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Clinical Microscopy > WBC abnormalities > Flashcards

WBC abnormalities Flashcards

1
Q
  • WBC > 10, 000
  • In response to acute infection, trauma or inflammation
  • WBCs release the colony-stimulating factor (CSF) to increase WBC production in the bone marrow
  • Increase in one of the five types of WBC (neutrophilic, lymphcytic…)
A

Leukocytosis

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2
Q
  • WBC <4,000

* Increased risk for infection

A

Leukopenia

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3
Q

Leukopenia is due to

A
  • Viral infections
  • Overwhelming bacterial infections (WBC consumption> production)
  • Bone marrow disorders
  • Certain drugs
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4
Q

specific reax of WBC

A

Leukoerythroblastic rxn

Leukamoid rxns

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5
Q

specific reaction of WBC with presence of nucleated RBC and immature neutrophils

A

Leukoerythroblastic reaction

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6
Q

What does the leukoerythroblastic reaction indicate?

A

severe disruption of marrow (common in myelofibrosis) and possible extramedullary hematopoiesis (secondary to metastatic cancer)

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7
Q

leukoerythroblastic reaction is secondary to what

A

tumor, fibrosis, lymphoma or leukemia

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8
Q

leukamoid reactions where WBC > 50 x 10^9/L indicate presence of immature forms such as

A
  • Blast form
  • Myelocytes
  • Promyelocytes
  • Metamyelocytes
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9
Q

It is the reactive leukocytosis seen in leukemia

A

Leukamoid reaction

benign or malignant condition

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10
Q

neutrophilia or the abnormally high neutrophil count (> 7.0 - 8.0 x 109 /L or 7000- 8000/uL) is associated with

A 
• Acute inflammation
• Acute stress
• Myelocytic leukemia
• Eclampsia
• Gout
• Autoimmune disease
(Rheumatoid arthritis and Thyroiditis)
• Trauma
(Infection, inflammation, malignancy)
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11
Q

neutropenia or an abnormally low neutrophil count (ANC: <1500/uL) is associated with

A 
• Aplastic anemia
(low cell lines)
• Widespread severe bacterial infection
• Chemotherapy
• Radiation therapy/ exposure
• Viral infection
• Increased risk of life-threatening bacterial infection
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12
Q

What happens if ANC 500 - 1000?

A

increased risk of

infection from exposure

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13
Q

What happens if ANC < 500?

A

increased risk of infection from host organisms/

normal flora

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14
Q

Causes of neutrophilia

A
  • due to acute shift from marginating to circulating pool

- due to chronic stimulation (excess cytokine stimulates proliferative pool)

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15
Q

causes of neutrophilia due to chronic stimulation

A
  • Infection
  • Chemotherapy recovery
  • Down’s Syndrome
  • Myeloprliferative disorders
  • Pregnancy or eclampsia
  • Marrow metastases
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16
Q

T or F: neutropenia is the most common cause of leukopenia

A

true

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17
Q

extreme neutropenia (<0.5 x10^9/L)

A

agranulocytosis

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18
Q

Causes of neutropenia

A

(Inherited vs. acquired)

  1. Decreased neutrophil production
  2. Increased neutrophil destruction
  3. Sequestration
  4. Pseudoneutropenia
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19
Q

[Causes of neutropenia] Examples of inherited causes of decreased neutrophil production

A 
• Defective stem cell
development
- Reticular dysgenesis
- Cyclic neutropenia
- Infantile agranulocytosis
- Fanconi’s syndrome
• Genetic disorders of IS
• Disorders of cellular
development
- Chediak-Higashi
syndrome
- Lazy Leukocyte
syndrome
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20
Q

[Causes of neutropenia] Examples of acquired causes of decreased neutrophil production

A 
• Chemical Toxicity
- Ionizing Radiation
- Benzene
• Marrow replacement
• Nutritional deficiency
-Vitamin B12, B9 (Folate)
• Cytotoxic Drugs
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21
Q

[Causes of neutropenia]

What are the immune reactions involved in increased neutrophil destruction?

A

• Isoimmune: transplacental transfer of maternal IgG
• Autoimmune
• Drug-induced
- Immunologic neutropenia: drug and neutrophil surface protein form an antigenic complex; neutrophils are destroyed by complement or the clumps of neutrophils are removed from the circulation or sequestered in the lungs, spleen, etc.

