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Lymphocytosis and Lymphocytopenia:
Normal Adults
20-40%
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Lymphocytopenia
decreased lymphs
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Lymphocytosis:
Increased lymphs
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Causes of lymphocytosis:
- Acute viral infections
- Some bacterial infections
- Some parasitic infections
- Drug reactions
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Causes of lymphocytopenia:
- HIV
- Genetic immune deficiencies
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Infectious Mononucleosis (IM):
- Epstein-Barr Virus
- DNA virus
- Common Worldwide
- Transmitted via oro-pharyngeal secreations
- 10-50 day incubation
- 95% of adults have been exposed to EBV
- Seronegative at birth-->Seropositive adults
- Asymptomatic to poorly defined symptoms
- Normally benign, but serious for immunocompromised.
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IM symptoms:
- Fatigue, sore throat, fever, lymphadenopathy
- Deaths have occurred from ruptured spleen
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Lab findings in IM:
- Leukocytosis (90%)
- 60-90% lymphocytes in peripheral smear
- 5-30% ALTs
- Heterophile Test: EBV antibodies crossreact with antigens of other species (horse RBC)
- Not all IM infections have positive heterophile tests
- More specific serological tests are available.
- EBV infected B-lymphs acquire new antigens and their corresponding antigens.
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- Variant Lymphocytes
- RBC indentation of the lymphocyte cytoplasm with blue ridge
- Large irregular nuclei and large amounts of irregular cytoplasm
- Nuclear chromatin may appear immature with possible nucleoli.
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Cytomegalovirus (CMV)
- Worldwide distribution
- Herpes virus family-DNA Virus
- Transmitted thru oral, respiratory, sexually, transfusions, organs
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Symptoms of CMV:
- Asymptomatic for immune competent
- Fever, chills, sore throat, malaise
- Significant cause of death for HIV and premature infants
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Lab of CMV:
- Leukocytosis with Variant Lymphs
- Elevated liver enzyme tests
- Positive serological tests
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Toxoplasmosis:
- Infection by the intracellular parasite Toxoplasma gondii
- T. gondii infects many different animals (common in domestic cats)
- Has 3 stages: Oocyts/Trophozoites/Tissue cysts
- Human infection occurs from cat boxes, undercooked or raw meet
- Infections can be serious for immunocompromised (HIV, Newborns)
- Lymphocystis with Variant lymphs
- Diagnosed by serological techniques
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Infectious Lymphocytes:
- Coxsackle virus (probably)
- usually seen in children
- Associated with isolated outbreaks
- Self-limiting
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Symptoms of Infectious Lymphocytes:
- Vomiting, diarrhea, fever, rashes, respiratory symptoms, swollen nodes
- Leukocytosis (up to 95% small,mature lymphs)
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Bordetella pertussis
- Bacterial infection from Bordetella pertussis (whooping cough)
- Acquired from airborne droplets (coughing, sneezing)
- Very infectious
- Uncommon because of DPT vaccine, but cases are increasing
- Painful, severe to fatal respiratory infections
- Leukocytosis and lymphocytosis
- Small lymphocytes with clef-nucleus
- Definition diagnosis from bacterial culture.
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(AIDS) Acquired Immunodeficiency Syndrome
- Infection of HIV-1 virus
- HIV-2 also causes AIDs but rare
HIV infects Helper/Inducer T-lymphs (CD4)
- Opportunistic infections (CMV, EBV, TB, Pneumocystis, Kaposi's)
- Acquired from body fluids
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Lab of AIDs:
- Leukopenia and lymphocytopenia
- T-lymph deficiency
- Helper/Suppressor Ratio < 2.0
- Diagnosis by serological tests
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SLE) Systemic Lupus Erythematosus
- Systemic autoimmune disease
- Increased Helper T-lymph and B-Lymph activity against connective and renal tissues
Diagnosed: ANA serological tests
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