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WBC Disorders Flashcards

1
Q

The rate of WBC is regulated. What do you need to control this?

A

intact bone marrow, and growth factors.
myeloid stem cell–> granulocytic and monocytic cells.
lymphoid stem cell –> lymphocytic cells

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2
Q

Normally, only mature cells are released. In disease, you see…

A

release of immature cells.

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3
Q

What is the most common cause of leukopenia?

A

neutropenia.

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4
Q

what is the most common cause of leukocytosis?

A

neutrophilia.

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5
Q

cell proliferation may be _____ or _____.

A

myeloid or lymphoid.

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6
Q

What are the parameters for WBCs?

A

4-11.

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7
Q

Platelet counts will ______ with WBC disorder.

A

vary. could be normal, increased or decreased with WBCs

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8
Q

what abnormal cell morphologies would you see for a bacterial, viral, or malignant disease?

A

bacterial: increased toxic neutrophils “toxic granulation, dole bodies, vacuoles”
viral: increased reactive lymphs
malignancy: increased blast cells.

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9
Q

What are the indications for a bone marrow exam?

A
  1. investigation of a peripheral blood abnormality if cause cannot be determined by other means.
    - suspected blast cells, pancotyopenia, significant neutropenia, or thrombocytopenia.
  2. needed to make a primary diagnosis
  3. staging and management of patients with:
    - hodgkins, NH-lymphoma
    - some carcinoma types
  4. ongoing monitoring
  5. Eval of fever of unknown origin, splenomegaly, or patients with infectious disease where bone marrow involvement is suspected.
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10
Q

What is the normal response to inflammation?

A

WBCs migrate to site of tissue damage and mediators of inflammation are activated. Elevated APRs cause increased CRP (acute) and ESR (chronic) tests.

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11
Q

What is the most common cause of neutropenia?

A

bacterial infections, associated with toxic changes in the neutrophils and left shift.

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12
Q

What two types of absolute neutrophilia exist?

A
  1. pseudo neutrophilia.

2. pathologic neutrophilia.

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13
Q

What is pseudo neutrophilia?

A

physical or emotional stimuli cause redistribution of blood pools–> marination pool goes into the circulating pools. You will see a short term increase in WBC count due to increased neutrophils, but NO LEFT SHIFT. NO INFECTION. ex. heat, joy, pain, fear, surgery, heavy exercise

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14
Q

What is pathologic neturophilia?

A

neutrophils leave blood in response to tissue damage. causes bone marrow release of mature and immature neutrophils into blood. see increased WBC count due to increased neutrophiils and A LEFT SHIFT. INFECTION!

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15
Q

What are the causes of pathologic neutrophilia?

A
  1. bacterial
  2. also fungal, parasitic, early viral
  3. tissue destruction (MI), metabolic disorders (diabetes), drugs (myeloid growth factors)
  4. chronic inflammatory disorders (RA, SLE)
  5. following hemorrhage or hemolysis.
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16
Q

What are the features of pathologic neutrophilia?

A

increased WBC, neutrophils with left shift, presence of toxic neutrophils (granules, dohle bodies, and vacuoles), increased ESR and CRP.

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17
Q

What are the causes of absolute neutropenia?

A

defects in bone marrow production due to injury, replacement/infiltration or drug/chemical suppression, overwhelming infection, viral infection, immune destruction, hypersplenism.

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18
Q

What does the degree of neutropenia parallel?

A

the degree of infection risk. high risk is less than 500, and should be strictly monitored.

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19
Q

What are the causes of absolute eosinophilia?

A
  1. control of parasites
  2. allergic states
  3. skin and pulmonary disorders, drugs
20
Q

what are the causes of absolute basophilia?

A

chronic allergies, or immediate hypersensitivy reactions. malginant hematologic disorders.

21
Q

What is the cause of absolute monocytosis?

A
  1. response to chronic infections (TB)
  2. chronic inflammatory disease (RA, SLE)
  3. recovery from acute bacterial infection or drug induced marrow suppression.
22
Q

What is the cause of absolute lymphocytosis?

A
  1. response of viral infections
  2. non viral infections
  3. must rule out malignancy if an adult
23
Q

What is infectious mononucleosis?

A

It is an acute self-limited disorder, usually caused by EBV. Mainly affects adolescents and young adults. Normal CBC values or WBC count up to 20. K/uL. The triad of mono is fatigue, sore throat, lymphadenoapthy.

24
Q

How do you diagnose mono?

