21. Lab Investigations of White Cell Disorders Flashcards
What do the suffixes -philia, -penia and -cytosis mean?
- philia = high
- penia = low
- cytosis = increase
What are some physical characteristics of a normal neutrophil?
- has 3-5 lobes
- is granular
- is larger than a red cell
- pinkish
What are some physical characteristics of a normal lymphocyte?
- pretty much same size as red cell
- hardly any cytoplasm seen
- very large, dense nucleus
- blue
What is the order WBCs from most common to the least common?
1) Neutrophils
2) Lymphocytes
3) Monocytes
4) Eosinophils
5) Basophils
Describe lymphocytes
- Major role is in Adaptive Immune Response
- Differentiation between self and non-self
-e.g. Viral attack.
Lymphocytes produce antibodies to destroy that virus
-They make memory cells
What are the 3 major types of lymphocytes?
- T-cells
- B-cells
- Natural Killer (NK) cells
Describe the major function of each of the three types of lymphocytes.
T-cells are involved in Cell-Mediated Immunity - CD4+ T-Helper cells and CD8+ Cytotoxic T-cells
B-cells in Humoral Immunity i.e. Antibody
Production
NK cells are part of the Innate Immune system attacking virally infected cells and tumour cells
How does a monocyte look?
Biggest cell in the blood film
- 2 lobes of nucleus , like dumbbells
Vaculations - vacuoles?
How does an eosinophil look?
Exactly like neutrophils, - but granules are more dense and nearly orange in colour
How do basophils look?
- Thicker and darker granules
- Very distinct, can’t differentiate nucleus from cytoplasm
What are the different terminology related to neutrophilias?
- Toxic Granulation ~ dark, coarse granulations
- Shift to the LEFT ~ less loves as there is an earlier exit (hyposegmented)
- Shift to the RIGHT ~ Hypersegmented neutrophil (usually due to B12 folate deficiency)
- Döhle Bodies ~
When is neutrophilia normal and when is it not?
NORMAL:
- Post-operative
- Pregnancy
OTHER CAUSES:
- Bacterial Infection
- Inflammation (e.g. vasculitis, myocardial infarction)
- Carcinoma
- Steroid treatment
- Myeloproliferative disorders
- Treatment with myeloid growth factors
How would you investigate neutrophila?
- FBC and differential white cell count
- Blood film examination
- Bacterial culture screen for infection
- Bone marrow examination + chromosome analysis for chronic myeloid leukaemia - Philadelphia chromosome: translocation between chromosomes 9 and 22
- Molecular analysis for BCR-ABL oncogene
List some causes of neutropenia
- Viral Infection
- Drug Induced e.g. sulphonamides
- Radiotherapy and chemotherapy
- Part of a pancytopenia in bone marrow failure (aplastic anaemia) or infiltration e.g. leukaemia
- Racial: ‘benign ethnic neutropenia’
List some causes of eosinophilia
- Allergic diseases e.g. asthma hayfever
- Parasitic infections
- Drug sensitivity
- Myeloproliferative diseases e.g chronic myeloid leukaemia
- Hodgkin’s Lymphoma
How do we investigate eosinphilia?
- FBC and differential white cell count
- Blood film examination
- Stool examination for ova and parasites
List some causes of monocytosis.
- Tuberculosis (TB)
- Acute and chronic monocytic and myelomonocytic leukaemia
- Malaria
How would you investigate monocytosis?
- FBC and differential white cell count
- Blood film examination:
- for abnormal white blood cells
- for malarial parasites
- Bone marrow examination - leukaemia
- TB cultures
When is lymphocytosis normal and when is it not?
NORMAL:
- Lymphocytosis of childhood (1-6 years)
OTHER:
- Bacterial Infection
- Viral Infections e.g. Hepatitis, Mumps rubella, Pertussis and Glandular Fever (Infectious Mononucleosis)
- Leukaemias and lymphomas
How would you investigate lymphocytosis?
- FBC and differential white cell count
- Blood film examination
- Look for atypical mononuclear cells
- Also do Immunophenotyping to determine if lymphocytes are:
- B-cells: Demonstrate clonality by light chain restriction
- or T-cells: Demonstrate clonality by T-cell Receptor Gene Rearrangement Studies
- B-cells: Demonstrate clonality by light chain restriction
What is infectious monocleosis (gladular fever)?
(kissing disease)
caused by EBV
Heterophile antibodies are antibodies which react against an antigen which is completely unrelated to the antigen which originally stimulated it
e.g. Human antibodies reacting against sheep or horse or bovine cells
