LO5 - conditions

What is a leukemoid reaction

a condition in which a normal bone marrow response mimics leukemia - caused by viral or bacterial infection

What is leukemia

cancer - malignancy, unregulated proliferation of bone marrow

What is the WBC Count of a leukemoid reaction

>50.00 × 10^9/L

What is the WBC Count of leukemia

Often increased - a lot higher than 50.00 × 10^9/L

What is the WBC differential contain for a Leukamoid reaction

immature cells may be present (not as early as promyelocyte or blast stage) - may see reactive changes - No affect on RBC, PLT, HGB

What is the WBC differential contain for leukemia

immature cells - blasts usually present - decreased PLT, RBC, HGB

What is an acute condition of leukemia

immediate treatment required - rapid progression and accumulation of malignant cells - mostly blasts >30%

What is a chronic condition of leukemia

months to years to progress - excessive buildup of relatively mature, but still abnormal, blood cells - all stages of maturity - blasts<10%

What is a left shift

increase in myeloblast, promyelocyte, myelocyte, and metamyelocyte

What are the benign myeloproliferative disorders

Bacterial infection, trauma/stress/physiological conditions, allergic reactions, Pelger (Huel Anomaly)

What is a bacterial infection lab findings and blood smear findings

most common cause of neutrophilia - accompanies by left shift ( bands and segmented neutrophils 60-90% - metamyelocytes and myelocytes 1-5% - toxic granulation, dohle bodies, toxic vacuolation may be present) - WBC may be slightly above reference range

What is shown when there is trauma/stress/physiological conditions

increase in neutrophils - left shift - inflammation/infection

What is an allergic reaction

histamine release - in basophils - acute reaction = increase in basophils

What is pelger - huet anomally

benign disorder (affects segmentation of neutrophil) - neutrophil still functions normally - nucleus may appear bilobed or peanut/dumbbell shaped

What are the malignant myeloproliferative disorders

Chronic myeloid leukemia (CML) and acute myelocytic leukemia (AML)

WHat is important about CML

insidious onset - predoninates in adults 46-53 years - can progress to acute

What is in the lab findings of CML

WBC: 50-150 ×10^9/L - some will be >300.00×10^9/L
Moderate anemia
Platelets are increased in 50% of cases = CML

Philadelphia Chromosome - due to translocation (exchange of genetic material) between chromosomes 9 and 22 - caused by genetic abnormality BCR-ABL

What is the blood smear findings of CML

30-70% Band and Segmented neutrophils
20-50% Meta, Myelo, and promyelocytes = dramatic left shift
<10% blasts
increase in eosinophils and basophils
harlequin cells may be present and contain eosino and baso granules

What is acute myelocytic leukemia

quick onset - young to mature adults (children may get it) - most common in leukemia in adults - can be rapidly fatal if untreated - therapy extends life 2.5-3 years - susceptible to infection, hemorrhage, and organ dysfunction

What is the laboratory findings and blood smear findings of AML

severe anemia
thrombocytopenia - huge decrease in PLTS
WBC: 20-50 × 10^9/L - can be >100 ×10^9/L
blasts >10%
Auer Rods - 10-50% of cases are present = myelocyte

What testing is performed to confirm problems

Bone Marrow Test (differentiates acute and chronic)
Flow Cytometry (identifies cells)
Special stains, molecular testing, and cytogenetics may aid in diagnosis when ordered

What is reactive lymphocytes - leukemoid reaction

when a non-malignany lymphocyte reacts to stimulus of viral or other = reactive - 1-2% of reactive lymphs may be seen on normal blood film - presence increases diagnostic importanct and should be reported

What is seen under the microscope for reactive lymphocyte

large amount of cytoplasm that is various shades of blues that are unevenly stained - fried egg or ballerina skirt shaped - peripheral basophilia - possible vacuoles (foamy) - nucleus have course to fine chromatin that is mixed (light/dark banding)

What is the benign lymphoproliferative disorders? What is always seen?

