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Hem/Onc > Leukocyte Eval- Exam 2 > Flashcards

Leukocyte Eval- Exam 2 Flashcards

1
Q

______ any of a number of substances, such as interferon, interleukin, and growth factors, that are secreted by certain cells (immune and non-immune) and have an effect on other cells, especially influencing inflammation and growth

A

cytokine

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2
Q

cytokine have an effect on other cells, especially influencing _____ and _____

A

inflammation

growth

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3
Q

______ a cell that descends from a stem cell and can differentiate into a specific type of “target” (or “daughter”) cell

A

Progenitor (cell)

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4
Q

_____ WBC count of >50,000/µL from causes other than leukemia

A

Leukemoid reaction

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5
Q

Agranulocytosis refers to what kind of cells?

A

Neutrophils, eosinophils, and basophils

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6
Q

Leukocytes refers to what cells?

A

Neutrophil
Basophil
Eosinophil
Lymphocyte
Monocyte

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7
Q

_______ Especially active in bacterial and fungal infections by attacking, ingesting, and digesting microorganisms

A

neutrophil

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8
Q

____ most active in allergies, bacterial and parasitic infections

A

basophil

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9
Q

______ most active in parasitic infections, allergies, asthma

A

eosinophil

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10
Q

Eosinophils are more common in ____ than _____

A

tissues than blood

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11
Q

______ cytotoxic, humoral, and antigen-processing
Especially active against viral infections

A

lymphocyte

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12
Q

_____ are major cells in the adaptive immune response

A

lymphocyte

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13
Q

_____ largest WBC, mature into macrophages or dendritic cells. Phagocytosis, antigen processing
Especially active in bacterial infections

A

Monocyte

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14
Q

Leukocytes with _____ in their cytoplasm, small sacs containing specific enzymes that are released to help further the inflammatory process and to help destroy target antigens/pathogens. What is the bigger category?

A

secretory granules

granulocytes

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15
Q

granulocytes all stem from _____

A

myeloblast

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16
Q

Leukocytes with an absence of staining granules in their cytoplasm and a _____. What is the bigger category?

A

unilobular nucleus

agranulocytes

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17
Q

What do agranulocytes stem from? (Except monocytes they stem from ______

A

lymphoblast (plasma cells, B lymphocytes, T lymphocytes, NK cells, lymphoid dendritic cells)

myeloblast

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18
Q

_____ are similar to basophils but are found in the connective and mucosal tissue

A

mast cells

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19
Q

PMNs refers to _____

A

all granulocytes

(Polymorphonuclear leukocytes)

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20
Q

_____ are fully mature monocytes in tissue. Are they granulocytes or agranulocytes?

A

Macrophages/Dendritic Cells

agranulocytes

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21
Q

What is the difference between a small resting lymphocytes and an activated atypical lymphocyte?

A

Inactive monocytes does not have very much cytoplasm when compared to the nucleus (E)

activated lymphocyte has more cytoplasm when compared to the nucleus (F)

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22
Q

What are the stages of granulocyte hematopoiesis?

A

self- renewal

proliferation stage

differentiation stage

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23
Q

What stage of granulocyte hematopoiesis? _______Originates from the hematopoietic stem cell (HSC). HSC are able to self-replicate (self-renew) and differentiate

A

self renewal

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24
Q

What stage of granulocyte hematopoiesis? ______ capable of cell division and differentiation
Myeloblast → promyelocyte → myelocytes

A

proliferation stage

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25
Q

What stage of granulocyte hematopoiesis? ______ capable of further maturation and differentiation, but not capable of cell division

Metamyelocyte → band → polymorphonuclear (PMN) cells

A

differentiation stage

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26
Q

______ and _____ are immature granulocytes. What stage of the granulocyte hematopoiesis?

A

metamyelocytes

bands

Granulocyte Hematopoiesis

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27
Q

polymorphonuclear cells are (mature/immature) granulocytes

A

mature

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28
Q

_____ is needed to determine morphology and will confirm presence of immature cells

A

Peripheral smear

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28
Q

______ of a WBC with diff are more reliable in pathologic states

A

Absolute values

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29
Q

How do you calculate the Absolute Neutrophil Count (ANC) if it is not given?

A
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30
Q

What type of WBC also plays a role in cytokine release and general inflammatory reponse?

A

Neutrophils

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31
Q

neutrophils progenitor matures in the marrow over ____. In a steady state, most neutrophils (will/will not) enter the bloodstream

A

7-10 days

will NOT!

