Quantitative WBC Abnormalities (Part 2)

Question 1

Normal WBC count

Answer 1

4.5- 11.5 x10^9/L

Question 2

Definition of leukocytosis

Answer 2

any WBC over 11.5 x10^9/L

Question 3

3 general mechanisms for all types of leukocytosis

Answer 3

1. Cells from BM (increased flow from BM)
2. Shift of cells from Marginal Granulocyte Pool to Circulating Granulocyte Pool
3. Decreased outflow of cells from blood

Question 4

5 Physiological causes of leukocytosis

Answer 4

1. Exercise
2. Stress
3. Hypoxia
4. Labor
5. (shift from MGP to CGP) ?

Question 5

6 Pathologic causes of leukocytosis

Answer 5

1. disease or tissue damage
2. Infection
3. Toxins (drugs, chemicals)
4. Necrosis (MI, burns, surgery)
5. Hemorrhage
6. Hemolysis

Question 6

Definition of Lukemoid Reaction

Answer 6

Excessive leukocytosis

• WBC > 50.0 x 10^9/L WITH a left shift
• shift to the left in myeloid series - immature cells in PB

Question 7

Two types of leukemoid reactions

Answer 7

Neutrophilic and Lymphocytic

Question 8

Production of bands, myelos, metas - sometimes difficult to differentiate from chronic myelogenous leukemia and occurs with infections, hemolysis, and burns

Answer 8

Neutrophilic leukemoid reaction

Question 9

Produces lymphs- maybe be hard to distinguish from Chronic Lymphocytic Leukemia and these reactions can occur in Pertussis, mononucleosis, and viral infeactions

Answer 9

Lymphocytic leukemoid reaction

Question 10

CML v.s. Leukemoid reaction

- increase in what cells

Answer 10

CML: increases in all granulocytes including eos and basos
Leukemoid: Increase in granulocytes BUT it is uncommon for increases in eos and basos

Question 11

CML v.s. Leukemoid reaction

- Dyspoietic morphology (mixed granulation)

Answer 11

CML: Dyspoietic morphology
Leuk: No dyspoietic morphology

Question 12

CML v.s. Leukemoid reaction

- platelets

Answer 12

CML: Giant and hypo granular platelets
Leuk: Normal platelet morphology

Question 13

Define Leukoeythroblastosis

Answer 13

Presence of both immature neutrophils and nucleated RBCs in the peripheral blood

Question 14

Cause of Leukoeythroblastosis

Answer 14

Caused by a space occupying lesion in the bone marrow

fibrosis, metastatic tumor, lymphoma, leukemia

Question 15

Define Leukopenia

Answer 15

less than 4.5 x10^9/L

Question 16

Mechanisms of leukopenia

Answer 16

1. Decreased flow of cells from bone marrow
2. Shift from CGP to MGP
3. Increased outflow from blood

Question 17

Causes of leukopenia

Answer 17

1. Viral infections
2. Drugs (some antibiotics, chemotherapy)
3. Radiation
4. Hematologic disorders (pernicious anemia, aplastic anemia, myelodysplatic syndromes- MDS)

Question 18

What is a relative value?

Answer 18

% of cell type in specified volume

Question 19

What is an absolute value?

Answer 19

of cell type in specified volume

Question 20

Calculation for the Absolute Value

Answer 20

Absolute= total WBC x % cell type

add up segs and bands for neutrophil count

Question 21

Definition of Neutrohilia

Answer 21

Increase in Neutrohils; greater than 8.1 x 10^9/L

Question 22

Neutrophilia may be caused by: (4)

Answer 22

1. Physiologic: stress,exercise, pregnancy
2. Acute Infection, usually bacterial
3. Chonic Inflammation - gout, rheumatoid, arthritis, burns
4. Steroids - cause demarginalization and inhibit neutrophil apoptosis

Question 23

Definition of Neutropenia

Answer 23

Decrease in neutrophils; less than 2.3 x 10^9

Question 24

Neutropenia mechanisms (3)

Answer 24

1. Decreased BM production
2. Shift from CGP to MGP
3. Increase in rate of outflow of neuts from blood

Question 25

Neutropenia severity - Severe with increased risk of infection - Increased risk of auto-infection - Very serious risk, reverse isolation and/or prophylactic antibiotics

Answer 25

- less than 1.5 x 10^9/L - less than 1.0 x 10^9/L - less than 0.5 x 10^9/L

Question 26

Eosinophilia Definition

Answer 26

Increase in Eosinophils above 0.6 x 10^9/L

Question 27

Eosinophilia may be caused by: (5)

Answer 27

1. Allergic responses 2. Skin Disorders 3. Parasitic infections, especially helminths (worms) 4. Infectious disease 5. Hematologic disorders

Question 28

Definition of Eosinopenia

Answer 28

A decrease in eosinophils is usually not significant and is difficult to measure

Question 29

Eosinopenia is caused by: (3)

Answer 29

1. Stress 2. Bacterial and viral infections 3. Steroids

Question 30

Definition of Basophilia

Answer 30

Increase in basophils above 0.2 x10^9/L

Question 31

Cause of basophilia (3)

Answer 31

1. Allergies 2. Hypothyroidism 3. Myeloproliferative Neopalsm (NPM)

Question 32

Definition of Basopenia

Answer 32

A decrease in basophils is difficult to measure and is not significant

Question 33

Basopenia is caused by: (3)

Answer 33

1. Hyperthyroidism 2. Stress 3. Infection

Question 34

Monocytosis definition

Answer 34

Increase in monocytes above 1.3 x 10^9/L

Question 35

Monocytosis is caused by (3)

Answer 35

1. Hematologic disorders (MDS, AMML, CMML, AMoL) 2. Connective tissue disorders 3. Infections - Recoverry from acute infection is a good prognosis

Question 36

Definition of Monocytopenia

Answer 36

Decrease in monocytes below 0.1 x 10^9/L

Question 37

Causes of monocytopenia 2

Answer 37

1. Hairy cell Leukemia | 2. Counts fall transiently after administration of prednisone

Question 38

Definition of Lymphocytosis

Answer 38

Lymphocytosis depends upon age Adults: >4.8 Children: >11.1

Question 39

Causes of lymphocytosis (3)

Answer 39

1. Infectious Mononucleosis (EBV most common) 2. Infectious lymphocytosis 3. Bordetella pertussis - children

Question 40

Definition of Lymphocytopenia / Lymphopenia

Answer 40

Adults < 0.8 | Children < 1.5

Question 41

Lymphocytopenia is caused by

Answer 41

1. Immunologic disorders - SCID, DiGeorge Syndrome 2. Chemotherapy, Radiation 3. Immunosuppressive agents - steroids