Question 1

How does immediate neutrophilia differ from acute neutrophilia?

Accepted Answer

Immediate neutrophilia lasts 20-30 minutes, whereas acute neutrophilia lasts hours to days.

Question 2

A patient presents with neutrophilia of 50 x 10⁹/L with many circulating immature cells.The blood contains many bands, metamyelocytes, myelocytes, promyelocytes, and a rare blast.There are no nucleated erythrocytes present.What disease state is most likely with these results?

Accepted Answer

The presence of immature cells, including blasts, in conjunction with neutrophilia, suggests a neutrophilic leukemoid reaction. Other potential causes, such as infection and inflammation, would typically not result in the presence of blasts. Additionally, the absence of nucleated erythrocytes does not support a diagnosis of leukoerythroblastosis. Hypersensitivity reactions and tissue damage from burns would not typically result in this type of hematological response.

Question 3

What disease state correlates highly with the presence of cytoplasmic vacuoles in freshly drawn blood?

Accepted Answer

B

Question 4

A peripheral blood smear examination shows many WBCs with many blue-staining round inclusions present.There is thrombocytopenia with giant platelets present.What autosomal dominant disease is associated with these findings?

Accepted Answer

May-Hegglin anomaly is an autosomal dominant disorder that is characterized by large platelets, thrombocytopenia, and the presence of blue-staining round inclusions in neutrophils and monocytes. Alder-Reilly anomaly is associated with the presence of large, dark-staining granules in neutrophils and other cells. Chédiak-Higashi anomaly is characterized by the presence of large, abnormal lysosomal granules in cells and is associated with recurrent infections and neurologic dysfunction. Megaloblastic anemia is not associated with the findings described in the question.

Question 5

A patient has a WBC count of > 50 x 10⁹/L with many circulating leukocyte precursors and a normal RBC count.What can be concluded from these findings?

Accepted Answer

The information provided is not sufficient to definitively diagnose CML, a leukemoid reaction, or reactive chronic neutrophilia, as these conditions can present with similar laboratory findings. Further diagnostic tests, such as cytogenetic analysis or additional clinical information, are needed to make an accurate conclusion.

Question 6

A patient presents with larger-than-normal neutrophils with hypersegmentation, macro- ovalocytes, and pancytopenia.This may be an indicator of:

Accepted Answer

The presence of larger-than-normal neutrophils with hypersegmentation, macro-ovalocytes, and pancytopenia are all characteristic of megaloblastic anemia, which is usually caused by vitamin B12 or folate deficiency. Pelger-Huët anomaly is a genetic abnormality that results in hyposegmentation of neutrophils. Myeloproliferative disorders typically present with increased production of one or more blood cell types. Infection may cause changes in white blood cell counts and morphology, but the specific changes described in the question are not typically associated with infection.

Question 7

A patient presents with splenomegaly and bone pain.Laboratory findings reveal large macrophages with small eccentric nuclei, and cytoplasm with a wrinkled appearance.
Further testing shows leukopenia, thrombocytopenia, and anemia.What is the probable
Cause?

Accepted Answer

The symptoms described are characteristic of Gaucher's disease, a lysosomal storage disorder where there is a buildup of glucocerebroside. Splenomegaly is a common finding, and bone pain may be due to osteopenia or osteoporosis. Large macrophages with small eccentric nuclei and wrinkled cytoplasm, called Gaucher cells, are typically present. Leukopenia, thrombocytopenia, and anemia may also occur as a result of splenic sequestration and bone marrow infiltration. Niemann-Pick disease, Tay-Sachs disease, and Sandhoff's disease can also cause macrophage accumulation, but they do not typically present with bone pain or splenomegaly.

Question 8

Interpret the following results: WBC count 1.4 x 10⁹/L; bone marrow shows myeloid hypoplasia with a decreased M:E ratio of 1:1.There is no history of medications or drug Exposure.What can be concluded from this?

Accepted Answer

The low WBC count and myeloid hypoplasia suggest decreased production of white blood cells, specifically neutrophils, leading to neutropenia. The normal M:E ratio would be around 3:1, but the decreased ratio of 1:1 indicates a relative decrease in granulocyte precursors, which would be consistent with decreased production. There is no evidence of drug exposure or toxin effects mentioned. A pseudoneutropenia would suggest a falsely low WBC count due to increased margination of neutrophils rather than decreased production.

Question 9

Which of the following characteristics is associated with the neutrophilia that accompanies bacterial infection?

Accepted Answer

Neutrophilia that accompanies bacterial infection is characterized by a left shift (an increase in the proportion of immature neutrophils), toxic granulation (abnormal granules within the neutrophils), and Döhle bodies (small, pale blue inclusions in the cytoplasm of neutrophils). Thus, all of the above options are associated with neutrophilia in bacterial infection.

