Sandbox leucocytosis: Difference between revisions

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*Leukocytosis is defined as an elevated white blood cell (WBC) count greater than 11,000 per mm3 (11.0 × 109 per L).
*The most common type of leukocytosis is neutrophilia.
**Neutrophilia can be defined as an increase in the absolute number of mature neutrophils to greater than 7,000 per mm3 [7.0 × 109 per L].
{| class="wikitable"
! colspan="3" |
!Differentiating Symptoms
!Differentiating physical exam findings
!Differentiating Labs
|-
| rowspan="3" |'''Physiological variation'''
| colspan="2" |Birth
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| colspan="2" |Adult
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| colspan="2" |Pregnancy
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| rowspan="6" |'''Primary'''
| rowspan="4" |'''Congenital'''
|Heridatary neutrophilia
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|Chronic idiopathic neutrophilia
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|Down syndrome
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|LAD
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| rowspan="2" |'''Acquired'''
|CML
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|Polycythemia Vera
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| rowspan="18" |'''Secondary'''
| rowspan="2" |'''Infection'''
|Acute
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|Chronic
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| rowspan="4" |'''Connective tissue disorders'''
|RA
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|JRA
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|IBD
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|Chronic hepatitis
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| rowspan="4" |'''Drug induced'''
|Steriod
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|Lithium
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|Beta agonists
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|Cytokines
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| rowspan="2" |'''Marrow stimulation'''
|Hemolytic anemia
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|Immature thrombocytopenia
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| colspan="2" |'''Post splenectomy'''
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| rowspan="5" |'''Metabolic'''
|Diabetic coma
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|Acidosis
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|Thyroid strom
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|Acute Gout
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|Seizures
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{| class="wikitable"
|+
! colspan="2" rowspan="2" |
! rowspan="2" |Pathophysiology
! rowspan="2" |Symptoms
! rowspan="2" |History
! rowspan="2" |Physical  Examination
! colspan="3" |Laboratory Findings
|-
!Immunochemistry
!Blood work
!Biospy
|-
| rowspan="7" |B cell lymphoma
|[[Mantle cell lymphoma]]
|
* [[CD5 (protein)|CD5]] positive antigen in pregerminal center of B-cell
* [[Chromosomal translocation]] at '''t(11:14)'''
** Over-express [[cyclin D1]]
|
* Stage IV disease
* B symptoms,
* Generalized lymphadenopathy
* Abdominal distention
* Fatigue
* Extranodal involvement of gastrointtestinal (GI) tract, lungs, and central nervous system (CNS)
|
* History of Night sweats
* Weight Loss
|
* Generalized lymphadenopathy
* Hepato-splenomegaly
* Mental Retardation
* Less commonly
** Palpable masses in skin, breast, and salivary glands
|
* CD5<sup>+</sup>
* B-cell antigen positive
** CD19
** CD20
** CD22
* Cyclin D1 is overexpressed.
|CBC
* Anemia and cytopenias are secondary to bone marrow infiltration
* Lymphocytosis > 4000/µL
* Elevated LDH
*
|
* Germinal centers filled by small-to-medium atypical lymphocytes.
* Nodular appearance may be evident from expansion of the mantle zone in 30-50% of patients early in the disease.
|-
|[[Nodal marginal zone B-cell lymphoma]]
|
* Arise from memory B cells. Include
** Splenic marginal zone lymphoma
** Nodal marginal zone lymphoma
** Extranodal marginal zone lymphoma.
* Stimulation of antigen receptor by autoantigen and co-stimulatory molecule CD40.
|
* Depends largely on its location
* Gastric marginal zone lymphoma
** Dyspepsia
** Abdominal pain
** Hemorrhage
|
* Chronic infectious conditions or autoimmune processes, such as
** ''H pylori'' gastritis
** Hashimoto thyroiditis
** Sjögren syndrome.
|
|
* AE1/AE3
* B-cell markers CD20, CD79a, CD10, CD23, and bcl-2 are expressed
|
|
* Follicular cells in reactive zone
* Centrocyte like cells in marginal zone lymphoma
|-
|[[Splenic marginal zone lymphoma]]
|
* Clonal rearrangements of the [[immunoglobulin]] genes (heavy and light chains) .
** Deletion 7q21-32
** Translocations of the CDK6 gene located at 7q21.
|
|
|
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* [[CD20]]
* [[CD79a]]
|
|
* [[B-cells]] replace the normal [[white pulp]] of the [[spleen]].