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32
Q

Where is the “storage pool” of neutrophils located?

A

bone marrow: mature neutrophils hanging out ready to go until they get “called up”

called medullary neutrophils

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33
Q

Where is the “circulation pool” of neutrophils located? Where is the “marginal pool”?

A

About ½ circulate in blood < 24 hours before entering into the tissue to be used for up to 1-2 days in tissue

About ½ are attached to the endothelial walls: not freely floating in the blood but are mostly available if needed

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34
Q

What is considered neutrophilia? What are the 2 categories?

A

ANC greater than 7.7K

neutrophilic shift

true neutrophilia

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35
Q

_____ is when neutrophils from the marginal pool shift to the circulating pool. What is the timeframe? What can cause it?

A

Neutrophilic shift

onset within 1-2 minutes, lasts 20-30 minutes

Results from acute physical/emotional stress
exercise
seizure
paroxysmal tachycardia
epinephrine injection
post-op state

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36
Q

exercise
seizure
paroxysmal tachycardia
epinephrine injection
post-op state

Can all cause _____

A

neutrophilic shift

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37
Q

______ is the release of neutrophils from the storage pool (bone marrow). What will the ANC look like? What are the classifications?

A

True neutrophilia

ANC may be 5-6x greater than normal

spurious
primary
secondary

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38
Q

What type of true neutrophilia? ______ falsely elevated neutrophils (lab error)

A

spurious

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39
Q

What type of true neutrophilia? ______ increased neutrophil production by the marrow due to impaired neutrophil production regulation

A

primary neutrophilia

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40
Q

What type of true neutrophilia? _____most common; reaction to another condition, usually some sort of infection

A

secondary neutrophilia

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41
Q

Severe neutrophilia can lead to early release of ______

A

bands (“left shift” or “bandemia”

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42
Q

What do you do if you see spurious neutrophilia?

A

results of a lab error

wait an hour/day and repeat the labwork

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43
Q

What is considered mild neutropenia? Moderate? severe? agranulocytosis?

A

Mild neutropenia – ANC ≥1000 and <1500 cells/µL

Moderate neutropenia – ANC ≥500 and <1000 cells/µL

Severe neutropenia – ANC <500 cells/µL

Agranulocytosis - ANC <200

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44
Q

________ :often exacerbated by various medications. More often seen with morning specimens

A

Pseudoneutropenia

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45
Q

What is the pathophysiology of neutropenia?

A

Insufficient or injured bone marrow stem cells likely from marrow disease, chemo, medications, toxins or infections

shifts in neutrophils

increased destruction in the circulation

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46
Q

Who is neutropenia more commonly found in? What is DANC?

A

elderly

Duffy-null associated neutrophil count (DANC) - in patients of African descent (aka they just have a chronically low WBC)

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47
Q

in neutropenia ______ s/s may be absent. Why? At what ANC should you worry?

A

bacterial infection, no s/s because the body is not responding to the infection like it should

serious infections can occur with an ANC below 500

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48
Q

How does neutropenia present? What PE findings are common?

A

low-grade fever; skin (abscesses), ENT (otitis, sinusitis, oral sores, dental infections); pneumonia; GU infections

Severe: sudden onset malaise, prostration, fever, stomatitis, periodontitis, pharyngitis

fever
Lymphadenopathy
Signs of systemic infection (fever, tachycardia, tachypnea, hypotension)

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49
Q

At what point do you refer out for neutropenia?

A

ANC is severely low (<200 cells/µL)
ANC is persistently < 1000 cells/µL
Other signs of hematologic malignancy on peripheral smear
Presence of or progression to pancytopenia

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50
Q

What else would you order to work a patient up for neutropenia?

A

Bone marrow biopsy - evaluate granulocyte precursors and other hematopoietic stem cells; looks for other disease (infiltration, fibrosis)

(+) serum antineutrophil cytoplasmic antibodies (ANCA) - suggests autoimmune neutropenia if bone marrow is normal

(+) Rheumatoid factor and splenomegaly (via US/CT) - suggests Felty syndrome

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51
Q

(+) serum antineutrophil cytoplasmic antibodies (ANCA) - suggests _____ if bone marrow is normal

A

autoimmune neutropenia

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52
Q

What is the management for neutropenia?

