Benign Leukocytoses Flashcards
What are the five benign leukocytes?
- Neutrophilia
- Lymphocytosis
- Basophilia
- Monocytosis
- Eosinophilia
Where do most neutrophils reside?
- Bone marrow: most neutrophils live here, all stages of maturation
- Blood: only 5% of neutrophils are here, normally only segmented neutrophils, half of neutrophils are marginated (pressed against the vessel walls, can be easily pulled off by stress)
What the two types of neutrophilia?
- Mature (lots of segmented neutrophils)
2. Immature (lots of immature neutrophils) - not all segmented neutrophils, some banned, some metamyelocytes, etc.
What are the causes of mature neutrophillia?
- Infection (most common)
- Inflammation (second most common)
- Physiologic things:
- Stress
- Hormones
When are toxic changes seen in cells?
- Can be seen in immature or mature leukocytes
- Seen mostly in INFECTION
- Toxic granulation, Dohle bodies (blue spots in neutrophils), cytoplasmic vacuolization
If you see a neutrophil with toxic granulation, what doe the patient have??
INFECTION (with toxic changes) - Leukocytoses
What is the significance of promyelocytes in leukocytoses?
- Last stage where you can still divide before you mature out into a segmented neutrophil
- Can decide not to go through division in order to mature and get in blood faster
- In these cell, toxic granulation hasn’t split/spread between cells
- This indicates a more rapid maturation of cells!
What are dohle bodies? What do you see them in?
- Blue spots in neutrophils
- Seen in toxic changes with leukocytoses
What is cytoplasmic vacuolization?
- Scariest toxic change!
- Seen in leukocytoses
What are the causes of immature neutrophilia?
- Infection (bacterial)
- Inflammation
- Severe anemia
- Something filling up the marrow (may indicate something really bad!)
What are three forms of Immature Neutrophilia?
- Left shift
- Leukemoid reaction
- Leukoerythroblastic reaction
What is a left shift?
- Doing differential counts by hand and seeing paper shifted to the left toward more immature lymphocytes
- Blast cells are more toward the left
What does a leukemoid reaction look like?
- Reaction in blood that looks like leukemia but isn’t
- Doesn’t have one single definition so we don’t use this very often
What does a leukoerythroblastic reaction look like?
- You see young white cells (left shift) & young red cells
- May see this with really bad anemia!
- This doesn’t worry you in anemia because its expected but if the isn’t anemic at all, the condition is worrisome! (probably means something is filling up the marrow and kicking red blood cells out before they’re ready - cancer, fibrosis, etc.)
Lymphocytosis
- Lymphocytes fight infection, participate in immunologic responses
- A lot of lymphocytes = patient has infection or undergoing an immunologic challenge
- Normal lymphocyte count:
- –Varies a lot with age
- –Bigger normal range in infants!
What is the normal immunotype in blood?
- T cells: 80%
- B cells: 15%
- NK cells: 5%
Who has the highest normal lymphocyte counts?
Infants!
What are the two types of lymphocytosis?
- Mature (lots of mature lymphocytes seen)
2. Reactive (lots of funny looking lymphocytes seen) - you don’t see immature lymphocytes in blood
What are the three causes of mature lymphocytosis?
- Infectious lymphocytosis - usually only in kids
- Bordetella pertussis - whooping cough, usually in kids
- Transient stress - sometimes after heart attack
What causes the biggest lymphocytosis?
Infectious lymphocytosis
What causes reactive lymphocytosis?
- Infectious mononucleosis (Downey Cells)
- Pediatric viral infections
- Viral hepatitis
- Immune disorders
What types of cells do you see in reactive lymphocytosis?
- Downey cells (can have skirt pleats, small, condensed nucleus, gigantic cytoplasm, etc.)
- Plasmacytoid lymphocyte
How do you tell “Is it benign, or is it malignant?”
- A whole bunch of mature neutrophils = benign
- A whole bunch of immature, left shift neutrophils = Chronic myeloid leukemia
What is a left shift?
- Toxic changes, maybe (probably from an infection)
- Fewer immature cells
- No basophilia
- LAP (lymphocyte alkaline phosphatase) normal/increased
What is CML?
- Super-high WBC
- Lots of immature cells
- BASOPHLIA - very early finding!
What is the best way to differentiate benign neutrophilic from CML?
Cytogenetics
What is reactive lymphcytosis?
- Atypical lymphocytes
- Occurs in
What is mature lymphocytosis?
- Mature lymphocytes
- VERY young (
What is CLL?
- ONLY IN OLDER ADULTS
- Mature lymphocytes
- Monomorphous! (all leukocytes look EXACTLY THE SAME!)
- Older >40 years!
What is the best way to differentiate benign lymphocytosis from CLL?
Immunophenotyping
What does basophlia usually indicate?
- CML (chronic myeloid leukemia)
- Basophils are usually so rare you never see two in the same slide like this
What does monocytosis indicate?
- Infection
- Autoimmune disease
- Malignancy
What does eosinophilia indicate?
- Drugs
- Asthma
- Skin Diseases
- Parasites
