L1 - Pathology Of WBCs

Question 1

What is the leukocyte common antigen?

Answer 1

CD45

Question 2

What marker is present when myeloblast -> promyelocyte?

Answer 2

CD34

Question 3

Which markers are associated with early lymphocytes (prolymphocytes)?

Answer 3

TdT

Question 4

Which markers are associated with B lymphocytes?

Answer 4

CD19, CD20, CD10 and Pax 5

Question 5

What markers are associated with NK cells?

Answer 5

CD16 and C56

Question 6

Which markers are associated with T cells?

Answer 6

CD4 and CD8

CD1-5, C7

Question 7

What is neutropenia?

Answer 7

Reduced number of neutrophils in the blood

Question 8

What is agranulocytosis?

Answer 8

Marked reduction in WBC production from the bone marrow

Question 9

What is cytopenia?

Answer 9

Reduction in the number of mature cells

Question 10

What is pancytopenia?

Answer 10

Deficiency of all cellular components of the blood (WBC, RBCs and platelets)

Question 11

What is absolute neutrophil count?

Answer 11

Combined percentage of neutrophils and bands x WBC

Question 12

ANC below what value is very serious?

Answer 12

<500

Question 13

Worsening degrees of neutropenia place people at risk for what?

Answer 13

Deadly infections

Question 14

What can cause severe neutropenia?

Answer 14

Not enough made or too much destroyed 
Drug toxicity (sometimes purposeful) 
Aplastic anemia 
Megaloblastic anemia 
Immune destruction (Ab mediated) 
Hypersplenism

Question 15

What happens as a result of severe neutropenia?

Answer 15

Overwhelming infection (bacterial or fungal)

Question 16

What are the basic types of lymphoid neoplasia?

Answer 16

B cells, T cells, plasma cells, Hodgkin and NK cell

Question 17

What are the types of myeloid neoplasia?

Answer 17

Acute myeloid leukemia
Myelodysplasia
Myeloproliferative neoplasia

Question 18

What is a type of histiocytic neoplasia?

Answer 18

Langerhans cell histiocytosis

Question 19

What things can contribute to white cell neoplasia?

Answer 19

Genetic mutations (typically acquired) - proto-oncogenes 
Viral infections (HTLV-1 EBV, HHV-8) 
Chronic infection (H pylori)

Question 20

What is a leukemia?

Answer 20

Affects the bone marrow/blood

Question 21

What is lymphoma?

Answer 21

Affects lymph nodes

Question 22

What circumstances will give a better prognosis for ALL?

Answer 22

Ages 2-10
Low peripheral WBC count
Hyperdiploidy
t(12;21)

Question 23

What circumstances will give a worse prognosis for ALL?

Answer 23

Age <2
Adolescence/adulthood
High WBC count (>100k)

Question 24

What kinds of cells are seen on a peripheral smear showing myeloma?

Answer 24

Plasma cells, plasma blasts, multinucleated forms, Mott cells, Russel bodies, Dutcher bodies

Question 25

What can monoclonal gammopathy of undetermined significance (MGUS) become?

Answer 25

Multiple myeloma

Question 26

What percentage of plasmacytosis confirms multiple myeloma?

Answer 26

Greater than or equal to 60%

Question 27

If you have a >10% plasmacytosis, what do you need?

Answer 27

More testing

Question 28

Describe multiple myeloma

Answer 28

Monoclonal gammopathy Plasma cells in the bone marrow Clinical evidence of organ damage (CRAB) Hyper viscosity

Question 29

How is ALL diagnosed?

Answer 29

With morphology, staining, flow cytometry

Question 30

How is B cell NHL diagnosed?

Answer 30

Morphology, staining, flow cytometry

Question 31

How is myeloma diagnosed?

Answer 31

Morphology, staining, SPEP/ImmFix

Question 32

How is Hodgkin lymphoma diagnosed?

Answer 32

Morphology and staining

Question 33

How is AML classified?

Answer 33

I. AML with genetic aberrations (t8;21, t15;17) II. AML with MDS like features (poor prognosis) III. AML, therapy related (very poor prognosis) IV. AML, not otherwise specific (based on differentiation of the blasts)

Question 34

What will you see in CML?

Answer 34

Marked leukocytosis (WBC >100k) Increased Buffy coat Splenomegaly Extramedullary hematopoiesis

Question 35

What are the functions of the spleen?

Answer 35

Phagocytosis of blood cells and blood borne matter Ab production Hematopoiesis (fetal and in certain adult conditions) Sequestration of blood cells

Question 36

What are some splenic conditions?

Answer 36

Enlargement (splenomegaly, hypersplenism) Rupture Neoplastic involvement Infarcts

Question 37

What can cause splenomegaly?

Answer 37

``` Reactive splenitis (most often due to viral infection) Congestive splenomegaly (most often due to hepatic dysfunction) ```

Question 38

What is hypersplenism?

Answer 38

Enlargement of the spleen associated with cytopenias | May be due to an issue with circulating cells themselves or due to a primary/secondary splenic disorder

Question 39

How can hereditary spherocytosis cause splenic enlargement?

Answer 39

Stiff red cells get stuck in sinuses

Question 40

How can sickle cell anemia cause splenic enlargement?

Answer 40

Sickled cells are trapped

Question 41

How can idiopathic thrombocytopenic purpura (ITP) cause splenic enlargement?

Answer 41

Platelets are opsonized, spleen clears them

Question 42

What splenic disorders can cause splenic enlargement?

Answer 42

Congestive splenomegaly

Question 43

What can cause splenic rupture?

Answer 43

Most often the result of blunt abdominal trauma | Splenomegaly may cause spontaneous rupture (more likely if associated with rapid enlargement)

Question 44

It is far more common to see splenic involvement by what than primary tumors?

Answer 44

Hematologic malignancies

Question 45

What can cause splenic infarct?

Answer 45

It can outgrow its vascular supply | Or it can get clogged (blood only has one way into the spleen - no collaterals)

Question 46

What are two forms of thymic pathology?

Answer 46

Hyperplasia | Thymoma

Question 47

Myasthenia gravis can be the result of what?

Answer 47

Auto Abs produced in either thymic hyperplasia or thymoma

Question 48

What are warning signs of lymphoma (B symptoms)?

Answer 48

Fever Night sweats Unexpected weight loss

Question 49

What are the causes of leukocytosis?

Answer 49

Increased marrow production Increased release from marrow stores Decreased margination Decreased extravasation into tissues

Question 50

What can cause increased marrow production of leukocytes?

Answer 50

Chronic infection or inflammation (GF dependent) Paraneoplastic (e.g. HL, GF dependent) Myeloproliferative neoplasms

Question 51

What can cause increased released of leukocytes from marrow stores?

Answer 51

``` Acute inflammation (e.g. with infection) Chronic inflammation (many causes) ```

Question 52

What can cause decreased margination of leukocytes?

Answer 52

Exercise and catecholamines

Question 53

What can cause decreased extravasation of leukocytes into tissues?

Answer 53

Glucocorticoids

Question 54

What can cause neutrophilic leukocytosis?

Answer 54

Acute bacterial infection

Question 55

What can cause eosinophilic leukocytosis (eosinophilia)?

Answer 55

Asthma, hay fever, parasitic infections, drug reactions

Question 56

What can cause basophilic leukocytosis (basophilia)?

Answer 56

Rare, often indicative of MPNs

Question 57

What can cause monocytosis?

Answer 57

Chronic infections such as TB | Auto immune disorders (SLE, IBS)

Question 58

What can cause lymphocytosis?

Answer 58

Viral infections (hepatitis, cytomegalovirus, EBV)