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Flashcards in Immuno 4 Deck (18)
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Lymphopenia (lymphocytopenia)-nonprolif WBC disorder

Not very common
Often secondary to disease or therapy/drugs
Reduced lymphocytes in blood (


Leukopenia (leukocytopenia)-nonprolif WBC disorder

Reduced granulocytes
Neutropenia as reduced neutrophils (


Leukocytosis-Reactive proliferative WBC disorder

Classified according to cellular subtype
 Neutrophilic leukocytosis:
As a result of bacterial infection or sterile inflammation (burns, myocardial infarction)
Eosinophilic leukocytosis (eosinophilia):
As a result of allergic reactions, parasitic infections
Basophilic leukocytosis (basophilia)
not common, usually associated with other conditions such as neoplastic disease
often associated with chronic infections


Leukocytosis in Infectious mononucleosis

Caused by EBV infection
Characterized by fever, sore throat, lymphadenitis & lymphocytosis of CD8+ T cells
Monospot test is diagnostic



Reactive proliferative WBC disorder
Lymphadenitis (inflammation of lymph node) is usually associated with lymphadenopathy (enlargement/swelling)
Cat scratch lymphadenitis by Bartonella henselae


Acute lymphadenitis is characterized by

enlarged B cell germinal centers


Chronic lymphadenitis occurs as:

Follicular hyperplasia: Activated B cells migrate into follicular zone
Paracortical (mantle) hyperplasia: Activation of interfollicular T cells that proliferate and displace B cell germinal centers
Sinus histiocytosis (draining sinuses): Distention of lymphatic sinusoids due to endothelial hypertrophy and infiltration of macrophages (histiocytes)


Neoplastic WBC Disease

Malignant leukocytes arise form either myeloid (RBC/granulocyte series) or lymphoid (T/B) cells representing arrested development
Cancers arising from early progenitor cells will be ‘blastic’ cancers (acute lymphoblastic leukemia)
WBC cancers arising in the bone marrow/thymus are leukemias
WBC cancers arising from germinal lymphoid tissues are lymphomas
‘acute’ vs ‘chronic’


Acute Lymphoblastic Leukemia/Lymphoma (ALL)

ALLs constitute 80% of childhood leukemias
B-cell origin in children by 4 years, while T-cell origin late teens
Clinically manifests as abrupt onset with anemic fatigue, fever from infections, bleeding, bone pain
Generalized lymphadenopathy, splenomegaly & hepatomegaly as well as CNS symptoms (vomiting, headaches) are more common in ALL than CML


B-ALLs can have

the 9:22 translocation of Philadelphia chromosomes as in CML, usually non-random karyotypic abnormalities


Acute myeloid leukemia (AML)

Myeloproliferative disorders result from acquired genetic abnormalities in myeloid cell progenitors that lead to excessive proliferation and diminished function
-AML neoplastic block of myeloid blast cell differentiation
-Auer rods


Chronic myeloid leukemia (CML) & Philadelphia chromosome

CML is a chronic myeloproliferative disorder with large numbers of mature, but functionally abnormal myeloid (granulocyte) cells
 -Associated with Philadelphia chromosome, a translocation between the bcr gene & abl proto-oncogene: t(9;21)
Generally affects adults (25-60 years) with initial onset of disease with nonspecific symptoms


Hodgkin’s Lymphoma

Classical Hodgkin's disease demonstrates a moderate number of Hodgkin's cells with identifiable Reed-Sternberg cells
Reed-Sternberg cells have a characteristic morphologic appearance with a bilobed (mirror image), nucleus prominent eosinophilic nucleoli and a moderate-to-abundant amount of cytoplasm
Large cells measuring 15-45 um
typically express CD30, CD15


Hodgkin’s (vs non)

Usually localized to single group of nodes
Orderly, contiguous (direct) spread
Mesenteric nodes and Waldeyer ring (tonsillar/nasal-associated lymphoid tissue) rarely involved
Extranodal involvement uncommon



Frequent involvement of peripheral nodes
Noncontiguous spread
Mesenteric nodes and Waldeyer ring involvement
Extranodal involvement common


Hodgkin’s: Nodular sclerosis

Most common form of Hodgkin’s
Typically involves cervical, supraclavicular & mediastinal lymph nodes
‘Lacunar’ type RS cells that is multilobulated


Hodgkin’s: Mixed cellularity

Most common form of Hodgkin’s in pts >50 years with male predominance
Disseminates more than nodular sclerosis type
Lacks dense bands of collagen seen in NS, but abundant eosinophils & Hodgkin's cells


Hodgkin’s: Lymphocyte-predominace

RS cells have multilobed, puffy nucleus
B cells express fail to express CD15 & CD 30 unlike other RS cells