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Heme/Onc > Leukocyte Evaluation and Disorders > Flashcards

Leukocyte Evaluation and Disorders Flashcards

1
Q

What cells are in the proliferation stage?

A

Myeloblasts
Promyelocyte
Myelocyte

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2
Q

What does the proliferation stage mean?

A

Cells can both self-renew and differentiate

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3
Q

What does the differentiation stage mean?

A

Cells are able to mature and differentiate but cannot divide

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4
Q

What cells are in the differentiation stage?

A

Metamyelocyte
Band
Polymorphonuclear (PMN) cells (mature granulocyte)

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5
Q

What is the function of a neutrophil?

A

Protect from bacterial and fungal infections

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6
Q

How long do the progenitor neutrophils spend in the marrow maturing?

A

7-10 days

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7
Q

Where are most neutrophils at steady state?

A

In the bone marrow storage pool

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8
Q

What are the extramedullary neutrophils and how many are there?

A

1/2 of neutrophils circulate in the blood for 24h to be used in the tissue for 1-2 days in the tissue. Called circulation pool. Other half are in endothelial walls and are known as the marginal pool.

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9
Q

What is neutrophilia?

A

Abs neutrophil count >7700
Can be neutrophilic shift (marginal move to circulation) or true neutrophilia (new neutrophils made)

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10
Q

What is neutrophilic shift?

A

Movement from marginal to circulating pool. Transient within 1-2 minutes lasting 20-30 minutes. Caused by acute physical/emotional stress (exercise, seizure, paroxysmal tachycardia, epinephrine injection, post-op state)

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11
Q

What is true neutrophilia?

A

The release of neutrophils from storage pool in the marrow. ANC may be 5-6 x normal. Can be false, inherited, acquired (MC is infectious).

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12
Q

What is neutropenia?

A

<1800 ANC

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13
Q

What is mild neutropenia?

A

1000-1800 ANC

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14
Q

What is moderate neutropenia?

A

500-1000 ANC

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15
Q

What is severe neutropenia?

A

<500 ANC

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16
Q

What are the causes of neutropenia?

A
  • Injured bone marrow stem cells
  • shift in neutrophils (circulating to marginal) aka pseudoneutropenia
  • increased destruction in the circulation
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17
Q

When is pseudoneutropenia common?

A

Morning specimens and a side effect of various medications

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18
Q

Who is neutropenia most common in?

A

Elderly
African americans, asians have low neutrophils at bsl

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19
Q

What are complications of neutropenia?

A

Bacterial infections, note that sx can be absent due to decrease in neutrophils

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20
Q

How should we work up neutropenia?

A

Referral to hematology if persistently <1000
They will do a bone marrow biopsy, serum antineutrophil antibodies, rheumatoid factor and US for splenomegaly for Felty syndrome

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21
Q

What are the Myeloid growth factors?

A

Granulocyte colony-stimulating factor (G-CSF) Filgrastim or pegfilgrastim
Granulocyte-macrophage colony stimulating factor (GM-CSF) sargramostim

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22
Q

What is the guidelines for treating neutropenic fever?

A

Everyone gets ABx
>1000 can be outpatient
<500 must be inpatient
500-1000 call for help deciding

23
Q

What are the treatments for neutropenic fever?

A

ABX but otherwise based on cause
Medication - Stop causative agents
Autoimmune - steroids and myeloid CSF
Chemo - myeloid CSF +/- if intense therapy
Can also give granulocyte transfusion

24
Q

What is the function of eosinophils?

A

Primarily tissue dwellers that assist in fighting parasites, allergies and asthma. Most commonly in skin, airway and GI tract

25
Q

What 3 cytokines stimulate eosinophil development?

A

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

26
Q

What is the line span of an eosinophil?

A

Circulated for 8-12 hours before entering tissue for 2-5 days and up to 14 if exposed to cytokines

27
Q

What is eosinophilia?

A

Eosinophil count >500

28
Q

What is hypereosinophilic syndrome?

A

Idiopathic primary cause of eosinophilia (not genetic mutation or malignancy)

29
Q

What is the pathophysiology of eosinophilia?

