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98 Cards in this Set
- Front
- Back
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What does a WBC report contain?
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the total number of cells—and percentage of each type of wbc.
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What is the primary actions of WBCs?
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Primary action
phagocytosis by the granulocytes and monocytes Formation of antibodies by the b-cell lymphocytes Delayed hypersensitivity response by the t-cell lymphocytes |
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What group of people tend to have leukocytosis?
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Smokers and in pregnancy
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What is leukocytosis and how is it named?
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Leukocytosis is usually caused by an increase of only one type of leukocyte and is given the name of the cell that shows the main increase:
Neutrophilia, lymphocytosis, monocytosis, basophilia, eosinophilia |
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How do you calculate the absolute value?
**Test Question** |
Relative value (%) x Total WBC (cells/mm)
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How should a differential be interpreted?
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Always in relation to the total WBC count
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2 groups of Leukocytes (WBC)
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Granulocytes (myeloid cells)
Agranulocytes (lymphoid cells) |
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3 types of granulocytes ( myeloid) cells
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Neutrophils
Eosinophils Basophils |
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2 types of agranulocytes (lymphoid cells)
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Monocytes
lymphocytes |
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Where do granulocytes and agranulocytes arise from?
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pluripotent stem cells
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What is the life span of a leukocyte?
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13-20 days
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Monocytes are transformed into what?
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Macrophages
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Lymphocytes are transformed into what?
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Plasma calls ( B or T lymphocytes)
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These do not contain lysomol enzymes for breaking down and digesting cellular invaders.
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Agranulocytes
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Why are they named granuloctyes?
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because contain many membrane-bound granules with enzymes that are capable of destroying microorganisms and digesting cellular debris. These cells also contain multilobed nuclei—so they are also called polys—or PMNs polymorphonucleocites They are all phagocytes
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Most abundant type of granulocyte
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Neutrophils
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Other names for neutrophils
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Polys, polymorphs, segs
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Life span of a neutrophil in circulation
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10 hrs
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Life span of a neutrophil in tissue
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4-5 days
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How is a neutrophil attracted to the site of infection?
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Attracted to site of infection by chemotaxis
Substances produced by Microbes, cellular injury, plasma proteins |
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What is Granulopoesis?
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Process of differentiation from earliest form to mature neutrophil
Health 7-11 days Increased demand Maturation period 48-72 hours |
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What are neutrophils?
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Mature granulocytes with characteristic granules in cytoplasm (segs, polys)
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What are bands?
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Immature, replacement cells for aged neutrophils
Banded nucleus, specific, distinctive granules Normally present in small numbers |
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Where are Metamyelocyte, myelocyte (metas, myelos) normally found?
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Normally found only in marrow or granulopoesis pool
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Class of drugs that can cause neutrophilia
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Steriods
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What is a left shift?
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Left shift is an increase in the number of immature leukocytes in the peripheral blood, particularly neutrophil band cells.
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With a degenerative shift to the left what increases and what decreases?
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WBC decrease
bands increase Poor prognosis |
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With a regenerative shift to the left what increases?
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Increase in bands with leukocytosis in bacterial infections
Good prognosis |
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Causes of Neutropenia
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Drug effects
Nutritional deficiencies Vitamin B12, folate, and copper deficiency Response to select infections Mononucleosis, hepatitis, tuberculosis Aplastic anemia Serious illness regardless of etiology Hormonal disorders Thyrotoxicosis, Addison’s disease, Acromegaly Leukemia Lymphoma |
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Absolute Neutrophil Count
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total WBC x % neutrophils in the diff
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Mild neutropenia
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1000-1500
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Moderate neutropenia
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500-1000
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Severe neutropenia
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less than 500
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Neutropenia increases risk to what infections
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gram+
gram- fungi Risk corresponds to severity of neutropenia |
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What is a significant temp in a neutropenic patient?
What is the treatment? |
100 F
and requires immediate broad spectrum antibiotics-at risk for septicemia, pneumonia. |
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Elevated in allergic responses to allergens,
Hay fever, skin disorders, asthma |
Eosinophils
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Increase in parasite infections
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Eosinophils
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Increase in autoimmune disease
Scleroderma,lupus, rheumatoid arthritis, sarcodiosis, Hashimoto’s thyroiditis |
Eosinophils
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Worms, wheezes, and weird diseases
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Eosinophils
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Characteristics of Eosinophils
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eosinophils ingest antigen-antibody complexes in inflammatory responses
Eosinophilic granules contain histamine Eosinophilic bronchitis in asthma Parasitic infections—intestinal and tissue Uncommon conditions such as Addison’s disease, certain cancers, pernicious anemia May also be elevated in acute infection. Elevated in long term PD |
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associated with allergic reactions and mechanical irritations
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Basophils
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Migrate to tissues and become mast cells
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Basophils
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Have cytoplasmic granules that contain
Histamine, bradykinin, serotinin, and heparin |
Basophils
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Elevation can indicate myeloproliferative process
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Basophils
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What can Mast cells trigger?
