Abnormal white cell counts Flashcards
What is the difference between normal and malignant haemopoiesis?
Normal - polyclonal
Malignant - clonal (cancer cells).
Diagram showing normal haematopoiesis.
What are the stages of differentiation from a myeloblast to a neutrophil?
myeloblast –> premyelocyte –> myelocyte –> metamyelocyte –> neutrophil.
Only neutrophil should be present outisde of bone marrow.
When might immature blood cells be present in the blood alongside mature ones?
Stress - e.g. sepsis
Cancer
What factors are responsible for controlling cell numbers of erythroid, lymphoid, myeloid cells?
Erythroid - erythropoietin
Lymphoid - IL2
Myeloid - G-CSF, M-CSF.
Cytokines influences differentiation and proliferation.
DNA directs this too. Damage can lead to cancer.
Diagram showing balance of cell production and survival.
What can cause increased/decreased cell production and survival?
What are the two main types of eosinophilia?
Reactive and malignant
What can stimulate/cause reactive eosiophilia?
- Inflammation
- Infection
- Increased cytokine production
–Distant tumour
–Haemopoietic or non haemopoietic
What can cause malignant eosinophilia?
- Cancers of haemopoietic cells
- Leukaemia
–Myeloid or lymphoid
–Chronic or acute
•Myeloproliferative disorders
What cell counts are associted with CML?
Large numbers of platelets/megakaryocytes, granulocytes, monocytes.
How is a raised WCC generically investigated?
- History and examination
- Haemoglobinand platelet count
- Automated differential
- Examine blood film
How can a raised WCC be investigated differentially?
Are only WBC abnormal, or are RBC and platelets also effected?
Is only one type oc WBC effected or all lineages (e.g. neutrophils/eosinophils/monocytes/lymphocytes).
Are only mature cells present or mature and immature cells?
FBC normal ranges.
Hb, platelets, WCC, neutro, lympho, mono, eosin, baso
Hb 120-160g/l
Platelets 150-400 x 109/l
WCC 4-11 x 109/l
Neutrophils 2.5-7.5 x 109/l
Lymphocytes 1.5-3.5 x 109/l
Monocytes 0.2-0.8 x 109/l
Eosinophils 0.04-0.44 x 109/l
Basophils 0.01-0.1 x 109/l
Outline the lifespan and location of neutrophils.
- Present in BM, blood and tissues
- Life span 2-3 days in tissues (hours in PB)
- 50% circulating neutrophils are marginated(not counted in FBC)
In what time period can neutrophilia develop? What might the cuase be?
- minutes > demargination
- hours > early release from BM
- days > increased production (x3 in infection)
Compare peripheral blood (PB) in infection and leukaemia.
Infection -
Neutrophilia >7.5x109/l
toxic granulation vacuoles
Leukaemia -
Chronicleukaemia
Chronic myeloid leukaemia
Neutrophilia and Precursor cells (myelocytes)
Give some potential causes of neutrophilia.
- Infection
- Tissue inflammation (e.g.colitis, pancreatitis)
- Physical stress, adrenaline, corticosteroids
- underlying neoplasia
- Malignant neutrophilia
- myeloproliferative disorders
- CML
How does neutrophilia relate to infection?
Seen in localised and systemic infections - e.g. acute bacterial, fungal, etc.
Often characteristically not seen - e.g. brucella, typhoid, many viral infections.
Name potential causes of eosinophilia.
Reactive -
- Parasitic infestation
- Allergic diseases e.g. asthma, rheumatoid, polyarteritis,pulmonaryeosinophilia.
- Neoplasms, esp. Hodgkin’s, T-cell NHL
- Hypereosinophilicsyndrome
Malignant Chronic Eosinophilic Leukaemia (PDGFR fusion gene)
Mutations in which precursor relate to eosinophilic malignant disease ?
GM CFC.
What can cause monocytosis?
- TB, brucella, typhoid
- Viral; CMV, varicella zoster
- Sarcoidosis
- Chronic myelomonocytic leukaemia (MDS)
Diagram to show potential causes of elevated WCC
Compare lymphocytosis involving mature and immature cells.
Mature - reactive to infection
immature - leukaemia/lymphoma
What can cause reactive lymphocytosis?
Infection
- EBV, CMV, Toxoplasma
- infectious hepatitis, rubella, herpes infections
Autoimmune disorders
neoplasia
sarcoidosis
