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Heme Path Exam 1 > Benign WBC Disorders > Flashcards

Benign WBC Disorders Flashcards

1
Q

derived visual appearance of “buffy coat”

A

White Cell

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2
Q

Leukocyte or leucocyte: Greek leucos

A

leucos= white
leukois the original German spelling
leucois the anglicized spelling.

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3
Q

Term coined by Virchow to indicate a malignancy which greatly increases the “Leuko” fraction of the blood, but now also includes aleukemicleukemias

A

Leukemia

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4
Q

Aleukemic leukemia

A

leukemia in which the leukocyte count is normal or below normal; it may be lymphocytic, monocytic, or myeocytic.

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5
Q

Solid tumors derived from lymphoid tissue that primarily involve lymph nodes and peripheral organs

A

lymphoma

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6
Q

Myeloid Disorders (leukemias)

A

precursors of erythroid, granulocytic, monocytic and megakaryocytic series
Granulocytes include neutrophils, eosinophils and basophils

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7
Q

Myeloid Cells (Myeloid: Erythroid ratio):

A

granulocytes and monocytes only

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8
Q

Nodes with low grade non-Hodgkin lymphoma

A

Tends to involve multiple lymph nodes (“matted” nodes)

High grade Non-Hodgkin’s lymphoma (NHL) tends to involve a single node, localized group of nodes or extranodalsite

Nodes involved with lymphoma usually appear fleshy tan and are rubbery firm

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9
Q

Plasma is made up of

A

it is 55% of total blood volume

made of:

91% water
7% blood proteins (fibrinogen, albumin, globulin)
2% nutrients (aa, sugars, lipids), homrones (erythropoietin, insulin, etc), electrolyets (sodium, potassium, calcium etc)

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10
Q

Cellular components of blood is made up of

A

45% of total blood volume

made of:

buffy coat - white blood cell about 9000 per mm3 of blood and platelets about 250000 per mm3 of blood

RBCs - about 5 million per mm3 of blood

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11
Q

anemia in cbc shows up as

A

mildly elevated WBC count due to lymphocytosis and an elevated erythrocyte sedimentation rate

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12
Q

Paul Ehrlich, M.D.

A

(Virchow’s PathologieInstitute, 1878 –1888) uses basic and acidic aniline dyes on blood smears to describe and name peripheral blood WBCs

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13
Q

Dimitri Romanovsky, M.D.

A

1891 reported use of eosin and methylene blue to identify malaria parasites in red cells —“Romanovskystains”
Most common types used to stain peripheral blood white cells
Wright Giemsa

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14
Q

wright stain

A

looking at dna

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15
Q

Giemsa stain

A

looking for parasites

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16
Q

Hematopoiesis

nk cell

A

hematopoietic stem cell>multipotent progenitor>early progenitor with lymphoid protential> pro nk cell>pre nk cell>nk cell

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17
Q

Hematopoiesis

b cell

A

hematopoietic stem cell>multipotent progenitor>early progenitor with lymphoid potential>pro b cell (lymphopoiesis)>pre b cell> b cell

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18
Q

Hematopoiesis

t cell

A

hematopoietic stem cell>multipotent progenitor>early progenitor with lymphoid potential> pro t cell (lymphoiesis)> pre t cell >t cell

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19
Q

Hematopoiesis

neutrophil

A

hematopoietic stem cell>multipotent progenitor>earl progenitor with myeloid potential>CFU-mix>cfu-g>myeloblast>neutrophil

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20
Q

Hematopoiesis

monocyte

A

hematopoietic stem cell>multipotent progenitor>earl progenitor with myeloid potential>CFU-mix>cfu-m>monoblast>monocyte

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21
Q

Hematopoiesis

Eosinophil

A

hematopoietic stem cell>multipotent progenitor>earl progenitor with myeloid potential>CFU-mix>cfu-eo>eosinophilic blast>eosinophil

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22
Q

Hematopoiesis

baophil

A

hematopoietic stem cell>multipotent progenitor>early progenitor withmyeloid potential>CFU-bme>cfu-b> basophilic blast>basophil

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23
Q

Hematopoiesis

platelets

A

hematopoietic stem cell>multipotent progenitor>early progenitor withmyeloid potential>CFU-bme>cfu-mg>megakaryoblast>platelets

