Non-Malignant Granulocytic Disorder Flashcards
Quantitative Differences in CBC results
AGE RELATED CHANGES
Pediatric Population:
-Ratio of Neutrophils to Lymphocytes changes with age
-Newborns have a HIGHER WBC count, Neutrophil % and absolute count
-By ___ year of age, the lymphocytes % is almost DOUBLE the neutrophil % - this is called a ‘reverse ratio’ or ‘inverted diff’
one
Quantitative Differences in CBC results
AGE RELATED CHANGES
Geriatric Population
-Adult Ref Intervals based on younger population
-CBC results of healthy older people only SLIGHTLY different than younger adults
- > 65y have slightly _____ WBC, RBC, HGB & PLTS & slightly ______ MCV
-As body ages some cells lose ability to divide (e.g muscle, nerve)
-Bone Marrow & Hematopoiesis slightly affected:
—–Less hematopoietic cells produced:
*Normal adult BM cellularity = __%
* >65y adult BM cellularity = __%
—–Probably due to loss of bone and increased BM fat stores
LOWER
HIGHER
50%
30%
Quantitative Differences in CBC results
AGE RELATED CHANGES
Geriatric Population
Immune Response:
-Reduced signaling in some cells
*_______ and _______
-Loss of thymus – must rely on memory & tissue T-cells
*T-cells regulate B-cells = less antibody production
*More susceptible to infections
lymphocytes and neutrophils
Quantitative Differences in CBC results
AGE RELATED CHANGES
Geriatric Population
-More prone to various anemias:
*IDA & Megaloblastic
*Anemia of chronic disease (Rheumatoid arthritis)
-More prone to cancers
-Leukemias
-Most hematological disorders have increased incidence with age
Quantitative Neutrophil Changes
Absolute Neutrophilia
__________
-Shift in Neuts from Marginal into Circulatory pool
—–Stress, Trauma, Labor, strenuous exercise, shock, burns or increase in epinephrine
*Pathological COnditions
-Shift in Neuts from Marginal into Circulatory pool
-Increased BM production
-Release of Neutrophils from Storage Pool to PB
—infections
Benign
Quantitative Neutrophil Changes
Absolute Neutrophilia
TERMINOLOGIES:
- ______ _______- describes an increased number of immature cells as an indicator of infection
-Increase in bands, metamyelocytes (possibly myelocytes)
-Increased release from storage pool
-Usually seen with neutrophilia and toxic changes
Left Shift
Quantitative Neutrophil Changes
Absolute Neutrophilia
TERMINOLOGIES:
- ________ _____________: A reactive leukocytosis above 50 × 10^9/L with NEUTROPHILIA and a MARKED LEFT SHIFT
-Bands & often metas/myelos
-Could have rare Pro or Blast
-are mostly a result of:
*Severe &/or chronic infection (e.g. TB, pneumonia)
*Metabolic disease
*Inflammation
*Response to a malignancy
Leukemoid reaction
Quantitative Neutrophil Changes
Absolute Neutrophilia
TERMINOLOGIES:
- ______________ _________: Presence of IMMATURE NEUTROPHILS, NUCLEATED RED BLOOD CELLS, and TEARDROP RBCs in the same sample
-Often accompanied by neutrophilia, but not always
-point to the possibility of a space-occupying lesion in the bone marrow:
*Metastatic tumor
*Fibrosis
*Lymphoma
*Leukemia
*or simply a marked increase in one of the normal marrow cells (e.g., erythroid hyperplasia seen in hemolytic anemia)
*is strongly associated with primary myelofibrosis.
-Presence of immature erythrocytes & increased neutrophils
-Not always a neutrophilia – could be normal count with early cells
Leukoerythroblastic picture
Quantitative Neutrophil Changes
Absolute Neutropenia
Causes:
1. Increased rate of removal or destruction
2. Decreased production or ineffective hematopoiesis
3. Decreased ratio of circulating vs. marginal pool
4. Depletion of BM storage pool
5. BM suppression – decreased production\impaired release:
*Some Acute Leukemias
*Aplastic anemia
EOSINOPHILS AND BASOPHILS
Eosinophilia- Absolute count > ____ x 10^9/L
causes:
-Allergies (asthma)
-Parasitic infection
-Some auto immune disorders (HIV)
-Fungal infections
-Some malignancies (ALL)
0.4
EOSINOPHILS AND BASOPHILS
Basophilia - Absolute count > ___ x 10^9/L
-Non Malignant causes:
*Bee stings
*Food/drug hypersensitivity
*Chronic infections
*Hypothyroidism
*Chronic Inflammation
*Radiation therapy
-Malignant myeloproliferative neoplasms:
*Chronic Myelogenous Leukemia
0.15
Qualitative Granulocyte Disorders
Qualitative Abnormalities
Acquired Granulocyte Alterations & Anomalies:
NUCLEUS
-Hypersegmentation
-Hyposegmentation
-Pyknotic and Necrobiotic forms
CYTOPLASM
-Toxic granulation
-Degranulation
-Vacuolization
—–with or without engulfed matter
-Dohle bodies
Acquired Qualitative Nuclear Disorders
-nucleus have over 5 segments
-chronic infections
-megaloblastic anemia
-drugs
Hypersegmented
Acquired Qualitative Nuclear Disorders
-bilobed or no segmentation
-Myelodysplastic syndromes
-Asynchrony of nuclear maturation:
——very clumped chromatin
——no segmentation
Hyposegmented
