Quantitative Leukocyte Abnormalities

What can make a WBC count look weird but is normal?

What can make a WBC count look weird but is normal?

- age (babies have inc up 30)
- count is lowest at complete physical/mental relaxation
- pregnancy can lower count

Neutropenia value

WBC < 3.0 X10^3

Neutrophilia value

WBC > 11.0 X10^3

What mechanisms can lead to changes in neutrophil concentration?

1. BM production and release of neutrophils
2. survival time
3. MGP to CGP ratio

Which condition has the most impact on infection defense?

neutropenia

What can cause neutropenia?

- block/ineffective production from the marrow
- inc removal
- altered distribution btwn MGP and CGP

What conditions are associated with decreased marrow production?

Kostmann's, Chronic familial and cyclic neutropenia, drug induced by chemo/radiation, aplastic anemia, Myelophtisis

Neutropenia caused by ineffective production?

Chediak-Higashi and Megaloblastic anemia

Transient neutropenia in Phase I of infection

- chemotaxis causes CGP to shift to MGP
- leukocytosis will follow once marrow catches up

Chronic infection left untreated

- neutropenia w/ left shift
- phase III of chronic infection

What viral infections cause decreased survival of neutrophils?

measles, rubella, typhoid fever

Hypersplenism

- neutrophils removed by spleen a lot

- Felty's syndrome (Splenomegaly, Anemia, Neutropenia, Thrombocytopenia, Arthitis)

How do circulating Abs cause neutropenia?

- can clump WBCs
- leukopenia of newborn from mom's Abs (HDN)
- immune neutropenia (autos)
- chronic benign neutropenia

Decreased survival of neutrophils caused by altered distribution

pseudo neutropenia (before BM kicks in) and bacterial endotoxins (shift from CGP to MGP)

What physiological mechanisms lead to neutrophilia?

- inc inflow of cells from marrow
- shift in cells from MGP to CGP
- dec removal/outflow

Physiologic neutrophilia

severe exercise, hypoxia, and stress (shift from MGP to CGP) and chronic severe stress/chronic corticosteroid use (inc marrow release)

Phase I of Pathologic neutrophilia

acute migration of cells from MGP to tissue in response to chemotactic factors (transient neutropenia), myeloid GF released

Phase II of physiologic neutrophilia

- established/severe infection
- marrow supply inc (neutrophilia w/ left shift and dec eos)
- typical bacterial infection

Phase III of physiologic neutrophilia

- infection recovery
- granulocytes dec and monos INC (2nd line of defense)

Bone Marrow Exhaustion

- body/treatment fails to correct
- production can't keep up w/ loss
- granulocytopenia w/ left shift

Non-leukemic leukocytosis

- shift to the left (more cells released)
- INC LAP
- seen in pneumonia, TB, meningitis

What does LAP measure?

activity of alkaline phosphatase within the WBCs

What other toxic factors are associated with pathologic neutrophilia?

metabolic (gout, diabetic acidosis), drugs (steroids epis), tissue destruction/necrosis (burns), hemorrhage, massive hemolysis

Eosinophilia

- > 0.5
- allergic diseases, parsites, loeffler's syndrome (hella eos in sputum), blood disease, splenectomy, drugs

basophilia

- > 0.2
- allergic response, CML or PV, pox, hyperlipidemia, colitis

Monocytosis

- > 1.0 X10^3
- recovery phase (3), bacterial endocarditis

What are the lab findings for neutropenia?

- dec BM production/release of neutrophils
- dec survival time
- inc MGP, dec CGP

What are the lab findings for neutrophilia?

- inc BM production/release
- inc survival time
- dec MGP, inc CGP