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Block 7; Week 1-Michelle > Benign WBC Abnormalities-Usera > Flashcards

Benign WBC Abnormalities-Usera Flashcards

1
Q

What are 4 ways to take lab measurements of WBCs?

A
  1. automated hematology analyzers-gives CBC
  2. bone marrow aspirate & biopsy
  3. flow cytometry
  4. peripheral blood smears
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2
Q

What are 3 factors affecting neutrophil conc’n in blood?

A
  1. bone marrow production & release
  2. rate of egress to tissue or survival time in blood
  3. ratio of marginated to circulating neutrophils in peripheral blood (MGP/CGP)
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3
Q

What is the definition of neutrophilia?

A

lots of neutrophils!
absolute neutrophil count>7X10^9
could be b/c of physiologic or pathologic process

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4
Q

What are the 3 types of neutrophilia kinetics? What is the timeframe for each?

A

Immediate: 20-30 min
Acute: 4-5 hrs
Chronic: days after

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5
Q

What happens in the immediate stage of neutrophilia kinetics?

A

20-30 min
redistribution from marginated to circulating pool
**can be stimulated by stress, steroids, epinephrine, IL-6

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6
Q

What happens during the acute stage of neutrophilia kinetics?

A

release of neutrophils from marrow storage pool to blood

**prompted by IL-6

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7
Q

What happens during the chronic stage of neutrophilia kinetics?

A

increase in marrow mitotic pool

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8
Q

Give 6 causes of neutrophilia.

A
  1. Acute inflammation
  2. Acute Infection
  3. Tissue Necrosis
  4. Drugs, Toxins, Metabolites
  5. Physiologic Cause
  6. Neoplastic Process
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9
Q

What are some possible causes of tissue necrosis–leading to neutrophilia?

A

burns
ischemic necrosis
tissue damage

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10
Q

What are some possible causes of neutrophilia via drugs, toxins, metabolites?

A 
corticosteroids
smoking
growth factors
uremia
ketoacidosis
lithium
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11
Q

What are some possible physiologic causes of neutrophilia?

A

stress
exercise
pregnancy

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12
Q

From a myeloblast to a mature neutrophil…what are the in between steps?

A
  1. Myeloblast
  2. Promyelocyte
  3. Myelocyte
  4. Metamyelocyte
  5. Band
  6. Mature Neutrophil
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13
Q

What is a myeloblast like?

A

a ton of nucleus
not much cytoplasm
high N/C ratio
only seen in the bone marrow

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14
Q

What is the promyelocyte like?

A

condensed chromatin in the nucleus
granules in the cytoplasm
still high N/C ratio

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15
Q

What is the myelocyte like?

A

smaller granules
chromatin super condensed in nucleus
there is a paranuclear glob that is the golgi
it is committed cell

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16
Q

What is the metamyelocyte like?

A

nucleus is kidney-bean shaped

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17
Q

What is a band like?

A

C shaped nucleus

still some granules

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18
Q

What is a mature neutrophil like?

A

polymorphonuclear
nuclear segmentation
still some granules

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19
Q

What does it mean when a doc says that a patient has left shifted & has more bands?

A

this is an acute response to infection

the bone marrow is just trying to spit out neutrophils to fight…get immature bands.

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20
Q

What is the lifespan of a mature neutrophil?

A

4-5 hours

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21
Q

What is an example of ischemic necrosis that could cause neutrophilia?

22
Q

What level of neutrophils qualifies as reactive neutrophilia? What does this form of neutrophilia do to myeloid maturation?

A

neutrophils<30X10^9

shift left in myeloid maturation

23
Q

Give some morphologic alterations in neutrophils & precursors that are frequently seen in reactive neutrophilia.

A

toxic granulation
dohle bodies
vacuolization

24
Q

What is the leukemoid reaction?

A

looks like leukemia, but isn’t.

A benign leukocyte proliferation with WBC usually >50 x 109/L with many circulating immature leukocyte precursors

Blasts are occasionally present; exclude chronic myelogenous leukemia with cytogenetics and LAP score

