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Haematology Y2 > Abnormal White Cell Count > Flashcards

Abnormal White Cell Count Flashcards

1
Q

When do you find reactive marrow physiologically

A

In someone with infection

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2
Q

When is malignant haemopoiesis seen

A

In someone with leukaemia

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3
Q

A myeloblast becomes a…

A

A promyelocyte

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4
Q

A promyelocyte becomes a…

A

myelocyte

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5
Q

A metamyelocyte becomes a…

A

neutrophil

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6
Q

In what exceptions do you immature neutrophils peripherally

A

during sepsis
chemo patients
and in CML

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7
Q

what is LEUKOERYTHROBLASTIC PICTURE

A

presence of myeloid precursors together with nucleated red cells (also immature) in the blood

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8
Q

What hormone and/or cytokine influences erythroid maturation

A

erythropoietin

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9
Q

What cytokine influences lymphoid maturation

A

IL2

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10
Q

What cytokine influences myeloid maturation

A

G-CSF, M-CSF, and GM-CSF

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11
Q

What are the three granulocytes

A

neutrophils, eosinophils, basophils

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12
Q

What are the phagocytic cells of the body

A

Monocytic cells

Granulocytic cells

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13
Q

4 reasons for increased WBC production?

A 
 Reactive to disease etc:
-	Infection
-	Inflammation
 Malignant
-	Leukaemia
-	Myeloproliferative
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14
Q

reason for increased WBC survival?

A

 Failure of cell apoptosis (e.g. acquired cancer causing mutation in some lymphomas)

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15
Q

5 reasons for decreased WBC production?

A 
 Impaired bone marrow (BM) function:
-	B12 or folate deficiency
-	Bone marrow failure:
Aplastic anaemia
Post chemo
Metastatic cancer
Haematological cancer (e.g. lymphoma- expansion of cells means less nutrients are available for normal cells leading to pancytopaenia)
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16
Q

Reason for decreased WBC survival? (2)

A

Immune breakdown, ITP immune thrombocytopenic purpura

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17
Q

Normal causes of eosinophilia? (3)

A
  • Inflammation
  • Infection (particularly parasitic)
  • Increased cytokine production(e.g. IL5):
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18
Q

abnormal causes of eosinophilia? (3)

A
  • Cancers of haemopoietic cells
  • Leukaemia:
     Myeloid or lymphoid
     Chronic or acute
  • Myeloproliferative disorders
19
Q

What is the most important test for a full diagnosis

A

Examination of a blood film

20
Q

How do you investigate a raised white cell count - 6 steps

A
  1. History and examination
  2. Haemoglobin and platelet count
  3. Examine blood film
  4. Only abnormal white cells, or all 3 linages affected (RBCs, platelets, white cells (IN CML ALL WHITE CELLS INCREASE)?
  5. Only one type of white cells, or more (e.g. neutrophils, eosinophils, monocytes etc.)?
  6. Mature cells only, or mature and immature?
21
Q

When does risk of infection become significant re. neutrophil count

A

when neutrophils fall below 1

22
Q

When does risk of infection become very worrying re. neutrophil count

A

when they’re below 0.5

23
Q

Normal life span of neutrophils? (tissues and blood)

A

2-3 days in tissues (and only hours in the peripheral blood)

24
Q

what is marginated neutrophils

A

Taken into the blood from tissues and vice versa very quickly (not counted in FBC)

25
Q

How can neutrophilia develop in minutes

A

Due to demargination (neutrophils leaving tissues)

26
Q

How can neutrophilia develop in hours

A

Early release from BM e.g. due to inflammation or infection

27
Q

How can neutrophilia develop in days

A

Increased production (x3 in infection)

28
Q

Causes of neutrophilia (5)

A
  • Infection
  • Tissue inflammation (e.g. colitis, pancreatitis)
  • Physical stress, adrenaline, corticosteroids
  • Underlying neoplasia
  • Malignant neutrophilia Myeloproliferative disorders, chronic myeloid leukaemia (CML)
29
Q

What infections don’t produce neutrophilia

A

Brucella, typhoid, many viral infections

30
Q

2 types of eosiniphilia?

A
  1. REACTIVE

2. MALIGNANT CHRONIC EOSINOPHOLIC LEUKAEMIA (PDGFR FUSION GENE MUTATION)

31
Q

How to test for MALIGNANT CHRONIC EOSINOPHOLIC LEUKAEMIA

A

we take peripheral blood from patient and do molecular tests to see if it is as a result of malignant disease

32
Q

4 causes of monocytosis?

A
  • TB, Brucella, typhoid
  • Viral; CMV, varicella zoster
  • Sarcoidosis
  • Chronic myelomonocytic leukaemia (an example of an MDS)
33
Q

What type of infection causes raised neutrophil count

A

Bacterial

34
Q

What type of infection causes raised eosinophil count

A

Parasitic

35
Q

What type of infection causes raised basophil count

A

Pox iruses

36
Q

What type of infection causes raised monocyte count

A

Chronic infections (TB, brucella)

37
Q

What type of infection causes raised monocyte count

A

Chronic infections (TB, brucella)

38
Q

2 types of lymphocytosis?

A

Mature and immature

39
Q

What causes mature lymphocytosis? (2)

A
  • Secondary (reactive) Polyclonal response to infection, chronic inflammation, or underlying malignancy
  • Primary disorder; monoclonal (all cells derived from same mother cell- have same antigens) lymphoid proliferation e.g. CLL, or autoimmune/inflammatory disease
40
Q

What causes immature lymphocytosis?

A
  • Primary disorder (leukaemia/lymphoma)
41
Q

What type of infection causes mature lymphocytosis

A

Mainly viral

42
Q

What type of autoimmune disorders causes mature lymphocytosis

A
  • Neoplasia, sarcoidosis
43
Q

HOW DO YOU DISTINGUISH BERWEEN AUTOIMMUNE AND CLL (MONOCLONAL FROM POLYCLONAL, REACTIVE AND MALIGNANT)? (3)

A
  • Morphology
  • Immuno-phenotype – distinguishes different lymphocytes by the molecules on their surface.
  • Gene re-arrangement – uses PCR
44
Q

How to evaluate lymphocytosis? Whats the principle behind this?

A

SOUTHERN BLOT ANALYSIS
Ig and T cell receptor (TCR) genes undergo recombination in antigen stimulated T cells or B cells
With primary monoclonal proliferation all daughter cells carry identical configuration of Ig, or TCR gene

Haematology Y2 (11 decks)

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