Abnomal white cell count Flashcards

1
Q

How is normal Haematopoesis?

A

Multipotent stem cells that are able to renew and produce the precusors necessary to produce the various blood cells

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2
Q

What are the different steps of differentiation of the myeloid lineage?

A

Myeloblast->promyelocytes->myelocytes->metamylocytes ->neutrophils
all but the last steps are in the BM -only neutrophil go to peripheral
give a patient GCSF (GF)- and then myeloid precsurs in the blood (except myeloblast)
Also rarly in sepsis-precursors of WBC and RBC - leukoertyhroblastic feature-can be also due to cancer

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3
Q

What are the factors that control WBC, RBC and Lymphoid cells

A

Erythropoetin control erythropoetin
Lymphoid-IL2
Myeloid - GCSF, M-CSF
these control differentiation and proliferation of different lineages (again all precrusors in BM, and only mature in peripheral)

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4
Q

What are the processes that can lead to abnormal WBC count?

A

Cell production high (reactive to infect/malignant), Cell survival (failure of apoptosis-cancer mutation causing cancer), Cell production down (impaired BM function-B12 deficiency, BM failure-post chemotherapy, metastatic cancer, heamtological cancerm aplastic aneamia), Cell survival down (immune breakdown-AID)

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5
Q

What is easinophilia>

A

Increase of eosinophils
but can be reactive (normal reponse to infection/parasites, to distant tumour)-will see normal eosinophils, and normal inflam markers,
can be abnormal heamotopoetis-cancer, leukemia (myeloid/lympoid, Chronic or acute), Myeloproliferative disorders (all of them)

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6
Q

How does chronic myeloid leukemia lead to increase of WBC?

A

Early mutations lead to overproduction/less death of GM-CSF cells-lead to large numbers of megakaryocytes, granulocytes and monocytes-all of them-and possible precursors in blood

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7
Q

How do you investigate a raised WBC count?

A

History and examination-a random find might not matter if asymptomatic (mild lymphocytosis can be caused by smoking (higher monocytes/lymphocyes), or can be caused by travels (just got worms or smth?)
Examination-need to focus on lymphadenopathy or spleenomegaly-indications of disorders

Then measure heamoglobin/platelet counts-raised WBC is less dangerous/worrying if low/normal RBC and platelets-means that the WBC is reactive. if all high, then bad

look at report from lab-not just automated differential-if the machine not giving differential, usually means machine isnt sure what the cells are. caused by G-CSF, or malignant condition

Finally/most important-examine the blood film-fundamental//crucial

need to see if WBC only or all 3 lineages? (myoleproliferative), or 1 WBC lineage only vs all 5 of them? Or mature cells only or immature cells as well?

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8
Q

How does clonal differences show in WBC count investigations of reactive/malignant? What are we looking for?

A

need to see if WBC only or all 3 lineages (myoleproliferative)

or 1 WBC lineage only vs all 5 of them?
usually when all types-reactive, except for CML -because mutation is early in the differentiation (also see basophils)-but eosinophils normally done rise so if they do, its CML not reactive

Or mature cells only or immature cells as well?-doesnt really differentiate from reactive/malignant

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9
Q

What can cause abnormal Neutrophils counts?

A

Present in BM and blood and tissue
Live 2/3 days in tissue
BUT 50% are marginated-not counted in the FBC
numbers-can change in minutes if demarginated, Hours if early BM release, or days-classical increase (up to 3x in infection)

overall can be dure to: infection, tissue inflam (colitis), physical stress, adrenaline, corticosteroids, Underlying neoplasia, malignant neutrophilia (myeloproliferative disroders, CML)

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10
Q

What do neutrophils look like in infections vs in leukemia?

A

In infection, neutrophilia, abnormal looking neutrophils with white spots in vacuole and toxic granulation -usually very sick
In leukemia-See precursors of myeloid maturations (like band cells), neutrophilia too, -very CML

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11
Q

What causes eosinophilia?

A

Reactive-parasites, allergy, drugs, neoplasms (hodgkins lymphomas, t cell lymphomas), Hypereosinophilic syndrome, asthma
Malignant chronic eosinophilic leukemia (Fusion gene)
Eosinophilia (chronic)can cause organ damage

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12
Q

What do eosinophils look in patients?

A

Esosinophilia-not specially abjormal
If malignant-then usually looking wrong and having precorsors

With MCEL-fusion gene measure in blood

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13
Q

What causes monocytosis?

A

Can be seen in certain inflammatory infection (Tb, typhoid, Viral (CMV, Varicella), sacroidosis) or from Chronoc myelocytosis leukemia)

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14
Q

What causes lymphocytosis? what are the first thing needed to be differentiated? How do you differentiate them?

A

very common after 60yo
Are they mature (reactive, or primary disroder) or immature (primary disorder (leukemia.lymphoma)
If mature: Blood fild measure them-in reactive-see different types of lympho, as polyclonal
In malignant-monomorphic population of cell (all look the same

If immature-always malignant (lymphoma or leukemia)

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15
Q

How do you differentiate in mature lymphocytosis between reactive and malignant?

A

usual causes of reactive-smoking, infectiom, EBV, CMV, infection hepatittis, rubella, herpes

AID (but sometime lymphopenia), neoplasia, sarcoidosis

In infectious mononucleosis-atypical lymphocytes - pateint is also very symptomatic (with red falgs like sweating)-but other cell lineages arent affected, best way to see not malginant

Look at blood film-monomorphic (malignant)-only kappa or lambda chains ONLY or polymorphic (reactive)-mix of kappa/lamda light chains

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16
Q

What is glandular fever

A

EBV infection of B lymphocytes via CD21
Infected cells proliferate and express EBV antigens
CTL response-acute infecctio resolved but lifelong infection