Heme 2 Exam 1 Part 2 Flashcards
“-Cytosis” means…
Increase in cell number due to a disorder
“-philia” means…
Increase in cell number
“-penia” means…
Decrease in cell number
What is an absolute count?
Absolute count (for that subtype) =
differential count (%) x total WBC count (uL)
An increase in 1 or more normal WBC types in p.b. or the presence of abnormal cell types in p.b. is known as:
Leukocytosis (WBC count of >15,000)
Decrease in neutrophils and/or lymphs is known as:
Leukopenia (WBC count of <2500/uL)
Decrease in absolute neutrophil count <2000/uL is known as _____ and may be acquired from:
Neutropenia
Neutropenia can occur due to 3 reasons:
- decreased bone marrow production due to stem cell disorders, megaloblastic conditions, chemical responses, and congenital disorders
- Increased cell loss due to immune response and hypersplenism (chemo also)
- Psuedoneutropenia (Short termed, will go back to normal)
Increase in absolute neutrophil count >7000/uL is known as _____ and is a result of 3 major causes such as:
Neutrophilia; Caused by Infection (Bacterial or fungal), Inflammation, or Malignancy (IIM)
(When not caused by malignancy, it is termed “reactive” and can be acute, immediate, or chronic in nature
What is immediate neutrophilia? When do we usually see this?
When there is redistribution from MP to CP- waiting for egression into tissues (psuedoneutrophilia).
We usually see this in people w/ high epinephrine.
What is acute neutrophilia?
Increased neutrophils from BM due to infection; Increase in bands seen in p.b.
What is chronic neutrophilia?
Increase in immature neutrophils in p.b. (left shift); Follows acute if stimulus continues
What is psuedoneutropenia?
Temporary decrease in p.b. neutrophil count due to hypersensitivity rxn, post-hypothermia, post-dialysis, w/ some tranquilizers
What is pseudo neutrophilia (physiologic or relative neutrophilia)?
Benign transient increase in p.b. neutrophilia due to shift of MP cells caused by release of epinephrine
Leukoerythoblastic is used to describe the presence of _____ and _____. What else can be observed? What is this associated with?
Presence of nRBCs and a neutrophilic left shit!
-Total neutrophil count can be >, N, or <
-Poikilocytosis, teardrop cells, and anisocytosis
-Associated w/ myoproliferative disorders, myelophthisis, and hemolytic anemias
Leukemoid reaction is a normal response to:
Infection, inflammation, or inflammatory response to malignancy
In leukemoid reaction, many immature leukocytes are in p.b. w/ what three cytoplasmic abnormalities?
Toxic granulation, dohle bodies, and vacuoles
Leukemoid reaction mimics chronic myeloid leukemia. However they differ because:
Leukemoid is transient, CML is chronic.
What is normal WBC (%) and absolute number in granulocytes in adults?
Segs: 50-70% (2500-7000)
Bands: 0-5% (0-500)
Eos: 0-5% (50-500)
Basophils: 0-5% (0-100)
What is normal WBC (%) and absolute number of mononuclears in adults?
Lymps: 20-40% (1000-4000)
Mono: 0-12% (50-500)
What is normal WBC (%) of smudge cells in adults?
0-12%
What is the normal total WBC count in adults?
5000-10,000
What are the three most common cytoplasmic abnormalities? Due to the infectious process of the patient, all are:
- Toxic granulation
- Dohle bodies
- Vacuoles
All are reactive and transient
Toxic granulation is what kind of WBC w/ what kind of granules?
Neutrophil w/ LARGE blue-black, altered primary cytoplasmic granules
Toxic granulation becomes more visible as the cell:
Responds to infection
Toxic granulation is associated with:
infections, chemo patients, burns, poisonings, and normal pregnancy
Real toxic granulation is usually seen in conjunction with:
Neutrophilia, Dohle bodies, and a left shift (Seen with CSF-therapy)
Dohle bodies have small gray-blue cytoplasmic inclusions of which WBCs? What are they made up of? Where are they typically found?
