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
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
