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MCD - haematology > Abnormal white cell counts > Flashcards

Abnormal white cell counts Flashcards

1
Q

What is the difference between normal and malignant haemopoiesis?

A

Normal - polyclonal

Malignant - clonal (cancer cells).

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2
Q

Diagram showing normal haematopoiesis.

A
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3
Q

What are the stages of differentiation from a myeloblast to a neutrophil?

A

myeloblast –> premyelocyte –> myelocyte –> metamyelocyte –> neutrophil.

Only neutrophil should be present outisde of bone marrow.

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4
Q

When might immature blood cells be present in the blood alongside mature ones?

A

Stress - e.g. sepsis

Cancer

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5
Q

What factors are responsible for controlling cell numbers of erythroid, lymphoid, myeloid cells?

A

Erythroid - erythropoietin

Lymphoid - IL2

Myeloid - G-CSF, M-CSF.

Cytokines influences differentiation and proliferation.

DNA directs this too. Damage can lead to cancer.

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6
Q

Diagram showing balance of cell production and survival.

What can cause increased/decreased cell production and survival?

A
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7
Q

What are the two main types of eosinophilia?

A

Reactive and malignant

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8
Q

What can stimulate/cause reactive eosiophilia?

A
  • Inflammation
  • Infection
  • Increased cytokine production

–Distant tumour

–Haemopoietic or non haemopoietic

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9
Q

What can cause malignant eosinophilia?

A
  • Cancers of haemopoietic cells
  • Leukaemia

–Myeloid or lymphoid

–Chronic or acute

•Myeloproliferative disorders

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10
Q

What cell counts are associted with CML?

A

Large numbers of platelets/megakaryocytes, granulocytes, monocytes.

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11
Q

How is a raised WCC generically investigated?

A
  • History and examination
  • Haemoglobinand platelet count
  • Automated differential
  • Examine blood film
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12
Q

How can a raised WCC be investigated differentially?

A

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?

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13
Q

FBC normal ranges.

Hb, platelets, WCC, neutro, lympho, mono, eosin, baso

A

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

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14
Q

Outline the lifespan and location of neutrophils.

A
  • 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)
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15
Q

In what time period can neutrophilia develop? What might the cuase be?

A
  • minutes > demargination
  • hours > early release from BM
  • days > increased production (x3 in infection)
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16
Q

Compare peripheral blood (PB) in infection and leukaemia.

A

Infection -

Neutrophilia >7.5x109/l

toxic granulation vacuoles

Leukaemia -

Chronicleukaemia

Chronic myeloid leukaemia

Neutrophilia and Precursor cells (myelocytes)

17
Q

Give some potential causes of neutrophilia.

A
  • Infection
  • Tissue inflammation (e.g.colitis, pancreatitis)
  • Physical stress, adrenaline, corticosteroids
  • underlying neoplasia
  • Malignant neutrophilia
  • myeloproliferative disorders
  • CML
18
Q

How does neutrophilia relate to infection?

A

Seen in localised and systemic infections - e.g. acute bacterial, fungal, etc.

Often characteristically not seen - e.g. brucella, typhoid, many viral infections.

19
Q

Name potential causes of eosinophilia.

A

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)

20
Q

Mutations in which precursor relate to eosinophilic malignant disease ?

A

GM CFC.

21
Q

What can cause monocytosis?

A
  • TB, brucella, typhoid
  • Viral; CMV, varicella zoster
  • Sarcoidosis
  • Chronic myelomonocytic leukaemia (MDS)
22
Q

Diagram to show potential causes of elevated WCC

A
23
Q

Compare lymphocytosis involving mature and immature cells.

A

Mature - reactive to infection

immature - leukaemia/lymphoma

24
Q

What can cause reactive lymphocytosis?

A

Infection

  • EBV, CMV, Toxoplasma
  • infectious hepatitis, rubella, herpes infections

Autoimmune disorders

neoplasia

sarcoidosis

25
Q

Outline the pathophysiology of glandular fever

A
  • EBV infection of B-lymphocytes via CD21 receptor
  • Infected B-cell proliferates and expresses EBV associated antigens
  • Cytotoxic T-lymphocyte response
  • acute infection resolved resulting in lifelong sub-clinical infection.
26
Q
A

MCD - haematology (6 decks)

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