Neutrophils and eosinophils; Made up of RNA remnant from rough ER; Typically found near edge of cell
Dohle bodies are usually seen with:
Toxic granulation
Dohle bodies can be seen in…? What is the cause?
Chemotherapy, burns, poisonings, and N pregnancy;
No known cause!!
Dohle bodies tend to be ____ in old p.b. specimens, but appear ____ in fresh blood
gray; blue
Cytoplasmic vacuolization is found in which two WBCs? Why?
Found in segs and bands;
Due to EITHER
1. autophagocytosis: long drug exposure (sulfa, chloroquine, ROH) or radiation –> Typically small vacuoles
- Microbe ingestion/degradation: Typically large vacuoles (chemotherapy, poisonings, burns)
Cytoplasmic vacuolization is usually ______ due to old blood; but is _____ if found in fresh blood. If found in fresh blood, what does it mean?
Artifact in old blood; significant in fresh blood
If in fresh blood, it means septicemia
What are the 3 nuclear neutrophilic abnormalities?
- Pyknotic nuclei in segs
- Hyposegmentation in segs
- Hypersegmentation in segs
Describe pyknotic nuclei in segs. When do we see this happen?
Pyknotic nuclei is also known as necrobiosis! Nuclei are shrunken and dying and are very prominent in sepsis
Pyknotic nuclei in segs is only significant if seen with ________. Otherwise, its probably just an _____ in old blood.
Only significant if seen w/ other toxic changes;
Otherwise, just an artifact in old blood!
Hyposegmentation in segs looks ____ or _____ and is common seen in which disorders?
Peanut shaped, or bilobed shape;
Commonly seen in pelger-huet anomaly, myeloproliferative or myelodysplastic disorders.
Hypersegmentation in segs is when there is more than ____ lobed and is prominent in:
> 6 lobes and is prominent in chronic infections and severe megaloblastic anemia
Rare hypersegmented seg is normal in p.b., but only if its an occasional
1 or 2 segs
Eosinophilia is an _____ in eosinophils. What are the three types? Explain them.
Increase in eosinophils;
1. Inherited: RARE!
- Reactive: MOST COMMON! due to allergies (IV shunts, and valves), drugs, skin diseases (eczema, psoriasis), parasitic infestations ) helminths: flatworms and roundworms) and some autoimmune disorders
- Malignant: Acute myelomonocytic leukemia (AML) and in some cases (chronic myelogenous leukemia (CML)
Eosinopenia is a ______ in eosinophils in response to what? Eosinophilia hard to detect in peripheral blood. Why? How can we detect it?
Decrease in eosinophils due to emotional stress or recovery from infection.
Hard to detect because the N range is already 0-5%, so we have to use absolute count.
Basophilia is an ____ in basophils and it is seen along with ____ in CML.
Increase in basophils and is seen w/ eosinophilia
Basophilia is found in what conditions?
CML, HYPOthyroidism, and ulcerative colitis;
Increase in tissue basophils/mast cells is seen in patients w/ contact dermatitis
Basopenia is a ______ in basophils due to what conditions? Why is it hard to detect? What can we do to detect this?
Decrease in basophils due to emotional stress or HYPERthyroidism.
Hard to detect because N range is 0-1%, but can be counted with absolute count.
Monocytosis is an _____ in monocytes due to the same conditions (“IIM”) as ______ because they share the a common stem cells. Monocytosis is seen especially whenever there is:
Increase in monocytes; same as neutrophilia
Monocytosis seen whenever there is: INCREASED CELL DAMGE! (Ex. active TB, long-term syph, parasitic/rickettsial infections, some autoimmune disease, trauma, SUBACUTE BACTERIAL ENDOCARDITIS (SBE), and in monocytic leukemias
Monocytes convert into tissue macrophages as needed. Their degradation action requires:
Enzymatic hydrolysis in secondary lysosomes (using lipases, proteases, non-specific esterases or NSEs, etc.)
Any lysosomal enzyme function of macrophages results in:
enlarged cytoplasm w/ large, cleared areas filled w/ undegraded wastes
There is _____ bone marrow storage of monos and they move into p.b. _____ granulocytes. So, p.b. monocytosis is usually the first sign of _____________.
