Leukemia, Questionnaire Example

List the 3 leukocyte categories on the basis of function.

• Granulocytes, monocytes, lymphocytes

List the 5 leukocyte categories on the basis of morphology

• Monocytes, Neutrophils, Lymphocytes, Eosinophils, Basophis

Describe the cell population and functions of the following WBC developmental compartments:

1. 1. Proliferative pool-consists of myeloblasts, progranulocytes, and myelocytes. They are undergoing cell division
   2. Maturation-Storage pool- consists of metamyleoytes, band neutrophils, and segmented neutropjols. They no longer undergo cell division
   3. Marrow reserve-storage pool of mature neutrophil pools that can be released as necessary
   4. Circulating pool-consists of neutrophils freely flowing in the vasculature, measured on a CBC
   5. Marginating pool-consists of neutrophils that are rolling along and loosely adhered to endothelial surfaces via adhesion proteins (selectins)

Define the following terms:

1. 1. CSF- Cerebral Spinal Fluid- is a clear colorless bodily fluid found in the brain and spine
   2. CFU-Colony-Forming Unit that is an estimate of viable bacterial or fungal numbers

List in order the WBC maturation series (cells) from the most immature to most mature stages – indicate which cells are able to undergo mitosis and how long each cell spends in the bone marrow.

• myeloblast (undergo one cell division) promyelocyte, myelocyte, metamyelocyte. Band or stab, segmenter, Each cell doesn’t spend very long as they are expelled through the spleen.

Describe the basic differences between a macrophage and a monocyte in morphology and function.

• macrophages are wbc within tissues that are produced by the division of monocytes, and monocytes are the largest of the leucocytes, and are large kidney shaped. They function is to act in non-specific defense and defense mechanisms of vertebrate animals.

List the normal or reference ranges of each WBC in a normal adult.

• NORMAL RANGES –. ADULT MALE. FEMALE. CBC. WBC. 3.6 – 11.0 K/UL. 3.6 – 11.0. RBC. 4.5 – 5.9 M/UL. 4.5 – 5.9. HEMOGLOBIN.

Describe the well-documented variations or situations observed that cause fluctuations or variations in the following WBC:

1. 1. Neutrophils-make up 55-70% of wbc, found around infections not completely segmented with four granules
   2. Monocytes-produced in myelo-monocytic stem cells, biggest among WBC.
   3. Eosinophils-2-5% of total wbc, outside blood vessels in organs

Describe the basic steps of phagocytosis, including the basic goal of phagocytosis.

• Unbound phagocyte surface receptors do not trigger phagocytosis. 2. Binding of receptors causes them to cluster. 3. Phagocytosis is triggered and the particle is taken up by the phagocyte. To remove pathogens and cell debris.

Name the 2 major WBCs that are associated/ responsible for phagocytosis.

• Macrophage, phagocytes

Describe the basic differences in function of a fixed vs wandering macrophage.

• Fixed-relatively immotile macrophage found in connective tissue, Wandering- travels throughout the blood stream

Describe the functions and locations of the following, relevant to their roles in the inflammatory response/ diapedesis.

1. 1. Sialyl-Lewis^x – s a tetrasaccharide carbohydrate that is usually attached to O-glycans on the surface of cells. It is known to play a vital role in cell-to-cell recognition processes
   2. L-selectin- is a cell adhesion molecule found on lymphocytes and the preimplantation embryo.
   3. Integrin- are a large family of heterodimeric transmembrane glycoproteins that attach cells to extracellular matrix proteins of the basement membrane
   4. E-selectin- is expressed on inflamed endothelial cells in response to treatment with inflammatory cytokines

Define sepsis and list the features of sepsis- is an illness in which the body has a severe response to bacteria or other germs. This response may be called systemic inflammatory response syndrome (SIRS).

