27-09-21 - White Blood Cells - Normal and Malignant Flashcards
What is chemotaxis?
- Chemotaxis is the movement of a cell/organism in a direction that correlates to a gradient of increasing or decreasing concentration of a particular substance
What are the 5 common types of white blood cell?
How can they be identified on a microscope?
- Granulocytes – Neutrophils - multilobed nucleus
- Granulocytes – eosinophils - bilobed nucleus (may appear orange and pink)
- Granulocytes – basophils - corse purple granules with bilobed nucleus
- Lymphocytes - dark nucleus with thin rim of cytoplasm
- Monocytes - nuclei with indentation to one side
Granulocyte neutrophils:
- What % of WBC in blood are these?
- What is their lifespan?
- What causes them to rise?
- What kind of immunity are they part of?
- What type of cells are neutrophils?
- What do they do with foreign bodies?
- Most common WBC type – make 50-70% of WBC count in blood.
- Short lifespan – 8-10 hours
- Neutrophils rise as an acute response to bacterial infection, inflammation and malignancy (e.g bacteria wall antigens) – this is chemotaxis
- Part of innate immune response.
- Neutrophils are phagocytic cells
- Foreign bodies (e.g bacteria) ingested and killed by enzymes in granules ex lysozyme and peroxidase.
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Granulocytes – eosinophils
- What % of WBC in blood are these?
- What is their lifespan?
- What is their growth promoted by?
- What causes them to rise?
- How do they kill foreign bodies?
- What kind of immunity are they part of?
- What stains the granules?
- Make up 1-6% of total WBC count in blood.
- Life span in blood is 4-5 hours (longer in tissues).
- Growth promoted by interleukin 5.
- Chemokines (signalling proteins) attract them to specific tissues.
- Their granules contain Major Basic Protein and reactive O2 species, which are toxic to what the eosinophils are trying to kill (parasites)
- Part of innate immunity.
- Eosin stains granules orange and pink.
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Eosinophils:
- What is their marked rise in numbers?
- Where are they most commonly seen?
- What causes their numbers to rise and fall?
- Marked rise in numbers in blood from 0.4 – 2-6 x 10^9/l
- Commonly seen in atopy – problem with your immune system that makes you more likely to develop allergic diseases e.g., eczema, asthma and hay fever
- Can also be found in Hodgkin’s disease, CML and other malignancy, adverse drug reactions, and helminth infection (intestinal worm)
- The blood levels of eosinophils often correlate with clinical activity e.g., during hay fever season.
Granulocytes – Basophils:
- What % of WBC in blood are these?
- What is their lifespan?
- What do their granules consist of?
- What 3 roles do they play?
- What kind of immunity are they part of?
- Make up less than 1% of WBC count in blood.
- Lifespan of 1-2 days
- Dark basophilic granules contain histamine, leukotrienes, proteases and heparin
- Acts as a cell surface receptor for IgE – binding produces degranulation following chemotaxis.
- Role in phagocytosis
- Role in hypersensitivity (allergic) reactions
- Part of the innate immunity
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What is the specific term given to an allergic reaction?
What can it cause?
- Anaphylaxis – type 1 allergic reaction
- Can results in:
- Swelling of lips, tongue and or throat
- Skin – hives, itching, flushing
- Light-headedness, loss of consciousness, confusion, headache
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Lymphocytes:
- What % of WBC in blood are these?
- What is their lifespan?
- How are they formed?
- What are the 2 types and where are they found?
- What are they both responsible for?
- What causes them to rise?
- What can they indicate?
- What kind of immunity are they part of?
- Make up 20-40% of total WBC count in blood.
- Lifespan of 1 week to a few months
- Differentiate early from other marrow derived cells
- Divide into T cells (Thymus – lymphoid gland in chest) and B cells (Bone marrow or bursa)
- Rise in response to viral infections, and Chronic Lymphocytic Leukaemia
- T and B cell malignancies with circulating cells = leukaemia
- Part of the adaptive immunity
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Macrophages/Monocytes:
- What % of WBC in blood are these?
- What is the difference between the 2?
- What is their lifespan?
- What do they contain?
- What are their 2 roles?
- What kind of immunity are they part of?
- Make up 5-10% of WBC count in blood.
- Macrophages are monocytes that have migrates to any tissue in the body.
- Monocytes have a lifespan of a few days; macrophages have a lifespan of months to years.
- They have a vacuole containing hydrolases and myeloperoxidase
- They act as antigen presenting cells by ingesting material (phagocytosis) and presenting the peptides to T cells so antibodies can be made.
- Their role is to kill mycobacteria’s (e.g. TB), fungi and intracellular organisms e.g. listeria.
- Part of the innate immunity.
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What is innate and active immunity? What immunity are each type of WBC part of?
- Innate immunity – the organism is born with it (non-specific)
- Adaptive immunity – organism acquires this through disease exposure (specific)
- Innate immunity
- Neutrophils, eosinophils, basophils, monocytes
- Adaptive
- T and B lymphocytes
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What is a WBC differential?
What are 4 reasons why is it useful in clinical practise?
- A WBC differential determines the % of each type of WBC in the blood.
- A WBC differential and blood film can be useful clues for:
- Evidence of different types of infection and response to treatment
- Allergic response
- Leukaemia (malignant T and B cells in circulating blood is leukaemia)
- Marrow infiltration
Chronic Myeloid Leukaemia (CML):
- What age group does it occur?
- What are symptoms?
- What are signs of it?
- How does it develop?
- What causes most cases?
- Occurs in all age groups.
- Symptoms of anaemia (tired, no energy), large spleen, bone pain
- Signs are anaemia, high WBC and platelet count (immature cells)
- Typically, a chronic phase and then an accelerated acute phase
- 95% of cases have an identical cytogenetic and molecular mutation.
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What is the cytogenetic mutation associated with Chronic myeloid leukaemia?
How does this cause CML?
How is this treated?
How is the effect monitored?
- Reciprocal translocation between chromosome 9 and 22.
- Each chromosome swaps a chunk.
- This results in the formation of a Philadelphia chromosome on chromosome 22
- This causes the tyrosine kinase gene to be activated which causes cell proliferation.
- The drug imatinib is used to treat CML by acting as a tyrosine kinase inhibitor
- Effect of drug monitored by PCR on blood test.
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Acute Myeloid Leukaemia (AML):
- What age group does it occur?
- What does it present with?
- What are symptoms?
- More common with increasing age
- Presents with symptoms of marrow failure:
- Anaemia
- Bleeding – purpura (small blood vessels bursting), bruises
- Infections – sepsis (life-threatening reaction to infection), pneumonia
How is Acute Myeloid Leukaemia treated?
What are the problems when treating AML?
- Unlike CML, there are diverse cytogenetic changes, so there is no specific target for chemotherapy for AML
- Chemotherapy produces marrow aplasia, where the red marrow disappears and ceases to create new blood cells.
- It is hope that the marrow stem cells will regenerate bone marrow faster than the chemotherapy destroys it
- Under 60s patients can undergo bone marrow transplants.
- During chemo, patients can get infections, bleeds, psychological difficulties from long hospital stays, and suffer pain from venous access and frequent marrow tests to check response.