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Year 2 - Haem > 6 - abnormal white blood cell count > Flashcards

6 - abnormal white blood cell count Flashcards

1
Q

Define polcythaemia

A

increased conc of haemoglobin

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2
Q

Define thrombocytopenia

A

deficiency of platelets in the blood

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3
Q

Define thrombocytosis

A

presence of high platelet (thrombocyte) counts in the blood
can be either primary (also termed essential thrombocythemia, and caused by a myeloproliferative disease) or secondary (also termed reactive).

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4
Q

Define neutropenia

A

an abnormally low level of neutrophils

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5
Q

Define neutrophilia

A

(leukocytosis of neutrophils)

a high number of neutrophil granulocytes in the blood.

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6
Q

What is the term used to describe a reduction in the number of white cells in the blood?

A

leucopenia

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7
Q

What is the term used to describe an increase in the number of white cells in the blood?

A

leukocytosis

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8
Q

What is the term used to describe reduction of all cell lines?
(deficiency of all three cellular components of the blood (red cells, white cells, and platelets))

A

pancytopenia

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9
Q

What is the difference between normal and malignant haematopoiesis?

A

normal - occurs in normal and in reactive bone marrow

malignant - occurs in leukaemia, myelodysplasia and myeloproliferative

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10
Q

Define lymphoid lineage

A

relating to or denoting the tissue responsible for producing lymphocytes (T cells, B cells and NK cells)

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11
Q

Which cells come under the myeloid lineage?

A 
o	Monocytes 
o	Macrophages 
o	Neutrophils 
o	Basophils 
o	Eosinophils 
o	Erythrocytes
o	Dendritic Cells 
o	Megakaryocytess
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12
Q

Describe how the appearance of white cells changes as they develop.

A

They become smaller and their cytoplasm becomes clearer. A multi lobed nucleus develops

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13
Q

Where do the stages of differentiation and maturation of a neutrophil occur?

A

normally, first 4 stages occur in bone marrow and only the fully differentiated neutrophils should be found in the blood

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14
Q

How is cell differentiation controlled?

Name the cytokines that stimulate the different cell lineages

A

via cytokines
o Myeloid = G-CSF and M-CSF
o Lymphoid = IL2
o Erythroid = Erythropoietin

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15
Q

Define Leukaemia.

A

malignant process in primary lymphoid organs
A malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leukocytes. This leads to suppression of the production of other blood cells such as erythrocytes, granulocytes and platelets.

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16
Q

Define Lymphoma.

A

lymphatic cell tumours in tissue/blood
A group of blood cell tumours that develop from lymphatic cells. If the disease is mainly in the lymphatic tissue then it is lymphoma, if it is mainly in the blood it is leukaemia.

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17
Q

Define Myeloma.

A

disease of bone marrow
A malignant disease of the bone marrow characterised by two or more of the following criteria:
• The presence of an excess of abnormal plasma cells in the bone marrow
• Typical lytic deposits in the bones on X-ray, giving the appearance of holes
• The presence in the serum of abnormal gammaglobulin, usually IgG

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18
Q

Broadly speaking, what are the two mechanisms by which white blood cell count can increase?

A

Increased white blood cell production - reactive or malignant
Increased white blood cell survival

19
Q

Broadly speaking, what can cause an decrease in white blood cell count?

A

Decreased white blood cell production - impaired bone marrow function
Decreased white blood cell survival

20
Q

What two broad categories of diseases can cause an increase in white blood cell count?

A

Reactive – in response to infection or inflammation

Primary – malignant

21
Q

What is the difference in the type of white blood cell seen in the peripheral blood of someone with an infection/inflammation (reactive) and someone with a malignancy (primary)?

A

In normal infection, the increased WBC is reactive and mature cells are released.
In haematopoietic cancers, immature AND mature cells are released.

22
Q

Where does the mutation occur in chronic myeloid leukaemia?

A

GM-CFC phase (granulocyte-monocyte colony forming cell)

23
Q

Is there are immature cells, what can you suspect?

A

leukaemia

24
Q

If there are only immature cells in the blood film with low haemoglobin and low platelets, what would you suspect?

A

Acute leukaemia

25
Q

If there are mature and immature cells present, what can you begin to suspect?

A

chronic leukaemia

but only if in the presence of neutrophils and myelocytes

26
Q

What can cause an elevated lymphocyte count?

