WBC Path

Question 1

Causes of Neutropenia?

Tx?

Answer 1

Drug toxicity (chemo w/ alkylating agents) damage ste cells
Severe infection (Neutro move into tissues)

Tx: GM-CSF, G-CSF

Question 2

Lymphopenia causes

Answer 2

Immunodeficiency (DiGeorge, HIV, etc)
High Cortisol state (Cushing, outside source) → apoptosis
Autoimmune destruction (SLE)
Whole body Radiation

Question 3

Neutrophiliic Leukocytosis causes

Answer 3

Bacterial infection (release from B and marg pool)
Cortisol- impairs WC adhesion, release from marg pool

Question 4

Eosinophilia cause

Answer 4

*IL-5
Type I HS
Parasites
Hodgkin lymphoma

Question 5

Basophilia cause

Answer 5

CML

Question 6

Lymphocytic Leukocytosis cause

Answer 6

Viral infections- T cell hyperplasia

Bordetella pertussis- makes factor that prevents lymphocytes to leave blood and enter LNs

Question 7

Cause of Infectious mono and testing

Answer 7

MCC: EBV
Also by CMV

Test by Monospot test: Detect IgM Abs that react w/ sheep or horse RBCs…heterophile Abs
+ 1 wk after infection. Neg result→ CMV cause

Question 8

In Infectious Mono, what gets infected and what’s body response? Clinical Sx and presentation

Answer 8

Oropharynx: Pharyngitis
Liver: Hepatomegaly w/ ↑LFTs
B cells: dormant here, ↑risk Bcell lymphoma in immunocomp

CD8 Tcell hyperplasia response→enlarged PALS in spleen, Splenomegaly.
Also, enalrged Paracortex in LNs; Lymphadenopathy

Atypical lyphocytes on blood smear

Question 9

What immuno cell infected in Infectious Mono and what immuno cell response? What is Clinical Sx?

Precaution w/ infection for youth?

Answer 9

EBV infects Bcells (can remain dormant)

CD+ T cell response. Hyperplasia in LN paracortex and PALS in spleen; Splenomegaly. Infected teens advised avoid contact sports ONE YEAR

Question 10

Generally, how does Acute Leukemia present in BM and blood?

Answer 10

> 20% blasts in BM→
crowding of 3 cells lines (↓RBC, WBC, PLT)→Bleeding, fatigue, infection
↑WBC count in blood

Question 11

Markers for ALL, B-ALL, and T-ALL

Answer 11

ALL: Tdt+ (also + in B-ALL and T-ALL)
B-ALL: CD10, CD19, CD20
T-ALL: CD2 to CD8

Question 12

How to test prognosis of B-ALL?

Answer 12

Look at chromosome abnormalities:
Good prognosis in t(12;21) in kids
Poor prognosis in t(9;22) in adults for Philidelphia +ALL

Question 13

Demographic for Acute Leukemia, B-ALL, and T-ALL

Answer 13

Children
Down syndrome (after age 5)

B-ALL kids, and adults for Philadelphia +ALL

T-ALL: teeneagers. Sx: Mediastinal thmic mass = acute lymphoblastic lymphOMA

Question 14

Markers for AML and age demo?

Answer 14

MPO in cytoplasmc staining, and Auer rods (MPO crystal)

age: 50-60yo

Question 15

Which Acute Leukemia presents in Down syndrome after age of five? Before age 5?

Answer 15

After age 5: ALL

Before 5: Acute Megakaryoblastic Leukemia (subtype of AML)

Question 16

Subtypes of AML?

Answer 16

Acute Promyelocytic Leukemia (APL)
Acute Monocytic Leukemia
Acute Megakaryoblastic Leukemia

Question 17

Do all AML have MPO?

Answer 17

No! Subtypes Acute Monocytic Leukemia and Acute Megakaryoblastic Leukemia lack MPO

Question 18

Presentation physical Sx of Acute Monocystic Leukemia?

Answer 18

gum infiltration

Question 19

Describe APL- Acute Promyelocytic Leukemia?

Answer 19

t(15,17), involved RAR (retinoic acid receptor)→blocks mauration of blasts→accumulation
blasts of increased primary granules→ ↑DIC

Question 20

Tx for Acute Promyelocytic Leukemia

Answer 20

ATRA

Vitamin A derivative
binds altered receptor and causes blasts to mature

Question 21

what pre-exhisting conditions ↑risk for AML?

Answer 21

Exposure to radiation & alkylating agents

Myelodysplastic syndrome