Hematology II Flashcards
How do WBC’s look different than RBC’s?
WBC’s appear to be more rounded and fluffy
RBC’s do not divide. Do WBC’s?
yes
produced in the bone marrow, produced under influence of GM-CSF, maturation occurs within 12 days, transforms from myeloblast to myelocyte, increased demand from body means mitosis increases and maturation decreases, remains in tissues once they are there, primarily for infection and inflammation, lifespan of 8 hours when in peripheral circulation, cytoplasmic components responsible for bacteriocidal activity, migrate to infection due to chemotactic substances
Neutrophils
produced in bone marrow by division and maturation, growth stimulated by ECSF and IL-5, attracted to tissue invasion by parasites and allergic reactions, contain cytoplasmic granules that damage parasites and impede replication, decrease anti-inflammatory pathway
Eosinophils
produced in bone marrow, enter tissues within several hours after release into circulation, function in hypersensitivity reactions, bind to antigens, cause degranulation of the cytoplasm and release of histamine, body sensitivity to food, medication or autoimmune
Basophil
produce in the bone marrow, mature within 4 days, no storage in the marrow, influenced by many growth factors, 3 days in circulation before entering tissues, made on demand, help to remove old RBC’s, function as tissue macrophages or specialized cells in tissues, play vital role in cell mediated and humoral immunity by presenting and processing antigens to both T an B lymphocytes
Monocytes
stem from the bone marrow, after maturation cells migrate to occupy peripheral lymphoid tissue including lymph nodes, spleen, tonsils, and mucosal sites, have a long half life, responsible for recognition of self vs. nonself, can proliferate when activated, CD4 and CD8
Lymphocytes
undergo differentiation and maturation in the bone marrow
B lymphocytes
undergo differentiation and maturation in the thymus
T lymphocytes
How are CD4 and CD8 cells named?
based on the glycoproteins in their cells
helper cells that signal other immune cells, order lysis, assist in production of antibodies by B cells and active macrophages
CD4 cells
killer cells that kills and destroys, moderate immune reactions and are able to lyse viral infected cells
CD8 cells
may or may not be T cells, able to cause cell lysis without prior antigen exposure
Natural killer cells
Laboratory tests for WBC’s include an anticoagulant. Why cannot the anticoagulant be heparin?
heparin causes WBC clumping and a blue background when examining
How long can WBC tests be kept?
counts can performed up to 24 hours after specimen collection if the vial has been stored at 4C
Can a traumatic or difficult venipuncture alter WBC results?
yes, the coagulation cascade could be activated which traps WBC and platelets producing falsely low levels
How do instruments determine [WBC]?
either electrical impedance or light scattering
What can cause falsely elevated WBC levels?
presence of reticulocytes, giant platelets, or blood born parasites
What can cause falsely lowered WBC levels?
paraproteins secreted during cancers, especially in leukemias
provides individual %’s of each WBC, usually automated report, faster than manual procedure
CBC-differential
-penia
decrease in number
-philia
increase in number
infections caused by bacteria, viruses, rickettsia, protozoa, debilitated patients, nutritional deficiencies, myelotoxic medications, seen regularly in acute leukemia and as a manifestation of myelodysplasia
Neutropenia
myelotoxic
kills marrow
What are reasons that could cause Neutrophilia?
acute infection, tissue dammage, necrosis, acute hemmorage, eclampsia, corticosteroids
-cytosis
elevated levels
What are reasons that could cause Lymphocytosis?
in children and young adults almost always non-neoplastic, incidence of neoplasm increases with age, worrisome if infection is not present, pertussis, chronic lymphocytic leukemia, mononucleosis, infections hepatis
What could cause Lymphocytopenia?
variety of infections, immune disorders, medications, in HIV patients T helper cells (CD4) used to monitor disease progression
What could cause a Monocyte disorder?
numerous infections and neoplasms, TB, malaria, syphillis, typhus, Hodgkin’s Disease, multiple myeloma, melanoma
What can cause an Eosinophil disorder?
may be seen in healthy individuals, without disease, allergic reactions, parasitic infections, neoplasm such as CML, acute inflammation or stress, corticosteroid use
elevated Eosinophil levels indicates
allergies
What can cause a Basophil disorder?
