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POM Haematology > White Blood Cells > Flashcards

White Blood Cells Flashcards

1
Q

Name the granulocytes

A

Neutrophil, basophil, esoinophil

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2
Q

What do the granules in granulocytes contain?

A

agents for killing phagocytic material

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3
Q

What growth factors control the synthesis of granulocytes?

A

G-CSF
M-CSF
GM-CSF

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4
Q

What are the earliest visible precursors of granulocytes?

A

Myeloblast

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5
Q

What are the precursors of macrophages?

A

Monocytes

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6
Q

How long does the neutrophil survive for in the circulation?

A

7-10 hrs

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7
Q

Describe the nucleus of the mature neutrophil

A

segmented (sometimes referred to as lobulated)

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8
Q

What is the main function neutrophils?

A

Defence against infection; it phagocytoses and then kills micro-organisms

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9
Q

What is the first step in neutrophil migration?

A

Chemotaxis

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10
Q

Outline neutrophil migration to tissues

A

Neutrophils become marginated in the vessel lumen, adhere to the endothelium and migrate into tissues.

Phagocytosis of micro-organisms occurs following cytokine priming

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11
Q

What are eosinophils characterised by on a blood film?

A

Bright pink with H and E staining

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12
Q

What is the main function of eosinophils?

A

Defence against parasitic infection

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13
Q

What do basophil granules contain?

A

Stores of histamine, heparin and proteolytic enzymes

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14
Q

What immune and inflammatory responses are basophils involved in?

A

Mediation of type 1 hypersensitivity reaction on which IgE-coated basophils release histamine and leukotrienes

Mediation of inflammatory response by releasing heparin and proteases

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15
Q

Precursor of macrophages?

A

Monocytes

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16
Q

How long are macrophages in circulation?

A

Several days in circulation

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17
Q

Another name for macrophages?

A

Histiocytes

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18
Q

What is the role of macrophages?

A

Play several key roles that include phagocytosis and APCs to lymphoid cells

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19
Q

What do lymphoid stem cells give rise to?

A

T cells, B cells and NK cells

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20
Q

Where do T cells undergo their final maturation?

A

Thymus gland

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21
Q

What types of cells can NK cells kill?

A

Part of the innate immune system - they can kill tumour cells and virus-infected cells

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22
Q

What do leukocytosis and leukopenia usually result from?

A

Both usually result from changes in the neutrophil count since this is usually the most abundant leukocyte in the circulation

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23
Q

Causes of neutrophilia?

A

Infection (particularly bacterial), inflammation, infarction or other tissue damage, myeloproliferative disorders (CML)

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24
Q

What is neutrophilia a normal feature of?

A

Pregnancy
After administration of corticosteroids
May be seen following exercise (caused by a rapid shift of neutrophils from the marginated pool to the circulating pool)

25
Q

What can neutrophilia be accompanied by?

A

Left shift

Toxic granulation

26
Q

What is left-shift?

A

Increase in non-segmented neutrophils or that there are neutrophil precursors in the blood.

Their presence reflects an increase output from the bone marrow.

27
Q

What is toxic granulation?

A

Heavy coarse granulation of neutrophils (it can be a feature of pregnancy)

28
Q

Which myeloproliferative disorder can cause neutrophilia?

A

CML -Increase in all granulocytes and their precursors in both blood and the bone marrow.

29
Q

What is the cause of CML?

A

Translocation between chromosome 9 and 22, occurring in a single HSC
BCR-ABL1 fusion gene
Formation of 2 fusion genes.
BCR-ABL1 gene encodes a protein with uncontrolled tyrosine kinase activity, which gives rise to leukaemic clone

30
Q

What feature can be a sign of CML?

A

Splenomegaly

31
Q

How can you prevent or inhibit CML?

A

Tyrosine kinase inhibitors leading to remission, and potentially cure the disease.

32
Q

Conditions in which neutropenia can occur

A

Chemotherapy

Radiotherapy

Autoimmune disorders

Severe bacterial infections, certain viral infections and drugs e.g. some anticonvulsant and antipsychotic drugs and some antimalarials

Benign ethnic neutropenia (African or Afro-Caribbean descent)

33
Q

What value is considered a low neutrophil count?

