Week 2 - Online White Cells tutorial (Granulocytes, Lymphocytes, Monocytes) and Microscopy Teaching with Tauro

Question 1

The origins of blood cells - the haematopoeitc stem cell - which of the following statements is true? A - Can be easily distinguished in the bone marrow B - Is capable of differentiating into all types of blood cells C - Can switch lineages ie start differentiating into a B lymphocyte and then swtich to an erythroid precursor D - Is a rapidly dividing cell

Answer 1

B - Is capable of differentiating into all types of blood cells - this is true Once decided, the lineage of the progeny cannot be changed

Question 2

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Answer 2

They transit the bloodstream and spend most of their time in the tissues They are part of the innate (non-specific) immune system Granulocyte sinclude basophils, eosinophils, neutrophils

Question 3

Which of the following statements are true Neutrophils are: A - monolobular B - contain red granules C - are able to stick to blood vessel walls (Marginate) D - are the least commonly found granulocyte E - circulate for several days before exiting the bloodstream

Answer 3

C - are able to stick to blood vessel walls (marginate)

Question 4

Maturator for granulocytes is seen as progressing from immature - the myeloblast to mature - the end granulocyte Presence of more immature forms of neutrophils, such as myelocytes, indicates what?

Answer 4

This indicates marrow stress or damage - allowing the neutrophils to exit the marrow early and is often described as a left shift on the blood film

Question 5

What two different lineages can arise form the precursor to neutrophils - the GMP (granulocyte macrophage progenitor)?

Answer 5

Monocytes (macrophages) and granulocytes (neutrophil, basophil, eosinophil)

Question 6

Not all neutrophils in circulation are circulating A proportion adhere to blood vessel walls -what is this known as? Are these neutrophils included in the blood count?

Answer 6

This is known as margination These neutrophils are not counted in the blood count

Question 7

Why may there may be a neutrophilia when a patient is on steroids on blood count? What is neutrophilia?

Answer 7

This is process the process by which neutrophils use a number of adhesion molecules to squeeze between endothelial cells and enter the tissues may be disrupted by steroids- leaving a higher than normal neutrophil count in the blood This is an increase in the number of neutrophils in the blood

Question 8

Which of the following can cause neutrophilia? 1. Inflammation 2. Bacteria - especially pyogenic bacteria 3. Acute haemorrhage 4. Tissue necrosis 5. Neoplasia eg carcinoma

Answer 8

All of them * Inflammation * Bacteria - especially pyogenic bacteria * Acute haemorrhage * Tissue necrosis * Neoplasia eg carcinoma

Question 9

Which of the following can cause eosinophilia? 1. Helminthic infection 2. Asthma 3. Malaria 4. Sepsis 5. Non-hodgkins lymphoma 6. Severe eczema What is a helminthic infection?

Answer 9

Helminthic infection Asthma Severe eczema Helminths are parasitic worms that feed on a living host to gain nourishment and protection, while causing poor nutrient absorption, weakness and disease in the host. These worms and larvae live in the small bowel and are referred to as intestinal parasites

Question 10

WHat type of lymphoma often causes an increase in eosinophil count? What type of infections? What pulmonary syndromes? What type of atopic conditions?

Answer 10

Hodkins lymphoma and T cell lymphoma Parasitic infections Eosinophilic pneumonia and Churg Strauss SYndrome (Eosinophilic granulomatosis with polyangiitis (EGPA)) - usually get asthma and vasculitis Eczema, asthma, hayfever, dermatitis

Question 11

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Answer 11

Polycythaemia ruba vera - can get too many red cells, platelets and white cells and Chronic myeloid leukaemia - causes proliferation of mature granulocytes

Question 12

Like eosinophils, basophils have a role in parasitic infections and allergy What is the usual levels of basophils?

Answer 12

Usually are not really found in circulation - levels basically 0 in blood in normal circumstances

Question 13

Describe a basophil on blood film?

