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M2 Hematology > 13. Disorders of WBCs > Flashcards

13. Disorders of WBCs Flashcards

1
Q

If the absolute numbers look ok on a blood count, should you stop there? or is there another test?

A

may need to test FUNCTION of neutrophils as well as numbers, percentages. can have dysfunction even with normal counts

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2
Q

when to worry about dysfunctional neuts even if absolute counts are ok?

A
  • recurrent bacterial infections
  • infections of unusual sites (brain,liver)
  • infections with unusual pathogens (fungal)
  • Chronic gingivitis or aphthous ulcers
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3
Q

if you have a young kid with recurrent infections and an ok absolute count, what should you be thinking of?

A

congenital disorder of neutrophils

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4
Q

Leukocyte Adhesion Deficiency. defect of what? sx? tx?

A
  • defect of adhesion and rolling.
  • recurrent bacterial infections
  • neutrophilia, NO PUS
  • tx: stem cell transplant
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5
Q

Hyperimmunoglobulin E syndrome: defect? sx? will be high in what? tx?

A
  • defect of chemotaxis.
  • sx are chronic dermatitis (eczema), recurrent staph, candidal infections. may also be facial abnormalities
  • High IgE levels
  • Tx generally supportive with prophy abx
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6
Q

Chediak-Higashi Syndrome: defect? sx? comorbid condition? tx?

A
  • degranulation defect: abnormal granules with impaired delivery of lysosomal enzymes to phagosomes, result in slow killing.
  • recurrent pyogenic (pus) infections
  • kids also have partial albinism
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7
Q

Chronic Granulomatous Disease: defect? sx? tx?

A
  • defect with bacterial killing. inability to generate neutrophil oxidative burst that produces ROS and bactericidal agent hypochlorous acid
  • recurrent pyogenic infectiosn of skin, lungs, formation of granulomas
  • tx with prophy abx
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8
Q

if I see eczema, what should I think?

A

hyperimmunoglobulin E

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9
Q

myelodysplasia/myelodysplastic syndrome: type of disorder? what will neut count be?

A
  • clonal disorder, dysfunction of neuts
  • neut count will be decreased OR normal
  • other cell lines (plts, RBCs) may be affected
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10
Q

alcoholism: affect on neutrophilis

A

decreased motility and phagocytosis

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11
Q

metabolic disorders: affect on neut function?

A

decr adhesion, motility, phagocytosis.

disorder could be diabetes, uremia, malnutrition, autoimmune

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12
Q

what could a dysplastic PMN look like?

A

might be bi-lobar rather than with 3-4 lobes

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13
Q

eosinophil: what does it do? is it granular? military analogy?

A

phagocytic cell, primary function is to kill parasites.
has dense red granules.
also involved in hypersensitivity rxns
“special ops”

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14
Q

what problems associated with a low eosinophil count?

A

low eosinophil count not clinically sig.

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15
Q

eosinophilia: most common cause globally

A

parasitic infections

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16
Q

eosinophilia: most common cause in dev countries?

A

atopic allergic disease

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17
Q

Causes of eosinophilia?

A

N: neoplasm (Hodgkins, Lymphoma, CML, Primary eosinophilic disorders)
A: Allergies
A: asthma
C: collagen vascular diseases and vasculitis
P: parasitic infection

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18
Q

what is the approach to eosinophilia?

A

more of a history than any test.

atopy, travel, pets, constitutional symptoms (fever, wt loss), drugs/toxins, autoimmune, connective tissue

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19
Q

eosinophilia: tests to run?

A

CBC, differential
stools for ova, parasites
connective tissue serology (think rheum process)
bone marrow/tissue biopsy

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20
Q

basophil: function? when is basophilia seen?

A

uncommon cell. disorders are rare
function in hypersensitivity rxns, releases histamine and leukotriends.
basophilia seen with myeloproliferative disorders (Chronic Myelogenous Leukemia: CML)

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21
Q

monocytes: function? when do they get involved? military analogy?

A

phagocytes, release granules to kill micro-organisms. involved in more chronic phase of infections.
military: reinforcements

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22
Q

what is monocytosis?

A

too many monocytes

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23
Q

what can cause monocytosis?

A
  • chronic infections
  • bone marrow recovery after chemo
  • autoimmune and CT disease
  • granulomatous disease (sarcoid)
  • malignancy
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24
Q

what are some causes of monocytopenia?

A

uncommon, but:
severe infections/sepsis
bone marrow failure
hairy cell leukemia (agent orange)

25
Q

Lymphocyte category includes what types of cells?

A

B cells, T cells, Natural Killer cells

26
Q

what do B cells do?

A

produce antibodies for humoral immunity

27
Q

what do T cells do?

