WBC HW Review

adult reference range WBC

4,500-11,000/uL

calculate hemacytometer white cell count

dilution factor x # white cells per WBC counting area

0.1 x WBC counting area

calculate absolute lymph count

% lymph x white count = # x 10³/uL

calculate corrected WBC for NRBCs

WBC x 100

NRBC + 100

usually correct WBC when NRBC is 5 or more

what stimulus causes CFU-GEMM cells to mature into CFU-GM?

IL-3 and GM-CSF

describe primary granules

lysosomal and non-specific

secondary granules appear in which phase?

myelocyte

function of primary granules

supply lytic and neutralizing enzymes for phagocytosis

which granulocyte stage is the last stage capable of mitotic division?

myelocyte

% of peripheral blod granulocytes in the marginal pool?

50%

capsule surrounding primary and secondary granules made up of what?

phospholipids

what form do granulocytes store energy for their journey into tissues?

glycogen

(anaerobic glycolysis)

what do superoxides produce?

hypochlorite and hydrogen peroxide

define respiratory burst

the sharp increase in oxygen uptake that macrophages experience during phagocytosiss

specific granules in basophils contain which stain with the basic dye in Wright’s stain?

heparin sulfate

at which stage of maturation are eosinophilic granules first expressed?

myelocyte

how do eosinophils respond to adrenal corticosteroids?

they decrease in the presence of corticosteroids

which cytokine is unique to eo maturation?

IL-5

Eosinophils kill parasites by what?

lytic enzyme exocytosis

myeloperoxidase in neutrophils is also found where?

monocytes

which Colony stimulating factor is responsible for forming a monoblast from GEMM?

GM-CSF and M-CSF

in peripheral blood, how many times larger is the pool of marginating monocytes comapred to circulating monocytes?

3 times

function of macrophages?

recognize antigen and phagocytize

where do lymph precursors differentiate to T or B cell?

primary lymphoid tissue

memory T cells live how long?

YEARS

when monocyte matures, it becomes

a macrophage

tissue basophil aka

mast cell

how does MPO and SBB separate acute lymphocytic from acute non-lymphocytic?

both positive for AML

both negative for ALL

what describes acute leukemia?

rapid onset with greater than 20% blasts

which chromosome with M3?

t(15;17)

acute myeloblastic leukemia without maturation

which FAB distinction?

M1

pathognomonic inclusion body in hematology lab in AML or AMoL is

auer rods

SBB stains which part of cell

phospholipid capsules

which cytochemical stain detects glycogen in cells?

periodic acid schiff (PAS)

which cytoplasmic enzyme is found in monocytes?

non-specific esterase

“kiddie leukemia” FAB category

L1

dohle bodies and toxic gran mean what?

inflammation conditions

polycythemia vera turns to which leukemia

AML

acute malignant proliferation of erythroblasts (>50%) in marrow with moderate anemia is which FAB classification

DiGuglielmo’s syndrome (M6)

what’s helpful about an LAP score?

it differentiates CML (low LAP) from leukemoid reaction (high LAP)

block positive PAS stain in blast cell shows what?

acute lymphocytic leukemia

which AML shows fluoride sensitive (non-specific) esterase activity?

Monocytic leukemia (M4/M5)

philadelphia chromosme in how much of CML patients?

90%

bundles of Auer rods are in which FAB stage?

M3

what abnormal cell found in peripheral blood of MM patient?

plasma cell

which WBC anomaly has no clinical significance?

Pelger-Huet

which WBC anomaly has dohle-like inclusion bodies?

May-Hegglin

Hurler’s and Hunter’s syndromes have which inclusions?

metachromatic granules (Reilly bodies)

hyperlobulation of neutrophils means

B12-folate deficiency

MEGALOBLASTIC anemia

most common ALL in adults

B cell ALL (L2)

which ALL blasts have vacuoles in the cytoplasm

L3 (burkitt’s)

Most L1 ALLs are what?

TdT and CALLA positive

M3 leukemia defined as what?

promyelocytic

M4Eo means what?

myelomonocytic leukemia with eosinophilia

which AML shows megaloblastoid changes?

M6

WHICH factor increases reticulum fibers in bone marrow found in M7 and myelofibrosis

platelet derived growth factor (PDGF)

which cell line is CML

myeloid

which cell line is PV

erythrocytes

which cell line is myelofibrosis

fibroblasts

which cell line is essential thrombocythemia?

megakaryocyte

common finding in myelodysplastic syndrome

cytopenia, dysplasia, anemia

which CD found on blast cells is on mature WBCs in MDS

CD34

which refractory anemia close to being an acute leukemia?

RAEB

cure for MDS and meyloproliferative disease

marrow transplantation

over 90% of CLL are which type?

