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Flashcards in wbc disorders Deck (99):
1

broad groups of wbcs

phagocytes (granulo and mono)
immunocytes (lympho and plasma)

2

2 pools in the bloodstream

ciculating
marginating

3

wbc kinetics

6-10 hrs in circu
4-5 days in tissues

4

factors that can modify degree of neutro response

age
virulence
hematinic deficiency

5

NV wbc count: adult

4-11 x 10^9/L

6

NV wbc count: neonates

10-25 x 10^9/L

7

NV wbc count: 1 yr

6-18 x 10^9/L

8

NV wbc count: 4-7 yrs

6-15 x 10^9/L

9

NV wbc count: 8-12 yrs

4.5-13.5 x 10^9/L

10

NV in diff count: neutro

37-80

11

NV in diff count: lympho

10-50

12

NV in diff count: mono

0-12

13

NV in diff count: eosino

0-9.5

14

NV in diff count: basophils

0-2.5

15

NV in absolute count (in x10^9/L): neutro

1.8-7
1-8.5

16

NV in absolute count (in x10^9/L): lympho

1.5-4
1.5-8.8

17

NV in absolute count (in x10^9/L): monocyte

.03-.9

18

NV in absolute count (in x10^9/L): eosino

0-.67

19

NV in absolute count (in x10^9/L): baso

0-.20

20

increase in WBC count above upper limit of NV for age and sex

leukocytosis with lymphocytosis/neutrophilia/monocytosis/eosinophils/basophilia

21

decrease in total wbc count below the lower limit of nv for age and sex

leukopenia with neutropenia/lymphocytopenia

22

increase in any wbc type maybe clinically significant but decrease is usually only for _____

neutrophils

23

absolute count of >7.5 bands and nuetrophils

neutrophilic luekocytosis

24

pathophysio mecahnisms for neutrophilic leukocytosis

inc. prod
inc. released from marrow
shift from marginal to circu pool
dec. egress of neutro to tissue
combination

25

increased production and peripheral survival of neutrophils is seen in

CML

26

increased shift from margianl pool of neutro is seen in

stress
intoxication
hypoxia
exercise
adrenalin
inf

27

decreased egress from circulating is seen in

corticosteroids

28

neoplasms that may lead to neutrophilia

solid tumor
MPD

29

seen when there's an increase in immature peripheral blood granulocytes usually in acute infection

shift to the left

30

reactive and excessive leukocytosis usually characterized by release of immature cells

leukemoid rxns

31

lab picture of leukemoid rxn

WBC ct. >50 x 10^9/L w/ shift to the left
high LAP score

32

leukemoid is seen in

severe and chronic inf
severe hemolysis
metastatic CA

33

absolute neutro count of <1.5 x 10^9/L

neutropenia

34

levels of neutropenia

>1500/uL normal
1k-1.5k mild
500-1000 moderate
<500 severe

35

3 factors that determine risk of infection

ANC
neutrophil reserve in the marrow
duration

36

absolute lympho count of >4 x 10^/L

lymphocytosis

37

lymphocytes seen in CLL

smudge cells

38

lymphocytosis may be categorized as

monoclonal or polyclonal

39

examples of dse that causes monoclonal lymphocytosis

lymphoproliferative disorder
CLL
non-Hodgkin's lymphoma
ALL

40

secondary to stimulation or rxn to factors extrinsic to the lymphocyte

polyclonal lymphocytosis

41

absolute lympho count of < 1 (adult) or <2 (children)

lymphocytopenia

42

absolute monocyte count of > 0.8 x 10^9/L

monocytosis

43

monocytosis causes

50% of hema disorder
10% of inflamm and immune disorders
8% malignant disorders

44

causes of monocytosis

TB SBE syphilis proptozoan rickettsia leukemia lymphomas multiple myeloma CMML
solid tumors
immune thrombocytopenic purpura
sarcoidosis

45

causes of lymphocytopenia

radiation
chemo
corticosteroids
starvation
aplastic anemia
terminal cancer
HIV
TB
viral hepa
typhoid
Wiskott-Aldrich syndrome

46

most common cause of eosinophilia

parasitism
allergic dse

47

levels of eosiphilia

<1500 mild
1.5k-5k moderate
>5k severe

48

causes of eosinophilia

allergic
parasitic
recovery from acute inf
skin dse
inflamm
respi
neoplastic
idiopathoc hypereosinophilic syndrome

