Chapter 13 - White Blood Cells Flashcards
Neutropenia
Decrease in neutrophils
What is leukoerythroblastosis
Abnormal release if immature precursors into the peripheral blood due to disease
Agranulocytosis
Clinically significant reduction in neutrophils
How does agranulocytosis occur? (2)
Ineffective granulopoeisis (decreased production) or accelerated removal of neutrophils (increased destruction)
Most common cause of agranulocytosis
Drug toxicity (alkylating agents, chloramphenicol, sulfonamides, chlorpromazine, thiouracil)
What is a consequence of agranulocytosis
Infections, especially lesions of the oral cavity
Leukocytosis
Increase in number of white cells in blood
What is a leukmoid reaction
In severe infections, immature granulocytes appear in the blood simulating a myeloid leukemia
Causes of neutrophils leukocytosis (3)
Infection, sterile inflammation (ie tissue necrosis like MI), drugs (agranulocytosis)
Causes of eosinophilic leukocytosis (2)
Allergic reactions, parasitic infections
What causes basophilic leukocytosis
Myeloproliferative disorders
What causes lymphocytosis
Viral infections (cmv, mono), bacterial infections (bordatella)
What causes monocytosis
Chronic infections (tb), collagen vascular diseases, inflammatory bowel diseases
Pathophysiology of lymphadenitis
Activation of immune cells –> primary follicles enlarge into germinal centers –> paracortical t-cell zones undergo inflammation
What are the nodes in acute nonspecific lymphadenitis like
Enlarged and painful, may have draining sinuses
Causes of acute lymphadenitis and what nodes are most likely involved
Systemic diseases like mono, cervical and inguinal
Causes of chronic lymphadenitis
Cancer
What are the nodes like in chronic lymphadenopathy
Nontender since the growth occurs slowly over time
What nodes are most likely involved in chronic lymphadenitis
Inguinal and axillary
Most lymphoid neoplasms are of what origin
B-cell
What is the most common cancer of children
Acute lymphoblastic leukemia
What are some positive markers for pre b-cell acute lymphoblastic leukemia. What is expressed in the more mature forms
Deoxynucleotidal transferase (TdT) and common ALL antigen (CALLA, CD10). CD 19 and CD 20
What translocation is for B-cell ALL and what kind of prognosis does it have
t(12;21) –> good prognosis
t(9;22) –> has a poor prognosis because there is mutation in the Philadelphia chromosome (seen with adults)
What positive markers are there for t-cell ALL
TdT and negative for CD10, CD2-8
What metastatic complications are associated with B-cell ALL
testicular enlargement, abrupt onset, anemic symptoms, CNS manifestations
What metastatic complications are associated with T-cell ALL
Mediastinal mass, abrupt onset, anemic symptoms, CNS manifestations
Does ALL in pediatric patients have a good prognosis?
Yes 95% complete emission
What does the bone marrow look like in ALL
Crowded with lymphoblasts
What disease is ALL associated with
Down’s syndrome
What is the most common leukemia in the Western World
Chronic lymphocytic leukemia
In CLL what does peripheral show
Smudge cells (small round lymphocytes with scant cytoplasm that get distrusted while trying to make a smear
In CLL if you get lymph node involvement and generalized lympohadenopathy what will this be called
Small lymphocytic lymphoma, stays localized
Complications of CLL
Hypogammaglobinemia (leads to infection) , autoimmune hemolytic anemia, richter syndrome
What is Richter syndrome
CLL/SLL transforms into a diffuse large B-cell lymphoma with a rapidly enlarging mass within a lymph node or spleen
Age group for CLL
Greater than 60 years old
Follicular lymphomas arise from what ? And are associated with what gene defect
From germinal B cells and chromosomal translocation of IgH on chromosome 14 and Bcl2 (antagonizes apoptosis) on chromosome 18
A positive marker that might be seen with follicular lymphoma
CD20
What may a follicular lymphoma progress to?
Diffuse large cell B lymphoma
What is the most common form of non Hodgkin’s lymphoma and is it aggressive or benign?
Diffuse large b-cell lymphoma, highly aggressive
What age group does diffuse large b-cell lymphoma typically present in
60 years
How does diffuse large b-cell lymphoma arise?
Derives from a germinal center or transformation from a low grade lymphoma
How does a diffuse large b-cell lymphoma clinically present?
Presents as a rapidly enlarging mass at a nodal or extra nodal site
Diffuse large b-cell lymphomas can be complicated by
HIV either immunodeficiency related with EBV or an effusion lymphoma with malignant pleural or ascitic effusion (with HHV-8)
Burkitt’s lymphoma is associated with what disease
EBV
What types of Burkitt’s lymphoma are there and what organs do they involve
African type (jaw) and American type (abdomen)
What appearance of Burkitt’s lymphoma have on histology and what causes it
Starry sky appearance from clear cytoplasmed macrophages that ingested nuclear remnants from tumor cells
What is the gene mutation associated with Burkitt’s lymphoma
c-MYC on chromosome 8 to the Ig heavy chain locus on chromosome 14
What markers does CLL/SLL Express
CD 5 and 20
What are plasma cell dyscrasias
Bcell proliferations with neoplastic plasma cells that secrete immunoglobin or a immunoglobin fragment
What do neoplastic plasma cells synthesize an excess of
Light or heavy chains with complete immunoglobins
What body part does multiple myeloma usually involve
The skeleton
Most common primary malignancy of bone
Multiple myeloma
Age incidence of multiple myeloma
65-75 years
For the myeloma cells to survive, what do they need?
IL-6
What are Bence Jones proteins
If only light or heavy chains are produced in a plasma cell dyscrasia, the free light chains are small enough to be excreted in the urine
What is the mechanism of bone pain in multiple myeloma and what is the result of it
Plasma cells activate RANKL on osteoclasts –> bone destruction –> punched out skeletal lesions on x-Ray
What is roleux formation and what disease is it seen in
Seen in multiple myeloma: high level of M proteins causes reed cells in peripheral blood smear to stick together in linear formations (can also be seen in lupus)
Other than the skeletal system, what other organ can multiple myeloma damage
Kidney –> Bence jones proteins can cause myeloma kidney by damaging tubular epithelium
What areas will multiple myeloma primarily affect
Vertebra (mostly) also rib skull pelvis
What is seen on bone marrow aspirate for multiple myeloma
Normal cells replaced by plasma cells
What is found on electrophoresis for multiple myeloma
M spike due to IgG or IgA
What’s the most common plasma cell dyscrasia
Monoclonal gamma patchy of uncertain significance (MGUS)
MGUS is most likely seen in what age group
Elderly disease. 3% of those older than 50 years and 5% of those older than 70