October 1, 2015 - Neutrophilia

Question 1

Left Shift

Answer 1

An increase in the number of immature leukocytes in the peripheral blood.

These can include band cells, metamyelocytes, myelocytes, promyelocytes or blast cells.

Question 2

Granulocytes

Answer 2

Neutrophils

Eosinophils

Basophils

Question 3

Neutrophil Growth Factors

Answer 3

GM-CSF

G-CSF

SCF

We have synthetic versions of these.

Question 4

Maturation of Neutrophils

Answer 4

Myeloblast

Promyelocyte

Myelocyte

Metamyelocyte

Band

Neutrophil

Question 5

Neutrophil Function

Answer 5

Acting as phagocytes.

Go to sites of inflammation and engage in phagocytosis and killing of microorganisms. This creates pus.

Question 6

Reactive Neutrophilia

Answer 6

“Orderly” WBC differential.

Same percentages.

Question 7

Neoplastic Neutrophilia

Answer 7

“Disorderly” neutrophilia.

Ratios are not normal. Or you are seeing cells that shouldn’t be present such as myelocytes, promyelocytes, and blast cells.

Question 8

Types of Myeloproliferative Disorders

Answer 8

Chronic myolegenous leukemia (CML)

Primary myelofibrosis (PMF)

Polycythemia vera (PV)

Essential thrombocythemia (ET)

Question 9

CML

Answer 9

Chromic myelogenous leukemia.

A clonal disorder of hematopoiesis that arises in a hematopoietic stem cell or early progenitor cell. Characterized by the dysregulated production of a particular lineage of mature myeloid cells with fairly normal differentiation. Exhibits a variable tendency to progress towards acute leukemia.

Characterised by the Philadelphia Chromosome.

Question 10

Philadelphia Chromosome

Answer 10

A balanced translocation of part of chromosome 9 to chromosome 22.

Causes chimeric BCR-ABL mRNA to be translated into a functional protein.

Question 11

Transformation by BCR-ABL

Answer 11

Transforms cytokine-dependent lymphoid and myeloid hematopoietic cell lines to become cytokine-independent for survival and proliferation.

Consistently activates tyrosine kinase.

Question 12

CML Bone Marrow Findings

Answer 12

Hypercellular

Question 13

Diagnosis of CML

Answer 13

Done by the detection of the Ph Chromosome or its products (BCR-ABL fusion mRNA and Bcr-Abl protein) is required for diagnosis.

Testing through standard cytogenetic analysis, FISH, or RT-PCR.

Question 14

Blast Phase

Answer 14

What CML will progress to. This can be myeloid (AML), lymphoid (ALL).

Without drugs (imatinib), medial survival was 3-6 months.

Question 15

Treatment Options in CML

Answer 15

Tyrosine kinase inhibitors is first line.