Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Path Exam 5 > WBC Disorders > Flashcards

WBC Disorders Flashcards

1
Q

General classes of WBC disorders

A

Leukopenias

Proliferative: 1) Reactive, 2) Neoplastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common cause of leukopenia (which cell type is low)

A

Low WBCs is usually caused by neutropenia

Lymphopenia is less common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the common causes of lymphopenia?

A

Lymphopenia is commonly caused by HIV, glucocorticoid treatment, autoimmune disorders, malnutrition, certain acute viral infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why do viral infections sometimes cause lymphopenia?

A

Viral infections cause release of interferon type I => lymphocyte redistribution and sequestration.
T-Lymphocytes become activated and their surface receptors change so that they stay in lymph nodes and adhere to endothelial cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neutropenia => inc risk of what?

What are some of the assoc. signs?

A

Bacterial and fungal infections
Candida and Aspergillus fungus
Often see ulcerating and necrotizing lesions in the mouth, but can also be present on the skin, vagina, anus, and GI
Deep infections can occur in the lungs, GU, and kidneys
Can also see bacterial colonies growing as if on agar plates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is pancytopenia?

A

decreased RBC’s, WBC’s and platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Morphology of the bone marrow for neutropenia

A

Hypercellular: in cases where granulocytes are destroyed in periphery, or with ineffective granulopoiesis (megaloblastic anemia, myelodysplastic syndromes)

Hypocellular: in cases that dec or destroy granulocyte precursors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical features of neutropenia

A

malaise, fever, chills, fatigue, weakness

infections can cause death in hours to days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

4 mechanisms causing leukocytosis

A

Increased production in marrow: infection/inflammation, Paraneoplastic, Myeloproliferative disorders
Increased release from marrow: endotoxemia, infection, hypoxia
Decreased leukocyte margination: exercise, catecholamines
Decreased extravasation: glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does infection => increased leukocytes in the blood?

A

Acute infection causes release of mature granulocytes from the marrow from TNF and IL-1.
With time, TNF and IL-1 cause macrophages, bone marrow stromal cells, and T-cells to release growth factors that will increase production of leukocytes for a prolonged period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sepsis or severe inflammatory disorders => what morphologic changes in neutrophils?

A

Toxic granules: coarse, dark cytoplasmic granules

Dohle Bodies: Sky-blue cytoplasmic “puddles” that are dilated endoplasmic reticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Type of leukocytosis commonly assoc with myeloproliferative disease

A

Basophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Type of leukocytosis commonly seen with allergic disorders like asthma, hay fever, parasitic infections, as well as drug reactions and some malignancies?

A

Eosiniphilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would you see monocytosis?

A

Chronic infections like TB, bacterial endocarditis, rickettsiosis, malaria, autoimmune disorders like SLE, and IBD like ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When would you see Neutrophilia?

A

Acute bacterial infections (escpecially pyogenic), sterile inflammation caused by infarction or burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When would you see lymphocytosis?

A

With monocytosis in chronic immune stimulation, viral infections, Berdetella pertussis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name stages of Neutrophil progression/development

A

blast => promyelocytes => myolocytes => metamyelocytes => bands => segs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Reference ranges for WBC, Neutrophils, Lymphocytes

A

WBC: 5,000-10,000
Neutrophils: 1,500-6,500
Lymphocytes: 1,200-3,400

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Normal Myeloid to Erythroid cell ratio in the marrow

A

2:1 to 5:1

More myelo/granulocytic cells than erythroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of neutropenia and also pancytopenia

A

Myelophthisis Anemia: infiltrative process of the marrow like cancer, infection, leukemic or lymphoma infiltrate

Aplastic Anemia: Precursor cells fail, hypocellular marrow

Large Granular Lymphocytic Leukemia: CD8+ T cell Leukemia, pancytopenia from marrow suppression by neoplastic cell products

