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WILLIAM'S HEMATOLOGY > 78 Lymphocytosis and Lymphocytopenia > Flashcards

78 Lymphocytosis and Lymphocytopenia Flashcards

1
Q

Lymphocytosis is defined as an absolute lymphocyte count exceeding

A

4 × 10 9 /L

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2
Q

TRUE OR FALSE

The normal absolute lymphocyte count is significantly higher in childhood

A

TRUE

The normal absolute lymphocyte count is significantly higher in childhood

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3
Q

Blood film association

Reactive lymphocytes:
Large granular lymphocytes:
Smudge cells:
Blasts:

A

Blood film association

Reactive lymphocytes: infectious mononucleosis
Large granular lymphocytes: large granular lymphocytic leukemia
Smudge cells: chronic lymphocytic leukemia
Blasts: acute lymphocytic leukemia

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4
Q

Patients with ______________________ leukemia may have only transient lymphocytosis that is induced by stress or exercise.

A

Large granular lymphocytic leukemia

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5
Q

A syndrome in patients who have expanded populations of monoclonal B cells without other associated clinical signs or symptoms

A

Monoclonal B-Cell Lymphocytosis

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6
Q

Defined as the expansion of a monoclonal population of B cells with an absolute B-cell count of less than 5.0 × 10 9 /L in the absence of organomegaly, lymphadenopathy, extramedullary involvement, and cytopenias

A

Monoclonal B-Cell Lymphocytosis

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7
Q

Absolute B cell count of Low-count MBL/ screening MBL

A

<0.5 × 10 9 /L

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8
Q

Absolute B cell count of High-count MBL/clinical MBL

A

≥0.5 × 10 9 /L

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9
Q

TRUE OR FALSE

Individuals with known high-count MBL should not be considered suitable for blood donation

A

TRUE

Individuals with known high-count MBL should not be considered suitable for blood donation, and whether this applies to low-count MBL is a matter of investigation.

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10
Q

TRUE OR FALSE

Low-count MBL require routine followup by a hematologist because of the progression of low-count MBL to high-count MBL and CLL.

A

FALSE

Low-count MBL does not require routine followup by a hematologist because the progression of low-count MBL to high-count MBL and CLL is negligibe

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11
Q

TRUE OR FALSE

High-count MBL is biologically indistinguishable from CLL. High-count MBL is characterized by having a higher risk of infection, development of nonhematologic cancer, and progression to CLL compared with low-count MBL.

A

TRUE

High-count MBL is biologically indistinguishable from CLL. High-count MBL is characterized by having a higher risk of infection, development of nonhematologic cancer, and progression to CLL compared with low-count MBL.

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12
Q

The risk of progression requiring CLL-specific treatment among individuals with high-count MBL

A

1%–2% per year

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13
Q

Patients with high-count MBL are at an increased risk of developing a nonhematologic cancer (breast, lung, and gastrointestinal tract) by a factor of

A

2

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14
Q

Individuals with high-count MBL should be followed with a physical examination and complete blood count with differential counts by a hematologist every _______ months, and monitored for progression to CLL

A

6–12 months

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15
Q

A chronic, moderate increase in absolute lymphocyte counts (>4 × 10 9 /L) without evidence for infection or other conditions that can increase the lymphocyte count

A

Persistent Polyclonal Lymphocytosis of B Lymphocytes

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16
Q

Mostly affects middle-aged women who often are human leukocyte antigen DR7–positive and is associated with smoking.

A

Persistent Polyclonal Lymphocytosis of B Lymphocytes

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17
Q

Characteristic of lymphocytes in Persistent Polyclonal Lymphocytosis

A

CD27+ IgM+IgD+ B cells
Binucleated lymphocytes
Increased IgM serum levels

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18
Q

Specific morphologic features predictive of Persistent Polyclonal Lymphocytosis of B Lymphocytes

A

Basophilic vacuolated cytoplasm and monocytoid changes

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19
Q

Conditions associated with an increase in the absolute number of lymphocytes secondary to a physiologic or pathophysiologic response to infection, toxins, cytokines, or unknown factors.

A

SECONDARY (REACTIVE) LYMPHOCYTOSIS

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20
Q

The most common reactive lymphocytosis

A

Infectious Mononucleosis

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21
Q

In cases of mononucleosis secondary to infection with Epstein-Barr virus (EBV), the atypical lymphocytes commonly consist of polyclonal populations of

A

CD8+ T cells, γ/δ T cells, and CD16+CD56+ NK cells

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22
Q

A disorder that occurs in children usually between the ages of 2 and 10 years’ characterized by an increase in blood lymphocytes, often to 20–30 × 10 9 /L and occasionally as high as 100 × 10 9 /L

A

Acute infection lymphocytosis

**Lymph node enlargement and splenomegaly do not occur
**Patient’s serum usually is negative for heterophile antibodies
**Caused by cytomegalovirus, coxsackievirus B2

23
Q

Characteristic of the lymphocytes in cases of pertussis

A

Lymphocytes have cleaved nuclei

24
Q

Pathophysiology of lymphocytosis in pertussis

A

Lymphocytosis in pertussis is polyclonal with a normal T:B lymphocyte ratio and primarily results from failure of lymphocytes to leave the blood because of pertussis toxin

25
Q

Result from expansions of NK cells, CD8+ T cells, or, more rarely, CD4+ T cells

A

Large granular lymphocytosis (LGL)

26
Q

The lymphocytosis in LGL is secondary to ______________NK cells and is termed NK lymphocytosis

A

CD3–CD16+CD56+ NK cells

27
Q

LGLL is a heterogeneous disorder characterized by an increase in the number of blood large granular lymphocytes between 2 and 20 × 10 9 /L for more than ____________ without a clearly identified cause

A

Six months

28
Q

Most notable mutation in T-LGLL and NK-LGLL

A

STAT3 and STAT5B

29
Q

STAT3 or STAT5B

Less common and are associated with a more aggressive disease.

