WBC Quantitative Disorders

Question 1

Objective 3: Explain how movement of neutrophils from one pool to another can affect laboratory values.

Answer 1

Remember – when drawing a patient’s blood, the white blood cell count reflects the cells in the circulating pool. The cells in the marginating pool move quickly into the circulating pool, when needed, immediately increasing the neutrophil count

Question 2

Objective 4: What physiologic factors can affect numbers and types of circulating leukocytes.

Answer 2

Strenuous exercise
Emotional stress
Hypoxia
Labor & Delivery

Question 3

Objective 5: Differentiate leukemoid and leukoerythroblastic reactions when CBC data is provided or by photomicroscopy image.

Question 4

Objective 6: Differentiate between a leukemoid reaction and chronic myelogenous leukemia (CML)

Answer 4

CML:
1. Increases in all granulocytes, including eos and basos
2. Dyspoietic morphology (mixed granulation)
3. Giant platelets
4. Decreased LAP
5. 9;22 translocation

Leukemoid Reaction:
1. Increases in granulocytes, but uncommon for increases in eos and basos
2. No dyspoietic morphology; toxic granulation
3. Normal platelet morphology
4. Increased LAP
5. Absence of 9:22 translocation

Question 5

Objective 9: Correlate the three “levels” of decreased absolute neutrophil count (ANC) with increased risk with their increased risk of infection.

Answer 5

SEVERE: <1.5 – increased risk of infection
MORE SEVERE: <1.0 – increased risk of auto-infection
MOST SEVERE: <0.5 – reverse isolation/prophylactic antibiotics