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Exam 23: Acute Myeloid Leukemias

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Question 21

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Use this case to answer the following questions: A 45-year-old female sees her physician because of unexplained bruising on her upper torso. The physician takes a history, and nothing remarkable is noted. Physical examination reveals a palpable liver and spleen. CBC results reveal a platelet count of 5,000/µL and WBC count of 12,000/µL with 80% blasts and 15% promyelocytes present. Additional CBC findings include: Hgb: 8.7 g/dL and Hct: 25% normal indices. Bone marrow findings: hypercellular marrow with 47% myeloblasts present. Nucleated erythroblasts: 22%; promyelocytes: 28%; megakaryopoiesis appears normal. Cytogenetic analysis: t (15, 17) present. -Flow cytometry has also been ordered on this patient.Which of the following markers will stain positive in this case?

A) HLA-DR
B) CD35
C) CD33
D) CD8

E) B) and C)
F) A) and B)

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Question 22

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Which of the following cell markers will differentiate AML from ALL?

A) CD10, CD19, CD20, and CD 22
B) CD2, CD3, CD5, and CD7
C) HLA-DR, CD34, and CD7
D) CD13, CD33, CD19, CD20, CD22, CD10, CD2, CD3, CD5, CD7.

E) C) and D)
F) All of the above

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Question 23

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The distinction between the FAB classification and the WHO classification is based on which of the following?

A technologist is reviewing a CBC on a new admission.The patient has a WBC count of 5 x 10³/µL with 32% blasts present.From what is the patient most likely suffering?

A technologist is reviewing a peripheral blood smear of a 10-year-old patient.She notices that 35% blasts are present on the patient's smear.What can you conclude from these findings?

A technologist is reviewing a blood smear of an AML patient.She notices single azurophilic needle-like inclusions in the cytoplasm of many of the circulating blasts.What is the most probable identification of the inclusion?

A PAS stain is ordered on a leukemic patient.The test is performed, and the technologist confirms that the PAS stain is positive with coarse granularity.Based on these findings, from what is the patient most likely suffering?

What is the typical erythrocyte morphologic picture in patients with AML?

An APL patient has been undergoing ATRA therapy for the last 5 weeks.A repeat bone marrow and cytogenetic analysis are performed at the end of the treatment cycle.Bone marrow shows no evidence of leukemic cells, and cytogenetic anomalies were not detected.Based on this information, what is the status of the patient?

According to the WHO classification, what must be true to differentiate myelodysplastic syndromes from acute leukemia? In acute leukemia:

Which of the following markers are positive for monoblasts?

Explain how bone marrow analysis helps establish an AML diagnosis.

Bone marrow review on a 15-year-old girl with acute leukemia revealed many blasts with the following characteristics: high N:C ratio, prominent nucleoli, open chromatin pattern, and basophilic cytoplasm.Cytochemical staining revealed negative reactivity with MPO and SBB.Nonspecific esterase was positive.No cytogenetic abnormalities were detected.What is the most likely lineage of the blast cells in question?

List the common cytochemical stains used in the detection of AML, and predict their results in AML.

Compare and contrast WHO and FAB classification systems of AML.