Abnormal Leukon: Neutrophilia (Balasz) Flashcards
What may cause hypersegmented neutrophilia? What effect may this have on counts?
Steroids prevent adhesion of neutrophils to wall
- less cells enter tissues and marginate
- neutrophilia results
“steroid neutrophilia”
What is a physiological casue of neutrophilia?
Being scared ^ BP washes marginaed neutrophils off
What causes neutrophilia?
- infections (bacterial, viral, protozoal)
- immune mediated dz (IMHA, polyarthritis)
- 2* to neoplasia
- haemolysis, haemorrhage, necorsis, thrombosis
> acute/chronic inflam leukogram, steroid, physiological shift, chronic myeloid leukaemia
What is the most common type of leukaemia?
- lymphoid
What is the difference ebetween chronic and acute leukaemia?
> chronic =
- well differentiated neutrophils transformed: chronic granulocytic leukaemia
- numbers can be v high, r/o other casues of increase
acute =
- poorly differentiated (early precursor) transformed: acute myeloid leukaemia
- porg v poor
eg. Neutrophilia d/t increased persistence in the circulation?
> stress/steroid response(neutrophils remain in circulation longer)
- may be hypersegmeneted
- accompanied by monocytosis and lymphopenia (other steroid effects)
Egs. Neutrophilia d/t Redistribution. Other changes seen concurrently?
- stress/excitement ^ BP
- marginated neutrophils not normally sampled swept into circulation
- may ^ WBC >200% cats
- lymphocytes prevented from leaving circulation and mobilised from thoracic duct so numbers also increase
Tx of neutrophilia?
Tx the patient!
- tx underlying cause
Px chronic granulocytic leukaemia?
- good short term
Px acute myeloid leukaemia?
- no successful tx
Normal description of a mature lymphocyte?
Small, round ,very small amount blue cytoplasma, nucleus massive and about the same size as RBC
How do B and T lymphocytes differ? Where are they formed and where do they circulate?
- look the same
- formed in BM but production and clonal proliferation in thymus, spleen LNs
- travel blood - tissues - lymphatics - in and out of lymphoid tissue - blood
> B cells - short lived (d/weeks) except memory cells
> T cells - long lived months/years
Are lymphoctes commonly looked at when assessing BM function?
No!
Reactive changes of lymphocytres seen micrscopically?
- ^ cytoplasm, dark blue
- indentation of nucleus
- vauloated/dotty cytoplasma (constipated plasma cell)
Causes of lymphopenia?
- acute inflammatory
- stay in tissues
- stay in LNs - steroid lymphopenia
- egression into LNs and BM
- destroys LNs - depletion lymphopenia
- chylous effusion - lymphoid hypoplasia or aplasia
Causes of lymphopenia d/t ^ demand
- PLE (loss of lymphocyte rich chyle)
- chylothorax/peritoneum if drained
- recruitment and emigration into tissue with some antigens
Causes of lymphopenia d/t redistribution?
- steroids (exo/endo) stress
> redistribution into BM, tissues and trapping in LN - trapping in lymph rich fluid (chylothorax etc.)
Causes of lymphopenia d/t v production?
> infectious
- virsuese (canine distemper, parvo, panleucopenia, FeLV, FIV)
lympholytic drugs
- chemo (eg. cyclophosphamide, azathioprine, long term steroids)
congential immunodeficiency
- eg. Bassett hound B and T cells affected
Causes of lymphocytosis?
- chonic inflammatory
- physiological (Shift)
= neutrophils ,will ^ circulating no. - lymphoproliferative
Which animals will have high unmbers of reactive lymphocytes?
young animals esp puppies
^ no. to ^ demand LOOK
- puppies can be higher than range of adult (normal!)
^ no indepednent of demand
> chronic lymphocytic leukaemia > acute lymphoiblastic leukaemia - v poor px, no tx - poorly differentiated - v. quick progressive aggressive dz > Stage V lymphoma (spleen, liver etc. involved aswell) - w/ BM involvement - release of neoplastic lymphocytes into circulation
Redistribution
> phyisological - inhibition of recirculation - release from thoracic duct > Hypoadrenocorticism - lymphocytosis even when stressed (which should cause lymphopenia) - d/t cortisol
How can a monocyte be identified
- larger than neutrophil
- blue grey cytoplasm
- +- cytoplasm can contain vacuoles (neutrophils dont)
- nucleus can look like anything!! lymphoid/nuetrophilic but is lighter than neutrophil nucleus
- can look like toxic neutrophils (bluer cytoplasm, vacuolated, giant neutrophils etc.)
Where are monocytes produced? How long do they take?
- BM
- 6d
How do pools of monocytes differ to neutrophils?
