Pathology 1 - Block 3 - Part 1

davidwurbel7's version from 2016-04-03 21:06

Autoimmune Hemolytic Anemia

Question Answer
Autoimmune Hemolytic Anemia is diagnosed by this testDirect Antiglobulin Test (DAT)
Direct antiglobulin test is also known as this testCoomb's Test
IgG Ab active at 37°CWarm Antibody Type
IgM Ab active below 37°CCold Agglutinin Type
IgG Ab active below 37°CCold Hemolysin Type
IgG globulins having relatively high binding affinity for human RBCs at 37°C. Most common type. May or may not fix complement typically leads to extravascular hemolysisWarm Antibody Type
Secondary causes for this are Autoimmune disorders (SLE), Lymphoid neoplasms (CLL) and Drugs (Penicillin, α-methyl dopa)Warm Antibody Type
RBCs typically are coated with IgG. Autoantibody-coated RBCs are trapped by macrophages. Red cell hemolysis is extravascular. Macrophages which will remove red cell membrane during partial phagocytosis. The red cell become spherocytic. These red cells are then broken down in spleenWarm Antibody Type
Mycoplasma pneumoniae infection IgM Ab binds to red cells and fixes complement at low temperatures. Remember C3b is an excellent opsonin, which the leads to removal of affected red cells by phagocytes in spleen, liver, and bone marrowCold Agglutinin type
Lab Findings include Hb: reduced. Reticulocytes: increased. Peripheral blood smear shows polychromatophils, nucleated red cells. Extravascular: spherocytes. Intravascular: schistocytes. Serum bilirubin: raised. Hemoglobinuria: intravascular. Haptoglobin: reduced. Coombs test: positiveAutoimmune Hemolytic Anemia
Detects the presence of antibody or complement coated red cells here, anti IgG or complement is added to patient’s red cells. there is agglutination if red cells are coated with IgG or complementDirect Coomb’s Test
Detects the presence of antibodies in patient’s serum here. Anti IgG and test red cells are mixed with patient’s serum there is agglutination if serum antibodies are presentIndirect Coomb’s Test
Mechanical hemolytic anemias red cells are traumatized with contact with endothelium, fibrin, etc. A type of intravascular hemolysisMicroangiopathic Hemolytic Anemia
Hemolytic anemia. Unconjugated hyperbilirubinemia increases the risk of developing kernicterusRh- Incompatibility
Deposition of unconjugated bilirubin in the basal ganglion of the brain due to the blood-brain barrier not being fully formed and the liver being not fully developedKernicterus
Occurs almost exclusively in infants with blood group A or B who are born to group O mothersABO Hemolytic Disease of the Newborn (HDN)

