Abnormal white cell count

Question 1

Recall 5 causes of a high WBC count

Answer 1

Infection
Inflammation
Leukaemia
Myeloproliferative disorder
Apoptotic gene mutation

Question 2

Recall 5 causes of a low WBC count

Answer 2

Aplastic anaemia
Haematological cancer
Metastatic cancer
B12/ folate deficiency
Immune breakdown

Question 3

What is a common initial presentation of AML?

Answer 3

Sore throat

Question 4

What would be seen in a blood film that was positive for leukaemia and not infection?

Answer 4

Immature WBCs

Question 5

Recall the laboratory markers that are indicative of acute leukaemia, that distinguishes it from infection

Answer 5

Immature cells
Elevated wbc count
Low Hb
Low platelets

Question 6

What is a normal value for white cell count?

Answer 6

4-11x10^9/ L

Question 7

What is a normal value for neutrophil count?

Answer 7

2.5-7.5x10^9/L

Question 8

Recall a possible cause for a neutrophilia that develops in a matter of minutes, hours and days

Answer 8

Minutes: demargination
Hours: early release from bone marrow
Days: infection

Question 9

How do neutrophils appear in the blood in the presence of infection?

Answer 9

Toxic granulation vacuoles present

Question 10

How do neutrophils appear in the blood in leukaemia?

Answer 10

High number of precursors

Question 11

Recall infection examples that will not produce a neutrophilia

Answer 11

Brucella

Typhoid

Question 12

Recall 4 common causes of a neutrophilia

Answer 12

Acute infection
Tissue inflammation
Underlying neoplasia
Malignancy

Question 13

Recall 6 reactive causes of eosinophilia

Answer 13

Drugs
Infection
Parasitic infection
Neoplasia
Hypereosinophilic syndrome
Allergy

Question 14

How is eosinophilia stimulated by hodgkin’s lymphoma?

Answer 14

Lymphoma secretes the cytokine IL-5 which stimulates a reactive eosinophilia

Question 15

What is the most important thing to look for when trying to establish the cause of a lymphocytosis and why?

Answer 15

Maturity of cells:

Mature cells indicate a reaction to infection, whereas immature cells are indicative of a leukaemia/ lymphoma

Question 16

Recall 3 possible causes of lymphocytosis when the WBCs on the blood film are mature

Answer 16

CLL
AI
Inflammation

Question 17

Recall a possible cause of lymphocytosis when the WBCs on the blood film are immature

Answer 17

ALL

Question 18

Describe the differences in cell expansion between primary and secondary causes of lymphocytosis

Answer 18

Primary = monoclonal

Secondary (reactive) = polyclonal

Question 19

Recall a cause of monoclonal lymphoid proliferation

Answer 19

CLL

Question 20

Recall 4 causes of reactive lymphocytosis

Answer 20

Infection
AI
Neoplasia
Sarcoidosis

Question 21

What is mononucleuosis syndrome also known as?

Answer 21

Glandular fever

Question 22

Describe a blood film that is positive for mononucleosis syndrome

Answer 22

Immature lymphocytes that are ROUND and clumped together

Question 23

What is glandular fever an infection of?

Answer 23

EBV infection of B cells via the CD21 receptor

Question 24

What is the most common cause of lymphocytosis in the elderly?

Answer 24

CLL

Question 25

Recall the 3 things to assess in order to distinguish a reactive polyclonal response from a lymphoproliferative disorder

Answer 25

Morphology
Immunophenotype
Gene rearrangement

Question 26

How can immunophenotype be used to distinguish reactive polyclonal response from a lymphoproliferative disorder

Answer 26

Polyclonal expansion (infection)= 50:50 kappa:lambda light chains
Monoclonal (lymphoproliferative) = kappa/ lambda restricted

Question 27

How can gene rearrangement be used to distinguish a reactive polyclonal response from a lymphoproliferative disorder

Answer 27

In monoclonal response the Ig and TCR genes will have an identical configuration and not be rearranged