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Hematalogy Lecture > Unit 1: Intro to Leukocytic Disorders > Flashcards

Unit 1: Intro to Leukocytic Disorders Flashcards

1
Q

↑ in 1 or more N. WBC types in p.b., OR the presence of
abnormal cell types in p.b.

A

Leukocytosis

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2
Q

Leukocytosis typically associated with total WBC count of > _____________ in adults.

A

5,000/uL (15.0 X 109/L)

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3
Q

Leukopenia is typically a decrease in _________ and./or __________. And is usually associated with a total WBC count of < ____________ in adults.

A

neutrophils, lymphs

2500/uL (2.5 X 109/L)

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4
Q

How do you calculate absolute count?

A

Absolute Count (for that subtype) = Differential count (in %) X Total WBC Count

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5
Q

How do you calculate absolute neutrophil count?

A

ANC = 70% segs x 10,000/uL = 7,000uL

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6
Q

Neutrophilia =

A

Increased ANC > 7,000/uL (7.0 X 103/uL) in adults (Children respond with even higher % jumps in
WBC count than adults. Elderly respond with lower %
jumps than other adults.)

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7
Q

Neutropenia =

A

↓ ANC < 2000/uL (2.0 x 103/uL) in
adults. May be acquired (for example, in
chemotherapy) , or (rarely) inherited.

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8
Q

Neutrophilia can be a qualitative or quantitative disorders. It results from what 3 major causes?

A
  • Infection (bacterial or fungal, NOT viral!)
  • Inflammation
  • Malignancy
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9
Q

When neutrophilia is not caused by malignancy, it is termed…

A

“reactive” –
can be acute, immediate, or chronic in nature

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10
Q

Due to redistribution from marginating pool to circulating
pool – waiting for egression into tissues

A

Immediate Neutrophilia

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11
Q

pseudoneutrophilia is what type of neutrophilia?

A

Immediate Neutrophilia

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12
Q
  • Increased neutrophils from BM due to infection
  • Increase in bands seen in p.b.
A

Acute Neutrophilia

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13
Q
  • Follows acute if stimulus continues
  • Increase in immature neutrophils in p.b. (left shift)
A

Chronic Neutrophilia

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14
Q
  • Pseudoneutrophilia
  • Aka. physiologic or relative neutrophilia; benign, transient ↑
    p.b. neutrophil count due to shift of marginating cells into
    the circulating pool. Caused by the release of what hormone?
    __________ in a stress response (Ex., in ketoacidosis, labor,
    tachycardia, azotemia, strenuous exercise.)
A

epinephrine

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15
Q

Temporary ↓ p.b. neutrophil count due to hypersensitivity
reaction, post-hypothermia, post-dialysis, with some
tranquilizers.

A

Pseudoneutropenia

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16
Q

Neutropenia:

  • Neutrophil count <1.5 x 109/L
  • Can occur due to:
A

-Decreased bone marrow production
* Stem cell disorders, megaloblastic conditions, chemical
responses, and congenital disorders
- Increased cell loss
* Immune response, and hypersplenism
- Pseudoneutropenia

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17
Q
  • Used due to the presence of nRBCs & a neutrophilic left shift
  • Total neutrophil count can be increased, decreased, or normal
A

Leukoerythroblastic

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18
Q

What morphology is associated with leukoerthoblastic?

A

Observed poikilocytosis, teardrop cells, and anisocytosis

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19
Q

Leukoerythroblastic is associated with…

A

myeloproliferative disorders, myelophthisis, hemolytic anemias

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20
Q

Mimics CML (chronic myeloid leukemia)
* Differentiation occurs by genetic analysis, and staining properties
* Transient disorder

A

Leukemoid reaction

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21
Q

Leukemoid reaction
* Response to severe infection, inflammation, or inflammatory response to malignancy
* WBC count greater than __________/L
*Many immature leukocytes in p.b. with toxic granulation, Döhle bodies, and
vacuoles

A

50 x 10^9 /L

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22
Q

What is the normal WBC % for bands, eosinophils, and basophils in adults?

A

0-5

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23
Q

What is the normal WBC % for segs in adults?

A

50-70

24
Q

What is the normal WBC % for lymphs in adults?

A

20-40

25
Q

What is the normal WBC% for monocytes and smudge cells in adults?

A

0-12

26
Q

Can automated analyzers detect neutrophil abnormalities?

A

No. identification occurs during the differential process

27
Q

3 most common cytoplasmic abnormalities?

A
  1. Toxic granulation
  2. Dohle Bodies
  3. Vacuoles

*All are reactive and transient due to the infectious process of the
patient

28
Q

large, blue-black, altered 1 o cytoplasmic
granules

A

Toxic Granulation

29
Q

What is a clue for artifactual toxic gran due to stain?

A

will be homogeneous throughout all cells!

