Blood Changes in Infection and Inflammation Flashcards
What factors affect the normal range of the FBC
Gender Age Ethnicity Geographical location (due to O2) Pregnancy Smoking Exercise Obesity
What are the ranges that are different in both males and females
- Hb g/l
- Basophil x10 9/l
Male
- Hb => 130-170
- Basophil => 0.00
Female
- Hb => 115-145
- Basophil => 0.03
What are the ranges for that are the same in both males and females
- MCV fl
- RDW
- platelets x10 9/l
- WBC x 10 9/l
- neutrophils x10 9/l
- lymphocytes x 10 9/l
- monocytes x 10 9/l
- eosinophils x 10 9/l
- MCV => 82-98 (average volume of cell)
- RDW => 9.9 - 15.5 (measure variation in RBC vol)
- platelets => 150-400
- WBC => 4-11
- neutrophils => 2.2 - 6
- lymphocytes => 1.1 - 3.5
- monocytes => 0.2 - 0.6
- eosinophils => 0.02 - 0.67
What cells can you see on a normal blood film?
Describe the abundance and shapes of each cell
Many enucleated RBCs
Neutrophils => sparse, 3 nuclei
Band neutrophil => rare, horseshoe nuclei
-presence indicates increased BM release of WBCs, immature neutrophils
Monocyte => rare, kidney nucleus Lymphocyte => rare, circular nucleus Eosinophils => rare, red granular appearance, multinuclear Basophil => rare, can only see granules Platelets => v small, spherical
Describe the function of each leukocyte
- neutrophils
- eosinophils
- basophils
- monocytes
- lymphocytes
Neutrophils
-innate, phagocytosis
Eosinophils
-parasite attach, involved in allergic reactions
Basophils
-histamine, heparin release in allergies
Monocytes
- slow response but in innate, phagocytosis
- communicate between innate and adaptive
Lymphocytes
- B cells => AB prod
- T cells => cell mediated attack
Differentials of lymphocytosis
- what is lymphocytosis
- viral
- bacterial
- tissue
- stress
- smoking
- allergies
- splenectomy
- haematological malignancies
What would this look like on a blood film
High lymphocyte count Reactive lymphocytes (large with irregular shape)
Viral
-measles, chicken pox, flu, EBV, CMV
Bacterial
-pertussis, brucellosis, TB
Tissue infarction
-MI, PE
Stress
-MI, cardiac arrest, trauma, obstetric complications
Smoking
-Tcells common, Bcells uncommon
Allergies, splenectomy
Haematological malignancies
- chronic lymphoproliferative
- lymphoma
- ALL
Differentials of red cell agglutination
-VITAMIN CDEF
What would this look like on a blood film
Clumps of RBCs
Infection/inflammation
-EBV, HIV, mycoplasma
Autoimmune
-RA, SLE
Idiopathic
Neoplastic
- CLL
- Waldenstroms macroglobulinemia
What signs, presentation and investigation results would indicate EBV infection?
Sore throat
Enlarged cervical lymph nodes
Fatigue
Hb => low (red cell agglutination)
Lymphocytes => high
Platelets => low (immune thrombocytopenia)
IgM positive (specific for the i antigen on RBCs)
Hepatosplenomegaly
Transaminitis => elevated liver enzymes
PCR for EBV DNA
Differentials for neutrophilia
- what is neutrophilia
- VITAMIN CDEF
What might you see on a blood film
High neutrophils
- left shifted (increase in band cells)
- toxic granulation
- (increased ER => Dohle)
- (increased phagocytosis => vacuolation)
- leukoerythroblastic (more nucleated RBC, immature WBCs)
Vascular
- MI, PE
- acute haemorrhage
Iatrogenic/idiopathic
-CS, adrenaline, lithium
Trauma
- surgery, burns
- acute hypoxia
Autoimmune
-RA, UC, scleroderma
Inflammatory/infective
-bacterial, viral, fungal
Neoplastic
-myeloproliferative neoplasm
Congenital
Endocrine/environmental
-smoking
What signs, symptoms and investigation results would indicate bacterial sepsis
Fever, hypotension, tachycardic
WBC => high
Neutrophils => high
Lymphocytes => high
Platelets => low or high
Hb => low
- due to BM suppression
- haemolysis
- DIC
Blood count, blood film changes
- neutrophilia (toxic granulation, left shift)
- leukoerythroblastic
- thrombocytopenia or thrombocytosis
What exogenous structures could you find on the blood film
What other blood count and blood film changes
Hb => low Platelets => low Lymphocytes => high or low Neutrophils => acute increase, then falls Monocytes => high
Organisms
Headphone shaped structures in RBC
What are the differentials for red cell fragments
What is the pathophysiology behind this
-VITAMIN CDEF
Endothelial damage and fibrin deposition in capillaries
Vascular
- Haemangiomas
- Thrombotic thrombocytopenia purpura
- Malignant HTN
- infection => haemolytic uremic syndrome => DIC
Iatrogenic/idiopathic
-Ciclosporin, clopidogrel, quinolones
Autoimmune
-Scleroderma, SLE
Inflammatory/infective
-infection (bacterial, viruses) => haemolytic uremic syndrome => DIC
Neoplastic
-cancer => haemolytic uremic syndrome => DIC
Congenital
-Microangiopathic haemolytic anaemia
Functional
- HELLP
- prosthetic valves
What are the signs, symptoms and investigation findings of haemolytic uraemic syndrome (food poisoning)
-what would you find on a blood film
Food bourne bacterial, viral infection =>
Diarrhea, bloody vomiting
Poor urine output (due to clots clogging up kidneys)
Drowsy (uremia)
Hb => low
Platelet => low
Neutrophils => high
Microspherocytes (round RBCs)
Red cell fragments (schistocytes)
Nucleated RBCs (come out early of BM to compensate for anemia
What are the differentials for monocytosis
-VITAMIN CDEF
Vascular
-MI, PE
Infective/inflammatory
-TB, syphillis
Autoimmune
- Crohns, UC
- RA, SLE
Neoplastic
-chronic myelomonocytic leukemia
What are the differentials for lymphopenia
-VITAMIN CDEF
Idiopathic/iatrogenic
-steroids, chemotherapy
Autoimmune
-SLE, RA, sarcoidosis
Infective/inflammatory
-HIV, acute infections
Neoplastic
-Non Hodgkin, Hodgkin lymphoma
Functional
-anorexia, alcohol, exercise
