Myeloid lineage cell stages in granulocytic maturation:

Question 1

What is the characteristics of the myeloblast?

Answer 1

• not present in p blood
• 2-4% of cells in marrow
• pale blue
• big nucleoli

Question 2

An increase in the number of myeloblasts in the marrow can be an indicator of?

Answer 2

Anything more than 5% in the blood can be an indicator of leukemia - acute myeloblastic leukemia.

Question 3

What are the characteristics of promyelocytes?

Answer 3

• not present in p blood
• occasional nucleolus
• deep blue cytoplasm in colour
• contains p granules

Question 4

What are the characteristics of myelocytes?

Answer 4

• not in p blood
• no nucleoli
• secondary granules present in cytoplasm
• Maturation

Question 5

What are the characteristics of the metamyelocyte?

Answer 5

• low nucleocytoplasmic ratio
• distinctive p and s granules
• nucleus becomes curved without being lobed and will mature in band neutrophils which are referred to by some as stab cells.

Question 6

What are metamyelocytes referred to as once the nucleus has become curved without being lobed during maturation?

Answer 6

Band neutrophils.

Question 7

What are the characteristics of the neutrophil?

Answer 7

• rich in granules
• hypersegmented (right shift)
  3-5 lobees, connected via chromatin strands.
• < 2 lobes = hypersegmented the Pelger Huet anomaly is an example of this.

Question 8

What is an example of a neutrophil population with 2 lobes or fewer?

Answer 8

Pelger-Huet anomaly.

Question 9

What is neutrophil lecocytosis?

Answer 9

An increase in neutrophils - greater than 7.5 x10^9/L.

Question 10

What are some of the causes that are are associated with neutrophilia?

Answer 10

Fever, inflammatory process, acute haemorrhage, drugs, chronic myeloid leukemia.

Question 11

What does neutrophilia cause in the blood?

Answer 11

A shift to the left - as there is an increase in the number of band neutrophils and occasionally metamyelocytes in the blood.

Question 12

What is toxic granulation?

Answer 12

This is the presence of really dark granules and Dohle bodies (light pale blue inclusions)
It is an increase in immune response

Question 13

What is NAP score?

Answer 13

This is the Nuclein alkaline phosphatase which involves the making of a blood film, stain (which the enzymes within the neutrophil will react with and cause a colour deposit)

Question 14

How does one do a NAP score?

Answer 14

Count 100 cells, score from 0-4

Question 15

How is neutrophilia treated?

Answer 15

With myeloid growth factors : g-csf, gm-csf.

Question 16

What is asplenia?

Answer 16

absence of normal spleen function and is associated with some serious infection risks.

Question 17

What is Leukemoid Reaction?

Answer 17

This is a white cell count > 50x10^9/L with cells of all myeloid maturation occuring in the p blood.

Question 18

What is neutropenia?

Answer 18

this is when the neutrophil count is 2.5x10^9/L.

Question 19

What happens when the absolute neutrophil level falls below 0.5x10^9/L?

Answer 19

The patient is likely to have recurrent infection.

Question 20

What happens when the neutrophil count falls to less than 0.2x10^9/L ?

Answer 20

The risks are very serious, especially if there is also a functional defect.

Question 21

What is generally pancytopenia?

Answer 21

This is when a person has low blood counts for all blood cells (3 types)
Conditions: Asplastic anaemia.

Question 22

What are the congential causes of neutropenia?

Answer 22

Kostmann’s syndrome - this is an early life presenting with a count of less than 0.2x10^9/L with life threatening infections.

Question 23

What is Kostmann’s syndrome assocaited with?

Answer 23

Mutations with the gene encoding for neutrophil elastase.

Question 24

What are the acquired causes of neutropenia?

Answer 24

• drug induced (antibacterial, direct toxicity or immune)
• Cyclical neutropenia (oscillating neutrophil and monocyte counts)
• immune - autoimmune and SLE

Question 25

What is SLE?

Answer 25

This is systemic lupus erythematosus (most common type). body produces antibodies attacking neutrophils.

Question 26

What is idiopathic benign neutropenia?

Answer 26

This is where there is an increase in the marginating fraction of neutrophils and corresponding reduction in circulating neutrophils.

Question 27

What are 2 lesser causes for neutropenia ? (Infection and ethnicity?)

Answer 27

• Viral infections

- Some african and middle east races appear to have neutrophil levels that are lower than caucasian 1.5x10^9/L.

Question 28

What are the defects of the phagocytic neutrophil ?

Answer 28

Chemotaxis
Opsonization and phagocytosis
Killing

Question 29

What is the name of the syndrome which is a rare congenital abnormality of the neutrophil?

Answer 29

Lazy leukocyte syndrome.

Question 30

What are the 2 opsonization/phagocytosis defects of phagocytic function of the neutrophil?

Answer 30

Congenital and acquired (causing hypogammaglobulinemia or lack of complement)

Question 31

What is an example of a defect with the killing function of the neutrophil?

Answer 31

Chronic granulomatous - disease from abnormal oxidative function.
Also, in chronic and acute leukemia.