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1.24 Non-neoplastic WBC abnormalities
by Dr. Weilbaecher
53
Pathology
01/24/2012

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Term
What do you call an increase in neutrophils? monocytes? eosinophils? basophils? lymphocytes?
Definition
neutropenia, monocytosis, eosinophilia, basophilia, lymphocytosis
Term
What is the clinical significance of monocytopenia?
Definition
rarely used term; clinically insignificant
Term
What is teh exact definition of neutrophilia?
Definition
an absolute neutrophil count of greater than 7000
Term
What are the three pools or compartments of PMNs.
Definition
circulating neutrophil pool, marginal pool (adhering to endothelial wall in blood vessels), bone marrow pool
Term
What are physiologic causes of neutrophilia?
Definition
strenous exercise, stress or prenancy
Term
How does strenuous exercise, stress, or epinephrine injection cause leukocytosis?
Definition
redistribution of neutrophils from the marginal pool to the circulating pool
Term
What are two iatrogenic causes of neutrophilia?
Definition
EPI injection, steroids or colony stimulating factors
Term
How do steroids cause neutrophilia?
Definition
increase flow of neutrophils from bone marrow to blood and decreased egress of neutrophils from peripheral blood to tissues
Term
What can you give to a patient post chemotherapy to increase WBC count?
Definition
colony stimulating factors (G-CSF)
Term
What are pathologic causes of neutrophilia?
Definition
acute infections, noninfectious inflammatory disorders, hematologic disorders, malignant neoplasms
Term
What non infectious inflammatory disorders can cause neutrophilia?
Definition
trauma, surgery, infarcts, burns, gout
Term
What hematologic (non neoplastic) d/o can lead to neutrophilia?
Definition
acute hemorrhage, hemolysis
Term
What are toxic granules?
Definition
dark blue primary granules in PMN cytoplasm during infection and other toxic states (Burns, tissue necrosis)
Term
What are Dohle Bodies?
Definition
pale, blue gray, oval shaped inclusions in neutrophil cytoplasm composed of RER; located by cell membrane and seen in conditions similar to toxic granulations
Term
What is a leukemoid reaction?
Definition
an extreme reactive neutrophilia with marked left shift (segs, bands, metamyelocytes and myelocytes, and infrequently promyelocytes and myeloblasts)
Term
How do you differentiate between a leukemoid reaction and CML?
Definition
increased LAP (leukocyte alkaline phosphatase) and no philadelphia chrom or BCR/ABL in leukemoid reaction
Term
What is agranulocytosis?
Definition
severe neutropenia (<500/ul)
Term
Where are common sites of recurrent infection in a pt with neutropenia?
Definition
skin and mucous membranes (oral cavity, perirectal and genital areas)
Term
What are the most common pathogens in patients with neutropenia?
Definition
endogenous bacteria (staph aureus from skin and gram-negative from GI and GU)
Term
Neutropenia can be due to what three types of defects?
Definition
production, maturation, survival
Term
What are common causes of decreased production of PMNs.
Definition
suppression or toxicity of hematopoietic precursors (drugs, radiation, infections, aplastic anemia), marrow replacemnt (hematologic cancers, metastatic neoplasms, myelofibrosis)
Term
Name two common causes of ineffective granulocytopoiesis?
Definition
megaloblastic anemia (B12 and folate deficiency)
Term
What types of infections can suppress hematopoietic precursors?
Definition
viral (HIV, EBV, hepatitis)
Term
What AI diseases cause increased utilization or destruction in peripheral blood?
Definition
SLE, felty's syndrome
Term
What causes eosinophilia?
Definition
allergic disorders (asthma, rhinitis, urticaria, angioedema), drugs, parasitic infections, hematologic d/o (CML, hodgkins), skin disseases (bullous pemphigoid, pemphigus), idiopathic hypereosinophilic syndrome
Term
What's the criteria for idiopathic hypereosinophilic syndrome?
