Non-neoplastic WBC abnormalities-Usera Flashcards
What are the four major lab measurements of WBCs?
Automated hematology analyzers
Bone marrow aspirate and biopsy
Flow cytometry
Peripheral blood smears
What does automated hematology do?
gives cell count
Are aspirate and biopsy the same thing?
no biopsy is taken from the core of bone marrow and aspirate is the jelly fluid stuff but you take both and look at both separetly
What does flow cytometry do?
helps to identify lineage by looking at cell markers
When do you do peripheral blood smears?
ONLY WHEN THERE IS NOT OTHER EXPLAINABLE CAUSE
What are the three factors that affect neutrophil concentration in blood?
Bone marrow production and release
Rate of egress to tissue or survival time in blood
Ratio of marginated to circulating neutrophils in peripheral blood (MGP/CGP)
Where do you find neutrophils when you have an infection? What do you call this and why is this significant?
line up around the periphery (next to endothelium)-> called margination, When you take needle aspirate you will get low number of neutrophils cuz none of them will be in the middle
Absolute neutrophil count greater than (blank) X 10^9/L in adults is considered neutrophilia
7
What is neutrophilia a response to?
physiologic or pathologic processes
why can you get immediate neutrophilia and how long does it take?
redistribution from marginated to circulating pool-> 20-30 minutes
What are some things that can cause immediate neutrophilia?
stress, steroids, epinephrine, IL-6
Why can you get an acute neutrophilia and how long does it take?
release from maroow storage pool to blood (IL-6) 4-5 hours
Why can you get a chronic neutrophilia and how long does it take?
increase in marrow mitotic poo
days
(blank) will immediately increase your neutrophil count
epinephrine
If you have a cell population with more bands than mature neutrophils, what do you call this? WHat does this mean?
a left shift
means you have an acute inflammatory response
Explain the matureation of neutrophil
Myoblast-> promylocyte-> myelocyte-> metamylocyte-> band-> mature neutrophil
What phase of maturation of a neutrophil is this:
have a giant N to C ratio (i.e the nucleus is huge compared to the cytoplasm) should only be found in bone marrow.
Myoblast cells
What phase of maturation of a neutrophil is this:
A cell you with a slightly smaller N but still high N to C ratio than myoblast cells and then there are some granules present.
Promyelocyte
What phase of maturation of a neutrophil is this is this:
semicircle nucleus and lots of condensed granules
myelocyte
What phase of maturation of a neutrophil is this:
looks like a pacman
metamyelocyte
What phase of maturation of a neutrophil is this:
looks like a C shaped nucleus
Band cell
What phase of maturation of a neutrophil is this:
multi lobed nucleus
neutrophils
Lifespan of neutrophils is only a couple of (blank) so they are just for acute responses
hours
What are these causes of: Acute inflammation Acute infection Tissue necrosis Drugs, toxins, metabolic Physiologic Neoplastic
Causes of neutrophilia
What do these cause:
collagen vascular, vaculitis
Acute inflammation -> which causes neutrophilia
What do these cause:
Corticosteroids, smoking, growth factors, uremia, ketoacidosis, lithium
Neutrophilia
Can carcinomas, sarcomas and MPDs cause neutrophilia?
yes!
What physiological things can cause neutrophlia?
pregnancy, exercise, stress
What can cause acute infections and thus neutrophilia?
bacteria, fungi, parasites, viruses, spirochetes
What are features associated with REACTIVE neutrophilia?
Usually <30 x 109/L
Shift to the left in myeloid maturation
Frequently associated with morphologic alterations in neutrophils and precursors
Toxic granulation
Döhle bodies
Vacuolization
Is there a heritable cause for neutrophilia?
no
WHo has higher amounts of neutrophils, adults or children?
Children
What morphologic alterations in neutrophils and precursors are seen in reactive neutrophilia?
toxic granulation, Dohle bodies, vacuolization
What is a leukemoid raction?
a reaction that resembles leukemia but isnt
What is this: a benign leukocyte proiferation with WBC usually greater than 50 X 10^9/L with many circulating immature leukocyte precursors.
Leukemoid reaction
Since blasts are occasionally present in leukemoid reactions, how can you exclude CML?
with cytogenetics and LAP score
What is this:
characterized by presence of nucleated RBC and a shift to the left in granulocyte maturation
Leukoerythroblastic reaction
What are leukoerythroblastic reactions aften associated with?
myelopthisic processes, severe hemorrhage, hemolytic anemia, or myelodysplastic syndromes
Why will you get a leukemoid reaction?
perforated appendicitis (neutrophils), whooping cough (lymphs), cutaneous larva migrans (eos).