* The neoplastic cells compromise
** Small [[lymphocytes]]
** Transformed blasts
* S[[Sinus|inus]] invasion
* Epithelial histocytes
* Plasmacytic differentiation of neoplastic cells.
* '''Splenic Hilar Lymph Nodes'''
** Involved hilar [[lymph nodes]] adjacent to the [[spleen]] show an effaced architecture without preservation of the [[marginal zone]] seen in the spleen
* '''Bone Marrow Biopsy'''
** Splenic marginal zone lymphoma in [[bone marrow]] displays a nodular pattern with morphology similar to what is observed in the splenic [[hilar]] [[lymph nodes]].
|-
|[[Hairy cell leukemia]]
|
* Production of [[Cytokine|cytokines]], such as [[TNF alpha]] and IL-2R, provide important stimuli for [[malignant]] [[B cell|B cells]] proliferation in hairy cell leukemia.
** The ''p38-MAPK-JNK'' cascade
** The ''MEK-ERK'' cascade
** The ''Phosphatidylinositol 3 kinase (PI3K)-AKT'' cascade
|
* [[Fever]]
* [[Night sweat|Night sweats]]
* [[Fatigue]]
* Easy [[bruising]] or [[bleeding]]
* Generalized weakness
* [[Weight loss]]
* Recurrent [[Infection|infections]]
* Early satiety
|
* Review occupational history related to sawdust exposure
* Review any exposure to radiations
* Review any exposure to herbicides or diesel
|
* [[Pallor]],
* [[Petechiae]]
* [[Splenomegaly]]
|
* [[Annexin A1]]
* [[CD20]]
* [[CD25]]
* [[CD103]]
* [[CD19]]
* [[CD11c]]
* [[FMC7]]
|
* Tartrate-resistant acid phosphatase  positive
* CBC
** Decreased [[hemoglobin]] concentration
** Decreased [[platelets]] count
**
|
:* Small cells with "fried egg"-like appearance
:* Well-demarcated thread-like [[cytoplasmic]] extensions
:* Clear cytoplasm
:* Central round [[nucleus]]
:* Peri-nuclear clearing ("water-clear rim" appearance)
|-
|[[Plasma cell myeloma]]
|
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|[[Diffuse large B-cell lymphoma]]
|
*Germinal centre B-cell-like (GCB)
*Activated B-cell-like (ABC).
**B cell receptor (BCR) signalling
**B cell migration/adhesion
**Cell-cell interactions in immune niches
**Production and class-switching of immunoglobulins
|
*
|
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*
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*
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* Neutropenia
* Anemia
* Hypergammaglobulinemia
|
====Centroblastic====
*Medium-to-large-sized [[Lymphocyte|lymphocytes]]
*Monomorphic
====Immunoblastic::====
*> 90% immunoblasts
*Trapezoid shaped large lymphoid cells with significant [[basophilic]] cytoplasm
====Anaplastic:====
*Very large cells with a round, oval, or polygonal shape that may resemble Reed-Sternberg cells of Hodgkin's lymphoma or Anaplastic Large cell Lymphoma.
|-
|[[Burkitt lymphoma]]
|
* Translocation of chromosome 8 ''[[myc]]'' locus with 3 possible partners (accounting for 90% of translocations):
** The Ig heavy chain region on chromosome 14: t(8;14)
** The kappa light chain locus on chromosome 2: t(2;8)
** The lambda light chain locus on chromosome 22: t(8;22)
|
* [[Fever]]
* [[Night sweats]]
* Unexplained [[weight loss]]
* [[Swollen lymph nodes]] in the neck, axilla, or groin
|
|
* [[Proptosis]]
* Jaw mass
* [[Abdominal mass|Abdominal masses]]
* [[Ascites]]
* [[Lymphadenopathy|Peripheral lymphadenopathy]]
|
* [[CD19]]
* [[CD20]],
* [[CD22]]
* [[CD10]]
* BCL6.
