WBC Flashcards

1
Q

indications for a CBC

A

o Hemorrhage (look at hct & hgb)
o Infection (look at WBC)
o Chronic fatigue/Sudden pain
o Unknown bruising/Blood in urine

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2
Q

what’s included in CBC

A

o total WBC
o red blood cells
o Hemoglobin & hematocrit
o WBC with differentials (neutrophils, lymphocytes, monocytes, eosinophils, basophils)

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3
Q

function of WBC (aka leukocytes)

A

fight infection, react against foreign invaders (inflammation

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4
Q

differentiation of WBCs

A

o Total WBC count
o Differential- % of each type of leukocyte= 100%
* Neutrophils (70%)
* Lymphocytes (20-40%)
* Monocytes (3-8%)
* Eosinophils (1-6%)
* Basophils (0.01-0.3%)

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5
Q

innate immunity

A

body’s first defense
* Rapid, non-specific
* Pathogen associated molecular patterns (PAMPs) bind to Pattern Recognition Receptors (PRRs)  immune response
* Response involves
* Granulocytes—–>Neutrophils, basophils, eosinophils
* Monocytes –> macrophages –> phagocytosis
* Activation of the complement system

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6
Q

adaptive immunity

A

based on antigen exposure
* Slower, specific, learned
* Response involves
* Lymphocytes
o T-cells (mature in the thymus)
o B-cells (mature in the bone marrow)

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7
Q

viral infection=

A

elevated lymphocytes

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8
Q

bacterial infection=

A

elevated WBCs

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9
Q

neutrophilia (increased neutrophil count): common causes

A

o Infection (typically bacterial)
o Inflammation
o Stress (physical and emotional)
o Vigorous exercise
o Cigarette Smoking
o Drugs
o Pregnancy
o Obesity
o Asplenia
o Myeloproliferative neoplasms (ie CML)

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10
Q

neutropenia (decreased neutrophil count): common causes

A

o Decreased production from the bone marrow
* Bone marrow injury/suppression

Overwhelming infection
* Bone marrow capacity exceeded by use

o Viral infection (including hepatitis, HIV, sepsis) – related to marrow injury from pathogen
o Drugs
o Radiation therapy
o B12/Folate deficiency
o Autoimmune/Idiopathic
o Lab artifact – EDTA

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11
Q

“Left Shift”

A
  • More bands and less segmented cells body is sending out these immature neutrophils bc there’s often an infection
  • Associate a left shift with bacterial infection
  • Left shift is associated with Neutrophilia (increased neutrophils)
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12
Q

ANC- infection risk: formula

A

ANC= WBC * (% neutrophils + % bands)

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13
Q

degree of neutropenia correlates with risk of infection

A

o Mild 1.0-2.0 x 10^9/L
o Moderate 0.5 – 1.0 x 10^9/L
o Severe <0.5 x 10^9/L

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14
Q

red flags

A

o <1.0 well or febrile: Urgent referral
o 1.0-2.0 febrile – Urgent eval; well – close follow-up, if persists- to heme
* Very low ANC would suggest immunocompromise

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15
Q

eosinophils

A
  • Physiologic function unknown
  • Reside primarily in tissue
  • Phagocytes of antigen-antibody complexes
  • Seen in allergic response
  • Elevated with parasitic infection
  • Unlikely to be seen in bacterial and viral infections
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16
Q

eospinophilia (increased eosinophils)–> worms, wheezes, weird diseases

A
  • Often found incidentally
  • Allergic disorders
    o Asthma, hay fever, food or drug sensitivity
  • Parasitic infection
    o Trichinosis, hookworm, roundworm, amebiasis
  • Skin
    o Eczema, psoriasis, dermatitis
  • Autoimmune
    o Scleroderma
  • Neoplastic diseases
    o Hodgkin’s disease, Chronic Myelocytic Leukemia (CML), tumors
  • Others…
    o Eosinophilic esophagitis, eosinophilic gastritis, ulcerative colitis, pernicious anemia, excessive exercise
17
Q

having LOW eosinophils is….