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24
Q

Hematopoiesis

erythrocyte

A

hematopoietic stem cell>multipotent progenitor>early progenitor withmyeloid potential>CFU-bme>cfu-e>erythroblast>erythrocyte

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25
Q

hematopoiesis at birth

A

bone marrow

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26
Q

hematopoiesis at 70

most to least

A

vertebral and pelvis

sternum

ribs

lymphnodes

femur

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27
Q

red cell myelopoiesis

A

myeloid stme cell>pronormoblast>basophilic normoblast>polychromic normoblast>orthochromic normoblast>red cell

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28
Q

megakaryocyte myelopoiesis

A

myeloid stem cell>megakaryoblast>promegakaryocyte>megakaryocyte

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29
Q

monocyte myelopoiesis

A

myeloid stem cell>monoblast>promonocyte>monocyte

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30
Q

mature basophil myelopoiesis

A

myeloid stem cell

myeloplast type I

myeloblast type II

promyelocyte

basophil myelocyte

basophil metamyelocyte

basophil band

mature basophil

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31
Q

segmented neutrophil meyloposiesis

A

myeloid stem cell

myeloplast type I

myeloblast type II

promyelocyte

neutrophil myelocyte

neutrophil metamyelocyte

neutrophil band

segmented neutrophil

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32
Q

mature eosinophil myelopoiesis

A

myeloid stem cell

myeloplast type I

myeloblast type II

promyelocyte

eosinophil myelocyte

eosinophil metamyelocyte

eosinophil band

mature esoinophil

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33
Q

CD4+ cell maturation overview

A

Lymphoid Stem cell in bone marrow>thymus>t precursor lymphoblast>naïve tcell>blood>CD4+>antigen presentation>node paracortex>t immunoblast>blood>effector tcell

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34
Q

Cd8+ maturation overview

A

Lymphoid Stem cell in bone marrow>thymus>t precursor lymphoblast>naïve tcell>blood>CD8+>antigen presentation>node paracortex>t immunoblast>blood>memory tcell

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35
Q

T precursory lymphoblast and t lymphoblastic lymphoma/ leukemia

A

Location - thymus/bone marrow

nuclear marker - tdt+

markers - cd1a, cd7, cd3, cd4-, cd8-

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36
Q

Naïve t cells

A

location - thymus

markers - cd1a, cd7, cd2, cd3, cd4+, cd8+

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37
Q

where do peripheral t cell lymphomas arise

A

node paracortex

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38
Q

plasmacytoid lymphocyte and lymphoplasmacytic lymphoma overview

A

lymphoid stem cell in bone marrow> bprecursor lymphoblast>blood>naïve b cell (in primary follicle or mantle zone>antigen presentation> folligular/germinal center>follicular b blast>node paracortex>b immunoblast>blood> plasmacytoid lymphocyte

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39
Q

Plasma cell and myeloma overview 1st way

A

lymphoid stem cell in bone marrow> bprecursor lymphoblast>blood>naïve b cell (in primary follicle or mantle zone>antigen presentation> folligular/germinal center>follicular b blast>node paracortex>b immunoblast>marginal zone>memory b cell> marrow (blood?)> plasma cell

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40
Q

plasma cell and myeloma overview 2nd way

A

lymphoid stem cell in bone marrow> bprecursor lymphoblast>blood>naïve b cell (in primary follicle or mantle zone>antigen presentation> follifular/germinal center>follicular b blast>centroblast>centrocyte>marginal zone>memory bcell> marrow (blood?)>plasma cell

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41
Q

plasma cell and myeloma overview 3rd way

A

lymphoid stem cell in bone marrow> bprecursor lymphoblast>blood>naïve b cell (in primary follicle or mantle zone>antigen presentation> follifular/germinal center>follicular b blast>centroblast>centrocyte>marrow (blood?)>plasma cell

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42
Q

b precursor lymphoblast and be lymphoblastic leukemia/lymphoma

A

location - bone marrow

nuclear markers - tdt+ and pax 5

markers - cd10,19,79a

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43
Q

naïve b cell and mantle cell lymphoma

A

location - blood/primary follicle or mantle zone

nuclear markers - bcl2 and pax5

markers - cd10,19,20,79a,5, sigm and sigd

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44
Q

follicular b blast and burkitt lymphoma

A

location - follicular/ germinal center

nuclear markers - bcl6 pax5

markers - CD10,CD19, CD20,CD79a, sIgM

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45
Q

b immunoblast and large b cell lymphomas

A

location - node paracortex

nuclear markers - pax 5

markers - cd20,79a and sigm

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46
Q

centroblast

A

location - follicular/germinal center

nuclear markers - bcl6 pax5

markers - cd10, 20, 79a sig?

