Leukemia Case Studies: Acute and Chronic Leukemias
Continuing Education Credits
Objectives
- Explain the theory of hematopoiesis, including the different characteristics of the hematopoietic stem cells, the names of the progenitor cells, and the lineage association.
- Define leukemia and discuss the pathophysiology of leukemias.
- Compare and contrast acute and chronic leukemias.
- Discuss cytochemical stains and their appropriate use.
- Describe the flow cytometry technique in identifying hematologic malignancies and identify key cell populations with immunophenotyping that are associated with acute and chronic leukemias.
- Describe the major WHO classes of acute myeloid leukemia (AML) and differentiate the leukemias by cytogenetic abnormalities.
- Interpret the results of diagnostic tests, including peripheral blood smears, cytochemical staining patterns, immunophenotyping, and cytogenetic analysis, and correlate the findings to a particular leukemia.
Course Outline
- Introduction to Leukemia
- Introduction to Leukemia Case Studies: WHO Classification 2022
- Introduction to Leukemia Case Studies
- Hematopoiesis Theory
- All of the following cells originate from the myeloid cell line except:
- Definition and Pathophysiology of Leukemia
- What Causes Leukemia?
- Predominant Types of Leukemia
- Acute and Chronic Leukemia
- Chronic Leukemias
- Acute Leukemias: Myeloid Cell Line
- Select all of the following ways acute leukemias are classified based on the WHO 2022 classification system.
- Acute Leukemias: Lymphoid Cell Line
- Which classification of leukemia is described as a rapid proliferation of immature cells that crowd out the bone marrow with the presence of >20% blasts, which can be a diagnostic feature?
- Laboratory Tests to Differentiate Leukemias
- Differentiating Leukemias Based on Testing
- Principle Uses of Cytochemical Stains
- Types of Cytochemical Stains
- Introduction to Immunophenotyping by Flow Cytometry
- Immunophenotyping by Flow Cytometry Principle
- Cluster of Differentiation Markers
- What CD marker is commonly present on B lymphocytes?
- Cytogenetic Analysis (Karyotyping)
- Other Types of Cytogenetic Diagnostic Tests for Leukemias
- Introduction to Case Studies
- Case 1: 12-Year-Old Child with Fever, Bruising, and Chest Pain
- Clinical Presentation
- Initial Laboratory and X-Ray Findings
- Interpretation of Laboratory and X-Ray Results
- Additional Testing: Cytochemical Staining
- Additional Testing: Immunophenotyping
- Based on the results of the cytochemical stains from the patient, which were MPO negative and block positive with PAS, what type of cells are present in the patient's blood?
- Which CD marker is a T cell marker that can be present in T-cell ALL?
- Diagnosis and Discussion
- Case 2: 60-Year-Old with Marked Leukocytosis, Basophilia, and Eosinophilia
- Clinical Presentation
- Initial Laboratory Findings
- Interpretation of Laboratory Results
- Additional Laboratory Testing
- Additional Testing: LAP Stain
- Additional Testing: Flow Cytometry and FISH Studies
- Which of the following stains could help differentiate the disorder based on the left shift and the high WBC count present?
- What cytogenetic abnormality must be present to confirm the diagnosis of CML?
- Diagnosis and Discussion
- Case 3: 21-Year-Old with a History of Gingival Bleeding
- Clinical Presentation
- Initial Laboratory Findings
- Interpretation of Laboratory Results
- Confirmatory Testing: Cytogenetic Analysis
- What cells are primarily seen in this image?
- What coagulopathy can acute promyelocytic leukemia with PML::RARA cause that is a medical emergency?
- Diagnosis and Discussion
- Case 4: 66-Year-Old with a 3-Month History of Persistent Fatigue
- Clinical Presentation
- Initial Laboratory Tests
- Interpretation of Laboratory Results
- Confirmatory Testing: Immunophenotyping
- Confirmatory Testing: Cytogenetic Analysis
- Identify the cells the arrows are pointing to in the image.
- Which of the CD marker combinations is commonly associated with CLL?
- Diagnosis and Discussion
- References
- References
Additional Information
Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists, medical laboratory technicians, laboratory supervisors, and laboratory managers. This course is also appropriate for MLS and MLT students and pathology residents.
Author Information: Autumn Vela, MHA, MLS(ASCP)CMSHCM, is a Clinical Assistant Professor in the Medical Laboratory Science (MLS) program at Texas State University in San Marcos, TX. She teaches a variety of courses within the program, with a particular passion for Hematology. Autumn earned her Bachelor of Science in Medical Laboratory Science from George Washington University and her Master of Healthcare Administration from Texas Tech University. She is certified by the ASCP as a Medical Laboratory Scientist and as a Specialist in Hematology. With over 12 years of experience in the field, she has held multiple roles, including serving as a multi-site laboratory manager, before transitioning to an academic role.
The author has no conflict of interest to disclose.
Reviewer Information: Valerie F. Jalicke, MS, MLS(ASCP)CMPBTCM, received her Bachelor of Science and Master of Science in Bioscience Technologies from Thomas Jefferson University in Philadelphia, PA. She currently serves as Program Director and Clinical Assistant Professor in the Medical Laboratory Science program at Thomas Jefferson University. She has over 30 years of experience as a medical laboratory scientist with a heavy focus on hematology, clinical chemistry, and urinalysis and body fluids.