Introduction to Leukocyte Disorder

Question 1

Cytosis means?

Answer 1

Condition of increase in cell number

Question 2

-philia means?

Answer 2

Increase in cell number

Question 3

-penia means?

Answer 3

Decrease in cell number

Question 4

What is the formula of absolute count?

Answer 4

Absolute count [cell type] = Differential count [%] X Total WBC count

Question 5

Define Leukocytosis

Answer 5

Increase in 1 or more normal WBC types in peripheral blood or presence of abnormal cell type(s) in peripheral blood. Usually seen in patients with a total WBC count of greater than 15k / uL in adults

Question 6

Define Leukopenia

Answer 6

Decrease in neutrophils and/or lymphs. Usually seen in adults with a total WBC count of less than 2500 / uL

Question 7

Neutrophilia occurs because of 3 major causes…

Answer 7

I.I.M; Infection (bacterial / fungal), Inflammation, and Malignancy

Question 8

Reactive can mean…?

Answer 8

Term used to describe causes other than malignancy. It can be acute, immediate, or chronic in nature.

Question 9

Describe Immediate neutropenia

Answer 9

Redistribution from marginating pool to circulating pool - waiting for egression into tissues (pseudoneutrophilia)

Question 10

Describe Acute neutrophilia

Answer 10

Increase neutrophils from Bone marrow due to infection. This can be seen with an increase in banded neutrophils in blood smears.

Question 11

Describe chronic neutrophilia

Answer 11

Like acute but stimulus is continuous unless underlying problems are solved. There will be a left shift meaning increase in immature neutrophil (band neutrophil).

Question 12

Describe pseudoneutrophilia

Answer 12

Benign, transient increase of neutrophil in peripheral blood due to shift of marginating cells into circulating pool. Its caused by release of epinephrine in a stress response.

Question 13

Pseudoneutropenia

Answer 13

Temporary decrease of neutrophil in peripheral blood due to hypersensitivity reaction, post-hypothermia, post dialysis, and with some tranquilizers. Neutrophil count under 1.5 x 10^9 / L

Question 14

What is associated with neutropenia due to decrease bone marrow production

Answer 14

Stem cell disorders, megaloblastic conditions, chemical responses, and congenital disorders

Question 15

What is associated with neutropenia (increased cell loss)?

Answer 15

Immune response and hyperspenism

Question 16

What are signs of an extreme left shift (Leukoerythroblastic)?

Answer 16

-Presence of nRBCs and neutrophilic left shift
-Variable total neutrophil count
-Poikilocytosis, teardrop cells, and anisocytosis

Question 17

What conditions/disorders are associated with an extreme left shift?

Answer 17

Myeloproliferative (granulocyte) disorders, myelopthisis, and hemolytic anemias

Question 18

What is a leukemoid reaction?

Answer 18

Its a transient response to the three I.I.M.; (severe) infection, inflammation, or malignancy.
Elevated WBC count
Presence of banded neutrophils in peripheral blood. Neutrophils will have toxic granulation, dohle bodies, and vacuoles.
-It mimics chronic myeloid leukemia (CML). To differentiate genetic analysis and staining must be done.

Question 19

Automated analyzers cannot…

Answer 19

Detect neutrophil abnormalities and differentiate nRBC from WBC

Question 20

Toxic granulation in WBCs are associated with…?

Answer 20

Infection, chemo patients, burns, poisonings, and normal pregnancies.

Question 21

Describe Toxic granulation

Answer 21

Large, blue-black, altered primary cytoplasmic granules. They lose their color as they mature. They become more visible if there is an infection. If there is no infection then similar patterns (in WBC) are seen as artifacts.

Question 22

Artifactual toxic versus True toxic granulation

Answer 22

Artifactual granulation will be seen throughout the WBC
True toxic granulation will be seen with dohle bodies, patients with neutrophilia, and left shift.

Question 23

What are dohle bodies?

Answer 23

Made of RNA remanants from rough ER. They are small gray-blue cytoplasmic inclusions in neutrophils and eosinophils. They will usually be seen with toxic granulation. In older specimens they will appear as gray colored but typically in freshly collected blood.

Question 24

Describe cytoplasmic vacuolization.

Answer 24

Small vacuoles are signs of autophagocytosis which are associated with drug exposure or radiation.

If vacuoles are large then it is signs of microbe ingestion and degradation which are associated with chemotherapy, infection, poisoning, and burns.

Vacuolization can be observed in old blood too! Double check collection date to be sure if the vacuoles are significant.

Question 25

What is pyknotic nuclei in segs.

Answer 25

A sign of necrobiosis which is dying nuclei. Associated with sepsis or old blood specimen

Question 26

Hyposegmentations in neutrophils are associated with…

Answer 26

Pelger-Huet anomaly, myeloproliferative or myelodysplastic disorders

Question 27

Hypersegmentation in segs

Answer 27

6 or more lobes that are prominent in chronic infection and severe megaloblastic anemia.