Reactive Lymphocytosis

Lymphatic cells show wide variability and transform easily. This is usually seen as enlarged nuclei, a moderately loose, coarse chromatin structure, and a marked widening of the basophilic cytoplasmic layer.

Clinical findings, which include acute fever symptoms, enlarged lymph nodes, and sometimes exanthema, help to identify a lymphatic reactive state. Unlike the case in acute leukemias, erythrocyte and thrombocyte counts are not significantly reduced. Although the granulocyte count is relatively reduced, its absolute value (per microliter) rarely falls below the lower limit of normal values.

Morphologically normal lymphocytes predominate in the blood analyses in the following diseases:

> Whooping cough (pertussis) with clear leukocytosis and total lymphocyte counts up to 20 000 and even 50 000/^l; occasionally, slightly plasmacytoid differentiation.

> Infectious lymphocytosis, a pediatric infectious disease with fever of short duration. Lymphocyte counts may increase to > 50 000/^l.

> Chickenpox, measles, and brucellosis, in which a less well-developed relative lymphocytosis is found, and the counts remain within the normal range.

> Hyperthyroidism and Addison disease, which show relative lymphocy-tosis.

> Constitutional relative lymphocytosis, which can reach up to 60% and occurs without apparent reason (mostly in asthenic teenagers).

> Absolute granulocytopenias with relative lymphocytosis (p. 86).

> Chronic lymphocytic leukemia (CLL), which is always accompanied by absolute and relative lymphocytosis, usually with high cell counts.

Transformed, "stimulated" lymphocytes ("virocytes") predominate in the CBC in the following diseases with reactive symptoms:

> Lymphomatous toxoplasmosis does not usually involve significant leukocytosis. Slightly plasmacytoid cell forms are found.

> In rubella infections the total leukocyte count is normal or low, and the lymphocytosis is only relatively developed. The cell morphology ranges from basophilic plasmacytoid cells to typical plasma cells.

> In hepatitis the total leukocyte and lymphocyte counts are normal. However, the lymphocytes often clearly show plasmacytoid transformation.

> The most extreme lymphocyte transformation is observed in mononucleosis (Epstein-Barr virus [EBV] or cytomegalovirus [CMV] infection) (p.68).

During lymphatic reactive states, variable cells with dense, round nuclei (e.g., virocytes) dominate the CBC

Ebv Related Lymphocytosis

Fig. 21 Lymphatic reactive states. a-e Wide variability of the lymphatic cells in a lymphotropic infection (in this case cytomegalovirus infection). Some of the cells may resemble myelocytes, but their chromatin is always denser than myelocyte chromatin.

Fig. 21 Lymphatic reactive states. a-e Wide variability of the lymphatic cells in a lymphotropic infection (in this case cytomegalovirus infection). Some of the cells may resemble myelocytes, but their chromatin is always denser than myelocyte chromatin.

Examples of Extreme Lymphocytic Stimulation: Infectious Mononucleosis

Epstein-Barr virus infection should be considered when, after a prodromal fever of unknown origin, there are signs of enlarged lymph nodes and developing angina, and the blood analysis shows predominantly mononuclear cells and a slightly, or moderately, elevated leukocyte count. Varying proportions of the mononuclear cells (at least 20%) may be rather extensively transformed round cells (Pfeiffer cells, virocytes). Immunological markers are necessary to ascertain that these are stimulated lymphocytes (mostly T-lymphocytes) defending the B-lymphocyte stem population against the virus attack. The nuclei of these stimulated lymphocytes are two- to three-fold larger than those of normal lymphocytes and their chromatin has changed from a dense and coarse structure to a looser, more irregular organization. The cytoplasm is always relatively wide and more or less basophilic with vacuoles. Granules are absent. A small proportion of cells appear plasmacytoid. In the course of the disease, the degree of transformation and the proportions of the different cell morphologies change almost daily. A slight left shift and elevated monocyte count are often found in the granulocyte series.

Acute leukemia is often considered in the differential diagnosis in addition to other viral conditions, because the transformed lymphocytes can resemble the blasts found in leukemia. Absence of a quantitative reduction of hematopoiesis in all the blood cell series, however, makes leukemia unlikely, as do the variety and speed of change in the cell morphology. Finally, serological tests (EBV antigen test, test for antibodies, and, if indicated, quick tests) can add clarification.

Where serological tests are negative, the cause of the symptoms is usually cytomegalovirus rather than EBV.