A

Generates cell mediated immunity and immunoregulation via helper and suppressor sub-populations

28
Q

what do NK cells do?

A

HLA-unrestricted killing

29
Q

generally, where does maturation of T cells take place?

A

start in the bone marrow, then either go to periphery as NK cells or to thymus. will become either CD4 of CD8 cell and then go to periphery, become either Memory T cell or Effector T cell.

30
Q

what happens to the surface markers of B cells as they mature?

A

gain and lose various surface markers as the cells travel from bone marrow to lymph nodes. some of the maturation process is antigen independent, some is antigen dependent.

31
Q

what do the surface markers of B cells indicate?

A

the stage of maturation.

32
Q

what happens in the germinal center of lymph nodes?

A

class-switching of B cells

33
Q

what does ALC stand for

A

absolute lymphocyte count

34
Q

what does elevated lymphocyte count indicate

A

absolute lymphocytosis

35
Q

on a peripheral smear, what do smudge cells indicate? what are they?

A

light purple cells that look smudgy, and distort around RBCs. classic for absolute lymphocytosis.

36
Q

2 categories of lymphocytosis?

A

non-malignant/non-clonal

malignant/clonal

37
Q

causes of non-malignant lymphocytosis?

A

acute infection, chronic infection, hypersens rxn. classic = MONO

38
Q

causes of malignant lymphocytosis?

A

chronic lymphocytic leukemia (CLL), acute lymphoblastic leukemia (ALL)

39
Q

what are atypical lymphocytes/what do they indicate?

A

big, sort of molding around RBCs, still have nucleus. think MONO.

40
Q

what is clonality?

A

confirmation that a malignancy (primary lymphoproliferative disorder) arose from a single cell

41
Q

define light chain restriction. what does it indicate?

A

vast change away from normal Kappa:Lambda ratio meaning that a vast number of B cells came from a single lineage. indication of B cell malignancy.

42
Q

How is malignancy of T cells detected?

A

T cells don’t have a surface marker that is easily detectable; have to use Western Blot or PCR to determine clonality

43
Q

Most lymphomas: B cell or T cell derived?

A

B cell

44
Q

Lymphocytopenia: definition?

A

ALC less than 1000

45
Q

Lymphocytopenia: differential?

A

congenital
infectious (HIV, TB, malaria)
meds
malignancy: lymphoma/Hodgkins

46
Q

Lymphocytopenia: once have CBC (established anemia and microcytic anemia) and differential/absolute (established low lymphocytes) what is the diagnostic test to confirm?

A

bone marrow biopsy

47
Q

Reed-Sternberg Cell: seen where? indicative of what disease?

A

bone marrow biopsy

Hodgkin Lymphoma

48
Q

Pancytopenia: definition?

A

all three cell lines are affected (WBC, RBCs, platelets)

49
Q

Pancytopenia: suggestive of what?

A

bone marrow failure. even if only 2 of 3 cell lines are affected, suggests bone marrow process

50
Q

pancytopenia: causes? (4)

A
  • primary bone marrow problem
  • secondary bone marrow problem
  • ineffective myelopoiesis
  • hypersplenism
51
Q 
what could cause this general pattern of the Differential? 
Total WBC HIGH
Neuts HIGH 
Bands HIGH
Lymphs
Monos
Eos
Basophils
Blasts
A

bacterial infection

52
Q 
what could cause this general pattern of the Differential? 
Total WBC LOW
Neuts 
Bands 
Lymphs HIGH
Monos
Eos
Basophils
Blasts
A

viral infection

53
Q 
what could cause this general pattern of the Differential? 
Total WBC HIGH
Neuts HIGH 
Bands
Lymphs
Monos
Eos
Basophils
Blasts
A

steroids

54
Q 
what could cause this general pattern of the Differential? 
Total WBC HIGH
Neuts  
Bands 
Lymphs
Monos
Eos
Basophils
Blasts
A

splenectomy

55
Q 
what could cause this general pattern of the Differential? 
Total WBC LOW
Neuts 
Bands 
Lymphs
Monos HIGH
Eos
Basophils
Blasts
A

chemotherapy

56
Q 
what could cause this general pattern of the Differential? 
Total WBC VERY HIGH
Neuts 
Bands 
Lymphs
Monos
Eos
Basophils
Blasts VERY HIGH
A

acute leukemia

57
Q

What is aplastic anemia? it is a problem with what kinds of cells?

A

diminished/absent hematopoietic precursors in bone marrow. usually due to damage to the pluripotent stem cell.

58
Q

Tear drop cells suggest what process? (general category and specific cause)

A

something infiltrating the bone marrow. Leukoerythroblastic reaction. specific: could be myelofibrosis

M2 Hematology (15 decks)

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