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RHS > L20- WBC Pathology I > Flashcards

L20- WBC Pathology I Flashcards

1
Q

what are the 2 general WBC disorders, include examples

A

Leukopenia: lymphopenia, neutropenia

Leukocytosis: reactive leukocytosis, neoplastic leukocytosis

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2
Q

define lymphopenia and provide common examples

A 
-reduced lymphocyte count
Ex:
-advanced HIV
-autoimmune disease
-acute viral infections
-drug induced (chemotherapy, steroid therapy)
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3
Q

define neutropenia and the 2 general mechanisms that cause it

A

-reduced neutrophil count

i) reduced / ineffective production (bone marrow issue)
ii) accelerated consumption / destruction (peripheral issue)

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4
Q

list the ways Neutropenia is caused by reduced production (hint- 5)

A
  • myeloid stem cell suppression: eg. aplastic anemia (usually idiopathic)
  • committed myeloid precursor suppression (usually drug induced)
  • ineffective granulopoiesis: megaloblastic anemia, myelodysplastic syndromes
  • marrow infiltration: granulomas, malignancies
  • rare inherited disorders: eg. Kostmann syndrome, cyclic neutropenia
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5
Q

list the ways Neutropenia is caused by increased consumption or destruction

A
  • Immune-mediated: auto-immune disease, drugs
  • Splenic sequestration of blood cells, as in splenomegaly
  • Increased consumption, during overwhelming infection
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6
Q

Complications of Neutropenia:
-(1) is a complication of severe anemia with (2) levels and can lead to (3)

-most severe neutropenia is due to (4), where the effect is defined as either (5) or (6)

A

1- agranulocytosis
2- <500 cells/µL
3- life-threatening infection

4- drugs
5- predictable: dose-related (chemotherapy)
6- idiosyncratic: many drugs, mostly immune mediated by precursor suppression

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7
Q

Patients with neutropenia will present with (1). Most treatment involves (2). In cases of predictable neutropenia (via dose-related issue), (3) treatment may also be necessary.

A

1- signs and Sxs of related infections
2- broad spectrum antibiotics
3- G-CSF replacement therapy

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8
Q

list the forms of reactive leukocytosis

A
  • neutrophilic
  • eosinophilic
  • basophilic
  • monocytic
  • lymphocytic
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9
Q

neutrophilic leukocytosis (reactive), aka (1), is caused by one of either (2), (3), (4)

A

1- neutrophilia
2- acute inflammation
3- acute hemorrhage
4- malignancy (extensive, necrotic tumors)

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10
Q

list some examples of how acute inflammation causes reactive neutropenia

A
  • infections: pyogenic bacteria
  • following tissue damage: burns, MI, trauma, surgery
  • chemical or Ab deposition: gout, RA
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11
Q

what are the 2 main features of neutrophilic leukocytosis (reactive) on peripheral blood smear

A
  • neutrophils contain purple cytoplasmic granules / toxic granulations
  • neutrophils contain blue cytoplasmic patches of ER / Dohle bodies

(-inc band cells, less lobulated nuclei)

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12
Q

list the causes of (reactive) eosinophilic leukocytosis (hint: 6, include alternate name)

A

(eosinophilia)

  • allergic disorders (asthma, hay fever)
  • skin diseases (pemphigus vulgaris, bullous pemphigoid, dermatitis herpetiformis)
  • parasitic infestations
  • collagen vascular diseases (vasculitis)
  • drug reactions
  • malignancies (Hodgkin lymphomas)
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13
Q

Basophilic leukocytosis, aka (1) is a (commonly/rarely) reactive in nature, and will almost always indicate (3).

A

1- basophilia
2- rarely reactive
3- myeloproliferative neoplasm, like CML

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14
Q

list some causes of reactive monocytosis

A
  • chronic infections: Tb, rickettsiosis, bacterial endocarditis, malaria)
  • Collagen vascular disease (SLE)
  • IBD (UC)
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15
Q

reactive lymphocytosis is seen in many disorders involving (1), or in (2) or (3) infections

A

1- chronic immunologic stimulation
2- viral infections (EBV, HepA, CMV)
3- B. pertussis infection

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16
Q

list the features of reactive lymphocytosis on peripheral blood smear (hint- 4 main ones)

A

(reactive atypical lymphocytes, eg. infectious mononucleosis)

  • larger than normal
  • more cytoplasmic content
  • eccentric large nucleus
  • membrane attachment to RBCs
17
Q

Reactive lymph node:

  • (1) is the result of B-cell response
  • (2) is the result of T-cell response
  • (3) is the result of plasma-cell response
A

1- follicular hyperplasia (cortical region)

2- parafollicular / interfollicular hyperplasia

3- sinus histiocytosis: dilated sinusoids containing histiocytes OR Medullary expansion

18
Q

If there is reactive leukocytosis in peripheral blood, what are the differential diagnoses that needed to be compared

A

i) reactive increase in granulocytes / leukemoid reaction VS CML
ii) reactive lymphocytosis VS chronic lymphocytic leukemia

19
Q

If there is reactive leukocytosis in lymph nodes, what are the diagnoses that need to be compared

A

reactive lymph node VS lymphoma

20
Q

In children, lymphadenopathy is most indicative of (1). Lymph nodes are described as (2). (3) may be an important finding in history.

