5.2 White blood cells Flashcards
Name the 5 major types of leukocyte.
- Neutrophil
- Lymphocyte
- Monocyte
- Basophil
- Eosinophil
(Not exhaustive)
What factors can affect the outcome of an FBC?
- Age (newborns have higher lymphocyte count than adults)
- Ethnicity
- Analyser used
What do leukocytes develop from?
Pluripotent stem cells -> CFU-GEMM -> cell types
Describe neutrophils.
- Distinct
- Well granulated, granules contain enzymes
- 3-5 lobed nucelus
- 12-15um diameter
- Spend 10 hours in circulation before moving to tissue where they survive for 4-5 days
- Deal primarily with bacteria and fungi
Describe monocytes.
- Large cells
- Blueish cytoplasm
- Large nucleus
- Migrate to inflamed and infected tissues
- Become macrophages when they reach tissues
- Present antigens to lymphocytes
Describe lymphocytes.
- Pale agranular cytoplasm
- Large nucleus, dense chromatin
- 6-10um diameter
- Deal with viruses
- 2 different lineages: T and B cells
Describe basophils.
- Heavily granulated cytoplasm
- Release histamine
- Large irregular nuclei
Describe eosinophils.
- Distinct pink cytoplasm
- Granulated
- Multi-lobed nucleus (similair to neutrophil but more heavily granulated)
- Mediate hypersensitivity reactions primarily to parasites and allergerns
What 2 divisions of leukaemia are there?
- Acute
- Chronic
Name 2 forms of acute leukaemia.
- Lymphoblastic
- Acute myeloid
Name 3 forms of chronic leukaemia.
- Lymhpocytic
- Chronic myeloid
- Myelo-monocytic
Describe the typical demographic of patients with acute leukaemia.
- Peak incidence in 7th decade
- 2-3 per 100 000 per annum in children
- 15 per 100 000 per annum in adults
Rare
What symtpoms may a patient with acute leukaemia present with?
- Lethargy
- Bleeding
- Gingival hypertrophy
- Infections
- Mouth ulcers
- Lymphadenopathy
Which acute leukaemia type causes bleeding, nosebleeds, bleeding gums and haemorrhage?
M3 acute promyelocytic leukaemia
Which acute leukaemia types can cause gingival hypertrophy?
M4 and M5.
How is acute leukaemeia diagnosed?
FBC, blood film, bone marrow tests
Describe acute lymphoblastic leukaemia.
- Most common childhood malignancy
- Has many subtypes
- Signs and symptoms: bleeding, infection, lymphadenopathy, other organ involvement
- Treatment involves chemotherapy and an allogeneic BM transplant for adults
- Susceptible to oral thrush and bacterial infections
- Good prognosis in children (over 90%)
- Survival rate decreases with age
How is acute myeloid leukaemia treated?
- 3-4 cycles of intensive inpatient chemotherapy
- Allogeneic bone marrow transplant for intermediate and high risk groups
Describe chronic lymphocytic leukaemia.
- Common in older patients
- Weight loss, night sweats, lymphadenopathy, splenomegaly
Describe chronic myeloid leukaemia.
- Raised WBC count
- Median pt age of 50-60
- Lethargy, weight loss, blurred vision, headaches, splenomegaly
- Treated with tyrosine kinase inhibitors to block cancer growth
What types of lymphoma are there?
- Non-Hodgkin’s: T or B cell
- Hodgkin’s: classical and non-classical
Describe the presentation of lymphoma.
Variable presentation.
- Lymphadenopathy
- Classic B symptoms: weight loss, night sweats and lethargy
What are the differential diagnoses for lymphoma?
- Different cancer type e.g. oral cancer
- Infection e.g. severe dental abscess, tuberculosis, sarcoidosis
What is the peak age for lymphoma?
20-29
How is lymphoma diagnosed?
- Thorough history
- Biopsy of lymph node/mass (within 6 weeks)
- CT thorax, abdomen and pelvis
- Bone marrow required for staging of cancer
How is Non-Hodgkin’s lymphoma treated?
- IV chemo
- Oral chemotherapy for low grade cancer
- Radiotherapy for local disease control
- Autologous stem cell transplant for relapsed aggressive types
How is Hodgkin’s lymphoma treated?
- IV chemo +/- radiotherapy
- Autologous translpant if relapsed or refractory disease
- Allogeneic transplant in select patients with multiple relapse
Describe myeloma.
- B-cell cancer
- Malignant plasma cell disorder
- Incurable
- Characterised by presence of a paraprotein or abnormal light chain and end organ damage
- Median age at diagnosis: 65
How is myeloma diagnosed?
- FBC
- Renal function
- Calcium
- Serum electrophoresis for paraprotein
- Urine electrophoresis for Bence Jones protein
- Skeletal survey
- Bone marrow examination
- CT skull shows raindrop appearance (small circles of bone loss)
How is myeloma treated?
Chemotherapy and bisphosphonates (ONJ risk).
Autologous bone marrow transplant used in pts under 70 with minimal/no comorbidities.
What is ONJ?
Osteonecrosis of the jaw.
Exposed bone in maxillofacial region for more than 8 weeks in the absence of radiotherapy.
What are myelodysplastic syndromes?
- Group of cancers in which immature blood cells in the bone marrow do not mature or become healthy blood cells
- Acquired bone marrow failure
- Increasing incidence with age
- Only cure is allogeneic transplantation
- Supportive care with blood products and GFs
- Some chemotherapy drugs may be suitable for some patients
