White cells, cytopenia, cytophilia Flashcards
What is the most common white cell?
Neutrophil
Which white cell is the first responder?
Neutrophil
How do neutrophils reach the site of infection?
Chemotaxis
follow cytokine signals to site of infection
What do neutrophils do at the site of infection?
Phagocytose pathogens
How long do neutrophils live?
1-4 days
What does the nucleus of a neutrphil look like?
Multi-lobed nucleus
3-5 segments
Where do neutrophils mature?
Bone marrow
What controls maturation of neutrophils?
Hormone G-CSF
What effect does G-CSF have on neutrophil maturation?
Increases production of neutrophils
Decreases time taken to release mature neutrophils from bone marrow
Enhances chemotaxis
Enhances phagocytosis of pathogens
Which stages of neutrophil maturation may be present in the blood?
Mature neutrophil
Band cell
Which stages of neutrophil maturation should not be present in the blood?
Myelocyte stages
What could cause immature neutrophils to be present in the blood? Why?
Haematological cancer - cells don’t differentiate
Sepsis - bone marrow releases them too early
What are the causes of neutrophilia?
Infection - particularly bacterial
Acute inflammation
Acute haemorrhage
Cancer
Excess G-CSF
Myeloproliferative diseases
What are the categories of causes of neutropenia?
Reduced production
Increased use or removal
Benign ethnic neutropenia
Cyclic neutropenia
What are the causes of reduced production of neutrophils?
B12, folate deficiency
Infiltration of bone marrow - cancer, fibrosis
Aplastic anaemia - empty bone marrow
Radiation
Drugs
Viral infection
What can cause increased use or removal of neutrophils?
Immune destruction
Sepsis
Splenic pooling
What is benign ethnic neutropenia? What is an example of such an ethnic group?
Low neutrophil count is normal for some ethnic groups
e.g. afro-caribbean
What is cyclic neutropenia?
Neutropenia occurring after regular intervals
normal for the individual
What are the consequences of neutropenia?
May develop severe bacterial infection
or severe fungal infection
Mucosal ulceration
How is neutropenic sepsis treated?
IV antibiotics given immediately
What is pancytopenia?
Reduction in red cells, white cells and platelets altogether
What are the categories of causes of pancytopenia?
Reduced production
Increased removal
What can cause reduced production of red cells, white cells, platelets?
B12, folate deficiency
Bone marrow infiltration - cancer, fibrosis
Aplastic anaemia - empty bone marrow
Radiation
Drugs
Viruses
What can cause increased use or removal of blood cells, platelets leading to pancytopenia?
Immune destruction
Splenic pooling
Haemophagocytosis
Which drugs may cause neutropenia, pancytopenia?
Chemotherapy
Antibiotics
Antiepileptics
Which viruses may cause pancytopenia?
HIV
EBV, CMV
Hepatitis virus
How does aplastic anaemia compare to normal bone marrow under a microscope?
Normal - 1:1 ratio of fat cells to white cells
Aplastic anaemia - way more fat cells
How does bone marrow infiltrated by malignancy compare to normal bone marrow under a microscope?
Normal - 1:1 ratio of fat cells to white cells
Infiltrated bone marrow - many more white cells
What is aplastic anaemia?
Hypocellular bone marrow
Absence of abnormal infiltrate
What are the categories of the malignancies that can cause pancytopenia?
Haematological
Non-haematological
What are the non-haematological malignancies that can cause pancytopenia?
Breast cancer
Prostate cancer
Lung cancer
What are the symptoms of pancytopenia?
Symptoms of anaemia - fatigue, shortness of breath
Symptoms of thrombocytopenia - bleeding, bruising
Symptoms of neutropenia - infection, ulcers
Symptoms of underlying cause
Is immune destruction a common cause of neutropenia, pancytopenia?
No
more associated with anaemia, thrombocytopenia
What is haemophagocytosis?
Cells are destroyed in the bone marrow
How common is haemophagocytosis?
Rarely occurs
What are the functions of monocytes?
Respond to inflammation
respond to antigenic stimuli
By phagocytosis
pinocytosis
What do monocytes do in tissues?
Differentiate into macrophages
What do monocyte lysosomes contain?
Lysozyme
Complement
Interleukins
What are the causes of monocytosis?
Chronic inflammatory conditions
Chronic infection
Malignancy - carcinoma
Myeloproliferative disorders
What are some examples of chronic inflammatory conditions?
Rheumatoid arthritis
Crohn’s
Ulcerative colitis
What is an example of a chronic infection?
TB
How much time do eosinophils spend in circulation?
3-8 hours
What is the lifespan of eosinophils?
8-12 days
What are the functions of eosinophils?
Infection with parasites
Mediating allergic reactions
What are some examples of allergic reactions?
Reactions to drugs
Reactions in allergic diseases
What do the granules of eosinophils contain?
Enzymes
What are the causes of eosinophilia?
Parasitic infection - roundworm, tapeworm, flukes
Allergic reactions
Hodgkin’s lymphoma
Myeloproliferative diseases
What are some examples of diseases that involve allergic reactions?
Asthma
Eczema
Uritacaria
Hay fever
What is the least common type of white cell?
Basophils
What is the largest type of granulocyte?
Basophils
What are the different types of granulocytes?
Neutrophils
Eosinophils
Basophils
(doesn’t include monocytes, macrophages - agranular)
What are the functions of basophils?
Allergic reactions
Inflammatory conditions
What do basophil granules contain?
Histamine
What are the causes of basophilia?
Allergic reactions
Inflammatory conditions
Myeloproliferative diseases
What are the different types of lymphocytes?
B cells
-plasma cells
T cells
- CD4+
- CD8+
Natural killer cells
What are the functions of B cells and plasma cells?
B cells - humoral immunity
Plasma cells - antibody producing cells
What are the functions of T cells?
Cell mediated immunity
What are the functions of NK cells
Cell mediated cytotoxicity
What are the causes of lymphocytosis?
Infection - bacteria, viruses
Post splenoctomy
Lymphoproliferative diseases
Lymphoma
How does a splenoctomy cause lymphocytosis?
Lymphocytes not contained in spleen
What is cytopenia?
Reduction in number of blood cells
What is anaemia?
Low red cell count
What is leucopenia?
Low white cell count
What is neutropenia?
Low neutrophil count
What is thrombocytopenia?
Low platelet count
What is pancytopenia?
Low red cell, white cell and platelet count
What is cytosis/philia?
Increase in number of blood cells
What is erythrocytosis?
High red cell count
What is leukocytosis?
High white cell count
What is neutrophilia?
High neutrophil cunt
What is lymphocytosis?
High lymphocyte count
What is thrombocytosis?
High platelet count
What do monocytes look like?
Large cells
Large nucleus
What do eosinophils look like?
Pink cytoplasm
Granular cytoplasm
Bilobed nulcues
What do basophils look like?
Blue-purple cytoplasm
Granular cytoplasm
What do lymphocytes look like?
Large nucleus
Little cytoplasm
How can neutropenia be treated? Give an example of when this is done
Injections with recombinant G-CSF
often done after chemotherapy
What are the types of myeloproliferative diseases?
Acute myeloid leukaemia
Polycythemia vera
Essential thrombocytosis
Myelofibrosis
What are sources of the haemopoietic stem cell?
Bone marrow aspiration
G-CSF
mobilises the haemopoietic stem cell into the blood
Umbilical cord stem cells