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Leukemia

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1
Primary location of overproduction of immature or mature cells in most types of leukemia refers to
Bone marrow and/or peripheral blood
2
Specific cell types frequently involved in leukemias include
WBCs of the myelogenous or lymphocytic cell types
3
Ability of malignant cells in leukemia to cross the blood-brain barrier is best described as
Easily trespass the blood-brain barrier
4
Anatomy primarily affected by solid malignant tumors in lymphomas consists of
Lymph nodes and related WBCs in the bone tissue
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Cell type identified as distinctive in lymphomas is the
Lymphocyte
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Neoplastic disease characterized by an overproduction of immature or mature cells in the bone marrow or peripheral blood is defined as
Leukemia
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Course of disease associated with a higher presence of blasts in leukemia is
Shorter, more fatal course of disease
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Direction of WBC count shift observed in general leukemias is
Shift to the left
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Myeloid to erythroid (M:E) ratio typically observed in general leukemias is
10:1
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Type of anemia usually present in cases of acute leukemia is
Normocytic, normochromic
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Describe the difference between acute leukemia vs chronic leukemia
Acute leukemia:
- Described by symptoms of short duration
- Numerous immature cell forms in the bone marrow
- Increased total WBC count

Chronic leukemia
- Described by symptoms of long duration
- Mostly mature cell forms in the bone marrow
- Total WBC counts range from extremely elevated to lower than normal
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Primary basis of the French-American-British (FAB) classification of leukemias includes
Morphology of cells in Romanowsky-stained smear and cytologic/histochemical characteristics
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Primary cellular site where myeloperoxidase enzyme is found includes
Primary granules of neutrophils, eosinophils, and monocytes (to a certain extent)
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Diagnostic utility of Myeloperoxidase (MPO) stain is
Differentiating blasts of AML from those of ALL
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Cells demonstrating POSITIVE Myeloperoxidase (MPO) staining include
Neutrophilic granulocytes (except normal blasts), Auer rods, Leukemic blasts in FAB M1, M2, M3, and Eosinophils
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Cells demonstrating WEAKLY POSITIVE or NEGATIVE Myeloperoxidase (MPO) staining include
Monocytes
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Lipids and structures stained by Sudan Black B (SBB) include
Sterols, neutral fats, phospholipids in primary/secondary granules of neutrophils and lysosomal granules of monocytes
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Sensitivity of Sudan Black B stain is highest for
Granulocytic precursors
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Cells demonstrating POSITIVE Sudan Black B (SBB) staining include
Promyelocyte, myelocyte, metamyelocytes, bands, segmented neutrophils (STRONGLY POSITIVE), leukemic blasts, Auer rods, and eosinophils
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Cells demonstrating WEAKLY POSITIVE or NEGATIVE Sudan Black B (SBB) staining include
Myeloblasts and Monocytic cells
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Lipids and structures stained by Sudan Black B (SBB) include
Sterols, neutral fats, phospholipids in primary/secondary granules of neutrophils and lysosomal granules of monocytes
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Sensitivity of Sudan Black B stain is highest for
Granulocytic precursors
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Cells demonstrating POSITIVE Sudan Black B (SBB) staining include
Promyelocyte, myelocyte, metamyelocytes, bands, segmented neutrophils (STRONGLY POSITIVE), leukemic blasts, Auer rods, and eosinophils
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Cells demonstrating WEAKLY POSITIVE or NEGATIVE Sudan Black B (SBB) staining include
Myeloblasts and Monocytic cells
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Cells demonstrating NEGATIVE Sudan Black B (SBB) staining include
Lymphocytes and its precursors, Megakaryocytes and platelets, and Erythrocytes
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Color of peroxidase positive granules depending on the method used appears as
Red-brown, dark brown, or black color