Characteristics of Infectious Mononucleosis

Age of onset: School age

Clinical findings: Enlarged lymph nodes (rapid onset), inflammations of throat and possibly spleen f

CBC: Leukocytes f , stimulated lymph nodes, partially lymphoblasts (hematocrit and thrombocytes are normal)

Further diagnostics: EBV serological test (lgM+), transaminases usually f

Differential diagnosis: Lymphomas (usually without fever), leukemia (usually Hb 4, thrombocytes 4 ) Persistent disease (more than 3 weeks): possibly test for blood cell markers, lymph node cytology (^ histology)

Course, treatment: Spontaneous recovery within 2-4 weeks; general palliation

Extreme transformation of lymphocytes leads to blast-like cells: mononucleosis a c

Lymphocytes Blasts

Fig. 22 Lymphocytes during viral infection. a "Blastic," lymphatic reactive form (Pfeiffer cell), in addition to less reactive virocytes in Epstein-Barr virus (EBV) infection. This phase with blastic cells lasts only a few days. b Virocyte (1) with homogeneous deep blue stained cytoplasm in EBV infection, in addition to normal lymphocyte (2) and monocyte (3). c Virus infection can also lead to elevated counts of large granulated lymphocytes (LGL) (1). Monocyte (2). d Severe lymphatic stress reaction with granulated lymphocytes. A lymphoma must be considered if this finding persists.

Fig. 22 Lymphocytes during viral infection. a "Blastic," lymphatic reactive form (Pfeiffer cell), in addition to less reactive virocytes in Epstein-Barr virus (EBV) infection. This phase with blastic cells lasts only a few days. b Virocyte (1) with homogeneous deep blue stained cytoplasm in EBV infection, in addition to normal lymphocyte (2) and monocyte (3). c Virus infection can also lead to elevated counts of large granulated lymphocytes (LGL) (1). Monocyte (2). d Severe lymphatic stress reaction with granulated lymphocytes. A lymphoma must be considered if this finding persists.

