Haematology/ Abnormal White Cell Counts Flashcards
What is leukocytosis?
Abnormally increased number of white blood cells
What are the causes of leukocytosis?
- Leukemoid reaction (reaction of healthy bone marrow to extreme stress)
- reactive leukocytosis (as a response to fever, infection, etc)
- malignancy
Patients with infections can always have a high white count. True or false?
False.
Allergies, asthma, and parasitic infections are associated with an increase in what type of white blood cells?
Eosinophils
Acute bacterial infections, especially pyogenic infections, are associated with an increase in what type of white blood cell?
Neutrophils
Viral infections are associated with an increase in what type of white blood cell?
Lymphocytes
Patients with leukemia can have a high, normal, or low white count. True or false?
True (depends on the subtype and stage of disease)
What signs and symptoms are common among people with leukemia or lymphoma? (11)
- Fever and night sweats
- frequent infections
- pancytopenia (fatigue from anemia, petechiae, easy bruising, etc
- enlarged lymph nodes
- hepatosplenomegaly
- abdominal discomfort
- loss of appetite
- weight loss
- bone pain
- chest pain
- shortness of breath
What white blood cell disease is associated with malignancy with translocation of Philadelphia chromosome?
Chronic myelogenous leukemia
What white blood cell disease is associated with Tartrate resistant acid phosphatase (TRAP) positive and upregulation of annexin A1 (ANXA1)?
- Hairy cell leukemia (when viewed under microscope the malignant B lymphocytes appear to have tiny hair-like projections)
What white blood cell disease is associated with Bence-Jones protein, renal failure, hypercalcemia, anemia, lytic bone lesions, and pathologic fractures?
Multiple myeloma (malignant plasma cells)
What blood cell disease is associated with most common leukemia in the United States; more common in men and the elderly?
Chronic lymphocytic leukemia
What white blood cell disease is associated with common childhood cancer?
Leukemia (of which, acute lymphocytic leukemia is most common)
What white blood cell disease is associated with Reed-Sternberg cells, bi-modal age distribution of disease, Epstein-Barr virus infection?
Hodgkin lymphoma
What white blood cell disease is associated with a recessive disease (gene carried by 1 in 100 Americans), most common lysosomal storage disease, enzyme deficiency causes glucocerebroside accumulation in cells, hypersplenism with subsequent pancytopenia
Gaucher disease
The following are all examples of what type of hematologic malignancy: Waldenstrom macroglobulinemia, Burkitt lymphoma, Sezary syndrome, and follicular lymphoma?
Non-Hodgkin lymphoma
What is leukopenia?
- Abnormally decreased numbers of white blood cells caused by decreased production or increased destruction of white blood cells.
- Leukopenia may be an isolated finding but often occurs with pancytopenia.
What is the most common subtype of leukopenia?
Neutropenia is the most common leukopenia.
Causes of Leukopenia
What is the mechanism of human immunodeficiency virus (HIV) transmission?
Contact with infected blood and body fluids, or vertical transmission from mother to fetus
What screening test is used for HIV?
HIV enzyme-linked immunosorbent assay (ELISA)
What confirmatory test is used for HIV?
Western blot
What groups of patients are at increased risk for HIV infection?
- Men who have sex with men
- persons who have unprotected sex with multiple partners
- an HIV-infected partner or a bisexual partner
- persons who exchange money or drugs for sex
- persons being treated for STDs
- intravenous (IV) drug users
- persons who received a blood transfusion between 1978 and 1985
Why is HIV-1 RN A viral load by polymerase chain reaction (PCR) a useful test in the early HIV infection?
ELISA and Western blot can be negative because antibodies have not been formed, but viral load is high.
Why is HIV-1 RN A viral load by polymerase chain reaction (PCR) a useful test in HIV in neonates?
Cannot use serologic tests since mother’s antibodies are passed through placenta and would result in false positive tests
What lab tests are used to monitor disease progression in HIV?
- CD4 count
- viral load
What determines whether a patient has AIDS?(4)
- HIV positive plus at least one of the following:
- CD4 count <200
- opportunistic infection
- B-cell malignancy or
- Kaposi sarcoma
What is the most common opportunistic infection in HIV patients?
Pneumocystis pneumonia (PCP)
What is the best predictor of an HIV patient’s susceptibility to infection? What infections is a patient susceptible to when the CD4 count is
CD4 count
What infections is a patient susceptible to when the CD4 count is < 500?
- Candida
- TB
- herpes simplex virus (HSV)
- varicella-zoster virus (VZV)
What infections is a patient susceptible to when the CD4 count is less than 200?
- PCP
- Toxoplasma
- Cryptococcus
- Histoplasma
- Coccidioides
- Bartonella
What infections is a patient susceptible to when the CD4 count is less than 50-100?
- Mycobacterium avium complex (MAC)
- Cytomegalovirus (CMV)
- Bacillary angiomatosis (disseminated Bartonella)
- CNS lymphoma
- Progressive multifocal leukoencephalopathy (PML)
What medications are given to HIV patients as prophylaxis for opportunistic infections, based on a CD4 count of Less than 200?
TMP/SMX DS daily (prophylaxis vs. PCP)
What medications are given to HIV patients as prophylaxis for opportunistic infections, based on a CD4 count of less than 150?
Itraconazole 200 mg daily (if in endemic area for histoplasmosis)
What medications are given to HIV patients as prophylaxis for opportunistic infections, based on a CD4 count of less than 100?
TMP/SMX DS daily (prophylaxis vs. toxoplasmosis)
What medications are given to HIV patients as prophylaxis for opportunistic infections, based on a CD4 count of less than 50?
Azithromycin 1250 mg every week (prophylaxis vs. MAC)
Name the four classes of medication used in HAART?
- Protease inhibitors (PIs)
- Nucleoside reverse-transcriptase inhibitors (NRTIs)
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Fusion inhibitors (FIs)
Which vaccinations should be provided to all HIV patients?
- Hepatitis A
- Hepatitis B
- pneumococcus
- influenza (intramuscular)
- tetanus
Which vaccinations should be avoided in HIV patients?
vaccines which contain live viruses:
- measles, mumps, and rubella (MMR) and varicella (unless the patient is asymptomatic and with a CD4 count >200)
- nasal influenza vaccine
