Disorders Of White Cells Flashcards
What are the two broad categories of disorders of WBCs?
Proliferation disorders- expansion of leukocytes
— reactive
— neoplastic
Leukopenias: deficiency of leukocytes
What are the most common etiologies of leukopenias?
Advance HIV Followed glucorticoids or cytotoxic drug therapy AI disorders Malnutrition Acute infection infection
_________ is a reduction in the number of neutrophils in the blood?
Neutropenia
________ is a clinically significant reduction in neutrophils and individuals are more susceptible to bacterial and fungal infections?
Agranulocytosis
What are the two method of neutropenia?
- Inadequate or ineffective granulopoiesis
2. Increased destruction or sequestration of neutrophils in the periphery
What are the 4 setting causing inadequate of ineffective granulopoiesis?
- Suppression of hematopoietic stem cells
- Suppression of committed granulocytic precursors
- Disease- ineffective heatopoiesis (megalobastic anemias and myeloid dysplastic syndrome
- Congenital conditions
What are the 3 setting of accelerated destruction or sequestration of neutrophils?
- Immunologically mediated injury: SLE, drugs, etc
- Splenomegaly
- Increased peripheral utilization
______________ is the most common cause of agranulocytosis?
Drug toxicity
—alkylating agents, anti-metabolites
—aminopyrine, chloramphenicol, sulfonamides, etc
The bone marrow appear ________ die to a compensatory increase in granulocytic precursors?
Hypercellular
— excessive destruction in the periphery
The bone marrow is _______ in agranulocytic disorders caused by agents that suppress or destroy granulocytic precursors?
Hypocellular
Describe the infections that are typical in agranulocytosis patients?
Ulceration got necrotizing lesion of the gingiva, floor of the mouth, buccaneers mucosa, pharynx, (less commonly- skin, vagina, anus, GI)
—deep, undermined, and covered by gray-green-black necrotic membrane
High risk for deep fungal infection- candida and aspergillosis
Describe the symptoms of neutropenia.
Related to infection- malaise, chills, fever, weakness, fatigability
Seen when neutrophil count is <500
How do you treat neutropenia?
Infections- broad spect. Abx
Myelosuppressive chemotherapy- G-CSF
______ is an increase in the number of WBCs?
Leukocytosis
What 4 thing determine the peripheral blood leukocyte count?
- Size of the myeloid and lymphoid precursor and storage cell pools in the bone marrow, thymus circulation and peripheral tissue
- Rate of re;ease of cells from the storage pools
- Proportion of cells that are adherent to BV wall at any time
- The rate of extravasated new of cells
What cytokines cause increased release of leukocytes from marrow storage>
TNF and IL-1
What leukocytic morphological changes(2) are associated with sepsis or sever inflammation?
- Toxic granules-coarse and darker than the normal neutrophilic granules, abnormal azurophilic granules
- Doyle bodies- patches of dilated endoplasmic reticulum that appear as sky-blue cytoplasmic “puddles”
What are the 3 lymphadenitis?
- Acute non-specific Lymphadenitis
- Hemophagocytic lymphohistiocytosis (macrophage activation syndrome)
- Chronic Nonspecific lymphadenitis
Describe the morphology of LN with acute nonspecific lymphadenitis?
Swollen, painful, gray-red and engorged
—large reactive germinal centers containing numberous mitotic figures
—if pyogenic=> neutrophils and the centers may undergo necrosis
—abscess may form => skin in red
What are the 3 morphologies of chronic nonspecific lymphadenitis?
- Follicular hyperplasia
- Paracortical hyperplasia
- Sinus histiocytosis
Describe follicular hyperplasia?
—Large oblong germinal centers=> surrounded by a collar of small resting naive B cells (the mantle zone)
—dark zone:proliferating blastlike B cells
—light zone: B cell w/ irregular or cleaved nuclear contours
—tangible-body-MO
—mitotic figure
—variation in follicles
— preservation of LN architecture
Describe paracortical hyperplasia?
Caused by T-cell immune response
—t cell region contains immunoblast: active T-cell with 3-4x size, round nuclei, open chromatin, several prominent nucleoli, moderate amounts of pale cytoplasm
—hypertrophy of sinusoid always and vascular endothelial cells
Describe sinus histiocytosis?
Aka- reticular hyperplasia
Increase in cells that line the lymphatic sinusoids => expansion and dissension