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Pseudoperoxidase activity in hemoglobin causes red blood cells to develop diffusely brown color due to
One method of peroxidase staining
28
Substrate used in peroxidase staining identified as a potential carcinogen is
3,3-diaminobenzidine (DAB) tetrahydrochloride
29
Precaution required when handling DAB reagent includes
Wearing protective clothing, using mechanical aids for pipetting, cleaning spills instantly, washing hands, and weighing benzidine in hood
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Environmental factor that peroxidase enzyme is sensitive to is
Light
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Storage condition requirement for smears to prevent false peroxidase negative results is
Stained in the dark, not older than 2 weeks, and not exposed to excessive light
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Indication for using Cyanide-resistant Peroxidase stain is
Detecting eosinophilic leukemia
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Enzymatic behavior of eosinophil peroxidase in the presence of sodium cyanide differs from other granulocytes because it is
Cyanide-resistant
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Cytoplasmic granule appearance of myelocytic precursors in Sudan Black B staining is
Brownish-black cytoplasmic granules
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Appearance of monocytes under Sudan Black B staining is
Few small brownish-black granules
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Eosinophilic granule appearance in Sudan Black B staining is
Brown with central pallor (granules positive at periphery with negative centers)
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Frequency of positive SBB staining in lymphoid cells is
Rarely stain
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Specimen age suitability for Sudan Black B stain performance is
Specimens that are several months old
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Carcinogenic status of reagents used in SBB staining is
NOT considered to be carcinogenic
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Time necessary to perform the Sudan Black B stain reaction is
1 to 2 hours
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Disadvantage of SBB reaction regarding false-positive results occurs in
Disorders characterized by cytoplasmic lipid vacuoles (Burkitt's lymphoma, acute lymphocytic leukemia)
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Disadvantage of SBB reaction regarding bone marrow specimens is
Increased background staining attributable to the fatty nature of bone marrow
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Reactivity of Lymphocytic Leukemias with Myeloperoxidase (MPO) is
Negative
44
Reactivity of Lymphocytic Leukemias with Sudan Black B (SBB) is
Negative
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Form of leukemia identified as the most common form of childhood leukemia is
Acute Lymphocytic Leukemia (ALL)
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Key peripheral blood feature in Chronic Lymphocytic Leukemia (CLL) is
Persistent lymphocytosis
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Characteristic microscopic finding on peripheral blood smear (PBS) in CLL is
Presence of smudge cells and basket cells
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Clinical variations of Chronic Lymphocytic Leukemia (CLL) include
Hairy-cell leukemia, Lymphosarcoma cell leukemia, and Prolymphocytic leukemia
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Solid tumor counterpart for Acute lymphoblastic leukemia (ALL) is
Lymphoma, poorly differentiated lymphocytic
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Solid tumor counterpart for Chronic lymphocytic leukemia (CLL) is
Lymphoma, well-differentiated lymphocytic
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Solid tumor counterpart for Monocytic leukemia is
Reticulum cell sarcoma
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Solid tumor counterpart for Acute myelogenousranulocytic leukemia is
Chloroma
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Solid tumor counterpart for Plasma cell leukemia is
Myeloma
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Solid tumor counterpart for Stem cell leukemia is
Lymphoma, undifferentiated
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General Myeloperoxidase reaction for Non-Lymphocytic Leukemias / Myelogenous Leukemias is
Positive
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General Sudan Black B reaction for Non-Lymphocytic Leukemias / Myelogenous Leukemias is
Positive
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Origin and remarks for AML Subgroup M0 are
Myelocytic origin; AML minimally differentiated (MPO neg, SBB neg)
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Origin and remarks for AML Subgroup M1 are
