MLS 1114 Exam 3

What is the function of myeloperoxidase?

Catalyzes a reaction during respiratory burst to produce hypochlorous acid.

Is myeloperoxidase oxygen independent or oxygen dependent?

Dependent, it requires O2 to create hypochlorous acid to kill bacterium

Where is MPO found?

Primary neutrophil granules

If neutrophil lacks MPO what happens?

The neutrophil's ability to effectively kill bacteria is impaired, leading to increased susceptibility to infections. No MPO = No hypochlorous acid

What is immediate hypersensitive reaction?

Marginating neutrophils temporarily release and freely circulate, occurs without pathologic stimulus

doesn’t require bone marrow output

caused by exercise, epinephrine, or anesthesia,

Which WBC is associated with an immediate hypersensitive reaction?

Mast cells (Basophils in the tissue)

What is margination?

Neutrophils that are rolling on the endothelial surface, first responder

What are the 3 main functions of a macrophage

Phagocytosis, antigen presentation, and cytokine production.

Most common cause of neutrophilia?

Bacterial infections

What are the differences between primary and secondary granules of neutrophils?

Primary - MPO Pos, cytotoxic compounds,

Secondary - peroxidase negative, give pink color to cytoplasm, pro-inflammatory and chemotactic factors

Both encased by phospholipid membrane

List the maturation stages of neutrophils

myeloblast, promyelocyte, myelocyte, metamyelocyte, band, segmented neutrophil

Last stage a neutrophil is capable of mitosis?

Myelocyte

Main function of eosinophil?

Degranulates in the presence of allergies or parasitic infections to release proinflammatory cytokines

Are the Azurophilic granules of a lymphocyte peroxidase positive?

No

Which WBCs have peroxidase positive granules?

Neutrophils and eosinophils

Plasma cell is terminal stage of which cell?

B-lymphocyte

WBC that expresses the CD4 marker are?

T-lymphocytes (T-helper cells)

WBC that express the CD8 marker are?

Cytotoxic T-lymphocytes

Which class of molecule presents to CD4 + cells?

MHC class II molecules

Which class of molecule presents to CD8 + cells?

MHC class I molecules

What cells use MHC Class II molecules to present antigens?

CD4+ Th cells

What cells use MHC Class I molecules to present antigens?

Tc cells,

T cells are part of which immune system

Cell mediated

B cells are part of which immune system

Humoral immunity

NK cells are part of which immune system

Innate immune system

Where does antigen-dependent lymphopoiesis occur?

In secondary lymphoid organs such as the spleen and lymph nodes.

With a bacterial Infection what cell line would you expect to see an increase of on the PBS

Neutrophil cell line

What are toxic granules

Toxic granules are primary granules that have gained back their ability to be stained again, indicative of infection but can be normal. Peroxide positive

Name three causes of immediate neutrophilia

Exercise, epinephrine, and anesthesia

What are hyper segmented neutrophils associated with?

Megaloblastic anemia or hereditary hypersegmentation

I am thinking of a cell that lacks enzymes to break down long chain sugars, what is the sugar and what do they call the inclusion?

The sugar is mucopolysaccharide and the inclusion is called alder-reilly anomaly

How would you describe Alder-Reilly inclusions

Large,dense liliac granuals, clearing around the granules

Where do you find Alder-Reilly inclusions

Alder-Reilly inclusions are found in the leukocytes of individuals with certain metabolic disorders, particularly related to mucopolysaccharides, gargoilism, and dwarfism

Patients with Chronic granulomatous disease suffer from frequent reoccurring infections why?

The cells can phagocytize but lack the ability to produce reactive oxygen species (ROS) necessary for killing certain bacteria. Bacteria grows intracellularly

On a bone marrow smear, I see large cells with a foamy appearance what disease is this most likely from

Niemann-Pick disease

What gives the Niemann-Pick cell its foamy appearance

Build up of lipids in the cell

What enzyme are you deficient in if you have Niemann-Pick?

Sphingomyelinase

What substance accumulates in the macrophages in Gauche disease?

Glucocerebroside

What classification do you give diseases like Gauche and Niemann-Pick

Qualitative monocyte/macrophage disorder

And what cell lines does Gauche and Niemann-Pick affect?

Monocyte/macrophage

If you have Gauche disease you are deficient in?

glucocerebrosidase

HIV patients have numerous infections because the HIV virus has infected

Helper T cells

AIDS is diagnosed when CD4 (Helper T-Cells) numbers are?

<0.2×10³

What cell does EBV like to infect

B lymphocytes

What lymphs do we see on the PB smear with EBV

atypical lymphocytes

What is the common name of lymphs with EBV

atypical lymphocytes

How can you tell a cell is immature

Immature cells often have a large nucleus-to-cytoplasm ratio and lack distinct cytoplasmic features.

What are the 4 steps a neutrophil goes through to kill a pathogen

Adherence

Migration

Phagocytosis

Bacteria Killing

I am thinking of a condition in this condition you see inclusions consisting of RNA from rough
endoplasmic reticulum. This condition is associated with thrombocytopenia and giant platelets.
Patients may present with abnormal bleeding or low PLT counts. What condition is this?

May-Hegglin Anomaly

A CBC is completed on a male, age 6. His report reads as follows: NE 37.0%, LY 59.1%, MO 3.4%,
EO 0.4% BA 0.1% Is this report normal? If not what should your next step be?

These results are normal for a child

What's the difference between antigen-independent lymphopoiesis and antigen-dependent lymphopoiesis?

