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EXAM #4: WBCs NON-M
MLT 126: HEMATOLOGY AND COAGULATION (NON MALIGNANT)
| Question | Answer |
|---|---|
| What type of cells get influenced by interleukins, hematopoietic growth factors, and the environment at large, to form granulocytes? What are the two series that they can produce | hematopoietic progenitor cells; granulocytic myeloid or macrophage-monocytic |
| Define Granulocytic kinetics | the differentiation, multiplication, and maturation of neutros, eosinos, and basos in the bone marrow |
| In the proliferative phase of granulocyte development, (blank) forms into (blank) within the bone marrow's mitotic pool | CFU-GEMM; CFU-GM progenitor cell |
| What cells are found within the proliferative phase of granulocyte development? | myeloblast, promyelocyte, myelocyte, metamyelocyte |
| When mature granulocytes get distributed within the body, they are either marginating or circulating. What is the difference? | marginating=adherence to blood vessels circulating=move from peripheral blood to tissue via diapedsis |
| On average, how long do granulocytes last in circulating blood? How are they removed? | 7-10hrs; splenic phagocytes or sloughing off by body fluids |
| This granulocytic stage is known for having fine chromatic, having 1-5 nucleoli, a thin basophilic stippling border with no granules, and auer rods | myeloblasts |
| Why would myeloblasts be present in peripheral blood? | pathogenicity |
| This granulocytic stage is known for being the size of a monocyte, and having prominent, nonspecific granules that cover other features within the cell. | promyelocyte |
| At what stage in granulocytic development do the granule become specific? | myelocyte |
| Describe a Myelocyte | a 10-18 micrometres cell with specific granulation, no nucleoli, and an oval-shaped nucleus concentrated towards one side |
| Which granulocytic stage has a kidney bean-esk nucleus, a pale blue cytoplasm, and specific granulation that makes it the most distinguishing feature | metamyelocyte |
| What would the chromatin pattern look like for metamyelocytes? | dense or clumped |
| Define the term "Shift to left", in relation to the ratio of segmented neutrophils to bands neutrophils. What is the classifying range that would indicate towards an inflammatory condition? | there is a premature release of increased bands, indicative of acute bacterial infection; 11%< |
| Define the term "Shift to right" | there is an increase of mature cells, in comparison to the amount of band neutrophils |
| How do Eosinophils differentiate from Neutrophils? | Eosinophils lack lysozyme in their granules |
| Describe Basophils and the function of them | their granules have histamines, which are important for responding to acute, systemic allergic reactions |
| Describe Eosinophils and the function of them | they have numerous pink granules that contain peroxidase to respond against parasitic infection and allergic reactions |
| What is a monocyte and its relation to macrophages | Monocytes are phagocytes that engulf pathogens in the blood, rather than in tissue (like macrophages do). However, hematopoietic factors can influence monocytes to further develop into macrophages |
| Describe promonocytes | second stage of monocyte development that has a NC ratio of 5:1, nucleoli present, and gray-blue cytoplasm with azo granules |
| Describe the physical characteristics of a monocyte | has a round or kidney bean-shaped nucleus, lacey chromatin, largest mature cell in blood circulation, and blue-gray cytoplasm that is irregularly shaped and contains vacuoles |
| What are the main differences between promyelocytes and promonocytes? Out of these options, which one is the most distinguishing feature | nuclear shape, chromatin, N:C ratio, granulation; granulation is the most distinguishing feature |
| What are the general functions of granulocytes and monocytes | Granulocytes: acute inflammatory response (AIR) triggers cells to aggregate to the affect site and trigger phagocytic activity Monocytes: enact phagocytosis to disable the pathogenic bacteria |
| Tissue basophils are referred to as | mast cells |
| Describe the process of Acute Inflammatory Response | Exudation occurs to vasodilation, which moves all fluids and WBCs to the tissue. Pathogen gets coated with complement (opsonization), mast cells release histamine, and the membrane becomes more permeable, allowing neutrophils to get activated |
