WBC Path Flashcards
- an increase in total circulating white blood cells
Leukocytosis
- an elevated white blood cell count that is a physiologic response to
stress or infection
Leukemoid reaction
– a decrease in total circulating white blood cell count
Leukopenia
– all cell lines affected – anemia, thrombocytopenia,
neutropenia
Pancytopenia
Clinically relevant neutropenia –
Absolute Neutrophil Count (ANC) < _____/mm3
500
Causes of ______
Decreased production of neutrophils
Drugs
Hematologic disease – cyclic neutropenia
Nutritional deficiency – B12, Folate
Myelophthisis
Increased destruction - autoimmune reactions
Neutropenia
Regular, periodic reductions in neutrophils Symptoms greatest at nadir – fever, lymphadenopathy, malaise, pharyngitis, ulcerations, periodontitis Treatment - supportive care, cytokine therapy (G-CSF)
Cyclic Neutropenia
- the neoplastic cells are in the bone
marrow and blood
Leukemias
- the neoplastic cells are in the
lymph nodes – (also extranodal sites)
Lymphomas
Arises in bone marrow
Spreads to peripheral blood
Leukemia
Arises in peripheral lymphoid tissue, usually in lymph nodes
Forms a discrete tissue mass
May eventually spread to peripheral blood and bone marrow
Lymphoma
\_\_\_\_\_ Leukemia Abrupt, stormy onset No maturation - precursor cells (blasts) proliferate Kills rapidly without treatment Cure is possible
Acute Leukemia
\_\_\_\_\_ leukemia Insidious course Maturation - mature cells proliferate Often not treated unless symptomatic Cannot be cured
Chronic Leukemia
Clinical Symptoms of _____ ______
Cytopenias - depression of normal bone marrow function
Bleeding – petechiae, ecchymoses, epistaxis, gingival
hemorrhage due to thrombocytopenia
Fever - infections due to absence of mature granulocytes
Fatigue - anemia
Acute Leukemia
Lymphoblasts - immature precursor B or T lymphocytes
arrested at early stage of development
A disease of children
Good prognosis with aggressive chemotherapy
Acute Lymphoblastic Leukemia
Myeloblasts – immature myeloid precursors (granulocytic,
monocytic, erythroid, megakaryocytic) with no terminal
myeloid differentiation
Adults
Prognosis – chemotherapy, bone marrow transplantation.
More difficult to treat than ALL.
Gingival enlargement in monocytic types
Acute Myeloblastic Leukemia
Clinical Symptoms of _____ leukemia
Often clinically silent
Incidental leukocytosis on CBC
Chronic Leukemia
Adults Insidious onset, slow progression Philadelphia chromosome – t(9:22) bcr-abl fusion gene Splenomegaly, fever, fatigue Blast crisis Bone marrow transplantation
Chronic Myelogenous Leukemia
Translocation t(9:22) Proto-oncogene abl on long arm chromosome 9(q34) Transposed to bcr region (breakpoint cluster region) on chromosome 22(q11) Results in bcr-abl fusion gene Gene product is abnormal bcr-abl tyrosine kinase Induces cell proliferation
Philadelphia Chromosome
Most common type of leukemia
Adults, often asymptomatic
Hypogammaglobulinemia – infections
Anti red cell autoantibodies – autoimmune hemolytic anemia
Anti platelet autoantibodies – autoimmune thrombocytopenia
Richter syndrome – may transform to high grade lymphoma
Chronic Lymphocytic Leukemia
- non-tender lymph node enlargement,
extra-nodal mass
Lymphoma
- cytopenias due to suppression of
hematopoiesis
Leukemia
Are there such things as benign lymphomas?