Acquired Qualitative Nuclear Disorders
-‘dying’ cell
-nucleus verydark/dense
-Filaments still visible
Pyknotic
Acquired Qualitative Nuclear Disorders
-dead cell
-no filaments
Necrotic
_________ cells
-Usually only seen in BM
-Not abnormality – just a phase
-Comment if several seen
-Don’t count in diff – cannot identify stage
Mitotic cells
Acquired Qualitative Cytoplasmic Disorders
Neutrophilic Cytoplasmic Abnormalities
-Absence of granules
——Hypo- or Agranular
——‘Degranulation’
-Abnormal granules
Toxic Changes in Neutrophils
While these changes may be considered “abnormal,” they usually reflect a normal, reactive response
- __________ _______________:
-Stress response to infection / inflammation
-Clinically significant
—–Marker of inflammation
-Report with WBC morphology
—–OCC/SOME/MANY
Toxic Granulation
Toxic Changes in Neutrophils
2.___________ ___________:
-Neutrophils contain several vacuoles
—–often seen with toxic granulation
——some spontaneously occur
-can indicate phagocytosis
——may contain bacteria and other material
*Report with WBC morphology
—-OCC/SOME/MANY
Toxic Vauolization
Toxic Changes in Neutrophils
3.________ _________:
-Pale blue, oval inclusions at periphery
—–Grey – light blue on Wright stain
—–Only in Neutrophils
-Remnants of ribosomal RNA
-Associated with
—-Bacterial infection
—-sepsis
—–pregnancy
*Report with WBC morphology
—-OCC/SOME/MANY
Dohle Bodies
Ingested Materials – Neutrophils
identify:
Platelet satellitism
Ingested Materials – Neutrophils
identify:
Histoplasma capsulatum
Ingested Materials – Neutrophils
identify:
Bacilli
Ingested Materials – Neutrophils
identify:
Yeast
LE Cell Phenomenon
Lupus Erythematous (LE) Cell
-a mature neutrophil which has phagocytized a spherical, homogeneous-appearing inclusion
-Inclusion is nuclear material of degenerating leukocytes coated with antinuclear antibody
-associated with SLE & some other autoimmune conditions
*Not seen in PB unless sample is manipulated
-can be seen in body fluids (serous and synovial fluid)
-Neutrophil segments are stretched around the phagocytose nucleus
-The protein in the engulfed nucleus is depolymerized by the antibody and appears homogenous
-LE Cell test previously used to diagnose SLE
Cytoplasmic Abnormalities
______ _______
-Not a non-malignant change
-Only seen in Blasts and Promyelocytes in acute leukemia
——Only seen in Myeloblasts – not lymphoblasts
-Fused Primarygranules
——Azurophilic rods not to be confused with Dohle bodies
Auer rod
INHERITED QUALITATIVE ABNORMALITIES
______-_____ _________
-Hyposegmentation of neutrophil nucleus
-Autosomal Dominant
-Asymptomatic (fully functional)
*________ state:
-Bi-lobed nucleus
-Dense heterochromatin
-Incomplete nuclear segmentation
-aka“dumbbell” or “pince-nez
*_______ state:
-Nucleus is round or oval
-No segmentation
*Nuclear chromatin is exceptionally coarse and condensed – it is a mature cell
*Could be confused with Band or Myelocyte
*Pelger-Huet - 70 to 90% neutrophils affected
Pelger-Huet Anomaly
Heterozygous
Homozygous
INHERITED QUALITATIVE ABNORMALITIES
_____-______ _________
-Autosomal Recessive
-Abnormally large metachromatic granules in the cytoplasm of:
*Granulocytes
*Monocytes
*Lymphocytes
-Incomplete degradation of mucopolysaccharides
———-Mucopolysaccharide deposits (granules) in most cells
-Leukocyte function is unaffected
-Deep-purple to lilac granules appear in WBCs
-In some cases only one cell line is involved
-May resemble promyelocytes or heavy toxic granulation
—–Neutrophilia, Dohle bodies and left shift = toxic granulation
—–Alder-Reilly = granules can be found in lymphocytes and monocytes
*very rare
Alder-Reilly Anomaly
INHERITED QUALITATIVE ABNORMALITIES
________-________ ________
-Inclusions similar to Döhle bodies except:
*Seen in all granulocytes & monocytes
*Composed of precipitated myosin heavy chains
*Larger than ones in infection and permanent, not transient
*Not seen with other toxic changes
*Giant and bizarre platelets, may be hypogranular
*Patients are usually asymptomatic or have mild bleeding disorders
May-Hegglin Anomaly
INHERITED QUALITATIVE ABNORMALITIES
________-_________ __________
-Autosomal Recessive
-Rare, fatal
-Characterized by abnormal fusion of granules in most cells that contain granules throughout the body
-Fused granules are large and mostly dysfunctional
-Hematopoietic cells are affected
-Disease manifestations can be found in hair, skin, adrenal and pituitary glands, and nerves
-Dysfunctional phagocytosis & inefficient bacterial destruction
——-Increased susceptibility to infection (immunodeficient) albinism and peripheral neuropathy
-Platelet dense granules
——Tendency to bleed
-Melanocytes:
—-Variable albinism
-Neurologic complications develop through childhood
Chediak-Higashi Syndrome