• Infection starts in the bloodstream, bones, kidney, etc. Symptoms: chills, delirum, shaking, skin rash

List at least 3 enzymes produced by neutrophils and briefly describe their targets

• Azurophilic-first granules formed in neutrohphil , specific or secondary released within seconds of contact with pathogen Myeloperoxidase (MPO) respiratory system.

State 1 enzyme produced by monocytes and list its target-matrix metalloproteienases (mmp), contribute to atherosclerotic arterial wall remodeling and to plague rupture

List at least 2 specialized functions of the following cells:

1. 1. Eosinophils-can destroy cancer cells and secrete substances which help to stop chemicals that mediate infections and also assist the body by performing phagocytosis
   2. Basophil-they help release chemical mediators that cause allergic symptoms and thus play a vital role in the allergic responses.
   3. Monocytes-are one of the major white cells that protect the body from infection and prevent microorganisms from entering the bloodstream.

For the following laboratory assays, state the basic principle of each test.

1. 1. Total WBC count-determines the number of white blood cells present in the blood. It helps identify whether the number of white blood cells is high or low.
   2. Differential Blood Smear Eval- A peripheral blood smear is often used as a follow-up test to abnormal results on a complete blood count (CBC). It may be used to help diagnose and/or monitor numerous conditions that affect blood cell populations
   3. Absolute cell counts- laboratory method that is based on the microscopic evaluation of a patient’s cells from a blood smear
   4. ESR-stands for erythrocyte sedimentation rate. It is commonly called a “sed rate.” It is a test that indirectly measures how much inflammation is in the body
   5. Basophil count- This test measures the amount of basophils in blood. This test is used to help evaluate and manage treatments
   6. Eosinophil Count- This test counts the number of eosinophils (a type of white blood cell) in blood. It is used to evaluate and manage allergic conditions, blood and infectious diseases
   7. LAP Test- Leukocyte alkaline phosphatase is a test that tells how much of a protein called alkaline phosphatase (ALP) you have inside your white blood cells
   8. Neutrophilic Function Test- helps us detect the levels of neutrophils in our body. These neutrophils are an integral part of our immune system and through a process called chemotaxis
   9. Neutrophilic Hypersegmentation Index- inexpensive blood test can confirm your folate levels

Ch 15 Objectives

List 4 ways in which leukocyte counts can be increased

• Eating a healthy, well balanced diet, increasing the intake of zinc, getting regular exercise and sufficient sleep

List at least 4 ways in which leukocyte counts can be decreased

• Infection, allergies, medications, diet

For the following morphological abnormalities of leukocytes, describe the appearance of cells and list the associated conditions or diseases in each,if any.

1. 1. Toxic Granulation- changes in granulocyte cells seen on examination of the peripheral blood film of patients with inflammatory conditions. Manifested by the presence of large granules in the cytoplasm of segmented and band neutrophils in the peripheral blood.
   2. Dohle bodies- are light blue-gray, oval, basophilic, leukocyte inclusions located in the peripheral cytoplasm of neutrophils.
   3. Hypersegmentation- one of the three granular leukocytes having a nucleus with three to five lobes connected by threads of chromatin, and cytoplasm containing lysosomes
   4. Pelger-Huet anomaly-All granulocytes (neutrophils, eosinophils, basophils) have hyposegmented nuclei -Nuclei are band to oval-shaped with a mature appearing chromatin pattern, inherited abnormality of neutrophils
   5. May Hegglin anomaly- also known as Dohle leukocyte inclusions with giant platelets and macrothrombocytopenia with leukocyte inclusions, rare, inherited, blood platelet disorder
   6. Chediak-Higashi syndrome-characterized by large eosinophilic cytoplasmic inclusions (lysosome fusion) -Neutrophil function is somewhat abnormal,
   7. Alder-Reilly inclusions- associated with the genetic mucopoly- saccharidoses. a rare autosomal recessive disorder in which the basic defect involves protein-carbohydrate complexes called mucopolysaccharides
   8. Ehrlichia- is a genus of rickettsiales bacteria. They are transmitted by ticks. obligately intracellular pathogens and are transported between cells through the host cell

Describe the consequences of defective locomotion and chemotaxis

• Serve in defense against microorganisms, their response are associated with increased susceptibility to infectious disease

Explain 2 defects in microbicidal activity

• Phagocytosis, Disorders of Oxygen-Dependent Microbicidal Activity

List and describe the functional anomalies of neutrophils

• Neutrophils shelter the body against disease and infections by removing and destroying bacteria, microbes, viruses, foreign substances, and other cells. These cells play a vital role by absorbing any invading microbes that try to enter the bloodstream.

