WBCs
________________ is the production of WBCs
Leukopoiesis
WBCs originate from ____________ ______ cells
pluripotent stem
Pluripotent stem cells are stimulated by cytokines to mature into either ___________ or ___________ cells
Myeloid or Lymphoid
Neutrophils are split between the _____________ _______ (stays in the bloodstream) and the ______________ _____ (inner blood vessel layer)
circulating pool and the marginal pool
To differentiate cells observe the cell _______, ____, _______ _________, and ___________ _________
size, N:C, chromatin pattern, and cytoplasmic quality
The 1st stage of granulocytic maturation is the ______________ stage
Myeloblast
The 2nd stage of granulocytic maturation is the ______________ stage
Promyelocyte
The 3rd stage of granulocytic maturation is the ______________ stage
Neutrophilic/Basophilic/Eosinophilic Myelocyte
The 4th stage of granulocytic maturation is the ______________ stage
Neutrophilic/Basophilic/Eosinophilic Metamyelocyte
The 5th stage of granulocytic maturation is the ______________ stage
Neutrophilic/Basophilic/Eosinophilic Band
The 6th stage of granulocytic maturation is the ______________ stage
Neutro/Baso/Eosinophil
Myelo/Monoblasts are present with 2-5 nucleoli with thin __________ ______
chromatin strands
Promyelocytes have prominent primary, nonspecific ________
granules
The Myelocyte stage is the first stage with _________ __________
specific granules
The metamyelocyte stage has no __________
nucleoli
Segmented neutrophils have _____ nucleus lobes connected together by filaments
2-5
Segs have many _____ _____________ __________
fine secondary granules
Eosinophils have an eccentric (red-orange), ________ nucleus
bilobed
Basophils have very many purple-black granules with a bilobed or ___________ nucleus
cloverleaf
The Promonocyte stage has ________ present on the nucleus
folding
Nuclei from the ________ stage takes different shapes
monocyte
Lymphoblasts have a smudgy chromatin with very little __________
cytoplasm
Prolymphocytes have a slightly ________ chromatin with little cytoplasm
coarsened
_____________ seek ingest and kill bacteria through Phagocytosis
Neutrophils
______________ respond to parasitic and allergic reactions, as well as regulates the inflammatory process
Eosinophils
______________ respond to hypersensitivity reactions and inflammation, contains heparin
Basophils
The lymphatic system is responsible for __________________________________
Blood filtration, Fluid balance, Antibody generation, and Lymphopoiesis
Lymphocyte B-Cells are produced in the ______ __________
Bone Marrow
Lymphocyte T-Cells are produced in the ___________
Thymus
Both Lymph B and T-Cells can be made in the _______________________________________
Spleen, lymph nodes, tonsils, and Peyer's patches
NK cells stay in the _______ ____________
bone marrow
T helper cells (CD4) promotes __________ production
antibody
T supressor cells (CD8) eliminates non-self by promoting ____________ activity
enzyme
B lymphocytes mature into _________ _____, which produce antibodies
plasma cells
B lymphocytes must be stimulated toward a specific __________ ____________
immune response
NK cells have a role in resisting _______, _______, and _______ (foreign bodies)
bacteria, viruses, and fungi
_______________ is the absolute increase in total WBC count
Leukocytosis
____________ is the absolute decrease in total WBC count
Leukopenia
A _____ ______ is a bone marrow response to an increased WBC count (Leukocytosis) by sending younger cells
left shift
A ____________ __________ is an exaggerated response to infections and inflammation
Leukemoid reaction
______________________________ is when a peripheral smear contains immature WBCs, NRBCs, and platelet abnormalities
Leukoerythroblastosis
Phagocytosis starts with _______________, then the _________________ phase, and then the injestion and killing phase
Chemotaxis; Opsonization
______________ is a process where Neutrophils use chemical signals released by foreign substances to move towards the site of invasion with the assistance of C3b
Chemotaxis
___________________ is a process where C5a "seasons" the foreign body with complement or immunoglobulins
Opsonization
Neutro/Eosino/Basophil levels are _____________ Neutro/Eosino/Basophilia
increased
Neutro/Eosino/Basophil and Mono/Lymphocyte levels are _____________ with Neutro/Eosino/Baso/Monocyto/Lymphocytopenia
decreased
Mono/Lymphocyte levels are ______________ in Mono/Lymphocytosis
increased
a left shift has an increase in_______ and ______________ on the peripheral smear
bands and metamyelocytes
________ ___________ is when granules are excessive due to enhanced lysosome enzyme production
Toxic granulation
Toxic granulation also resembles the primary granules of _____________
promyelocytes
______ _____________ has round, clear spaces within granulocyte cytoplasm
Toxic vacuolization
_______ ________ has remnants of ribosomal RNA after lysosome overproduction
Dohle Bodies
_________ _____________ is a new tick-borne disease caused by 2 varieties of a Rickettsia like bacteria
Human Ehrlichiosis
Toxic granulation and vacuolization as well as Dohle bodies happens due to the ____ ______
left shift
