Question 1

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

Accepted Answer

MPO (myeloperoxidase) is a marker for myeloid cells, while SBB (Sudan Black B) is a marker for both myeloid and monocytic cells. NSE (neuron-specific enolase) is not lineage-specific, but its presence in a bone marrow sample could suggest the presence of leukemic cells with neuroendocrine features. Overall, the positive staining for MPO and SBB suggests involvement of myeloid and monocytic lineages.

Question 2

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?

Accepted Answer

The presence of 32% blasts in the WBC count is indicative of acute leukemia (AL), as acute leukemias are characterized by a high percentage of immature white blood cells (blasts) in the blood or bone marrow.

Question 3

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.
-What is the most likely diagnosis?

Accepted Answer

The presence of t (15, 17) and hyper leukocytosis with a predominance of promyelocytes and blasts is strongly indicative of acute promyelocytic leukemia (APL). APL is a subtype of acute myeloid leukemia (AML).

Question 4

The FAB classification nomenclature for acute leukemia also appears under which WHO classification group?

Accepted Answer

The FAB classification is incorporated into the WHO classification under the group "AML not otherwise categorized," which includes subtypes that align with the older FAB system.

Question 5

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?

Accepted Answer

The positive nonspecific esterase stain suggests a monocytic lineage, as this stain is typically positive in monocytic cells.

Question 6

Predict the typical platelet concentration of a patient with AML.

Accepted Answer

Patients with acute myeloid leukemia (AML) often have a marked decrease in platelet concentration, which is a common symptom of the disease.

Question 7

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

Accepted Answer

The erythrocyte morphologic picture in patients with AML is variable and can include normocytic normochromic, microcytic hypochromic, and macrocytic normochromic. It depends on the underlying cause of the anemia in the specific patient. Therefore, all options are possible and the best choice is D, which includes all of them.

Question 8

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?

Accepted Answer

A positive PAS stain with coarse granularity is a characteristic finding in acute erythroleukemia. In this disease, abnormal erythroblasts accumulate glycogen, which reacts positively with the PAS stain. Other leukemias may also show a positive PAS reaction, but the coarse granularity seen in this case makes erythroleukemia the most likely diagnosis.

Question 9

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.
-Which of the following laboratory findings would be most consistent with this clinical picture?

Accepted Answer

Auer rods are cytoplasmic inclusions that are characteristic of acute myeloid leukemia (AML). They are composed of a protein called myeloperoxidase, which is a marker of myeloid differentiation. In this case, the patient has AML with a t(15,17) translocation, which is associated with the presence of Auer rods.

Question 10

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

Accepted Answer

According to the WHO classification, to differentiate myelodysplastic syndromes from acute leukemia, the blasts must be less than 20% in myelodysplastic syndromes and greater than or equal to 20% in acute leukemia. Auer rods and fibrosis are not specific to acute leukemia and blast count close to 100% is suggestive of acute leukemia but not necessary for differentiation from myelodysplastic syndromes.

Question 11

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?

Accepted Answer

CD33 is a marker commonly expressed on myeloblasts and is used to help identify acute myeloid leukemia. This patient's bone marrow findings and cytogenetic analysis are consistent with acute promyelocytic leukemia, which typically expresses CD33. HLA-DR is not typically expressed on AML cells and is not a useful marker in this case. CD35 is a marker for complement receptor 1 and is not typically expressed on AML cells. CD8 is a marker for cytotoxic T lymphocytes and is not typically expressed on AML cells.

Question 12

The presence of which of the following findings with a blast of unknown lineage confirms that the lineage is myeloid?

Accepted Answer

Auer rods are rod-shaped inclusions found in the cytoplasm of myeloid blast cells, particularly in acute myeloid leukemia (AML) or other myeloproliferative disorders. Therefore, the presence of Auer rods in a blast of unknown lineage confirms that the lineage is myeloid. The other choices (toxic granulation, leukocytosis, basophilia) are not specific for myeloid lineage determination.

Question 13

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

Accepted Answer

The M:E ratio is typically increased in patients with AML due to myeloid hyperplasia.

Question 14

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?

Accepted Answer

Auer rods are needle-like inclusions seen in the cytoplasm of myeloblasts, which are characteristic of acute myeloid leukemia (AML). They are composed of fused primary granules from abnormal granulocytic precursors. Therefore, the observation of such inclusions in the blood smear of an AML patient indicates the presence of the disease.

Question 15

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

Accepted Answer

CD13 and CD33 are myeloid markers, while CD19, CD20, and CD22 are lymphoid markers.

Question 16

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?

Accepted Answer

The presence of 35% blasts on a peripheral blood smear is indicative of acute leukemia. Blasts are immature blood cells that are not typically present in the peripheral blood of a healthy individual. The high percentage of blasts suggests that there is abnormal proliferation of immature cells in the bone marrow, leading to a deficiency of normal blood cells in the circulation.

Question 17

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

Accepted Answer

Biphenotypic leukemia is characterized by a blast population with both myeloid and lymphoid markers on the same cell. AML with multilineage dysplasia, mixed lineage leukemia, and AML not otherwise categorized may have some features of biphenotypic leukemia but do not fit the complete criteria for it.

Question 18

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

Accepted Answer

The answer of All of the following AML subtypes have...

Question 19

A patient presents with a morphological smear examination revealing greater than 20% blasts with prominent granules and ++ Auer rods, MPO, and Sudan Black 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 categorized, does this picture fall?

Accepted Answer

The presence of both granules and Auer rods suggests a myeloid origin. The high blast count (greater than 20%) and the presence of monocytes in the peripheral smear indicate acute leukemia. The absence of recurrent cytogenetic abnormalities rules out a specific subtype, such as acute promyelocytic leukemia. Therefore, this presentation falls under the umbrella category of acute myeloid leukemia, not otherwise categorized, and specifically under the subtype of acute myelomonocytic leukemia.

Question 20

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

Accepted Answer

The distinction between the FAB classification and the WHO classification is based on the percentage of blasts in the bone marrow or peripheral blood. The FAB classification is based on the percentage of blasts, while the WHO classification incorporates additional factors such as genetic abnormalities and cell morphology.

Quiz 23: Acute Myeloid Leukemias

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

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?

The FAB classification nomenclature for acute leukemia also appears under which WHO classification group?

Predict the typical platelet concentration of a patient with AML.

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

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?

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

The presence of which of the following findings with a blast of unknown lineage confirms that the lineage is myeloid?

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

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?

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

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?

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

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

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

Quiz 23: Acute Myeloid Leukemias

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

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?

The FAB classification nomenclature for acute leukemia also appears under which WHO classification group?

Predict the typical platelet concentration of a patient with AML.

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

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?

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

The presence of which of the following findings with a blast of unknown lineage confirms that the lineage is myeloid?

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

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?

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

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?

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

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

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

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

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?