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diagnostics exam 1 > WBC > Flashcards

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….

A

UNCOMMON

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
Q

Lymphocytopenia (decreased lymphocytes)

A
  • Not typically significant
  • Can be seen in:
    o Steroid use
    o Late stage HIV
    o Radiation
    o Lupus
26
Q

Pediatric Variations of WBC

A
  • 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
Q

WBC Variations in Pregnancy

A
  • 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
Q

Platelets (not part of the WBC)

A
  • 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
Q

Thrombocytosis (increased platelets)

A
  • 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
Q

Thrombocytopenia (decreased platelets)

A
  • 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
Q
  • Bleeding risk
A

Correlates with platelet count
 Mild 100-150000/microL
 Moderate 50-99000/microL
 Severe < 50000/microL

32
Q
  • Peripheral smear
A

o Evaluates RBC, WBC, and platelets
o Shape, size, general appearance
o Blood mixed with dye and placed under a microscope

33
Q
  • Flow cytometry
A

o Measures physical and chemical characteristics of cells
o Looking for abnormal markers on the cell that could indicate, for example, cancerous cells

diagnostics exam 1 (3 decks)

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