WBC disorders

Question 1

Normal adult WBC

Answer 1

4,400 to 11,000 cells/ uL, ~60% neutrophils

Question 2

Leukocyte alkaline phosphatase (LAP)

Answer 2

LAP is low/lacking in malignant WBCs. LAP is high in normal WBC; high LAP score = good; low = bad

Question 3

Leukemoid reactions

Answer 3

increase WBC count in response to stress or infection as opposed to a primary malignancy like leukemia

Question 4

Neutrophil distribution and mobilization

Answer 4

In circulation (3-6 hrs), margination along vascular walls, demargination can increase counts by 3x in 4 hours

Question 5

SIRS

Answer 5

sensitive, nonspecific marker for disease state; high or low temperature and WBC, fast heart and respiratory rate

Question 6

Infection diagnosis

Answer 6

WBC counts (> 25,000/ uL), increased PPV, left shift (bands)

Question 7

Primary neutrophilia

Answer 7

Down Syndrome; normal neutrophil function but counts high, splenomegaly, skull abnormalities, elevated LAP score

Question 8

Pelger- Heut anomaly

Answer 8

benign, autosomal dominant, 1:6000; neutrophils are hyposegmented (bilobed) but are functionally normal

Question 9

Leukocyte adhesion deficiency

Answer 9

Neutrophils lack CD18 which is needed to adhere to the vasculature. All the neutrophils are thus in the vasculature (5-20x normal); neutrophils can not extravasate into infected tissues -> frequent infections, delayed umbilical cord separation

Question 10

Febrile neutropenia

Answer 10

fever in neutropenia patient = Pseudomonas risk

Question 11

Mononucleosis (EBV)

Answer 11

2-3 weeks into symptoms, atypical lymphocytosis (> 10%) in teenagers and older; clinically indistinguishable from acute HIV infection; heterophile antibody test - agglutination of the horse RBCs by (any) antibodies against EBV in patient’s serum

Question 12

Eosinophilia

Answer 12

> 1500 increase risk of tissue damage; risk factors: allergy, atopy (hyperallergic), asthma, rhinitis, eczema, asthma; Churg-Strauss syndrome