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lymphocyte disorders Flashcards

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1
Q

types of WBCs

A

neutrophils (60-70%)
lymphocytes (25-35%)-> T, B, and NK cells
monocytes (3-7%)
eosinophils (0-3%)
basophils (0-1%)

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2
Q

types of leukopenias

A

neutropenias
lymphocytopenia
monocytopenia
eosinophilia
basophilopenia

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3
Q

neutropenia

A

measured by ANC (absolute neutrophil count=% of neutrophils x WBCs)
<1500 cells per microliter is neutropenia
lower ANC= increased risk of infection
mild= 1000-1500 cells
moderate=500-1000 cells
severe= <500 cells

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4
Q

causes of neutropenia

A

chemo/radiation
antivirals
immunosuppressive drugs
autoimmune disorders
AIDs
parvovirus
leukemias
folic acid and vit. 12 deficiencies
direct injury to BM

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5
Q

complications of neutropenia

A

pneumonias
UTIs
cellulitis
delayed symptoms

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6
Q

diagnosis of neutropenia

A

fever
sepsis
ANC
peripheral blood smear
WBC
bone marrow biopsy
chest x-ray (can indicate of TB or pneumonia)

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7
Q

treatment of neutropenia

A

neupogen w/ chemo
stem cell transplant
stop meds
prophylaxis= used to reduce incidence and severity of infections in high risk patients

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8
Q

febrile neutropenia

A

fever may be the only symp
get cultures
empiric broad-spectrum treatment AFTER cultures

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9
Q

neutrophilia

A

caused by infection, response to inflammatory mediators, drug (steroids)
ANC= >7700 cells
get cultures
bone marrow biopsy
search for site of infection

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10
Q

lymphocytes

A

develop in bone marrow, lymph node, spleen, tonsils

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11
Q

lymphocytopenia

A

ALC= <1000 cells
decreased lymphocyte production
increased lymphocyte destruction
altered lymphocyte traffic b/w body sites
viruses
immunosuppression
infection
surgery
hemorrhage
trauma

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12
Q

assessment and management of lymphocytopenia

A

treat underlying condition/ precipitating disorder

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13
Q

lymphocytosis

A

ALC>4000 cells
viral and bacterial infections
medication rxn
stress rxn
cancer
evaluate morphology of cells
access levels of B and T cells

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14
Q

eosinophils

A

produced in bone marrow
eosinophilia= AEC>500 cells
hypereoisinophilia= AEC>1500 cells
HES= AEC>1500 cells on 2 occasions/ > 1 month apart/ organ dysfunction

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15
Q

causes of eosinophilia

A

allergies
infections
inflammation
neoplastic disorder

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16
Q

symptoms of eosinophilia

A

vague and asymptomatic
may be related to cause
fever
night sweats
wheezing and rhinitis
chest pain/SOB
neuropathy
abdominal pain
dermatitis

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17
Q

diagnosing eosinophilia

A

CBC and peripheral smear
infection and drug exposures
genetic causes
stool culture for parasites
cardiac testing
vit. B12 levels

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18
Q

treatment of eosinophilia

A

treat or remove secondary cause (allergen, parasite, drug)
high dose of glucocorticoids
IFN alpha for steroid resistant disease
chemo meds

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19
Q

monocytosis

A

increased monocyte circulating in blood
give rise to macrophages and dendritic cells
chronic infection
hodgkin’s disease and other cancers
hematologic malignancies

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20
Q

lymphadenopathy

A

normal immune rxn leads to proliferation of cells in nodes
nodes= >1 cm in adults require investigation
location indicates affected region
may indicate systemic disorder

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21
Q

causes of lymphadenopathy

A

infections
immune disorders
endocrine disorders

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22
Q

diagnosis of lymphadenopathy

A

size
consistency
fixation
tenderness
<2-3 cm= soft lymph node (observe over few days, CBC and peripheral blood smear)
>2-3 cm= grows over a few wks (biopsy or imaging, CBC and peripheral blood smear)

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23
Q

spleen

A

largest lymphatic organ
filters blood and removes old RBCs
contains immune cells (macrophages, B and T cells)

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24
Q

absence of spleen

A

post splenectomy
nonfunctional spleen (sickle cell)-> autosplenectomy
presence of howell-jolly bodies
increased risk of infection

