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Path Leukopenia Lymphopenia Lymphadenitis
KYCOM Block 14
43
Pathology
Graduate
02/22/2014

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Cards

Term
what are the 2 leukopenias, which is most common, how many cells
Definition
neutropenia/agranulocytosis <1000 cells/ul
lymphopenia (T/B cells) - less common
Term
2 causes of neutropenia
Definition
inadequate or ineffective granulopoiesis
increased grnulocytosis removal or destruction
Term
what are 3 causes of neutropenia caused by inadequate or ineffective granulopoiesis
Definition
aplastic anemia: marrow failure
leukemia: marrow replaced by tumor
chemotherapy drugs
Term
what are 3 causes of neutropenia caused by increased granulocyte removal or destruction
Definition
immune mediated injury: drug, autoimmune
splenic sequesteration: enlarged spleen, hypersplenism
infection: increased peropherial utilization pulls PMN into tissues
Term
3 signs of neutropenia in patient
Definition
susceptibility to bacterial and fungal infection
malase, weakness, fatigue
chills, fever
agranulocytic angina: ulceration of mucosa of mouth and pharynx
Term
what are 2 possible changes in the marrow in neutropenia and why
Definition
marrow hypercellularity: when excess destruction or ineffective granulopoiesis

marrow hypocellularity: when drugs or autoimmune supressed granulocytopoesis
Term
treatment of neutropenia, why
Definition
GMCSF, GCSF
stimulates neutrophil production in marrow
Term
what are 5 types of leukocytosis, how many cells
Definition
WBC >10K
neutrophilic leukocytosis
reactive leukocytosis
monocytosis
eosinophilia
basophilia
Term
why is normal leukocytosis confused with leukemia
Definition
when WBC get so high they look like leukemia (often in kids with acute viral infection) called leukemoid reaction
Term
causes of neutrophilic leukocytosis 3, and some examples of each
Definition
bacterial infection: esp pyogenic
tissue necrosis: MI, burns
high cortisol
Term
why does cortisol cause increase in neutrophils
Definition
cortisol disrupts adhesion of PMN increasing circulation of marginated pool
Term
2 lab signs of neutrophilic leukocytosis
Definition
immature neutrophils (shift left)
cells have fewer Fc (CD16) receptors (cannot recognize Ig as well)
Term
2 causes of reactive leukocytosis
Definition
viral infections
borditella pertussis
Term
why does boretella pertussis cause leukocytosis and not neutrophilia
Definition
bordatella blocks lymphcotyes from leaving blood to enter node for further development
Term
how is EBV transmitted 2
Definition
saliva
normally in teenagers
Term
what are the risk factors for mono 2
Definition
unable to control infected B cells...

marrow and organ transplant patients: post transplant lymphoproliferative disorder

x-linked lymphoproliferative disorder
Term
when EBV gets in the body where does it go 3
Definition
oropharynx, liver, B cells
Term
when EBV invades B cells what does it do in there 2
Definition
lytic: replication and release of virons

latent: polyclonal activation and proliferation, Ab secretion (heterophil anti-sheep red cell Ab)
Term
when EBV affects T cells what does it do
Definition
causes circulating atypical lymphocytes (not the main infection point, response to infection)
Term
what is the body's response to EBV at the location of initial infection 5
Definition
oropharynx: sore throat
liver: hepatitis, rarley jaundice
B cells: fever, lymphadenopathy (post. cervical, axilla, groin)
Term
what do the atypical T cells in EBV look like 4
Definition
large nuclei
abundent cytoplasm
oval nuclei
few granules
Term
why do people with EBV have splenomeagly
Definition
white pulp (lymphoid T cell area peri-lymphatic sheath) expansion due to atypical lymphocytes

spleen in fragile and prone to rupture
Term
diagnosis od EBV 3
Definition
increased liver enzymes
monospot test: detect IgM heterophile antibodies (positive within 1wk)
definitive testing: EBV viral capsid antigen
Term
treatment of EBV
Definition
none, normally self limiting in 2-6wk
Term
5 complications of EBV 4
Definition
hepatic dysfunction: jaundice, liver failure

splenic rupture: avoid sports to 1y

rash if exposed to penicillin

immune compormised allows uninhibited B cell proliferation that transforms into monoclonal B cell lymphoma
Term
causes of monocytosis 3, and some examples of each
Definition
chronic infection: TB, endocarditis, rickettsia, malaria

collagen vascular disease: SLE

inflammatory bowel disease: ulcerative colitis
Term
causes of eosinophilis causes 9
Definition
asthma
hay fever
vasculitis
allergic reaction
phemigus
dermatitis
herpatiforms
parasites
drug reactions
malignancies: hodgkin lymphoma (increased IL-5)
Term
cause of basophilia 1
Definition
CML
Term
what is the typical presentation of X-linked lymphoproliferative disorder, why is it a concern
Definition
EBV can be fatal
usually young male
Term
acute non-specific lymphadenitis: location, cause
Definition
group of nodes or generalized nodes

infection (systemic or localized)
Term
acute non-specific lymphadenitis: node color, shape, internal changes, cells
Definition
swollen red-gray TENDER engourged nodes

large germinal center
central follicle necrosis and abscess when infection severe (may cause overlying skin reaction)

neutrophils: when caused by pyogenic organism
Term
chronic non-specific lymphadenitis: 3 types
Definition
follicular hyperplasia
paracortical hyperplasia
sinus histocytes
Term
cellular changes in chronic non-specific lymphadenitis
Definition
B cell activation causes follicular/germinal center reaction

node archecture preserved
variable germinal center size
T cells, B cells, tangible body macrophages appear
Term
cause of chronic non-specific lymphadenitis 3
Definition
inflammation or infection...
RA, early HIB, toxoplasmosis
Term
cellular changes in paracortical hyperplasia
Definition
immune reaction causes T cell activation
Term
3 causes of paracortical hyperplasia
Definition
viral infection
post-vaccination
drugs
Term
cellular changes in sinus histocytes 3
Definition
distension and prominence of sinusoids

infiltrated by macrophages

hypertrophy of lining of endothelial cells
Term
cause of sinus histocytes
Definition
nodes draining cancer
Term
cause of cat scratch disease
Definition
bartonella henslae infection via feline scratch
usually <18yo
Term
common signs of cat scratch disease, timing of signs, location
Definition
regional lymphadenopathy: usually neck of axilla

2wk after scratch, lasts 2-4wks
Term
3 rare signs of cat scratch disease
Definition
encephalitis
osteomyelitis
thrombocytopenia
Term
what would a bopisy show in cat scratch disease, how do we visualize it
Definition
silver stain

irregular stellate necrotizing granulomas: sarcoid like granulomas with neutrophils and central necrosis
Term
why does cat scratch disease get sent for biopsy analyzation so often
Definition
lymphoma is common in kids so need to be cautious, biopsy will clearly distinguish
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