B cell type

common finding on peripheral smear in CLL

smudge cells

which lipid storage disease has glucocerebrosides?

Gaucher’s

sea blue histocytes what type of disorder?

lipid metabolism disorder

which cell is pathognomonic in Hodgkin’s disease?

Reed-Sternberg cell

Hodgkin’s patient with organ involvement

IV

type of hodgkin lymphoma composed of cells with multilobulated nculeus with delicate nuclear membranes, fine granular chromatin, small indistinct nucleoli (popcorn or L and H cells)

lymphocyte predominant

what term is used if cell has chromosome count other than 46?

aneuploid

term given for patient with 46 karyotype, XX, +8, -21?

pseudodiploid

karyotype 47, XY, +8 -21 means what

male

trisomy 8

monosomy 21

philadelphia chromosome t(9;22) found in which cells?

myeloid and lymphocyte

mycosis fungoides describes what?

skin lesions progressing to tumor

when mycosis fungoides T-helper cells invade peripheral blood, what’s it called?

Sezary syndrome

in Waldenstrom’s macroglobulenemia, which aberrant cell makes monoclonal IgM?

plasmacytoid lymphocytes

which lymphoma associated virus is incriminated in T cell leukemia/lymphoma?

HTLV-1

which test is helpful in diagnosing CGD?

nitroblue tetrazolium test

protein p210 found when the philadelphia chromosome is present has what kind of increased activity?

tyrosine kinase

idiopathic myelofibrosis vs other types of chronic MPD

marro fibrosis is greatly increased

how to calculate LAP stain

multiply the number and grade, then add ‘em up

WHO blast criteria vs FAB criteria

WHO: >20% blast

FAB: >30% blasts in bone marrow

immunophenotyping for WHO

Lymph progenitor: CD34

cytochemical stains for WHO

MPO and SBB (+) for AML and (=) for ALL

cytochemical stains for FAB

M1-4: MPO, SBB, CAE (+)

M0: all = stains

M5: ACP, non-specific (+)

M6a: MPO, specific esterase, SBB (+)

M6: Acid phosphatase

M7: PAS (+)

FAB immunophenotyping

is used

how to differentiate WHO ALL?

immunophenotype, cytochemical lymphocytes (T, B, NK cells), and clinical features

how to differentiate WHO ALL?

Acute: L1 L2

Burket’s Mature: L3

 

L1: Lymphoblastic Leukemia with homogeneity

L2: Lymphoblastic leukemia with heterogeneity

L3: Burkitt-type lymphoblastic leukemia

how to differentiate WHO AML

how to differentiate FAB AML

Blast count, degree of dyspoiesis, cytochemical cell reactions

WHO MDS subgroups

MDS Subgroups:

1. MDS with single lineage dysplasia (MDS-SLD)

2. MDS with ring sideroblasts (MDS-RS)

• MDS-RS and single lineage dysplasia (MDS-RS-SLD)

• MDS-RS and multilineage dysplasia (MDS-RS-MLD)

3. MDS with multilineage dysplasia (MDS-MLD)

4. MDS excess blasts (MDS-EB)

• MDS-EB-1

• MDS-EB-2

5. MDS with isolated del(5q)

6. MDS, unclassifiable

7. Childhood MDS

• Refractory cytopenia of childhood (provisional)

what’s the NBT test and reaction?

detect affected neutrophils in chronic granulomatous disease (CGD). If the neutrophil is able to produce the oxygen burst normally, it will reduce the NBT to a blue-black compound that makes the cell appear like a dark crystal. The affected cells cannot produce oxygen so they will not turn dark.

During a respiratory burst, there is a combination of metabolic activities. Phagocytosis increases that oxygen consumption 2-3 times, and glucose oxidation 2-10 times.

what condition is NBT test diagnostic?

Chronic Granulomatous Disease, since the cells are morphologically normal but cannot make the H2O2 metabolites, so the patients suffer from recurrent infections.

what type of lymphoma is Burkitt?

B-cell lymphoma

Burkitt lymphoma describe the different types

Endemic Burkitt: EBV and involves the face and jaw

HIV associated Burkitt: EBV, and causes a “starry sky” biopsy of neoplastic cells. The sky is the neoplastic lymphs and stars are the body macrophages. The macrophages get ingested. The cells affected are the intense cytoplasmic vacuolization of ALL blasts, and the ingested macrophages.

burkitt lymphoma positive stains

CD19, sIg, CD10, CD20, CD22

burkitt lymphoma negative stains

CD5, CD23, Tdt

how to differentiate burkett lymphoma from other lymphomas/leukemias?

C-MYC gene, which impacts the t(8;14), which is not found in DCLBCL

Starry sky, sIg+, t(2,8), t(8,22)