White Blood Cell Pathology-- from Neutrophilia, Lymphocytosis

Question 1

what types of neutrophils are seen along the vessel wall (right arrow)

Answer 1

marginal neutrophils.

Question 2

what is seen here

Answer 2

A LEUKOERYTHROBLASTIC PICTURE: increase in immature RBC and WBC seen in differential and on blood film; caused by marrow infiltration, severe stress etc.

• often due to cancer.
• there are nucleated RBCs and well as blasts more immature than a left shift.

Question 3

how does prednisone cause neutrophilia

Answer 3

by demargination and increased release of neutrophils from the marrow.

Question 4

Patient quite well, not septic, not even febrile (i.e.
systemically well)
 Inflammatory markers – ESR 14, CRP normal
 Review of old labs:
– Nov 2014: WBC 13.2, PMNs 10.0
– Sept 2015: WBC 18.9, PMNs 14.0, metamyelocytes 0.9,
myelocytes 0.6, basophils 0.4 – Sept 8, 2016: WBC 33.5, ANC 25.5, bands 1.7,
metamyelocytes 1.0, myelocytes 1.3, basophils 0.7 – Sept 19, 2016 (after 10 days of antibiotics): WBC 21.8,
ANC 15.9, metamyelocytes 0.9, myelocytes 0.9,
basophils 0.4
 Hematology consulted

Answer 4

basophils are high (should be 0.01-0.05, but it’s 0.7)

too many premature cells (metamyelocytes and myelocytes), neutrophils super high (should be 3.0-5.8)– definititely neutrophilic.

the myeloid line is compromised.

He probably has leukmia (CML)

Question 5

basophils are an indicator of which type of leukemia?

Answer 5

think CML.

Question 6

is CML a pediatric disease?what are risk factors of CML?

Answer 6

CML= affects mainly older adults. risk factors include exposure to ionizing radiation (atomic bomb survivors)

Question 7

which chromosome is associated with CML

Answer 7

philadelphia chromosome (9;22). juxtaposes c-ABL oncogene of chromosome 9 to BCR gene on chromosome 22.

causes an expansion of myeloid cell population and resistnace to programmed cell death.

Question 8

Answer 8

CML

• elevated WBC– more neutrophils
• basophilia (see the granulated cell)
• anemia (white central pallor)

Question 9

normal?

Answer 9

NO. CML

Question 10

a person with CML who wasn’t receiving treatment because it wasn’t originally progressing starts feeling more tired, pain in bones and chest, and coughing a lot. PBS shows this. what is the new development

Answer 10

blast phase. acute leukemia acceleration. Without SCT or imatinib median survival is 3-5 months.

Question 11

Symptoms of EBV

Answer 11

Fever
 Tender lymph nodes
 Fatigue – often extended duration
 May have palpable splenomegaly
 May have hepatitis
 Typical age – teens/20s
 Not necessarily aware of “sick contacts”

Question 12

Answer 12

normal lymphoctyes

Question 13

what cells are present

Answer 13

atypical lymphocytes–indicative of EBV or viral infection.

Question 14

is reactive lymphocytosis polyclonal or uniclonal

Answer 14

polyclonal. can be due to EBV, rubella, pertussis, CMV.

Question 15

this person is most likely suffering from:

Answer 15

CLL. Look at the enlarged soccer ball nuclei and the central pallor and irregularly shaped of the RB C(indicating autoimmune hemolytic anemia)

Question 16

this person most likely has:

Answer 16

CLL. Smudge cells and some schistocytes or spherocyts (AIHA) are characteristic of CLL.

Question 17

which cell morphology is characteristic of CLL

Answer 17

smudge cells,

soccer ball cells

schistocytes/autoimmune hemolytic anemia.

Question 18

Is CLL a T cell of B cell disease

Answer 18

B cell. usually

Question 19

which phenotypes indicate B cell lymphocytosis (CLL diagnosis)

Answer 19

CD5+, CD19+, Cd23+, Dim CD20, Dim surface lg.

Question 20

diagnosing CLL

Answer 20

blood count and smear

-immunophenotyping and flow cytometry, looking for the presence of CD5+, CD19+, CD23+ Dim CD20, CD200+

don’t usually need to do a BMBx

if there is lymphocytosis do a lymphnode bx.