A

Myeloid growth factors

Granulocyte colony-stimulating factor (G-CSF):
filgrastim (Neupogen), pegfilgrastim (Neulasta)

Granulocyte-macrophage colony stimulating factor (GM-CSF):
sargramostim (Leukine)

d/c medication that caused it

treat contributing causes (nutritional deficiencies, infections)

may be a candidate for hematopoietic cell transplatation

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53
Q

filgrastim (Neupogen), pegfilgrastim (Neulasta) are what kind of myeloid growth factor?

A

Granulocyte colony-stimulating factor (G-CSF): just neutrophils

54
Q

sargramostim (Leukine) is what kind of myeloid growth factor?

A

Granulocyte-macrophage colony stimulating factor (GM-CSF) : neutrophils and monocytes

55
Q

What is the difference between G-CSF and GM-CSF?

A

GM-CSF includes growth factor for neutrophils and monocytes

56
Q

systemic flu-like reaction; bone pain; possible stimulation of malignancy or HIV replication; development of antibodies to growth factors

These are the SE for ______

A

myeloid growth factors

57
Q

What is the treatment for Autoimmune neutropenia?

A

5 days of steroids + intermittent myeloid growth factor doses

58
Q

What is the treatment for chemo-induced neutropenia?

A

myeloid growth factor +/- prophylactic antimicrobials

59
Q

When is granulocyte infusion indicated?

A

indicated for bacterial infections without a clinical response to antibiotics within 24-48 hours

60
Q

What is the protocol for in vs out patient therapy for neutropenic fever?

A

ANC >1000 cells/µL = outpatient basis

ANC 500-1000 cells/µL = management is case-based

ANC of <500 cells/µL = inpatient treatment with parenteral antibiotics

61
Q

How are eosinophils distinguished on a gram stain?

A

Leukocytes with secretory granules in their cytoplasm that are readily stained by eosin, and which are distinguishable by a bilobed nucleus.

62
Q

_____ are primarily tissue dwellers, commonly found in the spleen, lymph nodes, thymus and digestive tract

A

eosinophils

63
Q

_____ protect the body from parasites, and play a role allergies, allergic response and asthma. What are their target organs? What is the tissue/blood ratio?

A

Eosinophils

skin, airway, GI tract

100:1

64
Q

What are the 3 primary cytokines that are responsible for eosinophil development and differentiation?

A

Interleukin-5 (IL-5)
Interleukin-3 (IL-3)
granulocyte-macrophage colony-stimulating factor (GM-CSF)

65
Q

What is the life span of an eosinophil?

A

Circulate for 8–12 hours before entering into the tissues

remain in tissue for days to weeks, average 2-5 days.

Cytokines can help eosinophils survive to 14 days or longer

66
Q

What is considered mild eosinophilia? moderate/severe?

A

Mild - 500 to 1500 cells/µL

Moderate-Severe (Hypereosinophilia) - ≥ 1500 cells /µL

67
Q

Eosinophilia can be _____ or ______.

A

primary or secondary

68
Q

primary eosinophilia can be ____ or _____. What are they caused by?

A

clonal: genetic mutation or malignancy

idiopathic: when everything else has been ruled out

69
Q

Which eosinophilia is more common? What is it caused by?

A

secondary: reactive to an underlying etiology

70
Q

What is the pathophysiology behind eosinophilia?

A

Dysregulation of cytokines IL-3, IL-5, GM-CSF leads to an increase in eosinophil production and/or eosinophil longevity

71
Q

What is the major complication with eosinophilia?

A

Tissue and organ damage

can happen at any eosinophil level above 500, degree of damage is NOT related to the level of eosinophils in the blood

72
Q

The tissue/organ damage that does occur as a result of eosinophilia is caused by ????

A

Release of toxic granule products that can damage epithelial cells and nerves

Production of lipid mediators (leukotrienes, prostaglandins) which control smooth muscle contraction and recruitment of inflammatory cells

Release of cytokines which may be involved in tissue remodeling and fibrosis (causes scarring)

73
Q

What are the main target organs of eosinophilia? How can you dx it?

A

MC target organs - skin, respiratory tract, GI tract

Biopsy of the organ will identify eosinophilic infiltration

74
Q

What is the treatment for eosinophilia?

A

Removal of any potential causative agents

Often multidisciplinary treatment with hematology, allergist, +/- other specialists

treatment varies widely depending on the cause!

75
Q

What does a basophil look like on a smear?

A

Leukocytes with a large quantity of dark blue-black secretory granules in their cytoplasm; the least common of the circulating WBCs.

76
Q

What is the role of a basophil?

A

contains heparin: so helps to prevent clotting

releases histamine when in contact with allergens

IgE antibody formation, activation and hypersensitivity reactions

77
Q

What is considered basophilia?

