MMSC 433 EXAM 3 QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

MMSC 433 EXAM 3 QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 chronic myeloid leukemia (CML) chromosomal abnormality - Answers Philadelphia chromosome (~95% of cases) polycythemia vera (PV) chromosomal abnormality - Answers JAK2V617F mutation (most cases) chronic myeloproliferative disorders - Answers -chronic myeloid leukemia (CML) -polycythemia vera (PV) -essential thrombocythemia (ET) -primary myelofibrosis (PMF) -chronic neutrophilic leukemia (CNL) -chronic myelomonocytic leukemia (CMML) -juvenile myelomonocytic leukemia (JMML) polycythemia vera major criteria (WHO) - Answers -hemoglobin 16.5 g/dL (men), 16 g/dL (women) -Hct 49% (men), 48% (women) -increased RCM 35 mL/kg (men), 31 mL/kg (women) -BM biopsy with hypercellularity and panmyelosis -presence of JAK2V617F or JAK2 Exon 12 mutations polycythemia vera minor criteria (WHO) - Answers subnormal serum EPO levels chronic myeloid leukemia (CML) - Answers -etiology: a single genetic translocation in a pluripotent hematopoietic stem cell causes clonal overproduction of immature neutrophils, usually diagnosed between age 45-55 -chromosomal abnormality: Philadelphia chromosome -morphology: myeloblasts, promyelovytes, bands, segmented neutrophils (all stages of neutrophil development) seen in the peripheral blood, nRBCs present, *gaucher-like macrophages present*, very small megakaryocytes present -symptoms: infections with Strep pneumoniae, anemia, bleeding, splenomegaly -PB: RBCs normal to inc, retics normal, total WBCs increased, granulocytes increased (neutrophils, basophils, eosinophils), PLTs normal to inc, *LAP stain decreased* -BM: hypercellular, increased granulopoiesis, decreased erythropoiesis, megakaryopoiesis increased, reticulin fibers increased chronic myeloid leukemia (CML) stages - Answers chronic phase (3-4 years) → accelerated phase → blastic phase → possible transition to acute leukemia (poor prognosis) chronic myeloid leukemia (CML) treatments - Answers -BM transplant or SCT= CURE -*gleevec* (imatnib mesylate) -sprycel, dasigna, bosulib, iclusig polycythemia vera (PV) - Answers -etiology: neoplastic clonal stem cells mature independently of EPO stimulation, causing panmyelosis with a predominate increase in erythrocytes (grans and PLTs can be increased too) -Chromosomal abnormality: JAK2V617F mutation -morphology: N/N RBCs, teardrop cells (dacrocytes) present -symptoms: triad of BM fibrosis, splenomegaly and anemia w/ teardrop cells (dacrocytes) -lab findings: Hgb/ Hct/ RCM increased, low serum EPO levels -PB: RBCs increased, total WBCs increased, granulocytes increased, PLTs increased, *LAP stain normal to inc.* -BM: hypercellular, normoblasts (immature RBCs) increased, granulocytes increased, megakaryocytes increased, reticulin fibers increased polycythemia vera (PV) treatments - Answers -therapeutic phlebotomy: bring Hct ≤45% -hydroxyurea -busulfan -JAK inhibitors: Ruxolitinib, Lestaurtinib essential thrombocythemia (ET) - Answers -etiology: clonal myeloproliferative neoplasm leading to increased megakaryopoiesis and thrombocytosis -chromosomal abnormality: JAK2V617F most common, CALR and MPL mutations also common (others possible: MPL W515L/K, TET2, ASX1, LNK, IDH1/2) -morphology: giant, agranular platelets, platelet clusters, RBCs are N/N -symptoms: vascular occlusion in digits, veins & arteries, splenomegaly, erythromyelalgia (throbbing/ burning in hands and feet) -PB: *increased PLT count* (≥450*10⁹/L) , Hgb/Hct slightly decreased, RBC count normal, total WBCs normal to inc, segmented neutrophils increased, *platelet function decreased* -BM: hypercellular, increased megakaryocytes, large/ variably sized megs with hyperlobulated/ dense nuclei, clusters of megs, mainly proliferation of megakaryocytes is seen, erythropoiesis increased, *reticulin fibers normal to mildly inc.* essential thrombocythemia (ET) treatments - Answers -hydroxyurea -JAK2 inhibitors: Ruxolitinib, Lestaurtinib -low dose aspirin (prevents thromboses) primary myelofibrosis (PMF) - Answers -etiology: splenomegaly and ineffective hematopoiesis caused by hypercellularity, fibrosis and increased megakaryocytosis of the bone marrow -chromosomal abnormality: JAK2V617F most common (also possible: MPL W515L/K, CBL, TET2, ASXL1, LNK, EZH2, IDH1/2) -morphology: tear drop cells (dacrocytes), nRBCs, anisocytosis, poikilocytosis, polychromasia, abnormal platelets and micromegakaryocytes present -symptoms: fatigue, pruritis (itching), bone pain, palpitations, night sweats, splenomegaly, hepatomegaly -Lab findings: Hgb normal to decreased -PB: normoblasts (immature RBCs) increased, immature granulocytes increased, total WBCs variable, PLT count variable, megakaryocytes present, LAP stain variable -BM: *INTENSE fibrosis* (lots of reticulin and collagen fibers), hypercellular, increased granulocytes and