by which of the following morphologic characteristics?
B) Fine chromatin
A) promyelocytes in acute leukemia (M3)
This patient has a white blood cell count of 25,000 with 90% lymphocytes. Select the best possible answer for this condition.
A) chronic lymphocytic leukemia
(T/F) The cells in this image are undifferentiated myeloblasts typically seen in acute myeloblastic leukemia without maturation (M1).
Identify the type of cell seen in this image of advanced multiple myeloma.
Use two separate parameters to describe the platelets in this specimen from a patient with myelofibrosis?
A 70 year old man comes to the lab with routine lab orders for his annual physical. His CBC indicates the following: WBC 40,000, Hgb/Hct 14/43, platelet ct: 204,000. WBC differential revealed 75% lymphocytes and 10% smudge cells. The lymphocytes all appeared mature. What is the most likely diagnosis?