Flashcards in Abnormal White Blood Cell Count Deck (34)
What is the lymphoid lineage?
Lymphoid cells are lymphocytes = T cells, B cells and NK cells
Which cells come under the myeloid lineage?
Describe how the appearance of white cells changes as they develop.
They become smaller and their cytoplasm becomes clearer.
Which factors stimulate the following cell lines:
a. Lymphoid - IL-2
b. Myeloid - G-CSF, M-CSF
c. Erythroid - Erythropoietin
A malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leukocytes.
This leads to suppression of the production of other blood cells such as erythrocytes, granulocytes and platelets.
A group of blood cell tumours that develop from lymphatic cells.
If the disease is mainly in the lymphatic tissue then it is lymphoma.
If it is mainly in the blood it is leukaemia.
A malignant disease of the bone marrow characterised by two or moreof the following criteria:
The presence of an excess of abnormal plasma cells in the bone marrow
Typical lytic deposits in the bones on X-ray, giving the appearance of holes
The presence in the serum of abnormal gammaglobulin, usually IgG
Broadly speaking, what can cause an increase in white blood cell count?
Increased white blood cell production
Increased white blood cell survival
What two broad categories of diseases can cause an increase in white blood cell count?
Reactive – in response to infection or inflammation
Primary – malignant
What is the difference in the type of white blood cell seen in theperipheral blood of someone with an infection/inflammation (reactive) and someone with a malignancy (primary)?
Reactive – only mature white blood cells
Primary – mature AND immature white blood cells present
Where does the mutation occur in chronic myeloid leukaemia?
GM-CFC phase (granulocyte-monocyte colony forming cell)
If there are only immature cells in the blood film with low haemoglobin and low platelets, what would you suspect?
What are the normal ranges of:
150-400 x 109/L
4-11 x 109/L
2.5-7.5 x 109/L
1.5-3.5 x 109/L
0.2-0.8 x 109/L
0.04-0.44 x 109/L
0.01-0.1 x 109/L
What can cause an elevated lymphocyte count?
Chronic lymphocytic leukaemia
What is the lifespan of a neutrophil?
Hours in the peripheral blood
2-3 days in the tissues
What is margination of neutrophils?
Around 50% of neutrophils in the circulation have marginated meaning that they have stuck to the wall of a damaged vessel (this means that they are NOT counted in the full blood count)
Describe the differences in the appearance of neutrophils in infection compared to leukaemia.
Neutrophils in infection are granular (show toxic granulation)
Neutrophils in leukaemia do not have granules and do not look toxic.
What else would be present in the blood film of someone with leukaemia that would not be present in someone with an infection?
Myelocytes and metamyelocytes – these precursors would not be found in the peripheral blood of someone responding to infection
State some causes of neutrophilia.
Malignant neutrophilia (myeloproliferative disorders, chronic myeloid leukaemia)
What types of infection cause neutrophilia?
Certain viral infections Generally: if the neutrophil count is low but there are other features of infection, then you can deduce that it’s a viral infection
State some infections that characteristically do NOT produce neutrophilia.
Many viral infections
State some reactive causes of eosinophilia.
Allergic diseases e.g. asthma Neoplasms e.g. Hodgkin’s and Non-Hodgkin’s Hypereosinophilic syndrome
State a malignant cause of eosinophilia.
Malignant chronic eosinophilic leukaemia (INCREDIBLY RARE)
What would you see in the chest X-ray of someone with Hodgkin’s lymphoma?
Increased mediastinal mass
What can cause monocytosis?
RARE but it is seen in certain chronic infections and primary haematological disorders
TB, brucella, typhoid
CMV, varicella zoster
Chronic myelomonocytic leukaemia (MDS – myelodysplastic syndrome)
Describe the appearance of chronic lymphocytic leukaemia on a blood film.
The lymphocytes have a typical appearance – big nucleus + little cytoplasm
They are mature lymphocytes
This appearance can also be present in autoimmune and inflammatory conditions
Describe the appearance of acute lymphoblastic leukaemia on a blood film.
There are immature lymphoblasts
They are much larger than the mature lymphocytes
Within the large nucleus you can see the nucleolus (showing that the cell is immature)
Describe the difference in the expansion of lymphocytes in secondary (reactive) lymphocytosis compared to primary lymphocytosis.
Secondary lymphocytosis = polyclonal expansion
Primary lymphocytosis = monoclonal expansion
State some causes of reactive lymphocytosis.
Infection (e.g. EBV, toxoplasma, infectious hepatitis, rubella, herpes infections)