WBC pathology Flashcards
(45 cards)
What is the normal range for total WBC?
4000-10000/fl
Decreased count of which cell type is the most common reason for leukopenia? What is second?
most common: neutrophils (neutropenia)
also possible: lymphocytes (lymphopenia)
Generally, what are potential reasons for leukopenia?
- congenital d/o’s
- post glucocorticoid or cytotoxic drug therapy
- autoimmune d/o’s
- malnutrition
- certain acute viral infections
- advanced HIV infection
Marked reduction in PMN count and increased susceptibility to infx are hallmarks of ______?
agranulocytosis
What are the four sub-types of leukopenia due to decreased production? What are the underlying conditions associated with each?
(1) suppression of myeloid stem cells:
• aplastic anemia
• infiltrative marrow d/o’s – tumors, granulomatous dz.
(2) Drug suppression of granulocytic precursors:
• alkylating agents – bone marrow suppression
• antimetabolites used in cancer tx- bone marrow suppression
• Aminopyrine – Aby mediated
• Sulfonamides – Aby mediated
(3) Defective precursors in marrow:
• megaloblastic anemia
• myelodysplastic syns
(4) Genetic defects:
• rare inherited conditions (Kostmann syn).
What are the three sub-types of leukopenia due to increased PMN removal? What are the underlying conditions associated with each?
(1) Immune mediated injury:
•SLE
•drugs
(2) Splenic sequestration:
•inc. destruction d/t enlargement of spleen.
(3) Increased peripheral utilization:
•overwhelming infxs from bacteria, fungal or rickettsial pathogens (lyme dz).
What would be the expected bone marrow morphology if there is excessive white cell destruction in the body?
hypercellular, filled with granulocyte precursors
What are some areas of increased infx in patients with leukopenia? What will be the state of he lymph nodes?
ulceration and necrotization in the oropharynx region. also life-threatening infxs in the lung and urinary tract.
regional lymph nodes will be enlarged and inflamed
What are the general reasons for leukocytosis and their underlying causes?
- INC. release from marrow stores:
- Endotoxemia = bacteria
- acute infxn
- hypoxia
- DEC. margination:= MORE IN CIRCULATION
- exercise
- epinephrine
- DEC. extravasation into tissues:
- glucocorticoid therapy
- INC. numbers of marrow precursors:
- chr.infxnor inflammation
- tumors
- myeloproliferative d/o’s
To what does toxic granulation refer? What is likely to be going on in a patient that has it? What is causing it?
toxic granulation: dark, coarse granules in peripheral granulocytes…usu neutrophils. it is a dilated ER. they suggest an inflammatory process.
patient presumed to have sepsis until proven otherwise.
it occurs b/c the cytoplasm is not given time to mature due to the high demand for cells.
What are the non-neoplastic bases for elevations of the following:
- neutrophils
- toxic granulation
- eosinophils
- monocytes
- lymphocytes
- band cells
- neutrophils: bacterial infx; acute inflamx; MI
- toxic granulation: sever infx; bacterial sepsis
- eosinophils: allergy; parasitic infx
- monocytes: chronic inflamx; mono; recovery post-infx
- lymphocytes: acute viral infx; chronic inflamx
- band cells: infx
What are the three types of chronic lymphadenitis and which portion of the LN does each affect? What is the stimulus for each?
- follicular hyperplasia: two types within the cortex.
1. affects the germinal centers secondary to an infx triggering humoral immunity - B-cell and M0 stimulation
2. lymphoid cell hyperplasia through the mantle zone surrounding the germinal centers. - paracortical lymphoid hyperplasia: in the paracortical region, drugs/viral infxs stimulate T-cell production.
- sinus histiocytosis (aka reticular hyperplasia): within the sinus; distention secondary to some type of cell (often breast cancer) getting stuck when draining through.
What genetic abnormalities are present in the majority of WBC neoplasms?
chromosomal translocations (t#:#) and oncogenes
Which d/o would be associated with the following causes?
- H. pylori
- gluten-sensitive enteropathy
- HIV infx
- radiotherapy/chemo tx
- H. pylori: gastric B-cell lymphoma
- gluten-sensitive enteropathy: intestinal T-cell lymphoma
- HIV infx: B-cell lymphoma
- radiotherapy/chemo tx: myeloid & lymphoid neoplasm due to mutation of progenitor cells.
Which type of lymphoma can exist outside the LN itself?
non-hodgkin’s. about 1/3 are extranodal (skin, stomach, brain)
How is it possible to differentiate between early lymphoma and reactive leukocytosis?
In lymphoma, the WBCs will be monoclonal
What impact does lymphocytic leukemia have on hematopoiesis?
Suppression. Tumor steals nutrients and also takes up space, forcing immature cells into circulation. Bleeding d/o and anemia result.
What kind of cell comprises a plasms-cell neoplasm? From where does it arise?
- terminally differentiated (mature) B-cells.
- arise in the bone marrow.
With what do most patients with multiple myeloma present? What causes it?
pain from multiple fractures. bence jones proteins take up a lot space within the bone and ruin the structural integrity.
What type of cells are Reed-Sternberg cells and what gives them their ‘owl eye’ appearance?
They are B lymphocytes from a crippled germinal center. They do not express their antibody.
Multi-nucleated or bi-lobed nucleus gives them the owl eye appearance.
Reed-Sternberg must not only be present but do what in order to be diagnostic for ________ lymphoma?
Hodgkin’s lymphoma.
Must be able to chemo-attract normal lymphocytes.
Are Reed-Sternberg cells +/- for the following markers? CD15 CD20 CD30 CD45
CD15 +
CD20 -
CD30 +
CD45 -
Which dz comes from a tumor of B and T cell precursors?
Who is most often affected by pre-B and pre-T?
Acute Lymphoblastic Leukemia (ALL)
Pre-B ALL: white children ~4 yrs when pre-B lymphoblasts peak.
Pre-T ALL: adolescence when thymus reaches max size.
How do the cells appear in ALL?
Cells are huge lymphocytes with condensed chromatin and scant cytoplasm.