Very little bone marrow storage of monos; move into p.b. BEFORE granulocytes.
First sign of: BONE MARROW RECOVERY
An increases in p.b. lymphocytes due to viral infections such as I.M, CMV, and toxoplasmosis is known as:
Lymphocytosis
A decrease in p.b. lymphocytes seen in some lymphomas secondary to some malignancies, TB, and AIDS, is known as:
Lymphocytopenia
Reactive lymphocytes (AKA atypical or variant lymphs) is evidence that the body is working and does not mean poor diagnosis unless _______________. Reactive lymphs vary in presentation, they can be:
Unless there are a great number in the p.b.
Can be: large, small, granular, clefted, or have vacuoles
What are the 5 non-malignant leukocyte disorders?
- Severe combined immunodeficiency syndrome (SCID)
- Wiskott- Aldrich syndrome
- 22q11 Syndromes
- Chediak- Higashi syndrome
- Chronic granulomatous disease (CGD)
SCID is caused by:
A mutation to the IL-2 receptor
In SCID, patients have few or no _____ and ___ have abnormal function.
Few or no T-cells & B cells have abnormal function (Also affects granulocytes)
Wiskott-Aldrich syndrome (WAS) is caused by:
Sex-linked recessive mutation that manifests a CD34 defect (Affects mainly boys)
In WAS patients, both ____ & ____ cells have abnormal function:
B & T cells
WAS is characterized by:
Recurrent infections, eczema, and thrombocytopenia
22q11 syndrome is caused by:
22q11 deletion
22q11 often involves the absence or decreased size of:
Thymus and T-lymphs
22q11 deletion can be associated with:
Cardiac defects, developmental delay, psychiatric disorders, short stature, hypocalcemia, thrombocytopenia, large platelets, cytopenias, and increased risk of malignancy
Chediak-Higashi syndrome is caused by:
A mutation in CHS1 LYST gene
Chediak- Higashi syndrome is characterized by:
-Gigantic, fused, primary and secondary granules
-Peroxidase + lysosomes in granulocytes, monocytes, and lymphocytes
-Abnormal dense granules in platelets, but usually normal sized
-***Slight neutropenia due to increased cell death in b.m. **
Although Chediak-Higashi granules are normal, they are still fused together, leading to:
Ineffective WBC killing causing recurrent infections and the syndrome is sometimes fatal
Chediak-Higashi granules cause sometimes fuse with melanocytes affecting their function causing:
Partial cutaneous albanism
Chediak-Higashi can also affect:
Other species!
Chronic granulomatous disease (CGD) is a syndrome that represents several genetic diseases. These defects cause WBCs to:
Have the ineffective killing ability to produce superoxide and H2O2 so they have extreme difficulty killing catalase positive bacteria
Catalase + bacteria don’t generate enough H2O2 to trigger MPO activity so bacteria “fly under the radar”
In CGD, bacteria can breed inside phagolysosomes causing _________.
Chronic infections characterized by granuloma formation. Patients also experience bacterial/fungal infection of the lung, skin, lymph nodes, and lungs.
What is granuloma?
Tissue accumulation of macrophages usually surrounded by lymphocytes due to unresolved inflammation
The nitroblue tetrazolium slide test (NBT) is done on CGD. What occurs in this test?
Normal neutrophils reduce the yellow nitroblue to a dark blue!!
CGD neutrophils will not have a reaction.
What are the two morphological (nuclear) abnormalities of leukocytes?
- Pelger-huet anomaly
- Twinning
Pelger-huet cells occur due to _______, causing what in all WBCs?
BENIGN, autosomal dominant disorder cause DECREASED NUCLEAR SEGMENTATION in all WBCs.
Pelger-huet anomaly is observed in two forms, what are they? Can these segs perform phagocytosis?
1st form: bi-lobed nuclei (55-93% of segs; peanut/dumbell shaped)
2nd form: Mostly unsegmented; round nuclei!
Yes, these segs still have a normal function and can perform phagocytosis!
What is the difference between pseugo pelger-huet anomaly and True pelger-huet?
