1Identify the condition characterized by the overproduction of various types of immature or mature cells in the bone marrow and/or peripheral blood.
Leukemia
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2Identify the solid malignant tumors of the lymph nodes and related WBCs in the bone tissue.
Lymphoma
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3True or False: Leukemia frequently involves WBCs of the myelogenous or lymphocytic cell types.
True
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4True or False: Malignant cells in leukemia can easily trespass the blood-brain barrier.
True
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5Identify the distinctive cell type found in lymphomas.
Lymphocyte
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6Fill in the blank: Malignant lymphoma cells are initially confined to the organs containing ________ phagocytic cells.
Mononuclear
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7Enumeration: Name four organs where malignant lymphoma cells are initially confined.
Lymph nodes, spleen, liver, and bone marrow
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8True or False: Lymphomas can spill over into the circulating blood and demonstrate a leukemic-appearing picture on a peripheral blood film.
True
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9True or False: Leukemia is a neoplastic disease characterized by an overproduction of immature or mature cells of various WBC types in all cases.
False
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10Fill in the blank: In leukemia, a greater presence of blasts typically indicates a shorter and more ________ course of disease.
Fatal
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11Identify the direction of the shift in the WBC count typically seen in leukemia generalizations.
Left shift
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12Identify the typical M:E ratio seen in general cases of leukemia.
10-1
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13Identify the type of anemia usually present in cases of acute leukemia.
Normocytic, normochromic
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14Enumeration: What are three generalizations described for acute leukemias?
Short duration symptoms, numerous immature cell forms, increased total WBC count
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15Identify the classification system of leukemias established in 1977.
French-American-British classification
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16Fill in the blank: The French-American-British (FAB) classification helps differentiate ________ characteristics to identify leukemia.
Morphological
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17Identify the enzyme found in the primary granules of neutrophils, eosinophils, and to a certain extent, monocytes.
Myeloperoxidase
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18Fill in the blank: A positive Myeloperoxidase (MPO) stain rules out ________.
Acute lymphocytic leukemia
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19Enumeration: Name four components or cell types that give a positive reaction with the Myeloperoxidase stain.
Neutrophilic granulocytes, Auer rods, Leukemic blasts in FAB M1, M2, and M3, Eosinophils
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20Identify the cell type that is weakly positive or negative for the Myeloperoxidase stain.
Monocytes
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21Identify the stain that is considered the most sensitive for granulocytic precursors.
Sudan Black B stain
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22Fill in the blank: Sudan Black B stains sterols, neutral fats, and ________ found in granules.
Phospholipids
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23Enumeration: Name four cell types or structures that are positive for Sudan Black B stain.
Promyelocyte, myelocyte, metamyelocytes, bands, segmented neutrophils, leukemic blasts, Auer rods, eosinophils
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24Identify the cells that are strongly positive for Sudan Black B stain.
Metamyelocytes, bands, and segmented neutrophils
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25Enumeration: Name two cells that are weakly positive or negative for Sudan Black B stain.
Myeloblasts, monocytic cells
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26Enumeration: Name the two initial stains used on a Wright-stained blood smear showing positive blasts to classify and determine the type of leukemia.
Myeloperoxidase, Sudan Black B
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27Enumeration: Name four cell types or series that are completely negative for Myeloperoxidase stain.
Myeloblasts, basophils, lymphocytic cell series, erythrocytic cell series
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28Enumeration: Name three components or cells that are completely negative for Sudan Black B stain.
Lymphocytes and its precursors, megakaryocytes and platelets, erythrocytes
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29Enumeration: Depending on the method, what three colors can peroxidase positive granules produce?
Red-brown, dark brown, black
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30Fill in the blank: In one MPO method, red blood cells develop a diffusely brown color due to ________ activity in hemoglobin.
Pseudoperoxidase
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31Identify the potential carcinogen used as a substrate in one of the peroxidase staining methods.
3,3-diaminobenzidine tetrahydrochloride
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32Enumeration: What are five safety precautions to take when handling the 3,3-diaminobenzidine (DAB) tetrahydrochloride reagent?
Wear protective clothing, use mechanical aids for pipetting, clean up spills instantly, wash hands properly, weigh benzidine in hood
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33True or False: Peroxidase enzyme is highly stable when exposed to light.
False
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34Fill in the blank: Smears that are older than ________ weeks or exposed to excessive light should NOT be reported as peroxidase negative.
2-
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35Identify the specific stain that may be used to detect eosinophilic leukemia.
Cyanide-resistant Peroxidase stain
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36Fill in the blank: The peroxidase of eosinophils is different from other granulocytes because of its activity in the presence of ________.