* BCL2 and TdT.
|
|
:* Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- '''key feature''' (i.e. tumor nuclei size similar to that of [[histiocytes]] or [[endothelial cells]])
:* Round nucleus
:* Small nucleoli
:* [[basophilic]] cytoplasm
:* Brisk mitotic rate and [[apoptotic]] activity
:* Cellular outline usually appears squared off
:* "Starry-sky pattern":
:** The ''stars'' in the pattern are tingible-body macrophages (macrophages containing [[apoptotic]] tumor cells)
:** The tumour cells are the ''sky''
|-
| rowspan="6" |T cell lymphoma
|[[T-cell granular lymphocytic leukemia]]
|
* Disregulation of signaling pathways:
** FAS/FAS-L
** Phosphatidylinositol-3 kinase (PI3K),
** Mitogen-activated proteinkinase/extracellular signal-regulated kinase (MAPK/ERK)
|
Symptoms of T-cell large granular lymphocyte leukemia may include the following:
* Generalised weakness and [[Fatigue (physical)|fatigue]]
* [[Anorexia]]
* Joint pain
* Night sweating
* [[Epistaxis]]
* [[Bone pain]]
* [[Dyspnea]]
|
|
* Usually appear pale and malnourished.
* Cardiac flow murmur
* High-grade fever
* [[Hepatomegaly]]
* [[Splenomegaly]]
|
* [[CD3]]+
* [[TCR]]αβ+
* [[CD4]]-
* [[CD8]]+
|
* Neutropenia
* Anemia
* Hypergammaglobulinemia
|
:* Clonal rearrangements of the [[T-cell receptor]] (TCR) gene
:* Chronic (> 6 months) elevation in large granular lymphocytes (LGLs) in the peripheral blood
:* Large granular lymphocyte count greater than 2.0 × 109/L
:* Lymphocytosis (typically 2-20x109/L)
|-
|[[Mycosis fungoides]] / [[Sézary syndrome]]
|
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* Cutaneous manifestaions
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|[[Subcutaneous panniculitis-like T-cell lymphoma]]
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|[[Enteropathy-type intestinal T-cell lymphoma]]
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|[[Anaplastic large cell lymphoma]]
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|[[Aggressive NK-cell leukemia]]
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|}
== Differential diagnosis of Lymphocytosis ==
{| class="wikitable"
|+
!
!Pathophyisiology
!Symptoms
!History
!Physical Examination
!Laboratory Findings
|-
|AML
|
* Mutation of myeloblast freezes the cell in its immature state and prevent [[cellular differentiation|differentiation]].
|
* Persistent or frequent [[infections]].
* [[Anemia]] leads to fatigue, paleness, and shortness of breath.
* Thrombocytopenia leads to  bruising or bleeding with minor trauma.
|
* History of pre-existing hematological disorder (e.g [[aplastic anemia]], [[PNH]], [[myelofibrosis]])
* History of exposure to anti-cancer [[chemotherapy]] agents especially alkylating agents
* History of exposure to [[ionizing radiation]]
* History of occupational exposure to [[benzene]] and other [[aromatic hydrocarbons]]
* History of any [[congenital]] disorders (e.g [[Down syndrome]], [[Bloom syndrome]])
|
* Bone tenderness
* Skin manifestations
|
* Immature Myeloblasts on blood smear
* Flow cytometry
* +Aur Rods
|-
|ALL
|
* Arrest of  [[lymphoblasts]].
* [[Chromosomal translocations]] involved
** 9 and 22, t(9;22) (q34;q11.2) ''BCR-ABL1''
** 12 and 21, t(12;21)(p13;q22) ''TEL-AML1''
** 5 and 14, t(5;14)(q31;q32)''IL3-IGH''
** 1 and 19 t(1;19)(q23;p13.3) ''TCF3-PBX1''  
|
* Generalised weakness and [[Fatigue (physical)|fatigue]]
* Frequent or unexplained [[fever]] and [[Infection|infections]]
* [[Weight loss]] and/or loss of appetite
* Excessive [[bruising]], [[Hemorrhage|bleeding]] from wounds, [[Nosebleed|nosebleeds]], [[petechiae]], [[bone pain]], [[Joint pain|joint pains]] and [[dyspnea]].
|
* History of cancer
* History of drug exposure
|
* [[Lymphadenopathy]]
* [[Hepatomegaly|Hepato-splenomegaly]]
* [[Stridor]]
* [[Pallor]]
* P[[Petechiae|etechiae]]
* B[[Bruising|ruising]]
* [[Papilledema]]
* Nuchar rigidity
* [[Cranial nerve palsy]]
* Testicular enlargement
|
* [[Eosinophilia]]
* [[Lymphocytosis]]
* Decreased erythrocytes production 
* [[Thrombocytopenia]].
