109 WBC Flashcards
3 basic types - 1. granulocytes
eo
neutro
basophils
3 basic types - 1. granulocytes what do they do?
phagotyic activity
Monocytes - mature into __
macrophages
Lymphocytes: mature into ?
▪ Maturesinlymphoidtissuesinbonemarrow,thymus,spleenlymphnotes ▪ B-cell(humoralimmunity)
▪ T-cell(cellularimmunity)
What factors may actually “normally” incr wbc (ie healthy person just has more)
age
ex
female
smoking
pregn
Alterations in wbc numbers are due to what 3 reasons (categories):
changes in production
marginal pool
tissue destruction
DDX main 4 categories of wbc disease when low:
suppress BM - chemo/rads/viral
destroy: beta lactam abx, RA, autoimm
Bacterial infections - use
sequestration: ischemic reperfusion injury, major trauma
DDX of leukocytosis: primary
PRIMARY:
- myeloprolif disorder like cml, pv
hereditary neutrophilia
familial myeloprolif
leukemoid rxn
DDX leukocytosis: secondary
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
Defn of leukocytosis
neutrophilia > ANC >7500
what is a left shift of wbc?
diff count and represents immat neutrophils into circulation
DDX of leukocytosis with lymphocytosis
viral infxn: mono, rubella, rubeola, varicella, toxo
lymphoprolif: ALL, CLL
immune: immuniz, autoimm disease, graft rejection
Hyperleukocytosis: what is this?
hem emergency where wbc >100 and can cause metabolic abn, coagulopathy and multiorgan failure
Hyperleukocytosis: sx
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
Hyperleukocytosis: tx
chemo
hydroxyurea
leukaphresis
Chronic myeloid leukemia: what is common reason
philadelphia chrom - genetic translocation
Chronic myeloid leukemia: how many ph?
3
Chronic myeloid leukemia: ph 1: chronic - insiduous sx
asymptomatic at sdx
if sx - abdo pain, decr appet, nausea, early satiety as hepato and splenomegaly
Chronic myeloid leukemia: ph 2 accelerated
abn bleed/bruise, petechiae, bone pain, fever
Chronic myeloid leukemia: ph 3: blastic
abn bleed/bruise, petechiae, bone pain, fever and possible blast crisis
CML: what is a blast crisis?
anemia
abn bleed (low plt), sob, neuro sx as leukostasis bm infil occurs
DDX of >25 wbc - 4 categories
- infection - cdiff, tb, shigella
- drugs: cs, g-csf, ethyl glycol
- tissue ischemia: MI, mes ischemia, gangrene
- paraneopl
Management of CLL general
chronic: tyr kinase ihibitors that stop pro from genetic abn
if acc: TKI, LT response more limited
blast crisis: chemo needed
Lymphocytic leukocytosis: ddx
infx vs lymphoprolifC
Chronic lymphocytic leukemia - demographics and what is this?
MC leuk >50y
b cell disorder impairing apop of b cells
Chronic lymphocytic leukemia - clinical features
- Heterogenous presentations and course
- Often incidentally diagnosed d/t increased WBC, enlarged lymph nodes, palpable
spleen, enlarged liver - B-symptoms
Chronic lymphocytic leukemia - dx testing
b lympocytes with lympho coutn >5 adults
monoclonal
Chronic lymphocytic leukemia - management
- 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
Acute lymphocytic leukemia - demographics?
child
Acute lymphocytic leukemia - what is this?
clonal diseaes of bm by prolif of b or t cell
Acute lymphocytic leukemia - labs
dec anemia
neutropenia
plt
wbc diff shows low neutrop
defin dx bm bx
Acute lymphocytic leukemia - tx
multiagent chemo
Leukopenia: mild vs mod vs sev
1500
1000
500
Leukopenia ddx
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
Felty syndrome
triad RA, splenomegaly, neutropenia
Leukopenia : clinical features
- B-symptoms
- Serious bacterial infections may be
minimally symptomatic - Neutropenic fever (single temp > 38.3
or 38 for 1 hour)
Febrile neutropenia tx
within 1 h, broad spec abx
Blast crisis defn
CML specific - elevated blast count >20% and or bone marrow
typically helpful to use hyperleukocytosis
Hyperleukocytosis defn
> /=50 to >/=100
Hyperleukocytosis 3 complications
leukostasis
dic
TLS
Leukostasis
when wbc level incr obstructs microvasculature - particlarly pulmonary or CNS
Leukostasis mc in which leukemia?
AML
CML
more sticky PTO
Leukostasis” common sx
lung disease - any sx
cns - any
eye - retinal hemorrhage!
ear
heart - MI
vascular sx - limb ischemia
Leukostasis: false pao2 why?
cells metabolize oxygen - so may look hypoxemic on abg but actually okay
pulse ox best here
Leukostasis tx
- 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
Leukostasis: risk of what complication?
TLS
Leukostasis: RBC transfusion - risk?
sparingly, incr blood viscosity
if rq avoid diuretic and try to amintain hydration
Leukostasis: plt threshold?
plt >20 until wbc decreased because of risk of hemorrhage is high during this time
Leukostasis: pre giving cytirabine or hydroxyurea, give?
fluids
allopurinol
rasburicase
