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POM HAEMATOLOGY > Tales from haem clinic: WBC > Flashcards

Tales from haem clinic: WBC Flashcards

1
Q

What is vacuolation?

A

When granulocytes have vacuoles

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2
Q

When is vacuolation normally seen?

A

In infection

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3
Q

What markers can show infection?

A

Inflammatory markers e.g., CRP
Sputum culture
Urine antigen test

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4
Q

What is CRP?

A

c-reactive protein is released (from the liver) more if there is inflammation

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5
Q

What are the types of leukocytes?

A
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6
Q

What are symptoms/ features of viral infections/ glandular fever?

A

Tonsillar inflammation
Widespread palpable small lymph nodes (cervical, axillary, Inguinal)
Lymphocytosis
leukocytosis

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7
Q

What are the areas of palpable lymph nodes?

A

cervical= neck
axillary= armpit
Inguinal= groin

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8
Q

How would you confirm a diagnosis of infectious mononucleosis (mono)?

A

Testing for mononuclear heterophile antibodies
‘monospot’ test
or by looking. for igM antibodies to Epstein-Barr virus (EBV)

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9
Q

What is a common type of lymphocyte when there is a viral infection?

A

atypical lymphocytes
- e.g., intensely basophilic cytoplasm

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10
Q

What is a characteristic of infectious mononucleosis (glandular fever)?

A

scalloped margins and ‘hugging’ of the surrounding RBCs

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11
Q

What are “smear/ smudge/ basket’ cells?

A

squashed mature lymphocytes

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12
Q

What are smear/ smudge/ basket cells a characteristic of?

A

CLL

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13
Q

How would you describe chronic lymphocytic leukaemia?

A

Lymphoproliferative disorder
it is the most common cause of persistent lymphocytosis in the elderly

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14
Q

How can you confirm a diagnosis of CLL?

A

characterise the profile of cell surface markers expressed by lymphocytes using flow cytometry

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15
Q

How is CLL staged?

A

according to the degree of lymph node/ liver/ spleen involvement
and whether Hb and platelet count are reduced (in more advanced disease)

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16
Q

What are the clinical signs shown on the drawing.
(shows widespread bruising)

A

lymphadenopathy (enlarged lymph nodes)
enlarged liver (hepatomegaly)
enlarged spleen (splenomegaly)
testicular swelling

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17
Q

Where is the lymphadenopathy in the image?

A

neck/ cervical
axillae
groin

18
Q

How do you recognise blast cells?

A

large size, high nucleus/ cytoplasm ratio, open chromatin patterns of nucleus, prominent nucleoli

19
Q

What is thrombocytopenia?

A

Low platelet count

20
Q

What is pancytopenia?

A

describes reduction in all 3 cell lineages

21
Q

What symptoms does leukocytosis with lymphoblasts circulating in the blood lead to?

A

lymphadenopathy
hepatomegaly
splenomegaly
testicular swelling

22
Q

What symptoms does anaemia (normocytic/ normochromic) lead to?

A

pale, lethargic/ listless (lack energy)

23
Q

What does symptoms does neutropenia lead to?

A

fever

24
Q

What symptoms does thrombocytopenia lead to?

A

bruising/ bleeding

25
Q

What are the symptoms/ characteristics of acute lymphoblastic leukaemia (ALL)?

A

listlessness, widespread bruising, febrile, pale, hepatomegaly, splenomegaly, testicular swelling, lymphadenopathy, low Hb (anaemia)

26
Q

What tests can you perform to get more information for the diagnosis of ALL?

A

Flow cytometry
Cytometric/ molecular analysis
bone marrow test (aspirate)

27
Q

What would bone marrow aspirate of ALL show?

A

shows replacement of normal bone marrow cells by lymphoblasts

28
Q

How can the lymphoblasts be further characterised?

A

by assessing the profile of their cell surface e.g., using flow cytometry

29
Q

How is cytogenetic and molecular genetic analysis useful with leukaemia?

A
  • Cytogenetic/molecular genetic analysis is useful for managing the individual patient because it gives us information about prognosis
  • Cytogenetic/molecular genetic analysis advances knowledge of leukaemia because it has permitted the discovery of leukemogenic mechanisms and the development of targeted treatment
30
Q

What are approaches to treatment for ALL?

A

supportive
- red cells
- platelets
- antibiotics

systemic chemotherapy

intrathecal (around the spinal cord) chemotherapy

31
Q

Why is both intrathecal and intravenous systemic chemotherapy required for ALL?

A

lymphoblasts infiltrate into the CNS, where they are protected from the systemic chemotherapy (aka sanctuary site)

32
Q

Describe the abnormalities on this blood film.

A

increased granulocytes, neutrophils, and basophils and an increase in granulocyte precursors (myelocytes and metamyelocytes)

33
Q

When you have extremely raised WBCs, what could be the cause of a patient’s abdominal pain?

A

enlargement of spleen and possibly liver/ splenomegaly and hepatomegaly

34
Q

What does the ABL1 gene encode for?

A

tyrosine kinase enzyme (tightly regulated activity)

35
Q

What gives rise to a leukaemic clone?

A

BCR:ABL1 gene encodes a protein with uncontrolled tyrosine kinase activity, which gives rise to leukaemic clone

36
Q

What can be done to treat chronic myeloid leukaemia?

A

the BCR-ABL1 protein signals between the cell surface and the nucleus can be inhibited

It can be inhibited by specific tyrosine kinase inhibitors leading to remission, and potentially cure of the disease

37
Q

What is the difference in blast cells from ALL and AML?

A

In AML, cytoplasm of blast cells contains granules, consistent with myeloblasts
- flow cytometry will characterise these further

38
Q

What are characteristics of AML?

A

blast cells with granular cytoplasm (myeloblasts)
anaemia with circulating nucleated RBCs
Neutropenia
Thrombocytopenia (low platelet count)

39
Q

Are you happy with this summary of the cases from this session.

A
40
Q

What are the clinical features that may be found in leukaemia?

A

Si or No (you want me to say it in spanish, no)

41
Q

What is the difference between acute and chronic leukaemias?- acute

A
  • In Acute Leukaemia (AML or ALL) there is an increase in very immature cells (myeloblasts or lymphoblasts) with a failure of these to develop into mature leukocytes
  • In Acute leukaemia, the bone marrow is infiltrated by immature blast cells, resulting in impaired haemopoiesis: blast cells also circulate in the peripheral blood and can be seen on the blood film
  • If Acute leukaemias are not treated, the disease is very aggressive and patients die quickly
42
Q

What are the differences between acute and chronic leukaemia?- chronic

A
  • In Chronic Leukaemias the leukaemic cells are mature, although abnormal: granulocytes or lymphocytes
  • In Chronic Leukaemias the disease and deterioration go on for a long period of time
  • In CML, the mature end cells are still able to function; in CLL the lymphocytes are functionally useless and there is a loss of normal immune function

POM HAEMATOLOGY (11 decks)

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