abnormal white cell counts

Question 1

define thrombocytopenia/cytosis

Answer 1

low WBC count vs hight

Question 2

define haemoposis and cells produces

Answer 2

production of blood cells in bone marrow T/B cells, RBC, megakaryocyte/platelets,granulocytes (neut, eon, baso) and monocytes

Question 3

neutrophils in bone marrow vs blood and clinical importance

Answer 3

blood should only have neutrophils, NOT precursors ( myelocytes/myeloblasts etc) if there are in blood along with nucleated RBC’s, can indicate sepsis or cancer cells invading bone marrow

Question 4

cytokines invovled

Answer 4

erythropoetin for RBC’s IL2 for lymphoid cells (T/B) G-CSF/M-CSF for myeloid cells eg neutrophils

Question 5

causes of abnormal WBC counts- high and low

Answer 5

increased- due to increased cell production (infection or leukemia) or increased survival (lack of apoptosis due to oncogenes) decreased- less bone marrow function (B12/ folic acid deficiency or bone marrow disorders) or decreased survival (autoantibodies)

Question 6

types of eosinophilia and causes

Answer 6

reactive (normal production)- due to infection malignant (abnormal production)- due to leukemia for example

Question 7

investigating raised WCC

Answer 7

history and examination- are they symptomatic, do they have hepatosplenomegaly haemoglobin/platelet count- if these are low, can indicate problem with bone marrow ie malignant rather than reactive cause of lymphocytosis automated differential in WBC count- if machine can’t detect cells, can indicate precursors in blood= possibly cancer blood film

Question 8

investigating raised WCC- relationship to other cells

Answer 8

abnormal white cells only, or all 3? low RBC/platelets can indicate cancer, high of all 3 can indicate MYLOPROLIFERATIVE DISORDERS white cell abnormality 1 cell type only, or all?- if 1 cell type, can indicate cancer, as cancer mutation of one precursor, forming identical clones- if all are abnormal, usually reactive lymphocytosis, EXCEPT chronic myeloid leukemia (all cell types abnormal) are cells mature or both immature/mature

Question 9

neutrophils in infection and leukemia

Answer 9

there are small white spots (vacuoles) in their cytoplasm, and their granules are distributed unevenly in a cell (toxic granulation) in infection in leukemia there are precursors (myelocytes) as well

Question 10

causes of neutrophilia and what doesn’t cause it

Answer 10

infection ie tissue inflammation, corticosteroids and cancer eg myeloproliferative disorders and chronic myeloid leukemia typhoid and most viral infections don’t cause it

Question 11

causes of eosinophilia

Answer 11

reactive causes include parasitic infection, allergic disease eg asthma, neoplasms (hodgkins disease) also malignant chronic eosinophilic leukemia (fusion gene involving PDGFR)

Question 12

monocytosis

Answer 12

seen in TB/typhoid, viral infections, and chronic myelomonocytic leukemia

Question 13

lymphocytosis- mature or immature DIAGRAM

Answer 13

in a reactive condition, the lymphocytes are mature but they look different eg size, as bone marrow healthy, and are smaller than in malignancy in malignancy you can see many immature cells that all look the SAME

Question 14

causes of reactive lymphocytosis and vs leukemia

Answer 14

infection, viruses eg hepatitis, neosplasms and sarcoidosis unlike leukemia, often RBC’s are fine and there is no anemia

Question 15

glandular fever

Answer 15

EBV infection of B lymphocytes, which cause cytotoxic T lymphocyte repsonse

Question 16

distinguish reactive vs malignant lymphocytosis

Answer 16

look at light chains- reactive (polyclonal) lymphocytosis has both KAPPA and LAMBDA chain, malignant (monoclonal- ie all look same) have EITHER kappa OR lambda

Question 17

acute vs myeloid leukema DIAGRAM

Answer 17

acute- large nasty looking WBC with low platelet/ RBC chronic- many immature WBC showing different precursor cells with normal RBC/platelet