Describe the following diseases, specifically noting the WBC affected.

1. 1. Gaucher disease- a genetic disease in which a fatty substance (lipid) accumulates in cells and certain organs. Autosomal recessive inherited disorder of metabolism where a type of fat (lipid) called glucocerebroside cannot be adequately degraded.
   2. Niemann-Pick disease- ne of a group of lysosomal storage diseases that affect metabolism and that are caused by genetic mutations, They stop the body from making an enzyme, acid sphingomyelinase.

Describe the role of lymphocytes and plasma cells in the body defense mechanism against disease.

• These immune lymphocytes are activated and function to neutralize or destroy the invading foreign substance cells are strategically located in areas that come in close contact with foreign substances.

Name and locate the 2 primary and 3 secondary lymphoid tissues.

• Bone Marrow, Thymus (Where lymphocytes develop and mature into immunocompotent cells) -Mucosa-associated, Lymph Nodes, Spleen (defense against specific antigens builds up)

Explain the importance of lymphocyte recirculation.

• Naïve lymphocytes enter lymph nodes from the blood circulation. Continuous lymphocyte recirculation between blood and lymphoid organs is a fundamental element of the immune system

State the percentage of T and B cells found in the peripheral circulation of adults.

• 25 to 33 percent

State the major type and percentage of leukocytes found in 6 month old infants

• Neutrophils 40 to 60 percent

Compare the normal percentages and quantities of lymphocytes at different ages ranging from birth to adulthood.

• Adults are 4 percent, infants are 20 to 40 %

State at least 3 conditions associated with specific lymphocytic abnormalities in the blood.

• Lymphocytosis, lymphocytopenia, luekemias

Describe the major roles of plasma cells.

• Upon interaction with foreign antigen and usually with the assistance of T helper cells, B lymphocytes become mature antibody secreting cells. Plasma cells are rarely found in the circulation but reside mostly in connective tissue (lamina propria) beneath epithelia, in the medullary cords of lymph nodes and in the white pulp of the spleen.

Ch 17

Define lymphocytosis, stating the actual numbers (relative % and absolute numbers), as compared to the normal ranges of lymphocytes in an adult.

• 20 to 40% actual circulation, Lymphocytosis is an increase in the number or proportion of lymphocytes in the blood. Greater than 40%

For the following diseases (infectious mononucleosis, CMV infection, Toxoplasmosis, acute infectious lymphocytosis), and Bordetella Pertussis infection) discuss the following:

• causative agent or etiology
• infection caused by Epstien Barr virus (spread through saliva)
• viral genus of the viral family known as Herpesviridae or herpesviruses
• a parasitic disease caused by the protozoan Toxoplasma gondii
• benign relative and absolute increase in the number of mature lymphocytes
• a Gram-negative, aerobic coccobacillus capsulate of the genus Bordetella

Individuals most at risk

• contact sports,
• through saliva, HIV, etc.
• cats, contact with raw meat
• found in children
• children

Clinical signs and symptoms, specifically noting the incubation period.

• 8 Weeks, fever, fatigue, sore throat, swollen lymph nodes
• fatigue, swollen glands, fever
• acute toxoplasmosis (flu-like)
• latent toxoplasmosis (forming cysts in nervous tissue)
• whooping cough, German measles
• 7-14 days, whooping cough

Important hematological laboratory data associated

• increase in a particular type of mononuclear white blood cells (lymphocytes) in the bloodstream relative to the other white blood cells as a result of the EBV infection
• associated through salivary glands
• determined by brain biopsy, affected lymph nodes
• increase in lymphocyte levels
• the toxin, known as pertussis toxin (or PTx), inhibits G protein coupling that regulates an adenylate cyclase-mediated conversion of ATP to cyclic AMP.

