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Path U2 > CH6 - 1) Leukopenia and Leukocytosis > Flashcards

CH6 - 1) Leukopenia and Leukocytosis Flashcards

1
Q

What does hematopoetic CD34+ stem cells produce?

A

Myeloid stem cells and lymphoid stem cells

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2
Q

What does myeloid stem cells produce?

A

Erythroblast, Myeloblast, Monoblast, Megakaryoblast

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3
Q

What does erythroblast produce?

A

RBCs

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4
Q

What does myeloblast produce?

A

Neutrophils, basophils, Eosinophils

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5
Q

What does monoblast produce?

A

Monocytes

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6
Q

What does megakaryoblast produce?

A

megakaryocytes

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7
Q

What does lymphoid stem cells produce?

A

B lymphoblast and T Lymphoblast

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8
Q

What does B lymphoblast produce?

A

Naïve Bcells

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9
Q

What does Naïve B cells produce?

A

Plasma cells

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10
Q

What does T lymphoblast produce?

A

Naïve Tcells

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11
Q

What does Naïve T cells produce?

A

CD8+ and CD4+ T cells

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12
Q

How does hematopoiesis occur?

A

via a stepwise maturation of CD34+ hematopoietic stem cells

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13
Q

What happens to hematopoetic stem cells?

A

Cells mature and are released from the bone marrow into the blood.

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14
Q

What is the normal white blood cell (WBC) count?

A

it is approximately 5-10 K/pL

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15
Q

What is a low WBC count? What is it called?

A

(< 5 K) is called leukopenia.

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16
Q

What is a high WBC count? What is it called?

A

(> 10 K) is called leukocytosis.

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17
Q

What is a low or high WBC count usually due to?

A

a decrease or increase in one particular cell lineage.

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18
Q

What is neutropenia?

A

refers to a decreased number of circulating neutrophils

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19
Q

What are some of the causes of neutropenia?

A

1) Drug toxicity 2) severe infection

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20
Q

How can drug toxicity lead to neutropenia?

A

e.g., chemotherapy with alkylating agents, cause damage to stem cells resulting in decreased production of WBCs, especially neutrophils.

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21
Q

How does severe infection lead to neutropenia?

A

e.g., gram-negative sepsis leads to increased movement of neutrophils into tissues resulting in decreased circulating neutrophils.

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22
Q

What is GM-CSF or G-CSF?

A

granulocyte monocyte stimulating factor or granulocyte stimulating factor, it can be used to boost the neutrophil count decreasing the risk of infection

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23
Q

What is lymphopenia?

A

it refers to a decreased number of circulating lymphocytes

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24
Q

What are the some of the causes of lymphopenia?

A

1) immunodeficiency 2) high cortisol state 3) autoimmune destruction 4) whole body radiation

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25
Q

What are some examples of immunodeficiency that lead to lymphopenia?

A

e.g., DiGeorge syndrome or HIV

26
Q

How does a High Cortisol state lead to lymphopenia?

A

exogenous corticosteroids or Cushing syndrome, induces apoptosis of lymphocytes

27
Q

What is an example of autoimmune destruction leading to lymphopenia?

A

e.g., systemic lupus erythematosus

28
Q

How can whole body radiation lead to lymphopenia?

A

Lymphocytes are highly sensitive to radiation; lymphopenia is the earliest change to emerge after whole body radiation

29
Q

What are the different types of leukocytosis?

A

1) neutrophilic leukocytosis 2) monocytosis 3) Eosinophilia 4) Basophilia 5) Lymphocytic leukocytosis

30
Q

What does neutrophilic leukocytosis refer to?

A

increased circulating neutrophils

31
Q

What are the causes of neutrophilic leukocytosis?

A

1) Bacterial infection 2) tissue necrosis 3) High cortisol state

32
Q

How does Bacterial infection or tissue necrosis lead to neutrophilic leukocytosis?

