HAEM - Leucocytes and neutrophils Flashcards
Fct neutrophils
Ingest and kill bacterial, fungal and cellular debris
Fct lymphocyte s
Produce antibodies for cell mediated immunity
Fct eosinophils
Role in allergic reactions
Defense of parasitic infection
Fct monocytes
Precursor tissue macrophages
Fct basophil
Release histamine in inflammatory reactions
Role spleen (5)
Reservoir of RBC
Site of B lymphocyte + antibody production
Reservoir platelets
Reservoir macrophages
Removes antibody coated bacteria and blood cells
Neutrophilia DDx >10 (5)
bacterial infection Tissue damage - MI.PE, burn Physiological - exercise, during preg CCS + inflamm - Gout, RA, UC, Chron's Malig - CML/solid tumour
Neutropenia DDx <1.5 (7)
Viral infection + severe bacterial infection - sepsis /typhoid Autoimmunity - commonly SLE Felty's syndrome Black people Alcohol + other drugs. Methotrexate ELA2 gene mutation BM failure
Neutropenic sepsis
Severe neutropenia leading to sepsis
Agranulocytosis
Complete abscence of circulating neutrophils
Which med is agranulocytosis a common SE of?
Carbimazole
Lymphocytosis DDx >5 (4)
Viral infections
Chronic infections - TB/toxoplasmosis/syphillis
Lymphoproliferative - CLL/some lymphomas
Post splenectomy
Lymphopenia DDx (5)
HIV/autoimmunity CCS + inflamm - CT disease Chemotherpy + lymphoma Renaal failure Transient - recent infection
Hx points - abnormal WCC (8)
Age Duration Sx W loss >10% 6m Drenching night sweats Unexplained fever Systemic disease - RA Evidence malig Lymphadenopathy >6w + >2cm
Possible Ix - abnormal WCC (6)
Blood film Immunophenotyping USS/CT Microbiology LN biopsy BM biopsy
What are the 2 lineages a multipotent cell can go down
Common myeloid progenitor
Common lymphoid progenitor
Cells the common myeloid progenitor can DDx into (5)
Erythrocyte Mast cell Megakaryocytes Neutrophil MOnocyte
What do megakaryocytes further divide into
Platelets
What do common lymphoid progenitor cells DDx into
B cell
T cell
NK cell
What is immature cells in peripheral blood a sign of?
That the marrow is stressed
Hence pre-leukaemic
ALL
Malignancy of lymphoid cells of B/T lineage –> uncontrolled proliferation of immature blast cells, BM failure and tissue infiltration
Who gets ALL
Children - 3-7y/o
Which syndrome is ALL more common in?
Downs
Prognosis ALL
80% cure rate in kids <10
Indicators - poor prognosis ALL (4)
Older ps
Male
B cell disease
Philadelphia chromosome
Philadelphia chromosome
9:22
What is AML
Malignancy of blast cells fom marrow myeloid elements
RF AML (4)
Myeloproliferative disorders
Previous chemotherapy
IR
Genetic syndromes
Median age PS AML
65
Prognosis AML
20% 3 y survival after chemo
Sx - acute leukaemia (6)
B Sx Bone pain Anaemia --> SOB on exertion, weakness Leukopenia --> rec infections Thrombocytopenia --> bleeding + bruising HS megaly
Ix Acute leukaemia
FBC Blood film - BLASTS CXR BM aspiration PET scan - mets U/E, LFT, cardiac fct
What is diagnostic Ix result for acute leukaemia
Blast cells on blood film
ALL - CXR findings
Mediastinum widening
General supportive management - acute leukaemia
Nurse Hickman line High kcal diet Freq blood + platelet transfusion Allopurinol Check blood/obs - signs infections
Use of ABx in acute leukaemias
If T>38’ on 2 occasions >1hr
Cephalosporin + gentamicin until afebrile 72hrs
Why give allopurinal to patients with acute leukaemia
To prevent tumour lysis syndrome due to chemo
Specific Mx ALL
High dose chemo
+ 2 y maintenance therapy
Consider transplant if poor prog/relapse
ALL cure if have Philadelphia chromosome
Transplant (BM)
Specific Mx AML
Intensive chemo
If poor prog AML - what Mx should be done
Allogenic marrow transplant after 1st round chemo
If intermediate prod AML - what Mx should be done
Autologous marrow transplant
Age - CML
40-60y/o
Which genetic linkage accounts for 95% cases CML
Philadelphia chromo