White Blood Cells and Lymph nodes 1

Question Answer
Decrease in number of circulating white blood cellsLeukopenia
Reduced neutrophilsNeutropenia
Whole body radiation. Immunodeficiency (HIV, DiGeorge syndrome). Drugs (corticosteroids)Lymphopenia
Aplastic anemia and Marrow infiltration (tumors, granulomatous dis) are causes of thisSuppression of Hematopoeitic Stem Cells
Drugs are the most common cause of this type of suppressionSuppression of Committed Granulocytic Precursors
Megaloblastic anemia and MDS are diseases associated with this type of marrow conditionIneffective Hematopoeisis
Absolute neutrophil count 1,500 to 8,000 cells/mm3Normal
Absolute neutrophil count value less than 1,500Neutropenia
Absolute neutrophil count value between 1000 to 1500Mild Neutropenia
Absolute neutrophil count value between 500 to 1000Moderate neutropenia
Absolute neutrophil count value less than 500Severe neutropenia
Absolute neutrophil count value less than 100Agranulocytosis
Diagnosis by total white cell count: reduced Peripheral blood smear: neutropenia. Absolute neutrophil count: reduced. Bone Marrow will vary with cause. Hypocellular: most common. Mostly drug induced. Hypercellular: occasionally, when there is increased peripheral destruction of neutrophils (SLE, megaloblastic anemias)Neutropenia / Agranulocytosis
Severe life threatening infections of Candida and Aspergillus are possible in patients that have this conditionAgranulocytosis
Bacterial infections generally have an increase in these WBCsNeutrophil
Viral infection generally have an increase in these WBCsLymphocytes
Parasitic infection and allergy generally have an increase in these WBCsEosinophil
Myeloproliferative diseases generally have an increase in these WBSsBasophil
Chronic infections generally have an increase in this WBCMonocytes
An increase in neutrophilsNeutrophilia
An increase in lymphocytesLymphocytosis
An increase in eosinophilEosinophilia
An increase in basophilBasophilia
An increase in monocyteMonocytosis
Some inflammatory states or chronic infections, the total white cell count is elevated. Immature granulocytes appear in peripheral blood. Shift to the left (more than 10% bands in peripheral blood smear)Leukemoid Reaction
Leukocyte alkaline phosphatase test that indirectly measure the number of WBCs in the bloodLAP Score
A high LAP score suggests thisLeukemoid Reaction
A low LAP score suggests thisChronic Myeloid Leukemia (CML)
Immature granulocytes and erythroid precursors enter peripheral blood. Pathogenesis - bone marrow infiltration (amyloidosis, Gaucher’s, leukemias, metastatic cancers) marrow fibrosis. A peripheral blood smear shows immature granulocytes, and nucleated red cellsLeukoerythroblastic Reaction
Seen in severe infections- sepsis. Neutrophils contain numerous dark purple granulesToxic Granulations
Toxic Granulations are associated with this conditionSepsis
Seen along with toxic granulations. Light blue smudge within mature neutrophilsDöhle Bodies
Increase in total white count. Neutrophilia, is the most commonLeukocytosis
This virus infects B-lymphocytes expressing CD21EBV
EBV infects B-lymphocytes that express this markerCD21
Pathogenesis could include an increase size of the precursor pool (BM, thymus, circulation, peripheral tissues), increase in the rate of release of cells from storage pools into circulation, increase proportion of cells that are adherent to blood vessel wall (marginal pool), increase rate of extravasation of cells from blood into tissuesLeukocytosis
Recognized as a clinical syndrome of fever, pharyngitis and lymphadenopathy. Usually seen in young age mostly. Benign infection of EBVInfectious Mononucleosis
Binds EBV to chromosomes (episomal form). Latency.EBNA1
These EBV viral genes drives B cell proliferationEBNA2 and LMP1
Investigation shows - Complete Blood Counts (CBC): WBC is increased; Peripheral blood smear: atypical lymphocytes ‘Downey cells’; Lymph node: paracortical lymphoid hyperplasia; Lab Investigation: positive antiviral capsid antigen testInfectious Mononucleosis
Clinical features include fever, lymphadenopathy, pharyngitis, rash (when treated with ampicillin), fatigue/malaise, splenomegalyInfectious Mononucleosis
Reactive changes occur in lymph nodes when presented with microbiologic agents, cell debris and foreign bodiesAcute Non Specific Lymphadenitis
Lymph nodes enlargement. tender on palpation, due to distension of lymph node capsule. overlying skin is inflamed. location is very importantAcute Non Specific Lymphadenitis
Occipital lymph nodeScalp Infection
Pre-auricular lymph nodeConjunctival infections, Cat-scratch disease
Posterior cervical lymph nodeToxoplasmosis
Inguinal lymph nodeSTD’s
Caused by activation of humoral immune responses. Morphology: formation of “secondary follicle”: large round to oblong B- cell rich germinal centers surrounded by a collar of resting B lymphocytes (mantle zone). Lymph node architecture is maintained reactive follicle, surrounded by mantle zone. Lymph node contains macrophages containing nuclear debris Chronic Nonspecific Lymphadenitis
Macrophages containing nuclear debris that refract color on moving the microscope stageTingible Body Macrophages
Seen after months. Usually seen in the axilla and inguinal. There is hyperplasia of the follicular tissue, tangible body macrophage are present. Germinal centers expandedFollicular Hyperplasia
Caused by activation of cellular immune responses reactive changes involve T- cell region. Morphology: expansion of the paracortical/interfollicular regions. Presence of immunoblasts - activated T-lymphocytes hypertrophy of sinusoidal and vascular endothelial cellsParacortical Lymphoid Hyperplasia
Commonly associated with acute viral infection and vaccination against certain virusesParacortical Lymphoid Hyperplasia
Caused by reaction of lymph node to tumor antigens. Morphology - characterized by distension and prominence of lymphoid sinusoids. Endothelial cells lining lymph sinuses are hypertrophied. Increase in number of macrophagesSinus Histiocytosis
This change is seen associated with lymph nodes draining cancersSinus Histiocytosis
Metastases from squamous cell ca. floor of the mouth go to this lymph nodeSubmental
Head & neck tumors go to this lymphCervical Lymph Node
Stomach and pancreas cancers go to this lymph nodeVirchow’s node (left supraclavicular)
Breast cancers go to this lymph nodeAxillary Lymph Node
Lung cancers go to this lymph nodeHilar Lymph Node
Lung cancers, Hodgkin lymphoma (nodular sclerosing) and T- cell ALL go to this lymph nodeMediastinal Lymph Node
Testicular and Burkitt lymphoma go to this lymph nodePara-Aortic Lymph Node
Vulva and penis cancers go to this lymph nodeInguinal Lymph Node

Markers and Stains

Question Answer
Myeloperoxidase positiveMyeloblasts (AML)
Myeloperoxidase negativeLymphocytes (ALL)
Sudan black positiveMyeloblasts (AML)
Sudan black negativeLymphocytes (ALL)
PAS positiveLymphoblasts (ALL)
PAS negativeMyeloblasts (AML)
Terminal deoxynucleotidyltransferase (TdT) positiveLymphoblasts (ALL)
Terminal deoxynucleotidyltransferase (TdT) negativeMyeloblasts (AML)
CD10, CD19, PAX5 positiveB Cell (ALL)
CD2, CD3, CD4, CD7 positiveT Cell (ALL)
CD19, CD20, CD5, and CD23 are positiveCLL
CD19, CD20 are positiveHairy Cell Leukemia
Tartrate-resistant acid phosphatase (TRAP) positiveHairy Cell Leukemia

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