Term
Normal relative concentrations of
-granulocytes,
-monocytes, and
-lymphocytes in peripheral blood
-metamyelocytes |
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Definition
lymphocytes: 20-50% (maj are T cells)
monocytes: 2-12%
neutrophils: 30-70%
eosinophils: 0-7%
basophils: 0-2%
metamyelocyte: 0-1% |
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Term
| Recognize each of the major granulocytes in a peripheral blood smear |
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Definition
lymphocyte: dense staining, full roundish nucleus
monocyte: horseshoe
neutrophil: 3-5 lobes
eosinophil: bilobed
basophil: lots of granules, obscure nucleus |
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Term
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Definition
Polymorphonuclear luekocytes
definite lobation
thread-like chromatin filaments joining 2-5 lobes
chromatin is coarsely clumped
cytoplasm is pink - lots of secondary granules
normally neutrophils are the only leukocytes to be divided into myelocyte, juvenile, band, PMN stages
45-75% in peripheral blood
Life span of 6-7 hrs |
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Term
| Describe the formation of the hematopoietic cells and recognize the terminology used for the progenitor cells for granulocytes, monocytes, and megakaryocytes |
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Definition
granulocytes -> myelocyte, metamyelocyte, band cell, PMN
-neutrophilic: pink cytoplasm, fine pink (neutrophilic) secondary granules |
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Term
Myelopoiesis-Segmented Neutrophils
Describe the appearance (which stage of development) and function of the specific and nonspecific cytoplasmic granules
-describe which enzymes appear in the specific granules of the three types of granulocyte |
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Definition
Specific/secondary start to appear in the myelocyte
-basophilic: peroxidase, heparin, histamine
-eosinophilic: major basic protein
-neutrophilic: lysozyme, other proteases
-when you start to see secondary granules, it's a myelocyte
*Primary/azurophilic granules* appear in the promyelocyte
azurophil: myeloperoxidase, elastase |
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Term
Recognize left shifted maturation in a description of a peripheral blood smear
-"bandemia"
-examples of immature cells |
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Definition
More immature leukocytes
BANDEMIA:
-i/c in fraction of band neutrophils
-U-shaped nucleus, secondary or specific (neutro or baso) granules predominate
-BM is responding to stress
-neutrophils are shifting from marginated pool to circulating pool
Blasts (lymphoblasts, myeloblasts)
Promyelocytes, myelocytes, metamyelocytes
Nucleated RBC
Band neutrophils > ref range |
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Term
Define:
leukocytosis
neutrophilia
-mechanisms of neutrophilic leukocytosis (5 pools)
monocytosis
eosinophilia
basophilia
lymphocytosis |
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Definition
LEUKOCYTOSIS
-reactive: infxn, inflammation, necrosis
-malignant: leukemia (uncontrolled proliferation of leukocytes -> accumulation of leukocytic cells in BM and blood)
NEUTROPHILIC LEUKOCYTOSIS
-5 pools of neutrophils & precursors:
mitotic pool (myeloblasts, promyelocytes, myelocytes)
non-mitotic pool (metamyelocytes, bands, segment neutrophils)
peripheral blood marginating pool
peripheral blood circulating pool
extravascular tissue pool
*sampling of peripheral blood assesses only the circulating pool (can be enlarged by i/c release of neutrophils & bands from BM, d/c margination, diminished extravasation into tissues, or expansion of BM precurosr pool)
certain stimuli (acute infxn) cause changes in flux b/t multiple pools simultaneously
-in reactive neutrophilic leukocytosis:
expect left shift
bacterial infxn most common cause
MONOCYTOSIS
reactive - lots of monocytes with vacuoles
circulate ~14 hrs then migrate into tissue -> macrophages
stem cell -> monoblast (BM) -> monocyte (blood) -> macrophage (tissues) |
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Term
| List the most common causes of neutrophilia, eosioniphilia, monocytosis, basophilia, and lymphocytosis |
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Definition
Neutrophilia - acute bacterial infxn
Eosinophilia - allergic, parasitic infxns
monocytosis - chronic inflammation
basophiliia - uncommon; can occur in CML
lymphocytosis - acute viral infections, ALL/CLL |
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Term
| Define leukemoid reaction |
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Definition
Marked neutrophilia
Similar to leukemia - but it's not!
-reactive, self-limiting rather than leukemic
marked reactive neutrophilia with immature neutrophils
marked acceleration of leukocyte production & release
bacterial infxn, stress, etc.
WBC count - above ref range of 12,000
as high as 40,000
occurs most often with neutrophilia, but also with lymphocytes
considerable left shift
differential is chronic myelogenous leukemia or acute myelogenous leukemia if numerous myeloblasts and promyelocytes |
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Term
| Absolute leukocyte counts |
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Definition
more important than relative amounts
(Total WBC count) x (% of luekocyte in differential) |
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Term
Terms related to leukocyte disorders:
-leukocytosis
-cytopenia
-leukopenia
-neutropenia
-lymphocytopenia
-aplastic anemia
-agranulocytopenia
-left shifted maturation |
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Definition
-cytosis: i/c WBC above ref range
neutrophilic, eosinophilic, basophilic
most commonly results from i/c in neutrophils
-leukopenia: decreased WBC count
-neutropenia: reduced granulocytes
-lymphocytopenia: decreased lymphocytes
<1500 cells/mm3
<700 cells/mm3: severe
-aplastic anemia: pancytopenia of the red cells, granulocytes, and platelets
-agranulocytopenia: marked reduction in granulocytes
<1000 cells/mm3
<500 cells/mm3: risk of infxns
-left shifted maturation: i/c proportion of immature cells
band forms or younger are increased
- bands, metamyelocytes, myelocytes
early release from the BM
stress, acute infxns, inflammation |
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Term
Granulocyte cytoplasmic changes
-myelocyte vs metamyelocyte |
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Definition
Metamyelocytes are slightly smaller
have kidney shaped indented nuclei & relatively dense chromatin
Cytoplasm is faintly pink, almost no blue background
secondary > primary granules |
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Term
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Definition
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Term
| Leukoerythroblastic reaction |
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Definition
immature red & white blood cells
due to abnormal infiltrates in the BM
space occupying lesions in the BM - metastasis and granulomas
requires BM sampling
stressed BM - has nRBCs and immature granulocytic cells, myelocytes
indicates severe disruption of the marrow
usually indicates BM has been infiltrated or replaced by secondary cancer or fibrosis, etc. |
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Term
What does a WBC measure?
