Lecture 1.3: WBC Disorders Flashcards
Which 7 drugs, hormones, or toxins which are common causes of acute neutrophilia?
- Corticosteroids
- Epinephrine
- Lithium
- Endotoxin
- Smoking
- Vaccines
- Venoms
What are some common causes of demargination syndrome leading to neutrophilia?
- Vigorous exercise
- Acute physical and emotional stress
- Infusion of epinephrine and other catecholamines
Shift of neutrophils from the marginal to circulating pool is quantitatively more important from which vascular bed and can account for about a doubling in neutrophil count?
Pulmonary capillaries
An increase in which cells in the blood can be helpful in distinguishing neutrophilia due to demargination from other causes such as infections, protracted stress, or glucocorticoid administration?
↑ in lymphocytes + monocytes + neutrophils
Acute neutrophilia occurs as a consequence of release of neutrophils from where; this type of neutrophilia is seen in response to what?
Marrow storage pool; in response to inflammation and infections
Inflammation or tissue necrosis, due to burns, trauma, gout, or vasculitis are causes of what type of neutrophilia?
Acute neutrophilia
Malignancy is a cause of what type of neutrophilia?
Chronic Neutrophilia
Asplenia and myeloproliferative disorders are causes of what type of neutrophilia
Chronic neutrophilia
If neutrophilia persists after repeat labs, what is the next step (flow chart)?
- Examine smear: Leukoerythroblastic?
- Yes: then proceed to BM examination: morphology, cytogenetics, culture
- No: determine if pt is febrile (if yes, evaluate and treat), if not then do serologies for AID
If blood smear of pt with neutrophilia shows leukoerythroblastic cells, what are you looking for with the BM examination and what are the DDx’s?
- Tumor granulomatous dx
- Ph1 or BCR-ABL —> CML
- JAK2 mutation –> Non-CML MPN = PCV or myelofibrosis
Smoking and obesity can be associated with what WBC abnormality?
Mild neutrophilia
Lymphocytes displaying coarse, clumped chromatin, in pt with lymphocytosis should raise suspicion of which primary marrow disorder?
CLL
Readily identifiable lymphoblasts in pt with lymphocytosis should raise suspicion of which primary marrow disorder?
ALL
An excess of large granular lymphocytes, particularly in a pt with RA, should raise suspicion of which disorder?
Large granular lymphocytic (LGL) leukemia
Why is examination of the blood lymphocytes in pt with lymphocytosis so important?
Lymphocyte morphology is generally more informative than is the case in neutrophilia
Larged lymphocytes with cleaved nuclei may be seen in which cause of lymphocytosis?
Follicular lymphoma
Pt presenting with rhinosinusitis, asthma, and eosinophilia should trigger screening for what?
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
List 3 medications which are common causes of eosinophilia?
- Antibiotics
- NSAIDs
- Antipsychotics
List 5 allergic diseases associated with eosinophilia
- Allergic rhinitis
- Atopic dermatitis
- Urticaria/angioedema
- Fungal allergy
- Asthma
Unexplained monocytosis, particularly in elderly patients with other cytopenias, should reflex concern for what; which work-up is generally warranted?
- Myeloid malignanacies, such as MDS and CMML
- Generally warrants examination of bone marrow
List 6 antibiotics associated with idiosyncratic neutropenia?
- Cephalosporins
- Clindamycin
- Gentamicin
- Sulfonamides
- Tetracyclines
- Vancomycin
List 3 anticonvulsants associated with idiosyncratic neutropenia
- Carbamazepine
- Mephenytoin
- Phenytoin
Which antidepressant is associated with idiosyncratic neutropenia?
Amitriptylene
List two H2 blockers associated with idiosyncratic neutropenia.
- Cimetidine
- Ranitidine
List 3 cardiovascular drugs associated with idiosyncratic neutropenia
- Hydralazine
- Captopril
- Propranolol
List 2 diuretics associated with idiosyncratic neutropenia
- Chlorothiazide
- Hydrochlorothiazide
Which drug commonly used to prevent gout is associated with idiosyncratic neutropenia?
Allopurinol
Which antipsychotic medication is associated with idiosyncratic neutropenia?
Chlorpromazine
Which 2 infections are commonly associated with chronic neutropenia?
HIV and Hepatitis
What is Felty’s Syndrome? *likely on exam*
Hypersplenism w/ neutropenia, due to long-standing RA
What is the management for a pt with neutropenia, fever, localizing signs, and ANC <500/mL?
Admit for IV antibiotics and consider G-CSF
A pt with a history of neutropenia whom also has a postive family hx or with no family hx but cyclic neutropenia should be worked up for what?
ELANE mutation –> the gene coding for neutrophil elastase, seen in cyclic neutropenia
What is the one of the most common causes of iatrogenic lymphopenia?
Glucocorticoids
List 4 congenital immunodeficiency diseases associated with lymphopenia?
- Severe combined immunodeficiency disease (SCID)
- Common variable immune deficiency
- Ataxia-telangiectasia
- Wiskott-Aldrich syndrome
List some of the acquired causes of lymphopenia?
- Aplastic anemia
- Infectious diseases: viral, bacterial, and parasitic
- Iatrogenic: immunosuppressive agents and chemotherapy
What is the most notable entity to exclude in a patient monocytopenia and constitutional sx’s + splenomegaly?
Hairy cell leukemia
Which 2 markers for Hairy Cell Leukemia can be seen via flow cytometry?
CD11c and CD103
Severe monocytopenia may be seen in which syndrome; due to what mutation?
- Seen in MonoMAC (monocytopenia and mycobacterial infection) syndrome
- Mutation in the GATA-2 gene
- High risk of progressing to MDS or AML