25
Give some examples of cases with the leukemoid reaction.
perforated appendicitis whooping cough (lots of lymphocytes) cutaneous larva migrans (lots of eosinophils)
26
What is the leukoerythroblastic reaction?
Characterized by presence of nucleated RBC and a shift to the left in granulocyte maturation Often associated with myelophthisic processes, severe hemorrhage, hemolytic anemia, or myelodysplastic syndromes white nucleated RBCs, left shift **bone marrow responding to a deficit in the body
27
What neutrophil count qualifies as neutropenia? In Caucasian? In African Americans?
Caucasians: ANC<1.3X10^9
28
What qualifies as agranulocytosis?
ANC<0.5X10^9
29
WHat are 3 mechanisms for neutropenia?
1. decreased marrow production 2. increased cell loss or tissue egress 3. pseudoneutropenia (endotoxin)
30
What are some drug causes of neutropenia?
``` EtOH benzene chloramphenicol chemotherapy antibiotics benzodiazepines clozapine ```
31
What are some intrinsic defects (rare) that could possibly cause neutropenia?
Fanconi's Kostmann's Cyclic Neutropenia Chediak-Higashi
32
What are some overwhelming infectious causes of neutropenia?
TB sepsis brucellosis
33
What are some hematologic disorder causes of neutropenia?
megaloblastic anemia myelodysplasia marrow failure hypersplenism
34
What are some autoimmune causes of neutropenia?
lupus | rheumatoid arthritis
35
T/F Cachexia & debilitated states can cause neutropenia.
True.
36
What's the deal with clozapine?
the FDA no longer approves it in the US it is a good anti-psychotic med it rarely causes agranulocytosis, neutropenia
37
What's the fun pneumonic to remember the deal with brucellosis?
brucella is a gram neg coccus infects bone marrow comes from livestock Betsy the Bovine had Brucellosis in the Bone Marrow
38
Give some viral infections associated with neutropenia.
Influenza, Measles, Chicken pox, Colorado tick fever, Dengue, Infectious mononucleosis, Poliomyelitis, Psittacosis, Sand-fly fever, Smallpox, Rubella, Infectious hepatitis
39
Give some bacterial infections associated with neutropenia.
Typhoid, Bacillary dysentery, Paratyphoid, Brucellosis, Ehrlichiosis
40
Give some rickettsial causes of neutropenia.
Rickettsial pox, Typhus, Rocky Mountain Spotted Fever
41
Give some protozoal causes of neutropenia.
Malaria, Kala-azar (visceral leishmoniasis), Relapsing fever
42
Give some causes of myeloid hypoplasia.
fanconi's anemia kostmann's syndrome cyclic neutropenia
43
Give a condition of maturation defects that can cause neutrophil disorders.
chediak higashi
44
What's the deal with fanconi's anemia?
PANMYELOID HYPOPLASIA-affects everything in the bone marrow. HETEROGENOUS DISEASE CAUSED BY CHROMOSOMAL INSTABILITY, DNA breakagex PRESENTS IN CHILDHOOD WITH APLASTIC ANEMIA AND CONGENITAL PHYSICAL MALFORMATIONS-no thumbs, radius problems. SUSCEPTIBLE TO HEMATOPOIETIC AND SOLID ORGAN MALIGNANCIES
45
What's the deal with Kostmann's syndrome?
SYNDROME (INFANTILE GENETIC CONGENITAL AGRANULOCYTOSIS) ANC <200/UL VARIABLE MODES OF INHERITANCE EARLY MYELOID PRECURSORS IN MARROW, BUT DO NOT MATURE ELA2 AND HAX-1 IMPLICATED
46
What's the deal with cyclic neutropenia?
Presents in infancy or childhood Rare autosomal dominant trait with variable expression 21-30 day periodicity ANC < 0.2 x 109/L for several days Infection, fever, malaise during neutropenic period Associated with transient marrow hypoplasia Associated with ELA2 gene mutation (neutrophil elastase
47
How would you go about diagnosing cyclic neutropenia? What would you order?
CBC peripheral smear bone marrow aspirate & biopsy flow cytometry
48
What are the 2 most common causes of congenital neutropenias?
pregnancy induced HTN | infection
49
What are some things that are found in lab error neutropenia--spurious neutropenia?
EDTA-dependent agglutinin, affects calcium, platelets, neutrophil counts Old specimen WBC fragility Paraprotein-found in patients with multiple myelomas
50
How can you clinically differentiate b/w a folate & a Vit B12 deficiency?
folate has no neurological symptoms. B12 does have neurological symptoms put a tuning fork on the foot...if can't feel it--TVP compromised. B12 problem.
51
What's the deal with chronic granulomatous disease?
* *Sex-linked and autosomal recessive inheritance patterns * *Defect in respiratory burst oxidase system * *Presents in childhood with recurrent infections with low-grade pathogens * *Formation of granulomas when neutrophils phagocytose, but do not kill, organisms * *Defects in membrane-associated cytochrome b (subunits gp91 and p22), and cytosol-associated p47 and p67.
52
How do you go about diagnosing chronic granulomatous disease? how do you treat it?
Nitroblue Tetrazolium Test (NBT): normal neutrophils produce H2O2 and O2- which reduce yellow NBT to blue formazan; CGD neutrophils cannot reduce NBT. **treat with prophylactic antibiotics

Block 7; Week 1-Michelle (7 decks)

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