The major function is to fight infection, react against inflammation, foreign bodies or tissues
WBC
WBC count has two components.
1. Total WBC in 1 cubic mm of peripheral venous blood.
2. Differential count measures the percentage of each type of leukocytes present in the same specimen.
T/F an increase in the percentage of one type of leukocytes means a decrease in the percentage of another?
T
An increased total WBC count beyond the upper limits.
Leukocytosis
Adult/child > 2 years >10,500
Child < 2 years >17,000
Newborn >30,000
Red flag >300k
A Decrease below the lower limit is called.
Leukopenia (WBC <4000)
Adult/child > 2 years <5,000
Child < 2 years <6,200
Newborn <9,000
Red flag < 500
Total WBC count normal value of each?
Adult/child > 2 years
Child < 2 years
Newborn
5,000 - 10,500
6,200 - 17,000
9,000 - 30,000
Normal Differential Count values of each?
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
50- 70% (2500-8000)
20- 40% (1000-4000)
2- 8% (100-700)
1- 4% (50-500)
0.5- 1% (25-100)
T/F There is an early morning low and late afternoon peak?
True, Hourly rhythm
What are three interfering factors affecting the WBC count?
Hourly Rhythm
AGE
Any stressful situation that leads to an increase in endogenous epinephrine production with a rapid rise in leukocyte
Some infections can be so high they reach a state of leukemia.
Leukemoid reaction, which will resolve as the infection is successfully treated.
What are some common causes of Leukocytosis?
hint: PIAD MATTS LIST
Polycythemia Vera
Acute hemolysis
Inflammation
Drugs - epinephrine and steroids
Malignant neoplasms (esp, bronchogenic CA)
Acute hemorrhage
Tissue necrosis
Trauma or tissue injury
Seizures
Leukemia
Infection - Bacterial, Viral, Fungal, Parasitic
Stress (Emotional or Physical)
Toxins, uremia, eclampsia, thyroid storm
List the forms of bone marrow failure that occurs with Leukopenia.
Overwhelming infections
Viral infections
Hypersplenism
S/P Anti-neoplastic CT or RT therapy
Marrow infiltrative dz (fungal infxn or mets)
Dietary deficiencies
Autoimmune dz
Bone marrow suppression due to - infection, heavy metal, drugs (some abx, antihistamines, anti-convulsive)
Which leukocytes are granulocytes?
Basophils
Eosinophils
Neutrophils
What are the granules within Granulocytes
They are membrane bound enzymes that act primarily in the digestion of endocytosed particles.
The most common granulocyte/leukocyte?
What percentage of WBC?
How long is the life span?
Neutrophils
Make up 40-70% of all WBC's
life span 5.4 days in circulation.
life span 1-2 days in tissue after migration upon activation.
Another name for Neutrophils.
What is its primary function?
Polymorphonuclear neutrophils.
Phagocytosis
How are Neutrophils directed toward sites of infection or inflammation?
Chemotaxis following chemical gradients:
interleukin-8 (IL-8)
interferon gamma (IFN-gamma)
C5a
Leukotriene B4
also cytokines released from endothelium, mast cells, and macrophages.
Neutrophils have three strategies for directly attacking micro-organisms.
1. phagocytosis
2. Release of soluble anti-microbials
3. neutrophil extracellular traps(NETs)
What is the process by which a pathogen is marked for ingestion and destruction by a phagocyte.
Opsonization is the process by which a pathogen is marked for ingestion and destruction by a phagocyte.
Opsonization kills foreign cells in 2 ways.
1. Activation of complementmarks the microbe for ingestion by phagocytes
2. Forms a membrane attack complex to assist antibodies.
What WBC can also cause some tissue damage by the release of their enzymes.
Neutrophils when they release elastase with COPD ptn.
What is an Increased neutrophil count of over 8000? Name some etiologies.
Neutrophilia - increased neutrophil count
Etiologies:
Physiologic- E.A.S.E.
Acute Bacterial, Viral, Fungal infections
Tissue injury and inflammation- B.M.C.H.