Sodium cyanide
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37Identify the typical appearance of eosinophilic granules when stained with Sudan Black B.
Brown with central pallor
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38True or False: Sudan Black B stain cannot be performed on specimens that are several months old.
False
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39True or False: Unlike MPO reagents, the reagents used in Sudan Black B staining are not considered to be carcinogenic.
True
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40Enumeration: What are three disadvantages of the Sudan Black B reaction?
Time necessary to perform, potential false-positive reactions in lipid vacuole disorders, increased background staining on bone marrow
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41Identify the disorder characterized by cytoplasmic lipid vacuoles that can cause a false-positive reaction in SBB staining.
Burkitt's lymphoma
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42Enumeration: What are the typical general MPO and SBB results for lymphocytic leukemias?
Myeloperoxidase negative, Sudan Black B negative
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43Identify the most common form of childhood leukemia.
Acute lymphocytic leukemia
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44Enumeration: Name the three FAB classifications of Acute Lymphocytic Leukemia.
L1, L2, L3
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45Identify the FAB classification that accounts for 70% of childhood ALL.
L1
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46Identify the FAB classification that accounts for 70% of adult ALL.
L2
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47Identify the immunologic markers characteristic of L1 ALL.
CALLA, TdT, CD19, CD20
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48Identify the immunologic markers characteristic of L2 ALL.
TdT
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49Identify the immunologic markers characteristic of L3 ALL.
sIg, CD19, CD20, CD22, CD24
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50Identify the alternate name for L3 type leukemia.
Burkitt-type of leukemia
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51Identify the ALL classification characterized by a homogeneous population of small blasts with a uniformly round small nucleus and single nucleolus.
L1
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52Identify the ALL classification characterized by a heterogeneous population of large blasts with an irregular nucleus.
L2
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53Identify the ALL classification characterized by a homogeneous population of large blasts with nuclear and cytoplasmic vacuoles.
L3
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54Identify the cytochemical stain that is positive in both L1 and L2 but negative in L3 ALL.
Periodic acid-Schiff
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55Enumeration: Name two cytochemical stains that are positive specifically for L3 ALL.
Methyl Green Pyronine, Oil Red O
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56Identify the ALL type that is positive for E rosettes but negative for Surface Ig and Serum Anti-ALL.
T-ALL
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57Identify the ALL type that is negative for E rosettes and Serum Anti-ALL but positive for Surface Ig.
B-ALL
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58Identify the ALL type that is positive only for Serum Anti-ALL.
Null ALL
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59Identify the most common type of leukemia in the elderly, characterized by persistent lymphocytosis.
Chronic lymphocytic leukemia
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60Enumeration: Name two distinctive cell types found in the peripheral blood smear of a patient with CLL.
Smudge cells, Rieder cells
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61Enumeration: Name three examples of clinical variations of Chronic Lymphocytic Leukemia (CLL).
Hairy-cell leukemia, lymphosarcoma cell leukemia, prolymphocytic leukemia
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62Identify the specific cytochemical marker associated with Hairy-cell leukemia.
TRAP
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63Identify the solid tumor counterpart or lymphoma of Acute Lymphoblastic Leukemia (ALL).
Lymphoma, poorly differentiated; lymphocytic
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64Identify the solid tumor counterpart of Chronic Lymphocytic Leukemia (CLL).
Lymphoma, well-differentiated; lymphocytic
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65Identify the solid tumor counterpart of Monocytic leukemia.
Reticulum cell sarcoma
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66Identify the solid tumor counterpart of Acute myelogenous granulocytic leukemia.
Chloroma
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67Identify the solid tumor counterpart of Plasma cell leukemia.
Plasma cell myeloma
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68Identify the solid tumor counterpart of Stem cell leukemia.
Lymphoma, undifferentiated
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69Enumeration: What are the typical general MPO and SBB results for non-lymphocytic or myelogenous leukemias?
Myeloperoxidase positive, Sudan Black B positive
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70Identify the AML subgroup designated as M0.
AML, minimally differentiated
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71Identify the AML subgroup designated as M1.
AML, without maturation
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72Identify the AML subgroup designated as M2, which is also the most common subtype of AML.
AML, with maturation
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73Identify the structure defined as a linear projection of primary granules often found in AML M1, M2, and M3.
Auer rod
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74Identify the AML subgroup designated as M3.
Acute Promyelocytic Leukemia
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75Identify the reciprocal translocation associated with Acute Promyelocytic Leukemia (M3).
t(15-17)
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76Identify the life-threatening coagulopathy frequently associated with AML M3.
DIC
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77Identify the cells containing bundles of Auer rods characteristic of AML M3.
Faggot cells
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78Enumeration: What are four terms used to describe the characteristic nuclei of the microgranular variant of M3 cells?