Myelocytic origin; AML without maturation (may demonstrate Auer rods)
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Origin and remarks for AML Subgroup M2 are
Myelocytic origin; AML with maturation (most common subtype of AML, may demonstrate Auer rods)
60
Full disease name and key associations for AML Subgroup M3 are
Acute Promyelocytic Leukemia (APL); associated with DIC and Faggot cells
61
Nuclear morphology characteristic of M3V (APL microgranular variant) includes
"Butterfly", "bowtie", "coin-on-coin", or "apple core" nuclei
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Origin and remarks for AML Subgroup M4 are
Myelocytic/Monocytic origin; Acute Myelomonocytic Leukemia (AMML, Naegeli monocytic leukemia), second most common subtype of AML, may demonstrate Auer rods
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Subtype designation for AMML with increased marrow eosinophils is
M4E
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Origin and remarks for AML Subgroup M5 are
Monocytic origin; Acute Monocytic Leukemia (AMoL, Schilling leukemia)
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Age group and marrow blast criteria for M5a (AMoL, poorly differentiated) are
Seen in children; > 80% monoblasts in BM
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Age group and peripheral blood blast criteria for M5b (AMoL, well differentiated) are
Seen in middle-aged adults; < 80% monoblasts in PB
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Origin and remarks for AML Subgroup M6 are
Erythrocytic/Myelocytic origin; Acute Erythroleukemia (Di Guglielmo's syndrome), may demonstrate Auer rods, macrocytic normochromic, erythroid cells in BM MPO/PAS strongly positive (+)
68
Origin and requirements for AML Subgroup M7 are
Megakaryocytic origin; Acute Megakaryocytic Leukemia (requires immunocytochemical staining for accurate diagnosis, Factor VIII stain positive)
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Classification of AML M8 is
Acute Basophilic Leukemia
70
Primary alternative name given for Chronic Myelogenous Leukemia (CML) is
Chronic granulocytic leukemia
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Key genetic abnormality that characterizes Chronic Myelogenous Leukemia (CML) is
Philadelphia Chromosome
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Three clinical phases comprising Chronic Myelogenous Leukemia (CML) are
Chronic phase, Accelerated phase, Blast crisis
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Non-malignant condition that must be differentiated from Chronic Myelogenous Leukemia (CML) is
Leukemoid Reaction (LR)
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Individual who first described Chronic Myelogenous Leukemia (CML) in 1960 is
Peter C. Nowell
75
Chromosomal alteration underlying the creation of the BCR-ABL1 fusion gene in CML involves
Reciprocal translocation involving the long arms of chromosome 9 and 22
76
Excessive leukocytic response in peripheral blood that can be confused with CML is defined as
Leukemoid Reaction
77
WBC count threshold typically associated with a Leukemoid Reaction is
Greater than 50 x 10^9/L (with neutrophilia and a marked left shift)
78
Primary diagnostic utility of the Leukocyte (Neutrophil) Alkaline Phosphatase (LAP/NAP) test is
Distinguish Leukemoid Reaction (LR) from CML
79
Biological principle underlying increased LAP activity in neutrophils relates to
Neutrophils that have undergone normal growth
80
Chemical principle of Kaplow's method for LAP staining involves
Hydrolysis of sodium alpha naphthyl phosphate by alkaline phosphatase producing a colored precipitate with a diazotised amine
81
Fixative reagent utilized in Kaplow's Method is
Methanol and formalin
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Buffer component utilized in Kaplow's Method is
Propanediol
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Substrate utilized in Kaplow's Method is
Sodium alpha naphthyl phosphate
84
Initial stain reagent utilized in Kaplow's Method is
Brentamine-fast gamet salt
85
Counterstain reagent utilized in Kaplow's Method is
Aqueous Mayer's hematoxylin
86
Immersion duration required for dry blood smear in fixative during the LAP procedure is
30 seconds
87
Standing time required after pouring working substrate onto smear in the LAP procedure is
At least 10 minutes
88
Duration specified for counterstaining in the LAP procedure is
10 to 15 minutes
89
Microscopic appearance of alkaline phosphate granules in neutrophil cytoplasm is
Reddish-brown to black precipitate
90
Total number of segmented neutrophils and bands counted and scored in the LAP procedure is
100 cells
91
Description for an LAP score of 0 is
No reddish brown to black precipitate
92
Description for an LAP score of 1+ is
Slightly diffused reddish brown to black precipitate
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Description for an LAP score of 2+ is
