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Clinical pathology specialities: Haematology > Haematology: Laboratory Investigation of White Cell Disorders > Flashcards

Haematology: Laboratory Investigation of White Cell Disorders Flashcards

1
Q

What are the normal haemoglobin values for a male and female?

A
  • Normal Male: 130 - 180g/L
  • Normal Female: 120 – 160g/L
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2
Q

What is the normal white Cell (Blood) Count for an adult?

A
  • Normal Adult: 4.0 - 11.0 x 109 / L
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3
Q

What is the normal Platelet Count for an adult?

A
  • Normal Adult: 150 - 400 x 109 / L
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4
Q

What are the 5 major groups of white blood cells and what are the normal ranges of all of these cells within the blood?

A
  • Neutrophils: Normal range 2.0 - 7.5 x 109/L
  • Lymphocytes: Normal range 1.5 - 4.0 x 109/L
  • Monocytes: Normal range 0.2 - 0.8 x 109/L
  • Eosinphils: Normal range 0.04 - 0.4 x 109/L
  • Basophils: Normal range < 0.01 - 0.1 x 109/L
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5
Q

Roughly what percentage of the white cell count is made up by neutrophils and lymphocytes?

A
  • 90-95%
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6
Q

Basophils are the least abundant white cell within the blood so it’s very rare to see a raised basophil count, what is the most common cause of a raised basophil count?

A
  • Haematological malignancy, e.g lymphoma or myeloma
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7
Q

What are some of the functions of Eosinophils?

A
  • Protect against parasetic infection
  • Play a role in allergic reactions
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8
Q

What is the name of the stain used on blood films?

A
  • Romanowsky Stain
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9
Q

What are the main components of the Romanowsky Stain?

A
  • Basic dye (Azure B or Methylene Blue) or Acidic dye (Eosin Y) with a buffer
  • Buffer keeps pH of stain at 6.8
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10
Q

What are some characteristics of lymphocytes?

A
  • Major role is in Adaptive Immune Response
  • They Differentiate between self and non-self cells within the body
  • Lymphocytes mainly protetc against viral attacks
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11
Q

Why might smeone have a low lymphocyte count (Lymphocytopenia) during a viral infection?

A
  • Would expect to have a high lympocyte count during a viral infection as lymphocytes mainy protect against viral infections
  • Lymphocytopenia may occur because viruses may suppress white cell production in bone marrow
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12
Q

What are the 3 major types of lymphocytes?

A
  • T-cells
  • B-cells
  • Natural Killer (NK) cells
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13
Q

What are the functions of each of the types of lymphocytes?

A
  • T-cells - Involved in Cell-Mediated Immunity, cytotoxity
  • B-cells - Involved in humoral Immunity (antibody production)
  • Natural killer cells - Can naturally attack virally infected cells and tumour cells without adaptive response - therefore they’re classified as part of innate immune response
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14
Q

What are the 2 different types of T-cell and what are their functions?

A
  • T-helper cells (CD4+ cells) - Help the activity of other immune cells by releasing T cell cytokines
  • Cytotoxic T-cells (CD8+ cells) - Kill tumour cells or virually infected cells that have antigens on their surface that the CD8+ cell is able to recognise as “non-self “ (Adaptive immunity)
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15
Q

Briefly describe the development of each of the different blood cells in the bone marrow

A
  • Pluripotent haemopoietic stem cells in bone marrow can commit to becoming either a myeloid progenitor cell or a lymphoid progenitor cell
  • Myeloid progenitor cells then commit to a specific lineage to become one of a vast number of granulated blood cells: Nuetrophils, monocytes, eosinophils or basophils
    • They can also differentiate into megakaryocytes which become platelets
    • They can also differentiate into erthroid cells which become the RBCs
  • Lymphoid progenitor cels commit to a specific lineage to become one of the 3 types of lymphocyte: B lymphocyte; T lymphocyte or a natural killer cell
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16
Q

What is Leucocytosis?

A
  • Increase in white cell count
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17
Q

What is Leucopenia?

A
  • Decrease in white cell count
18
Q

What is Neutrophilia?

A
  • Increase in neutrophil count
  • For normal bacterial infection neutrophil count doesn’t really go above 20 x 109/L
19
Q

What does a neutrophil count above 20 x 109/L (severe neutrophilia) indicate?

A
  • Usually indicates a haematological malignancy
  • May also indicate severe sepsis or infection
20
Q

What changes can occur to neutrophils during bacterial infection?

