Deck 26: Acute Myeloid Leukemias

Question 1

Questions 2-4: Use this case to answer the following questions:
A 45-year-old female was evaluated by her physician because she had unexplained bruising on her upper torso.Patient history was unremarkable.Physical examination revealed a palpable liver and spleen.CBC results revealed:
WBC count: 12 × 10⁹/L
Hb: 8.7 g/dL
Hct: 25%
Normal indices
PLT count: 5 × 10⁹/L
Differential: 80% blasts and 15% promyelocytes present
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

Answer 1

CD33

Question 2

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?

A)Acute myelomonocytic leukemia
B)Acute erythroleukemia
C)Acute megakaryoblastic leukemia
D)AML with minimal differentiation

Answer 2

Acute erythroleukemia

Question 3

According to the WHO classification,when differentiating myelodysplastic syndromes and acute leukemia,acute leukemia's:

A)Blasts must be >20% in the bone marrow.
B)Blasts must be >20% in the bone marrow and contain Auer rods.
C)Bone marrow must contain fibrosis.
D)Blast count is close to 100%.

Answer 3

Blasts must be >20% in the bone marrow.

Question 4

A laboratory professsional reviewed the CBC of a patient who had a WBC count of 5 × 103/μL with 32% blasts present.Follow up testing with cytogenetics revealed t(15;17) ( q22;q12).Which of the following is a likely diagnosis for the patient?

A)APL
B)MDS
C)MPN
D)CLL

Question 5

A bone marrow sample is sent to the lab for cytochemical staining.MPO,SBB,and nonspecific esterase (NSE)have been ordered.Staining results come back as follows: MPO: positive SBB: positive NSE: positive
Based on these findings,what lineage(s)is(are)most likely affected?

A)Myeloid and monocytic
B)Lymphoid
C)Erythroid
D)Monocytic

Question 6

A laboratory professional is reviewing a peripheral blood smear of a 10-year-old patient and notes that 35% blasts are present.Which of the following diagnoses is likely based on these findings?

A)Myelodysplastic syndrome
B)Acute leukemia
C)Chronic myeloid leukemia
D)Aplastic anemia

Question 7

All of the following AML subtypes have positive reactivity with myeloperoxidase stain except:

A)Acute monocytic leukemia
B)AML with maturation
C)Acute erythroid leukemia
D)AML minimally differentiated

Question 8

Questions 2-4: Use this case to answer the following questions:
A 45-year-old female was evaluated by her physician because she had unexplained bruising on her upper torso.Patient history was unremarkable.Physical examination revealed a palpable liver and spleen.CBC results revealed:
WBC count: 12 × 10⁹/L
Hb: 8.7 g/dL
Hct: 25%
Normal indices
PLT count: 5 × 10⁹/L
Differential: 80% blasts and 15% promyelocytes present
Bone marrow findings: hypercellular marrow with 47% myeloblasts present.Nucleated erythroblasts: 22%;promyelocytes: 28%;megakaryopoiesis appears normal.
Cytogenetic analysis: t(15,17)present.
Which of the following laboratory findings would be most consistent with this clinical picture?

A)Multiple Auer rods in leukemic cells
B)Positive reactivity with PAS stain
C)CD4-positive cells
D)Swollen lymph nodes

Question 9

A 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?

A)Myeloid
B)Lymphoid
C)Monocytic
D)Erythroid

Question 10

A laboratory professional notes single azurophilic needlelike inclusions in the cytoplasm of many of the circulating blasts while reviewing a blood smear of an AML patient.What is the most probable identification of the inclusion?

A)Toxic granulation
B)Uric acid crystals
C)Döhle bodies
D)Auer rods

Question 11

Which of the following confirms that a blast of unknown lineage is myeloid?

A)Toxic granulation
B)Leukocytosis
C)Auer rod
D)Basophilia

Question 12

Which of the following differentiates an AL and an MPN?

A)The cells in an MPN are dysplastic,but morphology is normal in an AL.
B)Patients present with leukocytosis and mostly mature cells in AL,whereas blasts predominate in MPNs.
C)MPNs are defined by a bone marrow blast count of at least 20%.
D)A defining characteristic of ALs is that the cell of origin acquires the ability to proliferate continuously and demonstrates arrested development.

Question 13

The M:E ratio of a patient with AML typically displays which of the following?

A)Myeloid hyperplasia
B)Erythroid hyperplasia
C)Both myeloid and erythroid hyperplasia
D)Nothing

Question 14

Which of the following does not fall into the category of AML as defined by the WHO classification?

A)AML with recurrent genetic abnormalities
B)Therapy-related myeloid neoplasms
C)Refractory anemia with excess blasts
D)Myeloid proliferations related to Down syndrome

Question 15

Which of the following cell markers differentiate AML from ALL?

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

Question 16

Predict the typical platelet concentration of a patient with AML.

A)Marked decreased
B)Marked increased
C)Normal
D)Cannot be determined

Question 17

A patient presents with a morphological smear examination revealing >20% blasts with prominent granules and Auer rods,MPO,and SBB positive.A 25% monocyte count was seen in the peripheral smear.There were no recurrent cytogenetic abnormalities observed.Under which classification of acute leukemia,not otherwise specific,does this diagnosis fall?

A)Acute myeloblastic leukemia without maturation
B)Acute myelomonocytic leukemia
C)Acute erythroid leukemia
D)Acute panmyelosis with myelofibrosis

Question 18

Which acute leukemia is characterized by a blast population with both myeloid and monocytic markers on the same cell?

