Pathology - S2B2 - Wbc/lymph 1

Front 1

What are the most abundant WBC's in the blood?

Back 1

Segmented Neutrophils = 50-70%

Front 2

WBC that usually make up 2-6% of total WBC count but during acute inflammation their number can elevate and cause a left shift

Back 2

Band neutrophils

Front 3

Decrease in the neutrophil count = ?

Back 3

Neutropenia

Front 4

What is the Absolute count of Neutrophils below in Neutropenia?

Back 4

< 1800 / microliter

Front 5

What would be the treatment for Neutropenia?

Back 5

G-CSF = stimulates the BM to produce Neutrophils

Front 6

List 7 causes of Neutropenia due to decreased production

Back 6

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

Front 7

List 3 causes of Neutropenia due to increased destruction

Back 7

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

Front 8

What is the definition of Neutrophilia?

Back 8

Neutrophil count > 7000 / uL

Front 9

List 6 causes of Neutrophilia

Back 9

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

Front 10

Normal Neutrophils
- 2-5 lobes with Secondary granules

Back 10

What is shown here?

Front 11

Toxic Granulation of Neutrophils
-Primary granules = play role in host defense = Respiratory burst
-Cytokines that stimulate acute inflammation stimulate Neutrophils to make Primary Granules

Back 11

What is shown here? What is the cause?

Front 12

Dohle Bodies = one or two light blue inclusion within the cytoplasm of Neutrophils
- aggregates of dilated RER
- occur in acute inflammatory conditions

Back 12

What is shown at the arrow?

Front 13

What do Toxic Granulation and Dohle Bodies allow you to differentiate?

Back 13

Their presence tells you that there is inflammation going on (Reactive, non-neoplastic neutrophilia), which rules out Malignant Neutrophilia

Front 14

What is the definition of Lymphocytosis?

Back 14

Lymphocyte count > 4000 / uL

Front 15

What are the causes of Lymphocytosis? (2)

Back 15

1. Viral infections
- Infectious Mononucleosis
- Cytomegalovirus
- Herpes Simplex Virus

2. Allergic Drug reactions

Front 16

Normal Lymphocyte
- nucleus is 1.5 times the size of RBC; cytoplasm is minimal

Back 16

What is the cell shown in the middle?

Front 17

Reactive Lymphocytes
-nucleus is large and elongated
-cytoplasm is abundant and basophilic where it touches RBC's = "ballerina skirt phenomenon"

Back 17

What is shown here?

Front 18

What is the definition of Monocytosis?

Back 18

Monocyte count > 800 / uL

Front 19

What are the causes of Monocytosis?

Back 19

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

Front 20

Monocyte
-irregular, folded nucleus
-highly vacuolated
-has some granules

Back 20

Cell type seen here?

Front 21

What is the definition of Eosinophilia?

Back 21

Eosinophilia count > 500 / uL

Front 22

What are the causes of Eosinophilia?

Back 22

PAANIC

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

Front 23

What is Idiopathic Hypereosinophilia Syndrome?

Back 23

Eosinophil count > 1500 / uL X 6 months

Front 24

What is the pathology of Idiopathic Hypereosinophilic Syndrome?

Back 24

Endomyocardial fibrosis --> restrictive heart failure

Front 25

What is the prognosis of Idiopathic Hypereosinophilic Syndrome

Back 25

-10% survival at 3 years without therapy

-70% survival at 5 years with Corticosteroids

**Prednisone/Corticosteroids sequester Eosinophils in Lymph Nodes

Front 26

Eosinophil
-pinkish granules containing Major Basic Protein, Histaminase, Arylsulfatase

Back 26

What is the arrow pointing at?

Front 27

Define Basophilia

Back 27

Basophil count > 200 / uL

Front 28

What are the 4 causes of Basophilia?

Back 28

1. Allergy
2. Collagen vascular disease
3. Inflammatory Bowel Disease
4. Severe Hypothyroidism

**involved in mediating allergic rxns

Front 29

Basophil
-granules contain Heparin and Histamine

Chronic Myelogenous Leukemia

Back 29

What cell is seen here?

It's -philia is seen with what cancer?

