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Ov haem > 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

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

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

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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 theperipheral 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

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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12
Q

What can cause an elevated lymphocyte count?

A

Viral infections

Chronic lymphocytic leukaemia

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13
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)

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14
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 do not have granules and do not look toxic.

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15
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 and metamyelocytes – these precursors would not be found in the peripheral blood of someone responding to infection

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16
Q

State some causes of neutrophilia.

A 
Infection 
Inflammation  
Physical stress 
Adrenaline 
Corticosteroids  
Underlying neoplasia
Malignant neutrophilia (myeloproliferative disorders, chronic myeloid leukaemia)
17
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

18
Q

State some infections that characteristically do NOT produce neutrophilia.

A

Brucella
Typhoid
Many viral infections

19
Q

State some reactive causes of eosinophilia.

A

Parasitic infection

Allergic diseases e.g. asthma Neoplasms e.g. Hodgkin’s and Non-Hodgkin’s Hypereosinophilic syndrome

20
Q

State a malignant cause of eosinophilia.

A

Malignant chronic eosinophilic leukaemia (INCREDIBLY RARE)

21
Q

What would you see in the chest X-ray of someone with Hodgkin’s lymphoma?

A

Increased mediastinal mass

22
Q

What can cause monocytosis?

A

RARE but it is seen in certain chronic infections and primary haematological disorders
TB, brucella, typhoid
CMV, varicella zoster
Sarcoidosis
Chronic myelomonocytic leukaemia (MDS – myelodysplastic syndrome)

23
Q

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

A

The lymphocytes have a typical appearance – big nucleus + little cytoplasm
They are mature lymphocytes

24
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

25
Q

State some causes of reactive lymphocytosis.

A

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

26
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

27
Q

What is the usual cause of lymphocytosis in elderly people?

A

Chronic lymphocytic leukaemia (CLL)

28
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 meaning that the light chains of the antigens produced by B cells and the B cell receptors will have a 50:50 kappa and lambda divide
In primary lymphocytosis, there will be a monoclonal expansion so you will get kappa or lambda restriction meaning that all the light chains are of one type

29
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

30
Q

Causes of high mature lymphocytes

A

Viral or CML

31
Q

Causes of elevated all lineages or only one lineage

A

Infection

32
Q

Causes of high mature and immature neutrophils, myelocytes and basophils

A

CML

33
Q

Causes of elevated blasts, low Hb and low platelets

A

Acute leukaemia

34
Q

Another name for glandular fever

A

Mononucleosis syndrome

Ov haem (11 decks)

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