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Responses

  • Erica Milano
    Where are virocytes observed?
    7 years ago
  • paul konig
    What Are Reactive Lymphocytes?
    6 years ago
  • Nuguse
    What are absoluate reactive lymphocytes?
    6 years ago
  • caelan hill
    Is relative lymphocytosis normal?
    6 years ago
  • Peter
    Can reactive lymphocytes be found in lymphoma?
    6 years ago
  • petra
    What Is A Reactive Lymphocyte?
    6 years ago
  • manuela
    Are reactive lymphocytes seen in lymphomas?
    6 years ago
  • domenica
    How to tell a blast from a lymphocyte?
    6 years ago
  • timba
    What are reactive lymphs for?
    6 years ago
  • maxima
    What is the significance of reactive lymphocytosis?
    6 years ago
  • Nora
    What is a reactive appearing lymphocyte?
    5 years ago
  • eric
    How many reactive lymphocytes are normal?
    5 years ago
  • Federica
    What is the significance of plasmacytoid lymphs?
    5 years ago
  • SAIMI
    Does intraepithetheal lymphocytosis show in cbc?
    5 years ago
  • franziska
    How do you defferentiate a blast cell from reactive lymphocyte?
    5 years ago
  • murron
    HOW TO IDENTIFY REACTIVE LYMPHOCYTES?
    5 years ago
  • wegahta
    HOW DO YOU IDENTIFY A REACTIVE LYMPHOCYTE?
    5 years ago
  • Veronica Hong
    What is reactive appearing lymphocytosis?
    5 years ago
  • David McGaha
    What are herpes virocytes?
    4 years ago
  • cara
    What is significance of high reactive lymphocyte?
    3 years ago
  • kobe
    How to tell an atypical lymphocyte from a monocyte?
    3 years ago
  • dawit
    Are reactive lymphs seenin CLL?
    3 years ago
  • sophie
    Can cbc that showed predominance in lymphocytes in teen be normal?
    3 years ago
  • chica
    What are blasts in relation to the lymphocyte percentage?
    3 years ago
  • clotilde
    What does it mean when your absolute reactive lymphocytes are 139 H?
    3 years ago
  • marko fuhrmann
    Why reactive lymphocytes are seen in blood?
    3 years ago
  • Nikodem
    How may reactive lymphs are significant?
    3 years ago
  • Maurizio
    What is high reactive lymphocytes?
    3 years ago
  • tobias
    What is normal range for atypical lymphocytes?
    3 years ago
  • Benito
    What is significance of high lymphocytes relative?
    3 years ago
  • pamphila
    What are Heterogenous population of lymphocytes, favor reactive (see comment).?
    3 years ago
  • lionel anderson
    How high can reactive lymphocytosis be?
    3 years ago
  • Asphodel
    When should you see a hematologist for elevated absolute lymphocyte count?
    3 years ago
  • karin
    What is LYMPHOCYTE REACTIVE that is high mean in blood?
    3 years ago
  • ivy
    When are reactive lymphs increased?
    3 years ago
  • ARMI
    How to differentiate reactive lymphocytes from monocytes?
    2 years ago
  • jay
    How to distinguish reactive lymphocytes from monocytes table?
    2 years ago
  • Tuula
    What is a plasmacytoid lymphocyte?
    2 years ago
  • Arthur Matz
    Does lymphocytosis always signify viral infection?
    2 years ago
  • anja
    What is a normal abs atypical lmphocyte range?
    2 years ago
  • Leon
    What do high level of reactive lymphocytes mean?
    2 years ago
  • RHIANNA
    What is absolut lymphocytes 3.28 h?
    2 years ago
  • claudia
    What is leucopenia with reactive lymphocytosis and causes?
    2 years ago
  • ryley
    Is an absolute lymphocyte count of 6.5 significant?
    2 years ago
  • mae
    What is the treatment for lymphocytes?
    2 years ago
  • luke
    What does a moderate level of atypical lymph percentage mean in cll?
    2 years ago
  • ZULA
    What does relative lymphocytosis reactive seen in a blood report mean?
    2 years ago
  • mebrat
    How to distinguish a reactive lymphocyte from a monocyte?
    2 years ago
  • Nile Efrem
    What is possibly reactive lymphocytes?
    2 years ago
  • david
    What does mildly reactive on feline leukimia test mean?
    2 years ago
  • hanno
    What are Reactive Lymphocytes with a cll patient?
    2 years ago
  • cottar longhole
    WHAT DOES INCREASED PLASMACYTOID CELLS MEAN?
    2 years ago
  • PANDORA
    How to recognize an atypical lymph?
    2 years ago
  • cooper
    What is normal range for reactive lymphocytes?
    2 years ago
  • pamphila
    HOW TO DIFFERENTIATE REACTIVE LYMPH MORPHOLOGY FROM LYMPHOMA?
    2 years ago
  • Rodger
    What is normal percentage of reactive lymphocytes?
    2 years ago
  • nairn
    How to differentiate between a atypical lymph and a monocyte?
    2 years ago
  • Leon
    What are absolute reactive lymphpcytes?
    2 years ago
  • kristian
    What does it mean for my test to show reactive lymphocytes present. causes?
    2 years ago
  • martina fuerst
    Can reactive lymphs be found in sepsis?
    2 years ago
  • mat burrowes
    What does this mean REACTIVE in hematology?
    2 years ago
  • JOHANNA SCHULZ
    What does reactive lymphs present mean?
    2 years ago
  • razanur
    What does high absolute reactive lymphocytes mean?
    1 year ago
  • ruben
    Are raective lymphocytes blast cells?
    1 year ago
  • Diana
    What are react lymphs in a cbc?
    1 year ago
  • Max
    How many reactive lymphocytes are present in infection?
    1 year ago
  • gundahar
    When to see a hematologist for increased absolute lymphocytes?
    1 year ago
  • adiam
    What is reactive lymphocytes in blood test?
    1 year ago
  • Claudia
    What causes a higher abs mono count in cll?
    1 year ago
  • gerda
    What does it mean by lymphocyte predominance in CBC?
    1 year ago
  • rosaria
    What does high lymphs absolute mean?
    1 year ago
  • Kibra
    What happens when lymphocytes cells few reactive in Blood picture?
    1 year ago
  • Juan
    What are high REACTIVE LYMPHOCYTES levels?
    1 year ago
  • reba
    How to distinguish lymph from atypical lymph?
    1 year ago
  • anja
    Are mono lymphs reactive or atypical?
    1 year ago
  • fatima
    Why does my bloodwork show a reference range of 0 for reactive lymphocyst?
    11 months ago
  • miranda
    What does it mean when reactive lymphocytes present in a blood culture?
    10 months ago
  • leila
    What does lymph absolute mean?
    10 months ago
  • sven lowe
    Do blasts in the blood mean CLL and transformed?
    9 months ago
  • Amanuel
    What does it indicate when 'kobe 2' appears as a result for blood test?
    6 months ago
  • Ennio
    What is a reactive form?
    6 months ago
  • reagan
    What does it mean some reacting lymphocytes present?
    5 months ago
  • amna bruce
    What does An increased number of lymphocytes, including occasional reactive forms. mean ?
    4 months ago
  • al
    What percentage of variant lymphs should be reported?
    4 months ago
  • JOHANNA ADLER
    What do reactive lymphocyte lab numbers mean?
    2 months ago
  • Fnan
    How long reactive lymphocytes persists?
    26 days ago

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