46y female WBC=62.000\ul Hb=16.1g% Normal indices Plat.=255000/ul Leokocytosis Neutrophilia Imm NE 1...
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Transcript of 46y female WBC=62.000\ul Hb=16.1g% Normal indices Plat.=255000/ul Leokocytosis Neutrophilia Imm NE 1...
77איכילוב איכילוב 27.02.200827.02.2008
46y female
WBC=62.000\ul
Hb=16.1g%
Normal indices
Plat.=255000/ul
LeokocytosisNeutrophiliaImm NE 1Imm NE 2
Flags:
77איכילוב איכילוב 27.02.200827.02.2008
תאי בלסט, גרנולציה ציטופלסמטית עדינהגרעינוןגרנולציהChediak-Higashi like granules
77איכילוב איכילוב 27.02.200827.02.2008
NRBCNRBChypochromiahypochromia
תאים אדומים100 טסיות בשדה של כ-7סטייה שמאלה
77איכילוב איכילוב 27.02.200827.02.2008
Ring neut. , dohle bodiesDysplastic myeloid cell
Dysplastic changes
77איכילוב איכילוב 27.02.200827.02.2008
Manual differential:
Blast 56%
Myelocyte 3%Metamy 5%St 8%Neut 11%Eos 1%Bas 1%
Plasma 1%
Mon 1%
Lymph 9%Prolymph 5%
NRBC 1\100
Leftshift
Leukoerythroblastic changes
תפיסת מח העצם
+
Dysplastic changesCytoplasmic granulation
AML with dysplasia
77איכילוב איכילוב 27.02.200827.02.2008
הממצאים הראויים לציון:
בלסטים
טרומבופניה
שינויים דיספלסטיים
נוכחות נורמובלסטים
שינויים לויקואריתרובלסטיים
77איכילוב איכילוב 27.02.200827.02.2008
0
10
20
30
40
50
60
70
80
90
102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
blast
AVERAGE
AVERAGE+2SD
AVERAGE-2SD
77איכילוב איכילוב 27.02.200827.02.2008
-10
-5
0
5
10
15
20
102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
NRBC
AVERAGE
AVERAGE+2SD
AVERAGE-2SD
77איכילוב איכילוב 27.02.200827.02.2008
FAB Name
Approximate % of adult AML
patientsPrognosis compared to average for AML
M0Undifferentiated acute myeloblastic leukemia
5%Worse
M1Acute myeloblastic leukemia with minimal maturation
15%Average
M2Acute myeloblastic leukemia with maturation
25%Better
M3Acute promyelocytic leukemia10%Best
M4Acute myelomonocytic leukemia20%Average
M4 eos
Acute myelomonocytic leukemia with eosinophilia
5%Better
M5Monocytic leukemia10%Average
M6Acute erythroid leukemia5%Worse
M7Acute megakaryoblastic leukemia
5%Worse
M0M0
M1M1
M2M2
M3M3
FAB Name
Approximate % of adult AML
patientsPrognosis compared to average for AML
M0Undifferentiated acute myeloblastic leukemia
5%Worse
M1Acute myeloblastic leukemia with minimal maturation
15%Average
M2Acute myeloblastic leukemia with maturation
25%Better
M3Acute promyelocytic leukemia10%Best
M4Acute myelomonocytic leukemia20%Average
M4 eos
Acute myelomonocytic leukemia with eosinophilia
5%Better
M5Monocytic leukemia10%Average
M6Acute erythroid leukemia5%Worse
M7Acute megakaryoblastic leukemia
5%Worse
M0M0
M3M3
M4M4
FAB Name
Approximate % of adult AML
patientsPrognosis compared to average for AML
M0Undifferentiated acute myeloblastic leukemia
5%Worse
M1Acute myeloblastic leukemia with minimal maturation
15%Average
M2Acute myeloblastic leukemia with maturation
25%Better
M3Acute promyelocytic leukemia10%Best
M4Acute myelomonocytic leukemia20%Average
M4 eos
Acute myelomonocytic leukemia with eosinophilia
5%Better
M5Monocytic leukemia10%Average
M6Acute erythroid leukemia5%Worse
M7Acute megakaryoblastic leukemia
5%Worse
M6M6
M7M7
Acute Myeloid Leukemia With Characteristic Genetic Abnormalities
Acute Myeloid Leukemia With an FLT3 Mutation
Acute Myeloid Leukemia With Multilineage Dysplasia
Acute Myeloid Leukemias and Myelodysplastic Syndromes, Therapy-Related
Acute Myeloid Leukemia Not Otherwise Categorized
Acute Leukemias of Ambiguous Lineage
All categories of FAB
AML with t(8;21)(q22;q22), (AML1/ETO)
AML with inv(16)(p13q22) or t(16;16)(p13;q22(,)CBFb/MYH11)
Acute promyelocytic leukemia (AML with t(15;17)(q22;q12(,)PML/RARa and variants(
tyrosine kinase receptor
expressed in a variety of cells:
myeloid and B-lymphoid lineage cells
The expression of FLT3 is restricted to early bone marrow progenitor cells expressing CD34+
(fms-like tyrosine kinase receptor-3 (Flt3), fetal liver kinase-2 (Flk2)
(CD135)
FLT3 contains a Juxtamembrane domain (JM)
that functions to inhibit the kinase activity.
