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Exam 2
Chapter 20: Non-Malignant Lymphocytes
41
Science
Graduate
03/27/2013

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Term
Infectious agent in infectious mononucleosis
Definition
Epstein-Barr virus
Term
Clinical symptoms in infectious mononucleosis
Definition
classic triad = fever, pharyngitis, lymphadenopathy-cervical, axillary, inguinal lymph nodes, splenomegaly, hepatomegaly, occasional jaundice, rare AIHA, thrombocytopenia, and aplastic anemia
Term
Corresponding leukocyte differential in infectious mononucleosis
Definition
12-25 x 103/uL (Lymphocytosis), lymphs are 50% of the differential, less than 20% are reactive lymphs
Term
Reactive morphology of lymphocytes in infectious mononucleosis
Definition
3 morphologies are seen: (1) irregular shape, cytoplasmic basophilia is the most common (2) plasmacytoid (3) immunoblast is the least common
Term
Heterophile antibody test to infectious mononucleosis
Definition
not specific for EBV, Heterophile negative syndrome can be seen in 10-20% of adults, and 50% < 10 year olds
Term
Absolute leukocyte count
Definition
ALC (x 103/uL) = % lymphocytes x WBC count (x 103/uL)
Term
Differentiate absolute lymphocyte from relative lymphocyte count
Definition
absolute lymphocyte count is the actual quantitative amount of lymphocytes in the peripheral blood, relative count is the percent of the total amount of WBCs that are lymphocytes
Term
Reactive cell morphology associated with viral infections
Definition
large cells with irregular shapes, cytoplasmic basophilia, and occasional granules and vacuoles
Term
Normal lymphocyte morphology
Definition
round cell with very round large nucleus and blue cytoplasm
Term
Clinical symptoms of disorders of leukocytosis caused by lymphocytosis
Definition
caused by infectious mononucleosis, lymphadenopathy, fever, lethargy, sore throat, and splenomegaly
Term
Complications associated with CMV infections
Definition
leukocytosis with absolute lymphocytosis, concern in immunocomprimised or post-transplant patients
Term
Absolute lymphocytopenia
Definition
< 1.0 x 103/uL in adults and < 2.0 x 103/uL in children
Term
Absolute lymphocytosis
Definition
> 4.8 x 103/uL
Term
Relative lymphocytopenia
Definition
> 25% of differential
Term
Relative lymphocytosis
Definition
40% of differential
Term
Conditions associated with Absolute lymphocytopenia
Definition
corticosteroid therapy, acute inflammatory conditions, disseminated neoplasms, chemotherapy, radiotherapy, malnutrition and immune deficiency disorders
Term
Conditions associated with Absolute lymphocytosis
Definition
infectious mononucleosis, infectious lymphocytosis, Bordetella pertussis, CMV and lymphocytic leukemia
Term
Conditions associated with relative lymphocytopenia
Definition
transient, granulocytopenia
Term
Conditions associated with relative lymphocytosis
Definition
secondary to neutropenia, occurs in viral infections and more common than absolute lymphocytosis
Term
Pathophysiology of HIV infections
Definition
HIV1/2 retrovirus infects helper T cells and depletes them, monocytes and macrophages are also infected but not depleted, because of the lack of T cells there is a defect in cell-mediated and humoral immunity
Term
How HIV infections affect lymphocytes
Definition
HIV infects and severely depletes CD4 T cells
Term
Abnormal hematological findings associated with AIDS
Definition
leukopenia, anemia, macrocytosis and thrombocytopenia
Term
Explain conflicting results between peripheral blood morphology and serologic tests in EBV
Definition
a patient with all clinical manifestations and peripheral blood findings of mono occasionally does not have a positive Heterophile test, called Heterophile negative syndrome
Term
How do you resolve conflicting results between peripheral blood morphology and serologic tests in EBV
Definition
test for EBV specific antibodies
Term
Pathophysiology of infectious mononucleosis
Definition
EBV attached to B cell CD21 which activates the lymphocyte and increased the expression of CD23 which is a receptor for B cell growth factor. The internalized virus is then incorporated into the genome and passed onto the cell’s progeny
Term
Asses the antibody titers found in infectious mononucleosis with respect to the various EBV viral antigens
Definition
10-20% of adults are Heterophile negative with EBV, 50% < 10 year olds are also Heterophile negative, this could be due to CMV, toxoplasmosis or hepatitis
Term
Pathophysiology of toxoplasmosis infections
Definition
intracellular protozoan is acquired from cat feces (or undercooked meat or congenital) and causes symptoms similar to infectious mononucleosis.
Term
Resulting lymphocytosis from toxoplasmosis infections
Definition
relative/absolute with reactive lymphs
Term
Benign lymphocytosis leukemoid reactions lab results
Definition
increase in relative lymph count with reactive or immature-looking lymphs
Term
Benign lymphocytosis leukemoid reactions cell morphology
Definition
lymphocytes are large reactive cells with deep blue cytoplasm, fine chromatin, and cytoplasmic vacuoles
Term
Pathophysiology of CMV infections
Definition
can be congenital or acquired, occurs in immunosupressed people, similar symptoms to mono except pharyngitis in absent
Term
Clinical findings associated with CMV infections
Definition
leukocytosis with absolute lymphocytosis, reactive lymphs, and a negative Heterophile antibody test lymphocytosis, reactive lymphs, and a negative Heterophile antibody test
Term
Cause of lymphocytosis in Bordetella pertussis infections
Definition
pertussis toxin stimulate lymphocytosis-promoting factor produced by bacteria the recruits lymphocytes into the peripheral circulating and blocks their migration back into lymphoid tissue, causing accumulation of lymphocytes in the blood.
Term
Recognize laboratory features associated with Bordetella pertussis infections
Definition
leukocytosis ~ 15-25 x 103/uL can be up to 50, small mature lymphocytes with toxic granules in PMNs
Term
CDC AIDS case surveillance criteria
Definition
at least 18 years old, laboratory confirmed evidence of HIV: positive serologic HIV ab tests, positive HIV nucleic acid tests and positive HIV cultures
Term
Appropriate laboratory testing for a patient using CDC AIDS case surveillance criteria
Definition
need to test serologically for HIV antibodies, nucleic acid and cultures.
Term
Cytopenia in Wiskott-Aldrich syndrome
Definition
thrombocytopenia
Term
Defect in Wiskott-Aldrich syndrome
Definition
WAS gene on the short arm of the X chromosome between Xp11.3 and Xp11.22, females are carriers, X- linked disease
Term
Laboratory features of Wiskott-Aldrich syndrome
Definition
decreased T helper and T suppressor cells, absent antibodies to blood group antigens, severe thrombocytopenia and microthrombocytes
Term
Cytopenia in DiGeorge Syndrome
Definition
deletion within chromosome 22q11, also found in the parent of the child with DiGeorge syndrome in 25% of the cases
Term
Laboratory features of DiGeorge syndrome
Definition
hypocalcaemia, decreased peripheral blood T lymphocytes
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