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YEAR 2 S2 PATHOLOGY > Disorder of WBC > Flashcards

Disorder of WBC Flashcards

1
Q

what are the 5 types of WBC

A
  • neutrophils (granulocyte)
  • basophils (granulocyte)
  • eosinophils (granulocyte)
  • monocytes
  • lymphocytes
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2
Q

what is the primary function of leukocytes (WBC)

A
  • against infection or infestation
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3
Q

what is the role of granulocytes and monocytes

A

they are phagocytic

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4
Q

what is the difference between infection and infestation

A

infection: against bacteria etc
infestation: against parasite

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5
Q

what is the role of lymphocytes

A
  • role in the IMMUNE RESPONSE

- cell mediated or abtibody mediated immune response

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6
Q

what % of leukocytes are neutrophils

A

45-75%

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7
Q

what % of leukocytes are monocytes

A

2-8%

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8
Q

what % of leukocytes are basophils

A

0.4-1%

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9
Q

what % of leukocytes are eosinophils

A

1-4%

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10
Q

what % of leukocytes are lymphocytes

A

20-40%

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11
Q

how are the granulocytes formed (neuto/baso/eosino)

A

myeloid stem cells –> colony forming units (granulo-N,Eo,baso, Mono) –> myeloblast –> band cell –> granulocytes

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12
Q

how are monocytes formed

A

myeloid stem cells –> colony forming units (granulo-N,Eo,baso, Mono) –> monoblast –> monocyte

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13
Q

how are lymphocytes formed

A

lymphoid stem cell –> pre-T, pre-B cells –> lymphoblast –> lymphocytes (T and B cells)

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14
Q

what are the features of monocytes

A
  • larger cell body

- nuclear dense

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15
Q

what is leukocytosis

A

INCREASE in total number of leukocytes

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16
Q

what is leukopenia

A

DECREASE in total number of leukocytes

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17
Q

what is leukaemia

A

neoplasia of leukopoietic tissue with a MASSIVE INCREASE in total numbers
- MALIGNANT process

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18
Q

what is leukaemoid reaction

A

massive leukocytosis and immature cells (chronic infections, severe haemolysis)
- BENIGN process

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19
Q

what is the normal range for neutrophils

what is it called when the neutrophil count exceeds this

A

NORMAL: 2.8-7.5 x10^9/L

Neutrophilia is when this is exceeded (>7.5x10^9/L)

20
Q

what are the causes of neutrophilia

A
  • bacterial infections
  • inflammation/tissue necrosis
  • metabolic disorders
  • malignant neoplasia
  • myeloproliferative disease
  • drugs (steroids)
  • physiological (pregnancy/exercise)
21
Q

what is neutropenia

A

when the numbers of neutrophils are BELOW the normal
- NORMAL: 2.8-7.5 x10^9/L
neutropenia is < 1.5x10^9/L(

22
Q

what is pancytopenia

A

deficiency of all three cellular components of the blood (red cells, white cells, and platelets)

23
Q

what are the causes of neutropenia

both as selctive neutropenia and part of pancytopenia

A

SELECTIVE:

  • drug induced (anti-inflammatory agents)
  • autoimmune (eg rheumatoid arthiritis)
  • severe bacterial infection eg typhoid
  • viral infection

PART OF PANCYTOPENIA:

  • bone marrow failure and infiltration
    • cytotoxic drug therapy, irradiation, malignant infiltration
  • severe megaloblastic anaemia (impaired DNA synthesis)
  • hyperslpenism
24
Q

what are the clinical features of neutropenia

A
  • INFECTIONS : more frequent and serious
  • if SEVERE neutropenia((<0.5x10^9/L): can lead to pneumonia, septicaemia
    • characteristic signs: glazed mucositis in the mouth and ulceration
25
Q

what can neutrophils leukocytosis suggest

A

bacterial infections, tissue damage

26
Q

what can lymphocytosis suggest

A

viral infection

27
Q

what can eosinophilia suggest

A

parasitic infestation/allergy

28
Q

what can monocytosis suggest

A

chronic bacterial infection (eg TB)

malignant neoplasms

29
Q

what can basophil leukocytosis suggest

A

it is uncommon

- but can suggest myeloproliferative disorders

30
Q

what are the causes of lymphocytosis

what is the clinical feature

A
  • acute, viral infections (eg infectious mononucleosis) can be extreme in children
  • chronic infections (eg tuberculosis)
  • leukaemia (chronic lymphocytic leukaemia CLL) and (acute lymphoblastic leukaemia ALL)
  • clinical feature: Lymphadenopathy
31
Q

what are neoplastic disorders of WBC
give examples
can they co-exist

A
  • malignancies of myeloid and lymphooid systems
  • LEUKAEMIA : occurs predominantly in bone marrow and the circulating blood
  • LYMPHOMA: in lymphoid tissue, tissue mass is a presenting feature
  • Leukaemias and lymphomas may co-exist
32
Q

how can you differentiate between lymphoma and leukaemia

A

there is a TISSUE MASS in lymphoma (mainly in lymph node)