* Chemistry panels with altered levels of [[uric acid]], [[creatinine]], [[blood urea nitrogen]], [[potassium]], [[phosphate]], [[calcium]], [[bilirubin]], [[hepatic transaminases]] and [[ferritin]].
* A [[Lumbar puncture|spinal tap]] will tell if the spinal column and [[Central nervous system|brain]] has been invaded.
|-
|CML
|
* Myeloproliferative expansion of pluripotent stem cells.
* Philadelphia chromosome resulting from the reciprocal t(9;22)(q34;q11.2)
** Resulting in a derivative 9q+ and a small 22q-. results in a ''BCR-ABL'' fusion gene
** Ativates numerous downstream targets including
*** ''c-myc''
*** ''Akt''
*** ''Jun'',
|
* Insidious in onset
* Nonspecific symptoms of fatigue and weight loss.
* Early satiety and decreased food intake due to splenic compression of stomach
* Low-grade fever and excessive sweating
|
|
* Splenomegaly
** Correlates with granulocyte counts
* Findings of leukostasis and hyperviscosity.
* Funduscopy may show papilledema, venous obstruction, and hemorrhages.
|
* WBC counts, exceeding 300,000-600,000 cells/μL
* Elevated alkaline phosphatase (ALP)
* Philadelphia (Ph1) chromosome\
*
|-
|CLL
|
* Clonal B cells arrested in the B-cell differentiation pathway,
* [[Genetic mutation|Genetic mutations]] that promote both [[malignant]] leukemic proliferation and [[apoptotic]] resistance of mature B cells.
* Structural [[Genetic mutation|genetic mutations]] involved in the pathogenesis of chronic lymphocytic leukemia include [[chromosome]] 13q deletion, chromosome 17p deletion, and chromosome 11q deletion.
** ''SF3B1'' gene located on [[chromosome 2]]
** ''FBXW7'' gene located on [[chromosome 4]]
** ''MYD88'' gene located on [[chromosome 3]]
** ''TP53'' gene located on [[chromosome 7]]
** ''NOTCH1'' gene located on [[chromosome 9]]
** ''ATM'' gene located on [[chromosome 11]]
** ''CHD2'' gene located on [[chromosome 15]]
|
* [[Fever]]
* Recurrent [[bleeding]]
* [[Weight loss]]
* [[Muscle wasting]]
* Generalized [[weakness]]
* Anorexia
* [[Night sweats]]
* [[Abdominal pain]]
* Recurrent [[Infection|infections]]
|
* Review family history for members with positive history of the disease
* Review occupational history related to farming
* Review any exposure to herbicides or insecticides
|
* Skin [[pallor]]
* Palpable [[cervical]] [[Lymph node|lymph nodes]]
* [[Hepatomegaly]].
|
* Monoclonality of kappa and lambda producing [[B cell|B cells]]
* Presence of smudge cells
* CBC
** Absolute [[lymphocytosis]] (>5000 cells/μl)
** Decreased [[hemoglobin]] concentration
** Decreased [[Platelet|platelets]] count
* Express [[CD19]], [[CD20]], [[CD23]], and [[CD5]] on the [[cell]] surface
|}
{| class="wikitable"
|+
!
! rowspan="2" |Pathophysiology
! rowspan="2" |Symptoms
! rowspan="2" |History
! rowspan="2" |Physical Examination
! colspan="3" |Laboratory Findings
|
|-
!
!CBC
!Blood smear
!Immunophenotype
!
|-
|'''Monoclonal B lymphocytosis'''
|
* Monoclonal population of B lymphocytes <5000 cells/microL
|
* Without other features of
** Lymphadenopathy
** Organomegaly
** Extra-medullary involvement
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* Active or prior infections
* History of hematologic malignancy
* Medications
* Family history of chronic lymphocytic leukemia (CLL)
|
* Fever
* Lymphadenopathy
* Hepatosplenomegaly
* Joint redness
* Abdominal pain
* Lung findings.
|
* Lymphocytosis  ≥4000 lymphocytes/microL
*
|
* Lymphocytes in MBL have no distinguishing appearance
* Appear as small, mature mononuclear cells.