Antigen-independent lymphopoiesis occurs in primary lymphoid organs (like bone marrow and thymus) where lymphocytes mature without exposure to antigens. In contrast, antigen-dependent lymphopoiesis occurs in secondary lymphoid organs (like lymph nodes and spleen), where lymphocytes encounter specific antigens, leading to activation and proliferation.

Which type of T cell recognizes an antigen presented via MHC class II? And what does this antigen activate?

Helper T cells

Stimulates B cells to become antibody producing plasma cells, enhances the functions of phagocytes, produces cytokines

What is the function for T cells?

Cell mediated immunity, cell to cell immunity

What is the function for B cells,

Profession APC, humoral immunity

What is the function for NK cells,

kill virus-infected and tumor cells, produce cytokines

What is the microscopic difference between Lymphoblasts and myeloblasts?

We do not differentiate between blasts

What are the Quantitative Monocyte/Macrophage Disorders

monocytosis and monocytopenia

What are Qualitative Monocyte/Macrophage Disorders

Gaucher disease, Neimann-Pick, systemic lupus erythematosus

What is Monocytosis caused by?

Chronic infection (TB, syph)

Inflammatory and immune response

Compensation for neutropenia

What is Gaucher disease caused by?

deficiency of glucocerebrosidase

What do Gaucher cells look like?

Large, eccentric nucleus, tissue like cytoplasm

What distinguishes Basophils from other granulocytes

The large black and purple granules

What do the granules of Basophils contain?

Histamine, heparin, and tryptase

What is the function of the Basophils and Mast Cells?

IgE mediated allergies, causes immediate hypersensitivities reaction

What are the 3 maturation stages of monocytes?

Monoblast, promonocyte, monocyte

Where are monocytes produced and are they agranulocytes or granulocytes?

Monocytes are produced in the bone marrow and are classified as agranulocytes.

What are the characteristics of a myeloblast?

High N:C Ratio

fine chromatin pattern

basophilic cytoplasm

Auer Rod!!!

Last stage of myeloid line capable of mitosis?

Myelocyte

What is the difference between an early myelocyte and later myelocyte?

Early - Basophillic cytoplasm, scattered primary granules, can look like a promyelo

later - neutro/pink cytoplasm, few primary granules, more pinker

Which cell does the HIV virus prefer to infect?

CD4+ T cells (Lymphs)

Diagnosis of AIDS is made when Th cell count falls below?

0.2

HIV can be transmitted 2 different ways name them

sexual contact and blood exposure (transfusion)

HIV can develop into which disorder?

AIDS (Acquired Immunodeficiency Syndrome)

What disease are foamy cells associated with?

Niemann-Pick

Which leukocytes does Niemann-Pick affect?

Monocytes/mascrophages

What causes Niemann-Pick?

Deficiency of sphingomyelinase

Describe LE cells

Neutrophils or macrophages that have phagocytized the nucleus of another cell. Lupus!

How does Lymphocytosis affect the Neutrophil count?

Lymphocytosis can lead to a relative decrease in the neutrophil count due to the increased number of lymphocytes, which may alter the balance of white blood cell types in the bloodstream.

How often are nucleoli visible on small Lymphocytes?

Very rarely

What other cell compares to the size of the nucleus in a small lymphocyte?

Red blood cell

How large is a large lymphocyte?

up to twice the size of an RBC

What is a reactive Lymph indicative of?

Viral infection

What is a Macrophage aka Histiocyte

A tissue form of a monocyte

What does a Macrophage look like?

Slowly become larger, round nucleus and nucleoli, blue/gray cytoplasm with ragged edges, many vacuoles, may see ingested material

What are the macrophage functions for innate and acquired immunity

Innate immunity - phagocytotic scavengers

Acquired immunity - professional antigen presenting cell, presents antigen via MHC Class II, production of cytokines

What neutrophilia disorder occurs without a pathological stimulus, and can be caused by exercise, epinephrine, or anesthesia?

immediate neutrophilia

Which neutrophilia disorder occurs within 4-5 hours of pathologic stimulus and is frequently
caused by bacteria

acute neutrophilia

Which neutrophilia disorder follows acute neutrophilia, and the BM storage is exhausted

chronic neutrophilia

What is “left shift”

a term used to describe an increased number of immature neutrophils (such as band cells) in the blood, indicating a response to acute infection or inflammation.

What is the most common cause of neutrophilia

Bacterial infections

Define effusion

the escape of fluid into a body cavity, often causing swelling and discomfort.

What does bacterial meningitis look like in CSF?

High neutrophils

What does viral meningitis look like in CSF?

High lymphocytes

What does fungal meningitis look like in CSF?

High eos

What does a true hemorrhage look like in CSF?

rbc count is consistent in all tubes

What does a traumatic tap look like in CSF?

Rbc count decreases in subsequent tubes, the wbc to rbc ratio is similar to peripheral blood

How to tell the difference between a traumatic tap and true hemorrhage in CSF?

A traumatic tap typically shows a decreasing red blood cell count in subsequent tubes, while true hemorrhage maintains a consistent red blood cell count across all tubes.

What does it mean if you see hematoidin crystals inside or outside of a macrophage in the CSF?

The presence of hematoidin crystals indicates that there has been prior hemorrhage in the central nervous system.

What does a malignant cell look like on a Wright-stained body fluid?

Poorly defined cell borders, weir size, irregular nuclear membrane, clefted nucleus, vacuoles in the nucleus

What does a benign cell look like on a Wright-stained body fluid?

Distinguished cell borders, uniform cells, smooth nuclear membrane, even chromatin