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47
Q

centrocyte

A

location - follicular/germinal center

nuclear markers - bcl6 pax5

markers - cd10,20,79a,sig g and sigm

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48
Q

memory b cell

A

location - marginal zone

nuclear markers - pax5

markers - cd20,38,79a, and sigm

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49
Q

plasmacytoid and lymphocyte lymphoplasmacytic lymphoma

A

location - blood

nuclear markers - pax5

markers - cd20 79a 38 138 and cigm

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50
Q

plasma cell and myeloma

A

location - blood? and marrow

nuclear markers - none

markers - cd79a 38 138 and cig gamde

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51
Q

Monocyte =

A

circulating macrophage or histiocyteprecursor

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52
Q

Count and normal range per 1000 bone marrow cells

myeloblast

A

14

0.1-0.7

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53
Q

Count and normal range per 1000 bone marrow cells

Promyelocyt

A

29

1.9-4.7

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54
Q

Count and normal range per 1000 bone marrow cells

myelocyte

A

103

8.5-16.9

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55
Q

Count and normal range per 1000 bone marrow cells

band (stab) neutrophil

A

116

9.4-15.4

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56
Q

Count and normal range per 1000 bone marrow cells

metamyelocyte

A

91

7.1-24.7

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57
Q

Count and normal range per 1000 bone marrow cells

segmented neutrophil

A

106

9.4-15.4

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58
Q

Count and normal range per 1000 bone marrow cells

lymphocyte

A

111

8.6-23.8

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59
Q

Use “Romanovsky” stains on

A

air-dried thin smears of blood.

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60
Q

The “Manual WBC differential” is performed by examining

A

The “Manual WBC differential” is performed by examining

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61
Q

The relative number of each typeof WBC is expressed as %

A

of the total white cell population.

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62
Q

count and normal range per 100 white cells in peripheral blood

basophil

A

1

0-3

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63
Q

count and normal range per 100 white cells in peripheral blood

segmented neutrophil

A

61

45-79

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64
Q

count and normal range per 100 white cells in peripheral blood

band neutrophil

A

2

0-5

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65
Q

count and normal range per 100 white cells in peripheral blood

lymphocyte

A

24

16-47

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66
Q

count and normal range per 100 white cells in peripheral blood

monocyte

A

8

0-9

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67
Q

count and normal range per 100 white cells in peripheral blood

eosinophil

A

4

0-6

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68
Q

Hyper-segmentation

A

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

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69
Q

Toxic granulation and vacuolization

A

increased and prominent azurophilic(primary) granules and cytoplasmic vacuoles; seen with infections

70
Q

Left shift

A

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

71
Q

Reactive changes in neutrophils

A

Neutrophils containing coarse purple cytoplasmic granules (toxic granulations) and blue cytoplasmic patches of dilated endoplasmic reticulum (Döhlebodies, arrow) are observed in this peripheral blood smear prepared from a patient with bacterial sepsis

72
Q

Changes in WBCs in Peripheral Blood

Relative change

A

in one type of white blood cell WBC expressed as a %of overall number WBCs usually doesn’t mean much
What matters for each WBC type is the “absolute’ count or % of total multiplied by the total WBC count; e.g.,

73
Q

Changes in WBCs in Peripheral Blood

Absolute neutrophil count

A

Absolute Neutrophil Count =% NeutrophilsX total WBC count

Absolute neutrophils = 46% X 10,000 cell/microliter
= 4,600 neutrophils/uL

74
Q

Adult Reference Ranges for Blood Cells

Platelets (×103/μL)

A

150-450

75
Q

Adult Reference Ranges for Blood Cells

White cells (×103/μL)

A

4.8-10.8

76
Q

Adult Reference Ranges for Blood Cells

Granulocytes (%)

A

40-70

77
Q

Adult Reference Ranges for Blood Cells

Neutrophils (×103/μL)

A

1.4-6.5

78
Q

Adult Reference Ranges for Blood Cells

Lymphocytes (×103/μL)

A

1.2-3.4

79
Q

Adult Reference Ranges for Blood Cells

Monocytes (×103/μL)