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22
Q

[Causes of neutropenia]

Sequestration indicates a shift to what pool

A

marginal pool (Neutrophils are removed from circulation and are redistributed within the body)

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23
Q

[Causes of neutropenia] It is the transient reduction in count involving neutrophil agglutination due to edta and antipsychotic medications

A

pseudoneutrophenia

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24
Q

What are qualitative abnormalities in WBC?

A

Morphological alterations or toxic changes in response to stress, infection, or inflammation
• Pelger-Huët Anomaly
• Pseudo-Pelger-Huët Anomaly

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25
Q

Qualitative abnormalities seen in neutrophilia (shift to the left)

A
  • Presence of increased numbers of immature/ younger/precursor/less differentiated granulocyte neutrophils in the peripheral blood
  • Reflects early or premature release of myeloid cells from the bone marrow, the site where neutrophils are generated
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26
Q

conditions where qualitative abnormalities seen in neutrophilia (shift to the left)

A

• Found in:

  • Normal in pregnancy or neonate
  • Infections
  • Bone marrow fibrosis
  • Bone marrow infiltration by malignancies
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27
Q

Qualitative abnormalities in WBC also indicate

A
  • Evidence of maturation abnormalities
  • Alterations in functional activity
  • Degenerative changes
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28
Q

What is the best

indicator of severity of infection?

A

Ratio of non-segmented and segmented neutrophils

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29
Q

Pelger-Huët Anomaly shows neutrophils with

A

uniformly sized round or bilobed nuclei (due to failure to segment)

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30
Q

an autosomal dominant inherited disorder with no clinical effect

A

Pelger-Huët Anomaly

*may be misinterpreted as shift to left

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31
Q

Pseudo-Pelger-Huët Anomaly morphology

A

Bilobed neutrophils with more condensed chromatin

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32
Q

Pseudo-Pelger-Huët Anomaly are found in

A
  • Myelodysplastic syndromes
  • Idiopathic myelofibrosis
  • Chronic leukemia
  • Drug Therapy
  • Infections (Malaria)
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33
Q

Cytoplasmic abnormalities of neutrophils

A
  • Toxic granules
  • Dohle bodies
  • May-Heggelin anomaly
  • Vacuolation
  • Degranulation
  • Pseudopods
  • Auer rods
  • Swelling
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34
Q

morphology of toxic granules

A
  • Altered primary granules through simulation of antigens
  • Large, dark blue-back granules
  • Clustering within the cell
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35
Q

[Cytoplasmic abnormalities] Transient cytoplasmic inclusions consisting of rRNA in parallel rows which are pale blue, round or elongated bodies, 1 – 5 μm located near cell membranes

A

Dohle bodies

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36
Q

[Cytoplasmic abnormalities] Dohle bodies are found in

A

segmented and band neutrophils associated with a wider range of conditions

37
Q

[Cytoplasmic abnormalities] An inherited autosomal dominant condition wherein large pale basophilic Dohle-like inclusion bodies primarily
in neutrophils

A

May-Heggelin anomaly

  • asymptomatic
  • decreased platelet counts = bleeding
38
Q

[Cytoplasmic abnormalities] autophagocytosis in cytoplasmic vacuolation is brought upon by

A
  • Sulfonamides and chloroquine (for malaria)
  • Prolonged storage of cells
  • Small and evenly distributed vacuoles
  • Degranulation on exposure to toxins and high dose radiation
39
Q

[Cytoplasmic abnormalities] Phagocytosis of ECM seen in cytoplasmic vaculation is seen in

A

sepsis; associated with toxic granules (large and unevenly distributed vacuoles)

40
Q

[Cytoplasmic abnormalities] These are granule-free protrusions of cytoplasm indicating sluggish neutrophil locomotion

A

Pseudopods

*artifactual due to prolonged storage in EDTA; rare

41
Q

[Cytoplasmic abnormalities] These are small azurophil rods in the cytoplasm of myeloblasts and promyelocytes sometimes found in mature neutrophils

A

auer rods

*AML and myelodisplastic syndrome

42
Q

Nuclear abnormalities of wbc

A 
• Pyknotic and/or necrotic
nuclei
• Hypersegmentation
• Nuclear projections
• Ring forms
43
Q

[Nuclear abnormalities of wbc] seen in long term infections; normal-large size with increased % of neutrophils with 5-6 lobes of >3% neutrophils

A

Hypersegmented nuclei

44
Q

Hypersegmented nuclei are found in

A
  • Megaloblastic anemia
  • Chronic infection
  • Iron deficiency
  • Liver disease
  • Uremia
  • Hereditary
45
Q

