Non-Malignant Granulocyte Disorders Flashcards
How are WBC values different in newborns?
Newborns will have a higher WBC count, Neutrophil %, and absolute count
What is referred to as ‘reverse ratio’ or ‘inverted diff’?
It is the fact that by one year of age, the lymphocyte % is almost double the neutrophil %
What the differences in the CBC of a person older than 65 compared to one younger than 65?
People older than 65 have a slightly lower WBC. RBC, HGB, and PLTS and have a slightly higher MCV
What are some benign reasons for an absolute neutrophilia?
Stress, trauma, labour, strenuous exercise, shock, burns, or an increase in epinephrine
What pathological condition causes absolute neutrophilia?
Infection
What is a left shift?
An increased number of immature cells - which indicates infection
What types of cells are usually increased in a left shift?
Bands, metamyelocytes (and possibly myelocytes)
What is a leukemoid reaction?
A reactive leukocytosis above 50 x 10^9/L with neutrophilia and a marked left shift
What kinds of cells are present in a leukemoid reaction?
Bands and often metas/myelos with a rare Pro or Blast
What causes leukemoid reactions?
Severe and/or chronic infection (e.g. TB, pneumonia)
Metabolic disease
Inflammation
Response to a malignancy
What is meant by a Leukoerythroblastic picture?
The presence of immature neutrophils, nucleated RBCs, and teardrop RBCs in the same sample
What kind of issue do Leukoerythroblastic reactions point to?
The possibility of space-occupying lesion in the bone marrow (e.g. metastatic tumor, fibrosis, lymphoma, leukemia)
What are 5 causes of absolute neutropenia?
- Increased rate of removal or destruction
- Decreased production or ineffective hematopoiesis
- Decreased ratio of circulating vs marginal pool
- Depletion of BM storage pool
- BM suppression - decreased production/impaired release
What are some causes of Eosinophilia?
Allergies (asthma)
Parasitic infection
Some auto-immune disorders (HIV)
Fungal infections
Some malignancies (ALL)
What are some non-malignant causes of basophilia?
Bee stings
Food/drug hypersensitivity
Chronic infections
Hypothyroidism
Chronic inflammation
Radiation therapy
What is a malignant cause of basophilia?
Chronic myelogenous leukemia
What kinds of acquired granulocyte nuclear anomalies are there?
Hyposegmentation
Hypersegmentation
Pyknotic & Necrobiotic forms
What kinds of acquired granulocyte cytoplasmic anomalies are there?
Toxic granulation
Degranulation
Vacuolization (with or without engulfed matter)
Dohle bodies
What can cause hypersegmented nuclei?
Chronic infections
Megaloblastic anemia
Drugs
What can cause hyposegmented nuclei?
Myelodysplastic syndromes
Asynchrony of nuclear maturation (very clumped chromatin with no segmentation)
Where are mitotic cells usually only seen?
In the bone marrow
Should you count mitotic cells in a diff?
No, just comment if several are seen
What kind of reactive morphologic changes in neutrophils are there?
Toxic granulation, Dohle bodies, and cytoplasmic vacuoles
What is toxic granulation a response to?
Infection/inflammation
Is toxic granulation clinically significant?
Yes, it’s a marker for inflammation
Do you report toxic granulation?
Yes with WBC morphology (occ/some/many)
What does toxic vacuolization in neutrophils indicate?
Phagocytosis, may contain bacteria and other material
Often seen with toxic granulation
Do you report toxic vacuolization?
Yes with WBC morphology (occ/some/many)
What do Dohle bodies look like?
Pale blue, oval inclusions at periphery only in neutrophils
What are Dohle bodies?
Remnants of ribosomal RNA
What conditions are Dohle bodies associated with?
Bacterial infection
Sepsis
Pregnancy
Do you report Dohle Bodies?
Yes with WBC morphology (occ/some/many)
What is an LE cell?
A mature neutrophil which has phagocytized a spherical, homogenous-appearing inclusion
What is the inclusion that is inside an LE cell?
Nuclear material of degenerating leukocytes coated with an antinuclear antibody
Are LE cells seen in a PBS normally?
No, unless the sample is manipulated. It’s only naturally seen in body fluids
Why does the inclusion in an LE cell appear homogenous?
Because the protein in the engulfed nucleus is depolymerized by the antibody
Is an Auer rod a malignant change?
No
In which condition are Auer rods typically seen?
Only in blasts (in myeloblasts only, not lymphoblasts) and promyelocytes in acute leukemia
What are Auer rods?
Fused primary granules
What do Auer rods look like?
Azurophilic rods
How do you report Auer rods?
With WBC morphology (occ/some/many)
What is the characteristic WBC morphology in Pelger-Huet Anomaly?
Hyposegmentation of neutrophil nucleus
What type of genetic disorder is Pelger-Huet Anomaly?
Autosomal Dominant
What symptoms are associated with Pelger-Huet Anomaly?
It’s asymptomatic
What is the difference between heterozygous and homozygous Pelger-Huet Anomaly?
The heterozygous state has a bi-lobed nucleus and the homozygous state has a round/oval nucleus with no segmentation
How many neutrophils are affected in Pelger-Huet anomaly?
70 to 90%
In which kinds of conditions are pseudo-Pelger-Huet forms seen?
Can be induced by certain drugs
HIV, TB, mycoplasma pneumonia, and severe bacterial infections
Secondary to MDS, acute leukemias, and chronic myeloproliferative disorders
What are the differences between true vs pseudo Pelger-Huet forms?
In true PH, all WBCs are affected whereas in pseudo PH, usually only neutrophils are affected and they are accompanied by other abnormal changes
When do you report Pelger-Huet forms in the comments?
If all the neutrophils are affected with classic bi-lobed or single-lobed forms
When you report hyposegmented neutrophils in the WBC morph section?
If the neutrophils have mature chromatin but no segmentation
What type of genetic disorder is Alder-Reilly Anomaly?
Autosomal recessive
What is the key characteristic of Alder-Reilly Anomaly?
Abnormally large metachromatic granules in the cytoplasm of: granulocytes, monocytes, and lymphocytes
What is the cause of the granules in Alder-Reilly Anomaly?
Mucopolysaccharide deposits
Is leukocyte function affected in Alder-Reilly Anomaly?
No
What type of genetic disorder is May-Hegglin Anomaly?
Autosomal dominant
What are the key characteristics of May-Hegglin Anomaly?
Leukopenia with large basophilic inclusions
Variable thrombocytopenia with giant forms