Ineffective Production:
-Defective DNA => intramedullary death, marrow is hypercellular, hypersegmented neutrophils, macrocytes and other WBC/RBC abnormal morphology; caused by Vit B12 and folate deficiency and Myelodysplastic syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Neutropenia due to accelerated removal/destruction

A

Immunological-mediated injury: SLE, reaction to drugs

Increased peripheral use: overwhelming bacterial, fungal, rickettsia infections

Splenic sequestration: 2ndary to enlarged spleen, Felty Syndrome= RA, splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Drug-induced neutropenia

A

Most common cause of neutropenia
Cancer chemotherapy
Immunologic reactions to drugs like sulfonamides, thiouracil
Alcohol toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Differential diagnosis of Pancytopenia

A 
Myelophthisis anemias including Leukemia
Aplastic anemia
Myelodysplatic syndromes
Megaloblastic anemias
Autoimmune like SLE
Splenic sequestration
Chemotherapy
Total body rediation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Other causes of Neutrophil Dysfunction

A 
Diabetes, Malignancy, Dialysis, Sepsis
Myelodysplatic syndromes
Chronic granulomatous disease
Leukocyte adhesion deficiencies
MPO deficiency
Chediak-Higashi syndrome
25
Q

What does a ‘left shift’ suggest?

A

Suggests a bacterial infection

26
Q

What is a leukemoid reaction?

A

Leukemia-like reaction where the granulocyte counts are above and beyond the normal upper limits. Usually caused by severe infection or tumors

27
Q

What is a leukoerythroblastic reaction?

A

Left shift in the presence of nucleated RBC’s

Implies a bone marrow space-occupying lesion

28
Q

What signaling molecule will cause an increase in Eosinophils?

A

IL-5

29
Q

Types of eosinophilic pneumonias

A

Coccidioidomycosis
Loeffler’s pneumonia
Chronic eosinophilic pneumonias

30
Q

What is classic sign of eosinophilia?

A

Charcot-leyden chrystals left behind and in macrophages

31
Q

Relationship between Neutrophils and Monocytes in terms of infection

A

Neutrophils show up first, but subside with time as monocyte numbers rise unless it is a pyogenic infection.

32
Q

Causes of monocytosis

A 
Chronic infection: TB
Bacterial endocarditis
Rickettsiosis
Malaria
IBD: ulcerative cholitis
Autoimmune: RA, SLE
33
Q

Causes of reactive lymphocytosis

A 
Bordetella pertussis (whooping cough)
Chronic infection (TB)
Viral infection
34
Q

Common viral causes of lymphocytosis and differences between them

A

Infectious mononucleosis (IM) caused by EBV: likely diagnosis if >20%reactive lymphs
CMV: IM-like but w/o cervical lymph node involvement
Toxoplasmosis: IM-like
Viral hepatitis

35
Q

What do reactive or atypical lymphs look like?

A

These are CD8+ lymphs
Larger cells with large and abnormally shaped nuclei
If seen, first think leukemia, but if large cytoplasm present then think virus caused

36
Q

What to think when see nucleated RBC’s in the peripheral blood

A

Rapidly evolving anemia=> increased release of RBC’s from the marrow
Post splenectomy
Bone marrow replacement–think myelophthisic process (space-occupying lesion in the bone)

37
Q

Categories of Neoplastic Proliferations of White cells

A

1) Lymphoid
2) Myeloid
3) Histiocytosis, Langerhans cell type

38
Q

Risk factors for leukemia

A

Inherited: defects in DNA repair–Bloom Syndrome, Ataxia Telangiectasia, Fanconi Anemia; Down Syndrome; Neurofibromatosis type I

Viruses, Radiation and Chemicals, Chemotherapy, Smoking, Benzene

39
Q

Categories of Leukemia

A

Can be acute or chronic
Can be lymphocytic or myelocytic

ALL, AML, CLL, CML

All acute cause death within months if not treated
Chronic cause death within years, CML=>death earlier than CLL

