lab med hematology pt 2

cells that are precursors for the basophils, neutrophils, and eosinophils

band cells (B. band is precursor for basophils, N. band for neutrophils etc)

blast cell =

immature lymphocytes

phagocytic cells that engulf bacteria to fight infection, and are from the myeloid series

granulocytes (the group that is made up of neutrophils, eosinophils, and basophils)

what is the order of the WBCs from most numerous to least

Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils (Never Let Monkeys Eat Bananas)

granulocyte that can be segmented or band form (band is immature), is the most numerous WBC and stains purple/blue

neutrophils

makes up 3% of WBCs, granules stain red-orange, and are active in immune or allergic reactions (eczema, asthma) or parasitic infections, drugs, or autoimmune disorders

eosinophils

0.6% of WBCs, granules stain deep purple or black, and are triggered by hyperimmune response or local inflammation

basophils

4-6% of WBCs, with a large cytoplasm and a “ground glass” appearance and vacuoles, mostly found in tissue as macrophages and are from the myeloid series and are important in defense of various microorganisms (virus, fungi, protozoa)

monocytes

34% of WBCs, from the lymphoid line, mainly formed in lymph nodes, more likely to indicate viral infxns

can be small (most abundant) w big purple nucleus and a narrow band of blue cytoplasm or can be large (atypical/reactive) w a bigger nucleus and cytoplasms and indented by surrounding RBCs and this means VIRAL infxn

lymphocytes

total number of WBCs in a given vol of blood

leukocyte (WBC) count

test that determines concentration of each WBC type and looks at the % of each WBC type and the absolute number of each WBC type

leukocyte differential

increased lymphs and reactive forms=

viral infection

inc PMNs (neutrophils) =

BACTERIAL infection, inflammation, stress

if anything on the leukocyte differential looks abnormal get a ____

Peripheral Blood Smear / Bone Marrow Smear

absolute blood count =

relative blod count =

the actual count of each of the WBCs

the % of each of the WBCs

high WBCs due to acute infections, hemorrhage, preg, post-op, carcinomas, leukemia

leukocytosis

reactive leukocytosis =

malignant leukocytosis =

toxic changes, shift to left (more immature cells bc making faster)

more immature and abnormal cells

low WBCs due to inc consumption and/or dec production or ineffective leukopoiesis

can be from aplastic anemia, megaloblastic anemia (B12 or folate def), myelodysplastic syndrome, overwhelming infxn (bacterial/viral), meds, or excessive destruction (splenic sequestration)

leukopenia aka immunodeficiency

philia or cytosis =

high count (neutrophilia = high neutrophils)

penia =

low count (neutropenia = low neutrophils)

lots of immature cells is bad bc it means

bone marrow in hyperdrive trying to pump out more cells asap

key features of benign WBC proliferation

temporary

inc WBC (primarily neutrophilia w left shift)

possible reactive qualitative changes like toxic granules, vacuoles, Dohle bodies (aka inclusion bodies), reactive lymphocytes

platelets and RBCs usually normal

from transient conditions like infection, inflammation, injury, stress, meds etc

neutrophilia =

common indicator of bacterial infection

can also be caused by strenuous exercise, menstruation, preg, neoplastic disorders, ischemia, autoimmune, meds (steroids and epi)

eosinophilia/ basophilia =

allergy or parasitic infection

can also be from asthma, eczema, meds, autoimmune disorders, hodgkins, and T-cell lymphoma

monocytosis =

acute infection, autoimmune disorder, connective tissue disease, (often seen w lymphocytosis)

lymphocytosis =

viral infection

can also be autoimmune, inflammatory, or drug rxns

leukemoid reaction =

inc WBCs, characterized by neutrophilia and may see toxic granulation or dohle bodies (if exposed to heavy metals/poison etc)

RBCs and platelets are normal

resembles leukemia (bc lots of cells but theyre all mature cells)

usually transient and resolves w tx of underlying condition

leukemoid reaction causes

infections (viral, becterial, parasitic), stress, intoxication, hemorrhage, inflammation, autoimmune, meds (steroids or lithium), non-hematologic cancer (lung or breast), metabolic disorders (hypoxia)

what do dohle bodies look like and mean

small round or oval shaped, clear or light blue staining areas in the neutrophil cytoplasm, RNA remnants of earlier stage, often seen w toxic granulation, and associated w infxns, burns, toxic exposure, and preg

what does toxic granulation look like and mean

deeply staining blue-black w large granules in the cytoplasm, resembling granules in early stages and associated w acute bacterial infections, drugs/toxic poisoning, and burns

are atypical lymphocytes benign or malignant

benign

key features of malignant proliferaiton

WBC usually inc but can be normal or dec

platelets can be norm, inc or dec

shift to the left w blasts present

abnormal karyotypes or molecular mutations in cells

abnormal immunophenotypes (seen on flow cytometry), and can identify antigen markers on cell surface

cell morphology usually similar to each other

categories of WBC neoplasms

lymphoid and myeloid

what diseases are included in the lymphoid WBC neoplasm classification

acute precursos lymphoblastic leukemia (ALL)

mature B-cell neoplasm (chronic lymphocytic leukemia or CLL)

hodgkins lymphoma

what diseases are included in the myeloid WBC neoplasm classification

Acute Myeloid Leukemia (AML)

