White Blood Cell Conditions Flashcards
Describe the appearance of neutrophils and their function
2-3 lobes of the nuclei, light staining with lobed nucleus. Involved in responding to BACTERIAL infections
Describe the appearance of eosinophils and their function
Have a red brick colour staining with two nuclei and are involved in responding to PARASITES (e.g. helminths)
Describe the appearance of basophils and their function
Rarely seen in blood film but cytoplasm is highly granular and is involved in allergies as it’s the equivalent to mast cels in the blood
Describe the appearance of monocytes and their function
Largest of the granulocytes with a kidney-bean shaped nucleus, and matures in tissues to become a macrophage
Describe the appearance of lymphocytes and their function
Large nucleus: cytoplasm ratio (very little cytoplasm visible) and involved in adaptive immunity
What are macrocytes and what may cause this?
Red cells with an increased MCV, due to liver disease or B12/folate deficiency
What are target cells and what may cause this?
Red cells with a ‘target-like’ appearance due to liver disease, haemoglobinopathies or iron deficiency
What are pencil cells and what may cause this?
These are where the red cells appear thin and pencil-shaped due to iron-deficiency
What are ecchinocytes and what may cause this?
These are star-shaped red cells due to liver disease
What are microcytes and what may cause this?
Red cells with a reduced MCV due to iron-deficiency or thalassaemia
What are spherocytes and what may cause this?
Spherical red cells due to hereditary spherocytosis, or autoimmune haemolytic anaemia.
What may the presence of red cell fragments in a blood film represent?
Diffuse intravascular coagulation (DIC) or cardiac prosthetic valves
What are elliptocytes and what may cause this?
Thicker versions of pencil cells present due to hereditary elliptocytosis
What are tear drop poikilocytes are what may cause this?
These are red cells that are tear-drop shaped due to myelofibrosis
What are Howell-Jolly bodies and what may cause this?
Remnant of DNA in red cell due to hyposplenism or post-splenectomy
How would a malarial parasite present in a blood film?
Look’s similar to an engagement ring within the red blood cells.
What is the mode of inheritance for hereditary ellpitocytosis?
Autosomal dominant
What is hereditary elliptocytosis?
Where there is a defect leading to failure of spectrum heterodimers to self-associate into heterotetramers so the normal bi-concave disc doesn’t form.
How does the genetic profile affect the severity of hereditary elliptocytosis?
Homozygous (or doubly heterozygous) have severe haemolytic anaemia, whereas those who are heterozygous tend to have no ill effects until discovered under routine examination
What is immune thrombocytopenia purpura (ITP)?
Usually appears as spontaneous skin purport and mucosal bleeding that tends to affect women 15-50 and bone marrow has increased levels of megakaryocytes.
In a 23-year-old woman with easy bruising, heavy periods, petechial haemorrhages around her ankles and microcytic anaemia, what is the likely cause?
Iron-deficiency anaemia due to chronic blood loss and immune thrombocytopenia purport for the petechial haemorrhages and easy bruising.
What are the characteristic blood film signs post-splenectomy or with hyposplenism?
Irregularly contacted red cells, target cells, Howell-Jolly bodies
Why does whooping cough cause a lymphocytosis in children instead of a neutrophilia?
Whooping cough is caused by Bordetella pertussis bacteria which would cause a neutrophilia in adults but lymphocytosis often occurs in response to bacterial infections in children.
A one-year-old boy presented with a recent respiratory tract infection. This had now developed into severe paroxysms of coughing. He has a normocytic anaemia with lymphocytosis. What is the likely diagnosis?
Whooping cough with bordetella pertussis, as bacterial infections in young children often lead to a lymphocytosis instead of a neutrophilia
What are the histological characteristics of chronic lymphocytic leukaemia?
Polychromasia (reticulocytosis) and normocytic anaemia with lymphocytosis
Outline the underlying pathophysiology of chronic lymphocytic leukaemia
There is clonal expansion of B-cells and the bone marrow is infiltrated by lymphocytes leading to it’s failure and subsequently the development of anaemia, neutropenia and thrombocytopenia.
What are promyelocytes?
Early granulocyte precursors characterised by bi-lobed nuclei and cytoplasmic granulation
What is acute promyelocytic leukaemia?
A type of acute myeloid leukaemia characterised by the presence of a t(15:17) translocation and the presence of DIC (disseminated intravascular coagulation)
Which form of leukaemia is a t(15:17) translocation and DIC characteristic of?
Acute promyelocytic leukaemia
Why does treatment of acute promyelocytic leukaemia with chemotherapy have to be done with care?
