Benign Leukocytosis- Krafts

Question 1

What are the two types of neutrophilia?

Answer 1

Mature (lots of segmented neutrophils)

Immature (lots of immature neutrophils….band cells etc.)

Question 2

Under normal conditions where are most of the neutrophils located?

Answer 2

In the bone marrow!!!

Question 3

What percentage of neutrophils are usually in the blood? What do they look like? What does marginated mean?

Answer 3

• 5% of all neutrophils are in the blood
• Normally only segmented neutrophils
• Half of the neutrophils are marginated, meaning they sit on the inside of endothelium of vessels waiting to be recruited….Stress can demarginate neutrophils!

(This probably happened a little bit to sym before he got the ear herpes!)

Question 4

Causes of mature neutrophilia?

Answer 4

• Bacterial infection #1 cause!
• Inflammation
• Physiologic stuff (stress, hormones)

Question 5

Toxic changes in mature neutrophilia, what do you see?

Answer 5

• Seen only in infection
• Toxic granulation, Dohle bodies, cytoplasmic vacuolization

-Cytoplasmic vacuolization is most concerning sign….means that the infection is really severe

Question 6

Why do we see toxic granulation?

Answer 6

Granulation is retained because the BM is pumping them out into the blood so fast….

Question 7

Causes of Immature neutrophilia?

Answer 7

• Infection (Bacterial)
• Inflammation
• Severe anemia
• Something filling up the BM

Question 8

What are the three forms of immature neutrophilia?

Answer 8

• Left Shift
• Leukemoid reaction (poopy term…)
• Leukoerythroblastoic reaction

Question 9

What do you see with leukoerythroblastoic reactions? What should you check with Leukoerythroblastoic reactions?

Answer 9

• Young RBC and WBC
• Check the Hgb…..if you’re anemic that’s not too bad….if you’re not anemic that means something is filling up the BM pushing cells out too early, THIS IS BAD!!!!

Question 10

Who has a bigger range of “normal lymphocyte count”? Adults or infants?

Answer 10

Infants have a larger normal range….# of lymphocytes decreases with age

Question 11

What is the normal immunophenotype of lymphocytes in blood?

Answer 11

T Cells: 80%
B Cells: 15%
NK Cells: 5%

Question 12

What are the two types of lymphocytosis?

Answer 12

Mature (lots of mature lymphocytes)

Reactive (lots of funny looking lymphocytes)

Question 13

What causes Mature Lymphocytes?

Answer 13

THESE ARE THE ONLY 3 CAUSES!
Infections lymphocytosis (viral infection in kids)
Bordetella pertussis (whooping cough)
Transient stress

Question 14

What causes the highest count in mature lymphocytes? Middle? Lowest?

Answer 14

Infectious is the highest (100)
Bordetella pertussis (55)
Stress (8)

Question 15

Causes of reactive lymphocytosis?

Answer 15

• Infections Mononucleosis
• Pediatric viral infections
• Viral hepatitis
• Immune disorders (autoimmune, vacc rxns, etc.)

Question 16

What do Downey Cells look like? When do we see them?

Answer 16

Fried egg appearance with radial striations

Usually see in Mono, but can see in other situations

Question 17

What is the first thing you do if you see an elevated WBC?

Answer 17

Determine if it’s benign or malignant…. hard to tell visually

Question 18

Best way to differentiate benign neutrophilia from CML?

Answer 18

Cytogenetics

Question 19

Best way to differentiate benign lymphocytosis from CLL?

Answer 19

Immunophenotyping….too many B cells in CLL

Question 20

What does it mean when you see basophilia?

Answer 20

CML!!!! It is the first sign…..you will ONLY see this in CML!!!

Question 21

Causes of Eosinophilia?

Answer 21

• Drugs
• Asthma
• Skin diseases
• Parasites (unproportionally seen on boards and other tests…way more common are the other causes in RL)

Question 22

Causes of Monocytosis?

Answer 22

Infection
Autoimmune disease
Malignancy (Could be due to a solid tumor somewhere else in the body)