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POM 3: Haematology > 3: White Blood Cells > Flashcards

3: White Blood Cells Flashcards

Covers Granulocytes and monocytes, Lymphocytes and WBC diseases

1
Q

What do myeloid growth factors do?

A

Signalling controls proliferation and survival of myeloid cells

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2
Q

3 myeloid growth factors

A

G-CSF : granulocyte colony stimulating factor
M-CSF: macrophage colony stimulating factor
GM-CSF : both granulocyte and macrophage colony stimulating factor

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3
Q

Myeloblasts are initial granulocytes, where do they develop

A

in the bone marrow
cell size reduced and granules develop as they mature

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4
Q

Neutrophils are

A

primary immune defence cells
- lobulated nucleus
-survive 7-10h in circulation
- migrate in tissue to carry out pathogen phagocytosis

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5
Q

what is chemotaxis

A

first step of neutrophil migration into tissues
- primed by cytokines ready to phagocytose pathogens

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6
Q

Characteristics of eosinophils

A

pink granules in stains
bilobed nucleus
less time circulating than neutrophils

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7
Q

2 functions of eosinophils

A

1) defence against parasitic infections and phagocytosis
2) regulation of type 1 hypersensitivity reactions - inactivate histamine and leukotrienes released by basophils and mast cells

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8
Q

Components of basophils

A

contain granules storing :
histamine
heparin
proteolytic enzymes

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9
Q

2 inflammatory responses of basophils

A

mediation of T1 hypersensitivity reaction where IgE-coated basophils release histamine and leukotrines

modulation of inflammatory responses by releasing heparin and proteases

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10
Q

3 functions of Monocytes

A

1)Phagocytosis of micro-organisms covered in antibody and complement
2)Phagocytosis of bacteria and fungi
3)Antigen presentation to lymphoid cells

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11
Q

Macrophages are formed from

A

Developed monocytes migrated in tissues with other cells that have a phagocytic scavenging function

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12
Q

4 types of granulocytes

A

Basophil
Neutrophil
Eosinophil
Monocyte

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13
Q

3 types of lymphocytes

A

B
T
natural killer cells

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14
Q

B lymphocytes originate form

A

foetal liver and bone marrow

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15
Q

Where do B lymphocytes develop

A

in bone marrow
- differentiate into plasma cells involving Ig heavy and light chain rearrangement

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16
Q

Function of mature B lymphocytes

A

mature after being exposed to antigens in lymphoid tissue e.g. lymph nodes

recognition of non-self antigens triggers production of specific Igs and antibodies

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17
Q

function of T lymphocytes

A

cell mediated immunity

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18
Q

Where do foetal lymphocyte progenitors migrate from to develop

A

from the liver to the thymus to develop

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19
Q

Function of natural killer cells

A

part of innate immune system
kill tumour cells and cells infected with viruses

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20
Q

Leukocytosis means

A

Too many WBCs

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21
Q

Normal leukocytosis

A

Occurs during infections, levels rise and then fall back down
- Transient leukocytosis
Infections, inflammation, infarction
Bacterial infection : neutrophilia/ monocytosis
Viral infection : lymphocytosis
Parasitic infection : eosinophilia

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22
Q

Abnormal leukocytosis

A

Leukaemia, lymphoma, myeloma
Examples -
Acute lymphoblastic leukaemia
Acute myeloid leukaemia
Chronic lymphocytic leukaemia
Chronic myeloid leukaemia

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23
Q

Neutrophilia is

A

Too many neutrophils

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24
Q

Causes of neutrophilia

A

Infection
Inflammation
Exercise
Infarction or tissue damage
Myeloproliferative disorders (CML)
Pregnancy - heavy toxic granulation of neutrophils
Use of corticosteroids

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25
Q

How to spot neutrophilia on a blood film

A

Left shift - non-segmented neutrophil precursors due to increased output from bone marrow

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26
Q

When can eosinophilia occur

A

Due to allergy / parasitic infection
Asthma / eczema / drugs
But can occur in leukaemia

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27
Q

Blood film in patients with basophilia

A

Myelocytes seen
Band forms
Neutrophilia
Left shift

28
Q

What does basophilia occur due to

A

Leukaemia
(uncommon)

29
Q

3 causes of monocytosis

A

Infection esp chronic
Chronic inflammation
Some types of leukaemia

30
Q

Two main types of lymphocytosis

A

Transient lymphocytosis
Persistent lymphocytosis

31
Q

Transient lymphocytosis is caused by

A

Viral infections
often atypical lymphocytes present

32
Q

Persistent lymphocytosis is a

A

Lymphoproliferative disorder

33
Q

Infectious mononucleosis is also known as

A

Mono
Or
Glandular fever

34
Q

glandular fever

A

Lymphocytosis due to viral infection - resulting in atypical lymphocytes

35
Q

WBCs in mono

A

Scalloped margins and hugging of nearby RBCS

36
Q

Leukaemia is

A

Cancer or WBC - can be myeloid or lymphoid

37
Q

How does a leukaemia clone arise ?

