Abnormal White Cell count Flashcards
Which white blood cells should you normally be ableto detect in a blood film?
Which finding would be abnormal?
Normally you should find
- Immunocytes (mature)
- T-cells
- B-cells
- NK-cells
- Phagocytes
- Granulocytes
- Eosinophils
- Neutrophils
- Basophils
- Monocytes
- Granulocytes
You shold not find any precursor cells in a normal blood film
What is a Leukoerythroblastic picture?
What can it indicate?
presence of immature forms of red and white cells in the peripheral blood
–> may indicate either sepsis or bone marrow cancer
Explain general/overall reasons for leukocytosis
Either
- Increased cell production
- Reactive
- Inefction
- Inflammation
- Malignant
- Leukaemia
- Myleoproliferative
- Reactive
- Increased cell survival
Explain the overall causes of leukopenia
- Decreased cell production (in bone Marrow)
- B12/FA deficiency
- BM failure
- Aplastic anaemia
- Post chemotherapy
- Metastatic cancer
- Haematological cancer
- Decreased cell survival
- immune break down
What are posible causes for eosinophilia?
- Reactive (Normal Haemopoiesis stimmulated by)
- Inflammation
- Infection
- Increased cytokine production
- –Distant tumour
- –Haemopoietic or non haemopoietic
- Primary –> Malignant —> AbnormalHaemopoiesis (autonomous cell growth)
- Cancers of haemopoietic cells
- Leukaemia
- –Myeloid or lymphoid
- –Chronic or acute
- Myeloproliferative disorders
How do you investigate a raised WCC?
- History and Examination
- recent travels, smoking (causes elevation)
- Lymph nodes enlarged?, Hepatosplenogamy?
- HB+ platelet count
- isolated leukopenia? Reactive leucocytosis (together with low BP –> sepsis?
- All raised (inkl. WBC) —> Myloproliferative disorder?
- Automated differential
- Examine blood film
- Mature cells? Immature cells
When looking at the automated differential of a blood film, what do you look for?
If there is no differential available –> no clear differentiation of cells (malignancy or premature release)
- Normal after GCSF injections (after chemotherapy)
Only 1 cell type elevated? All cell types elevated?
What is the normal timespan of a developin neutrophilia?
Neutrophilia can develop in:
- minutes > demargination of adhered neutrophils into circulation
- hours > early release from BM
- days > increased production (up to x3 in infection)
What are the possible causes for neutrophilia?
•Infection!!!
- Tissue inflammation (e.g.colitis, pancreatitis)
- Physical stress, adrenaline, corticosteroids
- underlying neoplasia
•
- •Malignant neutrophilia
- myeloproliferative disorders
- CML
How does a blood film with neutrophilia look like in infection compared to a malignant one?
In infections
- Neutrophils are toxically granulated with included vacuoles
In Malignancy
- non-differentiated, premature cells
What kind of infections can induce a neutrophilia?
- Localised and systemic infections
- acute bacterial, fungal, certain viral infections
NO Neutrophilia e.g. brucella, typhoid, many viral infections.
In which conditions would you expect to see a eosinophilia?
- 1 Reactive
- Parasitic infestation
- Allergic diseases e.g. asthma, rheumatoid, polyarteritis,pulmonary eosinophilia.
- Neoplasms, esp. Hodgkin’s, T-cell NHL
- Hypereosinophilic syndromMalignant Chronic Eosinophilic Leukaemia (PDGFR fusion gene)
In which conditions do you expect to see a Monocytosis?
- Part of inflammatory process
- Typical in viral infections
- TB, brucella, typhoid
- Malignancy: Chronic myelomonocytic leukaemia (MDS)
If a lymphocytosis has many immature cells- what might be the cause?
Usually: primary disorder (leukaemia/lymphoma)
If in a lymphocytosis there are mainly mature cells, what might be the reason?
If mature can be both:
- reactive to infection
- primary disorder
How could you differentiate between a secondary (reactive) lymphocytosis or a primary (proliferative) lymphocytosis?
Is it primary or reactive ?
- Secondary (reactive); polyclonal response to infection, chronic inflammation, or underlying malignancy.
- Primary; monoclonal lymphoid proliferation e.g. CLL
How can a lymphocytosis be secondary to malignancy?
It might be that the tumor is not in the bone marrwo but produces e.g. cytokines or induces infections that increase lymphocyte producition
What are the characteristics in a blood film when looking for mature vs. immature lymphocytes?
Mature
- all should look different
- big nucleus (almost no cytoplasm)
Immature
- cytoplasm visible
How can you differentate a reactive polyclonal lymphocytosis from a lymphoprolaferative disorder?
Mature vs Immature
- Mature= reactive or primary disorder
- Immature= primary disorder
Polyclonal vs Monoclonal
- Polyclonal
- Or Monoclonal: With primary monoclonal proliferation all daughter cells carry identical configuration of Ig, or TCR gene. This can be detected by Southern Blot analysis
