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Haematology > Abnormal White Blood Cell Count > Flashcards

Abnormal White Blood Cell Count Flashcards

1
Q

What is the lymphoid lineage?

A

Lymphoid cells are lymphocytes = T cells, B cells and NK cells

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2
Q

Which cells come under the myeloid lineage?

A 
Erythrocytes  
Neutrophils 
Basophils  
Eosinophils 
Monocytes 
Macrophages  
Megakaryocytes  
Dendritic Cells
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3
Q

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

A

They become smaller and their cytoplasm becomes clearer.

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4
Q

Which factors stimulate the following cell lines:

a. Lymphoid
b. Myeloid
c. Erythroid

A

a. Lymphoid - IL-2
b. Myeloid - G-CSF, M-CSF
c. Erythroid - Erythropoietin

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5
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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6
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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7
Q

Define Myeloma.

A

A malignant disease of the bone marrow characterised by two or moreof 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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8
Q

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

A

Increased white blood cell production
Increased white blood cell survival
(Opposite for decreased WBC)

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9
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

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10
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

Reactive – only mature white blood cells

Primary – mature AND immature white blood cells present

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11
Q

Where does the mutation occur in chronic myeloid leukaemia?

A

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

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12
Q

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

A

Acute leukaemia

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13
Q

What are the normal ranges of:

a. Hb
b. Platelets
c. WCC
d. Neutrophils
e. Lymphocytes
f. Monocytes
g. Eosinophils
h. Basophils

A 
a.Hb
120-160 g/L
b. Platelets 
150-400 x 109/L
c.WCC
4-11 x 109/L
d. Neutrophils 
2.5-7.5 x 109/L
e. Lymphocytes  
1.5-3.5 x 109/L
f. Monocytes 
0.2-0.8 x 109/L
g. Eosinophils 
0.04-0.44 x 109/L
h. Basophils 
0.01-0.1 x 109/L
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14
Q

What can cause an elevated lymphocyte count?

A

Viral infections

Chronic lymphocytic leukaemia

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15
Q

What is the lifespan of a neutrophil?

A

Hours in the peripheral blood

2-3 days in the tissues

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16
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)

17
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 show absence of granules

18
Q

What else would be present in the blood film of someone with leukaemia that would not be present in someone with an infection?

A

Myelocytes – these precursors would not be found in the peripheral blood of someone responding to infection

19
Q

State some causes of neutrophilia.

A 
Infection 
Inflammation  
Physical stress 
Adrenaline 
Corticosteroids  
Underlying neoplasia
Malignant neutrophilia (myeloproliferative disorders, chronic myeloid leukaemia)
20
Q

What types of infection cause neutrophilia?

A

Bacterial
Fungal
Certain viral infections Generally: if the neutrophil count is low but there are other features of infection, then you can deduce that it’s a viral infection

21
Q

State some infections that characteristically do NOT produce neutrophilia.

A

Brucella
Typhoid
Many viral infections

22
Q

State some reactive causes of eosinophilia.

A

Parasitic infection
Allergic diseases e.g. asthma
Neoplasms e.g. Hodgkin’s lymphoma and T-cell NHL (Non-Hodgkin’s)
Hypereosinophilic syndrome

23
Q

State a malignant cause of eosinophilia.

A

Malignant chronic eosinophilic leukaemia (INCREDIBLY RARE)

24
Q

What are the characteristic features of someone with Hodgkin’s lymphoma?

A

Increased mediastinal mass
Increased IL-5 secretion
Can also get mutation in GM-CFC

25
Q

What can cause monocytosis?

A

RARE but it is seen in certain chronic infections and primary haematological disorders :

Bacterial- TB, brucella, typhoid
Viral-CMV, varicella zoster
Sarcoidosis
Chronic myelomonocytic leukaemia (MDS – myelodysplastic syndrome)

26
Q

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

A

Oligoclonal expansion
The lymphocytes have a typical appearance – big nucleus + little cytoplasm
Mature lymphocytes
This appearance can also be present in autoimmune and inflammatory conditions

27
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)

28
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

29
Q

State some causes of reactive (secondary) lymphocytosis.

A

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

30
Q

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

A

Atypical lymphocytes
They look similar to immature lymphocytes but cytoplasm tends to be indented by surrounding RBC’s.

High WCC with atypical lymphocytes is typical of glandular fever

31
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
Acute infection is resolved leading to life-long sub-clinical infection (asymptomatic)
Common in the young

32
Q

What is the usual cause of lymphocytosis in elderly people?

A

Chronic lymphocytic leukaemia (CLL)
Autoimmune disorder
(will see mature lymphocytes)

33
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, involving more than one mother cell, so light chains express both kappa and lambda.
Indicative of INFECTION
In primary lymphocytosis, there will be a monoclonal expansion (all antibodies from one mother cell) so you will get either kappa or lambda restriction (not both) meaning that all the light chains are of one type. Indicative of CANCER.

34
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 - Indicative of CANCER.

35
Q

State a cause of primary lymphocytosis.

A

Monoclonal lymphoid proliferation e.g CLL

36
Q

What are the two main ways of evaluating lymphocytosis?

A

Monoclonal/Polyclonal expansion, looking at light chain expression
IG/TCR gene arrangement

37
Q

What gene is relevant in Malignant chronic eosinophilic leukaemia?

A

PDGFR fusion gene

38
Q

Describe the appearance of a blood film of someone with chronic myeloid leukaemia

A

Immature and mature cells,

Neutrophils, basophils and myelocytes

39
Q

Neutrophillia can develop in minutes, hours or days due to?

A

Minutes- Demargination
Hours- Early release from BM i.e sepsis
Days- Increased production (x3 in infection)

Haematology (11 decks)

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