1. Pathology 6 White blood cell and lymph node disorders (1)

2. Toxic changes in neutrophils include all the following, except:
Cytoplasmic basophilia
Large basophilic granules
Hypersegmentation
Cytoplasmic vacuoles
Dohle bodies

3. Large granular lymphoma is associated with
Neutropenia
Lymphocytopenia
Neutrophilia
Eosinophilia
Basophilia

4. Monocyopenia is associated with which one of the following tumors
Lymphoplasmacytic lymphoma
Chronic lymphocytic leukemia
Large granular lymphoma
Hairy cell leukemia
Hodgkin lymphoma

5. Nonneoplastic WBC disorders.
High number (cytosis)
Low number (cytopenia)
Abnormal function

6. 5 major types of WBCs Neutrophils Lymphocytes Monocytes Eosinophils
Basophils

7. What is the characteristic finding that lymphocytes display on peripheral blood in patients with pertussis?
Reactive lymphocytes
Lymphocytes with cleaved nuclei
Normal lymphocytes
Prominent nucleoli
Hairy cytoplasmic extensions

8. Neutropenia Decrease in the number of neutrophils
When severe, it is called agranulocytosis
Usually less than 500
Increased risk of infection
Two major mechanisms
Decrease production
Increase peripheral destruction of neutrophils

9. Decrease production
Marrow hypoplasia in patients who receive chemotherapy
Leukemia or other tumors replacing the marrow
Medications
Certain types of neoplastic lymphocytic proliferations such as large granular leukemia (LGL)

10. Increased peripheral use
Autoimmune destruction
Overwhelming bacterial, fungal or rickettsial infection
splenomegaly

11. Clinical manifestations
Infection, infection, infection!!!
bacterial
Fever, chills, malaise
Mucocutaneous necrotizing ulcers
High risk of sepsis

12. Treat with broad spectrum antibiotics
Depending on the clinical setting, treat with G-CSF

13. lymphocytopenia Low number of lymphocytes Less than 1000 in adults
Less than 3000 in children <2 years of age

14. Increased risk of Opportunistic infections Autoimmune disorders
Malignancy

15. Causes Acquired: HIV/AIDS Protein malnutrition Viral infections
Autoimmune disorders: SLE and RA
Certain leukemia or lymphoma tumors

16. Inherited
Severe combined immunodeficiency
Wiscott-Aldrich syndrome

17. Clinical manifestations
Infections with unusual microoganisms
Pneumocystis jiroveci
Fungal infections
CMV
Zoster
These infection could be fatal
Risk of malignancies
Autoimmune disorders

18. Symptoms of associated diseases
Small or absent tonsils or lymph nodes in HIV or immune deficiency diseases
Lymphadenopathy: again in early HIV or lymphoma
Eczema in WAS
Stigmata of pancytopenia in cases of leukemia

19. Treatment Treat infections Treat underlying condition
IVIG for certain types of immune deficiency
Bone marrow transplantation

20. Monocytopenia In the setting of other pancytopenia
Associated with hairy cell leukemia

21. eosinopenia Can be found in healthy individuals Steroid use
Of limited clinical significance
Steroid use
Acute inflammatory condition

22. Basopenia Limited clinical significance Acute hypersensitivity
Thyrotoxicosis
Infection

23. Neutrophilia Increased number of neutrophils Caused by
Acute bacterial infections
Sterile inflammation
Burns
Myocardial infarction
Morphology: TOXIC CHANGES

26. Toxic changes Occur in the setting of bacterial infection
Cytoplasmic basophilia
Vacuoles
Dohle bodies

27. Lymphocytosis Increased number of lymphocytes
Chronic bacterial infections
TB, brucella
Pertussis
Viral infection
Morphology depends on the cause

28. Infectious mononucleosis
Reactive lymphocytes

29. Pertussis

30. Monocytosis Increased number of monocytes
Chronic infections such as TB (associated with lymphocytosis)
Endocarditis
Rickettsial infection
Collagen vascular disease such as SLE
Inflammatory bowel disease
Certain myeloid leukemia with monocytic differentiation

31. Eosinophilia Allergic disorders Parasitic infections Medications
Collagen vascular disorders
Vasculitis
Atheroembolic disorders (transient)
Certain myelproliferative neoplasms
Certain lymphoma, specifically Hodgkin lymphoma

32. Basophilia
Rare,
Usually in the setting of chronic myelogenous leukemia.

33. Reactive lymphadenopathies

35. Acute nonspecific lymphadenitis
Enlargement of a localized or generalized group of lymph nodes
Localized in cases of draining a site of infection
Generalized viral or bacterial infection

36. Painful enlargement of the lymph nodes. Histology:
Large follicles with germinal center formation
Frequent GC macrophages
Sinus enlargement with histiocytes
Parafollicular neutrophils, necrosis and possible pus formation

37. Chronic Nonspecific Lymphadenitis
It assumes three patterns
Follicular hyperplasia
Paracortical hyperplasia
Sinus histiocytosis

38. Follicular hyperplasia

39. No neutrophils
Can be confused with follicular lymphoma
(1) the preservation of the lymph node architecture;
(2) variation in the shape and size of the germinal centers;
(3) the presence of a mixture of germinal center lymphocytes of varying shape and size;
(4) prominent phagocytic and mitotic activity in germinal
centers.
(5) BCL2 is negative in the follicles and positive in follicular lymphoma

40. Paracortical hyperplasia
Viral infections
Medications
After vaccines

42. Sinus histiocytosis

43. Toxic changes in neutrophils include all the following, except:
Cytoplasmic basophilia
Large basophilic granules
Hypersegmentation
Cytoplasmic vacuoles
Dohle bodies

44. Large granular lymphoma is associated with
Neutropenia
Lymphocytopenia
Neutrophilia
Eosinophilia
Basophilia

45. Monocyopenia is associated with which one of the following tumors
Lymphoplasmacytic lymphoma
Chronic lymphocytic leukemia
Large granular lymphoma
Hairy cell leukemia
Hodgkin lymphoma

46. What is the characteristic finding that lymphocytes display on peripheral blood in patients with pertussis?
Reactive lymphocytes
Lymphocytes with cleaved nuclei
Normal lymphocytes
Prominent nucleoli
Hairy cytoplasmic extensions