Front 30

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

Back 30

Describe each label

Front 31

Explain Acute Lymphadenitis

Back 31

when Pyogenic microbes cause prominent Follicular Hyperplasia and infiltration of the lymph nodes sinuses and stroma by Neutrophils

Front 32

Give 2 examples of Acute Lymphadenitis

Back 32

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

Front 33

List the 3 types of Chronic Lymphadenitis

Back 33

1. Follicular Hyperplasia
2. Paracortical Lymphoid Hyperplasia
3. Sinus histiocytosis

Front 34

List 4 causes of Acute Lymphadenitis and the lymph nodes they affect

Back 34

1. Tooth abscess = cervical
2. Bacterial pharyngitis = cervical
3. Appendicitis = Mesenteric
4. Gonorrhea = Inguinal

Front 35

What is the pathology of Acute Lymphadenitis?

Back 35

1. Neutrophil infiltrate in Sinuses and Paracortex

2. Suppurative necrosis

Front 36

What are the 3 causes of Follicular Hyperplasia?

Back 36

1. Rheumatoid arthritis
2. HIV infection
3. Toxoplasmosis

**typically in response to bacterial infections

Front 37

What is the pathology of Follicular Hyperplasia?

Back 37

1. increased Secondary Follicles = stimulated B cells
2. High mitotic activity
3. Tingible body macrophages = phagocytosed apoptotic cells

Front 38

Follicular Hyperplasia -> Secondary Follicle

Mitotic figure

Tingible body macrophage

Back 38

What is shown on the left?
Green Arrow?
Black arrow?

Front 39

What are 3 causes of Paracortical Lymphoid Hyperplasia?

Back 39

1. Infectious Mononucleosis = T cell response to infected B cells with EBV
2. Phenytoin = Dilantin
3. Vaccination

Front 40

What is the pathology of Paracortical Lymphoid Hyperplasia?

Back 40

1. Increased T cell immunoblasts = activated T cells

2. Decreased Follicles

Front 41

What are the causes of Sinus Histiocytosis?

Back 41

1. Lymph nodes draining cancer
-breast cancer = axillary LN
-macrophage are responding to the tumor antigens

2. Idiopathic

Front 42

What is the pathology of Sinus Histiocytosis?

Back 42

1. Increased Histiocytes in sinuses

2. Preserved follicles

Front 43

In the Spleen, what comprises the Red Pulp?

Back 43

RBC's and Histiocytes (macrophages)

Front 44

In the Spleen, where are the B and T cells?

Back 44

B cells = Follicles

T cells = Periarteriolar sheath

Front 45

List the causes of Splenomegaly

Back 45

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

Front 46

List the causes of Splenic Infarction

Back 46

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

Front 47

What infections are those with Sickle Cell Disease at an increased risk for? Why?

Back 47

Encapsulated microbes = S. pneumo and H. Influenza

Autosplenectomy due to sickle cells occluding small vessels

Front 48

What is the clinical significance fo Splenic infarction?

Back 48

Hyposplenism making patients more susceptible to encapsulated bacterial infections

Front 49

Splenic Infarction
-contains several infarcts
-splenic infarcts are well circumscribed

Back 49

What is this picture showing?

Front 50

What are the causes of Splenic Rupture?

Back 50

1. Trauma
2. Infections = EBV, malaria, typhoid fever
3. Neoplasm

Front 51

What is the significance of Splenic Rupture?

Back 51

Hypovolemic shock
-presents without anemia (takes 24 hours to develop)

Front 52

Congenital anomaly of the spleen that is present in 20-30% of people

Back 52

Accessory spleen

Front 53

What are the most common locations of Accessory Spleen?

Back 53

1. Gastrosplenic ligament
2. Pancreas tail
3. Omentum
4. Mesentery

Front 54

What is the clinical significance of Accessory Spleen?

Back 54

Some conditions treated by Splenectomy may not respond due to Accessory Spleen
-Hereditary Spherocytosis
-Autoimmune Cytopenias

Front 55

What are the malignant Splenic neoplasms?

Back 55

Hematopoietic
- Chronic Lymphocytic Leukemia
-Chronic Myelogenous Leukemia
-Acute Lymphoblastic Leukemia

Front 56

What are the benign Splenic Neoplasms?

Back 56

1. Lymphangioma
2. Hemangioma
3. Fibroma
4. Osteoma
5. Chondroma

*1&2 are Blood Vessel tumors