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Lab Dx: Myeloproliferative, meylodisplastic, leukemias, lymphomas, plasma cell dyscrasias

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4 Meyloproliferative disorders
Polycythemia vera
Meylofibrosis
Essential primary thrombocytopenia
Chronic Myelogenous Leukemia
Meyloproloferative disorders: unifying concepts
Clonal expansion from pleuripotent stem cell
Multiple cell lines usu affected though can be just one
Idiopathic
Polycythemia vera: Etiology/incidence
increased Hgb and RBC mass
60 year old median onset
Relative PV
Low plasma volume
EPO Normal
Secondary PV
"Reactive PV"
Hypoxia, smoking, altitude, lung Dz
EPO Increased
Primary PV (vera)
Malignant
Not self limiting
Tx = phlebotomy
Significant increases in all formed elements
EPO Decreased
When do we consider PV in the Dx?
Hct > 52% (18g/dl) in white males
47% (16g/dl) in AA population and females
Also when RBC, WBC, Platelets are all high with splenomegaly
PV: Diagnostic criteria
Last slide
Increased uric acid
EPO low or undetectable
RBC > 6 million/mm3
Hypercellular BM
RBC survival time decreased by 25%
What is the PB picture for PV?
Immature WBC's
Immature RBC with POIK/ANISO
May see DACROCYTES, microcytes, elliptocytes
Thrombocytosis, neutrophilia
Define Meyloid Metaplasia
Extramedullary hematopoiesis
Cells are formed in the liver and spleen
Define Meylofibrosis
Bone marrow that becomes fibrotic
Leads to difficulty making cells
What is the PB for Meylofibrosis?
Normo/normo
Mild poik/polychromatophilia
NRBC's (nucleated RBC's)
DACROCYTES
WBC's: leukocytosis
Platelets: THROMBOCYTOPENIA (late)
Distinguish primary thrombocytopenia
Idiopathic platelet count above 500,000/microL
--Above in the absence of other meyloproliferative disorder features
Clinical presentation for Meylodysplastic Syndrome
Sxs nonspecific.
Fatigue, weakness, anorexia, weight loss, abd fullness.
CBC for MDS:
MACROCYTIC ANEMIA
THROMBOCYTOPENIA
Monocytosis and up to 5% blasts
Define Leukemia
Malignant neoplasms of the blood-forming tissues.
Uncontrolled proliferation of a malignant clone and eventual marrow replacement with that line

Leukemic cells increase dt decreased reate of apoptosis
Acute Lymphocytic Leukemia: ALL
T-ALL: adolescents
B-ALL: <4 yo

LYMPHOBLASTS common in smear
More than 30% blasts in the smear usually means:
Leukemia
Always do what in ALL
BM Exam
Acute Myelogenous Leukemia: AML
MEYLOblasts in PB

-> AUER RODS
Chronic Meylocytic Leukemia: CML
Philadelphia Chromosome
ABSOLUTE EOS/BAS increased!!

Age 20-50, rare in kids
Platelets high in 60%, low in 10%
Chronic Lymphocytic Leukemia: CLL
Middle age and older
LOW Platelets
WBC 20-150,000: mature lymphocytes
CLL DX is made by what factor?
Sustained ABSOLUTE lymphocytosis of >5000/ul for longer then 6mo
Refer to a hematologist when:
You see any blast cell on a PB smear!!
Hodgkin's Dx:
Reed Sternberg cells in LN biopsy
Slight to moderate neutrophilia
Lymphocytopenia
Eosinophilia in 20%

Micro/Hypo in advanced disease
Contiguous LN spread
What exacerbates Hodgkin's?
Booooooze
Define NHL:
Clonal proliferation of lympoid cells in LN, BM, Tonsils, slpeen, liver, GI
Features of NHL:
Anemia present in 30%
Non-contiguous spread
LN biopsy
Lab findings: Multiple Meyloma
RBC's Rouleaux
-> ESR elevated >100 mm/hr
55% make IgG
40% Bence Jones proteinuria

Anemia: Normo/normo
Waldenstrom's Labs:
Clonal expansion of IgM secreting plasma cells.
Cryoglobulins, RHfactor, cold agglutinins

Hx Raynauds
IgG or IgA?
Multiple Meyloma
IgM?
Waldenstrom's