All lymphomas are malignant
Clinical Presentation of \_\_\_\_ Painless lymphadenopathy with firm, enlarged, rubbery, freely movable, non-tender lymph nodes Generally involves multiple lymph nodes in a non-contiguous pattern Frequently involves extranodal sites
NHL
____ grade lymphoma - indolent, difficult to cure
Low grade
____ grade lymphoma - aggressive, often curable
High grade
_____ lymphoma
“African Jaw Lymphoma”
B-Cell NHL
EBV association
Burkitt Lymphoma
\_\_\_\_\_\_ Lymphoma– Low Grade Arises from Mucosal- Associated Lymphoid Tissue “MALT-oma” - mature B cells Often indolent Salivary glands, Sjogren Syndrome May transform to high grade lymphoma
MALT Lymphoma
_____ Lymphoma
A sub-type of non-Hodgkin lymphoma (NHL)
A high grade B cell neoplasm, most rapidly-growing
human neoplasm
The endemic form has a predilection for jaws of children
Burkitt Lymphoma
What are the 4 EBV associations?
- Infectious Mononucleosis
- Lymphomas – NHL and HL
e. g. Burkitt lymphoma (NHL) - Nasopharyngeal Carcinoma
- Oral Hairy Leukoplakia
Cytogenetics of \_\_\_\_\_\_ Translocations, t(8:14) is the most common c-myc proto-oncogene on chromosome 8 has a role in cell cycle progression Immunoglobulin gene promoters cause overexpression of c-myc Overexpression of c-myc oncogene promotes inappropriate cellular proliferation
Burkitt Lymphoma
Oral Findings in \_\_\_\_\_\_ Rapidly growing painless swelling, producing paresthesia, loose teeth Rapid demise if untreated
Burkitt Lymphoma
What is the neoplastic cell present in Hodgkin Lymphoma?
Reed-Sternberg cell/ Owl-eye cell
General Characteristics of \_\_\_\_\_\_\_\_ Bimodal age distribution - young adults, older adults Painless lymphadenopathy Constitutional symptoms variable Fever – Pel-Ebstein fever Night sweats Weight loss Generalized pruritus Association with Epstein Barr virus
Hodgkin Lymphoma
Spread of ______________
Uniform, predictable pattern of spread from one lymph node region to the next
Hodgkin Lymphoma
“B” Symptoms for Staging of ________
Recurrent, unexplained fevers
Night sweats
Unintended weight loss
Non-Hodgkin Lymphoma
If Hodgkin lymphoma is stage 1, radiation or chemo?
radiation
If Hodgkin lymphoma is stage 4, radiation or chemo?
Chemo
Older adults
Disseminated neoplasm of terminally-differentiated B
lymphocytes (plasma cells)
Multifocal lytic bone lesions, hypercalcemia, bone pain
Myelophthisic anemia, predisposition to infections
Multiple Myeloma
Oral Findings of _______:
Lytic lesions, loose teeth, pain, paresthesia,
pathologic fracture
Macroglossia - amyloidosis
Multiple Myeloma
Laboratory Findings of _________
Elevated serum calcium, protein, immunoglobulins
Elevated erythrocyte sedimentation rate (ESR)
Rouleaux formation
Multiple Myeloma
Clinical assessment for adequate number and function of platelets.
The bleeding time test represents the time taken for a standardized skin puncture to stop
bleeding
The normal range depends on the actual method used and varies from 2 to 9 minutes
It is abnormal when there are congenital or acquired platelet defects
Drugs – ASA, NSAIDS
Von Willebrand Disease
Bleeding Time Test
- decrease in platelets
Thrombocytopenia
- increase in platelets
Thrombocytosis
Aspirin - inhibits aggregation for lifetime of platelet (8-10d) (irreversible)
NSAIDs - inhibits aggregation until drug eliminated (reversible)
Von Willebrand Disease - compound defect involving platelet function and
coagulation pathway
Normal platelet count with increased bleeding time
Thrombasthenia
Platelet count < 100,000 /mm3
Thrombocytopenia
Causes of \_\_\_\_\_\_\_ Decreased production - aplastic anemia Increased destruction – immunologic destruction Sequestration in spleen – splenomegaly Dilution - massive transfusion
Thrombocytopenia
Autoimmune disease– antiplatelet autoantibodies
produce thrombocytopenia
Treatment with steroids, splenectomy
Immune Thrombocytopenic
Purpura (ITP)
Primary: hematopoietic stem cell disorder
Increased numbers of megakaryocytes producing dysfunctional platelets
Reactive
Asplenia
Inflammatory disorders
Thrombocytosis
What type of leukemia is most likely to infiltrate the gingiva?
AML
