Term
| What do you call an increase in neutrophils? monocytes? eosinophils? basophils? lymphocytes? |
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Definition
| neutropenia, monocytosis, eosinophilia, basophilia, lymphocytosis |
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|
Term
| What is the clinical significance of monocytopenia? |
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Definition
| rarely used term; clinically insignificant |
|
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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 |
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|
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 |
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|
Term
|
Definition
| dark blue primary granules in PMN cytoplasm during infection and other toxic states (Burns, tissue necrosis) |
|
|
Term
|
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 |
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|
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
|
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
|
|
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
|
Definition
| CML and other chronic myeloproliferative diseases? |
|
|
Term
|
Definition
| chronic myelogenous leukemia |
|
|
Term
| What does CMPD stand for? |
|
Definition
| chronic myeloproliferative diseases |
|
|
Term
|
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
|
|
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
|
|
Term
| How long after infection does it take anti-EBNA to appear? |
|
Definition
|
|
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, |
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