Myeloproliferative disorder- ML,MM,PV
Metabolic condition- MAKE HAN
Medications- CLB
Metabolic tox- (DM, Uremia, Hepatitis)
When neutrophil production is significantly stimulated, early Immature forms often enter into circulation called what?
immature forms are called BAND or STAB cells
What is a "shift to the left" mean?
it's indicative of an ongoing acute bacterial infection.
Bands of > 3% in the CBC usually indicate what?
Acute, Severe bacterial infection.
How many lobes does a normal Neutrophil have?
~ 5
What is considered as Chronic neutropenia?
neutropenia lasting more than 3 months.
aka leukopenia.
Absolute Neutrophil Count formula?
What value is considered Neutropenic?
List possible causes.
ANC = WBC x (% neutrophil + % Bands)
ANC of < 1500
Causes:
Hematopoetic dz
RT/CT
some Viral infections
Overwhelming Bacterial infections
A granulocyte disorder characterized by an abnormally low number of neutrophils.
Neutropenia
Etiologies of Neutropenia in more detail.
Decreased BM prod: (aplastic anemia, arsenic, CA, hereditary, Radiation, B12 or copper deficiency)
Increased destruction: (AI neutropenia, CT/RT tx)
Marginalisation & sequstration: Hemodialysis
Medications: Antipsychotics
Neutropenia management?
care for patients with neutropenia is mostly supportive and based on the etiology, severity, and duration.
One of the immune components responsible for combating muticellular parasitic infections and control mechanisms associated with allergies and asthma.
Eosinophil granulocytes
Developed in BM before migrating into blood.
Occupy 1-4% of blood
Circulates for 6-12 hours
Name the common association for each Leukocyte.
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Neutrophils - Bacterial
Lymphocytes - Viral
Monocytes - Intracellular
Eosinophils - Allergic & parasitic conditions
Basophils - Carry histamines and increase allergic rxn. similar to eosinophils.
This Leukocyte is often chronically mildly elevated in asthmatic and eczematous ptns.
Eosinophils, which are the main effector cells in asthma exacerbations.
Which cell type fights helminth colonization as well as scabies infestation.
Eosinophil
Also Enterobius vermicularis aka pinworms
SSX:Restlessness, crying, abdominal pain.
tape to the butt
TX: Pinworms
Vermox
Vermox
Tx: Pinworms
DX Scabies
Scrape Burrows and see mites on slide.
Permethrin (Elimite Cream)
Treatment for Scables
Apply from chin to toes and leave in for 14hr then rinse. repeat in 1 week.
TX for Scabies
Permethrin (Elimite Cream)
ABX PCN secondary bacterial infxn. MC organisms of superinfection are GABHS and Staph Aureus
The least common of the granulocytes that occupy 0.5-1.0 percent of the blood.
Basophil granulocytes aka basophils
Similar to the mast cell
Stores inflammatory mediators and is active in allergic reactions.
Contain anticoagulant heparin and also contain the vasodilator histamine. They can be found in unusually high numbers at sites of ectoparasite infection.
Basophils- Like eosinophils, basophils play a role in both parasitic infections and allergies
These cells have no clearly visible cytoplasmic granules and have a single nuclei
Agranulocytes
Lymphocytes
Monocytes
WBC condition that is extremely dangerous and is often fatal because the body is unprotected against invading agents. (in the setting of neutropenia/ leukopenia)
Agranulocytosis
Known as the killer cells, suppressor cells, and the T4 helper cells.
T cells, which mature in the thymus
These cells participate in humoral immunity (antibody production)
B Cells
The primary function of these cells is to fight chronic bacterial and acute viral infections.
How are they counted in the CBC
Lymphocytes.
CBC diff count does not separate T and B cells
Normally 20-40% of total leukocyte count. If >4000 in adults and 7200 in children
Lymphocytes
Lymphocytosis
Causes of lymphocytosis
Lymphatic Leukemia
Viral infections of:
URI, EBV, CMV, HIV, Varicella, Hepatitis
Lymphopenia ranges and causes?