A

0.1-0.6

80
Q

Adult Reference Ranges for Blood Cells

Eosinophils (×103/μL)

A

0-0.5

81
Q

Adult Reference Ranges for Blood Cells

Basophils (×103/μL)

A

0-0.2

82
Q

Adult Reference Ranges for Blood Cells

Red cells (×106/μL)

A

4.3-5.0, men; 3.5-5.0, women

83
Q

Common Reference Range Absolute Neutrophils

Birth

1-7 days

8-14 days

15 days-1 month

2-5 months

6 months-5 years

6-15 years

Adult

A 
Birth
6.0-26.0
1-7 days
1.5-10.0
8-14 days
1.0-9.5
15 days-1 month
1.0-9.0
2-5 months
1.0-8.5
6 months-5 years
1.5-8.5
6-15 years
1.5-8.0
Adult
1.7-7.0
84
Q

Lifespan of WBCs in Peripheral Blood

Neutrophils (Granulocytes):

A

1 -48 Hours

Note:

85
Q

Lifespan of WBCs in Peripheral Blood

Eosinophils:

A

1 –48 hours (average 8 hours)

Note:

86
Q

Lifespan of WBCs in Peripheral Blood

Lymphocytes:

A

Hours to days (B-cells)

Days to years (T-cells)

87
Q

Changes in Peripheral Blood WBCs Associated with “Disease”

Segmented neutrophils (granulocytes) includes bands

A
  • Granulocytopenia≃Neutropenia
  • Granulocytosis
    • Leukemoidreaction
    • Leukoerythroblastosis
88
Q

Changes in Peripheral Blood WBCs Associated with “Disease”

Eosinophils

A

Eosinophilia

89
Q

Changes in Peripheral Blood WBCs Associated with “Disease”

Lymphocytes

A
  • Lymphopenia
  • Lymphocytosis
    • Atypical (activated) lymphocytes
90
Q

Changes in Peripheral Blood WBCs Associated with “Disease”

What about, basopenia, basophilia, monocytosis, monocytopeniaand eosinophilopenia?

A

Can be a hint to underlying disorders !!!!

91
Q

Neutrophilicleukocytosis

A

Acute bacterial infections, especially those caused by pyogenicorganisms; sterile inflammation caused by, for example, tissue necrosis (myocardial infarction, burns)

92
Q

Eosinophilicleukocytosis

eosinophilia

A

Allergic disorders such as asthma, hay fever, helminthicparasitic infestations; drug reactions; certain malignancies (e.g., Hodgkin and some non-Hodgkin lymphomas); automimmunedisorders (e.g., pemphigus, dermatitis herpetiformis) and some vasculitides; atheroembolicdisease (transient)

93
Q

Basophilic leukocytosis

basophilia

A

Rare, often indicative of a myeloproliferativedisease (e.g., chronic myeloid leukemia)

94
Q

Monocytosis

A

Chronic infections(e.g., tuberculosis), bacterial endocarditis, rickettsiosis, and malaria; autoimmune disorders(e.g., systemic lupus erythematosus); inflammatory bowel diseases(e.g., ulcerative colitis)

95
Q

Lymphocytosis

A

Accompanies monocytosisin many disorders associated with chronic immunological stimulation (e.g., tuberculosis, brucellosis); viral infections (e.g., hepatitis A, cytomegalovirus, Epstein-Barr virus);Bordetellapertussisinfection

96
Q

granulocyte hemopoietic pools

A

bone marrow pool - prolif and mature>storage

peripheral blood - 50% storage and 50% functional

97
Q

thrombocyte hemopoietic pools

A

bone marrow is all prolif and mature

peripheral blood - storage is 30% and functional is 70%

98
Q

erythrocyte hemopoietic pools

A

bone marrow is all prolif an dmature

peripheral blood is all functional

99
Q

Mechanisms and Causes of Leukocytosis

INCREASED PRODUCTION IN THE MARROW

A

Chronic infection or inflammation
(growth factor-dependent)

Paraneoplastic
(e.g., Hodgkin lymphoma; growth factor-dependent)

Myeloproliferativedisorders
(e.g., chronic myeloid leukemia; growth factor-independent)

