Leukopenia/leukocytosis

Question 1

Neutrophils/granulocytes

Answer 1

• Most numerous of WBCs.
• First line of defense against pathologic bacteria
• Elevation of less mature form (i.e., bands) commonly due to acute bacterial infections. This is also called a “Left shift”.
• If there is an Increase Percent of Segs, it’s called a “Right shift”.
• Decreases may be due to viral infections with subsequent increase in lymphocytic line of white blood cells

Question 2

What are mature neutrophils called?

What are “less” mature neutrophils called?

Answer 2

most mature are called Segment neutrophils (“Segs”) and the Less mature are called “Bands” :

Question 3

Eosinophils

Answer 3

• Account for generally <4% of WBCs.
• Increases in blood and tissue generally due to parasites, bronchial asthma, hay fever(Worms, Wheezes & Other Weird Diseases)
• Decreases may occur when marrow severely stressed (e.g., shock, severe burns)

Question 4

Basophils

Answer 4

• Rarely seen - representing <1% of WBCs. Not phagocytic.
• Contain secretory products (e.g., heparin, histamine).
• Most ominous cause of increase = leukemia or Chronic Myelogenous Leukemia (CML).

Question 5

Lymphocytes

Answer 5

• Second most numerous WBC - 20-40 % of WBCs on differential.
• Reactive (atypical) lymphocytes can occur viral infections and some bacterial infections.
• Lymphocytosis is also associated acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), and lymphoma.

Question 6

Functionally Lymphocytes are of three broad classes

Answer 6

B cells (Bursa)
T cells (Thymus)
NK cells (Natural Killer Cells).

Question 7

Monocytes/ macrophages

Answer 7

• 2-8% of WBCs
• Phagocytic leukocytes representing first line of defense against some organisms and foreign cells
• Assist with removal of damaged tissues, malignant cell destruction, and antigen processing
• Increases seen in chronic inflammatory reactions, recovery from cell injury, and some malignancies

Question 8

in order for it to be considered leukocytosis you need a WBC of what?

Answer 8

WBC count > 10,000

Question 9

Primary Defect of the Bone Marrow

Answer 9

overproduction of WBC

due to diseases, disorders

Question 10

reactive cause of leukocytosis?

Answer 10

Drugs: corticosteroids, lithium, beta agonists, G(M)-CSF
– Stress: overexertion, seizures, anxiety
– Infections
– Inflammation: tissue necrosis, infarction, burns, arthritis
– Trauma: splenectomy, bleeding or hemolysi

Question 11

If the granulocytosis is not due to a reactive cause what will you do?

Answer 11

REFER to hematology

Question 12

If someone presents with eosinophilia why would you refer to hematology?

Answer 12

refer to hematology if parasitic infection or allergic reaction ruled out or abnormality persists beyond treatment

Question 13

Someone presents with basophilia what is the first step?

Answer 13

Extremely rare and suggests chronic basophilic leukemia
•First step: Refer for bone marrow testing
Refer

Question 14

What are you going to be thinking first when someone presents with basophilia?

Answer 14

myloproliferative disease

Question 15

Someone presents with monocytosis what is the first step?

Answer 15

If persistent – refer for bone marrow testing (R/O CML)

**REFER

Question 16

Someone presents with lymphocytosis what is the first step?

Answer 16

Review morphology •May be reactive vs. leukemic
•Reactive lymphocytosis commonly secondary to viral infections
If persistent REFER**

Question 17

Leukopenia

Answer 17

WBC count < 3.0 x 103/
mm3
– Can be secondary to viral infections, sepsis, bone marrow suppression
– If its not obvious, it’s DRUGS

Question 18

What does severe leukopenia increase the risk of?

Answer 18

for serious infection, usually with an absolute neutrophil count

Question 19

Lymphocytopenia

Answer 19

Abnormally low level of lymphocytes in the blood

Question 20

what are some causes of lymphocytopenia?

Answer 20

immunosuppressive medications (e.g., corticosteroids)
– Viral infections: severe (AIDS, Viremia)
– Connective tissue disease (e.g., SLE, RA)
– Congenital

Question 21

How to diagnose acute leukemia

Answer 21

Abnormalities in peripheral blood counts are the usual initial laboratory markers of acute leukemia
Dx typically established with bone marrow aspirate
increased LDH
hyperuricemia
anemic, thrombocytopenia

Question 22

CLL (leukemia)

Answer 22

• Most patients no sx and dx on routine lab draw
• H&H & Platelets often Normal with increased lymphs
anemia, thrombocytopenia

Question 23

CML

Answer 23

• One sees a variety of Immature Myeloid Cells in the Peripheral Smear, A Leukomoid Reaction
• One of the Myeloproliferative Disorders.
• Basophilia is common
• Middle age

Question 24

3 stages of CML

Answer 24

• Chronic Stage– Leukocytosis and Significant Left Shift may be the only Signs
• Accelerated stage– increased blasts with some Other Immature Cells
• Acute phase–blast crisis.

Question 25

Bone marrow aspiration

Answer 25

Definitive diagnosis of hematological malignancies
invasive and painful
**usually easier procedure done– this is last
can only help with primary bone marrow issue