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Essential Hematology > Chapter 7: Granulocytes, Monocytes, and their benign disorders > Flashcards

Chapter 7: Granulocytes, Monocytes, and their benign disorders Flashcards

1
Q

Are immature Leukocytes (phagocytes and lymphocytes) found in normal peripheral blood?

A

No only mature phagocytes and lymphocytes are found in peripheral blood

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2
Q

What sorts of granules are found in neutrophils?

A

Primary appear at the premyelocyte stage and contain MPO, acid phosphatase, and other acid hydrolases.
Secondary granules appear at the myelocyte stage and contain collagenase, lactoferrin, and lysozyme.

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3
Q

What is the average lifespan of a neutrophil in the peripheral blood?

A

6-10 hours.

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4
Q

What are myeloblasts?

A

Myeloblasts are the earliest recognizable precursors of neutrophils. (They make up 4% of normal bone marrow)

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5
Q

What is the lineage of the neutrophil?

A

myeloblast –> Promyelocyte –> Myelocytes –> Metamyelocytes –> Bands –> Neutrophils

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6
Q

What are the morphological characteristics of monocytes?

A

Oval indented nucleus, clumped chromatin, bluish cytoplasm, many vacuoles in the cytoplasm.

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7
Q

What is the lineage of the monocyte?

A

myeloblast –> promonocyte –> Monocyte –> Immature macrophage –> Mature macrophage.

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8
Q

To what cell type are basophils closely related?

A

Basophils are very closely related to mast cells.

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9
Q

What is more abundant in the bone marrow; myeloid cells or erythroid cells?

A

Myeloid cells are the most abundant in the bone marrow by a factor of 2:1 to 12:1. (Neutrophils and metamyelocytes are the most abundant specific types)

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10
Q

Are more granulocytes found in the bone marrow or the peripheral blood?

A

10-15 times more granulocytes are found in the bone marrow than in the peripheral blood.

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11
Q

What happens to granulocytes that are released from the bone marrow?

A

They spend about 6-10 days in the circulation. Then they marginate and move into the tissues where they spend 4-5 days carrying out their phagocytic function before they are destroyed or they senesce.

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12
Q

What growth factors stimulate granulocyte growth, maturation, functioning?

A

(1) IL-1
(2) IL-3
(3) IL-5 (eosinophils)
(4) IL-6
(5) IL-11
(6) GM-CSF
(7) G-CSF
(8) M-CSF

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13
Q

What is the result of the clinical application of G-CSF?

A

G-CSF will increase the numbers of Neutrophils.

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14
Q

What is the result of the clinical application of GM-CSF?

A

GM-CSF given intravenously has been shown to increase the numbers of neutrophils, eosinophils, and monocytes.

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15
Q

Why is G-CSF given after chemotherapy, radiotherapy, or bone marrow transplant?

A

G-CSF is given to accelerate hematopoietic recovery thus reducing the post-therapy neutropenic period.

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16
Q

Why is G-CSF given to treat acute myeloid leukemia?

A

G-CSF is used in AML post treatment speed up bone marrow recovery. Sometimes it is given with treatment to move cells into the cell cycle thus increasing sensitivity to antineoplastics.

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17
Q

Why is G-CSF used to treat Acute lymphoblastic leukemia?

A

G-CSF is used to reduce the severity of neutropenia after treatment of ALL.

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18
Q

How is G-CSF used to treat myelodysplasia?

A

G-CSF is used in conjunction with erythropoietin to improve bone marrow function without stimulating malignant transformation.

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19
Q

Why is G-CSF used to treat Severe Neutropenia?

A

G-CSF is found to be effective at stimulating replacement neutrophils in cases of severe neutropenia.

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20
Q

Why is G-CSF given to donors before peripheral blood stem cell transplants?

A

Because G-CSF will increase the number of multipotent progenitors in the circulation that can be harvested

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21
Q

Why is G-CSF given to treat lymphomas?

A

G-CSF is given to reduce infection, delay giving chemotherapy, and shorten hospitalization after chemotherapy.

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22
Q

How long do monocytes circulate in the blood?

A

20-40 hours

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23
Q

How long do mature macrophages live for?

A

months to years

24
Q

What are the three basic functions of neutrophils and monocytes?

A

(1) Chemotaxis
(2) Phagocytosis
(3) Killing and digestion

25
Q

What is neutrophil and monocyte chemotaxis?

A

Neutrophils and monocytes are attracted by chemicals, such as chemokines or complement, to bacteria or sites of inflammation.

26
Q

On what cells do CXC chemokines act?

A

Neutrophils

27
Q

On what cells do CC chemokines act?

A

Monocytes, basophils, eosinophils, and natural killer cells.

28
Q

What is the oxygen dependent intracellular killing/digestion pathway?

A

superoxide, hydrogen peroxide and other ROS react with MPO and halides to destroy ingested material/cells.

29
Q

What is the non-oxidative microbicidal pathway?

A

microbicidal proteins such as cathepsin G, lysozyme, elastase, lactoferrin, and nitric oxide kill the ingested microbe.

