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SEM 4: Haematology > Lab Investigation of White Cell Disorders > Flashcards

Lab Investigation of White Cell Disorders Flashcards

1
Q

What is a haemocytometer neubauer chamber used for?

A
  • It is used to count a cells, the blood film was put here and the cells counted.
  • Then, the number of squares were counted to find out the cells. It is automated to count the number of cells.
  • The results will show a complicated plot that will divide things in terms of size and granules.
  • This will produce a RBC, platelets, WBC and a differential WBC count, Hb shown in the results
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2
Q

What is contained in a full blood count?

A
  • Haemoglobin
  • White cell (blood) count
  • Platelet count
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3
Q

Normal haemoglobin in male

A

130 - 180 g/L (Hb)

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4
Q

Normal haemoglobin in female

A

120 - 160 g/L

  • Females have a lower Hb because of menstruation every month
  • The loss of blood means they always have a lower Hb.
  • Differentiated depending on MCV: micro and macrocytic
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5
Q

Normal WBC in Adults

A
  1. 0 - 11.0 x 109/L
    - 10x less than the Hb count
    - Although, this is the normal value, nothing else is told in terms of what type of WBC is from the particular number.
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6
Q

Normal Platelets in adults

A

150 - 400 x 109/L (Platelets)

  • Normal Values
  • Easy: Number of platelets only.
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7
Q

What is a normal differential WBC count?

A

An important test that is able to differentiate what the cells look like and what the normal values are. The total from these cell numbers will add up to the total while blood cell count.

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8
Q

Where are neutrophils found? What is neutrophilia? What is neutropenia?

A
  • Most plentiful in the blood
  • High count = neutrophilia
  • Low count = neutropenia
  • Important in bacterial infection
  • Belongs to the myeloid pathway
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9
Q

What are lymphocytes? What lymphocytosis? What are lymphopenia? Where are lymphocytes found?

A
  • Belongs to the lymphoid pathway
  • High Count = lymphocytosis
  • Low count = lymphopenia
  • Seen in viral infections
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10
Q

What is the white cells found on WC count?

A
  • Neutrophils and Lymphocytes account for 90 - 95% of the WC count
  • Everything else is minor populations
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11
Q

What are basophils?

A
  • Unusual, specialised white cell and when realised - the most common cause is a haematological malignancy
  • There is no such thing as a low basophil count = if you don’t see anything it is normal.
  • High basophils is when more than one is seen on a blood film
  • Not involved in infection
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12
Q

What are eosinophils?

A
  • High count = eosinophilia
  • Seen if there is a parasitic infection and allergic reaction
  • Normally not more than one on a blood film
  • Unusual infections like worms, parasites; also seen in a higher count
  • Seen in some autoimmune diseases
  • No such thing as low
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13
Q

What are monocytes?

A
  • Involved in unusual infections such as TB
  • Raised in other haematological malignancies
  • Can have a low monocyte count
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14
Q

What is a peripheral blood film?

A

This is seen under a microscope. Look at the tail to see each cell population

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15
Q

Structure of a normal neutrophil

A
  • At least 3-5 lobes; bean shaped
  • Also has granules
  • Larger than a RBC
  • When looking at the size of RBC, compare to a lymphocyte.
  • Neutrophils are bigger than lymphocytes
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16
Q

Structure of a normal lymphocytes

A
  • At least 3-5 lobes; bean shaped
  • Also has granules
  • Larger than a RBC
  • When looking at the size of RBC, compare to a lymphocyte.
  • Neutrophils are bigger than lymphocytes
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17
Q

What is the role of lymphocytes?

A
  • Adaptive immune response
  • Differentiation between self and no-self e.g. Viral attack and lymphocytes produce
  • Can be divided into T and B lymphocytes
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18
Q

What are the function of neutrophils?

A
  • Part of the innate response so ready when there is a bacterial infection
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19
Q

What is the function of B-lymphocytes?

A
  • Responsible for producing antibodies e.g. produce flu antibodies after the flu vaccination
  • It is a specific resposne rather than an innate response = the adaptive immune response.
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20
Q

How can virus affect lymphocyte and neutrophil count?

A
  • The virus can suppress the bone marrow and reduce the lymphocyte and neutrophil count.
  • Therefore, sometimes there can be a paradoxical neutropenia and lymphopenia e.g. HIV and dempa
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21
Q

How does bacteria affect the lymphocyte and neutrophil count?

A
  • Lymphocytosis sometimes, like when bacteria attacks the body and there is neutrophilia.
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22
Q

What are the 3 major types of lymphocytes?

A
  • T-cells: involved in Cell-Mediated Immunity (CD4+ and CD8+)
  • B-cells: involved in Humoral Immunity (Antibody Production)
  • Natural Killer (NK) cells: Parts of the innate immune system attacking virally infected cells and tumour cells. Ability to kill naturally without producing an adaptive response - similar to neutrophils as can be innate more than adaptive.
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23
Q

How to identify the difference between cells of film?

A
  • B-cells and T-cells on a blood film

- Cannot identify on a NK (looks like a B-cells and T-cells) not expected to know how they resemble a lymphocytes

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24
Q

What do NK cells look like on a blood film?

