CBC WBC

Question 1

WBC abnormalities

Answer 1

infection, inflammation, neoplasm, malignancy

drug reactions

Question 2

what are the two components of the WBC

Answer 2

WBC count
The total number of white blood cells (leukocytes)

The Differential
The percentage of each type of leukocyte present in the sample and the Reference ranges for each type

Question 3

Reference ranges for total WBC count

Answer 3

5,000 to 10,000 mm3 adult
6,700 to 17,000 mm3 child greater the 2 years old
9,000 to 30,000 mm3 newborns

Question 4

newborns and WBC

Answer 4

newborns tend to have high WBC counts and they gradually decline to normal ranges over 2 weeks

Question 5

WBC differentials

Answer 5

Neutrophils				40-85%
Lymphocytes				10-45%
Monocytes				3-15%
Eosinophils				0-7%
Basophils				0-2%

Question 6

Granulocytes

Answer 6

have granules in their cytoplasm & multilobed nuclei
AKA: PMNs
include neutrophils, basophils and eosinophils

Question 7

eosinophils and basophils are involved in

Answer 7

allergic reactions

Question 8

most common PMN

Answer 8

neutrophils

Question 9

neutrophils are involved in the phagocytosis of

Answer 9

bacteria

Question 10

what are the Nongranulocytes?

Answer 10

the lymphocytes and the monocytes

Question 11

what are the lymphocytes?

Answer 11

T and B cells that fight acute viral infections and chronic bacterial infections

Question 12

monocytes are phagocytic cells that

Answer 12

are capable of fighting bacteria like neutrophils do

Question 13

elevated WBC count

Answer 13

typical response to acute bacterial infection is increase of total WBC count with a left shift

Question 14

what is Leukocytosis?

Answer 14

an elevated WBC count

Question 15

what is the left shift seen in bacterial infection

Answer 15

Elevated WBC count due to an increase in neutrophils
Bands enter the circulation when neutrophil production is highly stimulated
Often see a reciprocal decrease in percentage of lymphocytes

Question 16

Leukemoid Response

Answer 16

The development of early neutrophilic cells (metamyelocytes)
Markedly elevated WBC, >50,000/mm3
May initially be confused with leukemia
Associated with infection
Benign, typically resolves as the associated condition resolves

Question 17

neutrophilia is an

Answer 17

Elevated neutrophil count

Question 18

conditions that cause neutrophilia

Answer 18

bacterial infections 
leukemia 
inflammation 
medication 
stress

Question 19

medications tha cause neutrophilia

Answer 19

steroids, epinephrine

Question 20

neutropenia is

Answer 20

decreased neutrophil count

Question 21

conditions that cause neutropenia

Answer 21

viral infections, aplastic anemia, overwhelming bacterial infection, drugs

Question 22

example of overwhelming bacteria infection

Answer 22

infections in the elderly, the elderly may not be able to generate neutrophilic responses

Question 23

drugs that cause neutropenia

Answer 23

Chemotherapeutic

Sulfa, antithyroid meds, phenothiazines

Question 24

chemo drugs and neutropenia

Answer 24

may need to hold chemo if neutrophil count is too low

Question 25

lymphocytosis

Answer 25

elevated lymphocyte count

Question 26

what causes lymphocytosis

Answer 26

viral infections such as mono and viral hepatitis | lymphocytic leukemia

Question 27

Lymphocytopenia

Answer 27

decrease lymphocytes count

Question 28

conditions that cause lymphocytopenia

Answer 28

corticosteroids, immunodeficiency diseases like late stage HIV leukemia

Question 29

eosinophilia

Answer 29

elevated eosinophil count

Question 30

conditions that cause eosinophilia

Answer 30

neoplasm (including leukemia) allergic reactions (drug allergies) and conditions (eczema and atopic conditions) Addison's disease collagen vascular disease (includes autoimmune diseases such as lupus) parasites coccidiomycosis

Question 31

eospinopenia

Answer 31

decreased eosinophil count

Question 32

conditions that cause eosinopenia

Answer 32

corticosteroids | acute stress or inflammatory conditions

Question 33

eosinophils and basophils do not respond to

Answer 33

bacterial or viral infections

Question 34

Total neutrophil count is a common and very useful

Answer 34

parameter of infection, especially in a bacterial infection

Question 35

the percentage of bands is ____ reliable than a total neutrophil count

Answer 35

less

Question 36

if you have an elevated percentage of neutrophils you should think

Answer 36

that the patient has an acute bacterial infection

Question 37

serial WBC and differential counts are used for

Answer 37

diagnosis and prognosis | help determine if an infection is getting worse or better

Question 38

WBC should be taken in consideration to

Answer 38

the clinical picture

Question 39

if WBC is abnormal and clinical picture is benign then check

Answer 39

medications

Question 40

history questions for WBC abnormalities

Answer 40

Does the patient have an active infection or inflammatory condition? What medications is the patient taking? Is the patient pregnant or has she recently delivered? Has the patient ever been diagnosed with a hematologic disease (e.g. leukemia, myelodysplastic disease, sickle cell disease)? Has the patient recently had surgery or experienced trauma (incl. an insect or snake bite)? Has the patient had a splenectomy? Has the patient recently received a vaccine? Family history? Does the patient smoke?

Question 41

Cigarette smoking can cause

Answer 41

neutrophilia

Question 42

WBC abnormalities physical exam

Answer 42

Fever Abscess or localized infection (e.g. HEENT) Hypotension, shock, tachycardia, hypothermia (i.e. overwhelming sepsis) Signs of pulmonary consolidation or pleural effusion Urinary symptoms Abdominal tenderness Hepatosplenomegaly Lymphadenopathy Joint swelling, erythema, tenderness

Question 43

point of WBC abnormalities physical exam

Answer 43

looking for source of infection or inflammation

Question 44

Leukemoid reaction blood smear

Answer 44

Peripheral blood smear may show metamyelocytes & bands but rarely myeloblasts Bone marrow shows more cells but is otherwise typical (with a mix of neutrophil precursors in various stages).

Question 45

actue leukemia bone marrow

Answer 45

predominance of the most immature elements such as myeloblasts