100
Q

Mechanisms and Causes of Leukocytosis

INCREASED RELEASE FROM MARROW STORES

A

endotoxemia

infection

hypoxia

101
Q

Mechanisms and Causes of Leukocytosis

DECREASEDMARGINATION

A

exercise

catecholamine

102
Q

Mechanisms and Causes of Leukocytosis

DECREASED EXTRAVASATION INTO TISSUES

A

glucocorticoids

103
Q

Neutrophils and their precursors are distributed in five pools…

A

bone marrow - precursor pool and storage pool

peripheral blood - marginating pool and circulating pool

tissues - tissue pool

peripheral blood is only the circulating pool

104
Q

Leukemoid Reaction

A

A marked elevation in white cell count
(usually > 20,000/uL) that
Simulates chronic myelogenousleukemia
high WBC count and immature precursors in blood

Leukocyte alkaline phosphatase score elevated

Low scores inChronic Myelogenous Leukemia

105
Q

Low scores inChronic Myelogenous Leukemia

A

(Can also be low in paroxysmal nocturnal hemoglobinuria, thrombocytopenic purpura, and hereditary hypophosphatasia)

106
Q

Leukocyte alkaline phosphatase score elevated

A

(Can also be high in polycythemia vera, myelofibrosis, aplastic anemia, hairy cell leukemia and Hodgkin disease)

107
Q

Leukoerythroblasticreaction

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 myeloproliferativeneoplasms
      • particularly primary myelofibrosis
108
Q

Critical Value for Neutropenia(Granulocytopenia)

A

Critical value generally quoted:

absolute count

109
Q

The lower the absolute neutrophil count

the greater the risk of infection

A
  • Infections are the most common cause of acquired neutropenia
  • Drugs the most common cause of clinically significant neutropenias
110
Q

Agranulocytosis

A

severe neutropenia, usually caused by drugs

111
Q

Neutropenia

pathogenesis

A
  • Decreased or ineffective production
    • Inherited, such as severe congenital neutropenia e.g. Kostmannsyndrome (severe congenital neutropenia, autosomal recessive type 3)
    • Acquired, such as acquired aplastic anemia, myelodysplastic syndrome, nutritional deficiencies
112
Q

Neutropenia

accelerated removal or destruction

A
  • Immunologic disorders
  • Splenomegaly
  • Severe infections, such as overwhelming bacterial infection
113
Q

Peripheral Blood Eosinophilia: relative & absolute

A

Relative Eosinophilia:>3% total wbcdifferential count

Absolute Eosinophilia:Total Eosinophils >0.5 x 109/L

(Variable depending on laboratory, institution & geographic location)

114
Q

Absolute Eosinophilia further subdivided into:

A

Mild Eosinophilia 0.35-0.90 x 109/L

Moderate Eosinophilia1.00-5.00 x 109/L

Marked Eosinophilia>5.00 x 109/L

115
Q

Eosinophilia

Screening ambulatory North American outpatients (1997)

A

0.1% Had absolute eosinophil counts of >0.7 x 109/L.

Etiology% Patients with Eosinophilia

Unknown36
Seasonal allergy/allergic rhinitis29
Asthma14
Eczema/dermatitis9
Cancer4
Drug allergy3
Parasitic disease2
116
Q

eosinophilia
Outside United States
Screening Asian young males (military service in Singapore)

A

5% had absolute eosinophil counts >0.7 x 109/L

Etiology% Total Patients with Eosinophilia

Helminthiasis49
Atopy-Allergy28
Helminth + Atopy16
Unknown7

117
Q

Lymphocytosis

Reference range values:

A

Total (absolute) Lymphocytes x 109/L

Ages 6 -11 yrs(male & female) 1.5 -6.5

Ages 12 -15 yrs(male & female) 1.2 -5.2

Adult (male & female) 0.9 -2.9

118
Q

Total lymphocytes normal adults

USC Clinical Laboratories; Flow Cytometry Section

A

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

Relative(%) lymphocyte count
Mean 40; Range 20 –47

119
Q

Lymphocyte SubpopulationsCirculating Lymphocytes

T-cell Peripheral

Antibody%Range Absolute /μL range

A

CD3+
60 -90
952 –2,745

120
Q

Lymphocyte SubpopulationsCirculating Lymphocytes

Antibody%Range Absolute /μL range

T-cell helper

A

CD4+
32 -56
518 –1,605

121
Q

Lymphocyte SubpopulationsCirculating Lymphocytes

Antibody%Range Absolute /μL range

T cell cytotoxic

A

CD8+
17 -40
367 -1,072

122
Q

Lymphocyte SubpopulationsCirculating Lymphocytes

Antibody%Range Absolute /μL range

B cell peripheral

A

CD19
4-20
91 -295

123
Q

Lymphocyte SubpopulationsCirculating Lymphocytes

Antibody%Range Absolute /μL range

nk cell

A

CD56+/16+ 4
-18
58 -335

124
Q

Most ( > 80%) of Circulating Lymphocytes are

A

t cell

125
Q

Normal CD4/CD8 ratio

A

1:1 to 4:1

126
Q

Normal kappa/lambda ratio (bs)

