Quantitative WBC Abnormalities

Question 1

Normal WBC count

Answer 1

4.5-11.5 x 10^9/L

Question 2

Definition of leukocytosis

Answer 2

Any WBC count over 11.5 x 10^9/L

Question 3

3 general mechanisms for all types of leukocytosis

Answer 3

1. Cells from BM (increased flow from BM)
2. Shift of cells from marginal granulocyte pool to circulating granulocyte pool
3. Decreased outflow of cells from blood

Question 4

5 physiological causes of leukocytosis

Answer 4

• Exercise
• Stress
• Hypoxia
• Labor
• Shfit from marginal pool to circulating pool?

Question 5

6 pathological causes of leukocytosis

Answer 5

• Disease or tissue damage
• Infection
• Toxins (drugs, chemicals)
• Necross (MI, burns surgery)
• Hemorrhage
• Hemolysis

Question 6

Definition of leukemoid reaction

Answer 6

Excessive leukocytosis

• WBC > 50.0 x 10^9/L WITH a left shift
• Shift to the left in myeloid series (immature cells in PB)

Question 7

2 types of leukemoid reactions

Answer 7

• Neutrophilic

- Lymphocytic

Question 8

Production of bands, myelos, metas - sometimes difficult to differentiate from chronic myelogenous leukemia and occurs with infections, hemolysis, and burns

Answer 8

Neutrophilic leukemoid reaction

Question 9

Produces lymphs- maybe be hard to distinguish from Chronic Lymphocytic Leukemia and these reactions can occur in Pertussis, mononucleosis, and viral infeactions

Answer 9

Lymphocytic leukemoid reaction

Question 10

CML vs. leukemoid reaction

- Incrase in what cells?

Answer 10

• CML: increases in all granulocytes including eosinophils and basophilis
• Leukemoid: increase in granulocytes BUT it is uncommon for increases in eosinophils and basophils

Question 11

CML vs. leukemoid reaction

- Dyspoietic morphology (mixed granulation)

Answer 11

• CML: dyspoietic morphology

- Leukemoid: no dyspoietic morphology

Question 12

CML vs. leukemeoid reaction

- Platelets

Answer 12

• CML: giant and hypogranular platelets

- Leukemoid: Normal platelet morphology

Question 13

Define leukoerythroblastosis

Answer 13

Presence of both immature neutrophils and nucleated RBCs in the PB

Question 14

Cause of leukoerythroblastosis

Answer 14

Caused by a space occupying lesion in the bone marrow (fibrosis, metastic tumor, lymphoma, leukemia)

Question 15

Define leukopenia

Answer 15

Any WBC count < 4.5 x 10^9/L

Question 16

Mechanisms of leukopenia

Answer 16

• Decreased flow of cells from bone marrow
• Shift from CGP to MGP
• Increased outflow from blood

Question 17

Causes of leukopenia

Answer 17

• Viral infections
• Drugs (some antibiotics, chemotherapy)
• Radiation
• Hematologic disorders (pernicious anemia, aplastic anemia, MDS)

Question 18

What is a relative value?

Answer 18

% of cell type in specified volume

Question 19

What is an absolute value?

Answer 19

of cell type in specified volume

Question 20

Calculation for the absolute value

Answer 20

Absolute = total WBC x % cell type (add up segs and bands for neutrophil count)

Question 21

Definition of neutrophilia

Answer 21

Increase in neutrophils > 8.1 x 10^9/L

Question 22

Causes of neutrophilia

Answer 22

• Physiologic: stress, exercise, pregnancy
• Acute infection, usually bacterial
• Chronic inflammation (gout, RA, burns)
• Steroids (cause demarginalization and inhibit neutrophil apoptosis)

Question 23

Define neutropenia

Answer 23

Decrease in neutrophils < 2.3 x 10^9/L

Question 24

Neutropenia mechanisms

Answer 24

• Decreased BM production
• Shift from CGP to MGP
• Increase in rate of outflow of neutrophils from blood

Question 25

Neutropenia severity | - Severe w/ increased risk of infection

Answer 25

< 1.5 x 10^9/L

Question 26

Neutropenia severity | - Increased risk of auto-infection

Answer 26

< 1.0 x 10^9/L

Question 27

Neutropenia severity | - Very serious risk, reverse isolation and/or prophylactic antibiotics

Answer 27

< 0.5 x 10^9/L

Question 28

Definition of eosinophilia

Answer 28

Increase in eosinophils > 0.6 x 10^9/L

Question 29

Causes of eosinophilia

Answer 29

- Allergic responses - Skin disorders - Parasitic infections, especially helminths (worms) - Infectious disease - Hematologic disorders

Question 30

Definition of eosinopenia

Answer 30

Decrease in eosinophils; usually not significant and is difficult to measure

Question 31

Causes of eosinopenia

Answer 31

- Stress - Bacterial infections - Viral infections - Steroids

Question 32

Definition of basophilia

Answer 32

Increase in basophils > 0.2 x 10^9/L

Question 33

Causes of basophilia

Answer 33

- Allergies - Hypothyroidism - MPN

Question 34

Definition of basopenia

Answer 34

Decrease in basophils is difficult to measure and is not significant

Question 35

Causes of basopenia

Answer 35

- Hyperthyroidism - Stress - Infection

Question 36

Definition of monocytosis

Answer 36

Increase in monocytes > 1.3 x 10^9/L

Question 37

Causes of monocytosis

Answer 37

- Hematologic disorders (MDS, AMML, CMML, AMoL) - Connective tissue disorders - Infections (recovery from infection is a good prognosis)

Question 38

Definition of monocytopenia

Answer 38

Decrease in monocytes < 0.1 x 10^9/L

Question 39

Causes of monocytopenia

Answer 39

- Hairy cell leukemia | - Counts fall transiently after administration of prednisone

Question 40

Definition of lymphocytosis

Answer 40

Depends on age - Adults: > 4.5 x 10^9/L - Children: > 11.1 x 10^9/L

Question 41

Causes of lymphocytosis

Answer 41

- Infectious mononucleosis (EBV most common) - Infectious lymphocytosis - Bordetella pertussis (in children)

Question 42

Definition of lymphocytopenia/lymphopenia

Answer 42

Depends on age - Adults: < 0.8 x 10^9/L - Children: < 1.5 x 10^9/L

Question 43

Causes of lymphocytopenia

Answer 43

- Immunologic disorders (SCID, DiGeorge Syndrome) - Chemotherapy, radiation - Immunosuppressive agent (steroids)

Question 44

What is the significance of the absolute neutrophilc count (ANC) to an oncologist?

Answer 44

It's an assessment of the patient's risk of contracting a potentially life-threatening infection