L1 - Pathology Of WBCs Flashcards
What is the leukocyte common antigen?
CD45
What marker is present when myeloblast -> promyelocyte?
CD34
Which markers are associated with early lymphocytes (prolymphocytes)?
TdT
Which markers are associated with B lymphocytes?
CD19, CD20, CD10 and Pax 5
What markers are associated with NK cells?
CD16 and C56
Which markers are associated with T cells?
CD4 and CD8
CD1-5, C7
What is neutropenia?
Reduced number of neutrophils in the blood
What is agranulocytosis?
Marked reduction in WBC production from the bone marrow
What is cytopenia?
Reduction in the number of mature cells
What is pancytopenia?
Deficiency of all cellular components of the blood (WBC, RBCs and platelets)
What is absolute neutrophil count?
Combined percentage of neutrophils and bands x WBC
ANC below what value is very serious?
<500
Worsening degrees of neutropenia place people at risk for what?
Deadly infections
What can cause severe neutropenia?
Not enough made or too much destroyed Drug toxicity (sometimes purposeful) Aplastic anemia Megaloblastic anemia Immune destruction (Ab mediated) Hypersplenism
What happens as a result of severe neutropenia?
Overwhelming infection (bacterial or fungal)
What are the basic types of lymphoid neoplasia?
B cells, T cells, plasma cells, Hodgkin and NK cell
What are the types of myeloid neoplasia?
Acute myeloid leukemia
Myelodysplasia
Myeloproliferative neoplasia
What is a type of histiocytic neoplasia?
Langerhans cell histiocytosis
What things can contribute to white cell neoplasia?
Genetic mutations (typically acquired) - proto-oncogenes Viral infections (HTLV-1 EBV, HHV-8) Chronic infection (H pylori)
What is a leukemia?
Affects the bone marrow/blood
What is lymphoma?
Affects lymph nodes
What circumstances will give a better prognosis for ALL?
Ages 2-10
Low peripheral WBC count
Hyperdiploidy
t(12;21)
What circumstances will give a worse prognosis for ALL?
Age <2
Adolescence/adulthood
High WBC count (>100k)
What kinds of cells are seen on a peripheral smear showing myeloma?
Plasma cells, plasma blasts, multinucleated forms, Mott cells, Russel bodies, Dutcher bodies
What can monoclonal gammopathy of undetermined significance (MGUS) become?
Multiple myeloma
What percentage of plasmacytosis confirms multiple myeloma?
Greater than or equal to 60%
If you have a >10% plasmacytosis, what do you need?
More testing
Describe multiple myeloma
Monoclonal gammopathy
Plasma cells in the bone marrow
Clinical evidence of organ damage (CRAB)
Hyper viscosity
How is ALL diagnosed?
With morphology, staining, flow cytometry
How is B cell NHL diagnosed?
Morphology, staining, flow cytometry
How is myeloma diagnosed?
Morphology, staining, SPEP/ImmFix
How is Hodgkin lymphoma diagnosed?
Morphology and staining
How is AML classified?
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)
What will you see in CML?
Marked leukocytosis (WBC >100k)
Increased Buffy coat
Splenomegaly
Extramedullary hematopoiesis
What are the functions of the spleen?
Phagocytosis of blood cells and blood borne matter
Ab production
Hematopoiesis (fetal and in certain adult conditions)
Sequestration of blood cells
What are some splenic conditions?
Enlargement (splenomegaly, hypersplenism)
Rupture
Neoplastic involvement
Infarcts
What can cause splenomegaly?
Reactive splenitis (most often due to viral infection) Congestive splenomegaly (most often due to hepatic dysfunction)
What is hypersplenism?
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
How can hereditary spherocytosis cause splenic enlargement?
Stiff red cells get stuck in sinuses
How can sickle cell anemia cause splenic enlargement?
Sickled cells are trapped
How can idiopathic thrombocytopenic purpura (ITP) cause splenic enlargement?
Platelets are opsonized, spleen clears them
What splenic disorders can cause splenic enlargement?
Congestive splenomegaly
What can cause splenic rupture?
Most often the result of blunt abdominal trauma
Splenomegaly may cause spontaneous rupture (more likely if associated with rapid enlargement)
It is far more common to see splenic involvement by what than primary tumors?
Hematologic malignancies
What can cause splenic infarct?
It can outgrow its vascular supply
Or it can get clogged (blood only has one way into the spleen - no collaterals)
What are two forms of thymic pathology?
Hyperplasia
Thymoma
Myasthenia gravis can be the result of what?
Auto Abs produced in either thymic hyperplasia or thymoma
What are warning signs of lymphoma (B symptoms)?
Fever
Night sweats
Unexpected weight loss
What are the causes of leukocytosis?
Increased marrow production
Increased release from marrow stores
Decreased margination
Decreased extravasation into tissues
What can cause increased marrow production of leukocytes?
Chronic infection or inflammation (GF dependent)
Paraneoplastic (e.g. HL, GF dependent)
Myeloproliferative neoplasms
What can cause increased released of leukocytes from marrow stores?
Acute inflammation (e.g. with infection) Chronic inflammation (many causes)
What can cause decreased margination of leukocytes?
Exercise and catecholamines
What can cause decreased extravasation of leukocytes into tissues?
Glucocorticoids
What can cause neutrophilic leukocytosis?
Acute bacterial infection
What can cause eosinophilic leukocytosis (eosinophilia)?
Asthma, hay fever, parasitic infections, drug reactions
What can cause basophilic leukocytosis (basophilia)?
Rare, often indicative of MPNs
What can cause monocytosis?
Chronic infections such as TB
Auto immune disorders (SLE, IBS)
What can cause lymphocytosis?
Viral infections (hepatitis, cytomegalovirus, EBV)