Neutrophilia is caused by __________ infections and responses
Bacterial
Eosinophilia is caused by ______________________
Allergies and skin and parasitic diseases
Basophilia is caused by __________ ____________ __________
chronic inflammatory conditions
Monocytosis is caused by ___________ __________ (TB)
Chronic infections
Lymphocytosis is a ______ _________ normal in children ages 4 months - 4 years old
viral infection
Giant platelets, thrombocytopenia, and large Dohle Bodies are seen in a __________________ Anomaly
May-Hegglin
Coarse, dark granules are seen in a ______________ Anomaly
Alder-Reilly
Spherical, dumb-bell shaped nucleus' are seen in a _____________ Anomaly
Pelger-Huet
_____________ and wbc chemotaxis and killing function are decreased in Chediak-Higashi Syndrome
Photophobia
Lipid storage diseases are caused by a ___________ ________ _____________
single gene deletion
___________ __________ is normal in young children (1-4 years)
Relative Lymphocytosis
Infectioun Mononucleosis is caused by the EBV and shows symptoms such as __________________________________-
sore throat, fatigue, and fever
The _________________ _______ (EBV) infects B lymphocytes and can be found in fluids such as saliva
Epstein-Barr virus
Infectious mononucleosis is diagnosed from _______% reactive lymphocyte concentration in smear
10-60
H-Segs are seen in ______________ _________
megaloblastic anemias
____________ is the mutation of pluripotent stem cells causing cell overgrowth (Cancer)
Leukemia
Chronic Leukemia is subtle, with high levels of _________ yet disfunctional wbcs
mature
In some cases of chronic leukemia; _______, _________________, and ______________ is present. With Acute leukemia these 3 are always present
Anemia, thrombocytopenia, and Neutropenia
Acute Leukemia is abrupt, with changing wbc levels, _____ and _________ ____ are also present
Blasts and immature wbcs
Acute Leukemia is seen in all stages of life and if left untreated turns fatal in ____ months
2-3
>___% of wbcs in the BM or blood is blasts in Acute Leukemia
20
_________ ________ _____________ (AML) is seen in middle age adults and is fatal between 2-3 months if not treated
Acute myeloid Leukemia
_______ ________________ ____________ (ALL) is mostly seen in children under the age of 10, which have a 70-80% cure rate (Adults 60-80%)
Acute Lymphoblastic Leukemia
With ALL, ~100% of lymph cells are ___________ and ____________
lymphocytes and lymphoblasts
AML requires a blast percentage of ⪰___% in the blood or BM for a positive result
20
AML with Myelodysplasia has ⪰20% blast percentage with _____________ in atleast 2 cell lines
Dysplasia
AML and Myelodysplasia is treated with __________ ______________ and/or ________ ___________
cytotoxic chemotherapy and/or radiation therapy
Acute Erythroid Leukemia has >___% erythroid precursors
80
The cytochemical stains MPO, SBB, and CAE identifies ___________
myeloblasts
The cytochemical stain TdT identifies ______________________
Lymphoblasts
Genetic abnormalities are identified using _____________ _________________
reciprocal translocations
AML(_____)
8:21
AML inv (___)
16
APL (_____) and is associated with DIC
15:17
Acute myeloid leukemia with _________
11q23
_______ affects cells in the granulocytic cell line
CML
______ affects cells in the Erythrocytic cell line
PV
____ affects cells in all cell lines
IMF
___ affects cells in the Mega-K cell line
ET
Chronic Myelogenous Leukemia(CML) affects people aged _______ years old
20-50
CML has 90-95% of chromosomes present with the ____________ mutation, which is formed from the translocation of chromosome 22 to chromosome 9
Philadelphia
Severe _____________ and the presence of the Philadelphia chromosome are features of CML
leukocytosis
_________ _________ ___________ (LAP) is a test used to differentiate CML from leukemoid reaction
Leukocyte Alklaine Phosphatase
CML has 3 phases, a chronic, accelerated, and blast phase; the chronic phase has a __% blast concentration, accelerated phase __%, and blast phase >___%
2; 5; 20
CMLs _______ phase is the most responsive to treatment, while the ______ phase is untreatable
chronic; blast
CMLs accelerated phase has a <__ year survival expectancy
1
If CML is treated soon enough the average life expectancy is ___ years
4-6
Polycythemia Vera (PV) affect people around the ages of ________ due to the overproduction of mature blood cells with the _____ mutation
60-70; JAK2
A increased ____ count is positive for PV
RBC
PV causes an increased ____, ________, and the JAK2 mutation to be present
RCM, Splenomegaly
__________ and ______________ is seen in the bone marrow of a PV patient
Hyperplasia and Hypercellularity
_________ __________ is used to treat PV patients
Therapeutic phlebotomy
The expected survival for PV patients is more than ___ years
10
__________ _____________ (PMF) has 2 stages, an initial and fibrotic stage
Primary Myelofibrosis
The PMF initial stage shows a slight cell count increase and the Fibrotic stage shows fibrosis of the _______ _________
bone marrow
PMF is also called _________ ___ ________ ________ (MMM) and _________ ___________ (IMF)
Myelofibrosis with myeloid metaplasia and Idiopathic myelofibrosis
