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33 Cards in this Set
- Front
- Back
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Define Leukocytosis.
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Total WBC count >12,000/microL
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To determine the clinical significance of an elevated WBC, it is important to...?
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...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 |
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Define Neutrophilia.
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Absolute PMN count > 8,000
NORMAL ANC = 2,000-8,000 |
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Where do neutrophils normally exist?
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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 |
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Neutrophilia can result from...?
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Shift of cells btwn pools or an increase in production of cells.
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Types of neutrophilia?
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1. immediate rxn
2. acute rxn 3. pathologic neutrophilia 4. leukemoid rxn 5. leukoerythroblastosis |
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Immediate rxn neutrophilia
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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 |
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Causes of immediate rxn neutrophilia?
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extreme exercise
acute stress epinephrine Occurs w/in minutes of exposure |
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Acute rxn neutrophilia
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Due to shift:
maturation/storage --> marginated/circulating Cells: segs w/ some bands and few metamyelocytes |
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Causes of acute rxn neutrophilia?
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steroids
endotoxins Occurs w/in few hours of exposure |
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Pathologic neutrophilia
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Caused by pathologic state that induces a sustained PMN response
Increase in: -- stem cell pool -- mitotic pool -- maturation/storage pool -- marginated/circulating pool |
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Causes of pathologic neutrophilia?
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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 |
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What is toxic granulation?
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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 |
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Leukemoid Reaction
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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 |
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Leukoerythroblastosis
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Smear w/ circulating immature PMNs as well as nucleated RBCs
Total WBC may be high, low, or normal depending on cause |
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Causes of leukoerythroblastosis?
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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 |
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Define eosiniphilia
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Absolute count eosinophils > 450
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Causes of eosiniphilia?
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allergic rxns
skin d/o's parasitic infections various neoplasms GI d/o's idiopathic hypereosinophilic syndrome part of various hematopoietic neoplasms |
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Define basophilia.
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Absolute count basophils > 200
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Causes of basophilia?
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May be rarely seen in allergic responses
Most cases is part of myeloprolif d/p, particularly CML |
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Define monocytosis.
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Absolute count monocytes > 1000
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Causes of monocytosis?
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chronic infectious disease
TB CT d/o's various neoplasms Part of hematopoietic neoplasms, especially CML |
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Define lymphocytosis.
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Absolute count lymphocytes > 4000
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Causes of lymphocytosis?
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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 |
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Define neutropenia.
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Absolute PMN count < 1500
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Causes of neutropenia?
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1. decreased production
-- aplastic anemia -- leukemia -- drug inhibition 2. ineffective production -- megaloblastic anemia -- myelodysplastic states 3. decreased survival -- bacterial infections -- splenic sequestration 4. combined |
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What are some morphologic d/o's of WBCs?
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1. Pelger-Huet anomaly
2. Hypersegmentation 3. Intracellular organisms |
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Pelger-Huet anomaly
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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
Congenital: -- autosomal dominant -- PMNs w/ normal fxn Acquired: -- "pseudo-Pelger-Huet" -- non-lobated PMNs and/or hypogranular cytoplasm -- NON-normal fxn -- pts prone to increased infection |
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Hypersegmentation
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10% of cells w/ 5 of 5+ lobes
Most common cause: Megaloblastic anemia Rarely: inherited d/o |
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Intracellular organisms
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In severe infections, may be seen in PMNs in the periph blood smear
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What are some qualitative WBC d/o's?
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1. chronic granulomatous disease
2. Chediak-Higashi Syndrome 3. Other miscellaneous d/o's that may result in ineffective phagocytosis, adhesion, or bacterial killing |
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Chronic Granulomatous Disease
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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 |
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Chediak-Higashi Syndrome
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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 |