Answer 13

Bilobed nucleus Usually covered by lots of cytoplasmic granules dark blue/purplish

Question 14

Tryptase is the most abundant secretory granule-derived serine proteinase contained in mast cells and has been used as a marker for mast cell activation Increased serum levels of mast cell tryptase may indicate- choose: 1. Immune complex disease 2. Systemic macrocytosis 3. A recent anaphylactic reaction 4. Severe sepsis

Answer 14

2. Systemic macrocytosis 3. A recent anaphylactic reaction

Question 15

Elevated levels of serum tryptase occur in both anaphylactic and anaphylactoid reactions, but a negative test does not exclude anaphylaxis. Tryptase is less likely to be elevated in food allergy reactions as opposed to other causes of anaphylaxis. What is systemic macrocytosis? What are the symptoms?

Answer 15

Mastocytosis, a type of mast cell disease, is a rare disorder affecting both children and adults caused by the accumulation of functionally defective mast cells Symtpoms include those similar to an allergic reaction due to the release of hsitamine

Question 16

Mast cells are the tissue equivalent of basophils What does degranulation of the mast cells cause the relase of? (3 main things) What is used as a measure of mast cell activity?

Answer 16

Degranualtion releases typtase, heparin and histamines Triptase levels is used as a measure of mast cell activity

Question 17

Monocytosis can be seen in A - Smokers B - connective tissue disease C - chronic bacterial infections D - Malignancy What can be seen in the incorrect answer?

Answer 17

A - Smokers - incorrect but can see neutrophilia B - connective tissue disease (SLE and RA) C - chronic bacterial infections D - Malignancy (chronic meylomonocytic leukaemia)

Question 18

What do monocytes share a common precursor with? How long do they circulate in the blood before entering tissues? Describe the monocyte on blood film? Describe the monocyte nucleus?

Answer 18

Monocytes share a common precursor with granulocytes Circulate in the blood for 1-2 days before entering the tissues On blood film - monocyte is a large monolobular cell with plentiful cytoplasm - a horse shoe/kidney shaped nucleys

Question 19

Lymphocytes arise in the bone marrow and develop in primary lymphoid organs - name two? What are different types of lymphocytes?

Answer 19

Bone marrow and thymus - primary lymphoid organs There are three main types known as T cells, B cells, and natural killer cells.

Question 20

What is the only cell to arise from both common myeloid progenitor and common lymphoid progenitor cells?

Answer 20

This would be dendritic cells

Question 21

When are lymphocytes described as atypical (active) ie in response to what infection? What is the activated lymphocyte described as on blood film?

Answer 21

Described as activated when in response to EBV - infectious mononucleiosis but can be in result to HIV (atypical/reactive/ activated lymphocytes can occur in response to any viral infection) On blood film, large abundant cytoplasm which wraps against neighbouring blood cells

Question 22

When carrying out confirmatory testing Which antibody confirms recent infection? Which antibody confirms past infection?

Answer 22

IgM specific antibodies confirm recent infection IgG specific antibodies confirm past infection

Question 23

WHat is an example of an infection where IgG is positive for life but IgM can be used to show that the treatment was successful?

Answer 23

Syphilis

Question 24

What defining feature of the neutrophil on microscopy allows male blood film to be identified from female bloood film?

Answer 24

The presence of a Barr body on the nucleus of a neutrophil indicates that it is a female nucleus - it represents the inactive X-chromosome in a female The Barr body is the small tail sticking of the end of the nucleus of the neutrophil

Question 25

Describe a monocyte on blood film? Why may vacuolization be present on the monocyte?

Answer 25

A monocyte usually has a horseshoe/kidney shaped nucleus The chromatin on a monocyte is usually more open and there is often vacuolation - also an abundance of cytoplasm Vacuolization may be present if recently phagocytosed foreign matter

Question 26

What is the order of leukocyte commonness in the blood?

Answer 26

1. Neutrophil - bacteria (others causes previously discussed) 2. Lymphocyte - viruses 3. Monocyte - non-specific 4. Eosinophil - allergies, parasites, helminths, fungi 5. Basophils - allergies/paraistes also

Question 27

What cancers are eosinophils also raised?

Answer 27

Hodgkins lymphoma and Tcell lymphoma

Question 28

Describe the appearance of a basophil under microscopy? What do basophils release? (remember they are very similar to mast cells - mast cells reside in the tissues)

Answer 28

The basophil appears as a large - usually bilobed nucleus with dark blue/purple granule over the nucleus Basophils release histamine and heparin Basophils are not really seen on a blood film

Question 29

When the bone marrow is under stress (ie sepsis), it ca produce precursors to neutrophils and will usually also see primitive erythrocytes, what is this known as?