A
  • Only lymphocyte with granules
  • Unlike neutrophils - only one, not a tri nuclei
  • The cytoplasm is paler -> more blue than neutrophils but paler blue than lymphocytes
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25
Q

What do monocytes look like on blood film?

A
  • Key to identify monocytes - it is the biggest cell in the blood film
  • Funny shaped neutrophils - shapes like a dumb bell
  • Vacuoles
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26
Q

What do eosinophils look like on blood film?

A
  • 3-5 lobes like a neutrophil
  • The granules are denser than neutrophils and almost orange in colour
  • Looks like it’s aboutto degranulate
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27
Q

What do basophils look like on a blood film?

A
  • Thicker, darker granules

- Hides the nucleus

28
Q

Describe the development of cells in the bone marrow

A
  1. Bone marrow produces all the cells, most of them belong to the myeloid progenitors.
  2. The myeloid progenitors leads to the formation of RBC, all the white cells with granules (neutrophils, monocytes, eosinophils and basophils)
  3. The cells in the lymphoid lineage is only the lymphocytes and natural killer cells.
29
Q

What is leucocytosis and leucopenia?

A

Leucocytosis - increase from normal of white cells

Leucopenia - decrease from normal of white blood cells

30
Q

What is neutrophilia and neutropenia?

A

Neutrophilia - increase in neutrophils

Neutropenia - decrease in neutrophils

31
Q

What happens during a bacterial infection?

A

The first thing that occurs is neutrophilia. This is mild to moderate. Then, the higher this goes, the more likely it is to be a haematological problem rather than an infection e.g. sepsis (50x higher they allow for a bacterial infection)

32
Q

What is toxic granulation of neutrophilias?

A
  • Granules in neutrophils become more prominent (can be confused with basophils but not as thick and dark)
33
Q

What is shift to the left in neutrophilias?

A

When the nucleus of neutrophils is not 3-5 but less as they are premature neutrophils produced from the bone marrowto fight infection.

34
Q

What is shift to the right in neutrophilias?

A

When there is more than 3-5 nuclei in neutrophils. This can lead to a hypersegmented neutrophil (9-12). The most common cause is B12 folate deficiency.

35
Q

What are Dohle Bodies?

A

When there is a prominent granulation. It is not very common.

36
Q

Describe the formation of a neutrophil

A
  1. A blast cell is shown, however, this should never be encountered on a blood film.
  2. In a normal individual, the blast cells grow into different cells as they are stem cells.
  3. It forms a promyelocyte to myelocyte then metamyelocyte.
  4. It then forms band form and the segmented neutrophils.
37
Q

Why is it important not to see a blast cell on a blood film?

A
  • If seen on a blood film, then there is a haematological problem, unless the bone marrow is under a lot of stress due to a severe infection.
  • A blast is very big and difficult to tell the cytoplasm and a nucleus apart - more homogenous.
38
Q

What does neutrophilia look like on a blood film? What is infection induced neutrophilia?

A
  • The white cell count is usually 10x lower than the RBC count.
  • There is a lot of neutrophils in one blood film and this increases a lot compared to normal.
  • They can look like mature neutrophils however, neutrophils can form vacuoles in infection. This is infection induced neutrophila.
39
Q

When does neutrophilia occur normally?

A
  • Post-operative

- Pregnancy

40
Q

What are the other causes of neutrophilia?

A
  • Bacterial infection - most common but inflammation mimics infection as it releases the same cytokines
  • Inflammation e.g. vasculitis; myocardial infarction
  • Carcinoma
  • Steroid treatment
  • Myeloproliferative disorders
  • Treatment with myeloid growth factors
41
Q

What drug can cause neutrophilia?

A

Steroids as neutrophils have a steroid receptor

42
Q

Which disease or disorder has neutrophilia?

A
  • Mild proliferative disorder or leukaemia

- If seen on the blood count, this can be one of the causes.

43
Q

What tests can be done to identify neutrophila?

A
  • FBC and differential white cell count
  • Blood film examination
  • Bacterial culture screen for infection
  • Bone marrow examination and chromosome analysis for CML
44
Q

Why is it important to do FBC and differential white cell count for neutrophilia?

A
  • To check if other cells are infected rather than just the WBC.
  • Only RBC could be anaemia
  • Differential WBC tells the types of WBC present
45
Q

Why is a bacterial culture screen for infection important?

A
  • Can show the bacteria involved causing neutrophilia
  • This is done to exclude infection as the cause for neutrophilia so can do the further tests such as bone marrow examinations to show if there is a bone marrow problem.
46
Q

Why is chromosome analysis done for CML?

A
  • It shows a translocation between chromosomes 9 and 22 called the philadelphia chromosome.
  • This gives rise to all the symptoms and signs involved in chronic myeloid leukaemia.
  • It produced more normal and mature cells. This is chronic as it present more slowly as the cells are normal unless a blood count is done. These are the classical things that cause neutrophilia unlike AML that produces myeloblasts.
  • It can be predicted from a molecular standpoint. The fusion gene caused an activated tyrosine kinase that causes uncontrolled proliferation.
47
Q

What is used to treat CML?