How do you calculate absolute count? |
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Definition
WBC measures the relative concentration
The most imp info is the absolute count
total WBC count x the % of a specific leukocyte in the diff |
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Term
| List the most likely leukemia in the ddx of neutrophilic leukemoid rxn |
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Definition
CML
AML (if lots of myeloblasts and promyelocytes) |
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Term
| List and describe the toxic cytoplasmic changes seen in neutrophilia |
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Definition
Leukocytosis - high WBC count
too many neutrophils
left shift (too many young neutrophils)
absolute count within ref range
cytoplasmic vacuoles, granules, Dohle bodies |
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Term
Peripheral blood smear
Recognize abnormal morphology for granulocytes:
-toxic cytoplasmic changes in neutrophils (left shift)
-toxic granulations
-cytoplasmic vacuoles
-Dohle bodies |
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Definition
DOHLE BODIES
single or multiple blue spots, various size & shape
round or elongated
remnants of free ribo or RER
seen with toxic granules and vacuoles
seen in bacterial infxn
focal basophilia
represent aggregated ribo and whorls of RER
TOXIC GRANULATIONS
coarse purple cytoplasmic granules
seen with Dohle bodies
seen in bacterial infxn
cytoplasm of neutrophil becomes greyish blue (retention of rRNA)
less condensed chromatin
frothy or granulated cytoplasm (represents degranulation of lysosomes)
specific granules are less visible |
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Term
| Recognize hypersegmented neutrophil |
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Definition
more than the usual 3-4 lobes
nucleus has 6+ lobes
larger than normal
vit B12 or folate deficiency (pernicious anemia)
dysplastic syndromes (megaloblastic anemia) |
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Term
Peripheral blood smear
Recognize circulating immature leukocytes
-band cells
-metamyelocytes
-myelocytes
-promyelocytes
-blasts |
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Definition
BLASTS
abnormal mononuclear cells that don't normally circulate in peripheral blood
immature cells, reside in BM
"nondescript" morphologically
the first stage of the granulocytic series
no cytoplasmic granulations
typical appearance is shared by lymphoblasts, myeloblasts, and circulating lymphoma cells
PROMYELOCYTES
have cytoplasmic granulations |
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Term
| Define and recognize Auer rods |
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Definition
Results from the fusion of primary granules
pathognomonic of myeloid differentiation
pink or red, round or rod shaped cytoplasmic inclusions
aggregated azurophilic granules
seen in acute non-lymphocytic leukemia (leuk of granulocytic cells)
acute promyelocytic leukemia has the most granules
elongated, bluish-red rods composed of fused lysosomal granules
seen in cytoplasm of myeloblasts, promyelocytes, and monoblasts and in patients with *AML* |
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Term
| Acute leukemia (immature stages) |
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Definition
*accumulation* of immature cells in BM & blood
-myelogenous
-lymphocytic
acute myeloblastic leukemia - lots of blasts |
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Term
| Chronic leukemia (maturation) |
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Definition
*accumulation* of immature and mature cells (terminally differentiated) in BM & blood, but mature cells predominate
-myelogenous (myeloid)
-lymphocytic
*peripheral blood cell diff is similar to bone marrow aspirate*
-in acute: no maturation increase |
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Term
Define leukemia
-lymphocytic
-myelogenous |
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Definition
leukemia: neoplasms arising in bone marrow cells; neoplastic cells may circulate in the blood and secondarily colonize other tissue
LYMPHOCYTIC
T and B cells
MYELOGENOUS
granulocytic (neutro, baso, eos) and other cells from the myeloid stem cell mononuclear-phagocytic cells
-monocytes and macrophages
thrombocytes/megakaryocytes |
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Term
Hematopoiesis
recognize and define the term "blast" |
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Definition
The earliest recognizable myeloid cell is the myeloblast
-large round to oval nucleus
-fine diffuse immature chromatin
-prominent nucleolus
-cytoplasm is basophilic with few or no granules
-shouldn't see blast cells in peripheral blood |
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Term
Peripheral blood smear
Recognize the clinical significance of circulating immature granulocytes from the initial stages of maturation
-myeloblasts
-promyelocytes
-myelocytes |
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Definition
Leukoerythroblastic rxn
Severe disruption of the BM
BM replaced with carcinoma so BM cells are crowded out before they mature |
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Term
Reactive leukocytosis
-neutrophils |
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Definition
Reactive leukocytosis - infections, inflammation, necrosis
(compare to malignant leukocytosis - leukemia)
Neutrophilic leukocytosis - expect left shift, bacterial infxn the most common cause |
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Term
| Recognize and explain nucleated RBC in a peripheral blood smear |
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Definition
Blue RBC (like a retic) with a dark purple nucleus
Can happen with anemias, thalassemias, bone marrow injury, extramedullary hematopoiesis, altered splenic function |
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