Question 10

A technologist is scanning a blood smear and notices that many of the neutrophils have more than six lobes.Which of the following would be consistent with that finding?

Accepted Answer

Neutrophils with more than six lobes are known as hypersegmented neutrophils, which are commonly seen with vitamin B12 and/or folate deficiency. Therefore, a decreased vitamin B12 level is consistent with this finding.

Question 11

What must be done when blood is drawn in EDTA and the neutrophils adhere to erythrocytes?

Accepted Answer

The answer of What must be done when blood is...

Question 12

In the identification of Pelger-Huët cells, what nuclear characteristic other than the dumbbell shape aids in differentiating these cells from bands?

Accepted Answer

Excessive coarse clumping of chromatin is a characteristic feature of Pelger-Huët anomaly cells, helping to differentiate them from band cells, which do not exhibit this feature.

Question 13

Define leukoerythroblastosis, and name a condition in which this is seen.

Accepted Answer

The answer of Define leukoerythroblastosis, and name a condition in...

Question 14

A patient has a high fever, leukopenia, thrombocytopenia, and elevated liver enzymes.A blood smear shows WBCs with large basophilic, spherical cellular inclusions.What could be The cause?

Accepted Answer

The symptoms described are consistent with ehrlichiosis, a tick-borne disease caused by various species of Ehrlichia bacteria. The characteristic large basophilic inclusions can be seen in infected white blood cells. Toxic drugs can cause liver damage and elevated liver enzymes, but would not typically cause the other symptoms described. Severe burns could cause leukopenia and elevated liver enzymes, but thrombocytopenia and basophilic inclusions would not be expected. Malaria infection can cause fever and thrombocytopenia, but typically does not cause leukopenia and basophilic inclusions.

Question 15

Which of the following disorders is characterized by a defect in sphingomyelinase, which results in macrophages with a foamy appearance?

Accepted Answer

Niemann-Pick disease is characterized by a defect in sphingomyelinase, resulting in accumulation of sphingomyelin within cells, particularly macrophages, which gives them a foamy appearance. Gaucher's disease is characterized by a defect in glucocerebrosidase and accumulation of glucocerebroside within cells. Fabry's disease is characterized by a defect in alpha-galactosidase A and accumulation of globotriaosylceramide within cells. Tay-Sachs disease is characterized by a defect in hexosaminidase A and accumulation of GM2 ganglioside within cells.

Question 16

A patient's smear shows clumping of neutrophils.The ANC shows a neutropenia. What can be done to obtain a reliable neutrophil count?

Accepted Answer

The answer of A patient's smear shows clumping of neutrophils.The...

Question 17

Acute infection, inflammatory reaction, and administration of glucocorticosteroids may result in:

Accepted Answer

Acute infection, inflammatory reactions, and administration of glucocorticosteroids can result in eosinopenia, which is a decrease in the number of eosinophils in the blood. Basophilia refers to an increase in the number of basophils, mastocytosis is a rare disorder characterized by an abnormal accumulation of mast cells, and histiocytosis is a group of rare disorders in which there is an overproduction of histiocytes (a type of white blood cell).

Question 18

A 45-year-old male goes to his physician for a routine checkup.His ANC (absolute neutrophil count) result comes back as 8.5 x 10⁹/L.Which of the following conditions could explain these results?

Accepted Answer

The ANC result of 8.5 x 10^9/L indicates an increased number of neutrophils in the blood, which is known as neutrophilia.

Question 19

A 45-year-old female came back from a trip abroad having had nausea and diarrhea, and then later muscle aches, fever, and chills.She is admitted to a local hospital, and is diagnosed
With trichinosis.Which of the following is most consistent with this disease?

Accepted Answer

Eosinophilia is a hallmark of trichinosis, as the larvae of the Trichinella roundworm elicit an eosinophilic response. The other choices (B, C, and D) are not commonly associated with trichinosis.

Question 20

A patient presents with a leukocyte count of 120 x 10⁹/L and splenomegaly.The blood smear reveals a shift to the left with promyelocytes and blasts.The platelets are increased, and the LAP is decreased.Which condition is associated with these results?

Accepted Answer

The combination of leukocytosis with a left shift, splenomegaly, increased platelets, decreased LAP, and presence of promyelocytes and blasts on the smear are all consistent with chronic myeloid leukemia (CML). Bacterial infection and reactive chronic neutrophilia would not explain the presence of blasts and promyelocytes. A leukemoid reaction can mimic CML, but the LAP is typically elevated in a leukemoid reaction.

Quiz 18: Nonmalignant Granulocyte and Monocyte Disorders