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Heme 2 > WBC Physiology > Flashcards

WBC Physiology Flashcards

1
Q

Myelocytic Maturation series

A

myeloblast
promyelocyte
myelocyte
metamyelocyte
*non-segmented granulocyte (band neutrophil)
*segmented granulocyte (segmented neutrophil)

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2
Q

What regulates leukopoiesis?

A

Colony stimulating factors (CSF) such as:

  • CSF-GM: stimulates granulocytes and monocytes
  • CSF-G: stimulate neutrophils (granulocyes)

*these factors stimulate maturation events

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3
Q

Name some of the nuclear and cytoplasmic “altered” cell morphologies

A

Nuclear:
-Pelger-Huet: autosomal dominant genetic disorder leading to hyposegmentation

Cytoplasmic:
-Gaucher: glucocerebroside accumulates in cells of liver and spleen. Massive hepatomegaly andd splenomegaly.

  • Niemann-Pick: myelin accumulation in cells (lysosomes)
  • Toxic Granulation: changes in granulocytes on peripheral blood smear(coarse deeply colored granules), occurs w/ infections of cell surface

-Dohle Bodies:
grey-ish blue areas in the cytoplasm representing residual ribosomes/RNA.

Vacuolization: occurs under stress, holes?

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4
Q

Leukocyte Differential: expected % seen in peripheral blood smear.

A

Segmented Neutrophil: 50-70%

Lymphocytes: 20-40%

  • -60-80% T cells
  • -10-20% B Cells
  • -5-10% NK

Monocytes: 0-7%

Neutrophil Bands 0-5%

Eosinophils 0-5%

Basophils 0-1%

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5
Q

When would you see an increase in the number of neutrophil bands on peripheral blood smear?

A

-pyogenic infection

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6
Q

What are two type of electronic blood cell counters?

A
  • Coulter Principle
  • Flow Cytometry
  • -forward scatter: size
  • -side scatter: granularity
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7
Q

What is hypersegmentation?

First hematologic abnormality seen in what disorders?

A
  • abnormally increased nuclear lobulation

- megaloblastic, B12 and Folate deficiency, iron deficiency anemia

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8
Q

On average how many lobes does a mature circulating neutrophil have?

eosinophil?

basophil?

A

-3-5

-

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9
Q

What are the requirements for hypersegmentation?

aka

A
  • more than 3 cells having 5 lobes or a single cell with 6 lobes found in the course of 100 cells is evidence of hypersegmentation.
  • “right shift”
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10
Q

What is hyposegmentation?

A

-neutrophils with few than 3 lobes

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11
Q

What is the cause of toxic granulation?

A
  • seveere inflamm states (sepsis)

- thought to be d/t impaired cytoplasmic maturation, in the effort to rapidly generate large numbers of granulocytes

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12
Q

What is vaculoization helpful in diagnosing?

A

-dx of septicemia(blood poisoning)

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13
Q

What are the suffixes used to describe quantitative disorders of WBC?

A
  • penia (low count)

- philia (high count)

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14
Q

What is the cause of pseudneutrophilia?

Left shift?

Sustained neutrophilia?

A
  • demargination of marginated pools of cells. (dbling of count)– Stress
  • acute inflamm
  • chronic infection
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15
Q

What is the consequence of giving glucocorticoids during an infection in relation to the leukocytes?

A

it decreases extravasation into the tissues leading to leukocytosis in the circulating pool.

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16
Q

What artifacts suggest “toxic” cell appearance in neutrophilia?

A
  • Dohle Bodies
  • Vacuoles
  • Intra-cellular microbes
17
Q

When are Dohle Bodies present in the cytoplasm of cells?

A

-infections, poisoning, burns, and following chemotherapy, neoplastic disease, myeloproliferative disorders, pregnancy

18
Q

What are some causes of neutrophilia?

A
  • Physiologic:
  • -emotional stimuli: fear, panic, joy, excitement, depression

–Physical stimuli: cold, heat, exercise, pain, menstruation, labor, pregnancy, vomiting, smoking

  • Infections/inflamm
  • -bacterial
  • -parasitic
  • Tissue Necrosis:
  • -acute gout
  • -burns
  • -trauma
  • infarcts

Metabolic:

  • ketoacidosis
  • uremia
  • eclampsia
  • thyrotoxicosis

Other:

  • -autoimmune
  • -myeloproliferative disorders
  • Drugs/Hormones:
  • -epinepherine
  • -steroids
  • -lithium
  • -venoms/poisons/toxins
19
Q

What can cause neutropenia?

A
  • age
  • race (african, middle eastern)
  • rxn to drug
  • infections (HIV/Hepatitits, TB, Malaria)
  • immune disorders (SLE)
  • Neoplasm
  • BM failure (megaloblastic anemia, aplastic anemia)
  • Idiopathic
20
Q

Pathophys of Neutropenia?

A

Defects inside or outside the BM

  • decreased proliferation (aplasia)
  • decreased maturation (insufficient number of precursors)
  • decreased survival (increased destruction)
  • Distribution (total body pools are normal, circulating numbers reduced) (Increased margination)
21
Q

Causes of Lymphocytosis

A
  • infection
  • -viral (CMV, EBV)
  • -bacterial (Pertussis)
  • Meds (Dilantin)
  • Rx
  • Neoplasm
  • -leukemias
  • -lymphomas
22
Q

Pathophys of Lymphopenia

A
  • decreased production
  • increased destruction
  • changes in distribution
23
Q

Causes of lymphopenia

A
  • Decreased production:
  • -SCID (severe combined immunodeficiency)
  • -protein-calorie malnutrition
  • -zinc deficiency
  • Increased Destruction
  • -HIV
  • -Radiation therapy
  • -chemotherapy
  • -SLE
  • Redistribution:
  • -glucocorticoid therapy
  • Anesthesia
  • TB
  • Flu
  • Burns

HEMATOLOGIC DISORDERS

24
Q

Causes of Monocytosis

A
  • Hematolgic disorders
  • -leukemia
  • -lymphoma
  • Infections
  • -TB
  • -SBE (Subacute bacterial endocarditis)
  • Fever of unknown origin
  • GI disorder
  • Collagen vascular disorders
25
Q

Causes of Eosinophilia

A 
-acute allergic rxn
(allergic rhinitis and asthma)
-parasitic infection
-TB
-Skin disorder (eczema and psoriasis)
-neoplasms
-autoimmune
26
Q

Causes of Basophilia?

A
  • CML
  • polycythemia vera)
  • allergies (hypersensitivity rxn)
  • inflamm disorder
  • irradiation
  • viral infection
27
Q

What is leukocytosis? Leukopenia? left shift?

A
  • increase in number of circulating white cells
  • decrease in the number of circulating white cells
  • increased circulation of immature neutrophils

:):):):)

28
Q

What happens in leukemoid rxn?

A

forms of neutrophils more IMMATURE than the band cells present in peripheral blood (metamyelocytes, myelocytes)

*may have to do BM bx to see why these primitive cells are getting into circulation?

29
Q

Summing it up, if you have bacterial infection what type of cells will you see?

allergic/parasitic/TB?

Viral infection?

A
  • neutroPHILIA
  • EosinoPHILIA
  • neutroPENIA & LymphoCYTOSIS

Heme 2 (8 decks)

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