A
  • Imatinib a tyrosine kinase inhibitor. It is a target treatment therapy but medicine has now changed to a more molecular basis because of this.
48
Q

How to differentiate between neutrophilia and CML?

A

In addition to neutrophils in CML, there will also be a lot of basophils and eosinophils. This can be identified by CML and confirmed by further genetic studies.

49
Q

What can cause neutropenia?

A
  • Viral infection
  • Drug induced e.g. sulphonamides
  • Radiotherapy and chemotherapy
  • Part of a pancytopenia in bone marrow failure (aplastic anaemia) or infiltration e.g. leukaemia
  • Racial: benign ethic neutropenia
50
Q

Why is it important to see if there are other cells in neutropenia?

A
  • This can be an indication of a bone marrow problem in neutropenia. It could be caused by another problem such as aplastic anaemia or infiltration from something like another cancer
51
Q

What is eosinophilia? What causes eosinophilia?

A
  • High eosinophil count
  • Caused by:
    • Allergic diseases e.g. asthma, hay fever
    • Parasitic infections
    • Drug sensitivity
    • Myeloproliferative diseases e.g. CML
    • Hodgkin’s Lymphoma
52
Q

How is eosinophilia identified?

A
  • FBC and differential white cell count
  • Blood film examination
  • Stool examination for ova and parasites
  • Take a drug history to check if there is a haematological problem
53
Q

What is monocytosis and give examples?

A

Monocytosis is when the monocytes have B-shaped nucleus. An example is:

  • Tuberculosis (TB)
  • Acute and chronic monocytic and myelomonocytic leukaemia
  • Malaria
  • Chronic myeloid proliferative
54
Q

How is monocytosis identified?

A
  • FBC and differential white cell count
  • Blood film examination to look for abnormal WBCs and malarial parasites
  • Bone marrow examinatino - leukaemia
  • TB cultures
55
Q

What is lymphocytosis?

A
  • When the lymphocytes are almost the same size as RBC
  • Large nulcues and small cytoplasm
  • Compared with blast cells; blast cells are bigger and less dense
  • The number of lymphocytes almost equates to RBC
56
Q

When does lymphocytosis occur normally?

A
  • During childhood (1-6 years)

- Normal: 5-5 - 8.5 x 10(9)/L

57
Q

What are the other causes of lymphocytosis?

A
  • Bacterial infection: neutrophila is linked with lymphocytosis
  • Viral infections e.g. Hepatitis, Mumps, Rubella, Pertussis, Glandular Fever (Infectious Mononucleosis)
  • There can be suppression of lymphocytes in some viral infections such as HIV
58
Q

Give examples of leukaemias and lymphomas

A
  • Acute Lymphoid Leukaemias: Blast Cells
  • Chronic Lymphoid Leukaemias: Mature Cells
  • Lymphoid leukaemias originate from bone marrow - lymphomas are lymphoid cancers that originate from the glands
59
Q

How is lymphocytosis identified?

A
  • FBC and differential white cell count
  • Blood film examination
  • Look for viruses, fever, throat swabs etc.
  • In lymphoid - feel the lymph nodes
60
Q

What do atypical mononuclear cells look like on a blood film?

A
  • Big cells: blasts or monocytes
  • Little granules in the cells above however, seem to border the RBC = atypical mononulcear cells
  • Resemble monocytes but they are actually lymphocytes that have been transformed by infections
  • Can be caused by glandular fever etc
  • Scalloping cell, and pale cytoplasm = atypical mononuclear cell
  • Identified on FBC and differential white cell count and blood film examination
  • An example of lymphocytosis
61
Q

How are atypical mononucelar cells shown in glandular fever?

A
  • Caused by EBV (infectious mononucleosis; kissing disease)

- Monospot, Paul Bunnell Test, Clearview Infectious Mononucleosis Test

62
Q

What are heterophile antibodies?

A

Antibodies that react against an antigen which is completely unrelated to the antigen which originally stimualted it e.g. human antibodies reacting against sheep or horse or bovine cells

63
Q

What is chronic lymphocytic leukaemia?

A
  • Another example of lymphocytosis

- This is almost the same number of lymphocytes as the RBCs.

64
Q

What does chronic lymphocytic leukaemia look like on a blood film?

A
  • The higher the lymphocyte count, the less it is contributed to infection and drug-induced but more closer to lymphocytic leukaemia.
  • The smudged cells are not lymphocytes, they may be neutrophils.
  • Leukaemia originated from the bone marrow.
65
Q

How is chronic lymphocytic leukaemia identified?

A
  • Blood film needs to be done but in lymphoid diseases need to distinguish between the T-cells and B-cells
  • This is done by immunphenotyping but can also do a flow cytometry with surface markers
  • This can also help us tell which type of cell it is. It can also determine clonality.
  • Mature lymphocytes: chronic lymphocytic leukaemia
  • B-cells: demonstrate clonality by light chain restriction such as CD19 and CD20.
  • T-cells: demonstrate clonality by T-cell receptor gene rearrangement studies such as CD3, 4, and 8

SEM 4: Haematology (8 decks)

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