Answer 29

This is known as leucoerythroblastic change

Question 30

When you see toxic granulation in a neutrophil, what is this a sign of? Also describe the appearance of toxic granulation of a neutrophil?

Answer 30

Toxic granulation refers to changes in granulocyte cells. They are commonly found in patients with sepsis. Toxic granulations are dark coarse granules found in granulocytes, particularly neutrophils. With toxic granualtion, there is usually also vacuolation of the neutrophil

Question 31

What is seen on the peripheral blood film in hyposplenism?

Answer 31

See target cell - Mexican Hat cells - these are RBcs with a central staining instead of pure central pallor (ring of pallor around the central stain) Howell Jolly Bodies - usually if there are any DNA nuclear remnants in the RBCs, they are removed by the spleen - you see Howell Jolly bodies when the spleen is not functioning and the DNA nuclear remnant remains Also can see acanothocyte - refers to a form of red blood cell that has a spiked cell membrane, due to abnormal thorny projections.

Question 32

What conditions can cause hyposplenism?

Answer 32

Sicke cell anaemia Coeliacs disease UC/crohns also

Question 33

If you have hyposplenism or splenectomy, what vaccines should be given? (before the splenectomy they would be given) And would prophylaxis should be given for life?

Answer 33

Vaccines against streptococcus, pneumococcus, haemophilus Also Give Pen V for life (oral tablet - phenoxymethylpenicillin)

Question 34

In EBV there are atypical (reactive/activated) lymphcoytes What are these lymphocytes said to do around the RBC? What is now tested for if suspecting EBV? (which immunoglobulin mediates the antibody you are testing for?) If the EBV antibody tests come back negative, what is tested for?

Answer 34

The lymphocytes are said to scallpo around the red blood cells Test for anti-EBV antibodies Will see anti-IgM antibodies if recent/current infection of EBV (M for immediate) IgG remains positive for life (not great for identifying new disease) If not HIV, should carry out a HIV test

Question 35

In iron deficiency anaemia, the RBCs cells produced have an abnormal shape and size - what is the term used to describe cells with abnromal shape and size? When looking at the cells on blood film, what re they described as?

Answer 35

Abnormal shape and size of RBC - anisopoikilocytosis These cells are described as pencil cells

Question 36

If have a blood film showing hypochromic microcytic anaemia, what should be measured? If there is a film showing macroovalocytes, what is also generally seen on the film? What is the usual cause?

Answer 36

If having a film with hypochromic microcytic anaemia - measure the serum ferritin If having a film showing macroovalocytes - will usually also see hypersegmented neutrophils - indicative of B12/folate deficiency

Question 37

Why can reticulocytosis cause a pseudo-macrocytosis? If there is a reticulocytosis with spherocytes present and loss of red cell central pallor, what does this make you think? May also see some nucleated red blood cells

Answer 37

Reticulocytes are larger than red cells and therefore may be counted as red cells by the automated analysers - this will bring up the MCV of the red cells Reticulocytosis (makes you think bone is combatting either haemolysis or haemorrhage), spherocytes present and loss of RBC central pallor - makes one think autoimmune haemolytic anaemia

Question 38

Where do platelets mature? Name two conditions When do tear drop cells occur?

Answer 38

Platelets mature in the lungs Tear drop cells form when there is bone marrow stress or extramedullar haematopoesis Two conditions - thalassemia and myelofribosis

Question 39

Target cell, Howell Jolly body, sickle cell, what is this condition? Patient seen with too many cells that are immature (myeloblasts for this question) - what is the condition? What are the cells known as? How would the condition be diagnosed?

Answer 39

Sickle cell anaemia - target cell, howell jolly body, sickle cells, also acanthoctyes In a patient with too many myeloblasts in the blood - this could be acute myeloid leukaemia Diagnose the condition via immunophenotyping

Question 40

Lots of mature lympocytes, blood film described as monotonous - this could make you think a monoclonal condition What may be the diagnosis?

Answer 40

Chronic lymphocytic leukaemia - can cause thrombocytopenia and autoimmune haemolysis

Question 41

Parasitic infections can be diagnosed based on the blood film ie malaria In malaria what can be seen in the RBCs that diagnoses the condition?

Answer 41

Can see ringforms on the bloodfilm in plasmodium falciparum