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notes to flashcards year 2 - MCD > Abnormal White Cell count > Flashcards

Abnormal White Cell count Flashcards

1
Q

What does neutro-cytopenia/cytosis mean?

A
  • reduced/raised cell counts
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2
Q

what does pancytopenia mean?

A

all cell lines reduced

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3
Q

where does normal haemopoiesis occur? when is it is normal/malignant?

A
  • occurs in bone marrow
  • normal haemopoiesis can occur in normal situations and in reactive situations
  • malignant happens in leukaemia, myelodysplasia and myeloproliferative
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4
Q

haematopoeitic stem cells can differentiate into many cell lines, including BFU-E. what are they?

A

blast forming unit erythrocyte

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5
Q

normally where do the steps of differentiation and maturation occur?

A
  • normally first 4 steps of differentiation and mature occur within bone marrow
  • neutrophil is formed in peripheral blood
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6
Q

what happens in pathology?

A

this changes

cell becomes smaller –> cytoplasm clearer –> multi-lobed nucleus

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7
Q

how is cell differentiation controlled?

A

via cytokines

  • RBCs by EPO
  • lymphoid cells by IL-2
  • myeloid cells by G-CSF, M-CSF
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8
Q

what does DNA damage in cancer do?

A

affect these regulating signals and lead to cancer proliferation

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9
Q

define leukaemia, lymphoma/leukaemia, myeloma

A

leukaemia: malignant process in primary lymphoid organs
lymphoma: lymphatic cell tumours in tissue/blood
- myeloma: disease of bone marrow

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10
Q

what can inc. WBC count be due to?

A
  • inc. cell production (reactive or malignant)

- inc. cell survival

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11
Q

name the reactive reasons

A
  • inflammation

- infection

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12
Q

name the malignant reasons

A
  • leukaemia

- myeloproliferative

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13
Q

what causes inc. cell survival?

A

failure of apoptosis (e.g. acquired cancer causing mutations in some lymphomas)

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14
Q

what can decreased WBC count be due to?

A
  • dec. cell production

- dec. cell survival

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15
Q

what causes dec. cell production?

A
  • impaired BM function
  • B12 or folate def
  • BM failure: aplastic anaemia, post chemotherapy, metastatic cancer, haematological cancer
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16
Q

what causes dec. cell survival?

A

immune breakdown

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17
Q

what is the difference between the WBC in normal infection and cancer?

A
  • normal infection: inc. WBC is reactive and mature cells released
  • haematopoietic cancers, immature and mature cells released
18
Q

what are the 2 causes of inc. number of eosinophilia?

A
  • reactive: infection/inflammation

- primary: malignant

19
Q

give an example of a malignany haematopoiesis?

A

CML

mutation occurs at GM-CFC

20
Q

how do you investigate a raised WCC?

A
  • history
  • exam
  • Hb and platelet count
  • blood film
  • abnormalities in white ells or all cell lineages
21
Q

what do you think about if there are immature cells?

A

think about leukaemia

22
Q

what do you think about when there are immature AND mature cells?

A

chronic leukaemia if in presence of neutrophils and myelocytes

23
Q

how does acute leukaemia present?

A

low Hb and platelets

24
Q

where are neutrophilia found?

A
  • present across BM, blood and tissues
  • life span of 2-3 days in tissues and hours in PB
  • 50% are marginalised (have stuck onto wall of a damaged vessel so aren’t in FBC)
25
Q

how long does it take neutrophilia to develop?

A
  • minutes: demargination
  • hours: early release from BM i.e. sepsis
  • days: inc. production - i.e. in infection
26
Q

what are the causes of neutrophilia?

A
  • infection
  • tissue inflammation
  • physical stress
  • adrenaline
  • corticosteroids
  • neoplasia
  • malignant neutrophilia
27
Q

what is the normal cause of neutrophilia?

A
  • infection (local and systemic, acute bacterial, fungal, certain viral infections)
  • some infections do NOT produce neutrophila (e.g. Brucella, typhoid)
28
Q

what are the reactive causes of eosinophilia?

A
  • parasitic infection
  • allergic disease
  • neoplasms - esp Hodgkin’s
  • hypereosinophilic syndrome
29
Q

when is monocytosis seen? what are the causes?

A 
- rare but seen in certain chronic infections and primary haematological disorders
causes:
- TB, brucella, typhoid
- Viral - CMV, VZV
- Sarcoidosis
- CML
30
Q

when are mature lymphocytes seen?

A

either reactive to infection or primary disorder

31
Q

when are immature lymphocytes seen?

A

primary disorder only

not reactive

32
Q

what are the secondary/reactive causes of lymphocytosis?

A

polyclonal response to infection, chronic inflammation or underlying malignancy

  • infection
  • AI
  • neoplasia
  • sarcoidosis
33
Q

what are the causes of primary lymphocytosis?

A

monoclonal lymphoid proliferation e.g. CLL

34
Q

what is seen in mononucleosis?

A
  • reactive looking lymphocyte
  • looks like immature lymphocyte seen in ALL
  • but these lymphocytes tend to have RBCs clump them
  • they are jagged and not self clumped
35
Q

what does a high WCC with reactive looking lymphocytes show?

A

glandular fever

36
Q

what causes glandular infection?

A
  • caused by EBV infection of B lymphocytes via CD21 receptor
  • infected B cell proliferates and expresses EBV-associated antigens
  • causes a cytotxic T- cell response
37
Q

what are the causes of lymphocytosis in the elderly?

A
  • more often going to be CLL or an AI disorder

- will see mature lymphocytes

38
Q

what is lymphocytosis in the elderly distinguishable by?

A
  • morphology
  • immunophenotype
  • gene rearrangement
39
Q

when evaluating lymphocytosis, what is polyclonal expansion?

A
  • involves more than 1 mother cell
  • so light chains express both kappa and lambda
  • indicative of a response to infection
40
Q

when evaluating lymphocytosis, what is monoclonal expansion?

A

all antibodies are from ONE mother cell

indicative of cancer

41
Q

what happens in primary monoclonal proliferation?

A

all daughter cells carry IDENTICAL TCR gene arrangement

isn’t normal for infection, indicative of cancer

notes to flashcards year 2 - MCD (24 decks)

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