Definition
eosinophils >1500/uL for >6 months with signs/symptoms of organ involvement
Term
What causes basophilia?
Definition
CML and other chronic myeloproliferative diseases?
Term
What does CML stand for?
Definition
chronic myelogenous leukemia
Term
What does CMPD stand for?
Definition
chronic myeloproliferative diseases
Term
What causes monocytosis?
Definition
hematopoietic malignancies (monocytic and myelomonocytic leukemias), recovery phase from acute infections, agranulocytosis, chronic inflammatory processes (infecious or immune, TB, syphilis, collagen vascular dis.)
Term
What acute infections cause reactive lymphocytosis?
Definition
infecious mono (atypical), infectious lymphocytosis (typical), pertussis (bordetella; typical)
Term
Name the lymphocytic malignancies?
Definition
CLL (chronic lymphocytic leukemia), ALL (acute lymphoblastic leukemia)
Term
Can lymphomas cause a lymphocytosis?
Definition
yes, in the leukemic phase of lymphomas
Term
What are some iatrogenic causes of lymphocytopenia?
Definition
radiation, chemo, steroids
Term
What effect does SLE have on lymphocyte count?
Definition
can cause lymphocytopenia
Term
characterisitcs of acquired versus inherited morphological abnormalities in WBCs.
Definition
acquired- transient, minority
inherited= uncommon, persistent, majority of WBCs
Term
How do you determine if PMNs are hypersegmented?
Definition
any PMN with 6 or more or >5% with 5 or more nuclear lobes
Term
List the inherited WBC morphological changes.
Definition
may-hegglin anomaly (abnormal cytoplasmic inclusions), alder-reilly (abnormal cytoplasmic granules), chediak-higashi syndrome (abnormal cytoplasmic granules/inclusions), pelger-huet (nuclear hyposegmentation)
Term
What is the clinical significance of inherited pelger huet anomaly?
Definition
looks like a left shift on CBC
Term
Describe the PBS of pelger huet anomaly.
Definition
bilobed nuclei connected by a filament affecting 70-90% of neutrophils, other nuclei are oblong/peanut-shaped and may resemble bands; others may have round nuclei
Term
What is the clinical significance of pseudo-pelger-huet anomaly?
Definition
seen in myelodyplastic syndromes or chemotherapy drug usage
Term
Is there a morphological difference in pseudo-pelger huet and inherited pelger huet?
Definition
pseudo has less numerous pelgeroid PMNs
Term
Do you acquired immunity to EBV?
Definition
yes, life long
Term
What are the three characteristic signs of infectious mono?
Definition
bilateral cervical LAD, fever, pharyngitis,
Term
What are the hematologic findings of infectious mono?
Definition
lymphs frequently > 60% of total WBC count; atypical lymphs are usually > 20% of all lymphs
Term
When do heterophile antibodies form during EBV infection?
Definition
peak at 2-3 weeks from illness onset then decline
Term
In what situations is a monospot test negative when a patient actually does have mono?
Definition
first week of infection or in infants and children
Term
What do you do if a patient has all classic signs and symptoms but is monospot negative?
Definition
EBV specific antibody (confirmatory test)
Term
W is the predictable sequence of viral specific antigens in EBV infection?
Definition
VCA (viral capsid antigen) abs, EA (early antigen) abs, EBNA (epstein-barr nuclear antigen) abs
Term
Which ab against EBV persists for life?
Definition
Anti-EBNA
Term
How long after infection does it take anti-EBNA to appear?
Definition
2 months
Term
What are complications of mono?
Definition
mild hemolytic anemia (anti-i cold agglutinins), mild thrombocytopoenia, splenic rupture
Term
Name some heterophile negative mononucleosis syndromes.
Definition
lymphocytosis with atypical lymphs, CMV infections, hepatitis, HIV, adenovirus, toxoplasmosis,