A

1:1 to 2:1

127
Q

Infectious Mononucleosis

virus

A

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

128
Q

Infectious Mononucleosis

clinical findings

A

Severe fatigue
Sore throat
Lymphadenopathy
Lymphocytosis due to variant forms (Downey cells)
•Lymphocytosis is transient, lasting a few days to weeks
•[An infectious mononucleosis-like picture rarely seen in CMV (cytomegalovirus) infection, viral hepatitis, herpes simplex infections, serum sickness illness and drug reactions]

129
Q

Epstein Barr virus (EBV) infects

A

B cells

EBV glycoprotein binds CD21/CR2 (C3d complement receptor)
May be asymptomatic in children
Sore throat, fever, febrile rash and lymphadenopathy
Can develop hepatitis, anemia (anti-i), thrombocytopenia, splenomegaly

130
Q

Subsequent B & T cell response after ebv infects b cells

A

Cytotoxic/supressorCD8+ 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/uland atypical lymphocytes)

131
Q

Monospottest

A

for ebv

sensitive fairly specific heterophileantibody test positive in 1-2 weeks in 85% (Serum absorbed with guinea pig kidney still binds horse erythrocytes)

132
Q

Epstein Barr-Virus antibodiesto capsidantigen

A

for heterophilenegative cases

133
Q

Differential HeterophilAbsorption test: cow erythrocytes

A

+/guinea pig erythrocytes -highly specific, but less sensitive, for the diagnosis (with typical clinical presentation and positive Monospot, not necessary)

134
Q

Paul-Bunnellreaction

A

(1932) heterophileantibodies to sheep red cells

135
Q

Atypical lymphocytes in infectious mononucleosis

A

The cell on the left is a normal small lymphocyte with a compact nucleus filling the entire cytoplasm. In contrast, an atypical lymphocyte on the right has abundant cytoplasm and a large nucleus with fine chromatin.

136
Q

“Atypical” lymphocytes

A

Atypical = larger (more cytoplasm); nucleoli in nuclei; cytoplasm indented by surrounding RBC’s. Atypical lymphocytes often associated with infectious mononucleosis –“Mono”.

137
Q

LymphocytopeniaLymphocytes Decreased Below Reference Range

A

Reference values: Total lymphocytes adults
(USC Clinical Laboratories; Flow Cytometry Section)

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

Relative (%) lymphocyte count
Mean 40; Range 20 -47

138
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

139
Q

Absolute lymphocytopeniawith Hemogramabnormality (anemia,

thrombocytopenia or leukopenia without known clinical cause)

A

Perform a bone marrow aspirate and biopsy

140
Q

Absolute lymphocytopenia+ suspect immune deficiency

A

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

141
Q

LymphocytopeniaCommon Causes

A

Chemotherapy or irradiation therapy
Cortisone “Steroid” therapy
Administration of erythropoietin
Pregnancy

142
Q

Diseases associated with lymphocytopenia

A 
AIDS
Hodgkin's disease
Idiopathic or acquired aplasticanemia
Acute bacterial infection
Cancer stomach, ovary and breast
Systemic lupus erythematosus
Viral infections on occasion
143
Q

dark zone

A

proliferation of b cells and somatic hypermutation

144
Q

Basal light zone

A

positive slection for binding to antigen on follicular dendritic clels

145
Q

apical light zone

A

generation of memory cells and plasma cell precursors and class switching

146
Q

lymph node capsule

A

Subcapsularsinus
MonocytoidB cells
IgGor IgM+. IgD-, BCL2

147
Q

Secondary Follicle

A

Germinal Center (BCL2-)

B-blast (small noncleaved)
sIgM+, transient

Centroblast(large noncleaved)
sIg-, persistent

Centrocyte(small/large cleaved)
sIgG+, persistent

148
Q

Mantle Zone

A

mostly naive

149
Q

marginal zone

A

IgM+, IgD-(memory cell)