A

It induces release of marginated pool and bone marrow neutrophils, including immature forms (left shift)

33
Q

When immature cells are released into the blood, how are they characterized?

A

by decreased Fc receptors

34
Q

What is the marker for the decreased Fc receptor?

A

CD16

35
Q

Why are Fc receptors important?

A

They help the neutrophil to recognize immunoglobulin which is going to act as an opsonin for phagocytosis

36
Q

How does high cortisol state lead to neutrophilic leukocytosis?

A

impairs leukocyte adhesion, leading to release of marginated pool of neutrophils

37
Q

What does monocytosis refer to?

A

increased circulating monocytes

38
Q

What are the causes of monocytosis?

A

inflammatory states (e.g., autoimmune and infections) and malignancy.

39
Q

What does eosinophilia refer to?

A

increased circulating eosinophils

40
Q

What are the causes of eosinophilia?

A

include allergic reactions (type I hypersensitivity), parasitic infections, and Hodgkin lymphoma,

41
Q

What is eosinophilia driven by?

A

increased eosinophil chemotactic factor

42
Q

What does basophilia refer to?

A

increased circulating basophils

43
Q

What is basophilia classically seen in?

A

chronic myeloid leukemia

44
Q

What does lymphocytic leukocytosis refer to?

A

increased circulating lymphocytes

45
Q

What are the causes of lymphocytic leukocytosis?

A

1) viral infection 2) Bordetella pertussis infection

46
Q

How does viral infections lead to lymphocytic leukocytosis?

A

T lymphocytes undergo hyperplasia in response to virally infected cells

47
Q

How does Bordetella pertussis infection lead to lymphocytic leukocytosis?

A

Bacteria produce lymphocytosis-promoting factor, which blocks circulating lymphocytes from leaving the blood to enter the lymph node.

48
Q

What is infectious mononucleosis?

A

EBV infection that results in a lymphocytic leukocytosis comprised of reactive CD8+ T cells; CMV is a less common cause

49
Q

How is EBV transmitted?

A

by saliva (kissing disease); classically affects teenagers

50
Q

What does EBV primarily infect?

A
  1. Oropharynx, resulting in pharyngitis 2. Liver, resulting in hepatitis with hepatomegaly and elevated liver enzymes 3. B cells
51
Q

CD8+ T-cell response leads to what?

A

1) LAD 2) Splenomegaly 3) High WBC count with atypical lymphocytes (reactive CD8+ T cells) in the blood

52
Q

How does the CD8+ T cell response lead to generalized lymphadenopathy (LAD)?

A

It is due to T-cell hyperplasia in the lymph node paracortex

53
Q

How does CD8+ T cell response lead to splenomegaly?

A

It is due to T-cell hyperplasia in the periarterial lymphatic sheath (PALS)

54
Q

What is used for screening of IM?

A

The monospot test

55
Q

What does the monospot test do?

A

Detects IgM antibodies that cross-react with horse sheep red blood cells (heterophile antibodies)

56
Q

When would the monospot test turn positive?

A

Usually turns positive within 1 week after infection

57
Q

What would a negative monospot test suggest?

A

CMV as a possible cause of IM

58
Q

How is a definitive diagnosis for IM made?

A

by serologic testing for the EBV viral capsid antigen.

59
Q

What are the complications of EBV?

A

1) increased risk for splenic rupture 2) Rash 3) Recurrence and B cell lymphoma

60
Q

What are patients told who have an increased risk for splenic rupture?

A

patients are generally advised to avoid contact sports for one year.

61
Q

When might a rash develop as a complication of EBV?

A

if exposed to ampicillin

62
Q

With EBV complications, why is there a risk of recurrence and B cell lymphoma?

A

Dormancy of virus in B cells leads to increased risk for both recurrence and B-cell lymphoma, especially if immunodeficiency (e.g., HIV) develops.

Path U2 (25 decks)

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