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Haematology > White blood cells > Flashcards

White blood cells Flashcards

1
Q

What are granulocytes?

A

Neutrophils, basophils, eosinophils - have granules and agents for phagocytic function

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2
Q

What are monocytes?

A

Circulate in blood and are precursors of macrophages
Can play roles in phagocytosis and antigen presentation to lymphoid cells

Kidney / horse shoe shaped nucleus (histology)

spend several days in circulation

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3
Q

Where are granulocyte precursors found?

A

In bone marrow from multipotent haemopoietic stem cell giving rise to myeloblast to band form (which undergo no cell division). Leaves as a granulocyte.

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4
Q

What are the characteristics of Basophils?

A

Contain prominent cytoplasmic granules when stained

Inflammatory responses (heparin and protease release)

Immediate type hypersensitivity, IgE coated basophils release substances ( histamine and leukotrienes.

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5
Q

What are the characteristics of Neutrophils?

A

Segmented nucleus

Phagocytosis occurs following cytokine priming

Migrate from blood to tissues after 7-10 hours of circulation

maturation : cell division occurs in myeloblasts, promyelocytes, myelocytes. Not band forms

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6
Q

How do neutrophils migrate into tissues from capillaries?

A

Chemotaxis

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

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7
Q

What are the characteristics of Eosinophils?

A

Main defence against parasitic infection although it can also phagocyte.

stained pink with eosin. Bi-lobed

spends less time in circulation than neutrophil

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8
Q

What cell is Leukocytosis and leukopenia usually attributed to?

A

Changes in neutrophil count as these are most abundant leukocyte.

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9
Q

What are the unnatural causes of Neutrophilia?

A

Bacterial infections
Inflammation
Infarction/tissue damage
Myeloproliferative disorders ( CML )

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10
Q

When may Neutrophilia be considered normal?

A

In pregnancy (toxic granulation can be seen) and may be seen after exercise ( caused by rapid shift of neutrophils into circulation after corticosteroids )

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11
Q

What toxic changes can be associated with Neutrophilia?

A

left shift : presence of early myeloid cells such as metamyelocytes. Increase in non-segmented neutrophils (band forms)

Toxic granulation - heavy course granulation in neutrophils

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12
Q

What causes Chronic Myeloid Leukaemia?

A

All granulocytes increase along with their precursors in blood

Due to translocation between chromosome 9 and 22 in a single haemopoietic stem cell

Mutation gives growth advantage and clonal expansion over mutated stem cell

clonal expansion = myeloid leukaemia

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13
Q

What is chromosome 22 known as (linked to CML)?

A

(Ph) Philadelphia chromosome, abnormally short

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14
Q

How do genes give rise to a Leukaemic clone for CML?

A

BCR-ABL1 gene encodes protein with uncontrolled tyrosine kinase activity

A potential cure is tyrosine kinase inhibitors

chimeric gene / dual colour / dual fusion

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15
Q

What are the symptoms of Chronic Myeloid Leukaemia?

A

Enlarged spleen

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16
Q

How can Chemo/Radiotherapy lead to Neutropenia?

A

Surpreses bone marrow activity leading to few neutrophils being made

17
Q

What causes Neutropenia, abnormal and normal causes?

A

Low neutrophil count: < 0.5 * 10^9 / L

Autoimmune disorders
Severe bacterial, viral infections
some Anti-convulsants, antipsychotic drugs, antimalarials

Physiological basis e.g. benign neutropenia in African/Afro-Caribbean

18
Q

What is Neutrophil hypersegmentation and what is it caused by?

A

Increase in average number of lobes or segments (should be 3-5) known as right shift

Lack of V B12 (able to grow but not divide) or folic acid ( megaloblastic anaemia )

19
Q

What can Eosinophilia be attributed to?

A

Allergy to parasitic infection ( asthma, eczema, drugs)

Can occur in CML

blood film example - px with strongyloidiasis

20
Q

What can Basophilia be attributed to?

A

Uncommon finding

Leukaemia .e.g CML

21
Q

What can Monocytosis be attributed to?

A

Infection - Chronic bacterial infection and chronic inflammation

Some types of leukaemia

22
Q

What can Lymphocytosis be attributed to

A

Transient Viral infection
(Whooping cough in children)by bordatella pertussis

Persistent Lymphoproliferative disorder

23
Q

What is infectious mononucleosis?

A

Glandular fever, due to epstein-barr virus infection

Leads to lymphocytosis with atypical lymphocytes ( larger cytoplasm and nuceli, membrane squashed by r.b.cs )

common to see scalloped margins of basophilia, hugging of surrounding red blood cells

24
Q

What is Chronic lymphocytic Leukaemia (CLL)?

A

Lymphoproliferative disorder
Common cause of persistent lymphocytosis in elderly

Can see smear cells

Leukaemic cells are mature although abnormal T,B,NK cells

25
Q

What is Acute Lymphocytic Leukaemia? (ALL)

A

Increase in immature cells specifically lymphoblasts with developmental failure which can be found in peripheral blood

Severe and sudden onset of symptoms.

Can see Lymphoblasts, Normocytic normochromic anaemia, Neutropenia, Thrombocytopenia, Replacement of bone marrow cells by lymphoblasts

26
Q

What are some clinic features attributed to ALL?

Which transfusions and therapies are available respectively?

A

Prominent bruising due to thrombocytopenia

Pale as a result of Low Hb ( Anaemia )

these symptoms are a result of normal bone marrow replacement by lymphoblasts

Red cells, Platelets, Antibiotics
Systemic chemotherapy, Intrathecal chemotherapy

27
Q

What may cause a < 1 * 10^9 / L total lymphocyte count?

A

Lymphopenia

in normal blood Most are CD4+ T cells

Can be caused by HIV infection,
Chemotherapy
Radiotherapy
Corticosteroids

Px may develop a transient low lymphocyte count due to severe infection

28
Q

Extra info?

A

Common myeloid progenitor –> granulocytes and monocytes

For proliferation and survival of myeloid cells need signalling through myeloid growth factors such as G-CSF, M-CSF, GM-CSF

-ALL, cytogenic and molecular genetic analysis
Information about prognosis, development of targeted treatment.

  • transcient leukocytosis is frequently seen with infection - neutrophilia and monocytosis due to bacteria
    Lymphocytosis due to virus
    eosinophilia due to parasitic
  • Persistent leukocytosis caused by leukaemia e.g. CLL ( lymphocytosis ) CML ( basophilia, neutrophilia, eosinophilia )
  • leukopenia usually due to low neutrophil count

Haematology (7 decks)

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