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Block F -- Defense > White Blood Cells > Flashcards

White Blood Cells Flashcards

1
Q

Define total white blood cell count

A

All circulating nucleated hematopoietic cells with the exception of nucleated red blood cells (NRBCs)

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2
Q

2 purposes of total white blood cell count

A
  • Diagnosis and management of patients with hematologic and infectious diseases
  • Monitor patients receiving cytotoxic drugs, radiation therapy, and some antimicrobial drugs
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3
Q

5 types of WBCs

A
  • Neutrophils
  • Lymphocytes
  • Monocytes
  • Eosinophils
  • Basophils
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4
Q

4 variables affecting the normal values for complete blood count

A
  • Age
  • Sex
  • How high above sea level you live
  • Type of blood sample
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5
Q

Normal value for WBC

A
  • 5,000 - 10,000 WBCs per mm3
  • 5.0 - 10.0 WBCs per L
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6
Q

2 uses for differential blood count

A
  • To look for quantitative abnormalities in morphologically normal WBC population
  • To look for morphologic abnormalities of WBCs (i.e. immature or atypical cells) for diagnostic or monitoring reasons
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7
Q

What is required to use the differential blood count as a means to look for quantitative abnormalities in morphologically normal WBC populations?

A

High level of precision and accuracy (i.e. ability to provide consistent and correct results)

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8
Q

What is required to use differential blood count to look for morphological abnormalities of WBCs?

A

High level of clinical sensitivity (i.e. ability to identify ALL patients who have circulating abnormal WBCs)

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9
Q

2 WBC populations that are the most difficult to do the differential blood count on and why

A
  • Monocyte
  • Basophil

(Low level of precision and accuracy)

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10
Q

2 uses for absolute neutrophil count (ANC)

A
  • Monitor chemotherapy patients
  • Superior indicator of infection and inflammation
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11
Q

Largest percentage of leukocytes found in a normal blood sample

A
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12
Q

Diameter of neutrophil

A

10 - 15 µm

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13
Q

General appearance of neutrophil on a stained blood smear

A

Numerous fine lilic-colored granules and a dark purple nucleus

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14
Q

3 classes of neutrophils

A
  • Metamyelocyte
  • Neutrophil band or stab
  • Segmented neutrophil
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15
Q

Youngest type of neutrophil

A

Metamyelocyte

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16
Q

Describe the appearance of a metamyelocyte

A
  • Large, round or bean-shaped nucleus
  • Abundant, pale blue cytoplasm
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17
Q

Describe the appearance of neutrophil bands or stabs

A
  • Elongated and surved (horseshoe or S-shape) nucleus
  • Abundant pink cytoplasm
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18
Q

Mature neutrophil

A

Segmented neutrophil

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19
Q

Describe the appearance of a segmented neutrophil

A
  • Nucleus separated into 2 - 5 segments or lobes
  • Pale red cytoplasm
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20
Q

Diameter of eosinophils

A

12 - 14 µm

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21
Q

Describe the appearance of eosinophils

A
  • Nucleus = large, typically bilobate
  • Cytoplasm = pale red, coarse round granules of uniform size (brick red)
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22
Q

Diameter of basophils

A

11 - 13 µm

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23
Q

Describe the appearance of basophils

A
  • Nucleus = large, irregular, sometimes trilobate
  • Cytoplasm = basophilic with scattered, large, dark blue granules which may overlay the nucleus
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24
Q

When do increased immature forms of eosinophils and basophils occur (9)

A
  1. Bacterial infections
  2. Acute inflammatory diseases
  3. Cancer (esp. marrow metastasis)
  4. Tissue necrosis
  5. Acute transplant rejection
  6. Surgical and orthopedic trauma
  7. Myeloproliferative diseases
  8. Steroid use
  9. Pregnancy (esp. third trimester)
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25
Q

What leukocyte increases in conjunction with increased immature forms of eosinophils and basophils? What are the exceptions?

A

Neutrophils, EXCEPT may not increase in conditions such as age and pregnancy

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26
Q

Largest WBC circulating in peripheral blood

A

Monocyte

27
Q

When do monocytes become mature macrophages?