30
Q

Normally, 1° granules loose their color as they mature, making
their presence unseen in mature cells.
* Toxic granulation becomes more visible as the cell response to
__________.
* Typically viewed as an artifact due to staining process

A

infection

31
Q

What is real toxic granulation associated with?

A

seen with Colony Stimulating Factor therapy.

32
Q

Real toxic granulation is usually seen in conjunction with…

A

neutrophilia, Dohle bodies, and a left shift

33
Q

small gray-blue cytoplasmic inclusions of neutrophils and eosinophils

A

Döhle bodies

34
Q
  • Made of RNA remnants from rough endoplasmic reticulum
  • Typically found near edge of cell
  • Usually seen with toxic granulation
  • Seen in chemotherapy, burns, poisoning, & N. pregnancy.
    Cause unknown!
A

Döhle bodies

35
Q

Döhle bodies:

CLUE: Tend to be ______ in old p.b. specimens, but appear blue in
fresh blood.

A

gray

36
Q

What can cause picnotic segs?

A

-old samples
-sepsis

37
Q

Cytoplasmic vacuolization in segs & bands - either due to:

A

*Autophagocytosis
* Prolonged drug exposure (sulfa, chloroquine, ROH) or radiation;
typically very small vacuoles,

  • Microbe ingestion/degradation
    * Typically large vacuoles (chemotherapy, poisoning, burns)
38
Q

What is the significance of cytoplasmic vacuolization in segs and bands with fresh blood?

A

septicemia

39
Q

CLUE: Pyknosis only significant if seen with other toxic changes;
otherwise probably just __________.

A

artifact (old blood)

40
Q

Aka. Necrobiosis - shrunken, dying nuclei. Very prominent in sepsis.

A

Pyknotic nuclei in segs

41
Q

-Peanut-shaped or bilobed shape
- Seen with Pelger-Huet anomaly, myeloproliferative or
myelodysplastic disorders

A

Hyposegmentation in segs

42
Q

= > 6 nuclear lobes; prominent in chronic infections & severe
Megaloblastic Anemia.
* Rare hypersegmented seg is normal in p.b.!

A

Hypersegmentation in segs

43
Q

What are the 3 types of eosinophilia?

A

-inherited (rare)
-reactive (most common)
-Malignant

44
Q

Type of eosinophilia due to allergic responses
(especially IV shunts & valves), drugs, skin diseases
(eczema, psoriasis), parasitic infestations (helminths:
flatworms & roundworms), & some autoimmune disorders.

A

reactive

45
Q

Type of eosinophilia, Acute Myelomonocytic Leukemia & in some
cases of Chronic Myelogenous Leukemia (CML)

A

Malignant

46
Q

Eospinopenia is hard to detect in peripheral blood because the relative
normal range is 0-5%. However, it can be detected using…

A

absolute eos. counts

47
Q

Eosinopenia is seen in response to…

A

emotional stress or recovery from infection.

48
Q
  • Frequently seen along with eosinophilia in CML.
  • Found in hypothyroidism & ulcerative colitis
A

Basophilia

“ ↑ Basos = CML? & ↓ thyroid function“

49
Q

Basopenia can be seen in response to…

A

emotional stress or hyperthyroidism.

“ ↓ Basos = ↑ thyroid function”

50
Q

How can Basopenia be detected?

A

using serial absolute baso counts

51
Q

Monocytosis occurs in many of the same conditions as ___________bc.
they share common stem cell.

A

neutrophilia

52
Q

Monocytes convert into tissue macrophages as needed.
Their degradative action requires enzymatic hydrolysis in ____
lysosomes (using lipases, proteases, non-specific esterases
or NSEs, lysozyme, etc.)

A

secondary

53
Q
  • Monocytosis seen whenever there’s ↑ cell damage
    (Examples: active TB, long-term syphilis, parasitic /
    rickettsial infections, some autoimmune diseases,
    trauma, _________________________, & in monocytic leukemias.)
A

subacute bacterial endocarditis

54
Q

Lymphocytosis = ↑ p.b. lymphocytes is seen in

A

Seen in VIRAL INFECTIONS – Mononucleosis, CMV, toxoplasmosis, etc

55
Q

Lymphocytopenia = ↓ p.b. lymphocytes is seen in…

A

Seen in some lymphomas,secondary to some malignancies, & in active TB & AIDS

56
Q

Reactive lymphocytes are also called?

A

“atypical lymphs” or “variant lymphs”

-* Great variance in presentation!!
* Can be large, granular, small, clefted, or have vacuoles

57
Q

What is the significance of reactive lymphs?

A

Evidence that the body is working – generally not
associated with a poor diagnosis, unless there are a
great number in the p.b
-Counted during a differential as a lymph and noted
as a ‘reactive’, ‘atypical’, or ‘variant’

Hematalogy Lecture (35 decks)

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