A

Absolute basophil count ≥ 100/µL (0.1 ×10³/µL)

Unusual, rare condition overall

78
Q

What is the primary cause of basophilia?

A

basophilic or mast cell variants
of acute or chronic leukemia

79
Q

What are some secondary causes of basophilia?

A

myeloproliferative disorders:
-Polycythemia vera
-Myelofibrosis
-Thrombocythemia)

Hypersensitivity or inflammatory reactions
Hypothyroidism

80
Q

How would you describe a lymphocyte on a smear?

A

single round nucleus and receptor molecules on their surface to bind to antigens and facilitate removal of the antigenic pathogen or agent.

81
Q

_____ can differentiate into plasma cells

A

B-cells

82
Q

What is the lymphocyte class % breakdown?

A

T-cell - 60-80%
B-cell - 10-20%

Natural Killer Cells (NK) - 5-10 % (these are made as needed)

83
Q

____ and ______ are lymphocytes that can mature and divide on demand

A

T cell and B cell

84
Q

Where do T cells mature and differentiate?

A

thymus

then are exported to the blood and secondary lymphoid tissues (Lymph nodes, spleen, tonsils, MALT)

85
Q

What is the function of the T cell?

A

destroy abnormal human cells (virus-infected, cancer) and contribute to adaptive immune response via memory T cells

86
Q

What are the 3 categories of T cells?

A

helper T cells
Cytotoxic T cells
Regulatory T cells

87
Q

types of T cells: ______ aka “CD4+ T-cell”- recognizes foreign antigens and stimulates antibody production; produces cytokines that activate other T-cells

A

Helper T

88
Q

types of T cells: ______ aka “CD8+ T-cell” - attacks and destroys abnormal cells (i.e infected cells, cancer cells and transplanted organ cells)

A

Cytotoxic T cells

89
Q

types of T cells: ______ - dampen or turn off the immune response of other T-cells preventing autoimmune responses

A

Regulatory T cells

90
Q

____ and ____ can become memory cells

A

Helper T and cytotoxic T

91
Q

Where do B cells develop?

A

differentiate and mature in the bone marrow, then reside in lymph tissue

92
Q

What is the function of a B cell?

A

capture and present antigens to activate T cells, contribute to adaptive immune response via memory B cells, and contribute to humoral immunity (precursor to plasma cells). Express surface immunoglobulin (Ig) receptors
to specific antigens

93
Q

______ fully differentiated lymphocyte with a
short life that produces a large number of antibodies
(Ig) until active infectious agent is removed

A

plasma cell

94
Q

Where do NK cells mature and develop?

A

differentiate and mature in multiple sites:
Bone marrow, lymph nodes, thymus, liver, tonsils, uterus

95
Q

What is the function of a NK cell?

A

first responders to abnormal human cells (virus-infected, cancer) while awaiting immune response from cytotoxic T-cells.

Can recognizes cells as “foreign” or “self”

Most healthy/normal cells express self-receptors that are recognized by the NK cells, preventing them from attacking

96
Q

_____ receive signals from foreign cells. Do they require activation?

A

NK cells

do NOT require activation

97
Q

What is considered lymphocytosis?

A

Absolute lymphocyte count > upper limit of normal (ULN) for age

98
Q

____ and ____ are the 2 categories of lymphocytic disorders

A

Monoclonal

Polyclonal

99
Q

What causes monoclonal lymphocytosis? Polyclonal lymphocytosis?

A

Benign or malignant disorder (think cancer)

Infectious
Transient
Reactive
Benign
(think reaction to something)

100
Q

_____ an expanded clonal B, T, or NK cell population in the blood without any sign of infection, autoimmune process or lymphoproliferative disorder. Do NOT have any PE findings either. What does this reflect?

A

Monoclonal Lymphocytosis

premalignant or malignant lymphoproliferative syndrome

101
Q

premalignant monoclonal B-cell lymphocytosis usually see ____ or ____ lymphocytosis. What does a low count MBL mean? High count MBL mean?

A

T or NK

Low-count MBL - rarely progresses to CLL

High-count MBL - more likely to become leukemia

102
Q

malignant monoclonal lymphocytosis will progress to ???

A

Chronic Lymphocytic Leukemia (CLL)
Non-Hodgkin Lymphoma (NHL) with circulating disease
Hairy Cell Leukemia (HCL)
Large Granular Lymphocytic Leukemia (LGL)

103
Q

______ is associated with underlying condition expected to normalize within 2 months after resolution of condition

A

Polyclonal Lymphocytosis

104
Q

polyclonal lymphocystosis is most likely due to ????

