white cells physiology and pathology

Question 1

Where are immature haematopoietic cells found?

Answer 1

Seen in bone marrow

Question 2

Where are mature haematopoietic cells found?

Answer 2

Blood

Question 3

Neutrophils

Answer 3

Most prevalent white cell in blood
Phagocytose and kill bacteria
Release chemokines causing inflammatory response (fevers etc)
Lack of number or function results in recurrent or severe bacterial infections

Question 4

B lymphocytes

Answer 4

Found in bone marrow
Differentiate into plasma cells
Produce immunoglobulins (antibodies) when stimulated by exposure to a foreign antigen
Vital for immunity and response to vaccinations

Question 5

Antibody response after vaccination

Answer 5

Primary immune response, slow to build up and not very strong
Memory cells remain
Infection by pathogen - secondary response stronger and more rapid than primary response

Question 6

T lymphocytes

Answer 6

Found in thymus
CD4 (helper) cells
CD8 (cytotoxic) cells
Aid B cells in antibody generation and also responsible for cell mediated immunity

Question 7

What does HIV do?

Answer 7

Invades CD4 cells

-low numbers: severe life threatening infections (AIDS)

Question 8

Bacterial infections

Answer 8

Neutrophilia (increased numbers)

Phagocytose and kill bacteria

Question 9

Viral infections

Answer 9

Lymphocytosis (increased numbers)
Generate immunoglobulins and memory B cells
Usually only get infection once

Question 10

Leukaemia

Answer 10

Malignancy of (white) blood cells
Bone marrow is replaced by malignant cells
-anaemia (fatigue, pallor)
-neutropenia (infections)
-thrombocytopenia (bleeding and bruising)

Question 11

Acute leukaemia

Answer 11

Proliferation of immature cells without differentiation

Agressive disease, unwell px

Question 12

Chronic leukaemias

Answer 12

Proliferation with differentiation

Question 13

Acute myeloid leukaemia

Answer 13

Caused by myeloblast
Primarily disease of older adults
Treatment - high dose chemotherapy +/- bone marrow transplant
Survival approx 50% at 5 years

Question 14

Chronic myeloid leukaemia

Answer 14

Caused by basophil, neutrophil, eosinophil, monocyte
Proliferation of mature myeloid cells (neutrophils, basophils, eosinophils)
Translocation between chromosomes 9 and 22
-forms “Philadephia” chromosome
Targeted therapy (tablets) -Imatinib
Survival - similar to general population

Question 15

Acute lymphoblastic leukaemia

Answer 15

Caused by common lymphoid progenitor
Primarily children age <10
Chemotherapy for 2-3 years
Survival >80%

Question 16

Chronic lymphocytic leukaemia

Answer 16

Proliferation of mature lymphocytes (usually B cells)
Lymphocytosis in blood
Lymphadenopathy, splenomegaly
Some don’t ever require treatment
Gentle, outpatient chemotherapy
More targeted oral treatments becoming available
Survival – several decades

Question 17

Lymphoma

Answer 17

Malignancy of lymphoid cells, predominantly in lymph nodes
Hodgkin’s lymphoma
Non Hodgkin lymphoma
-high grade –> aggressive, acute, treat with chemotherapy/ curable
-low grade –> chronic, indolent, may not require treatment/ incurable

Question 18

Myeloma

Answer 18

Malignant proliferation of plasma cells
Produces monoclonal immunoglobulin (paraprotein)
Clinical features:
-calcium (hypercalcaemia – -bone pain, constipation)
-renal failure
-anaemia
-bone lesions (lytic lesions, fractures, pain)
Treatment – outpatient, mainly oral chemotherapy