Infectious mononucleosis, - infectious disease, fever and lymph node enlargement

What is infectious mononucleosis?

viral infection in young adults - exibits reactive lymphocytes - caused my epstein barr virus

What are the symptoms of mono

malise, chils and feverm los of apetitem sore throat, nauseam lymph enlargement, splenomegally (common). Hepatomegally (rare)

What is the lab findings of mono

WBC: 11.00-20.00 ×10^9/L
Relative Lymphocytosis: >60% Absolute lymphocytosis: >4.00 × 10^9/L
RBCs - normal unless hemolytic anemia due to cold agglutinins
Platelets normal or slightly low

What is malignant (abnormal) lymphocytes

present in diseases - most chanfes in lymphocytes are directly related to antigenic stimulation and are considered to be normal activity

What is lymphocytic leukemia

proliferation and accumulation of lymphocytes (in the vascular, bone marrow, and lymphatic system) that are unresponsice to antigenic stimuli, suppressing maturation of other cell lines - acute or chronic - the homogenous (monotonous) blood picture unique to patient = clonality

What are the malignances of lymphocytes

Cancer = altered DNA
Leukemia = Bone Marrow
Lymphoma = lymph nodes

What are the malignant lymphoproliferative disorders

Acute lymphoblastic leukemia (ALL), Chronic Lymphoblastic leukemia (CLL), and lymphoma

What is acute lymphoblastic leukemia

25% of childhood cancers 75% childhood leukemia
now better treatment 95% remission rate, 88% children cured
Over 20 years old = 5 year survival rate 35%
Under 20 years = 5 year survival rate 89%

What is the laboratory findings and blood smear findings of ALL

moderate anemia
Plts are normal and then decreased later in disease
WBC 50-500 ×10^9/L - may be more - can falsify HGB
Numerous blast cells present and no auer rods

What is chronic lymphocytic leukemia (CLL)

effects elderly - Male:Female 2:1
Prognosis varies 3-15 years

What is the first indication of CLL

WBC Count 10.00-150.00 ×10^9/L

What are the lab findings of CLL

moderate to severe anemia
decreased platelets
WBC usually above 50 ×10^9/L - may be seen low

What is the blood smear findings of CLL

Lymphocytosis 80-90% in differential - appear normal but may have course chromatin (soccer ball pattern) with nucleoli and basophilic cytoplasm
few prolymphocytes
Smudge cells - fragile lymphocytes
high level BCL2 expression

What are smudge cells

prominent in CLL
Old and fragile lymphocytes that have not been removed from circulation and are destroyed in peripheral smear
counted as lymphocytes on instrument

What is the criteria for reporting smudge cells

diagnosis of CLL
Lymphocytosis >5.0 ×10^9/L
>30 years old
>10/100 leukocytes (10%)

What is the proof that smudge cells are present

Add albumin to 4 or 5 drops of RBCs
CLL = smudge cells remain >10%

What is lymphoma

exact cause is unknown - abnormal cell arising in lymph nodes produces a new strain which proliferates - can move into peripheral bloos - they have a variety of appearances and are abnormal (cannot always differentiate between blasts and abnormal cells)

What are the key differentiating features of lymphoma

Prominent nucleoli that may appear light blue
lobulated or clefted nucleus
very blue cytoplasm

What is the laboratory findings and blood smear findings of lymphoma

Lymph Node Stage - no significant changes
Peripheral blood involvement stage: moderate anemia - patelets are normal or decreased later in disease - WBC 10-500 ×10^9/L
numerous abnormal lymphoid cells present
neutropenia

What do we do if we are unsure of what a cell is

ask senior/ other lab personal
count identifiable cells as part of 100 cell WBC report
previous patient reports
alert physician to presence of abnormal cells

what is the saskpolytech criteria for referring blood smears for WBC abnormalities

Refer unexpected or unexplained blasts/promyelocytes, lymphocytes with smudge cells, reactive lymphocytes, pelger-huet anomally
Pathologist = furthur explanation

When do we refer to a pathologist

unidentifiable cells
abnormal or immature cells not previously diagnosed
abnormal findings

Immediately refer if anything life threatening

How do we confirm infectious mono

mono agglutination test