[Nuclear abnormalities of wbc] shrunken and dense nuclei found in sepsis, AML or poor staining/prep

A

Pyknotic nuclei

46
Q

[Nuclear abnormalities of wbc] hairlike projection with detached nuclear material in cytoplasm which are seen in band forms found in inner side of the band form, facing the centriole

A

Toxic nuclear projections

*irregular staining inside the nucleus)

47
Q

Toxic nuclear projections are seen in

A
  • Metastatic carcinoma
  • Irradiation
  • Dysgranulopoiesis
  • Patients on anti-cancer chemotherapy
  • HIV
48
Q

[Nuclear abnormalities of wbc] nucleus ring or doughnut shaped found in toxic and malignant myeloproliferative states, early infxnss, AML, MA

A

Ringed nuclei

49
Q

A morphological abnormality which is a rare fetal hereditary disorder found in children making them susceptible to infxns wherein neutrophils, monocytes, and lymphocytes are affected with large irregular granules

A

Chediak-Higashi Syndrome

*primarily due to neutrophil’s impaired function

50
Q

Patients display these in Chediak-Higashi Syndrome

A
  • Oculocutaneous albinism
  • Photophobia
  • Sun sensitivity
  • Neuropathy (deranged senses)
  • Pancytopenia (all blood cell lines are decreased)
  • Infections (especially Staphylococcus aureus)
51
Q

eosinophilia, an inherited autosomal dominant, malignant or reactive disorder is indicated by

A

> 0.7 x 10^9/L and eosinophil metamyelocyte in peripheral blood

(left shift)

52
Q

Where is eosinophilia found?

A

• Reactive eosinophilia
- Parasitic or hypersensitivity disorders
- Suppress all helminths (Association of eosinophil count and parasitic death)
• Myeloproliferative disorders
• Acute Myeloid Leukemia

53
Q

[Quantitative Abnormalities of eosinophil] persistent and extreme eosinophilia which is parasitic, allergic, malignant, idiopathic

A

Hypereosinophilic syndrome (>1.5 x 109/L)

54
Q

Eosinopenia is indicated by _____ and is associated with production abnormalities

A

0.05x10^9/L

55
Q

Where is eosinopenia usually seen?

A

• Acute bacterial infections
(Due to sequestration, margination and chemotaxis)
• ACTH administration
(Glucocorticoids, prostaglandins and epinephrine)

56
Q

Qualitative eosinophil abnormalities

A

Degranulation (most prominent)
Vacuolation
Hypersegmentation

57
Q

basophilia (>0.3 x10^9/L) is seen in

A

Conditions caused by eosinophilia since both of them are
controlled by T-lymphocytes and are of the same stem cell
line
Myeloproliferative disorders

58
Q

Type I hypersensitivity reactions, long-term foreign antigen stimulation, hypothyroidism, ulcerative colitis, estrogen therapy

A

Reactive basophilia

59
Q

Transient basophilia is usually seen in

A

newborns

60
Q

Degranulation in basophil quali abno are due to

A

ingestion of fatty meal

antigen-related stimulation

61
Q

Monocytosis or >0.9 x10^9/L monocytes accompanies what other quantitative abno?

A

neutrophilia due to common stem cell line

*may be reactive or malignant

62
Q

Monocytosis is usually seen in

A

• Chronic bacterial infections
(Bacterial endocarditis, malaria, tuberculosis, typhoid)
• Chronic inflammation
(Collagen vascular diseases, Systematic Lupus Erythematosus, Rheumatoid Arthritis, ulcerative colitis, Sarcoidosis)
• Malignant – AML, CA, MDS, Hodgkin’s disease
• post splenectomy in chronic neutropenia

63
Q

Monocytopenia or <0.03x10^9/L is seen in

A

Administration of glucocorticoids and overwhelming infections

64
Q

T or F: qualitative abno in monocytes are responses to stimuli

A

true

(immature monocytes; transformation into histiocytes, macrophages [^cyto volume, ^dense granules, ^cyto vacuolation, IC debris, highly irreg cytoplasmic borders, reticular chromatin and visible nucleoli], alteration into long thin band-like shape)

65
Q

These abnormalities are nonmalignant, reactive Disorders with self-limited lymphoproliferative responses