A

MC viral infections (especially EBV), Pertussis, cat scratch disease, toxoplasmosis

emotional/physical stressor (acute illness or surgery)

drug reaction

105
Q

benign persistent Polyclonal Lymphocytosis is usually due to ?????

A

rare, mainly in adult female smokers
Post-splenectomy
Thymoma

106
Q

What is the dx workup for lymphocytosis?

A

Repeat CBC with diff.
Peripheral blood smear
Flow Cytometry: will detect surface antigens to specific B or T cells

107
Q

What is the defines lymphocytopenia?

A

Absolute lymphocyte count < lower limit of normal (LLN) for age

108
Q

What are some complications associated with Lymphocytopenia?

A

Opportunistic infections

Higher risk of malignancy and autoimmune disease

109
Q

Lymphocytopenia can be ____ or _____

A

inherited or acquired

110
Q

Name some causes of acquired lymphocytopenia

A

HIV and other viral infections
radiation
cytotoxic
steroids
alemtuzumab, rituximab
autoimmune disorders
zinc deficiency
chronic alcohol use
malnutrition

111
Q

What does a monocyte look like on a smear?

A

Phagocytic leukocyte, the largest WBC, with a large ovoid (notched or kidney-shaped) nucleus and clear, grayish cytoplasm.

112
Q

____ is the monocyte precursor

A

myeloblast

113
Q

What are the functions of monocytes?

A

Phagocytosis
antigen presentation
inflammatory cytokine production

114
Q

Monocytes allow T cell ____, _____ and ______

A

recognition, activation and immune response

115
Q

monocytes remain in circulation for ____ before entering tissues. Upon entering tissues, what happens?

A

1-3 days

Upon entering tissues, differentiate into macrophages or dendritic cells

116
Q

_____ of total monocyte count is stored in _____ as a reserve

A

Half

spleen

117
Q

What is monocytosis defined as?

A

Absolute monocyte count > 800 cells/µL ( 0.8 x ×10³/µL )

118
Q

monocytosis is usually due to a _____ that isn’t a result of hematopoietic dysfunction. What is the MC?

A

transient condition

bacterial infections complicated by neutropenia

119
Q

What 2 medications can cause monocystosis?

A

steroids or colony stimulating factors

120
Q

Overall, the management of leukopenia is geared toward ???? and ?????

A

correcting the underlying condition

prevention of complications

121
Q

Overall, how do you manage leukopenia?

A

Broad spectrum antibiotics

Myeloid growth factors

Corticosteroid Therapy (if immune mediated)

Nutritional Therapy (if any deficits)

Splenectomy - Reserved for chronic neutropenia unresponsive to other tx

122
Q

splenectomy puts you at a higher risk of ????

A

Complicated by risk of recurrent life-threatening bacterial infections

60x higher risk of sepsis, especially in young children

OPSI - overwhelming post-splenectomy infection (mortality 40-70% with tx)

123
Q

What is a PE that you would want to avoid on pt with leukopenia?

A

NO rectal exams!!!

124
Q

When are peripheral smears indicated?

A

leukocytosis, leukocytopenia

125
Q

When is hypersegmentation seen on a peripheral smear?

A

megaloblastic anemias, sometimes with myeloproliferative disorders, or following chemotherapy (methotrexate)

126
Q

When is granulation seen on peripheral smear?

A

seen most often with bacterial infections and in association with cytoplasmic vacuolization

127
Q

When are Dohle bodies often seen on a peripheral smear? What do they look like?

A

Irregularly shaped blue staining area in the cytoplasm; seen with infections

128
Q

_____ is a a ruptured cell remnant, classically associated with fragile lymphocytes in CLL

A

Smudge cell / Basket cell

129
Q

An artifact of EDTA anticoagulation, this may cause the platelet count to be artifactually low. What am I?

A

Platelet satellitosis

130
Q

Describe the process of flow cytometry. What does it detect?

A

A process that measures (-metry) cellular (cyto-) properties as they are moving in a fluid stream (flow), past a stationary set of laser detectors

Detects antigens or markers on the surface of the cells

Differentiates normal cells from malignant cells

131
Q

What types of body products are eligible for flow cytometry?

A

blood, bone marrow, lymph node tissue

131
Q
A

Hem/Onc (14 decks)

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