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LAMP Week 3 > Leukocytosis and Leukopenia > Flashcards

Leukocytosis and Leukopenia Flashcards

1
Q

What is the most important number regarding WBCs?

A

the ABSOLUTE COUNT NOT the % of each cell type

*normal ranges for leukocyte numbers are AGE DEPENDENT

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2
Q

What is the most important number regarding WBCs?

A

the ABSOLUTE COUNT NOT the % of each cell type

*normal ranges for leukocyte numbers are AGE DEPENDENT

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3
Q

72 year old African American male presents to dialysis clinic and complains of feeling tired. A CBC (ordered without a differential count) shows increased WBC. A chest x-ray is somewhat suggestive of an infiltrate and he is started on an
empiric antibiotic

Initially:

  • Normocytic anemia
  • Leukocytosis
  • Elevated RDW

Three days later the WBC is normal but he has a rash and lymphadenopathy so a CBC w/ automated dif is ordered.

A
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4
Q
A

You don’t know until you get a diff count!! This shows neutrophilia

                                                                                                                                                                                                              ...get a blood smear
  • w/ fever plus neutrophilia think sepsis and get blood cx
  • sepsis plus thrombocytopenia could be DIC so get coags
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5
Q

What is a leukoerythroblastic reaction?

A

Leukoerythroblastic reaction means that there are immature myeloid cells and nucleated red cells on the blood smear.

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6
Q

What are signs of a systemic bacterial infection?

A

marked toxic change
frequent left shift
leukoerythroblastic reaction
DIC

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7
Q

What do neutrophils do?

A

Host defense!!

  • protect against infectious organsims
  • move rapidly into tissue sites of infection/inflammation
  • phagocytize and digest microorganisms

left shift (increase in number of immature leukocytes in the blood, particularly neutrophil bands)

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8
Q

What caues neutrophilia?

A
  1. Infections (pyogenic bacteria)
  2. tissue damage
  3. acute hemolysis
  4. acute blood loss
  5. inflammatory disorders
  6. Metabolic
  7. physiolgoic
  8. surgical
  9. neoplasms
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9
Q

What caues neutrophilia?

A
  1. Infections (pyogenic bacteria)
  2. tissue damage
  3. acute hemolysis
  4. acute blood loss
  5. inflammatory disorders
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10
Q

72 year old African American male presents to dialysis clinic and complains of feeling tired. A CBC (ordered without a differential count) shows increased WBC. A chest x-ray is somewhat suggestive of an infiltrate and he is started on an
empiric antibiotic

Initially:

  • Normocytic anemia
  • Leukocytosis
  • Elevated RDW

Three days later the WBC is normal but he has a rash and lymphadenopathy so a CBC w/ automated dif is ordered.

A
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11
Q
A

You don’t know until you get a diff count!! This shows neutrophilia

                                                                                                                                                                                                              ...get a blood smear
  • w/ fever plus neutrophilia think sepsis and get blood cx
  • sepsis plus thrombocytopenia could be DIC so get coags
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12
Q

What is a leukoerythroblastic reaction?

A

Leukoerythroblastic reaction means that there are immature myeloid cells and nucleated red cells on the blood smear.

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13
Q

What are signs of a systemic bacterial infection?

A

marked toxic change
frequent left shift
leukoerythroblastic reaction
DIC

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14
Q

The risk of infection is…

A
  1. greater when neutrophils are DECREASING than when increasing
  2. greater when associtaed with mono/lymphopenia or hypogammaglobulinemia
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15
Q

neutrophil fxn?

A
  • move reversibly between circulating and marginated pools

- rapid transit through circulation (t1/2 6-9 hrs)

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16
Q

What caues neutrophilia?

A
  1. Infections (pyogenic bacteria)
  2. tissue damage
  3. acute hemolysis
  4. acute blood loss
  5. inflammatory disorders
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17
Q

What drugs cuase neutrophilia?

