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wbc path 1


WBC count Normal: 5-10 K/µL Leukopenia: <5 K/µL Leukocytosis: >10 K/µL
Causes of neutropenia Drug toxicity (e.g. chemotherapy)//Severe infection (e.g. gram
Causes of lymphopenia Immunodeficiency (e.g. DiGeorge syndrome [no thymus] or HIV)// High cortisol state (e.g. exogenous corticosteroids or Cushing syndrome)// Autoimmune destruction (e.g. SLE)// Whole body radiation
Causes of neutrophilic leukocytosis Bacterial infection or tissue necrosis (release of marginated pool and recruitment of bone marrow neutrophils/ High cortisol state (release of marginated pool)
Marginated pool leukocytes "hang" in lung vasculature//cortisol disrupts adhesion, releases marginated pool// causes leukocytosis
Fc receptors Fc receptors help neutrophils recognize immunoglobulin (opsonin for phagocytosis)//lack of CD16 indicates lack of Fc receptors
Causes of monocytosis chronic inflammatory states (autoimmune or infectious)// malignancy
Causes of eosinophilia due to increased IL 5 production//allergic reactions//parasitic infections//Hodgkin lymphoma
Causes of basophilia classically seen in chronic myeloid leukemia
Causes of lymphocytic leukocytosis viral infections//B. pertussis infection
Acute leukemia accumulation of neoplastic blasts (>20% in the bone marrow)//blasts crowd out normal hematopoiesis// blasts enter blood, result in high WBC count with large appearance and "punched out" nucleoli
TdT DNA polymerase in lymphoblasts, but not myeloblasts or mature lymphocytes// can stain for TdT to diagnose ALL
ALL accumulation of >20% lymphoblasts in bone marrow// positive stain for TdT// most commonly arises in children// association with Down syndrome (usually >5yo)// subclassified into B
B- ALL accumulation of TdT+ lymphoblasts expressing CD10, CD19, and CD20//excellent response to chemo// requires prophylaxis to scrotum and CSF// t(12,21) has good prognosis (usually in kids), t(9,22) has poor prognosis (usually in adults)
T-ALL usually presents in teenagers as a thymic mass (called "lymphoma")// remember T's: T cells, teenagers, thymic mass
AML accumulation of >20% myeloblasts in bone marrow// positive stain for myeloperoxidase// crystal aggregates of MPO: Auer rods// may arise from myelodysplastic syndromes
Acute promyelocytic leukemia subtype of AML// has t(15;17): translation of retinoic acid receptor// RAR blocks maturation of promyelocytes// treatment = atra
Acute monocytic leukemia subtype of AML//blasts usually lack MPO //characteristically infiltrate gums//
Acute megakaryoblastic subtype of AML// blasts usually lack MPO //associated with Down syndrome (usually <5yo)
Chronic leukemia accumulation of mature LYMPHOcytes, characterized by a high WBC count with blasts <20%// often insidious onset// usually seen in older adults
CLL accumulation of naive B cells that co// most common type of leukemia// see increased lymphocytes and smudge cells// can involve lymph nodes
Complications of CLL hypogammaglobulinemia (infection most common cause of death)// autoimmune hemolytic anemia//transformation to large B cell lymphoma (will see enlarging lymph nodes or spleen)
Hairy cell leukemia accumulation of mature B cells with "hairy" cytoplasmic processes// TRAP+ // features: splenomegaly (hairy cells in red pulp), "dry" bone marrow tap (due to marrow fibrosis)// excellent response to cxtrpy
Adult T cell leukemia/lymphoma (ATLL) accumulation of mature CD4+ T cells//associated with HTLV// presents with rash, generalized lymphadenopathy, hepatosplenomegaly, punched out bone lesions with hypercalcemia
Mycosis fungoides accumulation of mature CD4+ T cells that infiltrate skin// presents with localized skin rash, plaques, nodules: called Pautrier microabscesses// cells can spread to the blood// characteristic lymphocytes with cerebriform nuclei (Sezary cells)
Myeloproliferative disorders accumulation of mature myeloid cells// usually in late adulthood(50//high WBC count with hypercellular bone marrow// all myeloid cells are increased, but classified based on dominant myeloid cell producedall myeloid cells are increased, but classified bas
Complications of MPD - increased risk for hyperuricemia and gout (high cell turnover) - progression to marrow fibrosis - transformation to acute leukem
CML - type of MPD, granulocytes are predominant cell type - basophils characteristically increased - t(9;22): Philadelphia chromosome --> BCR-ABL fusion protein with increased tyrosine kinase activity
Treatment for CML Imatinib// blocks tyrosine kinase activity of BCR
Outcomes of CML can transform to AML (2/3) or ALL (1/3) because mutation is in the pluripotent stem cell
How to distinguish CML from leukemoid reaction CML will have: negative LAP stain//increased basophils//t(9;22)
Polycythemia vera - type of MPD, RBCs are predominant cell type - assoc with JAK2 kinase mutation - blood becomes hyperviscous, requires phlebotomy (without, death usually within a year)
