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56 Cards in this Set

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What are the most abundant WBC's in the blood?
Segmented Neutrophils = 50-70%
WBC that usually make up 2-6% of total WBC count but during acute inflammation their number can elevate and cause a left shift
Band neutrophils
Decrease in the neutrophil count = ?
What is the Absolute count of Neutrophils below in Neutropenia?
< 1800 / microliter
What would be the treatment for Neutropenia?
G-CSF = stimulates the BM to produce Neutrophils
List 7 causes of Neutropenia due to decreased production
1. Radiation = physician-induced; BM transplant patients
2. Drugs --> Daunorubicin, Chloramphenicol (specific for only causing Neutropenia)
3. Viruses = CMV and HIV
4. Alcohol
5. Megaloblastic Anemia = Folate/B12 deficiency cause Pancytopenia
6. Hereditary disorders
7. Myelodysplastic syndrome
List 3 causes of Neutropenia due to increased destruction
1. Overwhelming infection = severe sepsis causes bacteria to be phagocytosed, causing neutrophils to die quickly

2. Hypersplenism = spleen has increased size and function in which it sequesters and destroys hematopoietic cells

3. Autoimmune = SLE and RA cause autoantibody production directed at Neutrophil antigens
What is the definition of Neutrophilia?
Neutrophil count > 7000 / uL
List 6 causes of Neutrophilia
1. Bacterial infection
2. Tissue necrosis
3. Collagen vascular disease = SLE and RA = cause acute inflammation and stimulate BM production
4. Pregnancy = induces mild neutrophilia
5. Neoplasia = Paraneoplastic syndrome that secretes G-CSF
6. Drugs = Prednisone, Lithium, & Epinephrine cause de-margination of Neutrophils which releases them from vessel walls into circulation
Normal Neutrophils
- 2-5 lobes with Secondary granules
What is shown here?
Toxic Granulation of Neutrophils
-Primary granules = play role in host defense = Respiratory burst
-Cytokines that stimulate acute inflammation stimulate Neutrophils to make Primary Granules
What is shown here? What is the cause?
Dohle Bodies = one or two light blue inclusion within the cytoplasm of Neutrophils
- aggregates of dilated RER
- occur in acute inflammatory conditions
What is shown at the arrow?
What do Toxic Granulation and Dohle Bodies allow you to differentiate?
Their presence tells you that there is inflammation going on (Reactive, non-neoplastic neutrophilia), which rules out Malignant Neutrophilia
What is the definition of Lymphocytosis?
Lymphocyte count > 4000 / uL
What are the causes of Lymphocytosis? (2)
1. Viral infections
- Infectious Mononucleosis
- Cytomegalovirus
- Herpes Simplex Virus

2. Allergic Drug reactions
Normal Lymphocyte
- nucleus is 1.5 times the size of RBC; cytoplasm is minimal
What is the cell shown in the middle?
Reactive Lymphocytes
-nucleus is large and elongated
-cytoplasm is abundant and basophilic where it touches RBC's = "ballerina skirt phenomenon"
What is shown here?
What is the definition of Monocytosis?
Monocyte count > 800 / uL
What are the causes of Monocytosis?
1. Tuberculosis (chronic disease)
2. Bacterial Endocarditis
3. Collagen Vascular Disease = SLE and RA
4. Inflammatory Bowel Disease = Crohn's or Ulcerative colitis
5. Malignancy

**response to Chronic inflammation & Malignancy
-irregular, folded nucleus
-highly vacuolated
-has some granules
Cell type seen here?
What is the definition of Eosinophilia?
Eosinophilia count > 500 / uL
What are the causes of Eosinophilia?

1. Parasitic infection
2. Allergic rxn (Type 1)
3. Adrenal insufficiency = Glucocorticoids have a suppressor effect on Eosinophils = take them away, Eosinophilia
4. Neoplastic disease = paraneoplastic that secretes IL-5
5. Idiopathic
6. Collagen vascular disease
What is Idiopathic Hypereosinophilia Syndrome?
Eosinophil count > 1500 / uL X 6 months
What is the pathology of Idiopathic Hypereosinophilic Syndrome?
Endomyocardial fibrosis --> restrictive heart failure
What is the prognosis of Idiopathic Hypereosinophilic Syndrome
-10% survival at 3 years without therapy

-70% survival at 5 years with Corticosteroids

**Prednisone/Corticosteroids sequester Eosinophils in Lymph Nodes
-pinkish granules containing Major Basic Protein, Histaminase, Arylsulfatase
What is the arrow pointing at?
Define Basophilia
Basophil count > 200 / uL
What are the 4 causes of Basophilia?
1. Allergy
2. Collagen vascular disease
3. Inflammatory Bowel Disease
4. Severe Hypothyroidism

**involved in mediating allergic rxns
-granules contain Heparin and Histamine

Chronic Myelogenous Leukemia
What cell is seen here?

