Leukemia and Lymphoma Questions..

[NRAI2001]

Have a path midterm coming up soon and about 1/4 of it is going to be heme-pathology. I was hoping to post a few questions here that maybe i could get some help with? (Most of them are probably not too difficult..its just that our notes for this section arent too great):

1) In leukemias I know you see an increased blasts cells and my notes say that you see pancytopenia....I ve read else where that you dont always see the pancytopenia (cells will definitely be dysfunctional though). I thought I understood that with for example ALL you would see increased lymphoblasts and pancytopenia of myeloid lineage cells (as they get crowded out) and the reverse would be true of AML you would see increased myeloblasts and leukopenia (decreased lympocytes)??

2) If there is an increased production of blasts cells will it only be seen in the Bone Marrow aspiration or will it also be seen in peripherial blood?

Thanks

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[JonnyG]

Have a path midterm coming up soon and about 1/4 of it is going to be heme-pathology. I was hoping to post a few questions here that maybe i could get some help with? (Most of them are probably not too difficult..its just that our notes for this section arent too great):

1) In leukemias I know you see an increased blasts cells and my notes say that you see pancytopenia....I ve read else where that you dont always see the pancytopenia (cells will definitely be dysfunctional though). I thought I understood that with for example ALL you would see increased lymphoblasts and pancytopenia of myeloid lineage cells (as they get crowded out) and the reverse would be true of AML you would see increased myeloblasts and leukopenia (decreased lympocytes)??

2) If there is an increased production of blasts cells will it only be seen in the Bone Marrow aspiration or will it also be seen in peripherial blood?

Thanks

Only acute leukemias show and increase in blasts, a chronic will not show an increase in blast until later in the disease when they go into blast crisis. Depending ont he stage and severity of the disease will determine the amount of anemia.

2) You will see blasts on a prepherial blood smear sometimes thats usually done before they aspirate

Others will probably go into more detail

 

[NRAI2001]

Only acute leukemias show and increase in blasts, a chronic will not show an increase in blast until later in the disease when they go into blast crisis. Depending ont he stage and severity of the disease will determine the amount of anemia.

2) You will see blasts on a prepherial blood smear sometimes thats usually done before they aspirate

Others will probably go into more detail

Ya I understand that you only see blasts in the acute leukemias bc of the differentiation blocks...I was wondering more about the pancytopenia and/or leukopenias??

From my understanding (correct me if i m wrong) you will see pancytopenia for the AMLs and ALLs; BUT will you also see it for the chronic leukemias?

Does anyone have a link to a good site that covers this stuff? Maybe a review sheet or something, would appreciate it greatly

 

[Cosmonaut]

Ya I understand that you only see blasts in the acute leukemias bc of the differentiation blocks...I was wondering more about the pancytopenia and/or leukopenias??

From my understanding (correct me if i m wrong) you will see pancytopenia for the AMLs and ALLs; BUT will you also see it for the chronic leukemias?

Does anyone have a link to a good site that covers this stuff? Maybe a review sheet or something, would appreciate it greatly

http://www.acponline.org/acp_press/essentials/hematology-section.html

There are some nice review sheets down under the leukemia section...not sure if any of them truly address your questions though.

 

[NRAI2001]

Got midterm in 2 days...I ve asked this question to a lot of my classmates and most people dont know and the rest are definite on their answers (not to mention they all vary on their answers).

Which of the lymphomas/Leukemias produce Pancytopenia and/or Leukopenia?

My guess/understanding:

ALL: Pancytopenia and leukopenia/blasts (very ACUTE over crowds myeloid cells and differentiation block for lymphocytes).

AML: Pancytopenia and leukopenia (same reasons as above..very ACUTE over crowds myeloid cells and differentiation block for lymphocytes).

CLL: Pancytopenia and leukocytosis (crowds out myeloid cells but bc of chronicity there is no differentiation block--> increased leukocytes that are dysfunctional)

CML: Trilinear hyperplasia and leukopenia (same logic as above but in reverse: myeloid cell hyperplasia(though dsyfunctional) and crowds out leukocytes)..

PLEASE tell me if I m correct or incorrect; everyone in my class seems to be confused about this.

Thanks

 

[NRAI2001]

With the Acutes (ALL, AML) will you see blasts for the respective condition with cytosis of the other lineage??

Ex:
AML = myeloblasts with leukocytosis

ALL = myelocytosis with leukoblasts??


I know (pretty sure) with CML eventually (late stage) you will get fibrosis of the BM due to the fibroblasts/megakaryocytes--> blast crisis (mimics AML).

Please correct me if my terminology or logic or WHATEVER is incorrect...I feel like the more details I learn the more of the big picture I forget...

 

[fahimaz7]

Go to the NCCN guideline page. It will tell you what the criteria is for the diagnosis of CLL, AML, CML, etc.

Blasts can be seen in the peripheral in either disease and the % that is seen is important in the diagnosis. You don't see pancytopenia, but you do end up with thrombocytopenia, anemia, and leukocytosis (can vary widely depending on the disease and stage).

For example, we have a CLL patient with a WC of 120,000 and platlets of 158. Apparently, we are not so worreid about his WC count, but we are worried about his disease due to his slow drop in platlet production. When he first came for treatment (he's been heavily treated before), his WC's were 58,000 and his platlets were ~230.

Remember that a lot of our drugs are poisons and they are going to wipe these cells out. I've seen grown men drop from 200,000 platlets to 6,000 in a week, post-treatment.

AML and CML can have reticulin fibrosis in the bone marrow. The difference is the peripheral blast %age and a few other small factors. If you have t(9,22) and >20% blasts then....

This is the kind of information on nccn.org: