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Haematology > Abnormal white cell counts > Flashcards

Abnormal white cell counts Flashcards

1
Q

What is the lymphoid lineage?

A

Lymphoid cells are lymphocytes = T cells, B cells and NK cells

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2
Q

Which cells come under the myeloid lineage?

A 
Erythrocytes 
Neutrophils 
Basophils 
Eosinophils 
Monocytes 
Macrophages 
Megakaryocytes 
Dendritic Cells
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3
Q

What are the cell derivatives for lymphocytes and phagocytes? Describe how the appearance of white cells changes as they differentiate and mature

A

Phagocytes:
myeloblast -> promyelocyte -> myelocyte -> metamyelocyte -> granulocytes/monocytes (in peripheral blood)

Lymphocytes:
Lymphoblast -> T/B/NK cell (in peripheral blood)

They become smaller and their cytoplasm becomes clearer.

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4
Q

Which factors stimulate the Erythroid, Myeloid and Lymphoid cell lines? What directs their differentiation and proliferation?

A

Erythroid - Erythropoietin
Lymphoid - IL-2
Myeloid - G-CSF, M-CSF

DNA directed differentiation and proliferation

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5
Q

Define Leukaemia.

A

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

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6
Q

Define Lymphoma.

A

A group of blood cell tumours that develop from lymphatic cells:

  • If the disease is mainly in the lymphatic tissue then it is lymphoma (i.e. cancer of the lymph nodes).
  • If it is mainly in the blood it is leukaemia.
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7
Q

Define Myeloma. What is it characterised by?

A

A malignant tumour of the bone marrow characterised by two or more of the following criteria:

  • The presence of an excess of abnormal 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 abnormal gamma globulin, usually IgG
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8
Q

Broadly speaking, what two factors can cause an increase in white blood cell count?

A

Increased white blood cell production

Increased white blood cell survival

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9
Q

What two broad categories of diseases would cause an increase in white blood cell production?

A
  1. Reactive - in response to infection or inflammation

2. Malignant (primary) - e.g. Leukemia, myeloproliferative disorders

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10
Q

What is the difference in the type of white blood cell seen in the peripheral blood of someone with an infection/inflammation (reactive) and someone with a malignancy (primary)?

A

Reactive – only mature white blood cells

Primary – mature AND immature white blood cells present

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11
Q

What are myelodysplastic syndromes?

A

Group of cancers in which immature blood cells in the bone marrow do not mature and therefore do not become healthy blood cells

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12
Q

Where does the mutation occur in chronic myeloid leukaemia? What is the result?

A

GM-CFC phase (granulocyte-monocyte colony forming cell) => increased and unregulated growth of myeloid cells in the bone marrow and the accumulation of these cells in the blood.

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13
Q

If there are only immature cells in the blood film with low haemoglobin and low platelets, what would you suspect?

A

Acute leukaemia

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14
Q

What are the normal ranges of:

a. Hb
b. Platelets
c. WCC
d. Neutrophils
e. Lymphocytes
f. Monocytes
g. Eosinophils
h. Basophils

A 
Hb; 120-160 g/L 
Platelets; 150-400 x 10^9/L 
WCC; 4-11 x 10^9/L 
Neutrophils; 2.5-7.5 x 10^9/L 
Lymphocytes; 1.5-3.5 x 10^9/L 
Monocytes; 0.2-0.8 x 10^9/L 
Eosinophils; 0.04-0.44 x 10^9/L 
Basophils; 0.01-0.1 x 10^9/L
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15
Q

What is the lifespan of a neutrophil?

A

Hours in the peripheral blood
2-3 days in the tissues
Note: also present in BM

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16
Q

What is the margination percentage of neutrophils? What does this mean for a FBC?

A

Around 50% of neutrophils in the circulation have marginated meaning that they have stuck to the wall of a damaged vessel - this means that they are NOT counted in the full blood count

17
Q

State some causes of neutrophilia.

A 
Infection 
Inflammation 
Physical stress 
Adrenaline 
Corticosteroids 
Underlying neoplasia

Malignant neutrophilia (myeloproliferative disorders, chronic myeloid leukaemia)

18
Q

Describe the differences in the appearance of neutrophils in infection compared to leukaemia.

A

Neutrophils in infection are granular (show toxic granulation)
Neutrophils in leukaemia do not have granules and do not look toxic.

19
Q

What else would be present in the blood film of someone with leukaemia that would not be present in someone with an infection?

A

Myelocytes and metamyelocytes (precursor cells) – these precursors would not be found in the peripheral blood of someone responding to infection

20
Q

What types of infection cause neutrophilia?

A
  • Bacterial
  • Fungal
  • Certain viral infections

Generally, if the neutrophil count is low but there are other features of infection, then you can deduce that it’s a bacterial/viral/fungal infection included neutrophilia

21
Q

State some infections that characteristically do NOT produce neutrophilia.

A

Brucella
Typhoid
Many viral infections

22
Q

State some reactive causes of eosinophilia.

A
  • Parasitic infection
  • Allergic diseases e.g. asthma
  • Neoplasms e.g. Hodgkin’s and Non-Hodgkin’s
  • Hypereosinophilic syndrome
23
Q

State a malignant cause of eosinophilia.

A

Malignant chronic eosinophilic leukaemia (INCREDIBLY RARE)

24
Q

What would you see in the chest X-ray of someone with Hodgkin’s lymphoma?

A

Increased mediastinal mass

25
Q

What can cause monocytosis?

A

RARE but it is seen in certain chronic infections and primary haematological disorders:

  • TB, brucella, typhoid
  • CMV, varicella zoster
  • Sarcoidosis
  • Chronic myelomonocytic leukaemia (myelodysplastic syndrome)
26
Q

Name the type lymphocytosis characterised by increased mature cells. Describe the appearance on the blood film.. What can this appearance also be explained by?

A

Chronic lymphocytic leukemia
The lymphocytes have a typical appearance – big nucleus + little cytoplasm (mature)

This appearance can also be present in autoimmune and inflammatory conditions

27
Q

Name the type lymphocytosis characterised by increased immature cells. Describe the appearance on the blood film.

A

Acute lymphoblastic leukaemia

They are much larger than the mature lymphocytes and you can see the nucleolus (showing that the cell is immature)

28
Q

State some causes of reactive lymphocytosis.

A
  • Infection (e.g. EBV, toxoplasma, infectious hepatitis, rubella, herpes infections)
  • Autoimmune disorders
  • Neoplasia
  • Sarcoidosis
29
Q

Describe the difference in the expansion of lymphocytes in secondary (reactive) lymphocytosis compared to primary lymphocytosis.

A

Secondary lymphocytosis = polyclonal expansion

Primary lymphocytosis = monoclonal expansion

30
Q

What do you see in the blood film of someone with mononucleosis syndrome (associated with reactive/infection induced lymphocytosis)? What is it typical of?

A

Atypical lymphocytes

  • They look similar to immature lymphocytes but they aren’t very round and its cytoplasm extends between surrounding cells
  • The nucleus of the cell lacks nucleoli

This is typical of glandular fever

31
Q

What is glandular fever caused by? How does it progress?

A
  • Epstein-Barr virus infection of the B-lymphocytes via the CD21 receptor
  • Infected B-cells proliferate and express EBV associated antigen
  • There is a cytotoxic T-lymphocyte response
  • Acute infection is resolved leading to life-long sub-clinical infection
32
Q

What is the usual cause of lymphocytosis in elderly people?

A

Chronic lymphocytic leukaemia (CLL)

33
Q

Explain how light chain restriction can be used to distinguish between causes of lymphocytosis.

A

In reactive lymphocytosis, polyclonal expansion of the lymphocytes => light chains of the antigens produced by B cells will kappa and lambda

In primary lymphocytosis, monoclonal expansion => only kappa or only lambda type light chains

34
Q

Normally, B and T cells will undergo gene rearrangement in the T cell receptor and immunoglobulin genes in a process called affinity maturation. How is this different in primary monoclonal proliferation of B and T cells?

A

With primary monoclonal proliferation, all the daughter cells carry identical copies of Ig genes or TCR genes

Haematology (11 decks)

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