Moderately diffused reddish brown to black precipitate
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Description for an LAP score of 3+ is
Heavily diffused reddish brown to black precipitate
95
Description for an LAP score of 4+ is
Very heavily diffused reddish brown to black precipitate
96
Normal reference range for Kaplow's (LAP) score is
15 to 100
97
LAP score interpretation typically seen in a Leukemoid Reaction is
High or elevated LAP score
98
LAP score interpretation typically seen in Chronic Myelogenous Leukemia is
Low LAP score
99
Clinical conditions associated with an INCREASED Kaplow's (LAP) score include
Third trimester of pregnancy, Polycythemia vera, Infections, Intoxication
100
Clinical conditions associated with a DECREASED Kaplow's (LAP) score include
CML, Paroxysmal Nocturnal Hemoglobinuria (PNH), Sideroblastic anemia, Myelodysplastic syndrome
101
Predominant leukocyte types found in peripheral blood in CML vs Leukemoid Reaction are
Blasts/promyelocytes in CML vs usually myelocytes in Leukemoid Reaction
102
Presence of toxic granulation in CML vs Leukemoid Reaction is
Absent in CML vs present in Leukemoid Reaction
103
Eosinophil/Basophil count levels in CML vs Leukemoid Reaction are
Increased in CML vs decreased in Leukemoid Reaction
104
Philadelphia chromosome (Ph1) status in CML vs Leukemoid Reaction is
Usually present in CML vs absent in Leukemoid Reaction
105
Degree of splenomegaly observed in CML vs Leukemoid Reaction is
Usually prominent in CML vs mild (if present) in Leukemoid Reaction
106
Platelet count levels typically observed in CML vs Leukemoid Reaction are
>600 or <50 x 10^9/L in CML vs normal in Leukemoid Reaction
107
Definition of LASER in flow cytometry stands for
Light amplified by stimulated emission of radiation
108
Basic unit of all radiation is defined as
Photon
109
Most common clinical application of flow cytometry is
Diagnosis of leukemias and lymphomas
110
Original design purpose of flow cytometry was
Evaluate physical properties of cells based on their ability to deflect light
111
Most significant discovery that led to widespread clinical application of flow cytometry is
Development of monoclonal antibodies
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Biological entities other than cells successfully analyzed using flow cytometry include
Chromosomes, microorganisms, and proteins
113
Properties of particles suspended in a fluid measured by flow cytometry include
Physical, antigenic, and functional properties
114
Major structural components comprising a flow cytometer are
Fluidics, a light source (laser), multiple detectors, and a computer
115
Main advantage of flow cytometry over other laboratory techniques is
Ability to quickly and simultaneously analyze multiple parameters in a large number of cells
116
Specimens most commonly analyzed using flow cytometry include
Bone marrow, peripheral blood, lymphoid tissues, body cavity fluids, and solid tissues
117
Processing timeframe requirement for peripheral blood and bone marrow specimens in flow cytometry is
Within 24 to 48 hours from time of collection
118
Anticoagulant tube and temperature requirements for flow cytometry specimen transport are
Heparin tube (preferably) transported at room temperature
119
Maximum number of antigens currently detectable at the same time on an individual cell by flow cytometry is
17 antigens
120
Molecules conjugated to monoclonal antibodies to allow direct detection in flow cytometry are
Fluorochromes
121
Technique used in flow cytometry to inject a cell suspension into sheath fluid creating single-file cell alignment is
Hydrodynamic focusing
122
Light scattering parameter that measures particle volume or size in flow cytometry is
Forward scatter (FS or FSC)
123
Light scattering parameter that reflects surface complexity and internal structures like granules/vacuoles is
Side scatter (SS or SSC)
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Lineage-associated immunologic markers for IMMATURE cells in routine flow cytometry include
CD34, CD117, Terminal deoxynucleotidyl transferase
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Lineage-associated immunologic markers for GRANULOCYTIC/MONOCYTIC cells in routine flow cytometry include
CD33, CD13, CD15, CD14
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Lineage-associated immunologic markers for ERYTHROID cells in routine flow cytometry include
CD71, Glycophorin A
127
Lineage-associated immunologic markers for MEGAKARYOCYTIC cells in routine flow cytometry include
CD41, CD42, CD61
128
Lineage-associated immunologic markers for B LYMPHOCYTES in routine flow cytometry include
CD19, CD20, CD22, kappa Light chain, lambda Light chain
129
Lineage-associated immunologic markers for T LYMPHOCYTES in routine flow cytometry include
CD2, CD3, CD4, CD5, CD7, CD8
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