A

steroids
lithium
growth factors
cigarette smoking

18
Q

What is the impt number to remember with neutrophilia?

A
19
Q

9mo M w/ one week history of fever and diarrhea

Initial CBC (no diff!):

  • normal WBC
  • thrombocytopenic

CBC w/ diff:
-marked neutropenia!!

Blood smear

  • marked neutropenia w/ reactive neutrophil changes
  • reactive lymphocytes

Suspect….

A

acute bacterial sepsis or viral syndrome

20
Q

what is neutropenia?

A

decrase in absulte number of circulating neutrophils

<1800 in adults

<100 in children (2wks to one year)

**Lower limit of normal is for WHITE PEOPLE

21
Q

the risk of infection is _____correlated wtih severity of neutropenia

A

INVERSELY

more severe neutropenia leads to a markedly increased risk of infxn

22
Q

basophils

A

key mediator of immediate hypersensitivity rxns (ashtma, uriticaria, anaphylaxis)
host resistance to certian parasites

23
Q

What causes monocytosis?

A 
endocarditis
TB
syphillis
Bacterial (mphage in sepsis)
Viral (CMV, VZV
GI
Sarcoid
HOdgkins
Myeloid
solid tumor
24
Q

What is hte MCC of monocytosis?

A

infections

*more typical of chronic infections

25
Q

What are causes of monocytopenia?

A

aplastic anemia
b cell leukemias
steroids

26
Q

62 yo F w/ respiratory distress

- eosinophilia

A

Eosinophilia!! Get a dif!!!!

27
Q

What is the MCC world wide of eosinophilia?

A

parasitic infections

US – allergic reactions (including drug hypersensitivity)

28
Q

healthy 16 yo F seeking birth control
- normocytic anemia

smear:

  • moderate neutrophilia w/ left shfit
  • moderate BASOPHILIA
  • hypercellular bone marrow
  • 9;22 translocation
A

CML

29
Q

What are hte MCC of basophilia?

A

renal failure
thyroid dysfunction
neoplastic myeloproliferative disorders

30
Q

What are cuases of mono syndromes?

A 
EBV (60% young kids, 90% adults)
CMV
HHV6
HSV
VZV
HIV
HEP A, B,C
Adeno
toxo
pertussis
31
Q

what are mono syndromes characterized by?

A

mild absolute lymphocytosis (>4 but <20)

32
Q

24 yo female w/ worst flu of my life, no sore throat but swolllen cervical nodes and ache in RUQ of belly

  • thrombocytopenia
  • erythrocytosis
  • neutropenic
  • lymphocytosis
A

Monospot
EBV IgG/M antibody

– consider ordering a DAT and a blood smear for morphology

33
Q

What is acute retroviral syndrome?

A 
1-3 weeks after primary infection
fatigue, malaise
high fever
HA
photophobia
persistent generalized lymphadenopathy
34
Q

what is the MCC of lymphocytosis?

A

mononucleosis type infections

35
Q

if absolute lymphocyte count is gerater than 20,000 what is most likely

A

neoplastic process

36
Q

what are causes of lymphocytopenia?

A 
congenital immunodeficiencies
viral infections (HIV, HHV)
SLE
sarcoid
zinc def
malignant lymphoma
hodgkins
37
Q

what are drug related cuases of lymphocytopenia?

A

steroids
immunosuppresive agents
antineoplastic agents
radiation therapy

38
Q
A

steroids?

39
Q

60 yo F comes back from cabing w/ worst flu of my life

  • leukopenia
  • neutrophilia
  • thrombocytopenia
A

Anaplasma positive!

40
Q

51 yo M previously healthy w/ suicidal ideation

- leukocytosis, monocytosis

A

smoking?

41
Q

Which of the following IS NOT associated with NEUTROPHILIA?
A.Acute bacterial infections. B.Aplastic anemia due to total body irradiation.
C.Cigarette smoking D.Lithium therapy
E.Steroid therapy.

A

B

LAMP Week 3 (11 decks)

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