Mutations in this domain,
cause a helical conformation that distorts the
small lobe of the kinase domain and blocks the
JM domain from performing its "autoinhibitory" function.
Internal tandem duplications (ITD)Or
Activating loop mutation
Mutations in the FLT3 receptor - in ~30% of patients with AML, This is the single most commonly mutated gene in AML - poor prognosisThese mutations may play a role in the survival or proliferation of leukemic blasts. Although FLT3 mutations may play a role in the disease process,FLT3 is not sufficient to cause AML, Additional mutation required to present with full diseas
Therapeutic impotrtance
Comparison of overall survival of significant disease groups in the World Health Organization classification. P < .001.
88מכבי מכבי 27.02.200827.02.2008
31.10.0731.10.0722.10.0722.10.07
3.23.25.95.9WBCWBC
3.743.743.873.87RBCRBC
10.110.110.610.6HBHB
31.431.432.732.7HctHct
84848484MCVMCV
272727.427.4MCHMCH
32.232.232.432.4MCHCMCHC
13.413.413.713.7RDWRDW
278278222222PLTPLT
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88מכבי מכבי 27.02.200827.02.2008
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33.833.846.846.8NeutNeut%.%.
1100110027002700ANCANC
56.956.934.534.5LymphLymph%%
1800180020002000ALCALC
7.57.516.716.7MonMon%%
20020010001000AMCAMC
0.90.91.71.7EosEos%%
100100AECAEC((00)מכשיר=)מכשיר=1818
0.90.90.30.3basobaso
ABCABC((00)מכשיר=)מכשיר=1717((00 )מכשיר= )מכשיר=33תהליך שגרם להופעת מונוציטוזיס בשלב ראשון שחלפה ופנתה מקום להופעת נויטרופניה
זיהום וירליזיהום חיידקי מסוים
88מכבי מכבי 27.02.200827.02.2008
31.10.0731.10.0722.10.0722.10.07
64mm/h64mm/h90mm/h90mm/hESRESR
CMVIgGCMVIgGחיוביחיובי
CMVIgMCMVIgMשלילישלילי
Past Past infectioninfection
EBV AbEBV Ab..
88מכבי מכבי 27.02.200827.02.2008
0
2
4
6
8
10
12
14
dohle bodies תאים אפופטוטייםוהרוסים
borrelia
מעבדות ציינו נוכחות בורליה17מתוך 1323.5%הרבה
מחלה זיהומית
נגרמת ע"י חיידק הבורליה spirocheteחיידק מסוג ספירוכטה
Ixodesמועבר ע"י עקיצת קרציה מסוג
Borrelia burgdorferi
flu-like symptoms in its initial stage
Musculoskeletal
Arthritic
Neurologic
Psychiatric
cardiac
doxylin
99אסף הרופא אסף הרופא 27.02.0827.02.08
88y female
Hb=11.6g%, normal indicesRDW=16 flag: anisocytosis
WBC=67700/ulMono 73.7%AMC=49900/ul
Plat.=373000/ul
ANC=7200/ulALC=10300/ul
99אסף הרופא אסף הרופא 27.02.0827.02.08
Manual differential:
Villous lymphocytes 87%Villous lymphocytes 87%
Mon 1%
neut 12%
99אסף הרופא אסף הרופא 27.02.0827.02.08
99אסף הרופא אסף הרופא 27.02.0827.02.08
0%
20%
40%
60%
80%
100%
102104105107108109112113114117119120121124125129130
ציינו נוכחות תאים שעירים101,112,114,129מעבדות
HCLHCLMZLMZL
pancytopeniapancytopenialymphocytosislymphocytosis
PB: Monocytopenia, few PB: Monocytopenia, few hairy cellshairy cells
PB: Many villous PB: Many villous lymphocyteslymphocytes
splenomegalysplenomegalysplenomegalysplenomegaly
BM dry tapBM dry tapReplaced, hypercellu. BMReplaced, hypercellu. BM
Mature B cellsMature B cellsPost germinal centerPost germinal center
B cells, unknown degree B cells, unknown degree of differntiationof differntiation
CD25+, CD103CD25+, CD103++CD5CD5--
Cyclin D1Cyclin D1--Cyclin D1Cyclin D1++
Cyclin-dependent kinases (CDK)
group of protein kinases
regulation of the cell cycle.
