Abnormal White Blood Cell Count Flashcards
What is the lymphoid lineage?
Lymphoid cells are lymphocytes = T cells, B cells and NK cells
Which cells come under the myeloid lineage?
Erythrocytes Neutrophils Basophils Eosinophils Monocytes Macrophages Megakaryocytes Dendritic Cells
Describe how the appearance of white cells changes as they develop.
They become smaller and their cytoplasm becomes clearer.
Which factors stimulate the following cell lines:
a. Lymphoid
b. Myeloid
c. Erythroid
a. Lymphoid - IL-2
b. Myeloid - G-CSF, M-CSF
c. Erythroid - Erythropoietin
Define Leukaemia.
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.
Define Lymphoma.
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.
Define Myeloma.
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
Broadly speaking, what can cause an increase in white blood cell count?
Increased white blood cell production
Increased white blood cell survival
(Opposite for decreased WBC)
What two broad categories of diseases can cause an increase in white blood cell count?
Reactive – in response to infection or inflammation
Primary – malignant
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)?
Reactive – only mature white blood cells
Primary – mature AND immature white blood cells present
Where does the mutation occur in chronic myeloid leukaemia?
GM-CFC phase (granulocyte-monocyte colony forming cell)
If there are only immature cells in the blood film with low haemoglobin and low platelets, what would you suspect?
Acute leukaemia
What are the normal ranges of:
a. Hb
b. Platelets
c. WCC
d. Neutrophils
e. Lymphocytes
f. Monocytes
g. Eosinophils
h. Basophils
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
What can cause an elevated lymphocyte count?
Viral infections
Chronic lymphocytic leukaemia
What is the lifespan of a neutrophil?
Hours in the peripheral blood
2-3 days in the tissues
What is margination of neutrophils?
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)
Describe the differences in the appearance of neutrophils in infection compared to leukaemia.
Neutrophils in infection are granular (show toxic granulation)
Neutrophils in leukaemia show absence of granules
What else would be present in the blood film of someone with leukaemia that would not be present in someone with an infection?
Myelocytes – these precursors would not be found in the peripheral blood of someone responding to infection
State some causes of neutrophilia.
Infection Inflammation Physical stress Adrenaline Corticosteroids Underlying neoplasia Malignant neutrophilia (myeloproliferative disorders, chronic myeloid leukaemia)
What types of infection cause neutrophilia?
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
State some infections that characteristically do NOT produce neutrophilia.
Brucella
Typhoid
Many viral infections
State some reactive causes of eosinophilia.
Parasitic infection
Allergic diseases e.g. asthma
Neoplasms e.g. Hodgkin’s lymphoma and T-cell NHL (Non-Hodgkin’s)
Hypereosinophilic syndrome
State a malignant cause of eosinophilia.
Malignant chronic eosinophilic leukaemia (INCREDIBLY RARE)
What are the characteristic features of someone with Hodgkin’s lymphoma?
Increased mediastinal mass
Increased IL-5 secretion
Can also get mutation in GM-CFC
