Unit 1: Intro to Leukocytic Disorders Flashcards
↑ in 1 or more N. WBC types in p.b., OR the presence of
abnormal cell types in p.b.
Leukocytosis
Leukocytosis typically associated with total WBC count of > _____________ in adults.
5,000/uL (15.0 X 109/L)
Leukopenia is typically a decrease in _________ and./or __________. And is usually associated with a total WBC count of < ____________ in adults.
neutrophils, lymphs
2500/uL (2.5 X 109/L)
How do you calculate absolute count?
Absolute Count (for that subtype) = Differential count (in %) X Total WBC Count
How do you calculate absolute neutrophil count?
ANC = 70% segs x 10,000/uL = 7,000uL
Neutrophilia =
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.)
Neutropenia =
↓ ANC < 2000/uL (2.0 x 103/uL) in
adults. May be acquired (for example, in
chemotherapy) , or (rarely) inherited.
Neutrophilia can be a qualitative or quantitative disorders. It results from what 3 major causes?
- Infection (bacterial or fungal, NOT viral!)
- Inflammation
- Malignancy
When neutrophilia is not caused by malignancy, it is termed…
“reactive” –
can be acute, immediate, or chronic in nature
Due to redistribution from marginating pool to circulating
pool – waiting for egression into tissues
Immediate Neutrophilia
pseudoneutrophilia is what type of neutrophilia?
Immediate Neutrophilia
- Increased neutrophils from BM due to infection
- Increase in bands seen in p.b.
Acute Neutrophilia
- Follows acute if stimulus continues
- Increase in immature neutrophils in p.b. (left shift)
Chronic Neutrophilia
- 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.)
epinephrine
Temporary ↓ p.b. neutrophil count due to hypersensitivity
reaction, post-hypothermia, post-dialysis, with some
tranquilizers.
Pseudoneutropenia
Neutropenia:
- Neutrophil count <1.5 x 109/L
- Can occur due to:
-Decreased bone marrow production
* Stem cell disorders, megaloblastic conditions, chemical
responses, and congenital disorders
- Increased cell loss
* Immune response, and hypersplenism
- Pseudoneutropenia
- Used due to the presence of nRBCs & a neutrophilic left shift
- Total neutrophil count can be increased, decreased, or normal
Leukoerythroblastic
What morphology is associated with leukoerthoblastic?
Observed poikilocytosis, teardrop cells, and anisocytosis
Leukoerythroblastic is associated with…
myeloproliferative disorders, myelophthisis, hemolytic anemias
Mimics CML (chronic myeloid leukemia)
* Differentiation occurs by genetic analysis, and staining properties
* Transient disorder
Leukemoid reaction
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
50 x 10^9 /L
What is the normal WBC % for bands, eosinophils, and basophils in adults?
0-5
What is the normal WBC % for segs in adults?
50-70
What is the normal WBC % for lymphs in adults?
20-40
What is the normal WBC% for monocytes and smudge cells in adults?
0-12
Can automated analyzers detect neutrophil abnormalities?
No. identification occurs during the differential process
3 most common cytoplasmic abnormalities?
- Toxic granulation
- Dohle Bodies
- Vacuoles
*All are reactive and transient due to the infectious process of the
patient
large, blue-black, altered 1 o cytoplasmic
granules
Toxic Granulation
What is a clue for artifactual toxic gran due to stain?
will be homogeneous throughout all cells!
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
infection
What is real toxic granulation associated with?
seen with Colony Stimulating Factor therapy.
Real toxic granulation is usually seen in conjunction with…
neutrophilia, Dohle bodies, and a left shift
small gray-blue cytoplasmic inclusions of neutrophils and eosinophils
Döhle bodies
- 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!
Döhle bodies
Döhle bodies:
CLUE: Tend to be ______ in old p.b. specimens, but appear blue in
fresh blood.
gray
What can cause picnotic segs?
-old samples
-sepsis
Cytoplasmic vacuolization in segs & bands - either due to:
*Autophagocytosis
* Prolonged drug exposure (sulfa, chloroquine, ROH) or radiation;
typically very small vacuoles,
- Microbe ingestion/degradation
* Typically large vacuoles (chemotherapy, poisoning, burns)
What is the significance of cytoplasmic vacuolization in segs and bands with fresh blood?
septicemia
CLUE: Pyknosis only significant if seen with other toxic changes;
otherwise probably just __________.
artifact (old blood)
Aka. Necrobiosis - shrunken, dying nuclei. Very prominent in sepsis.
Pyknotic nuclei in segs
-Peanut-shaped or bilobed shape
- Seen with Pelger-Huet anomaly, myeloproliferative or
myelodysplastic disorders
Hyposegmentation in segs
= > 6 nuclear lobes; prominent in chronic infections & severe
Megaloblastic Anemia.
* Rare hypersegmented seg is normal in p.b.!
Hypersegmentation in segs
What are the 3 types of eosinophilia?
-inherited (rare)
-reactive (most common)
-Malignant
Type of eosinophilia due to allergic responses
(especially IV shunts & valves), drugs, skin diseases
(eczema, psoriasis), parasitic infestations (helminths:
flatworms & roundworms), & some autoimmune disorders.
reactive
Type of eosinophilia, Acute Myelomonocytic Leukemia & in some
cases of Chronic Myelogenous Leukemia (CML)
Malignant
Eospinopenia is hard to detect in peripheral blood because the relative
normal range is 0-5%. However, it can be detected using…
absolute eos. counts
Eosinopenia is seen in response to…
emotional stress or recovery from infection.
- Frequently seen along with eosinophilia in CML.
- Found in hypothyroidism & ulcerative colitis
Basophilia
“ ↑ Basos = CML? & ↓ thyroid function“
Basopenia can be seen in response to…
emotional stress or hyperthyroidism.
“ ↓ Basos = ↑ thyroid function”
How can Basopenia be detected?
using serial absolute baso counts
Monocytosis occurs in many of the same conditions as ___________bc.
they share common stem cell.
neutrophilia
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.)
secondary
- Monocytosis seen whenever there’s ↑ cell damage
(Examples: active TB, long-term syphilis, parasitic /
rickettsial infections, some autoimmune diseases,
trauma, _________________________, & in monocytic leukemias.)
subacute bacterial endocarditis
Lymphocytosis = ↑ p.b. lymphocytes is seen in
Seen in VIRAL INFECTIONS – Mononucleosis, CMV, toxoplasmosis, etc
Lymphocytopenia = ↓ p.b. lymphocytes is seen in…
Seen in some lymphomas,secondary to some malignancies, & in active TB & AIDS
Reactive lymphocytes are also called?
“atypical lymphs” or “variant lymphs”
-* Great variance in presentation!!
* Can be large, granular, small, clefted, or have vacuoles
What is the significance of reactive lymphs?
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’
