Lymphocytosis Flashcards
reactive lymphocytosis
a polyclonal proliferation of T-Cells, almost always due to infection. excess of 4.0<10^9 for absolute lymphocyte count
lymphocyte populations in the blood
T cells: 60-80%, 70% of them being helper T cells and 30% of the T cell population being CD8+ cells B cells: 10-20% NK cells: 5-10%
neoplastic. lymphocytosis
monoclonal proliferation of B cells 1. chronic lymphocytic leukemia 2. acute lymphoblastic leukemia
reactive lymphocytosis history and physical examination
Reactive Lymphocytosis History: Consistent with viral infection fever, chills, night sweats cough (non-productive), sore throat headache, muscle aches general malaise-loss of appetite photophobia rash Physical Examination: the patient may have: pharyngitis meningismus rash jaundice Lymphadenopathy (tender) hepatomegaly/splenomegaly shortness of breath
Ddx for findings of reactive lymphocytosis
Differential diagnosis: INFECTIONS: Epstein-Barr virus (mononucleosis) cytomegalovirus (CMV) rubella mumps pertussis infectious hepatitis HIV seroconversion
Symptoms of EBV (cause of reactive lymphocytosis)
Fever Tender lymph nodes Fatigue – often extended duration May have palpable splenomegaly May have hepatitis Typical age – teens/20s Not necessarily aware of “sick contacts”
investigation/protocols when someone presents with suspected reactive lymphocytosis
Investigations: A neoplastic cause must be excluded. Differentiating factors include: History - eg time frame - symptoms not improving (fever, fatigue; pallor) Physical exam: large organomegaly (if splenomeagly, maybe EBV)? or lymphadenopathy, petechiae Lab - blood smear - atypical lymphocytes vs. blast cells flow cytometry: polyclonal increase in T-cells NB: complete blood count and differential -bone marrow examination not usually needed
appearance of atypical lymphocytes
larger than normal lymphocytes, nucleus is more irregular
natural history/prognosis/ complications of reactive lymphocytosis
no complications due to lymphocytosis. prognosis generally excellent with supportive care. repeat blood work when they are feeling better in a few weeks
3 specific infectious illnesses to be wary of when someone presents with reactive lymphocytosis
- pertussis– gram negative bacteria 2. rubella– measels 3. cytomegalovirus (CMV)
Summary to reactive lymphocytosis
Summary: 1. Reactive lymphocytosis is usually due to infection 2. History/physical exam most important to distinguish
from neoplastic cause 3. Laboratory investigations show a polyclonal
lymphocytosis 4. Prognosis generally very good with supportive
measures 5. Most simple solution is to repeat blood work when they
are feeling better in a few weeks
outline the appraoch to the classification of hematological malignancies (name the myeloid and lymphoid diseases)
outline approach to diagnosis/classification of lymphomas (hodgkin vs non-hodgkin)
most common adult leukemia
CLL. incidence increaes with age
what is CLL
A neoplastic disease characterized by the
clonal proliferation and accumulation of small,
mature –appearing immunologically
incompetentB lymphocytes in the blood,
marrow, lymph nodes and spleen
what type of appearance of the lymphocytes in classic CLL?
soccer ball lymphocytes. condensed areas of nuclear material
what finding on the PBS would you see with CLL
smudge cells and soccer ball lymphocytes
how does ethnicity play a rolein CLL
seen more in caucasians. also seen more in males.
name the B cell malignancies based on state of b cell maturation
the more mature of the B cell, the less proliferative. the least mature cancer cells are the most aggressive.
which test is required for the diagnosis of CLL?
cytogenetic analysis of peripheral blood or bone marrow.
-immunophenotyping and flow cytometru
outline the APPROACH to the diagnosis of CLL
Diagnosis
– History
– Physical exam
– Bloodwork
• CBC, flow cytometry, immunoglobulins, chemistry – Lymph node biopsy
- If lymphoma is high on differential diagnosis – Bone marrow aspiration and biopsy
- Not usually required
typical phenotypes of B cells in CLL
CD5+, CD19+, CD23+, DimCD20, Dim Surface Lg
Minimum needed to confirm diagnosis is
≥ 5 x 109/L B lymphocytes in peripheral blood for ≥ 3
months1 (if less, called “monoclonal B cell lymphocytosis”)
general and clinical features of CLL
- 25% are asymptomatic when caught. some may have some weight loss.
- minimal lymphaenopathy or unexplained lymphocytosis.
- possible systemic symptoms of weight loss, recurrent infections (particularly encapsulated organisms Streptococcus pnemoniae, Klebsiella pneumonia, group B streptococci, Escherichia coli, Neisseria meningitides and Haemophilus influenzae), bleeding or fatigue/shortness of breath
- clinical features:
- lymphadenopathy (non tender, asymptomatic)
- organomegaly (splenomegaly due to leukemic cell infiltrate, can cause cytopenia)
- cytopenias including anemia and thrombocytopenia due to splenic sequestration, autoimmune, or marrow infiltration.
