Abnormal White Cell Count

Question 1

When do you find reactive marrow physiologically

Answer 1

In someone with infection

Question 2

When is malignant haemopoiesis seen

Answer 2

In someone with leukaemia

Question 3

A myeloblast becomes a…

Answer 3

A promyelocyte

Question 4

A promyelocyte becomes a…

Answer 4

myelocyte

Question 5

A metamyelocyte becomes a…

Answer 5

neutrophil

Question 6

In what exceptions do you immature neutrophils peripherally

Answer 6

during sepsis
chemo patients
and in CML

Question 7

what is LEUKOERYTHROBLASTIC PICTURE

Answer 7

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

Question 8

What hormone and/or cytokine influences erythroid maturation

Answer 8

erythropoietin

Question 9

What cytokine influences lymphoid maturation

Answer 9

IL2

Question 10

What cytokine influences myeloid maturation

Answer 10

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

Question 11

What are the three granulocytes

Answer 11

neutrophils, eosinophils, basophils

Question 12

What are the phagocytic cells of the body

Answer 12

Monocytic cells

Granulocytic cells

Question 13

4 reasons for increased WBC production?

Answer 13

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

Question 14

reason for increased WBC survival?

Answer 14

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

Question 15

5 reasons for decreased WBC production?

Answer 15

 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)

Question 16

Reason for decreased WBC survival? (2)

Answer 16

Immune breakdown, ITP immune thrombocytopenic purpura

Question 17

Normal causes of eosinophilia? (3)

Answer 17

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

Question 18

abnormal causes of eosinophilia? (3)

Answer 18

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

Question 19

What is the most important test for a full diagnosis

Answer 19

Examination of a blood film

Question 20

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

Answer 20

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?

Question 21

When does risk of infection become significant re. neutrophil count

Answer 21

when neutrophils fall below 1

Question 22

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

Answer 22

when they’re below 0.5

Question 23

Normal life span of neutrophils? (tissues and blood)

Answer 23

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

Question 24

what is marginated neutrophils

Answer 24

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

Question 25

How can neutrophilia develop in minutes

Answer 25

Due to demargination (neutrophils leaving tissues)

Question 26

How can neutrophilia develop in hours

Answer 26

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

Question 27

How can neutrophilia develop in days

Answer 27

Increased production (x3 in infection)

Question 28

Causes of neutrophilia (5)

Answer 28

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

Question 29

What infections don't produce neutrophilia

Answer 29

Brucella, typhoid, many viral infections

Question 30

2 types of eosiniphilia?

Answer 30

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

Question 31

How to test for MALIGNANT CHRONIC EOSINOPHOLIC LEUKAEMIA

Answer 31

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

Question 32

4 causes of monocytosis?

Answer 32

- TB, Brucella, typhoid - Viral; CMV, varicella zoster - Sarcoidosis - Chronic myelomonocytic leukaemia (an example of an MDS)

Question 33

What type of infection causes raised neutrophil count

Answer 33

Bacterial

Question 34

What type of infection causes raised eosinophil count

Answer 34

Parasitic

Question 35

What type of infection causes raised basophil count

Answer 35

Pox iruses

Question 36

What type of infection causes raised monocyte count

Answer 36

Chronic infections (TB, brucella)

Question 37

What type of infection causes raised monocyte count

Answer 37

Chronic infections (TB, brucella)

Question 38

2 types of lymphocytosis?

Answer 38

Mature and immature

Question 39

What causes mature lymphocytosis? (2)

Answer 39

- 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

Question 40

What causes immature lymphocytosis?

Answer 40

- Primary disorder (leukaemia/lymphoma)

Question 41

What type of infection causes mature lymphocytosis

Answer 41

Mainly viral

Question 42

What type of autoimmune disorders causes mature lymphocytosis

Answer 42

- Neoplasia, sarcoidosis

Question 43

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

Answer 43

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

Question 44

How to evaluate lymphocytosis? Whats the principle behind this?

Answer 44

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