Lenfositoz

>4000 üstü

Increased lymphocyte production may be due to a malignant process or in response to an infectious or inflammatory stimulus. 

- splenomegali , lap varlığı değerlendir .periferik yayma,akut fazlar, geniş viral seroloji , splenomegali açısından batın USG istenir.

Öykü ve FM 

- medikal stres,(travma,kardiyak,epilepsi vs) lenfositoz yapabilir.

- Enfektif ve inflamatuar süreçlere ilişkin bulgular (travma ,nöbet, artrit, döküntü vb.)

Hematolojik malignite ilişkili bulgular 

(Lap,HSM,ateş,terleme,kilo kaybı ) 

-cerrahi veya fonksiyonel aspleni 

-sigara kullanımı , aile öyküsü sorgulanmalıdır.

- önceki tetkiklerde bakarak lenfositozun süresi hakkında bilgi edinilmelidir.

20-30 bin e kadar lenfositozda enfeksiyon ve inflamasyon gibi reaktif süreçler ön plana çıkarken, >30 bin degerlerinde malignite olasılığı daha yüksektir.

3 aydan uzun süren ve altta yatan bir patoloji saptanmayan lenfositoz varlığında daha düşük değerlerle KLL tanısı konulabilir.

CAUSES 

Infectious causes — Specific infectious causes of reactive lymphocytosis vary depending on demographic characteristics of the population.

Infectious mononucleosis (IM) is a viral infection characterized by fever, tonsillar pharyngitis, and lymphadenopathy.IM is most often caused by infection with Epstein-Barr virus (EBV).Other infectious agents can cause a nearly indistinguishable IM syndrome including cytomegalovirus (CMV), human immunodeficiency virus (HIV), other viruses, and toxoplasmosis. 

Other viral illnesses that can be associated with lymphocytosis include:

•HIV

•HTLV-I (human T-lymphotropic virus type I)

•CMV

•Mumps

•Rubella

•Measles

•Influenza

•Hepatitis

•Adenovirus

•Coxsackie virus

•Poliovirus

Pertussis – Pertussis (whooping cough) is a respiratory infection caused by Bordetella pertussis infection. Unlike most other acute bacterial infections, pertussis commonly causes lymphocytosis.

Cat scratch disease – Cat scratch disease is an infection with Bartonella henselae that manifests as lymphadenopathy and can be associated with neurologic, ocular, and other organ involvement. The lymphocytosis usually includes large atypical lymphocytes and may be accompanied by mild eosinophilia, monocytosis, anemia, and/or thrombocytopenia.

Other infectious causes – Infections such as tuberculosis, brucellosis, syphilis, babesiosis, and rickettsial infections may present a similar hematologic picture.

Non-infectious causes

Drug hypersensitivity reactions — Drug reaction with eosinophilia and systemic symptoms (DRESS) is an allergic/hypersensitivity reaction to a medication. DRESS usually occurs two to six weeks after starting the offending drug.

Stress — Lymphocytosis can be associated with severe medical stress, including trauma, cardiac emergencies, or status epilepticus. 

Asplenia — Moderate levels of polyclonal lymphocytosis are common after splenectomy. 

Thymoma — Thymoma is a thymic malignancy that typically affects middle-aged adults and may be associated with paraneoplastic autoimmune syndromes (eg, myasthenia gravis, pure red cell aplasia).

Clonal processes — Causes of clonal lymphocytosis exist on a spectrum and range from premalignant disorders (that may later evolve to overt malignancies) to a variety of lymphomas and leukemias.

Monoclonal B lymphocytosis 

Congenital B cell lymphocytosis

Large granular lymphocyte leukemia — Large granular lymphocyte (LGL) leukemia is characterized by infiltration of peripheral blood and bone marrow by clonal LGLs, splenomegaly, and cytopenias (usually neutropenia).

Chronic lymphocytic leukemia — Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative neoplasm characterized by progressive accumulation in peripheral blood and bone marrow of lymphocytes that may be accompanied by lymphadenopathy, splenomegaly, and/or constitutional symptoms. 

Non-Hodgkin lymphoma

Sézary syndrome, which is defined by the presence of circulating malignant T lymphocytes

Mantle cell lymphoma (MCL) has the highest prevalence of lymphocytosis among B cell lymphomas; about one half of patients with MCL have lymphocytosis.

Follicular lymphoma and splenic marginal zone lymphoma are often associated with lymphocytosis.

Acute lymphoblastic leukemia — Acute lymphoblastic leukemia (ALL) may be derived from T, B, or NK cells, and can present at any age.

Flow Sitometri Endikasyonları 

-Akut lösemi şüphesi

-lenfosit sayısı >30 bin olup bilinen tanısı olmayan hastalar ( KLL gibi ) 

- lenfosit sayısı >5000 olup viral enfeksiyon,ilaç aspleni ilişkisi gibi sebepler düşünülmeyen hastalar

- 1 aydan uzun süredir ,açıklanamayan >4000 lenfosit sayısı olan hastalar

- takiplerinde lenfosit artışı olan hastalar

- morfolojik olarak malignite düşündüren lenfosit varlığı

- eşlik eden sitopeniler

- HSM ve Lap varlığı