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eMCD - Hae > Haematology 11: Abnormal White Cell Count > Flashcards

Haematology 11: Abnormal White Cell Count Flashcards

1
Q

As myeloblast matures, it becomes _____
and
its cytoplasm becomes _____

A

As myeloblast matures, it becomes SMALLER
and
its cytoplasm becomes CLEARER

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2
Q

Factors stimulating and controlling cell no. for:
Myeloid =
Lymphoid =
Erythroid =

A

Factors stimulating
Myeloid = G-CSF + M-CSF
Lymphoid = IL2
Erythroid = Erythropoietin

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3
Q 
Lymphocytes 
Myeloblasts 
Promyelocytes 
Myelocytes 
Metamyelocytes 
are found in =
A 
Lymphocytes 
Myeloblasts 
Promyelocytes 
Myelocytes 
Metamyelocytes 
are found in = THE BONE MARROW
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4
Q

Immunocytes (T / B lymphocytes + NK cells)

Phagocytes (Granulocytes + monocytes)

are found in =

A

Immunocytes (T / B lymphocytes + NK cells)

Phagocytes (Granulocytes + monocytes)

are found in = peripheral blood

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5
Q

What might cause an increase in WBC cell production?

A

(reactive)
- Infection
- inflammation

(malignant)

  • leukaemia
  • myeloproliferative
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6
Q

What might cause an increase in WBC cell survival?

A
  • failure of apoptosis

e. g acquired cancer

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7
Q

What might cause a decrease in WBC cell production?

A
  • impaired bone marrow function
  • B12/folate deficiency
  • bone marrow failure
  • aplastic anaemia
  • post chemotherapy
  • metastatic cancer
  • hematological cancer
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8
Q

What might cause a decrease in cell survival?

A
  • immune breakdown
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9
Q

What are the 2 general causes of an increase in WBC count?

A
  1. reactive

2. primary (malignant)

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10
Q

In chronic myeloid leukemia, mutation occurs at the _____ phase

A

GM-CFC phase

(granulocyte-monocyte colony forming cell) phase

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11
Q

List methods of investigating a raised WCC

A
  • history + examination
  • Hb and platelet count
  • automated differential
  • examine blood film
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12
Q

If there are any immature cells in the blood film –>

A

If there are any immature cells in the blood film –> might be leukaemia

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13
Q

In a normal reactive response to infection/inflammation, would you get immature cells in the peripheral blood?

A
  • NO
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14
Q

if you get ONLY immature cells + low hb + low platelets –>

A

if you get ONLY immature cells + low hb + low platelets –> might be acute leukemia

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15
Q

What is a normal full blood count?

Hb 
Platelets 
WCC
Neutrophils 
Lymphocytes 
Monocytes 
Eosinophils 
Basophils
A 
Hb  120-160g/L
Platelets 150-400 x10^9/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 x10^9/L
Basophils 0.01-0.1 x10^9/L
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16
Q

50% of circulating neutrophils are marginated.

What does it mean by “marginated”?

A

marginated = they have stuck onto the wall of a damaged vessel

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17
Q

Give some causes of neutrophilia

A

causes of Neutrophilia:

(reactive)
- infection
- tissue inflammation
- corticosteroids
- underlying neoplasia

(malignant)
- CML
- myeloproliferative disorders

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18
Q

How do you tell if someone has Hodgkin’s disease (on X-ray) ?

Describe its onset.

A

hodgkin’s disease –> increased mediastinal mass on the chest x-ray

onset:
- there is secretion of IL-5
- which stimulates reactive eosinophilia
OR
- you get mutation of GM-CFC eosinophilia
- which expands the eosinophils

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19
Q

What are some primary causes of lymphocytosis ?

A
  • monoclonal lymphoid proliferation

- e.g chronic lymphocytic leukemia

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20
Q

What are some secondary causes of lymphocytosis ?

A
  • polyclonal response to infection, chronic inflammation / underlying malignancy
21
Q

What are some causes of reactive lymphocytosis?

A
  • infection
  • autoimmune disorders
  • neoplasia
  • sarcoidosis
22
Q

Describe the onset of Glandular fever

A
  • EBV infection of B lymphocyte occurs
  • via CD21 receptor
  • Infected B cell proliferates
  • and expresses EBV associated antigens
  • Cytotoxic T-lymphocyte response
  • Acute infected = resolved
  • resulting in lifelong sub-clinical infection
23
Q

glandular fever = more common amongst

A

glandular fever = more common amongst young people

24
Q

In older patients, lymphocytosis is more commonly caused by __________.