| Describe Chemotaxis and its relation to phagocytosis | Factors get released to allow neutrophils to move |
| What roles do Extravasation and Diapedesis play in phagocytosis? | Extravasation: brings neutrophils to the site of damage Diapedesis: allows neutrophils to move through the blood to get to the tissue |
| Lysosomal action contributes to which phase of Phagocytosis | Digestion |
| What are the main two substances within basophilic granules that allow the cells to deal with varying degrees of allergic reactions? | heparin and histamine |
| What would an elevated Total Leukocyte Count be seen in? | Acute inflammation, pregnancy, or strenuous exercise |
| What would a decreased Total Leukocyte Count be seen in | sepsis, immunosuppressive agents |
| What does the Absolute Cell Count determine? | total leukocyte population during an overwhelming infection |
| What is the formula for Absolute Cell Count? | total number of leukocyte (number before the 10^3/9 uL/L) multiplied by differential percentage of specific leukocyte population |
| The normal range for total leukocytes in an Absolute Cell Count is... | 4.00-11.0x10^9/L |
| 2.5-7.5x10^9/L is the normal range in an Absolute Cell Count for which leukocyte population? | Neutrophils |
| The normal range for lymphocytes in an Absolute Cell Count is... | 1.5-3.5 x 10^9/L |
| 0.2-0.8 x 10^9/L is the normal range in an Absolute Cell Count for which leukocyte population? | Monocytes |
| The normal range for eosinophils in an Absolute Cell Count is... | 0.04-0.4 x 10^9/L |
| 0.01-0.1 x10^9/L is the normal range in an Absolute Cell Count for which leukocyte population? | Basophils |
| If we have a Neutrophil Absolute Cell Count of 5.1 x 10^9/L, is that normal? | it is in range, so it's normal |
| What is the method of choice for ESR diagnostic testing? | Westergren method |
| What cytochemical stain is used to differentiate malignant disorders from leukemoid reactions (increase in WBCs) | Leukocyte Alkaline Phosphate (LAP) |
| What does Neutrophilic Function assess? | defects in neutrophilic abilities (chemotaxis, locomotion, phagocytosis) |
| Define Leuokcytosis | an increase in the concentration/percentage of WBCs, but typically neutrophils (known as neutrophilia) |
| Which Morphological abnormality in mature granulocytes has RNA precipitants and causes metabolic toxicity? What disorders are they typically seen in? | toxic granulation; burns, malignancy, infectious diseases |
| Describe Dohle bodies | these are aggregates/inclusions of endoplasmic reticulum that are seen in viral infections, burns, result of drug use, or mainly May-Hegglins anomaly. it is seen in neutrophils, monocytes, and lymphocytes |
| What classifies sepsis? | 2 or more system inflammations |
| Phagocytosis can be triggered due to (blank) and (blank) | 1) localized inflammation 2) sepsis |
| Describe Pelger-Huet Anamoly (cause, cells affected, major findings) | an acquired, benign disorder that causes hyposegmented, dumbbell neuts due to nucleic acid metabolism error. does not affect normalcy |
| The hypersegmentation, aka 5 or more nuclear lobes, is often associated with (blank) deficiencies | B12/folate |
| Which mophological anomaly is known for having excessively large thrombocytes, likelihood for abnormal bleeding, and can have Dohle-like inclusions in granulocytes and monocytes? | May-Hegglin |
| Describe Chediak-Higashi Syndrome (cause, cells affected, major findings) | Lysosomal hereditary disorder that creates granulation difficulty/incomplete phagocytosis, affects granulocytes, causes grey-green large cytoplasmic inclusions that resemble Dohle bodies |
| Which morphological anomaly is known for producing mucopolysaccharide precipitants that resemble toxic granulation, cause mental and physical deformities, but does not impair cell function | Alder-Reilly Inclusions |
| Describe CGD | a defect in phagocytic ability; neuts and monos can ingest the microbes, but cannot kill catalase-positive organisms |
| Which morphological anomaly is known for not only having a beta-glucocerebrosidase deficiency that causes a disturbance in cellular lipid metabolism, but also can cause premature death in children? List some main lab findings associated with this disease | Gaucher's disease; wrinkled cytoplasm, 1-3 eccentric nuclei of monocytes, erythrocytopenia and leukocytopenia |
