Disorders Of Leukocytes

Neutrophilia (>7500-10.000,p.1)

Infection

Usually bacterial; t toxic granulations. Dohle bodies

Inflammation

Burn, tissue necrosis. Ml. PE. collagen vascular disease

Drugs and toxins Stress

Corticosteroids. ($-agonists. lithium. G-CSF; cigarette smoking Release of endogenous glucocorticoids and catecholamines

Marrow stimulation

Hemolytic anemia, immune thrombocytopenia

Asplenia

Surgical, acquired (sickle cell), congenital (dextrocardia)

Neoplasm

Can be 1c (MPD) or paraneoplastic (eg. carcinomas of lung. Gl)

Leukemoid reaction

50.000 jil • left shift, not due to leukemia: unlike CML, t LAP

Lymphocytosis (-4000-5000 p.!)

Infection

Usually viral; "atypical lymphocytes" with mononucleosis syndromes Other: pertussis, toxoplasmosis

Hypersensitivity

Drug-induced, serum sickness

Stress

Autoimmune

Cardiac emergencies, trauma, status epilepticus, postsplenectomy Rheumatoid arthritis (large granular lymphocytes), malignant thymoma

Neoplasm

Leukemia (ALL. CLL others), lymphoma

Monocytosis (>500/p.l)

Infection

Usually TB. SBE. Listeria. Brucella, rickettsiae. fungi, parasites

Inflammation

IBD. sarcoidosis, collagen vascular diseases

Neoplasm

Hodgkin's disease, leukemias. MPD. carcinomas

Eosinophilia (>500 >1)

Infection

Usually parasitic (helminths)

Allergic

Drugs: asthma, hay fever, eczema; ABPA

Collagen vascular disease

RA Churg-Strauss syndrome, eosinophilic fasciitis. PAN

Endocrine

Adrenal insufficiency

Neoplasm

Hodgkin's lymphoma. CML. mycosis fungoides. carcinomas, mastocytosis

Atheroembolic disease Hypereosinophilic syndrome

Cholesterol emboli syndrome

Multiorgan system involvement including heart and CNS. associated with FIP1L1-PDGFRA fusion (nejm 2003:348 1201)

Basophilia (> 150/|xl>

Neoplasm

MPD. Hodgkin's disease

Alteration in BM or reticuloendothelial compartment

Hemolytic anemia, splenectomy

Inflammation or allergy

IBD. chronic airway inflammation

Lymphadenopathy

Viral

HIV. EBV. CMV, HSV, VZV. hepatitis, measles, rubella

Bacterial

Generalized (brucellosis. leptospirosis.TB. atypical mycobacteria, syphilis) Localized (streptococci, staphylococci, cat-scratch disease, tularemia)

Fungal and parasitic

Histoplasmosis, coccidioidomycosis, paracoccidioidomycosis Toxoplasmosis

Immunologic

Collagen vascular disease, drug hypersensitivity (eg. phenytoin). serum sickness. histiocytosis X. Casdeman s and Kawaski disease

Neoplasm

Lymphoma, leukemia, amyloidosis, metastatic carcinoma

Other Factors that favor biopsy

Sarcoidosis; lipid storage diseases

Age ( -40). size (>2 cm), location (supraclavicular is always abnormal), duration (>1 m).

Consistency (hard vs. rubbery vs. soft) & tenderness are not reliable.

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