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Flashcards in WBC Disorders Deck (20):
1

Leukemoid reaction

• 25-30k WBCs
• Exaggerated response after infection or trauma

2

Leukoerythroblastosis

• Immature WBCs and nucleated RBCs in peripheral blood
• Severe hemolytic anemia, abnormal bone marrow, massive trauma, Paget disease of bone, extramedullary hematopoiesis

3

Neutrophilic leukocytosis

• Neutrophils >7.5k
• Infection, inflammation w/ necrosis, drugs

4

Neuropenia

• Neutrophils

5

Eosinophilia

• Eosinophils >400
• Type 1 hypersensitivity rxn, helminth infection, Churg-Strauss, Addison disease (eosinophils not sequestered in lymph nodes)

6

Job syndrome

• STAT 3 mutation
• Abnormal neutrophil and monocyte chemotaxis
• "Cold" abscesses (lack of inflammatory response)

7

Basophilia

• Basophils >110
• Myoproliferative disorders

8

Lymphocytosis

• Lymphocytes >5000
• Infection, drugs, neoplasia, Graves disease (autoimmune thyroid disease)

9

Mononucleosis

• Epstein-Barr virus
• Virus attaches to B cells and remains dormant there
• B cells are stimulated, release IgM
• Exudative tonsillitis, hepatosplenomegaly, lymphadenopathy
• Rarer findings: encdphalitis, pancreatitis, Guillain-Barré (peripheral nerve dmg), CN palsies, myositis
• Lymphocytes >20% of WBCs
• Heterophil Ab test, VCA + EA + EBNA Ab tests

10

Monocytosis

• Monocytes >800
• Chronic inflammation, autoimmune disease, malignancy

11

Polycythemia vera

• JAK2 mutation on chromosome 9
• Increased production of RBCs, granulocytes (neutrophils, eosinophils, basophils), mast cells, and platelets
• Hepatosplenomegaly, ruddy face, thromboses, CNS Sx, itchiness after bathing from mast cells, gout
• Increased RBCs, RBC mass, plasma vol
• Later stages: fibrotic marrow
• Treat with hydroxyurea

12

Chronic myelogenous leukemia

• Middle-aged adults
• Risk factor: radiation
• Philadelphia chromosome: t(9;22) translocation leads to BCR-ABL fusion gene
• High WBCs, normocytic or macrocytic anemia, myeloid hyperplasia with few myeloblasts, decreased LAP
• Blast crisis: 5 yrs in, increased myeloblasts
• Treat with imatinib

13

Myelofibrosis with myeloid metaplasia

• Adults >50 y/o
• JAK2 mutation
• Ineffective erythropoiesis in marrow w/ fibrosis; extramedullary hematopoiesis
• Massive splenomegaly, portal HTN, splenic infarct w/ L pleural effusion
• Normocytic anemia w/ teardrop cells, weird platelets
• Treat with hydroxyurea, interferon alpha

14

Essential thromocythemia

• JAK2 mutation
• Excess, defective platelets
• GI bleeding, thrombosis, splenomegaly
• Thrombocytosis, basophilia, hypercellular marrow, weird megakaryocytes
• Treat with hydroxyurea

15

Myelodysplastic syndromes

• Men 50-80 y/o
• Pancytopenia, normocytic to macrocytic or dimorphic anemias, ringed sideroblasts
• Often progresses to AML

16

Acute myeloblastic leukemia

• Adults 30-60 y/o
• Risk factors: Down, Turner, Klinefelter syndromes; benzene and alkylating agents; t(8;21) translocation
• Constitutional Sx, hepatosplenomegaly, generalized lymphadenopathy; gum infiltration in acute monocytic leukemia
• Normocytic anemia, thrombocytopenia, leukocytosis; Auer rods in myeloblasts
• DIC common

17

Acute lymphoblastic leukemia

• Common in children
• Risk factors: anticancer agents, Hodgkin lymphoma, multiple myeloma, benzene, radiation
• Mostly pre-B cell type
• Tests: CALLA, TdT
• t(12;21) translocation = good prognosis
• High WBCs, normocytic anemia, thrombocytopenia, bone marrow replaced by lymphoblasts
• Bad prognosis

18

Adult T-cell leukemia

• Associated w/ HTLV-1 virus
• Activation of TAX inhibits p53; T cells proliferate
• Skin infiltration, lytic bone lesions
• Lymphoblasts positive for CD4, negative for TdT
• Normocytic anemia, thrombocytopenia, bone marrow replaced by CD4 lymphoblasts

19

Chronic lymphocytic leukemia

• Adults >60 y/o
• Neoplastic disorder of virgin B cells (can't differentiate into plasma cells)
• Immune hemolytic anemia
• High WBCs, few lymphoblasts, neutropenia, normocytic anemia, thrombocytopenia, bone marrow replaced by B cell lymphoblasts
• "Smudge" cells (fragile leukemic cells)
• Hypogammaglobulinemia

20

Hairy cell leukemia

• Men 40-60 y/o
• B-cell leukemia; overexpression of cyclin D1
• Splenomegaly, autoimmune vasculitis/arthritis
• Pancytopenia, reticulin fibers in marrow, positive TRAP stain
• Leukemic cells with hair-like projections
• Treat with purine analog