White blood cell disorder path

Question 1

a patient with pneumonia and sepsis presents with leukocytosis (leukocyte count >11000/mm3), increased bands (>5%), and high neutrophils (>62%). leukocyte alkaline phosphatase (LAP) test score is increased. What is the significance of the last finding?

Answer 1

with the lab values you should be asking what is the cause of this leukemoid rxn (i.e. a benign leukocytosis that occurs in response to acute infection/hemorrhage or a result of underlying malignancy).

leukemoid reaction from sepsis/infection etc produces high LAP

Chronic myleoid leukemia produces low LAP.

Question 2

what is expected on peripheral blood smear for lukemoid reaction with high LAP?

Answer 2

Dohle bodies - light blue (basopphilic) peripheral granules in neutrophils - blue color is due to ribosomes bound with rough ER

Question 3

increased peripheral myelocytes vs increased promyelocytes and myeloblasts is useful for distingishing between what?

Answer 3

leukemoid reaction to systemic infection (increaesed early mature neutrophil precusors i.e. myelocytes) vs acute leukemia (increased immature cells e.g. promyelocytes and myeloblasets)

Question 4

what is basophilic stippling? What conditions present with this?

Answer 4

various sizes of blue granules which represent ribosomal precipitates in the cytoplasm of red blood cells.

Most commonly seen in thalassemias, alcohol abuse, and lead or heavy metal poisoning

Question 5

what condition is associated with sparse small lymphid cells (slightly larger than RBCs) with increased nuclei to cytoplasmic ratio (looks almost al blue on HandE) and cleaved nuclei found in peripheral blood?

Answer 5

follicular lymphoma