18
Q

basophils

A
  • As with neutrophils and eosinophils, basophils perform phagocytosis
  • Seen in allergic reactions
  • Can be simulated in parasitic infections
  • Unlikely to be seen in bacterial in viral infections
  • Contain histamine, heparin, and serotonin
    o Hives
  • Basophilia often indicates a myeloproliferative disorder
    o Chronic myelocytic leukemia (CML)
    o Polycythemia Vera
    o Myelofibrosis
    o Multiple myeloma
19
Q

agranulocytes

A
  • Monocytes
  • Lymphocytes
20
Q

Granulocytes

A
  • Neutrophils
  • Basophils
  • Eosinophils
21
Q

Monocytes

A
  • Phagocytes
    o Differentiate into macrophages when they migrate into tissue
  • Fight bacterial infection (similar to neutrophils)
    o Remove injured and dead cells, microorganisms and particles – clear debris
  • Stay in circulation longer than neutrophils
22
Q
  • Monocytosis: indicative of:
A

o chronic infection (TB, syphilis, malaria),
o chronic inflammatory disorders (RA, Lupus),
o malignancy (if in conjunction with other leukocyte abnormalities)

23
Q

Lymphocytes

A
  • Primary function is to fight acute viral and chronic bacterial infection
  • 2 main types
    o T cells
  • Helper T Cells – stimulate the production of other immune cells
  • Killer T Cells - destroy infected cells
    o B cells: produce antibodies to attack invading bacteria, viruses and toxins
24
Q

Lymphocytosis (increased lymphocytes): causes

A

o Acute infection
* EBV, hepatitis, CMV, HIV, Pertussis, Measles, Mumps, Rubella
o Stress
o Smoking
o Asplenia
o Thymoma
o Autoimmune disorders
* Thyroiditis, RA
o Malignancy (CLL, Non-Hodgkin’s Lymphoma)

25
Lymphocytopenia (decreased lymphocytes)
* Not typically significant * Can be seen in: o Steroid use o Late stage HIV o Radiation o Lupus
26
Pediatric Variations of WBC
* It is different with neonatal (-4 weeks), infants (4 week+), children (1-8-12 yrs /puberty) * The WBC is increased and then decreases after the first few weeks and gradually declines to adult levels
27
WBC Variations in Pregnancy
* The WBC count can increase in the 3rd trimester with a slightly increased percentage of neutrophils * Will see leukocytosis (increased leukocytes) * Neutrophil count: increases throughout the pregnancy * Lymphocyte count: stable * Monocyte count: stable * Eosinophil: may slightly increase * Basophils: may slightly decrease
28
Platelets (not part of the WBC)
* Function: regulate hemostasis and thrombosis formation = stop bleeding * Activated by vascular injury, adhere to the extracellular matrix of the vasculature forming a platelet plug * Platelets are circulating, live for 7-9 days
29
Thrombocytosis (increased platelets)
* Reactive/secondary causes o Infection o Surgery o Acute blood loss o Splenectomy o Iron deficiency anemia o Living at high altitude o Strenuous exercise o Medication * Estrogen, OCPs * Bone marrow problem (ie essential thrombocythemia) * Pregnancy * Thrombocytosis is interchangeable with thrombocythemia. * Diseases a/w spontaneous thrombocytosis are: o Iron deficiency anemia o Malignancy (leukemia, lymphoma, solid tumors) o Polycythemia vera o Post splenectomy syndrome o Acute or chronic infections and inflammatory processes * The main risk in this is a clot, leading to tissue or organ infarction
30
Thrombocytopenia (decreased platelets)
* Decreased platelet production * Increased platelet destruction * Increased platelet sequestration in the spleen * Hemorrhage * Medications o Chemotherapy, H2RAs, isoniazid, indomethacin, sulfas, thiazide diuretics * Bleeding risk o Assess for any evidence of bleeding o Correlates with platelet count * Mild 100-150000/microL * Moderate 50-99000/microL * Severe < 50000/microL o Surgical bleeding a concern if <50,000 o Spontaneous bleeding a concern if < 20,000 – urgent referral * Confirm with a Peripheral Blood Smear due to risk of artifact * Rule out pseudo thrombocytopenia * Once confirmed it is true thrombocytopenia, confirm etiology
31
* Bleeding risk
Correlates with platelet count  Mild 100-150000/microL  Moderate 50-99000/microL  Severe < 50000/microL
32
* Peripheral smear
o Evaluates RBC, WBC, and platelets o Shape, size, general appearance o Blood mixed with dye and placed under a microscope
33
* Flow cytometry
o Measures physical and chemical characteristics of cells o Looking for abnormal markers on the cell that could indicate, for example, cancerous cells