_________, _____ and ______ pain are all seen with PMF
Osteosclerosis, bone and joint
A PMF patient CBC shows an increase in _________ and ______ count that decreases over time
platelet and WBC
A PMF patients bone marrow has an increase in ________ __________ that also decreases over time
cellular production
No treatment can reverse the effects of PMF but __________ can be used to control the disease, as well as a _________ or ___ ___________
Hydroxyurea; Splenectomy or BM transplant
The expected survival of PMF patients is ____ years
3-5
___________ _______________ (ET) has an increased PLT production due to hypersensitivity of Mega-Ks
Essential Thrombocythemia
The hallmark sign of ET is an unexplained elevated ____ count; the early stages of ET is asymptomatic
PLT
The bone marrow of ET patients has increased cellularity with ________ ______________
mega-k hyperplasia
____________, _____________, or ________________ is used to treat ET patients
Hydroxyurea, anagrelide, or alfa-interferon
Patients with ET has a survival expectancy of ___ years and usually die from thrombotic complications
10
_________ _____________________________ ___________ are all the malignant proliferation of B and T cells
Chronic Lymphoproliferative Disorders
Chronic Lymphoproliferative Disorders primarily affect the _________ and people with compromised immune systems
elderly
Symptoms of Chronic Lymphocytic Leukemia is _______________ (enlarged lymph nodes) and a high _____ count
Lymphadenopathy; WBC
The peripheral smear of a Chronic Lymphocytic Leukemia patient is almost exclusively small _____________ mixed with a very small amount of lymphoblasts
Lymphocytes
Chronic Lymphocytic Leukemia patients can be treated with ____________ and ________ ______
irradiation and cytotoxic drugs
Most CLL cases have ______ (an anti-apoptosis gene) which causes Dysfunctional B cells to live longer
BCL2
__________ _____________ ___________ (CLL) makes mature lymphs dysfunctional, leaving the skin prone to infection
Chronic Lymphocytic Leukemia
CLL causes lymphocytes to accumulate in the BM, causing ________, _____________________, and _____________
anemia, thrombocytopenia, and neutropenia
______ _____ _________ (HCL) is a rare B cell malignancy
Hairy cell leukemia
"Hairy" _______________ cells are seen in the peripheral smear of HCL patients
mononuclear
HCL causes BM fibrosis, leading to _______ _______
Dry Taps
HCL is diagnosed with the cytochemical stain ____________________ ______ _______________ (TRAP)
tartrate-resistant acid phosphatase
__________ ___________ is a cutaneous T-cell Lymphoma with the infiltration of abnormal Lymphs; shows Sezary Cells on the peripheral smear
Sezary Syndrome
Sezary Cells are large with a _______, _________, or ___________ nucleus
ovoid, clefted, or folded
___________ ____________ is the most common Lymphoma in males age 14-40 AND over 50
Hodgkins Lymphoma
Hodgkins Lymphoma is usually diagnosed based on the _______ _______, where a single ________ _______ becomes firm to the touch
lymph node
lymph nodes
___________________ cells are usually found in the BM with Hodgkins Lymphoma
Reed-Sternberg
___________________ ______________ is diagnosed based on history of lymphocytic cells; a enlarged lymph node and Lymphoma Cells may be present
Non-Hodgkins Lymphoma
The __________ ______ evolves from B lymphocytes and has a well-defined Golgi Apparatus
Plasma Cell
The Plasma Cell makes ________________ (IgG, M, D, E, A)
immunoglobulins
___________ ____________ (MM) is the overproduction of plasma cells, causing excessive immunoglobulin production; affects older males
Multiple Myeloma
Multiple Myeloma may develop _______ _______, _________ _________/________, and ______ _______
Russel Bodies, kidney failure/stones, and bone loss
______________________ ______________________ is the overproduction of IgM caused by abnormal lymphocytes; interferes with coagulation factors
Waldenstrom's Macroglobulinemia
Waldenstrom's Macroglobulinemia may lead to ___________ ____________
Raynaud's Phenomenon
________________ may be found in some patients with Waldenstrom's Macroglobulinemia
Cryoglobulins
The key features of MDS is __________ ____________ __________, __________, and __________ ____
Refractory Macrocytic anemia, Cytopenia, and Hypercellular BM
________ ________ ______ _________ is the most common hematologic malignancy
Clonal Stem Cell Disorder
MDS is diagnosed with the presence of <__% blasts in the BM
20
MDS has different types of dyplasia; ____________, _____________, and ________________
Dyserythropoiesis, Dysgranulopoiesis, and Dysthrombopoiesis
______________ is confirmed by the presence of ringed sideroblasts, dimorphism, and multinuclearity
Dyserythropoiesis
________________ is confirmed with the presence of Hypo/Hypersegmentation, poorly stained granules, and degenerating neutrophils
Dysgranulopoiesis
_______________ is confirmed with the presence of giant platelets and micromegakaryocytes
Dysthrombopoiesis
______ ________, ___________ ________, and __________ are all possible causes Myelodysplastic Syndromes
Prior Therapy, Alkylating Therapy, and radiation
30-40% of MDS cases become ________ ____________
Acute Leukemia