2013-10-23 Intro to WBCs Flashcards
What are the normal values and units of a CBC?
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
What are the patterns of WBC differentials?
.
Neutrophilia physio
a.k.a. bandemia
Neutropenia physio
.
Dysfunctional PMN physio
.
ANC
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”
plasma vs. serum
plasma is the water, proteins, electrolytes, nutrients, hormones of UNCLOTTED, separated blood
SERUM is the fluid leftover after blood HAS CLOTTED
What cells are typically seen in the peripheral blood?
platelets, RBCs, [basophils, eosinophils, monocytes and neutrophils (MYELOID)]
buffy coat
the layer between the RBCs and plasma
contains:
- White Blood Cells
- Platelets
Draw CBC shorthand
MCV
WBCs\_______/
/ Hct \ Plts
bandemia
increase in bands/stab cells “reservists”
How does WBC get out into tissue?
- Rolling [WBC: L-selectinSialyl-Lewis^x:vessel
- Adhesion [WBC:IntegrinE-selectin:vessel
- Diapedesis
- Chemotaxis [C3a, C5a, histamine, prostaglandins, leukotrienes
causes of neutrophilia
poison (venom, Hg, ethylene, glycol) physio (stress, exercise) obestity smoking s/p splenectomy rebound s/p chemo s/p G-CSF tx
What were the different patterns of neutrophilia discussed?
- Shift
- Left-shift
- Leukomoid rxn
- Leukoerythroblastic rxn
- Acute leukemia
- Chronic leukemia
Shift Neutrophilia
- what you see
- what causes it
Shift neutrophilia
- see: rapid-onset, short-lasting, moderate neutrophilia, NO BANDS
- cause: steroids, epi, exercise/stress, sz —> all of which cause DEMARGINATION
Left-shift Neutrophilia
-what you see
-SEE: metamyelocytes and BANDS in blood
Leukomoid rxns
- what you see
- what causes it
- 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
Leukerythroblastic Rxn
- what you see
- what causes it
- SEE: severe left-shift, nRBCs, premature precursors
- CAUSES: anything causing marrow infiltration; myelofibrosis
Acute Leukemia
-what you see
-blast, blast, blasts
Chronic Leukemic Neutrophilia
- what you see
- what causes it
-SEE: incr in all forms + profound L-shift; periph blood looks like bone marrow
Neutropenias: skeleton of types
CONGENITAL
- Cyclic neutropenia
- Severe congential neutropenia (SCN)
- Kostmann Syndrome
- Immune-mediated (e.g. Felty Syndrome)
ACQUIRED—Intrinsic
- Nutritional deficits
- Neoplasm
ACQUIRED—Extrinsic
- Infection (bact OR viral)
- Drug/Toxin
- Hyperspleenism
Cyclic Neutropenia
congenital neutropenia -> cyclic neutropenia
—q21 days
—recurrent, intermittent infxs
—autosomal dominant
Severe Congenital Neutropenia
- inheritance
- s/sx
- tx
- autosomal dominant
- severe recurrent infxs
- responds to G-CSF tx
Kostmann syndrome
- inheritance
- presentation?
-autosomal recessive form of SCN (presents same?)
Felty Syndrome
RA + splenomegaly + leukopenia