| Describe Niemann-Pick Disease (cause, cells affected, major findings) | inherited lipid metabolism disorder caused by sphingomyelinase deficiency, making the cytoplasm of monocytes foamy, creating pick cells with 1-3 eccentric nuclei; causes CNS issues due to build-up , which results in high child mortality (5yrs) |
| What differentiates Gaucher's disease from Niemann-Pick disease? | Gaucher cytoplasm is wrinkly, while Niemann-Pick cytoplasm is foamy (pick cells) |
| Following embryonic and bone marrow development, what do hematopoietic stem cells differentiate into and where do they fully form? | T cells (thymus) and B cells (stay in bone marrow until active - then go to secondary tissue) |
| Which WBC has the core function of coordinating antibody production via cellular/humoral immunity | Lymphocyte |
| Primary lymphoid tissue includes | bone marrow and thymus |
| What is the normal range of lymphocytes in circulation? | 25-35% |
| Which stage(s) in lymphocyte development contains nucleoli and a slightly condensed chromatin pattern? | Lymphoblast, Prolymphoblasts |
| Name all lymphocytes with CD34+ immunophenotypically markers | B lymphocyte, plasmocyte, CD56dim, CD56bright |
| Which lymphocyte variation(s) would be seen in viral infections | binucleated lymphos, vacuolated lymphos |
| Which lymphocyte variation(s) would be seen in lymphocytic leukemias | rieder (clover) cells, binucleated lymphocytes |
| What artifact can be an indicator of lymphocytosis? What would cause it to form? | smudge cells; occurs during slide making, but can indicative of increased fragility if there are a lot |
| Compared to B cells, T cells are (blank) and make up (blank) % of circulating lymphocytes | smaller in size, 80% |
| What are some characteristics of variant lymphs? | enlarged nucleus, increase in overall size, fine to granular chromatin pattern |
| True or false: T cells utilize cell-mediated immunity, which does not rely on antibodies to destroy pathogens | true; T-cells activate macrophages and NK cells to destroy foreign antigens, |
| Which cells is responsible for antibody production | B-cells, which differentiate into plasmocytes |
| What purpose do antigen markers serve in the lab? | they bind to specific antigens, which allows us to determine the type of lymphocyte; this aides in classifying leukemias and lymphocyte non-malignant disorders |
| Out of T-cells, B-cells, and NK-cells, which one is not cytotoxic? | B-cells |
| Describe the two roles T-cells play in immunity | Cellular: present receptors that recognize foreign antigens Humoral: after taking the antigen from a foreign pathogen, it will bring it to the macrophages to deliver it to B-cells, which then code for the antibody |
| Cell-mediated immunity is most effective in removing (blank) | virus-infected cells |
| What differentiates Cytotoxic T cells from NK cells? | NK cells do not require antigenic activation to kill off harmful cells |
| Which lymphocyte coordinates immune response via transporting an antigen for antibody production? | T helper cells |
| CD8+= | suppressor T cells |
| CD4+= | T helper cells |
| When do suppressor T cells appear, and why is it important to have them? | post-infection/completed recovery; they switch off B cells and T cells to prevent aggressive T-cells from attacking normal tissue |
| True or false: B-lymphocytes are the sole producers of immunoglobulins | false; they are a precursor to plasma cells, which produce antibodies |
| What types of daughter cells do mature B cells produce following clonal expansion? | memory cells and plasma cells |
| Which cells contain the immunophenotypical marker CD34+ | NK (CD56dim + bright), plasma cells, mature B cells |
| Which phase of B-cell maturation can contain nucleoli | plasmacytoid lymphocyte |
| What are the six stages of granulocyte development? | Myeloblast, Promyelocyte, Myelocyte, Metamyelocyte, Band cell, Segmented |
| Which stage of B-cell maturation will have a cartwheel-shaped chromatin pattern, visible hof and vacuoles, but no granulation? | plasma cells |
| Which CD34+ marker lymphocyte lives for a really short amount of time, and can induce apoptosis in pathogenic cells due to the release of perforin making pores in the cell membrane | NK lymphocytes |
| How do NK cells get activated, if not from antigenic presence? What is its main purpose? | cytokines derived from macrophages; reject host cells infected by tumors or viral infections |