A

correlate clinical symptoms and hematologic findings with test for heterophile antibodies of IM. However, 50% of children less than 4 and 10% of adults do not form these antibodies.

25
What are malignant WBC disorders? Name top two
uncontrolled cell proliferations that are not a response to tissue damage. Stimulus is unknown, cells do not respond to normal mechanisms. 1. leukemia 2. lymphoma
26
Describe leukemia:
proliferations of malignant cells in bone marrow. often involves blood. it may infiltrate liver, spleen, lymph nodes, CNS or skin. Initially a SYSTEMIC disease. ABNORMAL CBC
27
Describe lymphoma:
Proliferation of malignant lymphoid cells in solid tissues...lymph nodes, spleen, GI tract. Initially a LOCALIZED disease that may spread to the bone marrow and blood. NORMAL CBC.
28
What are several of the theories for WBC malignant disorders?
1. viral theory 2. radiation/chemical change 3. genetic factors and mutated oncogenes 4. environmental hotspots 5. immune dysfunction **refer to notes for more info.
29
What does diagnosis of malignant WBC disorders require?
bone marrow exam or tissue biopsy.
30
What is the goal of diagnosis for malignant WBCs?
identify myeloid or lymphoid cell origin
31
What are additional diagnostic methods for malig WBCs?
morphological features, cytochemical stains, flow cytometry, cytogenetic and molecular testing to detect specific mutations.
32
What is the treatment goal of malignant WBC?
eradication of malignant clone to achieve remission.
33
What are treatment options for malig WBCs?
cytotoxic chemotherapy, radiotherapy, bone marrow/stem cell transplant (lymphoma), immunotherapy or targeted therapies, supportive care during aplasia.
34
Describe leukemias:
uncontrolled proliferation of malignant cells in the bone marrow that progressively crowd out normal precurose cells...initially a systemic disease. CBC is abnormal at presentation. there are four major forms: AML, CML, ALL, CLL.
35
Describe the acute leukemias:
predominant cell type is immature blast cells. bone marrow exam shows at least 20% blasts and decreased normal precursors. The clinical symptoms include: 1. anemia 2. thrombocytopenia 3. neutropenia Causes of death are bleeding and infection
36
AML:
infants and adults WBC count noral to 100 k/uL due to myeloblasts Prognosis depends on type (anemia, thrombocytopenia, neutropenia)
37
ALL:
peak age 2-10 years old WBC count normal to 100 K/uL due to lymphoblasts prognosis dpends on age and cell type.
38
Describe chronic leukemias:
predominant cell type is maturing/mature cells that easily escape bone marrow. Clinical symptoms include: 1. few symptoms initially 2. lymphadenoapthy or hepatosplenomegaly 3. mild anemia 4. normal PLT count 5. HIGH WBC count
39
CML:
25-60 years old WBC 50-300 K/uL due to granulocyte proliferation 95% or > have an oncogene mutation (philadelphia chromosome: BCR/ABL fusion gene) Tx: Gleevec
40
CLL:
over 50 years old, males more common WBC count is 20-200 k/uL due to smal mature lymphocytes 5-10 years survival. no cure :(
41
Describe lymphomas:
``` proliferation of malignant lymphoid cells in solid tissues such as lymph nodes, spleen, GI tract...initially a localized disease. CBC is often NORMAL at presentation. 2 main types: 1. hodgkins (15-30 and >50) 2. non hodgkins (50-60 years old) ```
42
Hodgkins:
- associated with EBV - commonly present with enlarged lymph nodes - staged biposies to determine diagnostic cell type and stage disease. - ESR abnormally increased in active disease
43
Non-Hodgkins:
>50 types -present with enlarged lymph nodes, GI tumors -Heterogenous group with good to poor prognosis certain types commonly spread to marrow and blood -biposises performed to determine b or T cell lineage.
44
What is multiple myeloma?
proliferation of a malignant clone of plasma cells in the bone marrow. - isolated bone turbos, painful and fractures - tumors become diffuse and replace normal bone marrow precursor cells.
45
What is special about the plasma cells in MM?
they produce one type of immunoglobulin type 1. monoclonal spike on electrophoresis is IgG or IgA 2. red cell rouleaux on blood smear due to excess Ig 3. markedly increased ESR, spontaneous falling.
46
What does advanced disease of MM present like?
1. problems with infection and bleeding 2. renal damage and high calcium levels 3. survival varies, has improved with thalidomide.

Med Lab 3 (7 decks)

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