- no storage pool
- marginatd and circulating pool present
- persistence in circulation varies (20hrs cattle)
> shorter with inflammation - leave circulation to tissues, differentiate into macrophages with inflammatory cytokines
Causes of monocytopenia ?
Does not occour
- normal levels very low/zero
Causes of monoytosis?
= neutrophils
> infectious (bacterial, fungal, protozoal)
>immune mediated dz (IMHA, meningitis, poly arthritis)
> necrosis, trauma, burns
> neoplasia
When do monocyte and neutrophil numbers not change in parallel?
Immune mediated destruction of neutrophils
- > GM-CSF release that stimulates neutrophil and monocyte production
- neutrophils destroyed but monocytosis d/t consant stimulation with GM-CSF
Causes of monocytosis?
> 2* to immune neutropenia - common precursor CFU-GM > myelomonocytic leukaemia - acute and chronic forms > acute monocytic leukaemia - with/without maturation - AML M5a/M5b
Redsitribution causes of monocytosis?
- steroids may move them fom the marginated pool
Tx monocytosis?
- Tx underlying cause!!
- chronic myelomonocytic = chronic granulocytic
- no really successful tx for acute myelomonocytic leakaemias in SA
How do eosinophils look like?
- granulocyte
- segemneted nucleus like neutrophils
- lots of eosinophilic (orange) granules
- lots of vacuoles in dogs (granules that dont stain, not true vacuoles)
- species differences
> dogs - variable granule size
> greyhounds - none of the granules stain at all!
- looks like a very toxic neutrophil
> cats - speckled full granulated
> horses - huge granules liek a raspberry
> cows - smaller round granules
How long do eosinophils take to differentate and mature/
- 2-6d species dependent
How long do eosinophils persist in circulation?
- variable (
Causes of eosinopenia?
> eosinopenia erference range starts at zro
- theoretically corticosteroids (endo/exo) via apoptosis
- possible neutraliation of histamine/MC degranulation and other mechanisms
- catecholamines
Casues of eosinophilia?
- Via sensitised T cells, mast cells: IL-5 release
- parasite antigen
- allergic dz - atopy, drug allergy, asthma, pulmonary infiltrate with eosinophils
- inflammatoion of MC rich tissue (gut, skin, lungs, uterus)
How do eosinophils attack destroy things?
Kill big things outside the cell (cg. neutorphils phagocytosing)
Eosinophilia ^ independent of demand?
> paranoplastic - lymphoma - mast cell tumour - IL5 > hyperoesinic syndrome in cats - numbers ^ in circulation with no cause - looks like leukaemia > eosinophilic leukaemia - rare
How commonly are basophils seen?
not!
Appearance of basophila?
> dog
- Ribbon like nucleus
- granules around and on top of nucleus (look like pores)
cat
- oval lavender/lilac/pale coloured granules
How long do basophils take to mature and release from BM? Persist in circulation?
- .5d
- persist for 6hrs
Persisence in cicrulcation
- 6hrs
ROle of basophils
- Type 1 hypersensistivity : analphylaxis, rhinitis, asthma, GI snesitivity, parasites
- ? role in delayed hypersensitivity
- poorly understood most domestic spp
Causes of decresed no. basophils
- impossibel to detect on normal blood screens (reference interval begins at 0)
- possible with anaphylactic, inflammatory and steroid responses
Causes of basophilia d/t ^ demand?
- immediate/delayed hypersensitivity (drugs, food, insects)
- parasitism (especially Dirofilaria, also GI paasites, fleas and ticks)
- other inflam
Causes of basophilia independent on demand?
- paraneoplastic (esp with MCTs)
- basophilic leukaemia (rare)
What is the stress leukogram
response to endogenous/exogenous steroid (stress/drugs prednisolone)
- neutrophilia
- lymphopenia
- monocytosis
- eosinopenia
Addisons leukogram?
- REVERSE stress leukogram (lack of cortisol)
- neutrophils and monocytes normal
- lymphocytosis
- eosinophilia
- changes mild
Acute inflammatory leukogram?
- neutrophilia +- left shift
- lymphopenia
- monocytosis
+- eosinopenia
Chronic inflammatory leukogram?
- neutrophilia +- left shift
- lymphocytosis
- monocytosis
Adrenaline response?
neutrophilia
lymphocytosis
(d/t ^ BP)
How does the blood of young animals differ to older?
> normal haemogram
- ^ WBC
- v HCT
changes mild and normalise ~3m
How would an acute and chronic inflammatory neutrophilia differ?
> acute - no storage pool - band neutrophils > chronic - storag pool re-established - fewer band neutrophils
What is a Mott cell?
Reactice B lymphocyte plasma cell full of vaculole like things
