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109 WBC Flashcards

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1
Q

3 basic types - 1. granulocytes

A

eo
neutro
basophils

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2
Q

3 basic types - 1. granulocytes what do they do?

A

phagotyic activity

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3
Q

Monocytes - mature into __

A

macrophages

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4
Q

Lymphocytes: mature into ?

A

▪ Maturesinlymphoidtissuesinbonemarrow,thymus,spleenlymphnotes ▪ B-cell(humoralimmunity)
▪ T-cell(cellularimmunity)

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5
Q

What factors may actually “normally” incr wbc (ie healthy person just has more)

A

age
ex
female
smoking
pregn

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6
Q

Alterations in wbc numbers are due to what 3 reasons (categories):

A

changes in production
marginal pool
tissue destruction

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7
Q

DDX main 4 categories of wbc disease when low:

A

suppress BM - chemo/rads/viral
destroy: beta lactam abx, RA, autoimm
Bacterial infections - use
sequestration: ischemic reperfusion injury, major trauma

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8
Q

DDX of leukocytosis: primary

A

PRIMARY:
- myeloprolif disorder like cml, pv
hereditary neutrophilia
familial myeloprolif
leukemoid rxn

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9
Q

DDX leukocytosis: secondary

A

secondary:
infection
tissue necrosis: burns, ca, infarct
metabolic: dka, thyrotoxicosis, uremia
non heme malign disease
physiologic: ex, pain, surgery, hypoxia, seizure, trauma
drug: epi, cs, li, cocaine
lab error

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10
Q

Defn of leukocytosis

A

neutrophilia > ANC >7500

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11
Q

what is a left shift of wbc?

A

diff count and represents immat neutrophils into circulation

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12
Q

DDX of leukocytosis with lymphocytosis

A

viral infxn: mono, rubella, rubeola, varicella, toxo
lymphoprolif: ALL, CLL
immune: immuniz, autoimm disease, graft rejection

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13
Q

Hyperleukocytosis: what is this?

A

hem emergency where wbc >100 and can cause metabolic abn, coagulopathy and multiorgan failure

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14
Q

Hyperleukocytosis: sx

A

cns - h/a, confused, lethargy, dizzy, blurry vision, ataxia, papilledema, retinal or IC hemorrhage

pulmonary: dyspnea, tachy, hypoxia, infiltr, resp failure

Mech obs caps - renal faiklure, peripher vascular occlu, MI

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15
Q

Hyperleukocytosis: tx

A

chemo
hydroxyurea
leukaphresis

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16
Q

Chronic myeloid leukemia: what is common reason

A

philadelphia chrom - genetic translocation

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17
Q

Chronic myeloid leukemia: how many ph?

A

3

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18
Q

Chronic myeloid leukemia: ph 1: chronic - insiduous sx

A

asymptomatic at sdx
if sx - abdo pain, decr appet, nausea, early satiety as hepato and splenomegaly

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19
Q

Chronic myeloid leukemia: ph 2 accelerated

A

abn bleed/bruise, petechiae, bone pain, fever

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20
Q

Chronic myeloid leukemia: ph 3: blastic

Study These Flashcards
A

abn bleed/bruise, petechiae, bone pain, fever and possible blast crisis

21
Q

CML: what is a blast crisis?

Study These Flashcards
A

anemia
abn bleed (low plt), sob, neuro sx as leukostasis bm infil occurs

22
Q

DDX of >25 wbc - 4 categories

Study These Flashcards
A
  1. infection - cdiff, tb, shigella
  2. drugs: cs, g-csf, ethyl glycol
  3. tissue ischemia: MI, mes ischemia, gangrene
  4. paraneopl
23
Q

Management of CLL general

Study These Flashcards
A

chronic: tyr kinase ihibitors that stop pro from genetic abn
if acc: TKI, LT response more limited
blast crisis: chemo needed

24
Q

Lymphocytic leukocytosis: ddx

Study These Flashcards
A

infx vs lymphoprolifC

25
Chronic lymphocytic leukemia - demographics and what is this?
MC leuk >50y b cell disorder impairing apop of b cells
26
Chronic lymphocytic leukemia - clinical features
* Heterogenous presentations and course * Often incidentally diagnosed d/t increased WBC, enlarged lymph nodes, palpable spleen, enlarged liver * B-symptoms
27
Chronic lymphocytic leukemia - dx testing
b lympocytes with lympho coutn >5 adults monoclonal
28
Chronic lymphocytic leukemia - management
* Patients with CLL require treatment once they become significantly symptomatic * Options include chemotherapy agents and monoclonal antibodies * In patients < 65 - chemoimmunotherapy is used and may have curative potential * Leukostasis rarely seen
29
Acute lymphocytic leukemia - demographics?
child
30
Acute lymphocytic leukemia - what is this?
clonal diseaes of bm by prolif of b or t cell
31
Acute lymphocytic leukemia - labs
dec anemia neutropenia plt wbc diff shows low neutrop defin dx bm bx
32
Acute lymphocytic leukemia - tx
multiagent chemo
33
Leukopenia: mild vs mod vs sev
1500 1000 500
34
Leukopenia ddx
Prolif BM - aplastic anemia, leukemia, chemo includ cyclophos, azathioprine, methotrex, chlorambucil drugs: phenothiazone, indomethacin, ptu, phenytoin, sulfonamides Maturation bm: folat/b12 defic, starvation Trapping: spleen large, sarcoid, portal htn, malaria incr use: infection - viral: mono, rubella, rubeola; ricketssia, overwhelming bacterial vs autoimm: sle, aids, felty lab error
35
Felty syndrome
triad RA, splenomegaly, neutropenia
36
Leukopenia : clinical features
* B-symptoms * Serious bacterial infections may be minimally symptomatic * Neutropenic fever (single temp > 38.3 or 38 for 1 hour)
37
Febrile neutropenia tx
within 1 h, broad spec abx
38
Blast crisis defn
CML specific - elevated blast count >20% and or bone marrow typically helpful to use hyperleukocytosis
39
Hyperleukocytosis defn
>/=50 to >/=100
40
Hyperleukocytosis 3 complications
leukostasis dic TLS
41
Leukostasis
when wbc level incr obstructs microvasculature - particlarly pulmonary or CNS
42
Leukostasis mc in which leukemia?
AML CML more sticky PTO
43
Leukostasis" common sx
lung disease - any sx cns - any eye - retinal hemorrhage! ear heart - MI vascular sx - limb ischemia
44
Leukostasis: false pao2 why?
cells metabolize oxygen - so may look hypoxemic on abg but actually okay pulse ox best here
45
Leukostasis tx
1. decr wbc: chemo, hydroxurea nad leukaphoresis preference = chemo and hydroxygurea (only against myeloid) - cytarabine via heme for lymphoid or myeloid (can give whenever) leuka just takes them out
46
Leukostasis: risk of what complication?
TLS
47
Leukostasis: RBC transfusion - risk?
sparingly, incr blood viscosity if rq avoid diuretic and try to amintain hydration
48
Leukostasis: plt threshold?
plt >20 until wbc decreased because of risk of hemorrhage is high during this time
49
Leukostasis: pre giving cytirabine or hydroxyurea, give?
fluids allopurinol rasburicase

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