Hematology

• Chronic Lymphoproliferative Disorders


  • Chronic Lymphocytic Leukemia
  • Pro-Lymphocytic Leukemia
  • Hairy Cell Leukemia
• Chronic Lymphocytic Leukemia


  • Predominant cell: Dormant B-cells (cannot produce antibodies)
  • Less likely to undergo blastic transformation (chronic- acute)
  • Chronic Granulocytic L- can undergo blastic T.
  • Autoimmune Hemolytic Anemia- hemolysis (presence of autoantibodies)
• Autoantibodies


  Cell antibodies, can react with RBC> Complement activated= HEMOLYSIS (decreased RBC count)
• Other Signs and Symptoms of Chronic Lymphocytic Leukemia

  • Lymphadenopathy (enlargement of lymph nodes)
  • Splenomegaly (enlargement of spleen why= hemolysis)
  • Hepatomegaly
  • Pruritus- skin infection caused by Herpes zoster
• Reason for skin infection in Chronic Lymphocytic Leukemia

  No antibodies
• Lab Findings for Chronic Lymphocytic Leukemia

  • Lymphocyte count: 10-150x 10^9/L
  • PBS: predominant of SMUDGE cells(T cells)
  • Hypogammaglobulinemia (decreased antibodies)
• Prognosis for Chronic Lymphocytic Leukemia

  1. 4 years
• Treatment for Chronic Lymphocytic Leukemia

  Leukapheresis (transfusion of granulocytes as well as WBC) and regular injection with IgG (additional AB)
• Hairy Cell Leukemia/ Lymphocytic Reticuloendotheliosis

  • Affected cell: B-cells
  • Pancytopenia (increased in all blood cells)
  • Splenomegaly- Splenectomy (removal of spleen)
• Characteristics of Hairy Cell Leukemia

  • 40-60 yrs old (Males 4x more prone)
• TRAP


  Tartrazine Resistant Acid Phosphatase
• Acid Phosphatase


  Common seen in prostate (seminal fluid)
• Pro-Lymphocytic Leukemia


  • Predominant cells: prolymphocytes
  • Increase promyelocytes
• Prognosis for Pro-Lymphocytic Leukemia

  < 1 year
• Other Lymphocytic Neoplasms


  • Infection/viruses
• Burkitt's Lymphoma


  • EBV and HIV
  • Translocation of c-myc on chromosome region
• Mycosis Fungoides and Sezary Syndrome

  • Different stages of a single neoplastic disorder (neoplastic: new cells(abnormal))
  • T-helper cell (lymphatic tissues) – skin
  • Skin: parakeratosis
  • Pautrier's microabscesses (lymphocyte clusters)
  • Lymph node: Sezary cells
  • Band-like infiltrates
• Plasma cell


  B lymphocytes (ANTIBODIES)
• Multiple Myeloma


  • Plasma cell Dysfunctional
  • 50% of IgG
  • 20% of IgA
  • 15% of lambda and gamma chain
  • Abnormal protein (BENCE JONES PROTEINS) not excreted = tends to accumulate; present in 80% of MM px
• How to know if there are BJP in the urine

  Test for solubility (heat at 60-80C= will form precipitate) 150C- DISSOLVE
• Hyaline cast


  First cast that will form, made up of uromodulin/Tamm–Horsfall protein
• Types of chains in Multiple Myeloma

  • Light chain (lambda, gamma), gamma chain
• Increased Protein


  RBC form roulex formation
• ESR


  Elevated/ Increased
• Flame cells


  With reddish tinge of ribosomal proteins (IgA)
• Dutcher bodies


  Intranuclear crystalline structures (IgG)
• Russel Bodies


  Accumulations of IgG
• Grape cell/Mott cell, Morula cell


  Plasma cell that contains small colorless/ blue/ pink globules
• Plasma Cell Leukemia


  >2x10^9/L plasma cell count
• Waldenstroms Macroglobulinemia


  • Increase production of IgM (>3 g/dL); Increase protein= Rouleux formation= Increase ESR
• Heavy Chain Disease


  • Abnormal synthesis (Gamma(IgG) or Alpha(IgA))
• Causes of Lymphoma


  • Infections (part. HIV/EBV)
  • Enlargement of the lymph nodes
• Signs and Symptoms of Hodgkin's Lymphoma

  • Fever
  • Night sweats or 10% weight loss in 6 months (it can be both)
  • Leukocytosis
  • Lymphocytopenia
• Leukocytosis


  Increased in all WBC
• Lymphocytopenia


  Decrease lymphocytes
• Prognosis of Hodgkin's Lymphoma with Lymphocytopenia

  Poor prognosis
• Diagnosis of Hodgkin's Lymphoma


  Lymph node biopsy (histopath) – presence of REED- STERNBERG CELL (lacunar histiocytes)
• Reed-Sternberg cell


  Giant multi/binucleated cell- hallmark finding for Hodgkin's lymphoma
• Ann Harbor Staging System for Hodgkin's Lymphoma

  • I-IV (locate region of lymph nodes)
  • A(no symptom) or B(presence of symptom (suffix)
  • E (extra lymphatic involvement- organs affected) or S(spreading) (subscripts)
• Stage 1 Hodgkin's Lymphoma

  • Single lymph node is affected (axillary area)