| A deficiency in NK cells is indicative of a patient within (blank) | early stages of HPV |
| Which lymphocyte types attracted to pathogens by the release of interferon from macrophages and helper T-cells, promoting growth and directly killing them | CD56dim NK lymphocytes |
| Which NK lymphocyte is known for producing many cytokines in response to inflammatory reactions? How does the mechanism work? | CD56bright; interferon gamma is produce to activate macrophages that will kill intercellular pathogens and prevent further proliferation |
| On a WBC differential, what is the normal reference range for lymphocytes in a peripheral smear? | 22-44% |
| Within the average total leukocyte population, what percentage makes up lymphocytes within circulation? | 25-35% |
| A state of Lymphocytosis is normal in which age demographic? | 10yrs< |
| Which benign, intracellular virus is known for producing variant B lymphocytes? What can the peripheral blood smear results look like? | Mononucleosis; 60-90% lymph population, 5-30% are variants |
| What serological testing can be done to prove the presence of Epstein-Barr virus? | Test for positive heterophile antibodies (1.56 titer or greater), EBV serology panel |
| Describe Cytomegalovirus (CMV) | this is a herpes DNA virus that affects lymphocytes; typically asymptomatic, but must be screened in infant blood transfusion since they cannot fight off the infection |
| Which lab findings typically correspond with CMV? | leukocytosis with slight lymphocytosis, positive cytomegalo antibody titer via urine or blood sample |
| What pathogen causes Toxoplasmosis, and how does it transmit to humans? | Toxplasma gondii; house cats have it and humans get it while cleaning the litter box |
| True or false: Toxoplasmosis is known to cause serious CNS complications a/o prenatal death | true |
| How can we differentiate Toxoplasmosis from Infectious Mononucleosis? | Toxoplasmosis antibody titer within 2 weeks (higher levels) |
| Infectious Lymphocytosis commonly affects children and is likely caused by | Coxsackie virus |
| If a patient's lab results contain the following, what can it be? - Leukocytosis (20-50 x 10^9/L) - majority small, mature lymphs - negative heterophil and negative EBV antibodies | Infectious Lymphocytosis |
| Describe Bordetella pertussis | well known as whooping cough, this disease causes total respiratory tract inflammation in unimmunized children |
| What lab results correspond with Bordetella pertussis? | - Bordetella pertussis isolate - 15-40 x 10^9/L (absolute lymph) - extreme lymphocytosis |
| When Russell bodies create globules within the cell's cytoplasm, what plasma cell abnomality is it? | Grape/Mott cells |
| What causes the formation of flame cells? | plasma cells produce too much IgA, which has carbs that make it stain red in cytoplasm |
| What lab result would constitute as Lymphopenia in adults? | less than 3.0 x 10^9/L |
| What lab result would constitute as Lymphopenia in children? | less than 1.5 x 10^9/L |
| Chemotherapy patients are will typically see a decrease in (blank) in their lab results | lymphocytes |
| Define DiGeorge Syndrome and how it affects the patients | an immune disorder in which a chromosome deletion causes a total decrease in T-cells due to absence of thymus and parathyroid glands; increases suppressor to helper T-cell ratio (it's not delivery, it's deletion) |
| Describe HIV and how it spreads | retrovirus that primarily targets T-cells and other CD4 antigen-presenting cells; invades host cell, injects its genes into the nucleus, which allows it to reproduce while dormant and ultimately lyse the cell |
| What lab results would correlate to a positive HIV antibody titer? | If patient has leukopenia, deficiency in CD4 lymphocytes, and a helper-to-suppressor ratio of less than 0.5:1 |
| Which lab results would be indicative of Systemic Lupus Erythematosus, aside from positive ANA ? | presence of lymphocytotoxic antibodies, lack of suppressor T cells or excess in helper T cells, B cell hyperactivity |
| This autoimmune disease is known for causing systemic rheumatic disorder in primarily females. What causes it? | Systemic Lupus Erythematosus; overproduction of B-cells produce autoantibodies that lyse T-cells |
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