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MCD Haematology > Abnormal white cell count- tricky > Flashcards

Abnormal white cell count- tricky Flashcards

1
Q

What does lymphoid mean?

A

Relating to or denoting the tissue responsible for producing lymphocytes (T cells, B cells and NK cells)

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2
Q

In the bone marrow, what sort of cells do you start haematopoiesis with ?

A

Haematopoietic stem cells

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3
Q

What happens to haematopoietic stem cells?

A

They become committed to different lineages such as pre T, pre B, Meg-CFC, GM-CFC etc

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4
Q

What are Meg-CFC?

A

Megakaryocyte colony forming cells

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5
Q

What are GM-CFC?

A

Granulocyte macrophage colony forming cells

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6
Q

As a myeloblast matures into a neutrophil, what happens?

A

Cell becomes smaller and smaller
Cytoplasm becomes clearer
Multi-lobed nuclei form

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7
Q

What regulates haematopoiesis?

A

Cytokines
Chemokines
Hormones

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8
Q

What factors stimulate haematopoiesis in myeloid, lymphoid and erythroid?

A

Myeloid: G-CSF and M-CSF
Lymphoid: IL2
Erythroid: Erythropoietin

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9
Q

What can DNA damage during differentiation cause?

A

These cells can stop being regulated and will have a survival advantage so stops being regulated by cytokines and starts replicating uncontrollably causing cancer

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10
Q

What is leukaemia?

A

A malignant progressive disease in which bone marrow and the blood-forming organ produce increased numbers of immature or abnormal leukocytes, this leads to suppression of production of other blood cells such as erythrocytes, granulocytes and platelets

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11
Q

What is lymphoma?

A

Any group of blood cell tumours that develop from lymphatic cells. If it is mainly in the lympathic tissue then it is lymphoma, if it is mainly in the blood then it is leukaemia

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12
Q

What is myeloma?

A

A malignant disease of the bone marrow characterised by two or more of the following criteria:
Presence of an excess of abnormal malignant plasma cells in the bone marrow
Typical lytic deposits in the bones on X-ray, giving the appearance of holes
The presence in the serum of an abnormal gammaglobulins, usually IgG

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13
Q

What causes increased white cell production?

A 
Reactive:
-Infection 
I-nflammation 
Malignant:
-Leukaemia
-Myeloproliferative
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14
Q

What causes decreased white cell production?

A 
Impaired bone marrow function
B12 or folate deficiency
Bone marrow failure:
-Aplastic anaemia
-Post chemotherapy 
-Metastatic cancer
-Haematological cancer
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15
Q

What causes increased white cell survival?

A

Failure of apoptosis (acquired in cancer)

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16
Q

What causes decreased white cell survival?

A

Immune breakdown

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17
Q

What is the difference between the cells that will be released in response to infection and in cancer?

A

In response to infection - mature cells

Cancer- immature and mature

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18
Q

In chronic myeloid leukaemia, where does the mutation occur?

A

GM-CFC

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19
Q

What effect does the GM-CFC have?

A

Massive proliferation of the myeloid cells beyond this point

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20
Q

How do you investigate a raised white cell count?

A

History and examination
Haemoglobin and platelet count
Automated differential
Examine blood film

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21
Q

What is a key sign in the blood film of leukaemia?

A

Immature cells

22
Q

What is the normal range for blood Hb?

A

120-160g/l

23
Q

What is the normal range for platelets?

A

150-400 x 10^9/l

24
Q

What is the normal range for WCC?

A

4-11 x 10^9/l

25
Q

What is the normal range for neutrophils?

A

2.5-7.5 x 10^9/l

26
Q

What is the normal range for lymphocytes?

A

1.5-3.5 x 10^9/l

27
Q

What is the normal range for monocytes?

A

0.2-0.8 x 10^9/l

28
Q

What is the normal range for eosinophils?

A

0.04-0.44 x 10^9/l

29
Q

What is the normal range for basophils?

A

0.01-0.1 x 10^9/l

30
Q

Where are neutrophils found?

A

Bone marrow, blood and tissues

31
Q

How long do neutrophils survive in tissues and blood?

A

2-3 days in tissue

Hours in blood

32
Q

50% of circulating neutrophils are marginated, what does this mean?

A

They have stuck onto the wall of a damaged vessel (not counted in FBC)

33
Q

Explain causes for neutrophilia developing in minutes, hours and days

A

Minutes- Demargination
Hours- Early release from bone marrow
Days- Increased production

34
Q

How can you tell the difference between infection and leukaemia?

A

Infection will have high WCC and granular neutrophils
Leukaemia will have neutrophils but not granular ones, also myelocytes and metamyelocytes will be present which aren’t in response to infection

35
Q

What causes neutrophilia?

A

Infection
Tissue inflammation
Physical stress- adrenaline and corticosteroids
Underlying neoplasia
Malignant neutrophilia- myeloproliferative disorders and CML

36
Q

What type of infections does neutrophilia occur in?

A

Local and systemic

Acute bacteria, fungal and certain viral infections

37
Q

If you had a low neutrophil count but other features of infection, what can you deduce?

A

Viral infection

38
Q

What infections characteristically don’t produce neutrophilia?

A

Brucella, typhoid, many viral ones

39
Q

What causes eosinophilia?

A 
Reactive:
-Parasitic infection
-Allergic diseases e.g. asthma
-Neoplasms
-Hypereosinophilic syndrome
Malignant Chronic Eosinophilic Leukaemia (PDGFR)- Rare
Hodgkin's disease
40
Q

How can you tell if someone has Hodgkin’s disease?

A

Increased mediastinal mass on chest X-ray

41
Q

When is monocytosis seen?

A 
Rare but seen in certain chronic infections and primary haematological disorders e.g:
TB, brucella and typhoid
Viral: CMV
Sarcoidosis
CML
42
Q

What would the blood film of someone with CLL or autoimmune/inflammatory disease be like?

A

Cells very similar to each other

Typical appearance of mature lymphocyte with big nucleus and little cytoplasm

43
Q

What would the blood film of someone with acute lymphoblastic leukaemia?

A

Immature lymphocytes- much larger than mature ones and you can see nucleolus

44
Q

What causes reactive lymphocytosis?

A 
Infection
EBV, CMV, toxoplasma
Infectious, hepatitis, rubella and herpes infections
Autoimmune disorders
Neoplasia
Sarcoidosis
45
Q

What do you see in mononucleosis syndrome?

A

An atypical reactive looking lymphocyte- it isn’t round like normal lymphocytes and it extends between red cells and the nucleus looks weird because it lacks nucleoli

46
Q

What is mononucleosis syndrome typical of?

A

Glandular fever

47
Q

What is glandular fever?

A

EBV infection of B lymphocytes via CD21 receptor which proliferate and express EBV associated antigens

48
Q

How does the body respond to glandular fever?

A

Cytotoxic T-lymphocyte response and the acute infection is resolved resulting in lifelong sub-clinical infection

49
Q

What is the most likely cause of lymphocytosis in elderly?

A

Chronic lymphocytic leukaemia (mature lymphocytes and maybe smear cells)

50
Q

Your differential diagnosis is reactive to underlying autoimmune disorder or chronic lymphocytic leukaemia, how can you distinguish?

A

Morphology
Immunophenotype
Gene rearrangement

51
Q

What sort of response will you get to an infection?

A

Polyclonal

MCD Haematology (11 decks)

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