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Heme Exam 2
Cell Cycle Phases
Characteristics
G0 Phase
Growth Arrest
G1 Phase
G1 Check By Rb And p53
S Phase
DNA Mismatch Repair
DNA Synthesis
G2 Phase
G2 Check
M Phase
Mitosis And Cytokinesis
3 mins
Acute Lymphoblastic Leukemia (ALL)
Ages < 15
May Present with Bone Marrow Involvement in Children
Mediastinal Mass in Adolescents
TdT Positive
CALLA Positive
t(12;21) Better Prognosis
Spread to CNS and Testes
Most Responsive to Chemotherapy
2 mins
Acute Myelogenous Leukemia (AML)
Myeloblasts Increase on Peripheral Smear
Median Onset 60 Years
T 15;17 M3 Subtype
Auer Rods
Disseminated Intravascular Coagulation (DIC) is a Common Presentation
M5 Gum Infiltration
Responds to Vitamin A
3 mins
Chronic Lymphocytic Leukemia (CLL)
Signs and Symptoms
Age > 60 Years
B Cell Neoplasm
Smudge Cells
Often Asymptomatic
Cold IgM Autoimmune Hemolytic Anemia
Warm IgG Autoimmune Hemolytic Anemia
Richter's Transformation
3 mins
Chronic Myelogenous Leukemia (CML)
Pathophysiology
BCR-ABL
9;22 Translocation
Philadelphia Chromosome
Signs & Symptoms
Tyrosine Kinase
Low Alkaline Phosphatase
Splenomegaly
Considerations
Blast Crisis
Age 30 to 90 Years
Responds to Imatinib
3 mins
Follicular Lymphoma
Derives from Germinal Center
Occurs in adults
T14;18
BCL 2 overexpression
BCL 2 inhibits apoptosis
Indolent
Generalized lymphadenopathy
Bone marrow involvement
2 mins
Burkitt's Lymphoma
Adolescents or young adults
C-myc gene moves next to heavy chain Ig gene
T 8;14
Starry sky appearance
Sheets of lymphocytes with interspersed macrophages
Jaw lesion in endemic (African) form
Pelvis or abdomen in non endemic form (American form)
Associated with EBV
2 mins
Diffuse Large B Cell Lymphoma
Epidemiology
Most Common Non-Hodgkin’s Lymphoma
Usually in Older Adults
20% in Children
Features
May be Mature T Cell in Origin
Derives from Germinal Center
GI Tract and Brain
2 mins
Hairy Cell Leukemia
Pathophysiology
Mature B Cell Tumor
Signs and Symptoms
Splenomegaly
Diagnosis
Flow Cytometry
Cells Have Filamentous Hair-Like Projections
Stains TRAP Positive
Dry Tap on Bone Marrow Aspiration
Treatment
Cladribine
Pentostatin
2 mins
Mantle Cell Lymphoma
Older Males
Activation of Cyclin D Gene
T 11;14
CD5
Poor Prognosis
55 secs
Adult T Cell Lymphoma
Caused by HTLV 1
Japan, West Africa, Caribbean
Present with cutaneous lesions
Aggressive
1 min
Mycosis Fungoides / Sézary Syndrome
Mechanism
Neoplastic CD4+ Cells
Adults 40 - 60 Years Old
Mycosis Fungoides
Neoplastic CD4+ Cells Infiltrate Skin
Rashes Or Plaques
Pautrier's Abscesses
Sézary Syndrome
Neoplastic CD4+ Spread from Skin to Systemic Involvement
Sézary Cells With "Cerebriform Nuclei"
2 mins
Non-Hodgkin's Lymphoma Assessment
Cause
Lymphatic Cancer
Non-Contiguous Spread
B or T Cells
Assessment
Painless Lymphadenopathy
Constitutional B Signs
Night Sweats
Fever
Weight Loss
Mediastinal or Abdominal Mass
Considerations
Older Adults
> 60 Subtypes
2 mins
Leukemia Assessment
Cause
Immature WBCs
Assessment
Recurrent Infections
Easy Bruising
Bleeding
Anemia
Fatigue
Weight Loss
Bone Pain
Considerations
May Have Normal or High WBC Count
2 mins
Leukemia Interventions
Diagnosis
Bone Marrow Aspiration
X-Rays
Interventions
Chemotherapy
Bleeding Precautions
Neutropenic Precautions
Strict Asepsis
Bone Marrow Transplant
Blood Transfusions
Monitor Temperature Elevations
Adequate Nutrition
Imatinib (Gleevec) for Chronic Myelogenous Leukemia (CML)
Failure to Develop Third and Fourth Pharyngeal Pouches
Signs and Symptoms
Undeveloped Thymus
T Cell Deficiency
Recurrent Viral and Fungal Infections
Undeveloped Parathyroids
Hypocalcemia
Tetany
Aortic Defects
Congenital Heart Defects
Diagnosis
Absent Thymic Shadow on CXR
2 mins
Hyper IgM Syndrome
Pathophysiology
Deficient CD40 Ligand on Helper T-cells
Defective CD40 Receptor on B-cells
Inability to Class Switch
Signs and Symptoms
Pyogenic Abscess
Decreased IgG, IgA, IgE
4 mins
Common Variable Immunodeficiency
Pathophysiology
Defect in B Cell Maturation
Decreased Plasma Cells
Decreased Immunoglobulins
Signs & Symptoms
Sinopulmonary Infections
Increased Risk of Autoimmune Disease
Lymphoma
1 min
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