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Pathoma WBC – Questions & Detailed Solutions (100%)
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Pathoma WBC – Questions & Detailed Solutions(100%)
Normal WBC count? Right Ans - 5-10 K/microliter
Causes of neutropenia? Right Ans - Drug toxicity: chemotherapy with
alkylating agents (damage to stem cells aka myeloblasts)
Severe infection: gram negative sepsis (neutrophils move into tissues ->
decreased circulating numbers)
Treatment of neutropenia? Right Ans - GM-CSF or G-CSF
Granulocyte-macrophage stimulating factor or granulocyte-stimulating factor
Causes of lymphopenia? (decreased lymphocytes only - not having to do with
neutrophils or leukocytes in general) Right Ans - Immunodeficiency (ie.
DiGeorge syndrome or HIV)
High cortisol (i.e. corticosteroids or Cushing's) -> apoptosis of lymphocytes
Autoimmune destruction (i.e. lupus - can also be rbc, wbc, platelets, etc.)
Whole body radiation: lymphocytes highly sensitive, so they are the first to die
(earliest change)
Causes of neutrophilic leukocytosis? Right Ans - Bacterial infection (not
gram-negative sepsis): induces release of marginated pool of BM neutrophils
(including immature forms -> left shift)
Tissue necrosis: left shift like above (drives inflammatory processes)
High cortisol: impairs neutrophil/leukocyte adhesion (decreases marginated
pool adherent to blood vessels), leading to release of marginated pool of
neutrophils, also impairs diapedesis (while inducing lymphocyte apoptosis ->
lymphopenia)
Markers of immature neutrophils? Right Ans - Decreased Fc receptors (aka
CD16 expression)
Causes of monocytosis? (3) Right Ans - Autoimmune chronic inflammatory
states (SLE, RA)
Infectious chronic inflammatory states (TB, bacterial endocarditis)
Malignancy
,Causes of eosinophilia? (3) Right Ans - Allergic reactions (type I
hypersensitivity)
Parasitic infections
Hodgkin lymphoma
Most common cause of basophilia? Right Ans - Chronic myeloid leukemia
(CML)
Causes of lymphocytic leukocytosis? (2) Right Ans - Viral infections (t-
lymphocyte hyperplasia)
Bordatella pertussis: Lymphocytosis-promoting factor blocks circulating
lymphocytes from entering lymph node (lymphocytes must enter lymph
nodes to encounter APCs with foreign antigens to get activated)
EBV - effects on cells in blood? Right Ans - Lymphocytic lymphocytosis
with reactive CD8+ T cells (CMV is a less common cause)
Organs/cells affected by EBV? Right Ans - Oropharynx (pharyngitis)
Liver (hepatitis + hepatomegaly + elevated liver enzymes)
B cells (recognized by CD8+ T cells)
Effects of CD8+ T cell response? (3) Right Ans - LAD due to T-cell
hyperplasia in the lymph node paracortex
Splenomegaly due to T-cell hyperplasia in the periarterial lymphatic sheath
(PALS = part of white pulp)
High WBC/lymphocytosis with atypical lymphocytes (CD8+ T cells)
Appearance of atypical lymphocytes in EBV infection? Right Ans - Note:
CD8+ T cells are atypical, but B cells are infected
Mono - diagnostic test? Right Ans - Monospot = screening
Serologic testing for EBV viral capsid = definitive diagnosis
Mono - screening test mechanism? Right Ans - Detects IgM antibodies that
cross-link with horse or sheep RBC (aka heterophile antibodies)
Type of antibodies detected in monospot test? IgG, IgA, IgM, IgE? Right Ans
- IgM
, Implications of mono symptoms and a negative monospot test? Right Ans -
CMV = cause of infectious mononucleosis?
Definitive testing for mono? Right Ans - Serologic testing for EBV viral
capsid antigen (also detects past infection)
Three major complications of mono infection? Right Ans - Inc. risk for
splenic rupture (avoid contact sports for 1 month)
Ampicillin -> rash (type of penicillin)
Inc. risk for recurrence + B-cell lymphoma (esp. if immunodeficiency
develops) - because virus lies dormant in B-cells
Acute leukemia vs. chronic leukemia - defining features? Right Ans - Acute
leukemia: >20% blasts, seen in bone marrow, crowd out hematopoesis quickly
-> acute sx (but also enter bloodstream -> high WBC count, but non-
functional)
Chronic leukemia: mature (but naiive) proliferation of cells in circulation, high
WBC count (often B-cell)
Appearance of blast cells? Right Ans - Large, immature cells, often with
punched-out nucleoli (shown in AML)
Acute Lymphoblastic Leukemia (ALL) - nuclear staining? Right Ans - TdT =
DNA polymerase (absent in myeloid blasts and mature lymphocytes)
Note: lymphoblasts create T and B lymphocytes
Acute lymphoblastic leukemia (ALL) - most common population affected?
Right Ans - Children
Associated with Down syndrome after age of 5 (acute megakaryoblastic
leukemia before age of 5)
Most common type of ALL? (B vs. T) Right Ans - B-ALL
Molecular expression pattern of B-ALL? Right Ans - CD10
CD19
CD20
(and TdT b/c they're lymphoblasts)
Therapy for B-ALL? Right Ans - Requires prophylaxis to scrotum and CSF
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