A

<0.5x10^9/l

Patients at a high risk of serious infection and they need urgent treatment with IV antibiotics

34
Q

What is neutrophil hypersegementation?

A

Means that there is an increase in the average number of neutrophil lobes (right shift)

35
Q

How many lobes does a normal neutrophil have?

A

Between 3 and 5 lobes

36
Q

What causes neutrophil hypersegementation?

A

Lack of VB12 or folic acid deficiency

37
Q

Causes of eosinophilia

A

Allergy or parasitic infection - asthma, eczema, drugs

Can occur in leukaemia e.g. CML

38
Q

Causes of basophilia

A

Leukaemia or related condition

39
Q

Causes of monocytosis

A

Infection (particularly chronic bacterial infection) or chronic inflammation

Some types of leukaemia

40
Q

What is transient lymphocytosis often a response to?

A

Infection

41
Q

What can be seen on a blood film of a patient with transient lymphocytosis caused by a bacterial, viral and parasitic infection respectively?

A

Bacterial - Neutrophilia/monocytosis
Viral - Lymphocytosis
Parasitic - Eosinophilia

42
Q

What can persistent lymphocytosis result from?

A

Can result from lymphoproliferative and myeloproliferative disorders

43
Q

What bacterium causes whooping cough?

A

Bordatella pertussis - Important cause of lymphocytosis in children.

44
Q

What are often seen when lymphocytosis is due to a viral infection?

A

Atypical lymphocytes

45
Q

What infection can infectious mononucleosis (Glandular fever) result from?

A

Epstein-Barr virus infection

(Blood film: Atypical lymphocyte: Middle lymphocyte has intensely basophilic cytoplasm. Hugging of surrounding RBCs is a characteristic finding in infectious mononucleosis)

46
Q

What is a leukaemia?

A

Cancer originating in haemopoietic or lymphoid cells

47
Q

What is CLL?

A

Lymphoproliferative disorder

Most common cause of persistent lymphocytosis in elderly.

48
Q

What is seen on a blood film of a patient with CLL?

A

4 mature CLL lymphocytes

Squashed CLL lymphocyte (smear/smudge cell → characteristic of CLL

49
Q

On a blood film of a patient with ALL what is there an increase in?

A

Very immature cells (lymphoblasts) with a failure of these to develop into mature lymphocytes.

50
Q

In ALL, what is infiltrated by mature lymphoblasts?

A

Bone marrow resulting in impaired haemopoiesis. Lymphoblasts circulate in the peripheral blood.

51
Q

Describe the onset of acute conditions.

A

Severe and sudden onset.

If acute leukaemias aren’t treated the disease is very aggressive and patients die quickly

52
Q

List the haematological features of ALL.

A

Leukocytosis with lymphoblasts in blood → suppression of normal haemopoiesis

Anaemia (normocytic, normochromic)

Neutropenia

Thrombocytopenia (low platelet)

Replacement of normal bone marrow cells by lymphoblasts

53
Q

What is a good and bad prognosis for ALL?

A

Good - Hyperdiploidy

Bad - t(4;11) > Translocation 4 to 11.

54
Q

Why is cytogenetic and molecule genetic analysis useful?

A

Useful for managing individual patient because it gives info about prognosis

55
Q

How can you treat ALL?

A

Supportive - Red cells, platelets, antibiotics
Systemic chemotherapy
Intrathecal chemotherapy

56
Q

Compare ALL and CLL.

A

CLL: Leukaemic cells are mature, although abnormal T cells, B cells and NK cells. Chronic therefore disease and deterioration go in for a long period of time.

ALL: Leukaemic cells are immature (lymphoblasts). Acute therefore severe and sudden onset.

57
Q

Define lymphopenia

A

Too few lymphocytes in circulation.

Total lymphocyte count - <1x10^9/l

58
Q

Important causes of lymphopenia?

A

HIV infection

Radiotherapy

Corticosteroids

59
Q

Patients with lymphopenia and a severe infection may develop what?

A

Transient low lymphocyte count

POM Haematology (10 decks)

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