CML, ulcerative colitis, chronic sinusitis, iron deficiency, smallpox, Hodgins disease
metastasize
spreading to other parts of the body
unregulated proliferations of hematopoetic cells in bone marrow, acute or chronic, often infiltrate other organs, can live with it for many years
Leukemia
characterized by proliferations of immature or precursor cells, rapid clinical course
acute Leukemia
proliferations of mature cells, longer clinical course
chronic Leukemia
- ) Establish Diagnosis
- ) Subtype Leukemia for treatment and prognosis
- ) Perform cytogenic studies
- ) Perform monogenic studies
- ) Examine extramedullary tissues and fluids for involvement
- ) Evaluate effectiveness of therapy
Goals of a Leukemia Workup
What are 3 ways to subtype and diagnose a Leukemia?
- ) peripheral blood smear
- ) bone marrow biopsy
- ) bone marrow aspirate
present with nonspecific complaints such as fatigue, persistent infection, most have normocytic normochromic anemia, WBC count can range from high to low, large number of blast cells, in order to make acute diagnosis, blast cells must be 30% or more of all marrow cells
Acute Leukemia
commonly seen in children, prognosis favorable in females ages 2-10, favorable with WBC count less than 10, cells usually have a suspicious nuclei, nucleus smaller and darker
Acute Lymphoblastic Leukemia (ALL)
What age group of children best responds to ALL treatment?
children aged 2-10
predominately disease of middle aged and older adults, most common leukemia in newborns and infants, subtyping depends on tendency toward differentiation, cells have multiple and a large nuclei, presence of an Auer rod is indicative
Acute Myelogenous Leukemia (AML)
The presence of this is indicative of AML
Auer rod
usually disease of adults, presentation is variable, usually found incidentally upon evaluation for other complaints, blood findings can rage fro pancytopenia (all cells almost gone) to marked leukocytosis
Chronic Leukemias
primarily affects adults, median age of 50, males slightly greater than females, nonspecific clinical symptoms, anywhere from weight loss to fatigue, splenomeagly common, lymphadenopathy usual, half of patients are asymptomatic
Chronic Myelogenous Leukemia
What does a left shift mean?
population or number is increasing
highly suggested by peripheral blood smear, neutrophilic leukocytosis with a left shift, WBC counts typically greater than 25, myelocytes and neutrohils predominate, normally normochromic, normocytic anemia
Chronic Myelogenous Leukemia
What is present in 90% of all chromic myelogenous leukemia cases?
the Philadelphia chromosome
initial phase lasts 3-4 years, after that patient may develop a blast crisis or accelerated phase, after a blast crisis, median survival is 2-6 months and resistant to chemo
Chronic Myelogenous Leukemia
most common adult leukemia, average age of diagnosis is 55, males outnumber females 2.5:1, results of accumulation of small round lymphocytes in the blood, bone marrow and organs, most discovered incidentally
Chronic Lymphocytic Leukemia
total WBC count may reach 600 or more, WBC’s are small, condensed, blotchy chromatin, inconspicuous nuclei and scant cytoplasm, almost all patients have splenomegaly and lymphadenopathy, increased number of other malignancies such as melanomas, carcinomas of GI ract and lungs
Chronic Lymphocytic Leukemia
Hodgkin’s Lymphoma vs. Non Hodgins lymphoma, clinical persentation similar due to elevated WBC count, tumors in lymph nodes, hard, non-mobile, non-tender is cancer until proven otherwise, fatigue night sweats and weight loss are common symptoms
Lymphoma
What confirms Hodgkin’s lymphoma?
presence of Reed- Sternberg cell on biopsy
delicate balance is needed to respond to injury and prevent hemorrhage
- ) vessel wall
- ) platelets
- ) coagulation system
platelets
What are the 4 steps to primary hemostasis?
- ) Adhesion to collagen at the site of vascular injury
- ) Aggregation of additional platelets to “plug” the leak in the blood vessel
- ) Platelets release chemotatic elements to promote hemostasis, vessel wall constricts
- ) Body’s coagulation cascade activated
reference range usually 150-400, hemorrhage not usually apparent until levels drop far below normal, levels below 50 will be dangerous when challenged with surgery or trauma, levels below 20 may result in spontaneous bleeding, young function better than old
platelet count