A

In older patients, lymphocytosis is more commonly caused by chronic lymphocytic leukemia

25
Q

What will you see in lymphocytosis in the elderly?

A
  • you will see mature lymphocytes
26
Q

If you get polyclonal expansion in B cell you get antibodies that are either _____ or _____

  • what is the ratio
A

If you get polyclonal expansion in B cell you get antibodies that are either Kappa or Lambda

ratio = 50: 50

27
Q

If you get monoclonal expansion in B cell you get antibodies that are either ______ or ______

A

If you get monoclonal expansion in B cell you get antibodies that are either ONLY Kappa or ONLY Lambda

AKA kappa/lambda restriction

28
Q

cases?

A

-

29
Q

whats the difference between normal haemopoiesis and malignant hemopoiesis

A

normal hemopoiesis (polyclonal healthy / reactive)

  • normal marrow
  • reactive marrow

malignant hemopoiesis (monoclonal)

  • leukemia
  • myelodysplasia
  • myeloproliferative
30
Q

myeloblast + lymphoblast distinguish

A

myleoblast - granule present

not present in lymphoblast

31
Q

conditions where you can see meta ,myeloma

A
  • if chemo
  • become neutropenia
  • give gcsh
  • stimulation causes all stages (apart from myeloblast) to be seen in blood film
  • sepsis
  • you can see myeloid precursors
  • chronic myeloid leukemia
  • you can see myeloblast in blood film
32
Q

increase in cell production may be due to

A
  • infection
  • inflammation
  • leukemia
  • myeloproliferative
33
Q

Decrease in cell production may be due to

A
  • impaired BM function
  • -> aplastic anaemia
  • -> post chemotherapy
  • -> metastatic cancer
  • -> hematological cancer
  • B12 / folate deficiency
34
Q

A decrease in cell survival may be due to

A

immune breakdown

35
Q

An increase in cell survival may be due to

A

failure of apoptosis

36
Q

mechanism of Chronic myeloid leukemia

A
  • CML = malignant hematopoiesis
  • chromosome philadelphia
  • chr 9 + 22
    translocation
  • in process of generating of precursors from HSC, there is a DNA damage (normal damage is fixed)
  • but in this case it isn’t fixed –> so mutation occurs at early stage of stem cell differntaitom and maturation
  • mutation derived cells –> have uncontrolled growth
  • in CML GCSF / MCSF affected most
  • increase no of neutrophils
  • eosinophils and basophilia is seen as well
  • ## lots of myeloid precursors
37
Q

investigating a raised WCC

A
  • history and examination
  • hb + platelet count
  • sautosmated differential
  • ## examine blood film
38
Q

infection –> increase in all lineage of WBC
CML –> increase in all lineage of WBC
AML –> majority of cells = immature cells

A

-

39
Q

neutrophilia can develop in minutes –>

A

demmargination

40
Q

how would peripheral blood blood film differ in infection and leukemia?

A

infection

  • neutrophils
  • toxic granulation
  • has vacuoles in the cytoplasm

leukemia

  • presence of mature neutrophils
  • increased no of monocytes cells
  • increased basophils
  • myeloblast can be seen
41
Q

what are main causes of neutrophila?

A
  • infection
  • tissue inflaammation
  • physical stress , adrenaline, corticosteroids
  • underlying neoplasia

malignant neutrophile

  • myeloproliferative disorder
  • CML
42
Q

Eosinophila causes:

  1. reactive
    - prasitic infection
    - inflammation
    - allergic diseases e.g asthma
    - neoplasms
    - hypereosinophilic syndrom
  2. malignant chronic eosinophilic leukemia
    - -> PDGFR fusion gene
A

-

43
Q

what is monocytosis?

in what cases is monocytosis observed ?

A
  • TB, typhoid
44
Q
  • Give some causes of Eosinophilia
A
  • Give some causes of Eosinophilia
  1. reactive
    - prasitic infection
    - inflammation
    - allergic diseases e.g asthma
    - neoplasms
    - hypereosinophilic syndrom
  2. malignant chronic eosinophilic leukemia
    - -> PDGFR fusion gene
45
Q

When might atypical lymphocytes be observed?

A
  • in response to glandular fever due to EBV virus infection

- infectious mononucleosis

46
Q

lymphocytosis is seen in mostly younger / elderly patients

A

elderly

47
Q

if there is reactive lymphocytosis, this may be due to:

A

an underlying auto immune disorder

48
Q

differentiating polyclonal vs monoclonal lymphocytes in light chain restriction

A

polyclonal
- kappa lambda

monoclonal
kappa only
or lambda only

eMCD - Hae (11 decks)

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