2013-10-23 Intro to WBCs

Question 1

What are the normal values and units of a CBC?

Answer 1

WBCs		4-10K/L
Hgb (Female)	11.2 – 15.7 g/dL
Hgb (Male)		13.7 – 17.5 g/dL
HCT (Female)	34 – 45 %
HCT (Male) 	40 – 51 %
Plts			145-370,000 cells/μl

Question 2

What are the patterns of WBC differentials?

Answer 2

.

Question 3

Neutrophilia physio

Answer 3

a.k.a. bandemia

Question 4

Neutropenia physio

Answer 4

.

Question 5

Dysfunctional PMN physio

Answer 5

.

Question 6

ANC

Answer 6

Absolute Neutrophil Count

ANC = WBC X (% Neutrophils + % Bands)

“N.B. Neutrophils & Bands are the functional cells. Precursors (e.g. metamyelocytes) are not able to fight infection so aren’t counted as part of the ANC”

Question 7

plasma vs. serum

Answer 7

plasma is the water, proteins, electrolytes, nutrients, hormones of UNCLOTTED, separated blood

SERUM is the fluid leftover after blood HAS CLOTTED

Question 8

What cells are typically seen in the peripheral blood?

Answer 8

platelets, RBCs, [basophils, eosinophils, monocytes and neutrophils (MYELOID)]

Question 9

buffy coat

Answer 9

the layer between the RBCs and plasma
contains:
- White Blood Cells
- Platelets

Question 10

Draw CBC shorthand

Answer 10

MCV
WBCs\_______/
/ Hct \ Plts

Question 11

bandemia

Answer 11

increase in bands/stab cells “reservists”

Question 12

How does WBC get out into tissue?

Answer 12

1. Rolling [WBC: L-selectinSialyl-Lewis^x:vessel
2. Adhesion [WBC:IntegrinE-selectin:vessel
3. Diapedesis
4. Chemotaxis [C3a, C5a, histamine, prostaglandins, leukotrienes

Question 13

causes of neutrophilia

Answer 13

poison (venom, Hg, ethylene, glycol)
physio (stress, exercise)
obestity
smoking
s/p splenectomy
rebound s/p chemo
s/p G-CSF tx

Question 14

What were the different patterns of neutrophilia discussed?

Answer 14

1. Shift
2. Left-shift
3. Leukomoid rxn
4. Leukoerythroblastic rxn
5. Acute leukemia
6. Chronic leukemia

Question 15

Shift Neutrophilia

• what you see
• what causes it

Answer 15

Shift neutrophilia

• see: rapid-onset, short-lasting, moderate neutrophilia, NO BANDS
• cause: steroids, epi, exercise/stress, sz —> all of which cause DEMARGINATION

Question 16

Left-shift Neutrophilia

-what you see

Answer 16

-SEE: metamyelocytes and BANDS in blood

Question 17

Leukomoid rxns

• what you see
• what causes it

Answer 17

• SEE: metamye’s and bands in blood; WBC>50k
• CAUSE: severe infection/inflamm, met Cancer, G-CSF tx
• *combo of a SHIFT (i.e. demarg) w/ left shift

Question 18

Leukerythroblastic Rxn

• what you see
• what causes it

Answer 18

• SEE: severe left-shift, nRBCs, premature precursors

- CAUSES: anything causing marrow infiltration; myelofibrosis

Question 19

Acute Leukemia

-what you see

Answer 19

-blast, blast, blasts

Question 20

Chronic Leukemic Neutrophilia

• what you see
• what causes it

Answer 20

-SEE: incr in all forms + profound L-shift; periph blood looks like bone marrow

Question 21

Neutropenias: skeleton of types

Answer 21

CONGENITAL

1. Cyclic neutropenia
2. Severe congential neutropenia (SCN)
3. Kostmann Syndrome
4. Immune-mediated (e.g. Felty Syndrome)

ACQUIRED—Intrinsic

1. Nutritional deficits
2. Neoplasm

ACQUIRED—Extrinsic

1. Infection (bact OR viral)
2. Drug/Toxin
3. Hyperspleenism

Question 22

Cyclic Neutropenia

Answer 22

congenital neutropenia -> cyclic neutropenia
—q21 days
—recurrent, intermittent infxs
—autosomal dominant

Question 23

Severe Congenital Neutropenia

• inheritance
• s/sx
• tx

Answer 23

• autosomal dominant
• severe recurrent infxs
• responds to G-CSF tx

Question 24

Kostmann syndrome

• inheritance
• presentation?

Answer 24

-autosomal recessive form of SCN (presents same?)

Question 25

Felty Syndrome

Answer 25

RA + splenomegaly + leukopenia