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trigger acute acute asthmatic attacks and urticaria
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Where will you see basophilia?
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in leukemia and other myeloproliferativ edisorders
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What are monocytes?
Where do they live? |
Immature macrophages
Live in circulation for 36 hours, then migrate to lymphoid tissues in liver, spleen, lymph nodes, peritoneum, GI tract, and lungs where they will remain for months or years |
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What are lymphocytes?
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Mature B cells (plasma cells)
B-cells T-cells |
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Responsible for phagocytosis of mycobacteria, and cellular debris, removal of senescent cells, from blood, and spleen, formation of cytokines
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Agranulocytes
Monocytes Lymphocytes |
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Where are monocytes elevated?
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TB infection
Recuperation from sepsis or severe bacterial infection WATCH OUT can indicate leukemia |
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What are Lymphocytes ?
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Mature B-cells (plasma cells)
B-cells (antibody mediated response) (20%) T-cells (cellular immunity) (80%) CD4 (director cells) CD8 (killer cells |
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What is responsible for the antibody mediated response
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mature B cells
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Increases in viral illnesses
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lymphocytes B cells
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Increases with rejection of transplant tissue
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lymphocytes B cells
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. Include surface markers such as CD4 and CD8.(CD clusters of differentiation)
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T cell lymphocytes
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Disorder in this process is the basis for autoimmune disease.
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T cell lymphocytes
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Cell-mediated immunity.
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T cell lymphocytes
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Acts against intracellular organisms such as certain bacteria, viruses, fungi and protozoa.
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T cell lymphocytes
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HELPS DELAY HYPERSENSITIVITY RESPONSES
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T cell lymphocytes
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found in lymph nodes, spleen, gut respiratory tract. Active aginst select bacterial infections via humoral or antibody-mediated immunity.
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B-cells—
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Common viral infections where you’d see a lymphocytosis
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ebstein Barr virus, mumps, adneovirus, varicella zoster, coxsackie virus, herpes simplex, CMV, syphilis, TB, pertussis.
CLL Viral infections Multiple Myeloma |
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Causes of Lymphopenia
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Immunosuppressive interventions such as chemotherapy, radiation
Steroid use Hodgkin’s disease Any debilitating disease HIV infection Radiation Therapy Sepsis |
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hematologic malignancies that affect the bone marrow and lymph tissue
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Acute and chronic leukemias
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Cancer that Comes from myeloid cells
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Myelogeoous leukemias
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Myeloid cells
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Monocytes
Platelets Erythrocytes Basophils Eosinophils Neutrophils |
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Cancer that comes from Lymphoid cells
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Lymphocytic leukemias
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Lymphoid cells
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T-lymphocyte
B-lymphocyte Natural killer cell |
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80% of childhood leukemias
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Acute lymphocytic leukemia (ALL)
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S & S ALL
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Abrupt onset of malaise
Bone pain Bruising, petechiae, ecchymosis Hepatosplenomegaly Cranial nerve palsies Lymphadenopathy |
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Diagnostic findings in ALL
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Neutropenia with circulating lymphoblasts
Anemia Thrombocytopenia |
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Immune suppression due to inadequate antibody production by the abnormal B cells
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Chronic lymphocytic leukemia
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Affects the lymphoid cell line, usually the B lymphocytes. There is an accumulation of normal but functionally ineffective lymphocytes. These lymphocytes will infiltrate the marrow, spleen, liver, and lymph nodes
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Chronic lymphocytic leukemia
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Etiology/incidence (CLL)
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Most common form of adult leukemia in Western countries
Most are >50, median age 65 Male to female ratio is 2:1 Prognosis is determined by clinical stage: 1-10 years |
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Signs and symptoms CLL
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Fatigue, malaise
Night sweats Bleeding Anorexia Early satiety Lymphadenopathy Splenomegaly |
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Hallmark sign of CLL
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Isolated lymphocytosis (HALLMARK)