< 1000 in adults, < 2500 in children
Lymphopenia occurs in
Aplastic Anemia
Renal failure
Chemotherapy/Radiation treatment
Hodgkin's and other malignancies
CHF
The nucleus of this cell is the same size as an RBC.
Lymphocytes
The largest blood cells, kidney shaped nucleus, phagocytic cells capable of fighting bacteria. Through phagocytosis, they remove necrotic debris and microorganisms from the blood.
Monocytes
What are Macrophages?
are altered monocytes that live in tissues.
______ produce interferon which is the body's endogenous immunostimulant.
Monocytes
T/F Young monocytes have an indented or notched nucleus.
True
Monocytes can be produced rapidly and can remain in the blood for how long?
Months
MONOCYTOSIS Causes include
CA stomach, breast, ovary
Leukemia
Chronic Bacterial Infections
• Tuberculosis
• SBE
• Syphilis
coarse black or purple cytoplasmic granules associated with acute reactive state.
Toxic granulation
small blue cytoplasmic inclusions in neutrophils found most commonly in burn patients and those suffering from severe infection.
Dohle bodies
Mature neutrophil with more than 5 distinct lobes. Seen in Megaloblastic anemia, long-term chronic infection
Hypersegmented Neutrophil
Damaged leukocyte Due to fragility Found in CLL.
Smudge Cell
What is Atypical Lymphocytes MC associated with and least commonly associated with?
Most commonly associated with EBV.
May be seen less commonly with CMV.
lymphocytes that become large as a result of antigen stimulation. The nucleus of a reactive lymphocyte can be round, elliptic, indented, cleft or folded
Reactive/ATYPICAL lymphocytes
Can be seen in the leukemic blasts of AML.
Aur rods
clumps of azurophilic granular material that form elongated needles seen in the cytoplasm of leukemic blasts. they are comped of fused lysosome and contain peroxidase, lysosomalenzymes, and large crystalline inclusions.
Aur rods
Lymphoblast are seen in what condition?
Seen in Leukemias
You order a CBC:
• HCT 40
• WBC 15,300
• NEUTROPHIL COUNT – 4,896(32%)
• LYMPHOCYTES – 9,180(60%)
• MONOCYTES – 765(5%)
• EOSINOPHILS - 306 (2%)
• BASOPHILS – 138 (1%)
• Bands – 15 (0%)
• Plts 300,000
What is your interpretation of the results above?
Lymphocytic leukocytosis
A 22 year old man presents with complaints of fever, fatigue, malaise and sore throat.
V: reveals 101F, 108, 140/90, 20, 96%RA.
HEENT - + peritonsilar exudates, + Posterior
cervical lymphadenopathy,
LUNGS – scattered rhonchi
ABD - +BS, soft, Mild LUQ tenderness and mild splenomegaly
Atypical lymphocytosis
Infectious Mononucleosis secondary to EBV
(with lymphocytic leukocytosis)
CONFIRMATORY TEST?
Mono spot (heterophile antibody test)
Case 2
You order a CBC with diff to screen this patient and find:
• Hematocrit 38
• WBC 29,100
• Neutrophils 81%
• Lymphocytes 6%
• Eosinophils 0%
• Monocytes 1%
• Basophils 0%
• Bands 12%
• Platelets 280,000
What is your interpretation of the lab results above?
Neutrophilic leukocytosis with a shift to
the left (bandemia).
A 19 year old college student complains of high fever, severe headache x 6 hours. The patient’s family states he had been well until about 2 days ago when he developed a sore throat and sinus congestion.
Physical Exam reveals:
General: Pale, diaphoretic, appears ill
V: 103.2F, 100/60, 116, 18, RA 96%
Skin: Petechiae and maculopapular pupura on lower extremities and trunk
HEENT: +petechiae soft palate, + nuchal rigidity. + Congested nasal mucosa
Lungs: CTA
Heart: Tachy, s1/s2
Abd: +BS, soft, NT/ND, No masses
Neuro: Alert and oriented x 2, No focal deficits
Meningococcal Meningitis (with neutrophilic leukocytosis and bandemia/shift to the left)
