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65 Cards in this Set

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What's the most important part of a WBC differential?
The absolute counts of each cell type. Convert from percent values if necessary.
What's the "mother" of all blood cells?
The hematopoetic stem cell.
What are the four major growth factors in maintaining hematopoetic stem cells?
1) Stem Cell Factors (SCF)
2) IL-3
3) GM-CSF
4) G-CSF
What are the best cell surface markers to use when identifying peripheral blood cells?
Cluster of Differentiation, or CD molecules
How long does normal PMN maturation take?
About three weeks. Accelerated with illness.
What is a myeloid cell?
Any LEUKOCYTE that is NOT a LYMPHOCYTE.
What are the characteristics of a myeloblast cell?
1) Large nucleus-to-cytoplasm ratio
2) Smooth "paved" nucleus
3) No cytoplasmic granules
What is a band cell?
A differentiating myeloid cell immediately preceeding the mature neutrophil.
What is a "Left Shift"
An increase in the number of band cells.
What affects the eosinophil count?
Eosinophils count rise in response to various allergic states and in response to parasitic infections.
How do eosiniphils stain? :-)
Eosinophils have large, red-staining specific granules.
How do basophils stain?
Basophils have large, blue staining granules that cover the cytoplasm and nucleus.
What special receptor does a Basophil have on its surface?
Basophils have IgE on their surface. Interaction with antigen triggers degranulation.
What do Basophils store in their granules?
Basophils store histamine.
What tissue-specific myeloid cell migrates and resides in tissues?
Monocytes migrate into specific tissues and take up residence as part of the innate immune system.
Where do neutrophils "live" while in circulation?
50% are in active circulation, while 50% stay in the "marginal pool."
How might the bone marrow respond to an acute stimulus for an increase in circulating neutrophils?
Before release neutrophils are held in a bone marrow "neutrophil pool."
What stimuli cause the release of neutrophils from the bone marrow pool?
1) Stress
2) Infection
3) Endotoxins
4) Corticosteroids
What's the lifespan of a neutrophil in the peripheral blood?
PMNs last about 6-10 hours in the peripheral blood.
What endothelial receptors are required for leukocyte adhesion and diapedesis?
Leukocyte Integrins.
What's the primary mission of a neutrophil?
To migrate to a site of infection, opsonize bacteria, and kill them.
What are the four steps in neutrophil bacterial killing?
1) Chemotaxis
2) Opsonization
3) Oxidative Respiratory Burst
4) Lysosomal Fusion
What are the two major neutrophil functional deficiencies mentioned?
1) Leukocyte Adhesion Deficiencies
2) Chronic Granulomatous Diseases
What complex is not expressed in Leukocyte Adhesion Deficiency?
The leukocyte integrin CD11/18 Complex
What organisms are most common in Chronic Granulomatous Disease?
Staph aureus and other Catalase-Positive Bacteria
What is the molecular defect in Chronic Granulomatous Disease?
The neutrophil NADPH Oxidase Enzyme
What is the definition of neutropenia?
Less than 1800 cells/microliters of neutrophils + bands in the peripheral blood.
At what point does neutropenia become absolute neutropenia?
>500 cells/microliter
What are the three general mechanisms for neutropenia?
1) Decreased marrow production
2) Trapping or sequestration (spleen)
3) Increased destruction of neutrophils.
What's the most common cause of decreases marrow production of neutrophils?
Drugs
What's the most common cause of in-hospital neutropenia?
Splenic sequestration due to portal hypertension.
Can neutrophil counts actually DROP with infection?
Yes - in severe sepsis the body's neutrophil stores and proliferative capacity may become exhausted.
In what adult disorders is IMMUNE NEUTROPENIA common?
SLE and RA
What new approaches are now used to treat neutropenia?
G-CSF and GM-CSF
What's the cutoff for neutrophilia?
>10,000 cells/microliter.
What are the three mechanisms behind neutrophilia?
1) PMN shift from marrow pool
2) Shift from marginal pool
3) Proliferation response
What are high white cell counts that are benign and reactive?
Leukemoid Reactions.
What laboratory study helps differentiate leukemoid reactions from a leukemia?
The Leukocyte Alkaline Phosphatase levels will be elevated in leukemoid reactions, and LOW in leukemia.
What disease should be considered with chronic neutrophilia?
CML
What other myeloproliferative disorders may go along with leukocytosis?
Polycythemia vera, essential thrombocythemia.
What are the three main classes of lymphocytes?
1) B Cells
2) T Cells
3) Natural Killer Cells
Leukocyte Adhesion Deficiency
Neutrophil congenital defect. Cell's can't adhere to vessel walls. Staph, gram negatives especially problematic. CD-18, others.
Chronic Granulomatous Disease
CGD is a congenital defect in the respiratory burst killing mechanism of neutrophils. Catalase + organisms especially problematic.
Chediak-Higashi Syndrome.
Impairment of neutrophil chemotaxis and killing impaired.
What is the most accurate test used to asses for CML?
BCR-ABL Chromosome Translocation.
What mutation assay may be used to ID myeloproliferative neutrophilia?
JAK-2 V6167F
What are the 3 major lymphocyte cell lines?
1) T-Cells
2) B-Cells
3) NK Cells
What genetic mechanism of adaptive immunity is commonly mutated in lymphocyte cancer?
Errant recombination of the antigen receptor diversity genes is common in leukemia.
Where are T-Cells produced?
Thymus
Where are B-Cells produced?
The bone marrow.
What is the percent breakdown for circulating lymphocytes?
70% T-Cells
10-15% B-Cells
NK cells remaining
What capillary specialization allows for easy extravasation of lymphocytes?
High endothelial venules.
What T Cell subtypes interact with which MCHs?
CD-4 T-Cells go with Class II MHCs
CD-8 T-Cells go with Class I MHCs
Where do activated B-Cells go to proliferate?
Primary Lymphoid Follicles.
How is a strong antigen-antibody reaction mediated?
Constant mutation and selective pressure for strong Ab-Ag interaction during an active immune response.
What are the most common causes of lymphocytosis?
Viral infections, esp. EBV Infectious Mononucleosis
What leukemia may be associated with lymphocytosis?
Chronic Lymphocytic Leukemia (CLL), others too.
What are the major causes of lymphocytosis?
1) Malnutrition
2) Burns/trauma
3) Acute inflammation
4) Corticosteroids
5) HIV/Immunosuppressive diseases
6) Connective tissue diseases
7) Chemotherapy/radiation
T-Cell immunodeficiencies lead to which types of pathologies?
1) Intracellular (viral, mycobacterial)
2) Fungi and Protozal
B-Cell deficiencies lead to which types of infections?
Bacterial, especially encapsulated.
What is the main acquired immunodeficiency discussed in class?
HIV/AIDS
Are all HIV complications infectious?
No - HIV infection is associated with malignancies that may have a viral etiology
What are the main causes of monocytosis?
Infection/inflammation, bone marrow pathology. Common infections include: mononucleosis, TB, malaria, syphilis.
Gaucher's Disease
Most common lysosomal storage disease. Problem with Beta-glucosidase, leading to a buildup of fatty tissue in multiple organs.
Fabry's Disease
X-Liniked recessive lysosomal storage diseases. Problem with alpha galactosidase, leads to acc'n of lipids in blood vessels and other organs.