|
* CD19, CD20, and CD23
|
* Does not require bone marrow examination or imaging for diagnosis
|-
|'''Congenital B cell lymphocytosis'''
|
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|
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|
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*
|
|-
|'''Large granular lymphocyte leukemia'''
|
* T-cell (T-LGL)
* Natural killer cell (NK-LGL)
|
* Recurrent infections
* Fever
* Night sweats
* Unintended weight loss
* Lymphadenopathy
|
|
|
* Pancytopenia
* Splenomegaly
|
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* CD3, CD57, CD56
* CD3-, CD56+
|
|-
|'''Chronic lymphocytic leukemia'''
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|'''Sezary syndrome'''
|
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|'''Mantle cell lymphoma'''
|
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|'''Follicular lymphoma'''
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|'''Splenic marginal zone lymphoma'''
|
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|'''Acute lymphoblastic leukemia'''
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|'''Acute Promyelocytic Leukemia'''
|
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|-
|'''Diffuse Large Cell Lymphoma'''
|
|
* Enlarged painful lymph node
*
|
* Neurological or gastrointestinal manifestations
* History of environmental and/or infectious disease exposure
|
* Lymphadenopathy
* Splenomegaly
* Low-grade fever
* Pedal edema:
|
|
|
|
|}
== Differential for Eosinophilia ==
{| class="wikitable"
|+
!
!Pathophysiology
!Symptoms
!History
!Physical Examination
!Laboratory Findings
|-
|Parasitic Infections
|
* Egg deposition
* Liberation of [[antigens]] of adult worms and eggs
* Strong [[inflammatory response]] characterized by high levels of pro-inflammatory [[cytokines]]
** I[[IL-1|nterleukins 1]], [[Interleukin 6|6]], [[TNF-α|tumor necrosis factor-α]], and circulating [[immune complexes]] participates in the pathogenesis of the acute phase of the [[disease]]
|Vary depending on the organism
* GI
* STD
* Neurological
* Swollen lymph nodes and muscle aches or pains
|
* History of travel
|
* Rash
* Fever
* Lymphadenopathy
* Ulcers
|
* +Stool examination
* + Serologic testing
* Urinalysis
|-
|Allergy/ Atopic Diseases
|
* Allergic hypersensitivity
** IgE stimulation
|'''Systemic anaphylaxis'''
* Reaction occurs within minutes
* Leading to symptomatology such as
** Acute asthma
** Laryngeal edema
** Diarrhea
** Urticaria
** Shock.
* Classic examples are penicillin allergy and bee sting allergy.
'''Local anaphylaxis (atopy)'''
* About 10% of people have "atopy" and are easily sensitized to allergens that cause a localized reaction when inhaled or ingested.
** Hay fever
** Hives, asthma.
* Classic examples are food allergies and hay fever to ragweed pollen
*
|
* History consistent with allergy and specific allergens
|
* [[Eczema]] ([[atopic dermatitis]])
* [[Allergic conjunctivitis]]
* [[Allergic rhinitis]]
* [[Asthma]]
*
|
* Increase in eosinophils
* Serum tryptase positive reaction
* Testing for specific IgE antigen.
|-
|Hypereosinophilic syndromes (HES)
|
* Activation of tyrosine kinases
** Clonal eosinophilic proliferation
** Overproduction of eosinophilopoietic cytokines.
|
* [[Shortness of breath]]
* [[Skin rash]]
* [[Cough]]
* [[Diarrhea]]
* [[Myalgias]]
* [[Fatigue]]
* [[Weight-loss]]
|
|
* [[Skin rash]]
:* Thickening of the skin ([[lichenification]])
:* Eczema (flexural areas)
:* [[Dermographism]]
* [[Low-grade fever]]
* [[Raynaud phenomenon]]
* [[Wheezing]]
|
* Persistently [[Eosinophilia|elevated eosinophil count]] (≥ 1500 eosinophils/mm³) in the blood
:* At least six months without any recognizable cause
:* Involvement of either the [[heart]], [[nervous system]], or [[bone marrow]].
|-
|Acute myelogenous leukemias
|
* Mutation of myeloblast freezes the cell in its immature state and prevent [[cellular differentiation|differentiation]].
|
* Persistent or frequent [[infections]].
* [[Anemia]] leads to fatigue, paleness, and shortness of breath.