Why can you get a leukoerythroblastic reaction?
marrow infiltration (fibrosis, mets)
What drug can make it look like a leukemoid or leukoerythroblastic reaction? WHy?
neupogen
it is used after bone marrow transplants to increase hemmopoietic activity
What is the definition of neutropenia?
less than 2.0 X 10^9 /L in whites and less than 1.3 X 10 ^ 9/L in blacks
What is the definition of agranulocytosis?
less than 0.5 X 10 ^9 /L
What are mechanisms for neutropenia?
decreased or ineffective marrow production
increased cell loss or tissue egress
pseudoneutropenia (endotoxin)
What are the 6 major causes of neutropenia?
Drugs Intrinsic Defects Overwhelming Infection Hematologic disorders Autoimmune Cachexia and Debiiatate States
WHat are the drugs that can cause neutropenia?
EtOH, benzene, chloramphenicol, chemotherapy, antibiotics, benzodiazepines
AND
CLOZAPINE!!!!!!!! (Anitpsychotic)
What hematologic disorders can cause neutropenia?
megaloblastic anemia
myelodysplasia
marrow failure
hyperslepnism (splenomegaly)
What autoimmune diseases cause neutropenia?
Lupus, Rh Arthritis
What intrinisic defects (rare) cause neutropenia?
Fanconi’s, Kostmann’s, Cyclic neutropenia, chediak-higashi
What overwhelming infections can cause neutropenia?
miliary TB, sepsis, brucellosis
Many conditions causing agranulocytosis affect both (blank) and (blank) lines
erythroid and myeloid lines
How do you remember what Brucella does?
Besty the Bovine had Brucella in her Bone marrow-> brucella causes bone marrow problems and you get it from cattle
What infections are associated with neutropenia?
Viral, Bacterial, Rickettsial, Protozoal
What do these cause:
Influenza, Measles, Chicken pox, Colorado tick fever, Dengue, Infectious mononucleosis, Poliomyelitis, Psittacosis, Sand-fly fever, Smallpox, Rubella, Infectious hepatitis
neutropenia via infection
What do these cause:
Typhoid, Bacillary dysentery, Paratyphoid, Brucellosis, Ehrlichiosis
Neutropenia via infection
What are these:
Rickettsial pox, Typhus, Rocky Mountain Spotted Fever
What do they cause?
Rickettsial infections
infections that cause neutropenia
What are these:
Malaria, Kala-azar, Relapsing fever
What do they cause?
protozoal infections
Infections associated with neutropenia
What causes quantitative neutrophil disorders?
Myeloid hypoplasia and maturation defects
What are the three major disorders that cause myeloid hypoplasia?
Fanconi’s anemia
Kostmann’s syndrome
Cyclic neutropenia
What are the maturation defects that cause quantitative neutrophil disorders?
chediak-higashi
What is this:
Panmyeloid hypoplasia
Heterogenous disease caused by chromosomal instability
Presents in childhood with aplastic anemia and congenital physical malformations
Susceptible to hematopoietic and solid organ malignancies
Fanconi’s anemia
What is a tell tale sign of fanconi’s anemia?
no thumbs, hand deformity
What is this: ANC <200/ul Variable modes of inheritance Early myeloid precursors in marrow, but do not mature Ela2 and hax-1 implicated
Kostmann’ syndrome
What exactly is Kostmann’s syndrome?
an infantile genetic congenital agranulocytosis
What are the 2 genes super implicated in Kostmann’s syndrome?
ELA2 and HAX-1
What is this: Presents in infancy or childhood Rare autosomal dominant trait with variable expression 21-30 day periodicity ANC
Cyclic neutropenia
What is the periodicity of cyclic neutropenia?
21-30 days
What gene is associated with cyclic neutropenia?
ELA2 gene mutation (neutrophil elastase)
How do you diagnose cyclic neutropenia?
routine CBC
then Bone marrow aspirate and biopsy
If you have an infection what will the neutrophil count be like?
low because they are making love to the endothelium
What are the most common ways to get congenital neutropenia?
Pregnancy induced hypertension (i.e eclampsia)
Babies born to pregnant moms who have overwhelming infections (babies get chorionamniotitis)
What are the five ways to get spurious neutropenia?
EDTA-dependent agglutinin
Old specimen
WBC fragility
Paraprotein
How can paraproteins cause spurious neutropenia?
a lot of antibodies circulating can effect N counts
What is spurious neutropenia?
fake/false neutropenia
What do toxic granullations look like?
large, blue-black granules
Primary (azurophilic) granules retain basophilia (easily stain with basic dye), perhaps due to lack of maturation.
What are toxic granulations associated with?
Dohle bodies and vacuolization
When do you see toxic granulations?
septicemia, sepsis