30
Q

What are some disorders associated with defective chemotaxis?

A

Lazy leukocyte syndrome, corticosteroid therapy, acute/chronic myeloid leukemia, myelodysplasia, and myeloproliferative syndromes.

31
Q

What causes disorders of phagocytosis?

A

Phagocytic disorders most commonly are the result of defective opsonization.

32
Q

What are the disorders of leukocyte killing mechanisms?

A

(1) Chronic granulomatous disease
(2) MPO deficiency
(3) G6PD deficiency
(4) Chediak Higashi syndrome.

33
Q

What is the Pelger-Heul anomaly?

A

A congenital condition characterized by bilobed or unsegmented neutrophils in the peripheral blood. Autosomal dominant

34
Q

What is the May-Hegglin anomaly?

A

May-Hegglin anomaly is characterized by neutrophils that contain basophilic inclusions of RNA. There may be associated thrombocytopenia with giant platelets. Autosomal dominant.

35
Q

What is Chediak-Higashi syndrome?

A

Chediak-Higashi syndrome is characterized by giant granules in neutrophils, eosinophils, monocytes, and lymphocytes, accompanied by neutropenia, thrombocytopenia, and hepatosplenomegaly. Autosomal recessive.

36
Q

What causes hypersegmented neutrophils?

A

Megaloblastic anemia.

37
Q

What causes Dohle bodies and toxic granules in neutrophils?

A

Infection

38
Q

What pathological conditions can cause Pelger cells (bilobed or unsegmented neutrophils)?

A

Acute myeloid leukemia or myelodysplasia.

39
Q

What conditions often accompany neutrophilia?

A

(1) Shift to the left (increased bands in peripheral blood)
(2) Toxic granules
(3) Dohle bodies
(4) elevated NAP score (0-400)(normal is 20-100)

40
Q

What is the leukamoid reaction?

A

The leukamoid reaction is a reactive and excessive leukocytosis characterized by the presence of immature leukocytes in the peripheral blood.

41
Q

With what conditions is a leukamoid reaction associated?

A

(1) severe or chronic infections
(2) severe hemolysis
(3) Metastatic cancer
(4) More pronounced in children.

42
Q

What is hypereosinophilic syndrome?

A

A condition characterized by elevated eosinophils for over 6 months with associated tissue damage.

43
Q

What is chronic eosionophilic leukemia?

A

Eosinophilic syndrome due to a clonal cytogenetic abnormality in the bone marrow.

44
Q

What are the causes of basophilia?

A

All rare

(1) Chronic myeloid leukemia
(2) Polycythemia vera
(3) Myxoedema
(4) smallpox
(5) chickenpox
(6) ulcerative colitis.

45
Q

What are some causes of Monocytosis?

A

(1) infection
(2) Connective tissue diseases (hypersensitivity)
(3) chronic neutropenia
(4) Malignancies
(5) treatment with growth factors.

46
Q

What is the normal cutoff for neutropenia?

A

2.5x10^9/L except in blacks and middle easterners for which 1.5x10^9/L is normal.

47
Q

What what level of neutrophils is the patient likely to have recurrent infections?

A

0.5x10^9/L

48
Q

What is Kostman’s syndrome?

A

Kostman’s syndrome is an autosomal recessive condition that presents in the first year of life with serious infections due to neutropenia. (G-CSF therapy may be helpful)

49
Q

What is a common cause of benign neutropenia?

A

Increased margination of neutrophils causes a decreased blood neutrophil count.

50
Q

What are the clinical features of severe neutropenia?

A

(1) infections of the mouth and throat
(2) ulceration of the mouth, throat, and anus
(3) Septicemia
(4) pathogenic infection by usually tolerated organisms.

51
Q

How is type of neutropenia diagnosed?

A

By examination of the bone marrow. (marrow aspiration of trephine biopsy).

52
Q

How is neutropenia treated?

A

Neutropenia is treated by prophylactic used of antibiotics to prevent infection. Immunosuppresants may actually be effective if the neutropenia is caused by AI disease. G-CSF may be effective in some benign neutropenias.

53
Q

What is Langerhans cell Histiocytosis?

A

LCH are a group of diseases that can be single organ or multi-system. The lesions found include Langerhans cells, eosinophils, lymphocytes, neutrophils, and macrophages. Additionally there are tennis racquet like birbeck bodies in the langerhans cells

54
Q

What is hemophagocytic lymphohistiocytosis (hemophagocytic syndrome)?

A

It is a rare AR, or acquired disorder (EBV/Herpes/Tumors) that is characterized with fever, pancytopenia, hepatosplenomegaly, multi-organ dysfunction, lymphadenopathy, and macrophages that have ingested other leukocytes.

55
Q

How is hemophagocytic syndrome treated?

A

treatment involve the underlying cause if it is known.

56
Q

What is the Rosai-Dorfman syndrome?

A

Sinus histiocytosis with massive lymphadenopathy is a condition typified by chronic painless cervical lymphadenopathy with fever and weight loss. It usually subsides by itself.

Essential Hematology (22 decks)

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