WBC Part 5

Question 1

what is a Reed-Sternberg cell

Answer 1

the neoplastic cell seen in Hodgkin lymphoma

makes up the minority of the cell population

Question 2

how does hodgkin lymphoma spread?

Answer 2

contiguous fashion

Question 3

most cells that make up Hodgkins lymphoma are what and where do they come from

Answer 3

reactive cells recruited by cytokines released by the Reed-Sternberg cells

Question 4

where are Reed-Sternberg cells derived from

Answer 4

germinal center or post germinal center B cells

Question 5

all Reed-Sternberg cells have identical what and what does this show

Answer 5

rearranged Ig genes that show evidence of somatic hypermutation

Question 6

what is the size of the Reed-Sternberg cell in relation to a RBC

Answer 6

RS is 15-45 micrometers

RBC is 6-7 micrometers

Question 7

what is the classical appearance of the nucleus of a Reed-Sternberg cell

Answer 7

bi-lobed to multi-lobed nucleus

“Owl Eyes”

Question 8

What flow cytometry results would one expect to see in Hodgkin Lymphoma due to classic Reed-Sternberg cells

Answer 8

CD15+
CD30+
negative for CD45, B and T cell antigens

Question 9

What flow cytometry results would one expect to see in NodularLymphocyte predominate hodgkin lymphoma (NLPHL) due to it’s Reed-Sternberg cells (L&H variant that looks like popcorn)

Answer 9

CD45+
Bcl-6+
B-cell antigen +
Negative for CD15 and CD30

Question 10

what is Ann Arbor Classification

Answer 10

staging (most important prognostic factor)
based on spread of the Hodgkin lymphoma
on a scale of I-IV (III is when it crosses midline)
A or B if w/ or w/o “B-symptoms”

Question 11

what age(s) is Hodgkin lymphoma common

Answer 11

bimodal age

most patients young, second peak after 55

Question 12

what is a common hodgkin lymphoma presentation

Answer 12

mediastinal adenopathy w/ enlarges mediastinum
painless localized or generalized adenopathy
+/- B symtoms

Question 13

CD15+
CD30+
negative for CD45, B and T cell antigens

Answer 13

Hodgkin Lymphoma due to classic Reed-Sternberg cells

Question 14

what is the most common hodgkin lymphoma?

Answer 14

Nodular Sclerosis Hodgkin Lymphoma (NSHL)

Question 15

what is seen in Nodular Sclerosis Hodgkin Lymphoma (NSHL)

Answer 15

cervical, supraclavicular, and mediastinal adenopathy
lacunar cells (RS variant) and bands of polarizing fibrosis
rare EBV association

Question 16

what is seen in Mixed Cellularity Hodgkin Lymphoma (MCHL)

Answer 16

second most common
EBV associated
older age, B symptoms
diffuse effacement by heterogeneous cellular infiltrate
classic Reed-Sternberg cells plentiful

Question 17

Lymphocyte rich Hodgkin Lymphoma (LRHL) is characterized by what?

Answer 17

EBV association
diffuse effacement with age modularity if residual follicles are present
many mononuclear and classic RS cells
lymphocytes make up background

Question 18

Lymphocyte dDepleted Hodgkin Lymphoma(LDHL) is characterized by what

Answer 18

numerous RS cells and few background lymphocytes
older patients, HIV+ patients
EBV associated

Question 19

Nodular Lymphocyte Predominant Hodgkin lymphoma (NLPHL) is characterized by what

Answer 19

effacement by small lymphs and some benign histiocytes
L&H variant RS cell (popcorn)
no EBV association
can transform to DLBCL
cervical or axillary adenopathy

Question 20

what leukopenia (define)

Answer 20

low WBC count

Question 21

Leukocytosis (define)

Answer 21

high WBC count

Question 22

how does one calculate absolute count of something (say neutrophils)

Answer 22

WBC x % cells (Ex: WBC x % neutrophils)

Question 23

in lymphopenia CBC and smear show what

Answer 23

decreased lymphocytes

Question 24

what some causes of lymphopenia

Answer 24

drugs: chemotherapeutic or glucocorticoids
systemic illness
congenital immunodeficiency disease
autoimmune (SLE)
malnutrition

Question 25

in neutropenia what would one see in CBC and smear

Answer 25

decreased neutrophils

Question 26

in neutropenia due to inadequate production what would one see in the bone marrow

Answer 26

hypocellularity because of loss of granulocytic precursors

Question 27

in neutropenia due to inadequate production can be caused by what

Answer 27

stem cell suppression (all lines affected) granulocytic precursor suppression Inherited condition with gene defects

Question 28

in neutropenia due to inadequate production because of stem cell suppression occurs in what conditions

Answer 28

aplastic anemia | marrow infiltrative processes

Question 29

in neutropenia due to inadequate production because of granulocytic precursor suppression occurs in what conditions

Answer 29

infection drugs (shame, phenothiazines, thiouracil, sulfonamides, aminopyrine) large Granulocytic Lymphocytic Leukemia (LGLL)

Question 30

in neutropenia due to inadequate production because of inherited condition with gene defects occurs in what conditions

Answer 30

Kostmann Syndrome

Question 31

in neutropenia due to ineffective production what would one see in the bone marrow

Answer 31

hypercellularity- make a lot that die before entering blood

Question 32

neutropenia due to ineffective production is caused by what

Answer 32

B12 deficiency Folate deficiency Myelodysplastic syndrome

Question 33

in neutropenia due to accelerated removal/destruction what would one see in the bone marrow

Answer 33

hypercellular- trying to compensate for peripheral loss

Question 34

neutropenia due to accelerated removal/destruction can be caused how?

Answer 34

immune mediated splenic sequestration increased peripheral utilization

Question 35

neutropenia due to accelerated removal/destruction because of immune mediated paths occurs in what conditions

Answer 35

drugs (aminopyrine, thiouracil, sulfonamides) associated with autoimmune disorder (SLE) idiopathic

Question 36

neutropenia due to accelerated removal/destruction because of splenic sequestration occurs in what conditions

Answer 36

enlarged spleen- increased destruction

Question 37

neutropenia due to accelerated removal/destruction because of increased peripheral utilization occurs in what conditions

Answer 37

overwhelming infections

Question 38

the main cause of neutropenia in neonates and children is what

Answer 38

infection

Question 39

the main cause of neutropenia in adults is what

Answer 39

drugs

Question 40

neutropenia may be treated with what

Answer 40

G-CSF

Question 41

in a patient with neutropenia and an infection what would one see

Answer 41

mucosal ulcers (often oropharynx) severe invasive infections of bladder, kidney, and lungs sites of infections show numerous organisms with little host leukocytic response