  • (4) is a key rule
  • patients must f/u in (5) fashion
A

1- reactive lymphadenopathy (common; cervical, axillary, inguinal area)
2- tender, but mostly asymptomatic
3- h/o infection / rash
4- no rush to biopsy
5- every 2-3 mos to observe for a dec in size

21
Q

In adults, lymphadenopathy is less indicative of (1) and more concerning for (2). (3) is the protocol if there is no obvious cause.

A

(adults >40 y/o)
1- reactive adenopathy
2- malignancy- lymphoma, metastatic CA
3- FNA (fine needle aspiration) or Tissue biopsy

22
Q

define:

(1) leukemia

(2) lymphoma

A

Leukemia: neoplasia involves predominately bone marrow (and usually peripheral blood) // affects myeloid and lymphoid progenitors

Lymphoma: neoplasia forms discrete tissue masses in lymph nodes or extranodal areas // affects lymphoid progenitors

23
Q

describe the difference in presentation of Acute VS Chronic leukemia

A

Acute- precursor cells predominate (note- not used to describe lymphomas)

Chronic- mature differentiated cells predominate

24
Q

what are the 5 common sources for WBC malignancy

A
  • chromosomal translocations and oncogenes
  • inherited genetic factors (down syndrome)
  • environmental agents (viruses, bacteria)
  • immune dysregulation
  • iatrogenic (radiation, chemotherapy)
25
Q

list the 3 mutations causing WBC malignancies, provide examples

A

Pro-growth: TK mutations, MYC translocation

Pro-survival: BCL2 translocation

Increased self-renewal: MLL translocation, PML-RARA fusion gene

26
Q

what are the 2 classifications of lymphomas

A

Non-Hodgkin Lymphoma / leukemia including plasma cell neoplasms

Hodgkins Lymphomas

27
Q

what are the classifications of leukemia

A
  • acute myeloid leukemia
  • myelodysplastic syndrome
  • chronic myeloproliferative neoplasms
28
Q

what are the additional classifications of Non-Hodgkin’s Lymphoma / Leukemia (according to WHO)

A

(note- hodgkin’s has no other sub-classifications)

  • precursor lymphoid neoplasms
  • mature / peripheral B-cell neoplasm
  • mature T/NK cell neoplasm
29
Q
  • 60% of NHL / HL (H- Hodgkins, L-lymphoma) patients will present with (1)
  • 40% of NHL are in (2) location and will present with (3)
A

1- nontender lymph node enlargement
2- extra-nodal (GIT, skin, brain, breast)
3- site related Sxs

30
Q

the signs and symptoms of leukemia include….

A

mainly related to bone marrow replacement –> cytopenias

31
Q

plasma cell neoplasms with result in and present with….

A

bone destruction => bone pain due to pathological fractures

32
Q

> 90% of lymphoid neoplasms are composed of (1), therefore (2) stage is very important. Most lymphomas show (3) property, therefore all neoplastic cells share (4), detectable by (5).

A 
1- B-cells
2- stage b-cell differentiation
3- clonality
4- Ag receptor gene arrangement pattern
5- PCR / molecular genetics
33
Q

B-cell neoplasms will show (1) as an essence of monoclonality and expressing it as (2) or (3) detectable by (4).

A

1- light chain restriction
2- κ-chains
3- λ-chains
4- flow cytometry or immunohistological stains

34
Q

Most lymphoid neoplasms have recurrent (1) abnormalities to help aid its diagnosis, which is detected by (2)

A

1- cytogenic abnormalities / frequent translocations

2- FISH

35
Q

Pair the recurrent translocation with the NHL type:

1) t(8;14
(2) t(11;14)
(3) t(11;18)
(4) t(14;18)

A

1- Burkitt lymphoma
2- mantle cell lymphoma
3- MALT lymphoma
4- follicular lymphoma

36
Q

Pair the type of NHL with the associated recurrent translocation:

(1) Burkitt lymphoma
(2) follicular lymphoma
(3) MALT lymphoma
(4) mantle cell lymphoma

A

1- t(8;14)
2- t(14;18)
3- t(11;18)
4- t(11;14)

RHS (35 decks)

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