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Lily PoM Haematology > White Blood Cells > Flashcards

White Blood Cells Flashcards

1
Q

What are the myeloid lineage white cells?

A

Granulocytes

Monocytes

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2
Q

What are monocytes?

A

The precursors of macrophages

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3
Q

What are granulocytes?

A

Basophils, neutrophils, eosinophils

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4
Q

Why are they called granulocytes?

A

They all have granules in them which contain agents essential for their microbicidal function
And the killing of phagocytosed microorganisms

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5
Q

What are some of the growth factory’s that control the proliferation of granulocytes?

A

G-CSF
Granulocyte colony stimulating factor

M-CSF
Macrophage

GM-CSF
Granulocyte-macrophage

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6
Q

What is the first stage of granulocyte maturation?

A

Myeoblast

Largest
Undergoes cell division
Prominent nucleoli
Open chromatin pattern of their nuclei

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7
Q

Which un matured forms of granulocytes undergo cell division?

A

Myeloblast
Promyelocyte
Myelocyte

These along with metamuelocytes and band forms should only be present in the bone marrow

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8
Q

How long does a neutrophil survive in circulation before migrating to tissues?

A

7-10 hours

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9
Q

What is the nucleus of a neutrophil like?

A

Segmented/lobulated

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10
Q

What is the main function of a neutrophil?

A

To phagocytose and kills micro organisms

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11
Q

By what process do neutrophils migrate to an infected tissue?

A

Chemotaxis

They are marginated in the vessel lumen, adhere to the vessel wall and migrate to the tissues

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12
Q

Neutrophils phogocytose pathogens which are then killed by the toxic intra cellular contents by two mechanisms, what are the two ways phagocytosis occurs?

A

Super oxide dependant mechanism

Oxygen independent

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13
Q

What is the role of eosinophils?

A

Phagocytose and destroy microorganisms, usually parasitic

They spend a much shorter time in circulation than neutrophils

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14
Q

What do the granules in basophils contain?

A

Histamine
Heparin
Proteolytic enzymes

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15
Q

In which ways are basophils involved in the immune response?

A

Mediation of the immediate type hypersensitivity reaction
In which IgE coated basophils release histamine and leukotrienes

Modulation of inflammatory response by releasing heparin and proteases

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16
Q

How long do monocytes spend in circulation, and what roles do they play in immunity?

A

Several days

Phagocytosis
Antigen presentation to lymphoid cells

They migrate to tissues where they then develop into macrophages

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17
Q

What is the role of macrophages?

A

Scavenging and macrocytic function

They also store and release iron

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18
Q

What are the main functions of neutrophils?

A

Chemotaxis
Phagocytosis
Killing of phagocytosed bacteria

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19
Q

What are the main roles of monocytes and macrophages?

A

Chemotaxis
Phagocytosis
Killing of some microorganisms
Antigen presentation

20
Q

What are the main functions of eosinophils?

A 
Chemotaxis 
Phagocytosis 
Killing of phagocytosed bacteria 
Main defence against parasites 
Regulation of some immediate type hypersensitivity reactions
21
Q

What are the main functions of basophils?

A

Mediation of immediate type hypersensitivity

Modulation of inflammatory responses by releasing heparin and proteases

22
Q

Where do lymphocytes develop from?

A

Common lymphoid progenitor
In the bone marrow
Requires transcription factors

23
Q

What do lymphoid stem cells turn into?

A

B cells
T cells
Natural killer cells (NK)

These circulate to lymph nodes and tissues then back to the blood stream

24
Q

What can B cells matur into?

A

Plasma cells, which produce antibodies

Required exposure to specific antigens

B cells originally develop in the bone marrow of the foetus where the heavy and light globulin chains are arranged to provide immunity against a lot of antigens. These circulate in the lymph so they recognise what is self and non self.

25
Q

What to T cells do?

A

Cell mediated immunity

Their development ends in the thymus

T helper cells gain CD4 markers, those release cytokines such as interferon, activating monocytes and macrophages

Cytotoxic T cells gain CD8 markers during development

26
Q

What are NK cells?

A

Part of the innate immune system

They can kill Timor cells and virus infected cells

27
Q

What abnormalities involving leukocytes can arise?

A

Numerical and/or morphological

28
Q

What is leukocytosis?

A

Too many white blood cells

Neutrophilia
Eosinophilia
Basophilia
Lymphocytosis
Monocytosis
29
Q

What is a reduction in white blood cell count called?

A

Leukopenia

Neutropenia
Lymphopenia

30
Q

What are leukocytosis and leukopenia usually caused by?

