6. Cytopenia Flashcards
What is cytopenia?
reduction in no. of blood cells
Name the different types of cytopenia.
- anaemia = low RBC count
- leucopenia = low WBC count
- neutropenia = low neutrophil count
- thrombocytopenia = low platelet count
- pancytopenia = low RBCs, WBCs and platelets
Name the different types of blood cell no. increases.
- erythrocytosis = high RBC count
- leucocytosis = high WBC count
- neutrophilia = high neutrophil count
- lymphocytosis = high lymphocyte count
- thrombocytosis = high platelet count
Which hormone regulates neutrophil maturation and how does it act?
G-CSF
i) increases neutrophil production
ii) decrease time to release mature cells from BM
iii) enhance chemotaxis
iv) enhance phagocytosis and killing of pathogens
What are the different stages of neutrophil maturation? Which types should be found in blood?
Myeloblast… promyelocyte… myelocyte… metamyelocyte… band (non-lobed)… neutrophil (lobed).
Only band cells and neutrophils should be in peripheral blood.
What is the treatment for neutropenia, e.g. after chemotherapy?
Recombinant G-CSF
Name examples of reactive and haematological causes for neutrophilia.
Reactive:
- infection
- acute inflammation or tissue damage
- cancer
- acute haemorrhage
- cytokines: G-CSF
- smoking
- drugs, e.g. steroids
- metabolic/endocrine disorders
Haematological:
- myeloproliferative diseases (cell overproduction by BM)
What is the value for neutropenia?
neutrophil count <1.5 x 10^9/L, severe if <0.5
Name different causes for the increased removal or use of neutrophils leading the neutropenia.
- sepsis
- splenic pooling
- immune destruction
- others: benign ethnic neutropenia (more prevalent in Afrocarribean), cyclic neutropenia
Name different causes for the reduced production of neutrophils leading the neutropenia.
- B12/folate deficiency
- infiltration of BM by maligancy or fibrosis
- aplastic anaemia (empty BM)
- radiation (if includes high proportion of BM)
- drugs (chemotherapy, antibiotics, anti-epileptics, psychotropic drugs, rituximab…)
- viral infection - v. common
- congenital disorders
What are the complications of neutropenia?
- severe life-threatening bacterial infection - neutropenic sepsis = medical emergency (IV antibiotics must be given immediately)
- severe life-threatening fungal infection
- mucosal ulceration, e.g. painful mouth ulcers
Name reactive and haematological causes for monocytosis.
Reactive:
- chronic inflammatory conditions e.g. RA, SLE, Crohn’s, UC
- chronic infection e.g. TB
- carcinoma
Haematological:
- myeloproliferative disorders/leukaemias
What is the function of eosinophils?
- Immune response against parasites via granulocytes containing arginine, phospholipids and enzymes.
- Phagocytosis of antigen-antibody complexes.
- Mediate allergic response and hypersensitivity reactions, e.g. to drugs, in asthma or skin inflammation.
What is the lifespan of eosinophils?
- 3-8hrs in circulation
- lifespan 8-12 days
Name some reactive and haematological causes for eosinophilia.
Reactive:
- allergic diseases (asthma, eczema, hay fever, aspergillosis)
- drug hypersensitivity (penicillin)
- parasitic infection (round worm, tapeworm, fluxes)
- skin diseases (bullous pemphigold)
Haematological:
- Hodgkin lymphoma
- acute lymphoblastic/myeloid leukaemia
- myeloproliferative conditions
- eosinophilic leukaemia
- idiopathic hypereosinophilic syndrome
What is the role of basophils?
Least common but largest WBC active in allergic reactions and inflammatory conditions. Contains dense granules containing histamine, heparin, hyaluronic acid and serotonin.
Name some reactive and haematological causes for basophilia.
Reactive:
- immediate hypersensitivity reactions
- ulcerative colitis
- rheumatoid arthritis
Haematological:
- myeloproliferative conditions
Name some reactive and haematological causes for lymphocytosis.
Reactive:
- viral or bacterial (esp. whooping cough) infections
- stress related: MI/cardiac arrest
- post-splenectomy
- smoking
Haematological - lymphoproliferative (i.e. malignant) conditions:
- chronic lymphocytic leukaemia (B cells)
- T- or NK- cell leukaemia (v rare)
- lymphoma (cells ‘spill’ out of infiltrated BM)
What is pancytopenia?
reduction in WBCs, RBCs and platelets
Name causes for increased removal of blood cells leading to pancytopenia.
- splenic pooling - hypersplenism
- haemophagocytosis (increased phagocytic activity in BM)
- immune destruction - rare to cause pancytopenia
Name causes for reduced production of blood cells leading to pancytopenia.
- B12/folate deficiency
- BM infiltration by malignancy (haematological or non-haematological)
- marrow fibrosis
- idiopathic immune aplastic anaemia
- radiation
- drugs (chemotherapy, antibiotics, anticonvulsants, psychotropic drugs)
- viruses (EBV, viral hepatitis, HIV…)
- congenital BM failure (e.g. Fanconi’s anaemia, dyskeratosis congenita)
What is aplastic anaemia?
pancytopenia with a hypocellular BM in the absence of abnormal infiltrate and with no increase in reticulin (fibrosis)
What are the symptoms of pancytopenia?
- symptoms of anaemia - fatigue, dizziness, chest pain, shortness of breath, etc.
- symptoms of thrombocytopenia - bleeding, bruising, etc.
- symptoms of neutropenia - infection, ulcers, fevers, etc.
- symptoms of underlying cause
What is a possible treatment for pancytopenia caused by reduced production of blood cells?
haemopoietic stem cell transplant