A

Lymphocyte abnormalities

66
Q

Lymphocytosis in adults and children

A
  • Adults: > 4.0 x109/L lymphocytes

* Children: > 9.0 x109/L lymphocytes

67
Q

T or F: It is important to determine the relative increase in the number of circulating lymphocytes

A

false, absolute

68
Q

Lymphocytosis can be seen in

A

Usually in viral infections, may also be seen in pertussis

69
Q

Lymphopenia occurs in

A

• Immunodeficiency syndromes
(Congenital (e.g. DiGeorge syndrome) and Acquired conditions (e.g. AIDS))
• Corticosteroid therapy
• Neoplasia
(Hodgkin’s disease, Non-Hodgkin’s lymphoma and advanced carcinomas)
• Radiation therapy
• Chemotherapy

70
Q

Lymphocyte abno where atypical, variant or Downey cell is seen with foamy, dense, vacuolated, basophilia (radial or peripheral) or irregular border (scalloped)

A

Reactive lymphocytes

*larger than normal

71
Q

variant of reactive lymphocyte which is also called

*with basophilic, vacuolated, foamy appearance of cytoplasm

A

Plasmacytoid Lymphocyte, Basophilic Lymphocyte, and the Turk’s irritation cell

*in transition to plasma cells; functionally immunocompetent

72
Q

origin of type I reactive lymphocyte

A

B-cell

73
Q

variant of reactive lymphocyte with infectious mononucleosis cells which is seen in EBV or CMV and others reactive conditions

A

type II

*Fried egg or flared skirt appearance
® Cytoplasm: abundant and indented, deep blue with peripheral accentuation, skirting ofcytoplasm around rbcs

74
Q

Transformed or Reticular Lymphocytes

coarse reticular nuclear pattern

A

Type III

75
Q

disorders in absolute lymphocytosis with variant lymphocytes

A
  • Infectious mononucleosis
  • Acute Viral Hepatitis
  • Cytomegalovirus infections
76
Q

disorders in Relative lymphocytosis

with variant lymphocytes

A
  • Toxoplasmosis

* Viral-related disorders: MMR, Chickenpox, Viral Pneumonia

77
Q

[Benign Disorders of Variant Lymphocytes] Immune disorders

A
  • Drug Reactions
  • Serum sickness
  • Idiopathic thrombocytopenia
  • Autoimmune Hemolytic anemia
78
Q

[Benign Disorders of Variant Lymphocytes] Non-viral infections

A
  • TB • Typhus
  • Syphilis • Diphtheria
  • Malaria • Brucellosis
  • Rickettsia
79
Q

[Benign Disorders of Variant Lymphocytes]Absolute lymphocytosis
with normal lymphocytes

A
  • Acute infectious lymphocytosis

* Pertussis

80
Q

[Benign Disorders of Variant Lymphocytes]
Relative lymphocytosis
with normal lymphocytes

A

• Neutropenia

81
Q

T or F: Neoplastic disorders of WBCs are derived from a single precursor cell with all the affected cells showing features of deviation from the precursor cell

A

true

82
Q

Three types of neoplastic disorders of wbcs

A
  • Myeloproliferative disorders
  • Lymphoproliferative disorders
  • Immunoproliferative disorders
83
Q

Malignancies of leukocytes

A

myeloma

leukemia

84
Q

malignant proliferation of plasma cells

A

myeloma

85
Q

Malignant proliferation of the WBC with the presence of the immature forms in the peripheral circulation

A

Leukemia

86
Q

Two classifications of leukemia

A

• Based on Duration: Acute or Chronic (Adults)
• Based on the Type of Blood Cell Affected:
- Lymphocytic leukemia: lymphoid cells
- Myeloid or myelogenous leukemia: pluripotent myeloid stem cells

87
Q

Acute leukemia

A 
• With symptoms of depressed
bone marrow function:
® Anemia ® Bleeding
® Fatigue ® Infection
• Bone pain
• Lymphadenopathy
• Splenomegaly
• Hepatomegaly
88
Q

lymphocytic leukemia involves

A

immature lymphocytes and their progenitors that originate in the bone marrow, but infiltrate the spleen, lymph nodes, CNS, and other tissues

89
Q

MALIGNANT DISORDERS OF VARIANT LYMPHOCYTES

A

• Acute lymphoblastic (ALL) leukemia (young children)
• Chronic lymphocytic leukemia (CLL) (adults)
• Lymphomas
® Non-Hodgkin’s lymphoma
® Hodgkin’s disease

Clinical Microscopy (10 decks)

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