A

Dysregulation of the cytokines (IL 3, IL 5, GM-CSF) results in an increased eosinophil production and/or eosinophil longevity

30
Q

What are the complications of eosinophilia?

A

Tissue damage
Mainly skin, airway, GI tract
Why? Release of toxic granule product damage epithelial tissue and nerves. Production of lipid mediations recruit inflammatory cells. Release cytokines that promote tissue remodeling and fibrosis

31
Q

What are the functions of the basophil?

A

Contain heparin to prevent clotting and release histamine during contact with allergens. Thought to help with IgE formation and activation.

32
Q

What is a common cause of primary basophilia?

A

CML

33
Q

What is a common cause of secondary basophilia?

A

Myeloproliferative disorders, hypersensitivity or inflammatory reactions, hypothyroidism

34
Q

How do T cells develop?

A

Mature and differentiate in the thymus and then exported to the blood and secondary lymph tissue

35
Q

What is the function of T cells?

A

Destroy human cells that have been attacked by viruses or have become cancerous

36
Q

What is the function of helper T cells/CD 4+?

A

stimulate antibody production and produce cytokines to activate other T cells

37
Q

What is the function of cytotoxic T cells/CD 8+?

A

Attacks and destroys foreign cells

38
Q

What is the function of regulatory T cells?

A

Turns off the immune response of other T cells to prevent autoimmune responses

39
Q

How do the B cells develop?

A

Mature in the bone marrow

40
Q

What are the functions of B cells?

A
  1. initiate T cell immune responses via antigens
  2. Express surface Ig receptors
  3. Become memory B cells to create long-lasting immunity
  4. Become plasma cells to produce hella antibodies during infection
41
Q

What are the natural killer cells?

A

First responders that attack cancerous or virally infected cells. Does not require immune system activation, just does self vs not self

42
Q

What is monoclonal lymphocytosis?

A

Expanded B-cell population in blood without sign of infection, autoimmune process, or lymphoproliferative disorder. Reflects a premalignant or malignant lymphoproliferative syndrome.

43
Q

What is polyclonal lymphocytosis?

A

Underlying condition expected to normalize within 2 months after resolution of condition. Commonly caused by viral infections (mononucleosis)

44
Q

What is the workup for lymphocytosis?

A
  1. Repeat CBC
  2. Peripheral blood smear
  3. Flow cytometry
45
Q

What are the causes of lymphocytopenia?

A

Decreased production
Increased destruction
Lymphocyte become lodged in the spleen or lymph nodes

46
Q

What are the adverse outcomes of lymphocytopenia?

A

Opportunistic infections
Increased risk of malignancy and autoimmune disorders

47
Q

What are the acquired causes of lymphocytopenia?

A

Infectious disease - HIV
Iatrogenic (chemo)
Autoimmune
Nutritional deficiency (zinc, ETOH use)

48
Q

What is the life cycle of a monocyte?

A

Remain in circulation for 1-3 days then enter tissues and differentiate into macrophages or dendritic cells. Half of monocytes are stored in the spleen.

49
Q

What are the functions of monocytes?

A
  1. Phagocytosis
  2. Antigen presentation to T-cells
  3. Inflammatory cytokine production
50
Q

What are the causes of moncytosis?

A
  • bacterial infections (MC)
  • AML CML Lymphomas
    -Asplenia
  • Inflammatory/autoimmune conditions
  • Treatment with corticosteroids or CSF
51
Q

What is the management of leukopenia?

A

Broad spectrum ABx
Myeloid growth factors (G-CSF and GM-CSF)
Corticosteroids
Correction of nutritional deficiencies
Splenectomy

52
Q

What patient education is required for leukopenia?

A

Avoid possible foodborne illness
Wash hands and care for indwelling catheters
Avoid rectal manipulation

53
Q

What do we use for leukocyte analysis?

A

Peripheral smear
Flow cytometry immunophenotyping (detects antigens/markers and differentiates normal cells from malignant cells)

Heme/Onc (10 decks)

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