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Haematology > 6. Abnormal white cell count > Flashcards

6. Abnormal white cell count Flashcards

1
Q

What are the different stages of myeloid maturation into a neutrophil?

A
  • Myeloblast - large cell with high nucleus:cytoplasmic ratio, not many granules
  • Promyelocyte - large, heavy granulation
  • Myelocyte - eccentric nucleus, smaller cytoplasm
  • Metamyelocyte
  • Neutrophil
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2
Q

When do you see cells that are in the differentiating phase (into neutrophils) in peripheral blood?

A

Septic patients
• Leukoerythroblastic picture
- myeloid precursors with nucleated red cells
• Bone marrow is trying to compensate for peripheral destruction

Chemotherapy patients
• Immature myeloid cells
• White cell count falls
• Given G-CSF growth factor

Chronic myeloid leukaemia
• Presence of cells at all stages of differentiation

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3
Q

What stimulates the process of myeloid maturation?

A

Cytokines and growth factors

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4
Q

What mediates the production of lymphoid cells?

A

IL2 along with other cytokines

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5
Q

Which growth factors mediate the production of myeloid cells?

A

G-CSF and M-CSF

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6
Q

Where should immature white blood cells be found?

A

Only in the bone marrow

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7
Q

What is reactive and malignant white cells production?

A
  • Reactive - increased production during infection and inflammation
  • Malignant - increased count in leukaemia and can be myeloproliferative
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8
Q

How do the following affect the WBC count:
• Impaired bone marrow function
• Bone marrow failure
• B12 or folate deficiency

A
  • Impaired bone marrow function - reduced WBC
  • Bone marrow failure - reduced WBC in aplastic anaemia, chemotherapy, metastatic/haematological cancer
  • B12 or folate deficiency - reduced WBC
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9
Q

What is the most common cause of eosinophilia?

A

Reactive and secondary to drugs

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10
Q

What are the reactive causes of eosinophilia (where haemopoiesis is normal)?

A
  • Inflammation
  • Infection (parasites)
  • Increased cytokine production (due to a distant tumour, haematopoietic or non-haematopoietic)
  • Neoplasms
  • Hypereosinophilic syndrome
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11
Q

What are the primary (malignant) causes of eosinophilia (where haemopoiesis is abnormal)?

A

• Cancers of haematopoietic cells
• Leukaemia
• Myeloproliferative disorders
• Malignant Chronic Eosinophilic Leukaemia - mutation in the PDGFR gene
- IL5 stimulates production of eosinophils

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12
Q

How can you investigated a white cell count?

A

1) History and examination (enlarged spleen, lymph nodes)
2) Haemoglobin and platelet count
3) Automated differential
4) Examine blood film
- which blood cells affected
- which type if only WBC
- mature or immature involved

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13
Q

Which WBCs are increased in chronic lymphocytic leukaemia?

A

B lymphocytes - mature

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14
Q

Are the WBCs that are increased in acute lymphoblastic leukaemia mature or immature?

A

Immature

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15
Q

What affect does smoking have on WBCs?

A
  • Elevated lymphocyte count
  • Persistent lymphocytosis
  • Persistant neutrophilia
  • Can persist for many years after quitting smoking
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16
Q

What is the life span of neutrophils?

A

2-3 days in tissues, hours in the peripheral blood

17
Q

How long does it take for neutrophilia to develop?

A
  • Minutes - due to demarginaiton
  • Hours - due to inflammation or infection
  • Days - increased production
18
Q

What are the causes of neutrophilia?

A
  • Infection
  • Tissue inflammation
  • Physical stress, corticosteroids
  • Underlying neoplasia
  • Malignant neutrophilia
19
Q

What causes monocytosis?

A
  • TB, brucella, typhoid
  • CMV, varicella zoster
  • Sarcoidosis
  • Chronic myelomonocytic leukaemia
20
Q

What is basophilia a sign of?

A
  • Rare
  • Underlying haematological cancer
  • Inflammation
21
Q

What is lymphocytosis a sign of (including involvement of mature/immature cells)?

A
  • Very common - reactive most of the time
  • After the age of 70, can be a sign of underlying chronic lymphocytic leukaemia
  • Mature cells - reactive response to infection
  • Immature cells - reflective of primary disorder (leukaemia/lymphoma)
22
Q

What is primary or secondary lymphocytosis (involving mature cells)?

A
  • Primary - monoclonal (all the same) lymphoid proliferation

* Secondary - polyclonal response to infection, chronic inflammation or underlying malignancy

23
Q

What are the reactive causes of lymphocytosis?

A
  • Infection e.g. EBV
  • Autoimmune disroders
  • Neoplasia
  • Sarcoidosis
24
Q

What happens in glandular fever?

A
  • EBV infection of B-lymphocytes via CD21 receptor
  • Infected cell proliferates and expresses EBV associated antigens
  • Cytotoxic T-lymphocyte response
  • Acute infection is resolved resulting in lifelong sub-clinical infection
25
Q

What can you used to analyse the configuration of the Ig, or TCR gene in primary monoclonal proliferation?

A
  • Souther blot analysis

* Identical configuration

Haematology (11 decks)

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