- if there is no tissue mass and there are malignant white blood cells then it is leukaemia

33
Q

what is the pathogenesis of WBC neoplasm

A
  • at least ONE OR MORE MOLECULAR ABNORMALITIES: chromosomal abnormalities detected in leukaemias and lymphomas
  • CLONAL PROLIFERATION of cell type
  • neoplastic cells TAKING OVER bone marrow or lymphoid tissue (O normal bone marrow function is affected causing symptoms, and shortage of all blood cell types)
34
Q

how common is leukaemia

A
  • incidence: 10/100,000 (a relatively common cancer)
35
Q

what is the pathogenesis of leukaemia

what are the pathological features

A
  • NEOPLASTIC MONOCLONAL PROLIFERATION of WBC precursors

PATHOLOGICAL FEATURES:

1) bone marrow REPLACED by leukaemic cells, variable accumulation of abnormal cells in peripheral blood
2) ORGAN INFILTRATION by leukaemic cells (liver, spleenlymph nodes, meninges, gonads)

36
Q

what is the major consequence of leukaemia

A
  • bone marrow failure (anaemia, neutropenia, thrombocytopenia)
37
Q

how is leukaemia classified

A

1) acute/chronic

2) myeloid/lymphoid origin

38
Q

describe acute leukaemia

A
  • about 50% of all L
  • MYELOBLASTIC (AML): affects all age groups, incidence INC with age, FAB (French-American-British) classification: M0-M7
    -LYMPHOBLASTIC (ALL):
    most commonly in children
    FAB: L1-L3
39
Q

describe chronic leukaemia

A

about 45% of all L
- MYELOID/granulocytic (CML/CGL)
all age groups
- LYMPHOCYTIC (CLL): .50 years age group

40
Q

describe the pathogenesis of acute Leukaemia

how do the symptoms arise

A
  • Blast cells divide but fail to differentiate and appear in blood
  • > 20% bone marrow taken up by myeloblasts or lymphoblasts
  • causes BONE MARROW FAILURE
  • SYMPTOMS:
    • bone marrow failure: leucopenia –> infections
    • bone marrow infiltration: pain
    • other organ infiltration: e.g. brain
41
Q

describe chronic L

in detail

A
  • Usually in adults (but may be seen in children)
  • Leukaemic cells retain ability to differentiate
  • CLL:
    • Commonest leukaemia, esp. in late age
    • Lymphocyte count > 100x10^9 /L
    • B cell proliferation
    • abnormal cells in marrow, blood film, lymph nodes
  • CML/CGL
    – Leucocyte count > 15x10^9/L
    – Mostly neutrophils but also myelocytes
    −Chromosome translocation: long arm of 22 fuses with that of 9–> Philadelphia chromosome
  • MAY TRANSFORM TO AML AND ALL
42
Q

whata re the clinical features of chronic leukaemia

A
  • very high peripheral WBC counts
  • anaemia, thrombocytopenia
  • splenomegaly
  • hepatomegaly
  • lymphadenopathy
  • some have NO SYMPTOMS
43
Q

describe lymphomas
incidence
classification

A
  • the 7th commonest cancer in UK
  • Malignant tumours of lymphoid cells - at lymph nodes or extra-nodal

Classification:
- Hodgkin’s Lymphoma:Lymph node origin (mostly);Reed-Sternberg cells

  • Non-Hodgkin’s
    3/4 in lymph nodes
    commonly manifest by lymphadenopathy
44
Q

describe Hodgkin’s lymphoma

A
  • Peak at 3rd decade of life
  • Lymphadenopathy: −rubbery/swollen lymph node (cervical, etc.)
    −spreads (spleen, liver, marrow, gut)
  • Linked to previous infection with Epstein Barr virus,with a genetic predisposition
  • Lymph node histology: Reed-Sternberg cells(multinucleate B lymphocyte)
  • Patient presents with fever, weight loss, sweating(called B symptoms)
45
Q

describe non Hodgkin’s lymphoma

A
  • Majority of malignant lymphoma are NHL
  • Arise in lymph nodes (eg. cervical) & spread,or extra –nodal(eg. gut) & generalised spread (eg. lungs)
  • A wide spectrum of disease;highly proliferative or slow & indolent
  • Most (85-90%) are B cell origin (Follicular, Burkitts); 10-15% T cell

CLINICAL FEATURES:

  • B-symptoms (fever, night sweats, weight loss)
  • Lymphadenopathy
  • extranodal presentation (GI, lung, etc.)

YEAR 2 S2 PATHOLOGY (22 decks)

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