A

STAT5B

30
Q

LGLL and chronic NK lymphocytosis are considered indolent diseases with a median survival of ______years

A

9–10 years

31
Q

Neutropenia and association with rheumatoid arthritis is more associated with ______ LGLL

A

T-LGLL

32
Q

LGL has been observed in 20% of allogeneic hematopoietic cell transplant recipients for a variety of malignancies, with a median onset of _____ days from transplant

A

312 days

33
Q

Patients with NK lymphocytosis frequently have recurrent cutaneous lesions, such as:

A

Livedoid vasculopathy, urticarial vasculitis, or complex recurrent aphthous stomatitis

34
Q

Drugs associated with lymphocytosis when used for chronic myelogenous leukemia and CLL

A

Dasatinib and ibrutinib

35
Q

TRUE OR FALSE

Some studies suggest that lymphocytosis after dasatinib is associated with a favorable response in chronic myelogenous leukemia.

A

TRUE

Some studies suggest that lymphocytosis after dasatinib is associated with a favorable response in chronic myelogenous leukemia.

36
Q

TRUE OR FALSE

The prolonged lymphocytosis in CLL taking Ibrutinib likely represents a persistent quiescent clone and is not associated with a risk of relapse

A

TRUE

The prolonged lymphocytosis in CLL taking Ibrutinib likely represents a persistent quiescent clone and is not associated with a risk of relapse

** this resolves within 8 months in most patient

37
Q

Two phases of stress lymphocytosis after catecholamine administration:

A

A quick (<30 min) mobilization of lymphocytes, followed by an increase in granulocyte numbers with decreasing lymphocyte numbers

38
Q

Delayed hypersensitivity reactions to insect bites, especially__________, may be associated with a large granular lymphocytic lymphocytosis and adenopathy.

A

Mosquitos

39
Q

Neoplastic disease that may have a polyclonal T-cell lymphocytosis thought to be secondary to the aberrant release of hormones by the neoplastic epithelium.

A

Malignant thymoma

40
Q

Lymphocytopenia is defined as a total lymphocyte count less than

A

1.0 × 10 9 /L

**but some consider the lower limit of normal to be 1.5 × 10 9 /L

41
Q

Approximately 80% of normal adult blood lymphocytes are ______lymphocytes and nearly two-thirds of blood T lymphocytes are ____________T lymphocytes

A

T lymphocytes

CD4+ (helper) T lymphocytes

42
Q

Average absolute number of T lymphocytes in normal adult blood

A

1.9 × 10 9 /L
ranging from 1.0–2.3 × 10 9 /L

43
Q

Average absolute number of CD4+ T lymphocytes

A

1.1 × 10 9 /L
ranging from 7.2–14 × 10 8 /L

44
Q

Average absolute number of CD8+ T lymphocytes

A

6.5 × 10 8 /L
ranging from 3.8–9.7 × 10 8 /L

45
Q

Condition with associated lymphopenia because of premature destruction of T cells secondary to a defect in the lymphocyte cytoskeleton

A

Wiskott-Aldrich syndrome

46
Q

Ethnic groups that have lower CD4+ T-cell counts in the absence of other identified factors

A

Ethiopians and Chukotka natives

47
Q

The most common infectious disease associated with lymphopenia

A

AIDS caused by HIV

**Destruction and/or clearance of CD4+ T cells infected with HIV-1 or HIV-2

48
Q

TRUE OR FALSE

Lymphopenia is considered a surrogate marker for sepsis-induced immunosuppression and identifies a subpopulation of patients at a higher risk of death

A

TRUE

Lymphopenia is considered a surrogate marker for sepsis-induced immunosuppression and identifies a subpopulation of patients at a higher risk of death

49
Q

Presence of_________ antibodies was independently associated with disease activity and lupus nephritis

A

Antilymphocyte antibodies

50
Q

TRUE OR FALSE

Lymphocytopenia remains a strong predictor of all-cause or cardiovascular mortality

A

TRUE

Lymphocytopenia remains a strong predictor of all-cause or cardiovascular mortality

51
Q

Deficiency of this mineral leads to a significant decrease in the development of B cells in the bone marrow.

A

Zinc

52
Q

Defined by the WHO as a CD4+ T-lymphocyte count less than 0.3 × 10 9 /L on two separate occasions in patients without serologic or virologic evidence of HIV-1 or HIV-2 infection or any other cause of immunodeficiency.

A

Idiopathic CD4+ T lymphocytopenia (ICL)

**Unlike in HIV infection, the decrease in the CD4 cell counts of patients with ICL is generally slow.

53
Q

A mutation in the ______ gene led to an immunodeficiency syndrome manifesting as an absence of B cells, agammaglobulinemia, and infections highlighting the importance of zinc in B-cell development

A

ZIP7 gene

WILLIAM'S HEMATOLOGY (90 decks)

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