Important serological data, if applicable, specifically noting important antibody titer parameters for affected individuals.

• individuals with antibodies against EB are immune to further infection
• viral genome encodes multiple proteins that interfere with MHC class I presentation of viral antigens
• seropositive for IgG antibodies against T. gondii
• none
• none

Define lymphocytopenia ,stating the actual numbers (relative % and absolute numbers), as compared to the normal ranges of lymphocytes in an adult.

• condition of having an abnormally low level of lymphocytes in the blood, lymphocyte level below 1,500 cell, normal lymphocyte count for adults usually is between 1,000 and 4,800

For the following diseases (DiGeorge Syndrome, HIV/AIDS, and Systemic Lupus Erythematosus or SLE) discuss the following:

1. 1. Whether or not the disease is acquired or inherited – 1) inherited 2) acquired 3) acquired
   2. Causative agent, if applicable-1) genetic deletions in one of two 22 chromosomes 2) retrovirus 3) systemic autoimmune disease
   3. Specific signs and symptoms-1) abnormal facies, thymic aplasia, cleft palate 2) flu-like, mononucleosis like illness 3) fever, malaise, joint pains, myalgias
   4. Important laboratory data, hematological – specific T or B cells affected.- lack of T-Cell mediate response is absent 2) T cell count below 200 cells per µL 3) is a retrovirus that primarily infects components of the human immune system such as CD4+ T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. 3) Low platelet and white blood cell counts may be due to the disease or a side effect of pharmacological treatment.
   5. Important serological markers associated (antibody titers)- 1) none 2) low 3) Autoantibodies to nRNP A and nRNP C initially targeted restricted, proline-rich motifs. Antibody binding subsequently spread to other epitopes.

Ch 18

Compare and contrast the characteristics of leukemia, lymphoma, and myeloma in terms of predominant cell type observed and site of malignant cell production

• The main difference between these types of cancers is that ALL mainly affects the bone marrow and the blood, and may spread to other places, while lymphomas mainly affect the lymph nodes or other organs and then may spread to the bone marrow/ lymphomas are larger than the other two

Compare and contrast acute vs chronic leukemia in terms of symptoms, duration, cell forms in the bone marrow and peripheral blood, and observed WBC counts.

• acute develops from immature forms of lymphocytes and cannot mature properly, chronic cells mature partially but not completely. Acute, too much of a certain wbc, chronic has increase in abnormal wbc

Compare and contrast the leukemia classifications, namely the FAB and WHO.

• FAB; French American British divided in subtypes M0 through M7 based on cell type and maturity of cells, WHO: World Health Organization divides AML in to broad groups such as genetic abnormalities, multilineage dysplasia, etc. WHO uses some of FAB but differ on cases of AML

List some risk factors associated with the occurrence of leukemias and lymphomas.

• spread to the rest of the body (major organs) exposed to large amounts of radiation, chemicals such as benzene, smoke, genetic problems.

Define (and include in the definition their roles in leukemia/lymphoma) the following:

1. 1. Oncogenes- a gene that, when mutated or expressed at high levels, helps turn a normal cell into a tumor cell. (cancerous tumor)
   2. Protooncogenes- normal gene that can become an oncogene due to mutations or increased expression, luekemia caused by translocation of proto-oncogenes
   3. Tumor Suppressing Genes- anti-oncogene, is a gene that protects a cell from one step on the path to cancer. When this gene is mutated to cause a loss or reduction on its function that can progress to cancer

Describe at least 2 viral agents that are associated with an increased incidence of leukemia/ lymphoma.

