Leukocytosis and Leukopenia Flashcards
What is the most important number regarding WBCs?
the ABSOLUTE COUNT NOT the % of each cell type
*normal ranges for leukocyte numbers are AGE DEPENDENT
What is the most important number regarding WBCs?
the ABSOLUTE COUNT NOT the % of each cell type
*normal ranges for leukocyte numbers are AGE DEPENDENT
72 year old African American male presents to dialysis clinic and complains of feeling tired. A CBC (ordered without a differential count) shows increased WBC. A chest x-ray is somewhat suggestive of an infiltrate and he is started on an
empiric antibiotic
Initially:
- Normocytic anemia
- Leukocytosis
- Elevated RDW
Three days later the WBC is normal but he has a rash and lymphadenopathy so a CBC w/ automated dif is ordered.
You don’t know until you get a diff count!! This shows neutrophilia
...get a blood smear
- w/ fever plus neutrophilia think sepsis and get blood cx
- sepsis plus thrombocytopenia could be DIC so get coags
What is a leukoerythroblastic reaction?
Leukoerythroblastic reaction means that there are immature myeloid cells and nucleated red cells on the blood smear.
What are signs of a systemic bacterial infection?
marked toxic change
frequent left shift
leukoerythroblastic reaction
DIC
What do neutrophils do?
Host defense!!
- protect against infectious organsims
- move rapidly into tissue sites of infection/inflammation
- phagocytize and digest microorganisms
left shift (increase in number of immature leukocytes in the blood, particularly neutrophil bands)
What caues neutrophilia?
- Infections (pyogenic bacteria)
- tissue damage
- acute hemolysis
- acute blood loss
- inflammatory disorders
- Metabolic
- physiolgoic
- surgical
- neoplasms
What caues neutrophilia?
- Infections (pyogenic bacteria)
- tissue damage
- acute hemolysis
- acute blood loss
- inflammatory disorders
72 year old African American male presents to dialysis clinic and complains of feeling tired. A CBC (ordered without a differential count) shows increased WBC. A chest x-ray is somewhat suggestive of an infiltrate and he is started on an
empiric antibiotic
Initially:
- Normocytic anemia
- Leukocytosis
- Elevated RDW
Three days later the WBC is normal but he has a rash and lymphadenopathy so a CBC w/ automated dif is ordered.
You don’t know until you get a diff count!! This shows neutrophilia
...get a blood smear
- w/ fever plus neutrophilia think sepsis and get blood cx
- sepsis plus thrombocytopenia could be DIC so get coags
What is a leukoerythroblastic reaction?
Leukoerythroblastic reaction means that there are immature myeloid cells and nucleated red cells on the blood smear.
What are signs of a systemic bacterial infection?
marked toxic change
frequent left shift
leukoerythroblastic reaction
DIC
The risk of infection is…
- greater when neutrophils are DECREASING than when increasing
- greater when associtaed with mono/lymphopenia or hypogammaglobulinemia
neutrophil fxn?
- move reversibly between circulating and marginated pools
- rapid transit through circulation (t1/2 6-9 hrs)
What caues neutrophilia?
- Infections (pyogenic bacteria)
- tissue damage
- acute hemolysis
- acute blood loss
- inflammatory disorders
What drugs cuase neutrophilia?
steroids
lithium
growth factors
cigarette smoking
What is the impt number to remember with neutrophilia?
9mo M w/ one week history of fever and diarrhea
Initial CBC (no diff!):
- normal WBC
- thrombocytopenic
CBC w/ diff:
-marked neutropenia!!
Blood smear
- marked neutropenia w/ reactive neutrophil changes
- reactive lymphocytes
Suspect….
acute bacterial sepsis or viral syndrome
what is neutropenia?
decrase in absulte number of circulating neutrophils
<1800 in adults
<100 in children (2wks to one year)
**Lower limit of normal is for WHITE PEOPLE
the risk of infection is _____correlated wtih severity of neutropenia
INVERSELY
more severe neutropenia leads to a markedly increased risk of infxn
basophils
key mediator of immediate hypersensitivity rxns (ashtma, uriticaria, anaphylaxis)
host resistance to certian parasites
What causes monocytosis?
endocarditis TB syphillis Bacterial (mphage in sepsis) Viral (CMV, VZV GI Sarcoid HOdgkins Myeloid solid tumor
What is hte MCC of monocytosis?
infections
*more typical of chronic infections