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25
causes of splenomegaly
bacterial infections immune disorders malignancies of the immune system hematologic disorders
26
diagnosis and treatment of splenomegaly
physical exam blood work and imaging splenectomy
27
myleoproliferative disorder
>55 yrs primary myleofibrosis essential thrombocytopenia polycythemia vera
28
primary myleofibrosis
bone marrow stromal cell (CT) rxn causes excessive deposition of matrix proteins results in collagen deposition, angiogenesis, osterosclerosis can lead to leukemia risk for infections
29
symptoms of myelofibrosis
anemia splenomegaly fever, night sweats, weight loss
30
diagnosis of myelofibrosis
H&P CBC, BM, and peripheral smear difficult to obtain BM immature RBCs and leukocytes in peripheral blood
31
treatment of myelofibrosis
palliative RBC GF or transfusions to manage anemia steroids stem cell transplant
32
essential thrombocythemia
excess platelets produced NOT true hematologic disorders reactive response inflammation and thrombosis of small vessels can lead to thrombic occlusion, hemorrhage, primary myleofibrosis headaches lightheadnesses visual symps palpitations chest pain
33
diagnosis and treatment of essential thrombocythemia
platelet count= >500,000 reduce platelet count= hydroxurea-> target < 400,000 heparin and warafin asprin
34
thrombocytopenia
platelet count= <150,000 platelet destruction (ITP, DIC, HIT) drug induced increased utilization abnormal distribution (splenic sequestration) decreased production (leukemia, B12, folate, and iron deficiency)
35
symptoms of via platelet count
>50,000= asymp; may bleed longer w/ trauma 25-50k= petechiae and bruising w/ minor trauma 10-25K= spontaneous petechiae and bruising, menorrhagia <10,000= prominent bruising, mucosal bleeding, risk of CNS bleed repeat platelets to rule out pseudothrombocytopenia
36
causes of thrombocytopenia
congenital recent infection drugs critical illness bacterial sepsis collagen vascular disease hematologic or oncologic malignancy
37
diagnosis of thrombocytopenia
H&P CBC bone marrow biospy peripheral blood smear
38
ITP
chronic immune thrombocytopenic purpura most common cause of isolated thrombocytopenia antibody coated platelets are destroyed
39
diagnosis of ITP
normal physical exam except for thrombocytopenia petechiae, purpura, mucosal bleeding normal or increased megakaryocytes no evidence of other causes of thrombocytopenia no adenopathy or splenomegaly
40
treatment of ITP
emergent therapy (IVIG or methylprednisone) PTL transfusion if bleeding long term therapy (goal is PTL count >25-30K)-> prednisone and IVIG splenectomy
41
DAIT
disease associated immune thrombocytopenia autoimmune collagen vascular disease (lupus)-> autoantibodies target platelets-> treat like ITP (IVIG, steroids, splenectomy) lymphoproliferative disorders (adenopathy and splenomegaly)-> treat underlying disease
42
allo immune thrombocytopenia
typically seen in women due to alloimmunization from previous transfusion or pregnancy appears 7-10 days after a blood transfusion rxn spreads to patient PLTs-> rapid development of purpura after transfusion PLT=<10,000 (extremely low)
43
diagnosis and treatment of post transfusion purpura
self-limiting and resolves 2-6 wks without treatment risks of intercranial hemorrhage (indicates use of IVIG steroids) plasma exchange used if IVIG fails PLT transfusions NOT effective (only in cases of severe bleeding)
44
causes of DITP
drug binds to carrier protein triggers antibody formation thrombocytopenia develops within days as PTLs decrease-> petechiae, bruising, mucosal bleeding nausea vomiting rash fever
45
diagnosis and treatment of DITP
drug history thrombocytopenia after drug exposure (DRUG SHOULD BE STOPPED) resolution= 7-10 days (3-4 wks-months to fully recover) PLT transfusion or IVIG steroids in severe bleeding
46
HIT
caused via IgG antibodies and bind to platelet membrane receptor thrombocytopenia and platelet activation potentially fatal venous or arterial thrombosis can develop 5-10 days after starting heparin (within hrs if used longer) thrombosis seen within 7 days after decreased PLTs
47
diagnosis of HIT
monitor PLT every other day in post-op patients receiving heparin PLT= <150,000 or decreaed 50% from baseline within 5-10 days after starting heparin ultrasound bleeding is uncommon and thrombosis develops in 50%
48
confirming HIT
HIT antibody testing immunoassay (detect antibodies in blood) functional assay serotonin release assay (measures platelet activation level)
49
treatment of HIT
discontinue heparin start alternative anticoagulant
50
NIRPD
non-immune related platelet disorders TTP HUS DIC infections kasabach-merritt syndrome massive transfusion enlarged spleen reduced platelet production congenital diseases
51
TTP
thrombotic thrombocytopenic purpura PLT aggregation and thrombus formation in microvasculature form beads-on-a-string structures results in thrombocytopenia, hemolytic anemia, organ ischemia, death
52
treatment of TTP
requires urgent identification start treatment immediately initiate daily plasma exchange with FFP (fresh frozen plasma) steroids, immunosuppressives, splenectomy
53
hemolytic uremic syndrome (HUS)
mostly seen in children infected w/ E. coli causes severe blood diarrhea adult cases due to drugs, postpartum, immunosuppression-> may cause severe renal damage requiring dialysis
54
diagnosing HUS
increased BUN/creatine hemolytic anemia decreased platelets increased LDH proteinuria hematuria
55
treatment of HUS
supportive care hemodialysis self-limiting
56
pentad signs
seen in TTP: 1. thrombocytosis w/ increase in megakaryocytes 2. hemolytic anemia w/ schistocytes on blood smear and increased LDH 3. renal insufficiency (increased BUN/creatine; decreased GFR) 4. fever 5. neurological symps
57
diagnosis of TTP
increased=LDH, bilirubin, recticulocyte count, BUN/creatine decreased=RBC count, haptoglobin, platelet count, GFR
58
CML chronic phase
lasts 30-40 months
59
complication of APL
pregnancy DIC differentiation syndrome
60
leukostasis treatment
leukapheresis cytoreduction
61
CLL progression to lymphoma
2-9% of cases usually large cell lymphoma occasionally hodgkin's
62
ALL patho
abnormal cells originate in the thymus and BM chromosome changes
63
burkitt's lymphoma
precursor B cell from ALL can develop into this
64
CLL symps.
often asymp. splenomegaly/hepatomegaly infections lymphadenopathy often painless
65
AML treatment
remission induction chemo post-remission therapy transfusions/antibiotics
66
leukostasis
medical emergency, commonly seen with AML, elevated blast cell count with symptoms respiratory and/or neurological distress
67
leukostasis diagnosis
absolute blast count
68
complications of acute leukemia
transfusion infection tumor lysis syndrome
69
acute leukemia labs
increased LDH (AML and ALL) DIC (APL) TLS (hyperuricemia, hyperkalemia, hypocalcemia, etc.)
70
treatment of ALL
induction therapy (chemo) prophylaxis (interthecal chemo) post-remission therapy (high-dose chemo)

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