A

Changes in number of neutrophils as these are the most abundant leukocyte in circulation

31
Q

What are causes of neutrophilia?

A 
Bacterial infection 
Inflammation 
Infarction or tissue damage 
Myeloproliferative disorders (chronic myeloid leukaemia) (often accompanied by basophilia.
Pregnancy 
Exercise
Administration of corticosteroids
32
Q

What toxic changes may accompany neutrophilia?

A

Left shift
Presence of early myeloid cells such as metamyelocytes
Cells usually only present In the bone marrow

Toxic granulation
Heavy coarse granulation of neutrocytes and maybe presence of vacuoles

33
Q

What happens in chronic myeloid leukaemia, and what is it caused by? (CML)

A

Increased presence of all granulocyte and their precursors

Results from a translocation between chromosomes 9 and 22, occurs in a single haemopoietic stem cell (that undergoes clinal expansion). This leads to an abnormally short chromosome 22 (Philadelphia chromosome)

34
Q

What happens to a patient with CML?

A

Enlarged spleen (splenomegaly)

The the BCR-ABL1 protein signals between the cell surface and the nucleus
It can be inhibited by specific tyrosine kinase inhibitors, leading to remission and potentially a cure

35
Q

What are some causes of neutropenia?

A

Following chemotherapy or radiotherapy
Autoimmune disorders
Severe bacterial infections
Certain viral infections
Drugs (anticonvulsants, antimalerial, antipsychotic)
Physiology (e.g.african/Afro Caribbean ancestry can give lower counts normally)

Patents with very low neutrophil counts (<0.5x10^9 / L) are at risk of serious infection. May need to be treated with intravenous antibiotics

36
Q

What Is a hypersegmented neutrophil?

A

Normal neutrophils should have between 3-5 segments or lobes

Neutrophil hypersegmentation (right shift) is when there is an increased average number of lobes

Usually results form a lack of vitamin B12 or folate: megaloblastic anaemia

37
Q

What causes eosinophilia?

A

Allergy (Asthma, eczema,drugs)
Parasitic infection
Leukaemia

38
Q

What causes basophilia?

A

Very unusual

Usually means leukaemia

39
Q

What causes monocytosis?

A

Infection (especially chronic bacterial)
Chronic inflammation
Some types of leukaemia

40
Q

What causes lymphocytosis?

A 
Viral infection (transient)
Lymphoproliferative disorders (persistent) (e.g. lymphoma)

Whooping cough (pertussis)

41
Q

When lymphocytosis is caused by a viral infection it can lead to atypical lymphocytes, what does this mean?

A

Intensely basophilic cytoplasm (blue)

Scalloped margins and “hugging” of the surrounding red blood cells

Both present in response to glandular fever

42
Q

Lymphocytosis can also be caused by chronic lymphocytic leukaemia, what atypical lymphocytes are present here?

A

Squashed CLL lymphocytes (smear or a smudge)

This is a lymphoproliferative disorder

CLL is the most common cause of persistent lymphocytosis in the elderly

43
Q

What is the difference between acute and chronic lymphoid lukaemia?

A

Leukaemia is cancer originating in haemopoietic or lymphoid cells

In acute lymphoblastic anaemia (ALL) there is an increase in lymphobalsts (immature cells), which don’t develop into mature cells
These infiltrate the bone marrow leading to impaired haemopoiesis

Acute: severe and sudden in onset. Aggressive and lead to death quickly

In chronic lymphoid leukaemia (CLL) the cells are mature but some lymphocytes are abnormal

Chronic: disease and deterioration go on for a long period of time

44
Q

What can cause ALL?

A

Mutation in the (B cell) progenitors so that mature B cells cannot be made

45
Q

Summarise ALL?

A

Leukocytosis with lymphoblasts in the blood

Anaemia (normocytic, normochromic)

Neutropenia

Thrombocytopenia (low platelet count)

All caused by Replacement of normal bone marrow cells by lymphoblasts

Cytogenetic/molecular genetic analysis can be used to give information about the prognosis e.g. hyperdiploidy has a good prognosis but t(4,11) does not

46
Q

What is the treatment for ALL?

A

Supportive:
Red cell and platelet transfusions
Antibiotics

Systemic and intrathecal chemotherapy

47
Q

What is and what causes lymphopenia?

A

Decrease in the number of circulating lymphocytes
(Normal : 1x10^9 /L)

Most lymphocytes are CD4+ T cells

Causes include:
HIV
Chemotherapy 
Radiotherapy 
Corticosteroids 
Very severe infection (transient)

Lily PoM Haematology (6 decks)

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