• human T-lymphotrophic virus, retroviruses, acute hepatitis

List causes associated with secondary leukemia.

• development of acute myeloid leukemia formed from myelodysplasia, after exposure to environmental or therapeutic toxins or radiation

State the most common type of leukemia observed in children 0 to 14 years of age

• acute myelogenous leukemia

State the most common type of leukemia observed in adults greater than 60 years old

• chronic lymphocytic leukemia

State the age range at which people develop myeloma.

• Patients older than 60

Ch 19

Describe the general characteristics of acute leukemia in terms of symptoms, hematological parameters (blood counts), age ranges most affected, and prognosis.

• is cancer that starts inside bone marrow, the soft tissue inside bones that helps form blood cells, bleeding from the gums, fever, bone pain, children 2-5, too many wbc, if not treated can get worse

Describe the FAB classification of acute leukemia, noting the predominant cells observed in peripheral blood, age range affected, and significant clinical signs and symptoms, hematological parameters (blood counts), and prognosis.

1. 1. L1-Small, monomorphic acute lymphoblastic leukemia
   2. L2-large, heterogeneous acute lymphoblastic leukemia
   3. L3-Burkitt-cell type acute lymphoblastic leukemia
   4. M0- Undifferentiated acute myeloblastic leukemia
   5. M1- Acute myeloblastic leukemia with minimal maturation (best AML prognosis)
   6. M2- Acute myeloblastic leukemia with maturation
   7. M3- Acute promyelocytic leukemia (APL)
   8. M4- Acute myelomonocytic leukemia
   9. M5- Acute monocytic leukemia
   10. M6- Acute erythroid leukemia (early forms of rbc)
   11. M7- Acute megakaryoblastic leukemia(cells that make platelets)

Describe the significance of the following biochemical markers associated with leukemia:

1. 1. TdT- s a specialized DNA polymerase expressed in immature, pre-B, pre-T lymphoid cells, and acute lymphoblastic leukemia/lymphoma cells
   2. cALLA antigen- a 749-amino acid type II integral membrane protein expressed by most acute lymphoblastic leukemias, certain other lymphoid malignancies with an immature phenotype, and normal lymphoid progenitors.
   3. Philadelphia (Ph) chromosome t(9;22)- s a specific chromosomal abnormality that is associated with chronic myelogenous leukemia (CML). It is the result of a reciprocal translocation between chromosome 9 and 22, and is specifically designated t(9;22)(q34;q11).

Describe the principle of the following cytochemical stains (paying special attention to what they are used for):

1. 1. Sudan black B- is a nonfluorescent, relatively thermostable lysochrome diazo dye used for staining of neutral triglycerides and lipids on frozen sections and some lipoproteins on paraffin sections
   2. MPO- distinguishes between the immature cells in acute myeloblastic leukemia (cells stain positive) and those in acute lymphoblastic
   3. Periodic acid-Schiff (PAS)- is a staining method used to detect polysaccharides such as glycogen, and mucosubstances such as glycoproteins, glycolipids
   4. Naphthol AS-D chloroacetate esterase- Known as the Leder stain, naphthol AS-D chloroacetate is enzymatically hydrolyzed by specific esterase. used in the differentiation and classification of acute leukaemias (AL) according to the FAB
   5. Alpha-naphthyl acetate-butyrate esterase with fluoride inhibition-staining process used in detecting hairy cells in human, bovine, and canine through the use of brownish red granules.
   6. Leukocyte alkaline phosphatase (LAP)- is a test that tells how much of a protein called alkaline phosphatase (ALP) you have inside your white blood cells
   7. Acid phosphatase with or without tartaric acid inhibition- The TRAP stain is primarily used to identify hairy cell leukemia cells. These cells stain with purple to dark red

List and describe the most common life- threatening emergencies confronting patients with acute leukemia.

• if not treated, would probably be fatal within a few months. They can then spread to other parts of the body, including the lymph nodes, liver, spleen, central nervous system (brain and spinal cord), and testicles (in males),