Benign Leukocytoses- Krafts

Question 1

What does marginated neutrophils mean?

Answer 1

The neutrophils are plastered up against the walls of the vessels (over half of them!)

Can release when stressed, so can essentially double your neutrophil count from stress

Question 2

If you see elevated mature/ segmented neutrophils what should you consider?

Answer 2

Infection (bacterial) or inflammation

Question 3

What is are “toxic changes”

Answer 3

Sometimes during infections, neutrophils show toxic changes =

• toxic granulation, abundant, deep dark granules in cytoplasm
• Dohle bodies = RER
• Cytoplasmic vacuolization = indicates severity of infection scariest

Question 4

When are you most likely to see toxic changes in neutrophils?

Answer 4

Any type of bacterial infection, especially abundant in serious infections like SEPSIS

Question 5

What are the three types of immature neutrophilia?

Answer 5

Left shift
Leukemoid Reaction
Leukoerythroblastotic reactions

Question 6

What is a left shift?

Answer 6

Immature neutrophils in bood

usually caused by infection and inflammation

Question 7

What is the leukemoid reaction?

Answer 7

Bad term! don’t use it! Doesn’t have clear defination- looks like leukemia, but it isn’t

could be high neutrophil count, or marked left shift, or both…..

Question 8

What is the leukoerythroblastotic reaction?

Answer 8

Both immature neutrophil precursors and immature red cell precursors are in the blood!!!

Question 9

How do you differentiate between physiological leukoerythroblastotic rxn, and a very scary cause of it?

Answer 9

Hemoglobin!

Can happen when very anemic (Hgb 6, likely something filling up marrow =
Carcinoma
Leukemia
Fibrosis

Question 10

How does lymphocyte vary with age?

Answer 10

Count decreases with age

Question 11

What are the percentages of immunophenotypes of the lymphocytes?

Answer 11

T-cells = 60-80%
B-cells = 10-20%
NK cells =5-10%

Question 12

3 causes of mature lymphocytosis?

Answer 12

infectious lymphocytosis
whooping cough
transient stress lymphocytosis

Question 13

How would you describe reactive lymphcytosis?

Answer 13

lymphocyte count is elevated and you see lots of funny-looking lymphocytes

=downey cell

Question 14

What would you consider if you saw a downey cell?

Answer 14

infectious mono-nucleosis

Pediatric viral infections- measles, mumps, rubella and chicken pox

Question 15

What is the best way to differentiate benign neutrophilia from CML (chronic myeloid leukemia)?

Answer 15

Cytogenetics

Question 16

Best was to differentiate benign lymphocytosis from CLL (Chronic lymphocytic leukemia)?

Answer 16

Immunophenotyping & AGE

CLL = mostly B-cells
CLL > AGE 40

Question 17

Your patient hast an elevated basophil count, she should be evaluated to see if she has?

Answer 17

CHRONIC MYELOID LEUKEMIA

Question 18

What are some causes of Eosinophilia?

Answer 18

Drugs
Asthma
Skin diseases
Parasites

Question 19

What are some causes of monocytosis?

Answer 19

Infection
Autoimmune disease
Malignancy