Hematology Week 2: Benign WBC Disorders Flashcards
The CBC
The differential
Abnormalities of WBC count
Leukocytosis
High WBC count
Leukopenia
Low WBC count
Leukocytosis Lab reference ranges
WBC abnormalities
if blasts are increased, consider neoplastic causes
Abnormal neutrophil counts
Neutropenia
Low neutrophil count
Neutrophilia
High neutrophil count
Agranulocytosis
- absence of neutrophils
- Makes patients highly susceptible to bacterial and fungal infections
Neutrophil Levels in racial and ethnic groups
Severe Neutropenia AKA
Agranulocytosis
Case 1
Case 1 Question
Peripheral Blood smear of neutropenia
Clinical Presentation of Neutropenia: Symptoms
4 Listed
- Malaise
- Chills
- Fever
- Weakness
Clinical Presentation of Neutropenia: Common Infections
- Infections commonly occur in the oral cavity
- Aphthous stomatitis
- less common in skin, vagina, anus, GI tract, lungs and kidneys
- can be bacterial or fungal (Aspergillus, Candida)
Oral ulcers may be indicative of
Severe neutropenia and Agranulocytosis
Common causes of Neutropenia
6 listed
Mechanisms of Neutropenia
3 listed
Cyclic Neutropenia Overview
Cyclic Neutropenia Etiology
Autosomal Dominant disorder
Cyclic Neutropenia Clinical Presentation
3-6 days of neutropenia occur every 21-30 days in a periodic pattern
Fever
Infection
- Stomatitis
- Cellulitis
- Vaginitis
Work up of Neutropenia
3 main subjects
Clinical Diagnosis of Case 1
Neutrophilia
Question 2
Toxic granulation
Neutrophilia
cytoplasmic vacuoles
no significant left-shift
The most common WBC abnormality and causes
Any stressful event can cause neutrophilia
Work up of Neutrophilia
2 main subjects
Toxic Changes of Neutrophils
- Heavier granulation
- Dohle Body
- Cytoplasmic vacuoles
Smears
Left Shift description
Benign causes of increased blasts in the blood
Leukemoid reaction
- Left shift of the granulocytes to the blast stage
- WBC count is very high Usually >50
- seen with severe bone marrow stress
Leukoerythroblastic reaction
- Left shift of the granulocytes to the Blast Stage
- Circulating nucleated RBCs are present
- Seen with severe bone marrow stress
Leukoerythroblastic smear
Mechanisms of Neutrophilia
4 listed
Clinical Diagnosis of Case #2
Lymphopenia
Low lymphocyte count
also Lymphocytopenia
Lymphocytosis
- High lymphocyte count
- can have activated or non-activated appearance
Lymphopenia prevalence
Rare
Lymphopenia causes
5 listed
- Drugs (glucocorticoids)
- Infection (HIV, other viral)
- Congenital immunodeficiencies
- Autoimmune Diseases
- Malnutrition
Lymphocyte Morphology
Causes of Non-activated Lymphocytes
5 listed
- Pertussis
- Smoking
- Transient stress lymphocytosis
- Thymoma
- Polyclonal B Lymphocytosis