Leukocytosis, Leukopenia, Polycythemia, Hemochromatosis

Question 1

leukocytosis

Answer 1

total WBC count >11,000/microL

most commonly due to neutrophilia

Question 2

leukomoid reaction

Answer 2

WBC >30,000-50,000 cells/microL due to causes other than leukemia

Question 3

hyperleukocytosis

Answer 3

WBC > 100,000 cells/microL

Question 4

granulocytosis

Answer 4

increased neutrophils, eosinophils, basophils

Question 5

leukocytosis diagnostic evaluation

Answer 5

CBC with differential/peripheral smear revealing increased WBC

Question 6

leukostasis

Answer 6

pathologic diagnosis in which WBC plugs are seen in microvasculature (almost always due to acute leukemia)

Question 7

leukostasis clinical presentation

Answer 7

fever common

pulmonary signs/symptoms including dyspnea, hypoxia +/- diffuse interstitial/alveolar infiltrates

neurological signs/symptoms including visual change, headaches, dizziness, tinnitus, gait instability, confusion, somnolence, coma (associated with increased risk of ICH)

Question 8

leukostasis diagnostic evaluation

Answer 8

reveals hyperleukocytosis +/- blast cells

Question 9

leukostasis treatment

Answer 9

medical emergency

supportive care

cytoreduction (chemotherapy, hydroxyurea, leukaphereses)

Question 10

neutrophilic leukocytosis

Answer 10

can develop due to increased production, increased release from bone marrow, defective margination

Question 11

neutrophilic leukocytosis most commonly occurs due to

Answer 11

infection, stress, smoking, medications, pregnancy

Question 12

lymphocytic leukocytosis

Answer 12

absolute lymphocyte count >4800.microL

Question 13

reactive causes of lymphocytic leukoytosis

Answer 13

viral infection, pertussis, drug hypersensitivity, stress

Question 14

clonal expansion causes of lymphocytic leukocytosis

Answer 14

lymphoproliferative disorders

Question 15

monocytic leukocytosis

Answer 15

absolute monocyte count >800 cells/microL

Question 16

monocyte leukocytosis can occur due to

Answer 16

acute and chronic monocytic variants of leukemia, Hodgkin lymphoma, other hematologic disorders, acute bacterial/viral/parasitic infections

Question 17

eosinophilic leukocytosis

Answer 17

absolute eosinophil count >500 cells/microL

significant tissue eosinophilia can develop without elevated peripheral eosinophil count and can lead to organ specific disease (commonly involves skin, lung, GI tract)

Question 18

basophilic leukocytosis

Answer 18

unusual

absolute basophil count >200 cells/microL

Question 19

leukopenia

Answer 19

decreased total WBC count

Question 20

granulocytopenia

Answer 20

decreased neutrophils, eosinophils, basophils

Question 21

agranulocytosis

Answer 21

complete absence of neutrophils, eosinophils, basophils

Question 22

neutropenia

Answer 22

absolute neutrophil count (ANC) <1500 cells/microL

Question 23

neutropenia can develop due to

Answer 23

decreased bone marrow production, shift of circulating neutrophils outside of peripheral blood circulation, increased destruction

Question 24

neutropenia etiologies

Answer 24

most common cause of mild chronic neutropenia: constitutional neutropenia, dose-related drug-induced neutropenia

severe acute neutropenia (in absence of decreased platelets and Hct) almost always due to drug-induced agranulocytosis

other causes include infection, autoimmunity, nutritional deficiency, hematologic conditions, congenital, idiopathic

Question 25

neutropenia clinical presentation

Answer 25

symptoms/signs of underlying disorder

+/- signs/symptoms of infection

Question 26

neutropenia diagnostic evaluation

Answer 26

CBC may reveal associated cytopenias

+/- nutritional deficiency screening (vitamin B12, folate, copper)

+/- infectious screening (viral hepatitis, HIV)

+/- screening for collagen/vascular disease

+/- ESR/CRP

+/- bone marrow examination

Question 27

neutropenia treatment

Answer 27

hematology referral for moderate-severe without clear etiology, development of infection and/or unexplained cytopenias, presence of splenomegaly and/or lymphadenopathy

+/- hospital admission

determine risk of infection and prevent infection as appropriate

myeloid growth factors

hematopoietic cell transplantation may be indicated

treat underlying condition