Tales from haem clinic: WBC Flashcards
What is vacuolation?
When granulocytes have vacuoles
When is vacuolation normally seen?
In infection
What markers can show infection?
Inflammatory markers e.g., CRP
Sputum culture
Urine antigen test
What is CRP?
c-reactive protein is released (from the liver) more if there is inflammation
What are the types of leukocytes?
What are symptoms/ features of viral infections/ glandular fever?
Tonsillar inflammation
Widespread palpable small lymph nodes (cervical, axillary, Inguinal)
Lymphocytosis
leukocytosis
What are the areas of palpable lymph nodes?
cervical= neck
axillary= armpit
Inguinal= groin
How would you confirm a diagnosis of infectious mononucleosis (mono)?
Testing for mononuclear heterophile antibodies
‘monospot’ test
or by looking. for igM antibodies to Epstein-Barr virus (EBV)
What is a common type of lymphocyte when there is a viral infection?
atypical lymphocytes
- e.g., intensely basophilic cytoplasm
What is a characteristic of infectious mononucleosis (glandular fever)?
scalloped margins and ‘hugging’ of the surrounding RBCs
What are “smear/ smudge/ basket’ cells?
squashed mature lymphocytes
What are smear/ smudge/ basket cells a characteristic of?
CLL
How would you describe chronic lymphocytic leukaemia?
Lymphoproliferative disorder
it is the most common cause of persistent lymphocytosis in the elderly
How can you confirm a diagnosis of CLL?
characterise the profile of cell surface markers expressed by lymphocytes using flow cytometry
How is CLL staged?
according to the degree of lymph node/ liver/ spleen involvement
and whether Hb and platelet count are reduced (in more advanced disease)
What are the clinical signs shown on the drawing.
(shows widespread bruising)
lymphadenopathy (enlarged lymph nodes)
enlarged liver (hepatomegaly)
enlarged spleen (splenomegaly)
testicular swelling
Where is the lymphadenopathy in the image?
neck/ cervical
axillae
groin
How do you recognise blast cells?
large size, high nucleus/ cytoplasm ratio, open chromatin patterns of nucleus, prominent nucleoli
What is thrombocytopenia?
Low platelet count
What is pancytopenia?
describes reduction in all 3 cell lineages
What symptoms does leukocytosis with lymphoblasts circulating in the blood lead to?
lymphadenopathy
hepatomegaly
splenomegaly
testicular swelling
What symptoms does anaemia (normocytic/ normochromic) lead to?
pale, lethargic/ listless (lack energy)
What does symptoms does neutropenia lead to?
fever
What symptoms does thrombocytopenia lead to?
bruising/ bleeding
What are the symptoms/ characteristics of acute lymphoblastic leukaemia (ALL)?
listlessness, widespread bruising, febrile, pale, hepatomegaly, splenomegaly, testicular swelling, lymphadenopathy, low Hb (anaemia)
What tests can you perform to get more information for the diagnosis of ALL?
Flow cytometry
Cytometric/ molecular analysis
bone marrow test (aspirate)
What would bone marrow aspirate of ALL show?
shows replacement of normal bone marrow cells by lymphoblasts
How can the lymphoblasts be further characterised?
by assessing the profile of their cell surface e.g., using flow cytometry
How is cytogenetic and molecular genetic analysis useful with leukaemia?
- 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
What are approaches to treatment for ALL?
supportive
- red cells
- platelets
- antibiotics
systemic chemotherapy
intrathecal (around the spinal cord) chemotherapy
Why is both intrathecal and intravenous systemic chemotherapy required for ALL?
lymphoblasts infiltrate into the CNS, where they are protected from the systemic chemotherapy (aka sanctuary site)
Describe the abnormalities on this blood film.
increased granulocytes, neutrophils, and basophils and an increase in granulocyte precursors (myelocytes and metamyelocytes)
When you have extremely raised WBCs, what could be the cause of a patient’s abdominal pain?
enlargement of spleen and possibly liver/ splenomegaly and hepatomegaly
What does the ABL1 gene encode for?
tyrosine kinase enzyme (tightly regulated activity)
What gives rise to a leukaemic clone?
BCR:ABL1 gene encodes a protein with uncontrolled tyrosine kinase activity, which gives rise to leukaemic clone
What can be done to treat chronic myeloid leukaemia?
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
What is the difference in blast cells from ALL and AML?
In AML, cytoplasm of blast cells contains granules, consistent with myeloblasts
- flow cytometry will characterise these further
What are characteristics of AML?
blast cells with granular cytoplasm (myeloblasts)
anaemia with circulating nucleated RBCs
Neutropenia
Thrombocytopenia (low platelet count)
Are you happy with this summary of the cases from this session.
What are the clinical features that may be found in leukaemia?
Si or No (you want me to say it in spanish, no)
What is the difference between acute and chronic leukaemias?- acute
- 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
What are the differences between acute and chronic leukaemia?- chronic
- 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
