WBC disorders Flashcards by Ashley Hafer

2 causes of neutropenia

drug toxicity/chemotherapy
severe infection (increased movement into tissues)

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4 causes of lymphopenia

immune deficiency
high cortisol state (induces apoptosis)
autoimmune destruction (SLE)
whole body radiation

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how to identify immature PMNs

band-like nucleus, decreased Fc16 receptors

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high cortisol effects on WBCs

lymphopenia (apoptosis)

neutriphilia (impairs adhesion, releases marginated pool)

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5 causes of eosinophilis

Neoplasm- HD, RS cells secrete IL-5
Allergic reaction
Asthma
Collagen vascular disease
Parasites

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classic cause of basophilia

CML

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2 causes of lymphocytosis

viral infection

B. pertussis infection (lymphocytosis-promiting factor blocks lymphs from leaving blood)

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cells increased in mono

CD8+ tcells

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sites of EBV infection (3)

b cells
oropharynx
liver

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EBV dormancy/consequences

dormant in B cells

immunodef could = recurrence, B cell lymphoma

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suggestive mono symptoms, negative monospot

consider CMV

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blasts in bone marrow to = acute leukemia

over 20%

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blast appearance

large, immature cells with punched out nucleoli

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lymphoblast marker

+tdt

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cells in ALL may exhibit –

hyperploidy

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B-ALL cell markers (5)

+Tdt, PAS+, CD10, 19, 20

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B-ALL chemo-

must be directly injected into scrotum and CSF

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genetic assoc with B-ALL

down syndrome, after age 5

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T-ALL cell markers

+tdt, PAS+, CD2-8

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typical T-ALL presentation

teenager with thymic mass, compression-type symptoms

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APL translocation

t(15;17)- moves retinoic acid receptor, making it non-functional

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histologic feature of promyelocytes

auer rods (MPO)

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complication if auer rods released

DIC

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treatment of APL

ATRA

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leukemia that presents with gingival hypertrophy, rash

acute monocytic leukemia

leukemia assoc with down syndrome before age 5

acute megakaryoblastic leukemia

myelodysplastic disorders marrow

hypercellular, abnormal maturaion, blasts under 20%

characteristic MDS cells

Pelger-huet cells (bilobed nucleus, thin strand connecting)

CLL markers (2)

CD5, CD20

characteristic CLL histology

small, mature lymphs | smudge cells

3 complications of CLL

hypogammaglobulinemia/infection autoimmune hemolytic anemia Richter transformation to DLBCL

hairy cell leukemia- 2 characteristic features

dry tap on BM biopsy | TRAP+

viral infection assoc with ATLL

HTLV-1

mycosis fungoides is maligancy of-

CD4+ t cells

pautrier microabsecesses

neoplastic cells in the epidermis (mycosis fungoides)

sezary cells

cerebriform nuceli, associated with disseminated mycosis fungoides

classic translocation of CML

t(9;22) philadelphia chromosome- BCR-abl fusion = active tyrosine kinase

3 phases of CML

chronic accelerated transformation

where is mutation in CML? significance?

mutation is in CD34 hematopoietic stem cell, meaning transformation can be to AML or ALL

how to differentiate CML from leukemoid reaction? (3)

Leukemoid: +LAP, no increase in basophils, no t(9:22)

JAK2 mutation

constitutive activity of cytoplasmic tyrosine kinase

JAK2 mutation present in

PCV, ET, MD

symptoms of PCV are related to

hyperviscosity (plethora, pruritis, headache, blurred vision)

feared complication of PCV

budd-chiari syndrome (hepatic vein thrombosis)

essential thrombocytosis is malignancy of-

platelets

lab decreased in essential thrombocytosis

decreased thrombopoietin

symptoms of essential thrombocytosis

increased bleeding or thrombosis

other condition, aside from essential thrombocytosis, that will have increase platelets on smear

iron def anemia

no increased risk of __ because platelets lack nucleus

hyperuricemia/gout

myelofibrosis is a malignant proliferation of

megakaryocytes

what growth factor causes myelofibrosis?

megakaryocytic release PDGF

histology in myelofibrosis (marrow)

hypo cellular marrow with collagen bands

histology in myelofibrosis (peripheral)

``` tear drop cells (squeezing out of marrow) nucleated RBCs (from spleen) ```

myelofibrosis vs. aplastic anemia

myelofibrosis- collagen | aplastic anemia- fat

predominant cells in LN during acute lymphadenitis

neutrophils

follicular lymphoma translocation

t(14;18) bcl2-ig heavy chain | decreases apoptosis

difference between follicular lymphoma and reactive follicular hyperplasia (4)

disruption of normal architecture lack of tangible-body macrophages BCL2 expression monoclonal

mantle cell lymphoma translocation

t(11;14)- cyclin D1

marginal cell lymphoma is assoc with (3)

sjogrens hashimotos H pylori infection *only in chronic inflammatory states

infection assoc with Burkitt lymphoma

EBV

burkitt translocation

t(8;14)- c-myc increases= transcription activation

histology of burkitt

starry sky pattern

location of burkitt

endemic- jaw | sporadic- abdomen

RS cell markers

CD 15, 30

most common subtype of HL

nodular sclerosis

type of HD in which RS cells lack CD15/30

lymphocyte rich/predominant

abdundant eosinophils in HD because

RS cells secrete IL-5

clinical features of multiple myeloma (6)

``` osteolytic bone lesions elevated serum protein/M spike (IgG) increased infection rouleaux on RBC smear AL amyloidosis proteinuria ```

MGUS

M spike but no other symptoms

Waldenstroms abnormality

IgM production

waldenstrom symptoms

hyper viscosity related (raynauds, near deficits)

langerhans cells (3)

birbeck graniles, CD1a, S100+

letterer-siwe

rash, bone lesion under 2 malignant

hans-schuller-christian

over 3 malignant exophthalmos, rash, DI, bone lesions

eosinophilic granuloma

benign pathologic fracture adolescents ddx- osteosarcoma