megakaryocytes, erythropoiesis and myelofibrosis increased, sinuses increased, dysmegakaryopoiesis and dysgranulopoiesis present -*dry tap on bone marrow aspiration due to extent of fibrosis* primary myelofibrosis (PMF) treatments - Answers -hydroxyurea -JAK2 inhibitors: Ruxolitinib, Lestaurtinib -CYT387 -TG101348 chronic neutrophilic leukemia (CNL) - Answers -etiology: rare clonal disorder that causes hyperproliferation of neutrophilic cells in the bone marrow, may progress to AML -chromosomal abnormality: +8, +9, +21, Del(20q), Del(11q), del(12p), philadelphia chromosome *NOT * implicated -morphology: *extreme neutrophilia*, increased neutrophil precursors (segmented neutrophils, bands), neutrophils containing toxic granules, decreased monocytes, RBCs and PLTs are normal -symptoms: hepatosplenomegaly, mucocutaneous bleeds, gout, pruritis (itching) -PB: extreme neutrophilia (70% of cells), WBC count increased 25x10⁹/L, monocytes decreased 1x10⁹/L -BM: hypercellular, increased neutrophils, myeloblasts 5% of nucleated cells chronic myelomonocytic leukemia (CMML) - Answers -etiology: malignant hematopoietic stem cells lead to bone marrow dysplasia and monocytosis, may transition to AML -chromosomal abnormality: deletion of chromosome 7, trisomy 8 -morphology: monocytes make up ≥10% total WBCs in PB -symptoms: hepatoplenomegaly -PB: ≥20% blasts, persistent monocytosis 1*10⁹/L, increased monocytes -BM: ≥20% blasts, BM dysplasia juvenile myelomonocytic leukemia (JMML) - Answers -etiology: aggressive hematopoietic disorder that presents in childhood (~2 years old) -chromosomal abnormality: 1. PTPN-11, K-RAS, N-RAS, CBL or NF1 mutations seen in ~90% of cases, Philadelphia chromosome *NOT* implicated -morphology: dysplsatic/ abnormal monocytes -symptoms: splenomegaly, anemia -PB: leukocytosis, monocytosis (≥ 1*10⁹/L), thrombocytopenia, 20% blasts -BM: increase of myeloid and monocytic cells (hypercellular), 20% blasts chronic myeloid leukemia (CML) accelerated phase criteria (WHO) - Answers -poor response to therapy -anemia is increased (hemoglobin is decreased) -mature WBCs decreased -basophils increased -platelets decreased -micromegakaryocytes & megakaryocyte fragments present -WBC count increased 10*10⁹ and unresponsive to therapy -splenomegaly unresponsive to therapy -thrombocytosis OR thrombocytopenia -≥20% blasts in PB -10-19% blasts in BM -additional clonal chromosomal abnormalities (other than philadelphia chromosome) appear fibrosis of bone marrow (PMF) - Answers increased Platelet Derived Growth Factor (PDGF) leads to increased collagen and reticulin fiber synthesis -increased collagen and reticulin fibers in the bone marrow= fibrosis of the bone marrow pre-PMF criteria (WHO) - Answers -Major: increased megakaryopoiesis, increased granulopoiesis, decreased erythropoiesis, NO reticulin fibrosis, hypercellular BM, JAK2, CALR, or MPL mutation present -minor: anemia not attributed to another condition, leukocytosis 11*10⁹/L, palpable splenomegaly, LDH increased overt PMF criteria (WHO) - Answers -major: increased megakaryopoiesis with either reticulin or collagen fibrosis, presence of JAK2, CALR or MPL mutation present, no other WHO diagnosis availible -minor: anemia not due to another disease, leukocytosis 11x10⁹/L, palpable splenomegaly, LDH increased, leukoerythroblastosis (immature Grans and RBCs in PB) essential thrombocythemia (ET) criteria (WHO) - Answers -major: platelet count ≥ 450x10⁹/ L, BM biopsy showing mainly enlarged megakaryocytes with hyperlobulated nuclei, no significant increase in reticulin fibers, presence of JAK2, CALR or MPL mutations, does not meet requirements for different diagnosis -minor: presence of clonal marker OR absence of reactive thrombocytosis therapy-related MDS (T-MDS) - Answers medical treatment (chemotherapy, radiation therapy) leads to myelodysplastic syndromes 4-7 years after treatment -therapies introduce mutations into cell lines and apply selective pressure on cells of the BM to allow mutations to accumulate -more aggressive than De Novo MDS -transitions into AML MDS-SLD (MDS with single lineage dysplasia) - Answers -*1 dysplastic lineage* -1-2 cytopenias -15% ringed sideroblasts -BM 5% blasts -PB 1% blasts -no auer rods -cytogenetics: anything that does not cause MDS-5q- MDS-RS-SLD (MDS with ringed sideroblasts, single lineage dysplasia) - Answers -*1 dysplastic lineage* -1-2 cytopenias -*≥15% ringed sideroblasts* -BM 5% blasts -PB 1% blasts -no auer rods -cytogenetics: anything that does not cause MDS-5q- MDS-RS-MLD (MDS with ringed sideroblasts, multilineage dysplasia) - Answers -*2-3 dysplastic lineages* -1-3 cytopenias -*≥15% ringed sideroblasts* -BM 5% blasts -PB 1% blasts -no auer ords -cytogenetics: anything that does not cause MDS-5q- MDS-MLD (MDS with multilineage dysplasia) - Answers -*2-3 dysplastic lineages* -1-3 cytopenias -15% ringed sideroblasts -BM 5% blasts