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33 Cards in this Set

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  • Back
Define Leukocytosis.
Total WBC count >12,000/microL
To determine the clinical significance of an elevated WBC, it is important to...?
...examine the absolute cell counts:

absolute cell count = total WBC x %cell

EX: total WBC is 20,000/microL and differential is 80%segPMNs and 20%lymphs

Absolute PMN = 20,000 x 0.8 = 16,000

Absolute lymphocyte = 20,000 x .20 = 4,000
Define Neutrophilia.
Absolute PMN count > 8,000

NORMAL ANC = 2,000-8,000
Where do neutrophils normally exist?
Four functional sites:
1. stem cell pool
2. mitotic pool
3. maturation/storage pool
4. marginated/circulating pool

Marginated/circulating is in peripheral blood and all others are in BM
Neutrophilia can result from...?
Shift of cells btwn pools or an increase in production of cells.
Types of neutrophilia?
1. immediate rxn

2. acute rxn

3. pathologic neutrophilia

4. leukemoid rxn

5. leukoerythroblastosis
Immediate rxn neutrophilia
Results due to a shift from the marginated to the circulating pool.

Equal numbers of cells in the marginated and circulating, so a shift can result in almost doubling the total WBC

Cells will predom be segmented PMNs
Causes of immediate rxn neutrophilia?
extreme exercise

acute stress


Occurs w/in minutes of exposure
Acute rxn neutrophilia
Due to shift:
maturation/storage --> marginated/circulating

Cells: segs w/ some bands and few metamyelocytes
Causes of acute rxn neutrophilia?


Occurs w/in few hours of exposure
Pathologic neutrophilia
Caused by pathologic state that induces a sustained PMN response

Increase in:
-- stem cell pool
-- mitotic pool
-- maturation/storage pool
-- marginated/circulating pool
Causes of pathologic neutrophilia?
1. infections
-- espec bacterial
-- also fungal, early viral

2. metabolic disturbances
-- uremia
-- gout
-- diabetic ketoacidosis

3. exposure to certain drugs/chemicals
-- lead
-- steroids
-- benzene

4. Tissue necrosis, post-surgical stress, hemorrhage, hemolysis
What is toxic granulation?
increase in number and predominance of primary granules in PMNs
-- most often seen in bacterial infections and can be important clue, espec if WBC not increased

DOHLE BODIES - consist of ribosomes and appear as irregularly shaped areas of cytoplasm of PMNs
-- usually seen w/ toxic granulation
Leukemoid Reaction
Term used when WBC elevated and immature cells circulating:
-- metamyelocytes
-- myelocytes

Still a predominance of segs and bands, and toxic granulation w/ Dohle bodies may be seen

Form of pathologic neutrophilia and occurs in response to pathologic state, frequently BACTERIAL infection

"Leukemoid" used b/c looks like leukemia, partic CML
Smear w/ circulating immature PMNs as well as nucleated RBCs

Total WBC may be high, low, or normal depending on cause
Causes of leukoerythroblastosis?
1. severe BM stress
-- hemorrhage
-- hemolysis
-- severe infection

2. Marrow replacement by tumor or granuloma -- MYELOPHTHISIS

3. True hematopoietic neoplasm such as myeloprolif d/o's
-- myelofibrosis w/ myeloid metaplasia
Define eosiniphilia
Absolute count eosinophils > 450
Causes of eosiniphilia?
allergic rxns
skin d/o's
parasitic infections
various neoplasms
GI d/o's
idiopathic hypereosinophilic syndrome
part of various hematopoietic neoplasms
Define basophilia.
Absolute count basophils > 200
Causes of basophilia?
May be rarely seen in allergic responses

Most cases is part of myeloprolif d/p, particularly CML
Define monocytosis.
Absolute count monocytes > 1000
Causes of monocytosis?
chronic infectious disease
CT d/o's
various neoplasms
Part of hematopoietic neoplasms, especially CML
Define lymphocytosis.
Absolute count lymphocytes > 4000
Causes of lymphocytosis?
1. Reactive (atypical) lymphocytes w/ LARGE transformed cells:
-- mono
-- hepatitis
-- toxoplasmosis
-- CMV
-- various other viral diseases

2. Reactive lymphocytosis w/ SMALL NON-transformed lymphocytes:
-- pertussis
-- infectious lymphocytosis
Define neutropenia.
Absolute PMN count < 1500
Causes of neutropenia?
1. decreased production
-- aplastic anemia
-- leukemia
-- drug inhibition

2. ineffective production
-- megaloblastic anemia
-- myelodysplastic states

3. decreased survival
-- bacterial infections
-- splenic sequestration

4. combined
What are some morphologic d/o's of WBCs?
1. Pelger-Huet anomaly

2. Hypersegmentation

3. Intracellular organisms
Pelger-Huet anomaly
PMNs are HYPOsegmented w/ two lobes to the nucleus connected w/ either a thin thread of chromatin of w/ a thicker segment, appearing as a band

-- autosomal dominant
-- PMNs w/ normal fxn

-- "pseudo-Pelger-Huet"
-- non-lobated PMNs and/or hypogranular cytoplasm
-- NON-normal fxn
-- pts prone to increased infection
10% of cells w/ 5 of 5+ lobes

Most common cause: Megaloblastic anemia

Rarely: inherited d/o
Intracellular organisms
In severe infections, may be seen in PMNs in the periph blood smear
What are some qualitative WBC d/o's?
1. chronic granulomatous disease

2. Chediak-Higashi Syndrome

3. Other miscellaneous d/o's that may result in ineffective phagocytosis, adhesion, or bacterial killing
Chronic Granulomatous Disease
Pts have repeated infections w/ bacteria that are CATALASE (+)

Group of d/o's that have common defects in genes encoding different components of NADPH oxidase
-- x-linked inherited OR
-- autosomal recessive

WBC are able to phagocytose, but not able to destroy
-- orgs remain intracellular
-- granulomatous inflamm develops

Manifest of disease vary among patients from mild to very severe
Chediak-Higashi Syndrome
Rare autosomal recessive d/o
-- lysosomes of various cell types are abnormal

-- Pancytopenia w/ abnormal appearing lysosomes in lymphocytes and neutrophils
-- WBC do not fxn normally and pts have severe infections early in life
-- also involvement of melanosomes w/ partial albinism

**Usually fatal w/in first two years of life

BM transplant is only possible treatment