Chemotherapy aggravates the DIC ad therefore multiple platelet transfusions and replacement of clotting factors with fresh frozen plasma have to be used.
How would acute pro-myelocytic leukaemia appear on a full blood count?
Normocytic anaemia (due to bone marrow infiltration), reduced leucocytes generally with increased pro-myelocytes, decreased platelets (due to DIC and marrow infiltration) and increased clotting and reduced availability of factors.
What is myelofibrosis?
Extensive scarring of the bone marrow which affects the production of blood cells
A 64-year-old woman presented with tiredness and left-sided abdominal discomfort. On examination she had an enlarged live and massive splenomegaly. There were occasional granulocyte precursors and a circulating erythroblast in the blood film. What is the likely diagnosis?
Primary myelofibrosis with extramedullary haemaopoiesis
What are the characteristic features of primary myelofibrosis?
Leucoerythroblastic anaemia with massive splenomegaly
What mutation is associated with primary myelofibrosis?
JAK 2 in the haematopoietic precursor cells.
What is ‘multiple myeloma’?
A form of cancer where there is clonal proliferation of plasma cells in the bone marrow with presence of monoclonal antibodies or light chains in the serum-urine with associated tissue damage.
What are the characteristic signs of a multiple myeloma?
Rouleaux formation, background staining and macrocyclic anaemia with monoclonal antibodies (paraproteins)
A 20-year-old male was admitted with sudden onset of left-sided chest pain and a productive cough with purulent sputum.
They had neutrophilia, increased monocytes and reduced lymphocytes. What is the likely diagnosis?
There is neutrophilia, which is likely to be indicative of a bacterial infection, as well as infiltration of monocytes and reduction in lymphocytes, therefore the diagnosis will be bacterial, and is therefore bacterial pneumonia.
25-year-old woman was admitted via the Casualty Department with increasing difficulty with breathing.
She had increased neutrophils and eosinophils. What is the likely diagnosis?
Eosinophilia is more pronounced and therefore it is likely she is having an acute asthma attack
An 18-year-old female presented to her general practitioner with a sore-throat and general malaise. On examination she had cervical lymphadenopathy and an inflamed throat with a temperature of 39°C.
They have increase neutrophils and increased reactive and non-reactive lymphocytes. What is the likely diagnosis?
This patient has lymphocytosis and their diagnosis would be infectious mononucleosis.
A 62-year-old male was admitted for the repair of an inguinal hernia. On examination he was found to have mild generalised lymphadenopathy.
He has a normocytic anaemia, reduced platelets and neutrophils with increased levels of lymphocytes. What is the likely diagnosis?
The patient has lymphocytosis, normocytic anaemia, mild neutropenia and thrombocytopenia and this leads to a diagnosis of chronic lymphocytic leukaemia.
What are the characteristic signs of chronic lymphocytic leukaemia (CLL)?
Lymphocytosis, normocytic anaemia, mild neutropenia and thrombocytopenia.
What are the characteristics of chronic myeloid leukaemia?
Granulocytosis, normocytic anaemia and mild thrombocytosis
A 45-year-old man presented with general malaise, night sweats and discomfort in the left hypochondrium. On examination he had palpable liver and spleen.
He had a increased granulocytes, lymphocytes and reduced platelets. What is the likely diagnosis?
Chronic myeloid leukaemia
A 12-year-old girl presented with increasing tiredness and easy bruising.
She has normocytic anaemia, reduced platelets and increased blast cells (leucocytosis). What is the likely diagnosis?
Acute lymphoblastic leukaemia
What are the characteristics of acute lymphoblastic leukaemia (ALL)?
Normocytic anaemia, thrombocytopenia and leucocytosis (increased blasts)
What are the characteristics of acute myeloid leukaemia?
Macrocytic anaemia, thrombocytopenia and leucocytosis (increased blasts)
A 65-year-old woman presented with increasing breathlessness, spontaneous bleeding from her gums and easy bruising.
They had macrocyclic anaemia, thrombocytopenia and leucocytosis. What is the likely diagnosis?
Acute myeloid leukaemia
What are the characteristics of sickle cell disease/anaemia?
Polychromasia (reticulocytosis), sickle cells and splenic atrophy features
A 26-year-old black woman was admitted with severe pain in her hip.
She has normocytic anaemia and increased platelets. What is the likely diagnosis?
Sickle cell anaemia
Which form of leukaemia is associated with the philadelphia chromosome?
Chronic myeloid leukaemia
What is the philadelphia chromosome?
Genetic abnormality of chromosome 22
