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Rosens > 109 WBC > Flashcards

109 WBC Flashcards

1
Q

3 basic types - 1. granulocytes

A

eo
neutro
basophils

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2
Q

3 basic types - 1. granulocytes what do they do?

A

phagotyic activity

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3
Q

Monocytes - mature into __

A

macrophages

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4
Q

Lymphocytes: mature into ?

A

▪ Maturesinlymphoidtissuesinbonemarrow,thymus,spleenlymphnotes ▪ B-cell(humoralimmunity)
▪ T-cell(cellularimmunity)

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5
Q

What factors may actually “normally” incr wbc (ie healthy person just has more)

A

age
ex
female
smoking
pregn

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6
Q

Alterations in wbc numbers are due to what 3 reasons (categories):

A

changes in production
marginal pool
tissue destruction

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7
Q

DDX main 4 categories of wbc disease when low:

A

suppress BM - chemo/rads/viral
destroy: beta lactam abx, RA, autoimm
Bacterial infections - use
sequestration: ischemic reperfusion injury, major trauma

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8
Q

DDX of leukocytosis: primary

A

PRIMARY:
- myeloprolif disorder like cml, pv
hereditary neutrophilia
familial myeloprolif
leukemoid rxn

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9
Q

DDX leukocytosis: secondary

A

secondary:
infection
tissue necrosis: burns, ca, infarct
metabolic: dka, thyrotoxicosis, uremia
non heme malign disease
physiologic: ex, pain, surgery, hypoxia, seizure, trauma
drug: epi, cs, li, cocaine
lab error

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10
Q

Defn of leukocytosis

A

neutrophilia > ANC >7500

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11
Q

what is a left shift of wbc?

A

diff count and represents immat neutrophils into circulation

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12
Q

DDX of leukocytosis with lymphocytosis

A

viral infxn: mono, rubella, rubeola, varicella, toxo
lymphoprolif: ALL, CLL
immune: immuniz, autoimm disease, graft rejection

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13
Q

Hyperleukocytosis: what is this?

A

hem emergency where wbc >100 and can cause metabolic abn, coagulopathy and multiorgan failure

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14
Q

Hyperleukocytosis: sx

A

cns - h/a, confused, lethargy, dizzy, blurry vision, ataxia, papilledema, retinal or IC hemorrhage

pulmonary: dyspnea, tachy, hypoxia, infiltr, resp failure

Mech obs caps - renal faiklure, peripher vascular occlu, MI

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15
Q

Hyperleukocytosis: tx

A

chemo
hydroxyurea
leukaphresis

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16
Q

Chronic myeloid leukemia: what is common reason

A

philadelphia chrom - genetic translocation

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17
Q

Chronic myeloid leukemia: how many ph?

A

3

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18
Q

Chronic myeloid leukemia: ph 1: chronic - insiduous sx

A

asymptomatic at sdx
if sx - abdo pain, decr appet, nausea, early satiety as hepato and splenomegaly

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19
Q

Chronic myeloid leukemia: ph 2 accelerated

A

abn bleed/bruise, petechiae, bone pain, fever

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20
Q

Chronic myeloid leukemia: ph 3: blastic

A

abn bleed/bruise, petechiae, bone pain, fever and possible blast crisis

21
Q

CML: what is a blast crisis?

A

anemia
abn bleed (low plt), sob, neuro sx as leukostasis bm infil occurs

22
Q

DDX of >25 wbc - 4 categories

A
  1. infection - cdiff, tb, shigella
  2. drugs: cs, g-csf, ethyl glycol
  3. tissue ischemia: MI, mes ischemia, gangrene
  4. paraneopl
23
Q

Management of CLL general

A

chronic: tyr kinase ihibitors that stop pro from genetic abn
if acc: TKI, LT response more limited
blast crisis: chemo needed

24
Q

Lymphocytic leukocytosis: ddx

A

infx vs lymphoprolifC

25
Q

Chronic lymphocytic leukemia - demographics and what is this?

A

MC leuk >50y
b cell disorder impairing apop of b cells

26
Q

Chronic lymphocytic leukemia - clinical features

A
  • Heterogenous presentations and course
  • Often incidentally diagnosed d/t increased WBC, enlarged lymph nodes, palpable
    spleen, enlarged liver
  • B-symptoms
27
Q

Chronic lymphocytic leukemia - dx testing

A

b lympocytes with lympho coutn >5 adults
monoclonal

28
Q

Chronic lymphocytic leukemia - management

A
  • Patients with CLL require treatment once they become significantly symptomatic
  • Options include chemotherapy agents and monoclonal antibodies
  • In patients < 65 - chemoimmunotherapy is used and may have curative potential
  • Leukostasis rarely seen
29
Q

Acute lymphocytic leukemia - demographics?

A

child

30
Q

Acute lymphocytic leukemia - what is this?

A

clonal diseaes of bm by prolif of b or t cell

31
Q

Acute lymphocytic leukemia - labs

A

dec anemia
neutropenia
plt
wbc diff shows low neutrop

defin dx bm bx

32
Q

Acute lymphocytic leukemia - tx

A

multiagent chemo

33
Q

Leukopenia: mild vs mod vs sev

A

1500
1000
500

34
Q

Leukopenia ddx

A

Prolif BM - aplastic anemia, leukemia, chemo includ cyclophos, azathioprine, methotrex, chlorambucil
drugs: phenothiazone, indomethacin, ptu, phenytoin, sulfonamides

Maturation bm: folat/b12 defic, starvation

Trapping: spleen large, sarcoid, portal htn, malaria

incr use: infection - viral: mono, rubella, rubeola; ricketssia, overwhelming bacterial vs autoimm: sle, aids, felty

lab error

35
Q

Felty syndrome

A

triad RA, splenomegaly, neutropenia

36
Q

Leukopenia : clinical features

A
  • B-symptoms
  • Serious bacterial infections may be
    minimally symptomatic
  • Neutropenic fever (single temp > 38.3
    or 38 for 1 hour)
37
Q

Febrile neutropenia tx

A

within 1 h, broad spec abx

38
Q

Blast crisis defn

A

CML specific - elevated blast count >20% and or bone marrow

typically helpful to use hyperleukocytosis

39
Q

Hyperleukocytosis defn

A

> /=50 to >/=100

40
Q

Hyperleukocytosis 3 complications

A

leukostasis
dic
TLS

41
Q

Leukostasis

A

when wbc level incr obstructs microvasculature - particlarly pulmonary or CNS

42
Q

Leukostasis mc in which leukemia?

A

AML
CML

more sticky PTO

43
Q

Leukostasis” common sx

A

lung disease - any sx
cns - any
eye - retinal hemorrhage!
ear
heart - MI
vascular sx - limb ischemia

44
Q

Leukostasis: false pao2 why?

A

cells metabolize oxygen - so may look hypoxemic on abg but actually okay

pulse ox best here

45
Q

Leukostasis tx

A
  1. decr wbc: chemo, hydroxurea nad leukaphoresis

preference = chemo and hydroxygurea (only against myeloid) - cytarabine via heme for lymphoid or myeloid (can give whenever)

leuka just takes them out

46
Q

Leukostasis: risk of what complication?

A

TLS

47
Q

Leukostasis: RBC transfusion - risk?

A

sparingly, incr blood viscosity
if rq avoid diuretic and try to amintain hydration

48
Q

Leukostasis: plt threshold?

A

plt >20 until wbc decreased because of risk of hemorrhage is high during this time

49
Q

Leukostasis: pre giving cytirabine or hydroxyurea, give?

A

fluids
allopurinol
rasburicase

Rosens (48 decks)

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