A

Viral infections

Chronic lymphocytic leukaemia

27
Q

What is the lifespan of a neutrophil?

A

Hours in the peripheral blood

2-3 days in the tissues

28
Q

What is margination of neutrophils?

A

Around 50% of neutrophils in the circulation have marginated meaning that they have stuck to the wall of a damaged vessel (this means that they are NOT counted in the full blood count)

29
Q

Describe the differences in the appearance of neutrophils in infection compared to leukaemia.

A

Neutrophils in infection are granular (show toxic granulation)
Neutrophils in leukaemia do not have granules and do not look toxic.
NOTE: myelocytes (precursors) may also be present in someone with leukaemia

30
Q

State some causes of neutrophilia.

A 
Infection
Inflammation 
Physical stress 
Adrenaline
Corticosteroids 
Underlying neoplasia 
Malignant neutrophilia (myeloproliferative disorders, chronic myeloid leukaemia)
31
Q

State some infections that characteristically do NOT produce neutrophilia.

A

Brucella
Typhoid
Many viral infections

32
Q

State some reactive causes of eosinophilia.

A

Parasitic infection
Allergic diseases e.g. asthma
Neoplasms e.g. Hodgkin’s and Non-Hodgkin’s
Hypereosinophilic syndrome

33
Q

State a malignant cause of eosinophilia.

A

Malignant chronic eosinophilic leukaemia (INCREDIBLY RARE)

34
Q

What would you see in the chest X-ray of someone with Hodgkin’s lymphoma?

A

Increased mediastinal mass

35
Q

What can cause monocytosis?

A

RARE but it is seen in certain chronic infections and primary haematological disorders
TB, brucella, typhoid
CMV, varicella zoster
Sarcoidosis
Chronic myelomonocytic leukaemia (MDS – myelodysplastic syndrome)

36
Q

Describe the appearance of chronic lymphocytic leukaemia on a blood film.

A

The lymphocytes have a typical appearance – big nucleus + little cytoplasm
They are mature lymphocytes
This appearance can also be present in autoimmune and inflammatory conditions

37
Q

Describe the appearance of acute lymphoblastic leukaemia on a blood film.

A

There are immature lymphoblasts
They are much larger than the mature lymphocytes
Within the large nucleus you can see the nucleolus (showing that the cell is immature)

38
Q

Describe the difference in the expansion of lymphocytes in secondary (reactive) lymphocytosis compared to primary lymphocytosis.

A

Secondary lymphocytosis = polyclonal expansion

Primary lymphocytosis = monoclonal expansion

39
Q

State some causes of reactive/secondary lymphocytosis.

A

Infection (e.g. EBV, toxoplasma, infectious hepatitis, rubella, herpes infections)
Autoimmune disorders
Neoplasia
Sarcoidosis

40
Q

What do you see in the blood film of someone with mononucleosis syndrome?

A

Atypical lymphocytes
They look similar to immature lymphocytes but they aren’t very round as its cytoplasm extends between surrounding cells
The nucleus of the cell lacks nucleoli

This is typical of glandular fever
So high WCC and reactive-looking lymphocytes can indicate reactive, infection-induced lymphocytosis

41
Q

What is glandular fever caused by?

A

Epstein-Barr virus infection of the B-lymphocytes via the CD21 receptor
Infected B-cells proliferate and express EBV associated antigen
There is a cytotoxic T-lymphocyte response

42
Q

What is the usual cause of lymphocytosis in elderly people?

A

Chronic lymphocytic leukaemia (CLL)

or autoimmune disorders

43
Q

Explain how light chain restriction can be used to distinguish between causes of lymphocytosis.

A

In reactive lymphocytosis, there will be polyclonal expansion of the lymphocytes meaning that the light chains of the antigens produced will have equal kappa and lambda divide.

In primary lymphocytosis, there will be a monoclonal expansion so you will get kappa or lambda restriction meaning that all the light chains are of one type

44
Q

Normally, B and T cells will undergo gene rearrangement in the TCR and Ig genes in a process called affinity maturation. How is this different in primary monoclonal proliferation of B and T cells?

A

With primary monoclonal proliferation, all the daughter cells carry identical copies of Ig genes or TCR genes

Year 2 - Haem (10 decks)

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