A
  • Increased production from bone marrow (nuetrophilia)
  • Toxic Granulation - Granules of neutrophil become more dark and coarse
  • Shift to the left - More immature neutrophils (mainly band form neutrophils) are released into the blood stream and so their nucleus is more band-like and less segmented compared to a mature neutrophil
  • Shift to the right - Increased release of hypersegemented (giant) neutrophils into blood stream
  • Döhle Bodies - can also be formed
21
Q

Briefly describe the formation of a neutrophil (myelod maturation)

A
22
Q

What is the most common cause of hypersegemnted neutrophils?

A
  • Vitamin B12/Folate deficiency
23
Q

What are some of the causes of neutrophilia?

A
  • Physiological stress
    • Post-operative
    • Pregnancy
  • Bacterial infection
  • Inflammation e.g. vasculitis
  • Carcinoma
  • Steroids - Neutrophils have steroid receptor on cell surface
  • Myeloproliferative disorders
  • Treatment with myeloid growth factors
24
Q

What is a leukemoid reaction?

A
  • When an infection causes a massive increase in neutrophil count that mimics the increase seen as a result of leukaemia
25
Q

How do you investigate neutrophilia?

A
  • Conduct a full blood count (FBC) and differential white cell count
  • Blood film examination
  • Bacterial culture screen for infection - test blood/urine/saliva cultures for different types of bacteria
  • Bone marrow examination and chromosome analysis (testing for presence of Philadelphia chromosome)
  • Molecular analysis for BCR-ABL oncogene
  • Last two tests for chronic myeloid leukaemia
26
Q

Why was Chronic myeloid leukaemia (CML) historically a very important disease in medicine?

A
  • It was the first disease discovered that was due to an acquired chromosomal translocation
    • Chromosomal translocation between chromosomes 9 and 22 causes fusion chromosome (Philadelphia chromosome to form)
    • As a result of this the BCR-ABL oncogene is also formed on the fusion chromosome
  • It was the first disease where a targeted therapy on molecular level (imatinib) was used to treat it
27
Q

What is neutropenia?

A
  • Decrease in neutrophil count
28
Q

What are some of the causes of neutropenia?

A
  • Viral Infection
  • Drug Induced e.g. sulphonamides
  • Radiotherapy and chemotherapy
  • May be due to ethnicity as afro-carribean and asian population have a slightly lower neutrophil count (benign ethnic neutropenia)
29
Q

What are some causes of eosinophilla?

A
  • Allergic diseases e.g. asthma
  • Parasitic infections
  • Drug sensitivity
  • Myeloproliferative diseases e.g Chronic myeloid leukaemia or Hodgkin’s Lymphoma
30
Q

How do you investigate eosinophilla?

A
  • FBC and differential white cell count
  • Blood film examination
  • Stool examination for ova and parasites
  • Check patients drug history
31
Q

What is monocytosis?

A
  • Increased monocyte count
32
Q

What are some casues of monocytosis?

A
  • Tuberculosis (TB)
  • Acute and chronic monocytic and myelomonocytic leukaemia
  • Malaria
33
Q

How do you investigate monocytosis?

A
  • FBC and differential white cell count
  • Blood film examination:
    • For abnormal white blood cells
    • For malarial parasites
  • Bone marrow examination - leukaemia
  • TB cultures
34
Q

What is lymphocytosis?

A
  • Increased lymphocyte count
35
Q

What are some causes of lymphocytosis?

A
  • Normal Physiological Status
    • ​Lymphocytosis of childhood
  • Bacterial Infection
  • Viral Infections
    • Hepatitis
    • Mumps
    • Rubella
    • Glandular Fever
  • Lymphoid Leukaemias and lymphomas
36
Q

How do you investigate lymphocytosis?

A
  • FBC and differential white cell count
  • Blood film examination
    • Look for Atypical mononuclear cells
  • Throat swabs/saliva/urine/blood samples to look for signs of viral infection
37
Q

What are atypical mononuclear cells?

A
  • Thye’re lymphocytes that have been transformed by an infection
38
Q

What diseases are most likely to produce aytpical mononuclear cells?

A
  • Glandular Fever (Infectious Mononucleosis)
39
Q

How do you diagnose glandular fever (Infectious Mononucleosis)?

A
  • Monospot/Paul Bunnell Test
  • Infectious Mononucleosis Test
40
Q

How do you distinguish if there’s an increased amount of B cells or T cells in the blood as a result of lymphocytosis?

A
  • Immunophenotyping
  • Flow cytometry
  • T-cells express CD3,4 and 8
  • B-cells express CD19 and 20
  • B-cells demonstrate clonality by light chain restriction
  • T-cells demonstrate clonality by T-cell Receptor Gene Rearrangement Studies
  • NOTE: Clonality = malignancy

Clinical pathology specialities: Haematology (8 decks)

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