Butterfly, bowtie, coin-on-coin, apple core
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79Identify the alternate name for AML subgroup M4.
Acute Myelomonocytic Leukemia
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80Identify the synonym used for Acute Myelomonocytic Leukemia (M4).
Naegeli monocytic leukemia
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81Identify the variant designated as M4E.
AMML, with increased marrow eosinophils
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82Identify the AML subgroup designated as M5.
Acute Monocytic Leukemia
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83Identify the synonym used for Acute Monocytic Leukemia (M5).
Schilling leukemia
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84Identify the specific designation for AML subgroup M5a.
AMoL, poorly differentiated
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85Identify the threshold percentage of monoblasts in the bone marrow required to classify as M5a.
80- or greater
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86Identify the specific designation for AML subgroup M5b, typically seen in middle-aged adults.
AMoL, well differentiated
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87Identify the alternate name for AML subgroup M6.
Acute Erythroleukemia
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88Identify the syndrome synonym for Acute Erythroleukemia (M6).
Di Guglielmo's syndrome
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89Identify the type of anemia and the specific cytochemical stain result typical for erythroid cells in AML M6.
Macrocytic normochromic anemia, PAS strongly positive
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90Identify the AML subgroup designated as M7.
Acute Megakaryocytic Leukemia
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91Identify the specific stain required for the accurate immunocytochemical diagnosis of AML M7.
Factor VIII stain
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92Identify the AML subgroup designated as M8.
Acute Basophilic Leukemia
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93Identify the specific cytochemical stain that relates to myelocytic origin.
Naphthol AS-D Chloroacetate esterase
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94Identify the cytochemical stain family used to relate cells to a monocytic origin.
Nonspecific esterase
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95Enumeration: Based on the cytochemical reaction table, which AML subgroups show positive reactions for both alpha-naphthyl butyrate and alpha-naphthyl acetate esterase?
M4, M5
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96Identify the alternate name for Chronic Myelogenous Leukemia (CML).
Chronic Granulocytic Leukemia
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97Identify the small abnormal chromosome that characterizes Chronic Myelogenous Leukemia.
Philadelphia chromosome
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98Enumeration: Name the three clinical phases of Chronic Myelogenous Leukemia (CML).
Chronic phase, accelerated phase, blast crisis
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99True or False: The presence of the Philadelphia chromosome in CML patients is associated with a good prognosis.
True
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100Identify the final clinical phase that marks the progression of CML in most patients.
Blast crisis
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101Identify the fusion gene responsible for causing Chronic Myelogenous Leukemia.
BCR-ABL1 fusion gene
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102Identify the scientist who first described the Philadelphia chromosome in 1960.
Peter C. Nowell
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103Fill in the blank: The Philadelphia chromosome is formed due to a reciprocal translocation involving the long arms of chromosomes ________.
9-and 22
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104True or False: The term Philadelphia chromosome refers to the structural change in chromosome 9 only.
False
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105Identify the condition defined as an excessive leukocytic response in the peripheral blood that can be confused with CML.
Leukemoid reaction
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106Fill in the blank: A leukemoid reaction features a WBC count greater than ________ x 10^9/L with neutrophilia and a marked left shift.
50-
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107Identify the primary test used to distinguish a Leukemoid Reaction from Chronic Myelogenous Leukemia.
Leukocyte Alkaline Phosphatase test
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108Identify the only type of white blood cell that contains alkaline phosphatase activity under normal growth conditions.
Neutrophil
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109Identify the method whose principle relies on the hydrolysis of sodium alpha naphthyl phosphate by alkaline phosphatase to produce a colored precipitate with a diazotised amine.
Kaplow's method
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110Enumeration: Name the five components or reagents used in Kaplow's method for LAP staining.
Methanol and formalin fixative, propanediol buffer, sodium alpha naphthyl phosphate substrate, brentamine-fast garnet salt initial stain, aqueous Mayer's hematoxylin counterstain
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111Fill in the blank: In the LAP staining procedure, the dry blood smear is immersed in fixative for ________ seconds.
30-
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112Fill in the blank: After pouring the working substrate onto the smear, it should be allowed to stand for at least ________ minutes.
10-
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113Fill in the blank: The counterstaining step in the LAP procedure takes ________ minutes.
10-15
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114Identify the mounting solution used before examining the LAP stained smear.
Glycerol
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115Identify the color of the alkaline phosphatase granules looked for in the cytoplasm of neutrophils during examination.
Reddish-brown to black
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116Fill in the blank: To calculate the LAP score, a medical technologist must count and score ________ segmented neutrophils and bands.
100-
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117Identify the LAP score description for a cell rated as 1+.