A

Leukaemic cells from in bone marrow and replace normal haemopoietic stem cells - can overspill into blood 🩸

Spontaneous mutations or exposure to mutagenic agents in oncogenes and tumour suppressor genes 🧬

Mutated cell has survival and growth advantage so replaces normal cell by clone 🧫

38
Q

What issues can an leukaemic clone cause 🧫

A

Clones don’t require usual growth factors
Proliferation and maturation disturbance
Faliure of apoptosis

39
Q

What type of cancer is leukaemia

A

Acute / chronic - depending on nature of mutation
As cells circulate in blood stream and migrate into tissues

40
Q

4 types of leukaemia 🩸🧫

A

Acute lymphoblastic
Acute myeloid
Chronic lymphocytic
( Chronic myeloid )

41
Q

Changes to cells in acute lymphoblastic leukaemia

A

Large
High nucleus to cytoplasm ratio

42
Q

Blast means

A

Immature cells

43
Q

Cystic means

A

Mature cells

44
Q

In chronic myeloid leukaemia (CML)

A

Increase in granulocytes and their precursors in blood and bone marrow

45
Q

Causes of CML

A

Translocation between (ABL1) gene on chr 9 (encoded tyrosine kinase enzyme)
(BCR) gene on chr22 causing chr 22 to have BCR-ABL1 (now called Philadelphia 🥯🧀 chromosome Ph) which causes uncontrolled tyrosine activity giving rise to a leukaemic clone

46
Q

Causes of CLL

A
47
Q

Causes of CLL

A

pluripotent HSC turns into Bcell progenitor in bone marrow due to common lymphoid progenitor
causing chronic lymphocytic leukaemia
(long period of time)

48
Q

Characteristics of CLL on blood film

A

smudge / smear lymphocytes

49
Q

what is the most common cause of leukaemia in elderly people

A

CLL

50
Q

What is CLL staged according to

A

degree of lymph node/ liver/spleen involvement
and if Hb and platelet count is reduced

51
Q

What is the most common cause of leukaemia in children

A

ALL

52
Q

Cause of Acute lymphoblastic leukaemia

A

Pluripotent HSC changed into B cell acute lymphoblastic leukaemia (via common lymphoid progenitor)
progenitor cell picks up mutations (esp. in genes for TF)
cells unable to mature, but still proliferate, leading to lots of blast cells rapidly

53
Q

What happens as there is a large number of B cell acute lymphoblastic leukaemia

A

Bone marrow inflitrated with lymphoblasts
resulting in impaired haemopoiesis
- only lymphoblasts in circulation

54
Q

effects of ALL

A

leukocytosis of lymphoblasts
leading to :
neutropenia
thrombocytopenia
anaema

55
Q

Clinical signs of ALL

A

prominent bruising due to thrombocytopenia
pale skin due to anaemia

56
Q

Treatment for ALL

A

supportive therapy - red cell / platelet transfusion, antibiotics

systemic chemotherapy - through body

intrathecal chemotherapy - through spine (sanctuary site for lymphoblasts)

57
Q

Clinical features of leukaemia due to accumulation of abnormal cells

A

leukocytosis
bone pain - acute leukaemia
hepatomegaly
splenomegaly
lymphadenopathy - if lymphoid
thymic enlargement if T lymphoid
skin infiltration

58
Q

clinical features of leukaemia due to metabolic effects of leukaemic cell proliferation

A

Hyperuricaemia and renal faliure
weight loss
low grade fever
sweating

59
Q

Clinical features of leukaemia due to crowding out of normal haemopoises

A

fatigue, lethargy, pallor, breathlessness (anaemia)
fever + features of infection (neutropenia)
bruising, petechiae, bleeding (thrombocytopenia)

60
Q

Clinical fetaures of leaukemia due to loss of normal immune function

A

Loss of normal T and B cell function
- feature of chronic lymphocytic leukaemia

61
Q

Neutropenia is

A

low neutrophil count

62
Q

What are individuals with neutropenia at risk of

A

v low count below 0.5 x10^9 / L
risk of serious infection
urgent need for Iv Abx

63
Q

what can result in neutropenia

A

-supressed bone marrow activity after chemo/radiotherapy
- Autoimmune disorders
-physiological effects e.g benign ethnic neutropenia in african heritage

64
Q

Lymphopenia is

A

too few lymphocytes (below 1x10 L)

65
Q

what cells are lymphocytes in normal blood

A

CD4+ T cells

66
Q

Causes of lymphopenia

A

HIV Infection
Chemo / Radiotherapy
corticosteroids
severe infection (transient)

67
Q

Neutrophil hypersegmentation

A

neutrophil has more than 3-5 lobes (normal)
- right shift
- results from lack of B12/folic acid (megaloblastic anaemia)

POM 3: Haematology (3 decks)

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