A

When they enter tissue

28
Q

What is the name of the system that encompasses both monocytes and macrophages

A

Mononuclear phagocyte system

29
Q

3 functions of macrophages

A
  • Arrive after injury and become predominant leukocyte within 48 hours
  • First cell to engulf and process antigen and present it ot the lymphocytes –> specific immune response
  • Can destroy the organism while keeping its cell surface markers to present to the lymphocyte
30
Q

Define lymphocytes

A

Non-granulocytes responsible for immune responses to specific organisms

31
Q

T lymphocyte function

A

Cell-mediated immunity

Stimulate B cell –> Trigger humoral/antibody-mediated immunity

32
Q

Role of B-cells

A

Humoral (antibody-mediated) immunity

33
Q

Location of T-cell maturation

A

Thymus

34
Q

Location of B cell maturation

A

Bone marrow

35
Q

Describe the purpose of natural killer cells

A
  • No T- or B-cell markers
  • Respond to changes in normal cell states
  • Very effective against tumor cells and virally infected host cells
36
Q

Most common cause of neutrophilia

A

Acute bacterial infection

37
Q

Define neutrophilia

A

Increase in neutrophil count that usually occurs 4 to 6 hours after an invasion by microorganisms

38
Q

2 examples of myeloproliferative disorders

A
  • Polycythemia vera
  • Chronic myelocytic leukemia (increased stem cell proliferation in bone marrow)
39
Q

3 non-disease states that are associated with increased neutrophil counts

A
  • Obesity
  • Smoking
  • Stress of surgery
40
Q

Describe a severly elevated neutrophil count

A

Pathologic conditions causing the neutrophils to become hypermature and have an increase number of segments

41
Q

3 conditions that cause a severely elevated neutrophil count

A
  • Liver disease
  • Down’s syndrome
  • Megaloblastic anemia
42
Q

Define a “right shift” in neutrophil count

A

Elevation in segmented neutrophils; an increased neutrophil count without the immature cells

43
Q

Define a “left shift” in neutrophil count

A

Elevation in bands; an increase in immature neutrophils released from the marrow

44
Q

Define neutropenia

A

Neutrophil count of less than 2,000 x 109/L

45
Q

2 causes of neutropenia

A
  • Severe prolonged infections
  • Increased destruction of WBCs
46
Q

2 ways increased destruction of WBCs can occur

A
  • Increased splenetic pooling (hypersplenism)
  • Drugs (i.e. antimicrobials, NSAIDs, antidepressants, anticonvulsants)
47
Q

Potential risk of neutropenia

A

Inability to mount and adequate defense when challenged by infection

48
Q

Define severe neutropenia

A

Neutrophil count of less than 500 x 109/L

49
Q

Consequence of severe neutropenia

A

Predisoposition to serious bacterial infection and opportunistic infection

50
Q

Consequence of having a neutrophil count below 1 x 109/L

A

The chance of gram-negative and gram-positive sepsis and fungal infections increases dramatically

51
Q

Define absolute monocytosis

A

Marker of a myeloproliferative disorder until proven otherwise

52
Q

What is required to conclude absolute monocytosis

A

Bone marrow examination and cytogenetic studies (can have hematology consultation for further evaluation)

53
Q

When can relative monocytosis occur?

A

During recovery from drug-induced neutropenia

54
Q

5 conditions that are a reflection of reactive absoute monocytosis

A
  • Chronic infectious, inflammatory, granulomatous processes
  • Metastatic cancer
  • Lymphoma
  • Radiation therapy
  • Depression
55
Q

Define reactive lymphocytosis

A

Lymphocytosis with normal appearing small lymphocyte morphology

56
Q

Etiology of reactive lymphocytosis. Give 3 examples

A

Virus

  • Monomucleosis
  • Cytomegalovirus
  • Measles
57
Q

Define eosinophilia

A

An increase in the eosinophil count

58
Q

2 conditions that can cause eosinophilia and give examples (2 and 3)

A
  • Parasitic infections
    • Toxoplasmosis
    • GI parasites
  • Bronchoallergic reactions
    • Asthma
    • Allergic rhinitis
    • Hay fever

NOTE: May also be notes with skin rashes

59
Q

Rare eosinophilia-related disorder that requires further investigations to diagnose

A

Hypereosinophilic Syndrome

60
Q

Most uncommon cause of an elevated WBC count

A

Basophilia

61
Q

When does basophilia occur?

A

In patients with hypersensitivities (should have a thorough allergy history obtained)

62
Q

4 relatively uncommon, rare or inconsequential -penias

A
  • Eosinopenia
  • Basopenia
  • Monocytopenia
  • Lymphopenia
63
Q

3 conditions to consider in the presence of monocytopenia

A
  • Glucocorticoid therapy
  • Hair-cell leukemia
  • Aplastic anemia
64
Q

2 situations where lymphopenia may be seen

A
  • Normal process of aging
  • Children = may be the only early sign of immune deficiency

Block F -- Defense (4 decks)

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