* Thrombocytopenia leads to  bruising or bleeding with minor trauma.
|
* History of pre-existing hematological disorder (e.g [[aplastic anemia]], [[PNH]], [[myelofibrosis]])
* History of exposure to anti-cancer [[chemotherapy]] agents especially alkylating agents
* History of exposure to [[ionizing radiation]]
* History of occupational exposure to [[benzene]] and other [[aromatic hydrocarbons]]
* History of any [[congenital]] disorders (e.g [[Down syndrome]], [[Bloom syndrome]])
|
* Bone tenderness
* Skin manifestations
|
* Immature Myeloblasts on blood smear
* Flow cytometry
* +Aur Rods
|-
|Hodgkin's, T- and B-cell lymphomas)
|
* Reed-Sternberg cell
** B-cell origin
** CD30 (Ki-1) and CD15 (Leu-M1) antigens
|
* Painless localized peripheral lymphadenopathy
* B symptoms
|
* Presence or absence, duration, and severity of other associated systemic symptoms.
* History of previous malignancy (including other lymphomas)
* Prior treatment with chemotherapy or radiotherapy
* Previous immunosuppressive illness
* Family history of HL or other lymphoproliferative, myeloproliferative, or tissue malignancies.
|
* Palpable, painless lymphadenopathy
* Superior vena cava
* Central nervous system (CNS) symptoms
* Paraneoplastic syndromes including
** Cerebellar degeneration
** Neuropathy
** Guillain-Barre syndrome
** Multifocal leukoencephalopathy
|
* Fine-needle aspiration
** Mononucleate and binucleate Reed-Sternberg cells in a background of inflammatory cells
* Lactate dehydrogenase (LDH) may be increased.
* ESR elevated
* Serum creatinine elevated in nephrotic syndrome.
* Alkaline phosphatase (ALP) increased
* Hypercalcemia, hypernatremia, and hypoglycemia.
|-
|Churg-Strauss
(Eosinophilic granulomatosis with polyangiitis)
|
* Complex interaction involving [[Genetics|genetic]] and environmental factors that lead to an [[Inflammation|inflammatory response]] involving [[Eosinophil granulocyte|eosinophils]], [[B cell|lymphocytes]] and [[Macrophage|giant cells]]
|
* '''Prodromal phase:'''  [[Rhinitis|Allergic rhinitis]] and [[asthma]].
* '''Eosinophilic phase:''' [[Eosinophilia|Peripheral eosinophilia]] and infiltration of [[Eosinophil granulocyte|eosinophils]] to [[lung]] and [[Gastrointestinal tract|GI tract]].
* '''Vasculitic phase:'''
** Small and medium-sized [[vasculitis]] and inflammatory granuloma formation.
** [[Granuloma|Granulomas]] can be either vascular or extravascular.
|
* History of allergy
*
|
* Skin involvement (60%)
* Nasal polyposis
* Peripheral neuropathy
|
* P-ANCA positive in most cases
* Elevated levels of [[Immunoglobulin E|IgE]]
* Elevated levels of [[rheumatoid factor]] at low titer
* [[Hypergammaglobulinemia]]
* Biopsy is diagnostic
** Eosinophilic infiltration
** Vasculitis of small and medium-sized vessels
** [[Granuloma]] formation.
|-
|Systemic mastocytosis
|
* Infiltration of bone marrow by mast cell affecting the peripheral blood and coagulation system. 
* The neoplastic clone of mast cells express abnormal cell surface markers CD25 and/or CD2.
|
* GI
* Cutaneous
* Urticaria pigmentosa
* Musculoskeletal
* Idiopathic and/or recurrent anaphylactoid reactions
|History of/ Associated with
* Hypereosinophilic syndrome
* Castleman disease
* Monoclonal gammopathy
* Hairy cell leukemia
* Non-Hodgkin lymphoma
* Polycythemia vera
* Primary thrombocythemia
|
* Signs of anemia,
* Hepatoslenomegaly
* Lymphadenopathy
* Urticaria
** Flushing
* Osteolysis
|
* CBC
** Eosinophilia
** Basophilia
** Thrombocytosis
** Monocytosis
* Total–to–beta-tryptase ratio greater than 20:1 is suggestive.
* CD117 positive and CD25 and/or CD2 positive.
* Abnormal mast cells.
** Larger than normal mast cells
** Irregularly shaped nuclear outlines
** Less densely packed mast cell granules
|}
<references />

Revision as of 15:28, 16 January 2019

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