Benign Leukocytoses - Krafts Flashcards

1
Q

What percent of total neutrophils live in the blood?

A

only 5%

(half are marginated)

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2
Q

What are marginated neutrophils? Why are they important?

A
  • Neutrophils that are plastered up against the walls of the vessels
    • important because if you get emotionally stressed, you can pull most of those marginated neutrophils off the walls of the vessels and into the bloodstream
    • effectively doubling your neutrophil count.
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3
Q

What are neutrophils important for?

A
  • Fight infection (baterial)
  • Participate in inflammatory response
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4
Q

What are causes of Mature Neutrophilia?

A
  • Infection (bacterial)
  • Inflammation
  • Physiologic things
    • stress
    • hormones
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5
Q

What are toxic changes of neutrophils that are seen in both Mature and Immature Neutrophilias?

A
  • Toxic granulation
  • Döhle bodies (sky blue chunks of RER)
  • cytoplasmic vaculoization (scariest = severe infection)

(Seen only in infection! = good indicators)

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6
Q

What are causes of Immature Neutrophilia?

A
  • Infection (bacterial)
  • Inflammation
  • Severe anemia
  • Something filling up the bone marrow
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7
Q

What are the three forms of Immature Neutrophilia?

A
  • Left shift
    • more premature cells present
  • Leukemoid reaction
    • bad term - many different meanings
  • Leukoerythroblastotic reaction
    • bone marrow is rushed so it releases premature white & red cells (nucleated)
    • normal when anemia is present (benign)
    • scary if no accompanying anemia (malignant)
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8
Q

What are lymphocytes important for?

A
  • fight infection (viral)
  • participate in immunologic responses
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9
Q

What is the normal immunophenotype in blood (%T-cells, % B-cells, % NK cells)?

A
  • T-cells: 80%
  • B-cells: 15%
  • NK cells: 5%

Normal lymphocyte count varies with age.

Bigger normal range in infants.

(adults 4-11 x10^9)

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10
Q

What are the causes of Mature Lymphocytosis?

A
  • Infectious lymphocytosis
    • rare, type of infection in kids
  • Bordetella pertussis
  • Transient stress
    • i.e. after a heart attack
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11
Q

What is the general difference in appearance of Mature vs. Reactive Lymphocytosis?

A
  • Mature = lots of mature lymphocytes
  • Reactive = lots of funny-looking lymphocytes
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12
Q

What are the causes of Reactive Lymphocytosis?

A
  • Infectious mononucleosis
  • Pediatric viral infections (e.g. Measles, Mumps)
  • Viral hepatitis
  • Immune disorders
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13
Q

What are two types of cells seen in Reactive Lymphocytosis?

A
  • Downey cells
    • I - small lymphocyte with lobed nucleus and scant, compact cytoplasm
    • II - a large, “fried-egg” lymphocyte with copious cytoplasm containing radial striations
    • III - very large lymphocyte with a large nucleus showing a fine chromatin pattern
  • Plasmacytoid lymphocyte
    • cells that have an eccentric nucleus and a hof, like plasma cells, but with clumpy-smudgy lymphocyte chromatin rather than the blocky clock-face chromatin of a plasma cell
  • Plasma cells and their precursors
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14
Q

Based on lab tests, how can you tell benign left shift vs. malignant CML?

A
  • Left shift
    • toxic changes (maybe)
    • Fewer immature cells
    • No basophilia
    • LAP (leukocyte alkaline phosphatase) normal/increased
  • CML
    • Super-high WBC
    • Lots of immature cells
    • Basophilia
    • LAP decreased
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15
Q

What is the best way to differentiate benign neutrophilia from CML?

A

Cytogenetics

(translocation between chromosome 9 & 22)

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16
Q

What type of lymphocytosis is almost indistinguishable from CLL?

A

Benign Mature Lymphocytosis

17
Q

How do physicians distinguish between Benign Mature Lymphocytosis and CLL?

A
  • Age
    • Benign Mature Lymphocytosis <14 yoa
    • CLL > 40 yoa
  • Immunophenotyping in flow cytometry
    • In a benign mature lymphocytosis, there would be a mixture of B and T cells, but in CLL, all the cells mark as B cells.
18
Q

What does a very HIGH Basophilia mean?

A

Chronic Myeloid Leukemia (CML)

19
Q

What could cause an Eosinophilia?

A
  • Asthma
  • Skin diseases (allergic skin reactions)
  • Drugs
  • Parasites (rare, rule out other possibilities first)
20
Q

What three things is a Monocytosis associated with?

A
  • Infection
  • Autoimmune disease
  • Malignancy (solid organ tumor)