regulation of transcription and mRNA processing.
serine/threonine kinases.
t(11;14)(q13;q32)
1010מכבי מכבי 27.02.0827.02.08
22y female
Hb=10.9g% normal indicesRDW=17.5
WBC=3700/ul ANC=1190/UL, ALC=2010/UL FLAG: IMMATURE GRANUKOCYTES
PLAT.=147000\UL
Esr=34/h
1010מכבי מכבי 27.02.0827.02.08
WBC=3700/ulNeut 23%(ANC=851)St 6%Myelo 3%Meta 1%Bas 2%Lymph 36%Prolymph 3%Mon 4%Atyp 2%Blast 20%
Manual differential:
No narrowAuer cytoplasmrods
Left shift
1010מכבי מכבי 27.02.0827.02.08
ממצאים ראויים לציון:בלסטים
סטיה שמאלהתאי דמעה
ALLקרוב לודאי ALLאיפיון אימונולוגי – סקירה קצרה על
T cell?
1010מכבי מכבי 27.02.0827.02.08
1010מכבי מכבי 27.02.0827.02.08
0
5
10
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20
25
30
35
102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
blast
AVERAGE
AVERAGE+2SD
AVERAGE-2SD
1010מכבי מכבי 27.02.0827.02.08
-2
0
2
4
6
8
10
12
14
16
18
20
22
102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
myelo+metamy stab promyelo
AVERAGE
AVERAGE
AVERAGE
AVERAGE+2SD
AVERAGE+2SD
AVERAGE+2SD
AVERAGE-2SD
ALL is most common in childhood and young adulthood Peak incidence at 4-5 years of age,
Another peak in old age .
The overall cure rate in children is 85%,
PrognosisCytogenetic findings
FavorableHyperdiploidy > 50 ; t (12;21)
Intermediate
Hyperdioloidy 47 -50;Normal(diploidy);
del (6q);Rearrangements of 8q24
Unfavorable
Hypodiploidy-near haploidy;Near tetraploidy;
del (17p);t (9;22);t (11q23)
Cytogenetic translocationMolecular genetic abnormality
t(9;22)(q34;q11)BCR-ABL fusion(P185
t(12;21)CRYPTICTEL-AML1fusion
t(1;19)(q23;p13E2A-PBX fusion
t(4;11)(q21;q23MLL-AF4 fusion
t(8;14)(q24;q32IGH-MYC fusion
t(11;14)(p13;q11TCR-RBTN2 fusion
The FAB classification:
ALL-L1: small uniform cells
ALL-L2: large varied cells ALL-L3: large varied cells with vacuoles(Burkitt like)
WHO proposed classification of acute lymphoblastic leukemia
TypesFAB ClassTdtT cell B cell c Igs Ig
Precursor BL1,L2+-+-/+-
Precursor TL1,L2++---
B-cellL3--+-+
WHO proposed classification of acute lymphoblastic leukemia
1 -Acute lymphoblastic leukemia/lymphoma Former Fab L1/L2
i. Precursor B acute lymphoblastic leukemia/lymphoma Cytogenetic subtypes:
Hyperdiploidy > 50 t(12;21)(p12,q22) TEL/AML-1
t(1;19)(q23;p13) PBX/E2A t(9;22)(q34;q11) ABL/BCR T(V,11)(V;q23) V/MLL
ii. Precursor T acute lymphoblastic leukemia/lymphoma
2 -Burkitt's leukemia/lymphoma Former FAB L3
3 -Biphenotypic acute leukemia