40
Q

Leukemia vs lymphoma

A

Leukemia is a lymphocytic neoplasm in the marrow

Lymphoma is a lymphocytic neoplasm in the lymph nodes or other place outside the marrow

41
Q

WHO classification of lymphoid malignancies

A

Precursor B and T cells (lymphoblasts): in marrow or thymus

Peripheral lymphoid malignancies: in lymph nodes, spleen, blood

42
Q

Pathogenesis of ALL

A

Accumulation of mutations (fewer than with solid tumors)

T-cell: NOTCH-1 gain of function in 70% of cases

B-Cell: Transcription factor PAX5, loss of development factors E2A, EBF; t(12;21) ETV6: RUNX in early precursors

Chromosomes often abnormal in number

43
Q

General epidemiology for ALL

A

Most common childhood malignancy

Generally

44
Q

Epidemiology of Pre-T neoplasms

A 
Lymphomas 50-70% of the time
Adolescent males
Mediastinal mass of Thymus
Respiratory symptoms
Rapidly progresses to leukemic phase
Worse prognosis than pre-B type
45
Q

If there are circulating blasts, think:

A

Acute form of leukemia

46
Q

Lab findings for ALL

A

Anemia always present
Thrombocytopenia almost always present
Peripheral WBC count can be high, normal, or low
Circulating Blasts

Bone marrow: hypercellular, blasts>20% of nucleated cells

47
Q

Significance of TdT, CD10/19/7/34, PAX 5

A 
TdT indicates a precursor cell and therefore an acute disease
CD10/19 are markers for B-Cells
CD7 is a marker for T-cells
CD34 on pre-T & B
PAX 5 with pre-B
48
Q

Histological presentation of ALL cells

A

Large, relatively uniform nuclei
Increased N:C ratio
Delicate chromatin
Vague nucleoli

49
Q

Symptoms of all Acute Leukemias

A

Think cytopenias:
Anemia=> fatigue
Neutropenia=> infections, fever
Thrombocytopenia=> bleeding, ecchymoses, epistaxis, gum bleeding, intracerebral bleeding

Think Infiltrate packing:
Bone pain and tenderness
Generalized lymphadenopathy
Hepatosplenomegaly
Mediastinal mass
CNS infiltrates=> meningeal spread=> headache, vomiting, nerve palsies (more common in ALL than AML)
50
Q

Treatment of ALL

A

Chemotherapy and prophylactic CNS treatment
95% reach complete remission
75-85% are cured

51
Q

ALL prognostic factors

A 
Best:
2-10 y/o, lots of chromosomes 50-60
pre-B
Low WBC counts
t(12;21)
trisomy of some chromosomes

Worst:

52
Q

Common features of Myeloid neoplasms

A

Involve hematopoietic progenitor cells
Involve the bone marrow

May also involve the spleen, liver, lymph nodes

53
Q

Categories of Myeloid Neoplasia?

A

AML
Myelodysplastic syndromes
Myeloproliferative diseases

54
Q

Peak age for AML

A

Peak age is 60, but can happen at all ages

Incidence rises through life

55
Q

Pathophysiology of AML

A

Mutation in transcription factors
Blasts accumulate in bone marrow because failure to mature
Causes anemia, neutropenia, thrombocytopenia

56
Q

WHO Classification of AML

A

Genetic Aberrations:
11q23 (MLL gene) -poor
t(8;21)-good

Myelodysplasia-like:
aberrations: 5q-, 7q-, 20q- all poor prognosis

Therapy-related: very poor prognosis
post alkylating agents; radiation > 2years
Follows topoisomerase II inhibitors by 1-3 yrs

57
Q

Auer Rods are a sign of:

A

AML?

They are seen in Myeloblasts

58
Q

CD34 vs 64 in myeloid cells

A

CD34 expressed by immature myeloid cells

CD64 expressed by mature myeloid cells

Path Exam 5 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions