Benign Leukocytoses - Krafts Flashcards
What percent of total neutrophils live in the blood?
only 5%
(half are marginated)
What are marginated neutrophils? Why are they important?
- Neutrophils that are plastered up against the walls of the vessels
- important because if you get emotionally stressed, you can pull most of those marginated neutrophils off the walls of the vessels and into the bloodstream
- effectively doubling your neutrophil count.
What are neutrophils important for?
- Fight infection (baterial)
- Participate in inflammatory response
What are causes of Mature Neutrophilia?
- Infection (bacterial)
- Inflammation
- Physiologic things
- stress
- hormones
What are toxic changes of neutrophils that are seen in both Mature and Immature Neutrophilias?
- Toxic granulation
- Döhle bodies (sky blue chunks of RER)
- cytoplasmic vaculoization (scariest = severe infection)
(Seen only in infection! = good indicators)
What are causes of Immature Neutrophilia?
- Infection (bacterial)
- Inflammation
- Severe anemia
- Something filling up the bone marrow
What are the three forms of Immature Neutrophilia?
- Left shift
- more premature cells present
- Leukemoid reaction
- bad term - many different meanings
- Leukoerythroblastotic reaction
- bone marrow is rushed so it releases premature white & red cells (nucleated)
- normal when anemia is present (benign)
- scary if no accompanying anemia (malignant)
What are lymphocytes important for?
- fight infection (viral)
- participate in immunologic responses
What is the normal immunophenotype in blood (%T-cells, % B-cells, % NK cells)?
- T-cells: 80%
- B-cells: 15%
- NK cells: 5%
Normal lymphocyte count varies with age.
Bigger normal range in infants.
(adults 4-11 x10^9)
What are the causes of Mature Lymphocytosis?
- Infectious lymphocytosis
- rare, type of infection in kids
- Bordetella pertussis
- Transient stress
- i.e. after a heart attack
What is the general difference in appearance of Mature vs. Reactive Lymphocytosis?
- Mature = lots of mature lymphocytes
- Reactive = lots of funny-looking lymphocytes
What are the causes of Reactive Lymphocytosis?
- Infectious mononucleosis
- Pediatric viral infections (e.g. Measles, Mumps)
- Viral hepatitis
- Immune disorders
What are two types of cells seen in Reactive Lymphocytosis?
- Downey cells
- I - small lymphocyte with lobed nucleus and scant, compact cytoplasm
- II - a large, “fried-egg” lymphocyte with copious cytoplasm containing radial striations
- III - very large lymphocyte with a large nucleus showing a fine chromatin pattern
- Plasmacytoid lymphocyte
- cells that have an eccentric nucleus and a hof, like plasma cells, but with clumpy-smudgy lymphocyte chromatin rather than the blocky clock-face chromatin of a plasma cell
- Plasma cells and their precursors
Based on lab tests, how can you tell benign left shift vs. malignant CML?
- Left shift
- toxic changes (maybe)
- Fewer immature cells
- No basophilia
- LAP (leukocyte alkaline phosphatase) normal/increased
- CML
- Super-high WBC
- Lots of immature cells
- Basophilia
- LAP decreased
What is the best way to differentiate benign neutrophilia from CML?
Cytogenetics
(translocation between chromosome 9 & 22)