S/sx of polycythemia vera - splenomegaly (extramedullary hematopoiesis) - leukoerythroblastic smear (teardrop RBCs, nucleated RBCs, immature granulocytes) - increased risk of infection, thrombosis, bleeding
How to distinguish polycythemia vera from reactive polycythemia In polycythemia vera: EPO levels are decreased// oxygen saturation is normal
Essential thrombocythemia type of MPD, platelets are particularly increased// assoc with JAK2 kinase mutation //symptoms related to increased risk of bleeding AND/OR thrombosis (platelets either working really well or not at all)//rarely progresses to marrow fibrosis or acute leuk
Myelofibrosis - type of MPD, megakaryocytes are particularly increased - assoc w/ JAK2 kinase mutation (50% of cases) - megakaryocytes produce excess PDGF --> marrow fibrosis
Causes of painful vs. painless lymphadenopathy lymphadenopathy Painful: usually draining region of acute infection// Painless: seen w/ chronic inflammation, metastatic carcinoma, or lymphoma
Follicular lymphoma - NHL of small CD20+ B cells that form follicle-like nodules - typically late adulthood - can progress to diffuse large B-cell lymphoma
Pathophys of follicular lymphoma - Bcl2 normally inhibits apoptosis in peripheral cells - follicular cells generally lack Bcl2 so they can undergo testing - t(14;19) --> overexpression of Bcl2 --> cells that fail testing no longer die --> neoplasm
Treatment of follicular lymphoma reserved for symptomatic pts//involves low
How to distinguish follicular lymphoma from reactive follicular hyperplasia Follicular lymphoma shows: disruption of LN architecture// lack of tingible body macrophages (white spaces in follicle indicate macrophages are gobbling up apoptotic B cells)// Bcl2 expression //monoclonality
Mantle cell lymphoma NHL of small CD20+ B cells that expand mantle zone around follicle //typically late adulthood
Pathophys of mantle cell lymphoma t(11;14) --> overexpression of cyclin D1 --> promotes G1/S transition in cell cycle --> neoplasm
Marginal zone lymphoma - NHL of small CD20+ B cells that expand the marginal zone around the mantle/follicle - assoc with chronic inflammatory states (e.g. Hashimoto thyroiditis, Sjogren syndrome, H. pylori gastritis)... marginal zone typically only present with chronic inflam
Burkitt lymphoma - NHL of intermediate-sized CD20+ B cells - associated with EBV - translocations of c-myc (nuclear regulator) --> cell growth - high mitotic index and "starry sky" appearance under microscope
Classic presentation of Burkitt lymphoma extranodal mass in a child or young adult extranodal mass in a child or young adult - African form: jaw - Sporadic form: abdomen
Diffuse large B - most common form of NHL - large CD20+ B cells grow diffusely in sheets - clinically aggressive - arises sporadically or from transformation of lower-grade lymphoma - presents in late adulthood
Hodgkin lymphoma overview - proliferation of Reed-Sternberg cells - cytokine release attracts other inflammatory cells, may lead to fibrosis and "B" symptoms (night sweats, fever, chills) - reactive cells are the bulk of the tumor - nodular sclerosis is most common subtype
Reed Sternberg cells - large B cells with multilobed nuclei & prominent nucleoli ("owl eye" appearance) - neoplastic in Hodgkin lymphoma - classically CD15 and CD30+ with NO CD20 expression - secrete cytokines that attract lymphos, plasma cells, macrophages and eosinophils
Nodular sclerosis - most common subtype of Hodgkin lymphoma - classically presents with enlarging cervical or mediastinal lymph node in young adult, usually female - lymph node divided by bands of sclerosis - Reed Sternberg cells present in lake-like spaces (aka lacunar
Best/worst prognosis for Hodgkin lymphoma - lymphocyte-rich subtype has best prognosis - lymphocyte-deprived has worst prognosis (usually in elderly and HIV+)
Multiple myeloma malignant proliferation of plasma cells in marrow// high serum IL //plasma cells overproduce osteoclast activating factor, Igs, light chain
S/sx of multiple myeloma osteoclast activating factor// IgA & IgG// = bence jones protiens
Monoclonal gammopathy of undetermined significance (MGUS) increased serum protein with M spike// other features of multiple myeloma are ABSENT// common in elderly, some will develop multiple myeloma
Waldenstrom macroglobulinemia B cell lymphoma with monoclonal IgM production// similar to multiple myeloma but: no lytic bone lesions// visual and neurologic deficits (due to serum hyperviscosity)// bleeding (defective platelet aggregation)// treat with plasmapheresis
Langerhans cell histiocytosis neoplastic proliferation of Langerhans cells// characteristic Birbeck (tennis racket) granules seen on EM// cells are CD1a+ and S100+//
data source clarebp on quizlet(dot)com
Created by: ljacob2010