It's -philia is seen with what cancer?
Follicles = B-cell rich zones
-Primary follicles = unstimulated B cells
-Secondary follicles = stimulated B cells

Paracortex = T cell rich zone

Medulla = contains both B and T cells; filled with sinuses where lymph percolates through
Describe each label
Explain Acute Lymphadenitis
when Pyogenic microbes cause prominent Follicular Hyperplasia and infiltration of the lymph nodes sinuses and stroma by Neutrophils
Give 2 examples of Acute Lymphadenitis
1. Bacterial Tonsillitis = cervial lymphadenopathy b/c bacteria are being drained into the nodes and the neutrophils respond

2. Acute appendicitis = mesenteric lymph nodes will be enlarged
List the 3 types of Chronic Lymphadenitis
1. Follicular Hyperplasia
2. Paracortical Lymphoid Hyperplasia
3. Sinus histiocytosis
List 4 causes of Acute Lymphadenitis and the lymph nodes they affect
1. Tooth abscess = cervical
2. Bacterial pharyngitis = cervical
3. Appendicitis = Mesenteric
4. Gonorrhea = Inguinal
What is the pathology of Acute Lymphadenitis?
1. Neutrophil infiltrate in Sinuses and Paracortex

2. Suppurative necrosis
What are the 3 causes of Follicular Hyperplasia?
1. Rheumatoid arthritis
2. HIV infection
3. Toxoplasmosis

**typically in response to bacterial infections
What is the pathology of Follicular Hyperplasia?
1. increased Secondary Follicles = stimulated B cells
2. High mitotic activity
3. Tingible body macrophages = phagocytosed apoptotic cells
Follicular Hyperplasia -> Secondary Follicle

Mitotic figure

Tingible body macrophage
What is shown on the left?
Green Arrow?
Black arrow?
What are 3 causes of Paracortical Lymphoid Hyperplasia?
1. Infectious Mononucleosis = T cell response to infected B cells with EBV
2. Phenytoin = Dilantin
3. Vaccination
What is the pathology of Paracortical Lymphoid Hyperplasia?
1. Increased T cell immunoblasts = activated T cells

2. Decreased Follicles
What are the causes of Sinus Histiocytosis?
1. Lymph nodes draining cancer
-breast cancer = axillary LN
-macrophage are responding to the tumor antigens

2. Idiopathic
What is the pathology of Sinus Histiocytosis?
1. Increased Histiocytes in sinuses

2. Preserved follicles
In the Spleen, what comprises the Red Pulp?
RBC's and Histiocytes (macrophages)
In the Spleen, where are the B and T cells?
B cells = Follicles

T cells = Periarteriolar sheath
List the causes of Splenomegaly
1. Congestion = Portal HTN = Red pulp hyperplasia = increased RBC's and Histiocytes
2. Primary Neoplasms = Lymphangioma = enlarge the spleen itself
3. Secondary Neoplasms = Lymphoma/Leukemia = White Pulp Hyperplasia
4. Collagen Vascular Diseases = SLE and RA = White Pulp Hyperplasia
5. Storage diseases = Mucopolysaccharidoses & Gauchers = Red pulp hyperplasia b/c of Histiocytes
6. Misc. = Cysts, Amyloidosis
List the causes of Splenic Infarction
1. Thromboembolism = from heart in post-MI patient
2. Subacute bacterial endocarditis = infected valve = thrombus
3. Sickle Cell Anemia = sickle cells occlude small vessels = Autoinfarction
4. Neoplasms = grow into vessel and occlude them
What infections are those with Sickle Cell Disease at an increased risk for? Why?
Encapsulated microbes = S. pneumo and H. Influenza

Autosplenectomy due to sickle cells occluding small vessels
What is the clinical significance fo Splenic infarction?
Hyposplenism making patients more susceptible to encapsulated bacterial infections
Splenic Infarction
-contains several infarcts
-splenic infarcts are well circumscribed
What is this picture showing?
What are the causes of Splenic Rupture?
1. Trauma
2. Infections = EBV, malaria, typhoid fever
3. Neoplasm
What is the significance of Splenic Rupture?
Hypovolemic shock
-presents without anemia (takes 24 hours to develop)
Congenital anomaly of the spleen that is present in 20-30% of people
Accessory spleen
What are the most common locations of Accessory Spleen?
1. Gastrosplenic ligament
2. Pancreas tail
3. Omentum
4. Mesentery
What is the clinical significance of Accessory Spleen?
Some conditions treated by Splenectomy may not respond due to Accessory Spleen
-Hereditary Spherocytosis
-Autoimmune Cytopenias
What are the malignant Splenic neoplasms?
- Chronic Lymphocytic Leukemia
-Chronic Myelogenous Leukemia
-Acute Lymphoblastic Leukemia
What are the benign Splenic Neoplasms?
1. Lymphangioma
2. Hemangioma
3. Fibroma
4. Osteoma
5. Chondroma

*1&2 are Blood Vessel tumors