WBC count is usually >20,000 and 75-98% or circulating cells are lymphocytes HGB and platelets are usually normal Bone marrow infiltrated with small lymphocytes |
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Disorder of myeloid stem cell
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Acute myelogenous leukemia (AML)
Increased production of granulocytes Incidence increases with age |
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Signs and symptoms of AML
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Fatigue
SOB Bleeding, easy bruising Headache Late: change in mental status |
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Diagnostic findings in AML
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Pancytopenia and circulating blast cells
Anemia Thrombocytopenia Neutropenia Hyperuricemia Increased LDH May have positive DIC profile |
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Associated with Philadelphia chromosome
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Chronic myologenous leukemia (CML)
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Three clinical stages of CML
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Stable or chronic: 3-4 years
Accelerated phase: 6-24 months Blast crisis 8-16 weeks |
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Signs and symptoms CML
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Fatigue
Night sweats Low grade fever Early satiety due to splenomegaly Sternal tenderness |
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Diagnostic findings in CML
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Leukocytosis
Many or may not have anemia, thrombocytopenia Increased uric acid and LDH Philadelphia chromosome is diagnostic marker 90% of the time |
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Management/treatment CMl
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Hydroxyurea (more palliative)
Recombinant alpha interferon (can suppress the Philadelphia chromosome and improve survival and delay blast crisis) Imatinib mesylate can induce remission Bone marrow transplant Blast crisis treated like AML |
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Malignant disorder of the lymphoreticular system characterized by the presence of Reed-Sternberg cells usually originating from the B lymphocyte line
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Hodgkin’s Disease
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Etiology/Incidence of Hodgkins Disease
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Bimodal age distribution, 20-30 and >50 years of age
More common in males, whites and higher socioeconomic groups EBV has been suggested as possible etiologic agent Excellent prognosis with a high cure rate |
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Signs and symptoms of Hodgkins Disease
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A’ symptoms=lack of ‘B’ symptoms
‘B’ symptoms: fever, night sweats, weight loss, pruritis Orderly spread of disease from one area to another Lymphadenopathy Hepatosplenomegaly A classic symptom is pain in an involved lymph node following alcohol ingestion |
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Laboratory findings of Hodgkins Disease
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Lymph node biopsy with Reed-Sternberg cells
Staging purposes need CT of chest, abdomen, and pelvis Staging laporoscopy sometimes necessary Bone marrow biopsy Leukocytosis with lymphocytopenia and eosinophilia |
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Etiology/Incidence of Non Hodgkins Disease
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Fifth most common cancer in the US
Incidence is increasing due to HIV Incidence increases with age Median age 50 Etiology is uncertain Pattern of dissemination is less orderly than Hodgkin’s disease |
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Signs and symptoms of Non Hodgkins Disease
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Asymptomatic
Painless swelling of lymph nodes with lymphadenopathy “B” symptoms may be present Fever, drenching night sweats, weight loss Hepatosplenomegaly |
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Diagnostic findings of Non Hodgkins Disease
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Lymph node biopsy to define cell type
Bone marrow biopsy Staging CTs of chest, abdomen, and pelvis |
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Factors associated with poor prognosis in Non Hodgkins disease
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“B” symptoms
More than 2 extra nodal sites Spleen involvement Stage III or Stage IV disease |
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Function of a Normal Plasma Cell
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Normal plasma cells are responsible for antibody production
to produce immunoglobulins (the basic unit from which antibodies are formed |
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cells that give rise to myeloma cells that proliferate unchecked
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Damaged B cells
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Immunoglobulin Structure
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Made up of 2 heavy chains
IgG, IgA and IgM in myeloma or AL 2 light chains Kappa or Lambda |
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Hallmarks of Mulitple Myeloma
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Anemia
Renal failure Bone destruction (lytic bone lesions) Hypercalcemia Presence of monoclonal protein (M protein) Increased risk of infection |
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Signs and symptoms of Multiple Myeloma
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Bone pain and/or pathologic fractures Bone pain is constant and worse with movement, as opposed to metastastic disease which is worse at night
Osteolytic lesions, osteopenia, and fractures are common Fatigue and weakness Recurrent infections Nausea and vomiting Confusion |
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Cause of renal insufficiency in Multiple Myeloma
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Hypercalcemia or the Multiple Myeloma process itself
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Bence Jones Protein
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protien globulin found in the urine and often blood of multiple myeloma patients
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