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Heme/ Lymph > Benign WBC Conditions > Flashcards

Benign WBC Conditions Flashcards

1
Q

Causes of neutrophilic leukocytosis

A

acute bacterial infections

sterile inflammation caused by, for example, tissue necrosis (myocardial infarction, burns)

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2
Q

Causes of eosinophilic leukocytosis

A

allergic disorders
*helminthic parasitic infestations
drug reactions
autoimmune disorders

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3
Q

Causes of basophilic leukocytosis (basophilia)

A

myeloproliferative disease

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4
Q

causes of monocytosis

A 
chronic infections
bacterial endocarditis
rickettsiosis
malaria
autoimmune disorders
inflammatory bowel diseases
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5
Q

causes of lymphocytosis

A

chronic immunological stimulation
viral infections
Bordetella pertussis

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6
Q

Hyper- segmentation

A

PMNs with 5 or more lobes indicate; seen with megaloblastic anemias, myeloproliferative disorders, and some chemotherapy

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7
Q

Toxic granulation and vacuolization

A
  • increased and prominent azurophilic (primary) granules and cytoplasmic vacuoles; seen with infections
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8
Q

Left shift

A

An absolute increase in neutrophils with an increase in bands +/- metamyelocytes or myelocytes- seen in infections and leukemias

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9
Q

Lifespan of WBCs in Peripheral Blood

A

Neutrophils (Granulocytes): 1 - 48 Hours

Eosinophils: 1 – 48 hours (average 8 hours)

Lymphocytes:
Hours to days (B-cells)
Days to years (T-cells)

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10
Q

Neutrophils and their precursors are distributed primarily in five pools…

A
  1. Bone marrow- proliferating
  2. bone marrow- storage
  3. blood vessel- storage
  4. blood vessel- circulating
  5. peripheral tissue- active and storage

Sampling of the peripheral blood assesses only the circulating pool!!!

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11
Q

Changes in Granulocyte Pools: Causes of increased neutrophil count- production in the marrow

A

Chronic infection or inflammation (growth-factor-dependent)
Paraneoplastic (e.g. hodgkin lymphoma; growth factor-dependent
Myeloproliferative disorders (e.g. chronic myeloid leukemia; growth factor- independent)

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12
Q

Changes in Granulocyte Pools: Causes of increased neutrophil count- increased release from marrow stores

A

Endotoxemia

Infection

Hypoxia

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13
Q

Changes in Granulocyte Pools: Causes of increased neutrophil count- decreased margination

A

exercise

catecholamines

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14
Q

Changes in Granulocyte Pools: Causes of increased neutrophil count- decreased extravasation into tissues

A

glucocorticoids

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15
Q

Leukemoid Reaction– what is it? How do we differentiate between it and leukemia?

A

looks like a leukemia but it’s not– it’s not neoplastic. Acute stress– like an infection, for example.

marked elevation in white cell count

Simulates chronic myelogenous leukemia

Leukocyte alkaline phosphatase (LAP) score elevated with infections

Low LAP scores in chronic myelogenous leukemia

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16
Q

Leukoerythroblastic reaction– what is it? When do we tend to see it?

A

Presence of immature granulocytes
and erythroid precursors in the blood

Commonly seen in:

  • Severe hemolytic anemia
  • Bone marrow infiltration
  • —- metastatic tumor
  • —- granulomas
  • —- infiltrative process (fibrosis)
  • Chronic myeloproliferative neoplasms
  • —- particularly primary myelofibrosis
17
Q

Critical Value for Neutropenia (Granulocytopenia)

A

absolute count less than 500/µL or less than 0.5 x 10^9/L

The lower the absolute neutrophil count
the greater the risk of infection
Infections are the most common cause of acquired neutropenia
Drugs the most common cause of clinically significant neutropenias

18
Q

Agranulocytosis

A

severe neutropenia, usually caused by drugs

19
Q

Neutropenia Pathogenesis

A
  1. Decreased or ineffective production
    - Inherited, such as severe congenital neutropenia e.g. Kostmann syndrome
    - Acquired, such as acquired aplastic anemia, myelodysplastic syndrome, nutritional deficiencies
  2. Accelerated removal or destruction
    - Immunologic disorders
    - Splenomegaly
    - Severe infections, such as overwhelming bacterial infection
20
Q

Peripheral Blood Eosinophilia: relative & absolute

A

Relative Eosinophilia: >3% total wbc differential count

***Absolute Eosinophilia: Total Eosinophils >0.5 x 10^9/L

(Variable depending on laboratory, institution & geographic location)

21
Q

Absolute Eosinophilia subdivisions:

A

Mild Eosinophilia 0.35-0.90 x 109/LModerate Eosinophilia 1.00-5.00 x 109/LMarked Eosinophilia>5.00 x 109/L

22
Q

Lymphocytosis

A

Increased Lymphocytes Above Reference Range

23
Q

Normal CD4/CD8 ratio

A

1:1 to 4:1

24
Q
  • Normal kappa/lambda ratio
A

1:1 to 2:1

25
Q

Most ( > 80%) of Circulating Lymphocytes

A

are T cells

26
Q

most lymphocytes in the lymph nodes are

A

B Cells

27
Q

low CD4/CD8 ratio is associated with

A

HIV

but can also be related to high allergies, as in Dr. Gomez’s case

28
Q

Infectious Mononucleosis

A

Acute infectious mononucleosis: Transient disease associated with Epstein Barr virus (EBV)

(sore throat, fatigue, lymphadenopathy)

*** Downey Cells

Epstein Barr virus (EBV) infects B cells
Subsequent B & T cell response

Cytotoxic/supressor CD8+ T cells and CD 16+ NK cells soon predominate in tissues and blood destroying infected B cells (with WBC of 12,000-18,000 cell/ul and atypical lymphocytes)

Monospot test, binds horse erythrocytes

Epstein Barr-Virus antibodies to capsid antigen

29
Q

Lymphocytopenia

A

Lymphocytes Decreased Below Reference Range

Absolute lymphocyte count
Mean 2.720; Range 1.359 - 3.479 × 109/L

	Relative (%) lymphocyte count
	Mean 40; Range 20 - 47
30
Q 
Absolute lymphocytopenia (no other abnormality) detected by
automated hematology analyzer testing:
A

Perform a microscopic examination of a peripheral blood smear to examine the lymphocyte morphology

31
Q

Absolute lymphocytopenia with Hemogram abnormality (anemia,

thrombocytopenia or leukopenia without known clinical cause) – what should we do?

A

Perform a bone marrow aspirate and biopsy

32
Q

Absolute lymphocytopenia + suspect immune deficiency

– what should we do?

A

Flow cytometry immunophenotyping
Serum protein concentration
Serum protein electrophoresis
Quantitative serum immunoglobulins

33
Q

Lymphocytopenia Common Causes

A 
AIDS 
	Hodgkin's disease
	Idiopathic or acquired aplastic anemia 
	Acute bacterial infection 
	Cancer stomach, ovary and breast 
	Systemic lupus erythematosus 
(less important:
Chemotherapy or irradiation therapy 
Cortisone “Steroid” therapy 
Administration of erythropoietin 
Pregnancy )

Heme/ Lymph (15 decks)

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