WBC Abnormalities

• increased

  • infection, inflammatory response, stress response, malignancies, chemical assault, pregnancy, or surgery

• decreased

  • certain infectious diseases, chemo, drugs, or autoimmune disease

  • neutropenia is the most significant abnormal WBC finding (count is less than 2)

What conditions cause increased and decreased neutrophils?

• increased

  • allergies, parasitic disease, skin disease, transplant rejection, or myeloproliferative disorders

• decreased

  • acute infections, bone marrow aplasia

What conditions cause increased and decreased eosinophils?

• increased

  • myeloproliferative disorders, hypersensitivity reactions, chronic inflammatory diseases

• decreased

  • steroids, inflammation

What conditions cause increased and decreased basophils?

• increased

  • chronic infections (TB), malignancies, leukemias, or bone marrow failure

• decreased

  • autoimmune diseases, Hairy Cell Leukemia

What conditions cause increased and decreased monocytes?

• leukocytosis

  • an increase in all WBCs

• leukemoid reactions

  • exaggerated responses to infections and inflammation results in high WBCs and immature cells (no blasts, though)

• leukoerythroblastic picture

  • PBS contains immature WBCs, nRBCs, and platelet abnormalities

What is leukocytosis, leukemoid reactions, and leukoerythroblastic pictures?

• an increase in bands, metamyelocytes, and myelocytes in the PBS

• seen in response to infection

  • BM is responding to the increased WBC count by sending out young cells

What is left shift?

• toxic changes in WBCs due to stress during maturation

  • in response to infection or inflammation

• takes place in the cytoplasm or nucleus

• toxic granulation, toxic vacuolization, and Dohle bodies

What are qualitative defects in WBCs?

• excessive granulation in segmented neutrophils

• response to enhanced lysosome enzyme production

• clusters of toxic, blue-black granules

toxic granulation

• vacuoles in the cytoplasm of segmented neutrophils

• caused by prolonged exposure to drugs or storage time (storage time causes pseudo-vacuolization)

• usually a sign of serious infection or sepsis

toxic vacuolization

• cytoplasmic inclusions composed of rRNA

• 1-5 um, rod-shaped, bluish-gray

• seen in neutrophils, some in monocytes and bands

• occurs in pregnancy, May-Hegglin anomaly, and bacterial infections

Dohle bodies

megaloblastic anemias

In what types of blood processes can you expect to see hypersegmented neutrophils (5+ lobes)?

• May-Hegglin Anomaly

• Alder’s Anomaly

• Pelger-Huet Anomaly

• Chediak-Higashi Syndrome

List 4 hereditary WBC disorders

• associated with thrombocytopenia and giant platelets

  • patients present with abnormal bleeding

• large Dohle bodies can be seen in the cytoplasm of neutrophils

  • response to infection or inflammation

What is May-Hegglin Anomaly?

• rare genetic disorder

• associated with coarse, dark granules in ALL WBCs

• granules thought to be lipid deposits

What is Alder’s Anomaly?

• hyposegmentation of neutrophils

• in heterozygotes, the nucleus is dumbbell shaped, in homozygotes, the nucleus is spherical and has no lobes

• pseudo-pelger huet seen in myeloproliferative disorders

• can be misidentified as bands or metas

What is Pelger-Huet Anomaly?

• presence of purple-gray granules in the cytoplasm of neutrophils

• causes decreased WBC chemotaxis and bactericidal function

• patients may develop hepatomegaly, liver failure, or abnormal bleeding times

• lymphs and monos may have red granules in their cytoplasm

What is Chediak-Higashi Syndrome?

• abnormal morphology:

  • increased cell size

  • increased basophilia

  • increased cytoplasm

• normal lymphocytosis is normal in young children (1-4 years)

• seen in EBV, CMV, and Hep A, B, and C

What is reactive lymphocytosis?

• infectious mononucleosis

  • caused by EBV, found in saliva and body fluids

  • infects B lymphocytes

  • sore throat, fatigue, fever, heachache, and enlarged lymph nodes

What is the most common disease showing variation in lymphocytes (reactive lymphocytosis)?

• the patients lymphocytes show reactive changes

  • with basophilic cytoplasm or vacuolization

• a decrease in T helper cells causes an overall decrease of immune function

• patients present with:

  • anemia of inflammation, decreased WBC counts, decreased platelet count, impaired iron studies, and reticulocytopenia

How does HIV/AIDS affect patients and their hematology parameters?

• group of diseases caused by missing or inactive strategic metabolic enzyme

  • results from a gene deletion

• undigested metabolic products accumulate in cells

• bone marrow shows large, identifiable cells specific to each disease

• no cure

  • but enzyme replacement therapy or BM transplant is possible

• 3 diseases: Gaucher’s Disease, Niemann-Pick Disease, and Tay-Sachs Disease

What are lipid storage diseases?

bacteremia or sepsis

The presence of bacteria in a peripheral blood smear indicates:

• a phenomenon when patient’s blood reacts with EDTA

• causes platelets to ring around neutrophils

• produces a falsely low platelet count

• can only be corrected by collecting specimens in sodium citrate tubes

What is platelet satellitism?

toxic granulation

Which inclusion is most likely seen in acute infections?

lymphocytosis WITHOUT anemia and WITH many reactive lymphocytes

A typical blood picture in infectious mononucleosis shows:

• decreased production by the bone marrow

• impaired release from BM to blood

• increased destruction

List 3 mechanisms by which neutropenia is usually produced