Pathoma WBC- Questions and Answers
EBV - effects on cells in blood? Correct Ans-Lymphocytic lymphocytosis with reactive CD8+
T cells (CMV is a less common cause)
Organs/cells affected by EBV? Correct Ans-Oropharynx (pharyngitis)
Liver (hepatitis + hepatomegaly + elevated liver enzymes)
B cells (recognized by CD8+ T cells)
Effects of CD8+ T cell response? (3) Correct 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? Correct Ans-Note: CD8+ T cells are
atypical, but B cells are infected
Mono - diagnostic test? Correct Ans-Monospot = screening
Serologic testing for EBV viral capsid = definitive diagnosis
Mono - screening test mechanism? Correct Ans-Detects IgM antibodies that cross-link with
horse or sheep RBC (aka heterophile antibodies)
, Pathoma WBC- Questions and Answers
Type of antibodies detected in monospot test? IgG, IgA, IgM, IgE? Correct Ans-IgM
Implications of mono symptoms and a negative monospot test? Correct Ans-CMV = cause
of infectious mononucleosis?
Definitive testing for mono? Correct Ans-Serologic testing for EBV viral capsid antigen (also
detects past infection)
Three major complications of mono infection? Correct 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? Correct 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)
Normal WBC count? Correct Ans-5-10 K/microliter
, Pathoma WBC- Questions and Answers
Causes of neutropenia? Correct 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? Correct 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) Correct 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? Correct 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)
EBV - effects on cells in blood? Correct Ans-Lymphocytic lymphocytosis with reactive CD8+
T cells (CMV is a less common cause)
Organs/cells affected by EBV? Correct Ans-Oropharynx (pharyngitis)
Liver (hepatitis + hepatomegaly + elevated liver enzymes)
B cells (recognized by CD8+ T cells)
Effects of CD8+ T cell response? (3) Correct 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? Correct Ans-Note: CD8+ T cells are
atypical, but B cells are infected
Mono - diagnostic test? Correct Ans-Monospot = screening
Serologic testing for EBV viral capsid = definitive diagnosis
Mono - screening test mechanism? Correct Ans-Detects IgM antibodies that cross-link with
horse or sheep RBC (aka heterophile antibodies)
, Pathoma WBC- Questions and Answers
Type of antibodies detected in monospot test? IgG, IgA, IgM, IgE? Correct Ans-IgM
Implications of mono symptoms and a negative monospot test? Correct Ans-CMV = cause
of infectious mononucleosis?
Definitive testing for mono? Correct Ans-Serologic testing for EBV viral capsid antigen (also
detects past infection)
Three major complications of mono infection? Correct 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? Correct 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)
Normal WBC count? Correct Ans-5-10 K/microliter
, Pathoma WBC- Questions and Answers
Causes of neutropenia? Correct 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? Correct 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) Correct 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? Correct 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)