Myeloproliferative Neoplasms (MPN)

Myelodysplastic syndromes (MDS)

what is necessary for an Acute Leukemia Dx

blast count over 20%

classification criteria for the different types of WBC neoplasms

degree of cell maturation, presence and degree of dysplasia (are they different or homologous?), percentage of blast cells present

to determine cell lineage and stage of mutation do: morphology, cytochemistry, and/or immunophenotype (flow cytometry)

to determine subgroup: cytogenetics and/or molecular genetics tests

most prevalent form of malignancy in kids (under 20yo), seen more in boys, w a bimodal age distribution that peaks in kids 3-5yo than again in 65+yo

acute lymphoblastic leukemia (ALL)

key lab findings for acute lymphoblastic leukemia (ALL)

abnormal bone marrow prolliferation of immature lymph blast cells (over 20% blasts in PBS/BMS)

cell surface markers are helpful to differentiate

uncontrolled production of 1 or more hematopoetic cells

a disease of later adult years (over 50yo) and the most common of the non-hodgkins lymphomas, starts slow and insidious and may exist for a long time w/o sx so pts are usually terminal at presentation

chronic lymphocytic leukemia (CLL)

cause of chronic lymphocytic leukemia (CLL)

inc WBCs due to defect in apoptosis (NOT overproduction); chromosomal abnormalities

key lab findings of chronic lymphocytic leukemia (CLL)

abnormal accumulation of mature lymphs (B-cells), w similar size and morphology (v homologous), little/no blast cells

fragile cells that may appear damaged aka smudge cells

immunophenoytping shows express surface IgM and CD5 antigens on cells

a common form of malignancy in young adults, second peak in old ppl (men more), originating in the upper lymph nodes (neck/chest/armpits) with the rye classification splitting this into either classical subtype (more common) or nodular lymphocyte-predominant subtype

hodgkins lymphoma

hodgkins lymphoma cause

idiopathic, but several factors inc risk (EBV, immunosuppression, family hx)

hodgkins lymphoma key lab findings

presence of large abnormal looking neoplastic lymph cells called “reed-sternberg cells” (abnormal B-cells) in the background of normal lymphocytes, plasma cells, and granulocytes

confirmed by biopsy of lymph nodes

hematologic malignancy of the bone marrow, stem cell lost ability to differentiate and proliferate

primarily seen in middle age ppl but can be all ages and all genders

acute myeloid leukemia

acute myeloid leukemia key lab findings

replacement of normal bone marrow elements by leukemic blasts (over 20% of cells)

WBC count is high (100-30×10^9)

anemia due to bleeding and thrombocytopenia

immunophenotyping using flow cytometry tor surface antigen markers CD14 and CD64

rare neoplasm of the bone marrow, common in old ppl but can be any age, with uncontrolled production of all blood cell lines (RBCs, WBCs, platelets) and myeloid stem cell dysfunction

myeloproliferative neoplasms (MPN)

myeloproliferative neoplasms (MPN) cause

idiopathic, genetic mutations in JAK2, radiation exposure, petrochemicals, electrical wiring

types of myeloproliferative neoplasms (MPN)

chronic myeloid leukemia (CML), polycythemic vera, essential thrombocytopenia, primary myelofibrosis

key lab findings for myeloproliferative neoplasms (MPN)

inc RBCs, platelets and WBCs, circulating immature cells (less than 20% blasts), presence of bone marrow fibrosis

morphologically NORMAL = no dysplasia

can develop into acute myeloid leukemia (by this time blasts inc a ton)

a primary myeloid stem cell disorder in all cell lines characterized by one or more peripheral blood cytopenias w prominent maturation abnormalities (dysplastic cells)

myelodysplastic syndrome

key lab findings for myelodysplastic syndrome

can have inc blasts but its less than 20%

subtypes defined by number of blasts, number of cell lines that are dysplastic, has a predisposition to terminate in acute leukemia

lab test for neoplastic blood disorders that is a biopsy to determine presence and morphology of cells

bone marrow

lab test for neoplastic blood disorders that is a laster-based technique to detect chemical/physical characteristics of cells

flow cytometry

lab test for neoplastic blood disorders that is an analysis of cells using staining, banding, or manipulating techniques to look for chromosomal changes

cytogenics

lab test for neoplastic blood disorders that is an analysis of molecules like DNA, RNA, and proteins to identify biomarkers/mutations/interactions

molecular diagnostics