150
Q

Primary Follicle (naïveB-cells)

A

IgM+,IgD+,CD5-/+,BCL2+

151
Q

Lymphadenopathy: definition

A

Painlessenlargement of a lymph node or group of nodes

152
Q

Lymphadenopathy: Applies to any enlargement of lymph node(s)

A
  • Infection most likely cause of lymphadenopathy, particularly in children
  • Viral infection most likely cause of lymphadenopathy
  • Supraclavicular and axillary lymph node enlargement is more concerning
  • Lymph node > 4 centimeters most likely is malignant
  • Hemophagocyticlymphohistiocytosis
153
Q

Hemophagocyticlymphohistiocytosis

A

rare familial or acquired over-activation of histiocytesvia CD8+ lymphocytes that leads to lymphadenopathy and hepatosplenomegaly from hemophagocytosisleading to pancytopenia; along with other clinical manifestations (rash, fever, etc.)

154
Q

Major Cause Adenopathy > Age60

A

Metastatic Carcinoma

155
Q

causes of adenopathy

A

Reactive
–general immune response (local/systemic)
–specific diseases

Uncertain cause: Sarcoidosis

Primary Neoplasms: Malignant
Lymphomas, etc

Secondary Neoplasms: Metastasis

156
Q

location of adenopathy in adults

A

head and neck - 55%

supraclavicular - 1 %

axillary - 5%

inguinal - 14%

localized - 75%

157
Q

Acute Nonspecific Lymphadenitis:

A

Swollen, edematous tender (painful)with distended capsule

Associated with acute bacterial infection of a localized body site resulting acute lymphadenitis affecting the regional lymph nodes draining the site

Most common node groups involved are cervical and mesenteric

May become suppurativeand form draining sinus

158
Q

Chronic Nonspecific Lymphadenitis

A

Enlarged but painless; capsule is proportionally enlarged. Nodes are palpable (> 2cm).

159
Q

3 patterns of chronic nonspecific lymphadenitis

A

Stimulus B-cell populations

Stimulus T-cell populations

Prominence of lymphatic sinusoids:

160
Q

Stimulus B-cell populations

A

Follicular Hyperplasia expansion of the germinal centers with increase in tingiblebody macrophages; Specific causes include: Rheumatoid Arthritis, Toxoplasmosis, early stages HIV

161
Q

Stimulus T-cell populations

A

ParacorticalHyperplasia Expansion of T-cell rich paracorticalregions; infectious mono, acute viral infections, following vaccinations, reactions to Dilantin.

162
Q

Prominence of lymphatic sinusoids:

A

Sinus HistiocytosisHyperplasia of macrophages lining sinuses, e.g. in axillary nodes draining a region of breast cancer.

163
Q

Reactive Hyperplasia
Manifestations of immune response in lymph node

B cell transformation/
proliferation

A

follicle

164
Q

Reactive Hyperplasia
Manifestations of immune response in lymph nnode

T cell transformation/
proliferation

A

paracortex

165
Q

Reactive Hyperplasia
Manifestations of immune response in lymph node

Histiocyterecruitment/ activation

A

sinuses

166
Q

Reactive Hyperplasia:

Follicular Hyperplasia

A

B CD20

Follicular hyperplasia

B cell transformation
+ proliferation –follicles

167
Q

Reactive Hyperplasia:

Diffuse Paracortical

A

T cell transformation
+ proliferation –Paracortex
Diffuse hyperplasia

TCD3

168
Q

Cat Scratch Disease

A
  • Self-limited lymphadenitis usually of head and neck
  • Bartonellahenselae
  • Cat scratch, splinter or thorn
  • Primarily in children
  • Rarely encephalitis, osteomyelitis, or thrombocytopenia
  • Initially, sarcoid-like granulomas
  • Laterstellate necrotizing granulomas
169
Q

follicular hyperplasia

low power view

A

reactive follicle and surrounding mantle zone. The dark-staining mantle zone is more prominent adjacent to the germinal-center light zone in the left half of the follicle. The right half of the follicle consists of the dark zone.

170
Q

follicular hyperplasia high power view

A

of the dark zone shows several mitotic figures and numerous macrophages containing phagocytosed apoptotic cells (tingiblebodies).

Heme Path Exam 1 (7 decks)

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