49

skin dse that causes eosinophilia

psoriasis
urticaria
angioedema

50

>1500 eosinophils/uL for more than 6 months

primary hypereosinophilic syndrome

51

affected organs in primary hypereosinophilic syndrome

skin
heart
nervous system

52

absence of underlying cause of eosinophilia despite extensive evaluation

primary hypereosinophilic syndrome

53

absolute basophil count of > 0.2 x 10^9/L

basophilia

54

group of disorders characterized by the accumulation of malignant wbcs in the bone marrow and blood

leukemia

55

classifications of leukemia

AML
ALL
CML
CLL

56

presence of >20% blasts in blood and marrow
accumulatoion of malignant white cells (blasts) in the blood and marrow

acute leukemias

57

lab pic of acute leukemia

anemia
thrombocytopenia
leukocyte count (high low or nomal, <5k, absolute lymphocytosis, high wbc ct with high lympho%)

pancytopneia minsan

58

classification of acute leukemia

myelogenous
lymphocytic

59

antibodies labelled with different flurochromes recognize the pattern and intensity of expression of the different antigens on the surface of normal and leukemic cells

immunophenotyping by flow cytometry

60

direct morphological analysis of chromosomes from tumor cells under the microscope

karyotype analysis

61

karyotypeing samples require the tumor cells to be

in metaphase

62

clonal disorder of a pluripotent stem cell

chronic myelogenous leukemia

63

seen in CML

philadelphia chromosome

64

Ph chromosome results to

chimeric BCR-ABL gene which codes for fusion protein with a tyrosine kinase actiity

65

clinical features of CML

hypermetab
splenomegaly
features of anemia and abn. plt. fx
gout or renal impairment caused by hyperuricemia
visual disturbance, priaprism
leukocytosis
complete spectrum of myeloid cells in PBS
basophilia
normo-normo anemia
low LAP

66

most common leukemia in Western but rare in far east

CLL

67

clinical features of CLL

occurs in elderly
2:1 male to female
symmertrical enlargement of nodes
anemia and thrombocytopenia
splenomegaly, hepatomegaly
immunosuppression

68

lab pic of CLL

absolute lymphocytosis (monoclonal B cells)
anemia or thrombocytopenia
35% (+) Coombs
pre red cell aplasia
hypogammaglobulinemia
hyper/normocellular marrow

69

BCR-ABL negative myeloproliferative meoplasia or non-leukemic myeloproliferative neoplasias include

polycythemia vera
essential thrombocythemia/cytosis
myelofribrosis

70

transmits info from outside the cell through the cell membrane and into the gene promoters on the DNA inside the nucleus

JAK-STAT signalling pathway

71

components of the JAK-STAT signalling pathway

receptor
JANUS kinase
signal transducer and activator transcription

72

nonreceptor tyrosine kinase that is essential for growth factor signalling

JAK2

73

inc. hgb/hct above upper limit for age and sex

polycythemia

74

2 subdivisions of polycythemia

absolute (primary vs secodnary)
relative/pseudopolycythemia

75

rbc volume normal but plasma is dec.

pseudopolycyhtemia

76

red cell mass >125% of that expected for body mass and gender

absolute polycythemia

77

polycythemia due to enhanced response of eythroid progenitor cells to cytokines

primary

78

polycythemia driven by factors outside erythroid compartment

secondary

79

acquired causes of secondary erythrocytosis

erythropoietin mediated
local hypoxia
drug associated
pathologic epo prodn

80

clonal stem cell disorder with trilineage myeloid involvement

poly vera

81

characterized by idneoendent eryhtrough proliferation resulting to markedly increased red cell mass

poly vera

82

present in over 95% of poly vera cases

JAK2 mutation

83

major criteria by the poly vear study groups

A1 rcm inc.
A2 normal O2 satn
A3 splenomegaly

84

minor criteria by the poly vear study groups

B1 PC > 400
B2 WBC count >12
B3 LAP score >100
B4 serum B12 >900

85

how to diagnose polycythemia vera by study group

A123
A12 + 2 of B

86

major criteria for poly vera by WHO

inc. rbc volume
JAK2 mutatuion

87

minor criteria for poly vera by WHO

hypercell marrow
serum Epo dec
endogenous erythroid colony formation in vitro

88

how to diagnose poly vera by WHO

2 major + 1 minor
first major + 2 minor

89

lab pic of poly vera

inc hgb hct rbc rcv
neutrophilic and basophilic leukocytosis
jak2 mut
hypercell marrow with panbmyelosis
dec epo
inc UA

90

clinical features in poly vera

hyperviscous hypervolemia hypermetab
headache dyspnea pruritis
cyanosis
splenomegaly
htn
gout

91

median survival of poly vera cases

10-16 yrs

92

30% of poly vera cases transform to

MF spent phase

93

5% of poly vera cases transform to

acute leukemia

94

causes of thrombocytosis

reactive
clonal/endogenous

95

persistent plt count of >450 x 10^9/L

essential thrombocytosis/thrombocythemia

96

essential thrombocyrtosis is caused by

megakaryocyte proliferation and overpod'n

97

clonal dse characterized by progressive generalized reactive marrow fibrosis with extramedullary hematopoiesis in the liver and spleen

primary myelofribrosis

98

primary myelofibrosis to simply put it is

myelofibrosis with myeloid metaplasia

99

findings in myelofibrosis

anemia
splenomegaly
immature granulo erythro, dacryocytes
marrow fibrosis
osteosclerosis