Slightly diffused reddish brown to black precipitate
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118Identify the LAP score description for a cell rated as 4+.
Very heavily diffused reddish brown to black precipitate
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119Identify the reference range for a normal Kaplow's (LAP) Score.
15-100
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120True or False: A patient with a Leukemoid Reaction will show a decreased LAP score.
False
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121True or False: A patient with Chronic Myelogenous Leukemia will show a decreased LAP score.
True
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122Identify the textbook source for the majority of the notes provided on the LAP/NAP test.
Hematology Handbook for Medical Technologists by Shirley I. Fabian-Cruzada
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123Enumeration: Name four clinical cases or conditions associated with an increased Kaplow's (LAP) score.
Pregnancy, polycythemia vera, infections, intoxication
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124Enumeration: Name four clinical conditions associated with a decreased Kaplow's (LAP) score.
CML, paroxysmal nocturnal hemoglobinuria, sideroblastic anemia, myelodysplastic syndrome
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125Identify the most common clinical application of flow cytometry.
Diagnosis of leukemias and lymphomas
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126Fill in the blank: Flow cytometry was originally designed to evaluate physical properties of cells based on their ability to ________ light.
Deflect
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127Identify the major developmental discovery that led to the widespread clinical application of flow cytometry.
Monoclonal antibodies
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128Enumeration: Apart from whole cells, name three other biological particles successfully studied using flow cytometry.
Chromosomes, microorganisms, proteins
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129Enumeration: What three general properties of particles are measured by flow cytometry?
Physical, antigenic, functional
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130Enumeration: Name the four main components that make up a flow cytometer instrument.
Fluidics, light source laser, multiple detectors, computer
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131Identify the primary advantage of flow cytometry over other diagnostic techniques.
Quickly and simultaneously analyze multiple parameters in a large number of cells
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132Enumeration: Name five specimens most commonly analyzed using flow cytometry.
Bone marrow, peripheral blood, lymphoid tissues, body cavity fluids, solid tissues
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133Fill in the blank: Peripheral blood and bone marrow specimens for flow cytometry must be processed within ________ hours from collection.
24-48
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134Identify the preferred anticoagulant used for collecting flow cytometry blood specimens.
Heparin
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135Identify the temperature at which flow cytometry samples should be transported to the laboratory.
Room temperature
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136Fill in the blank: Based on the sample problem, if the number of neutrophils scored are 32 (for 0), 24 (for 1+), 21 (for 2+), 15 (for 3+), and 8 (for 4+), the total calculated LAP score is ________.
143-
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137Identify the cell type predominantly present in the peripheral blood of a CML patient compared to a Leukemoid Reaction patient.
Blasts or promyelocytes
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138True or False: Toxic granulation is typically present in the neutrophils of a patient with Chronic Myelogenous Leukemia.
False
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139Identify the status of eosinophils and basophils in a patient with Chronic Myelogenous Leukemia.
Increased
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140Identify the status of splenomegaly severity in a patient with a Leukemoid Reaction.
Mild if present
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141Identify the full phrase represented by the acronym LASER.
Light amplification by stimulated emission of radiation
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142Identify the basic unit of all radiation.
Photon
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143Fill in the blank: Currently, up to ________ antigens can be detected simultaneously on an individual cell using flow cytometry.
17-
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144Identify the method where monoclonal antibodies are conjugated to a variety of ________ to be directly detected by a flow cytometer.
Fluorochromes
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145Identify the method of injecting a cell suspension into a stream of sheath fluid to line cells up individually.
Hydrodynamic focusing
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146Identify the type of light scatter measured directly in line with the illuminating laser beam, which is proportional to cell size.
Forward scatter
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147Identify the type of light scatter that reflects cell surface complexity and internal structures like granules or vacuoles.
Side scatter
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148Enumeration: Name three lineage-associated immature markers commonly analyzed in flow cytometry.
CD34, CD117, Terminal deoxynucleotidyl transferase
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149Enumeration: Name two lineage-associated granulocytic or monocytic markers commonly analyzed in flow cytometry.
CD33, CD13
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150Enumeration: Name two lineage-associated erythroid markers commonly analyzed in flow cytometry.
CD71, Glycophorin A
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151Enumeration: Name three lineage-associated megakaryocytic markers commonly analyzed in flow cytometry.
CD41, CD42, CD61
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152Enumeration: Name five lineage-associated B lymphocyte markers commonly analyzed in flow cytometry.
CD19, CD20, CD22, kappa light chain, lambda light chain
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153Enumeration: Name six lineage-associated T lymphocyte markers commonly analyzed in flow cytometry.
CD2, CD3, CD4, CD5, CD7, CD8