A)AML with multilineage dysplasia
B)Acute myelomonocytic leukemia
C)Acute monoblastic and monocytic leukemia
D)AML with an MDS-related cytogenic abnormality

Question 19

Questions 2-4: Use this case to answer the following questions:
A 45-year-old female was evaluated by her physician because she had unexplained bruising on her upper torso.Patient history was unremarkable.Physical examination revealed a palpable liver and spleen.CBC results revealed:
WBC count: 12 × 10⁹/L
Hb: 8.7 g/dL
Hct: 25%
Normal indices
PLT count: 5 × 10⁹/L
Differential: 80% blasts and 15% promyelocytes present
Bone marrow findings: hypercellular marrow with 47% myeloblasts present.Nucleated erythroblasts: 22%;promyelocytes: 28%;megakaryopoiesis appears normal.
Cytogenetic analysis: t(15,17)present.
What is the most likely diagnosis?

A)AML without maturation
B)AML minimally differentiated
C)APL
D)AMML

Question 20

How is erythrocyte morphology likely to be described in patients with AML?

A)Normocytic normochromic
B)Microcytic hypochromic
C)Microcytic normochromic
D)Variable with anisocytosis

Question 21

An acute leukemia patient presents with blast morphology that is of neutrophil lineage with Auer rods and pseudo-Pelger-Huët nuclei,myeloperoxidase,and Sudan Black B.Cytogenetic analysis reveals a t(8;21) ( q22;q22)translocation in the majority of the blasts.Which classification of AML best fits this morphology,immunophenotyping,and cytochemistry?

A)AML not otherwise categorized
B)AML with multilineage dysplasia
C)AML with recurrent genetic abnormalities
D)AML,therapy-related

Question 22

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

Question 23

A patient presents with acute leukemia with blasts identified by a positive CD34,CD13,and CD33.Less than 3% of the blasts stain positive for MPO and SBB.Which category of AML is the most likely diagnosis for this patient?

A)AML minimally differentiated
B)AML without maturation
C)Acute myelomonocytic leukemia
D)Acute erythroid leukemia

Question 24

An APL patient has been undergoing ATRA therapy for the last 5 weeks.A repeat bone marrow and cytogenetic analysis is 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 patient's status?

A)The patient is in remission.
B)The patient has relapsed.
C)The patient has undergone engraftment.
D)The patient has undergone partial engraftment.

Question 25

Patients with acute myelomonocytic leukemia are at higher risk of infection compared with individuals with acute myelocytic leukemia with differentiation.Explain why there is a higher risk of infection in patients diagnosed with acute myelomonocytic leukemia.

Question 26

Which of the following markers are positive for monoblasts?

A)HLA-DR
B)CD33
C)CD14
D)All of the above

Question 27

Traditional therapy in APL includes pharmacological concentration of retinoic acid (ATRA)and chemotherapy.What is the function of the chemotherapy component in this treatment protocol?

A)Induces maturation of the promyelocytes to mature granulocytes
B)Binds with the target PML/RARA gene and represses gene transcription
C)Eradicates the leukemic stem cells
D)Induces cytolysis of the malignant promyelocytes

Question 28

The WHO classification system of AML incorporates which of the following?

A)Morphology of the proliferating cells
B)Immunophenotyping
C)Cytogenetic analysis
D)All of the above

Question 29

A patient presents with 25% blasts (nonerythroid),34% monocytic cells,and 31% granulocytic cells in the bone marrow.The peripheral blood smear has 10% monocytes.The alpha-naphthyl esterase and chloroacete esterase are positive.What is the probable diagnosis based on these findings?

A)Acute monocyte leukemia
B)Acute monoblastic leukemia
C)Acute myelomonocytic leukemia
D)Acute erythroid leukemia

Question 30

Questions 9 and 10: Use the following case to answer these questions:
A 57-year-old male was admitted to the hospital with suspicion of AML.Preliminary CBC results show a high WBC count with 47% blasts present.Cytochemical staining shows negative reactions with MPO,SBB,and NSE.Platelet peroxidase staining was positive.Immunophenotyping was also ordered.
Predict the results of the immunophenotyping panel based on the information already given.

A)Positive reactions with CD13,CD33,and CD34
B)Positive reactions with CD41,CD42,and CD61
C)Positive reactions with HLA-DR and CD13
D)Positive reactions with CD11b and CD14

Question 31

A patient presents with bleeding and is found to be in DIC.The peripheral smear contains hypergranular promyelocytes.The white count is slightly elevated.The bone marrow contains cells with multiple Auer rods with a clear blue cytoplasm.What is the probable type of AML?

A)AML with 11q23 abnormalities
B)AML with t(15;17)q22;q12)
C)Microgranular APL variant
D)AML with multilineage dysplasia

Question 32

Why are Auer rods seen only in myeloblasts?

Question 33

Explain how bone marrow analysis helps establish an AML diagnosis.

Question 34

Questions 9 and 10: Use the following case to answer these questions:
A 57-year-old male was admitted to the hospital with suspicion of AML.Preliminary CBC results show a high WBC count with 47% blasts present.Cytochemical staining shows negative reactions with MPO,SBB,and NSE.Platelet peroxidase staining was positive.Immunophenotyping was also ordered.
What is the most likely diagnosis?

A)Acute erythroid leukemia
B)Acute megakaryoblastic leukemia
C)AML with maturation
D)AML minimally differentiated

Question 35

What is the definition of acute leukemia,according to the World Health Organization?