True: Inherited; Psuedo: Acquired
True: All neutrophils infected; Psuedo: some
True: Normal granulation; Pseudo: Hypogranulation
Pseudo: Seen w/ AML, CML, HIV, and myelodysplastic syndromes
What does twinning mean? What is this associated with?
Nucleus w/ axial symmetry; Associated w/ malignancies and chemo
Neutrophil hypersegmentation means there are more than ____ lobes, and this is associated w/ what conditions?
> 5 lobes; associated w/ megaloblastic anemia or inherited (myelokathexis)
What are the three cytoplasmic abnormalities?
- May- hegglin anomaly
- Alder-Reilly anomaly
- Lysosomal storage diseases
May hegglin anomaly is what kind of abnormality? What causes it? What is this characterized by?
Cytoplasmic abnormality caused by MUTATION IN MYH9 gene on 22q12-13.
Characterized by leukopenia, variable thrombocytopenia, and GIANT PLATELETS (with abnormal function)
What do may-hegglin anomaly abnormalities look like? What do they look like?
Gray-blue RNA inclusions that are in ALL WBCs! They are a combination of rods and ribosomal granules that look Dohle-like
Real dohle bodies vs Dohle like?
Real Dohle bodies are composed of rRNA and are found ONLY in granulocyte cytoplasm.
Dohle-like inclusions are found in ALL WBCs and are RNA inclusions, rods, and ribosomal granules
Alder-Reilly anomaly is what kind of disorder? What is this characterized by?
Cytoplasmic disorder IN ALL WBCS characterized by clusters of large, primary, non-specific, azurophilic granules RESEMBLING toxic granulation.
Sometimes the nucleus is completed obscured with these granules
Alder-Reilly is known as Pseudo-toxic granulation. Why?
These granules can be seen in all WBCs, but toxic granulation can only be seen in neutrophils!
Remember: toxic granulation has Left shift, neutrophilia, and Dohle bodies!
Lysosomal storage diseases in monocytes/macrophages are a type of cytoplasmic disorder known as “lipidosis”. What are the 3 major disorders?
- Gaucher’s disease **MOST COMMON*
- Neimann-pick disease (NPD)
- Familial sea-blue histiocytosis
Gaucher’s disease is a type of lipidosis, cytoplasmic abnormality. What is the cause? What do they cells look like? What stain can we use for this?
Cause: Accumulation of unmetabolized sphingolipid glucocerebroside
Large macrophages w/ small eccentric nuclei, and cytoplasm w/ characteristic “crinkled” appearance!
Stain w/ periodic acid schiff (PAS) due to their glycogen content
Neimann-pick disease (NPD) is a type of lipidosis, cytoplasmic abnormality. What is the cause? What do these cells look like?
Group of disorders due to lack of spingomyelin in macrophages on b.m, spleen, liber, and brain
Macrophages are large, with small eccentril nuclei, and cytoplasm has roung, uniform sized droplets of accumulated lipid (FOAM CELLS)! ALSO, VACUOLATED LYMPHS
Familial sea-blue histioctosis is a type of lipidosis, cytoplasmic abnormality. What is the cause? What do these cells look like?
Cause: unknown enzyme def. that causes lipid storage disease
Enlarged tissue macrophages in spleen, liber, and b.m. show numerous lipid granules that stain blue-green w/ wrights stain
Can be seen in CML and NPD
Infectious mono, caused by EBV is characterized by:
Reactive lymphs (downey cells) IN THE P.B. and a positive heterophile test.
P.B monocytosis can be seen, but monocytes are NOT the definitive cell type.
IF the monospot is negative, but there are reactive lymphs in the p.b. , this is an indication of ____ caused by:
CMV;
Caused by a virus shed into urine, BF, WBCs, so transmission is primarily venereal
Acute infectious lymphocytosis (AIL) is caused by viral (coxsackie) or nonviral infections. What is the characteristic of this?
Extreme, absolute T-cell lymphocytosis (<100,000/uL when its usually 40,000-50,000/uL)!
However, the lymphs are small, uniform, and non-reactive.
