Abnomal white cell count Flashcards
How is normal Haematopoesis?
Multipotent stem cells that are able to renew and produce the precusors necessary to produce the various blood cells
What are the different steps of differentiation of the myeloid lineage?
Myeloblast->promyelocytes->myelocytes->metamylocytes ->neutrophils
all but the last steps are in the BM -only neutrophil go to peripheral
give a patient GCSF (GF)- and then myeloid precsurs in the blood (except myeloblast)
Also rarly in sepsis-precursors of WBC and RBC - leukoertyhroblastic feature-can be also due to cancer
What are the factors that control WBC, RBC and Lymphoid cells
Erythropoetin control erythropoetin
Lymphoid-IL2
Myeloid - GCSF, M-CSF
these control differentiation and proliferation of different lineages (again all precrusors in BM, and only mature in peripheral)
What are the processes that can lead to abnormal WBC count?
Cell production high (reactive to infect/malignant), Cell survival (failure of apoptosis-cancer mutation causing cancer), Cell production down (impaired BM function-B12 deficiency, BM failure-post chemotherapy, metastatic cancer, heamtological cancerm aplastic aneamia), Cell survival down (immune breakdown-AID)
What is easinophilia>
Increase of eosinophils
but can be reactive (normal reponse to infection/parasites, to distant tumour)-will see normal eosinophils, and normal inflam markers,
can be abnormal heamotopoetis-cancer, leukemia (myeloid/lympoid, Chronic or acute), Myeloproliferative disorders (all of them)
How does chronic myeloid leukemia lead to increase of WBC?
Early mutations lead to overproduction/less death of GM-CSF cells-lead to large numbers of megakaryocytes, granulocytes and monocytes-all of them-and possible precursors in blood
How do you investigate a raised WBC count?
History and examination-a random find might not matter if asymptomatic (mild lymphocytosis can be caused by smoking (higher monocytes/lymphocyes), or can be caused by travels (just got worms or smth?)
Examination-need to focus on lymphadenopathy or spleenomegaly-indications of disorders
Then measure heamoglobin/platelet counts-raised WBC is less dangerous/worrying if low/normal RBC and platelets-means that the WBC is reactive. if all high, then bad
look at report from lab-not just automated differential-if the machine not giving differential, usually means machine isnt sure what the cells are. caused by G-CSF, or malignant condition
Finally/most important-examine the blood film-fundamental//crucial
need to see if WBC only or all 3 lineages? (myoleproliferative), or 1 WBC lineage only vs all 5 of them? Or mature cells only or immature cells as well?
How does clonal differences show in WBC count investigations of reactive/malignant? What are we looking for?
need to see if WBC only or all 3 lineages (myoleproliferative)
or 1 WBC lineage only vs all 5 of them?
usually when all types-reactive, except for CML -because mutation is early in the differentiation (also see basophils)-but eosinophils normally done rise so if they do, its CML not reactive
Or mature cells only or immature cells as well?-doesnt really differentiate from reactive/malignant
What can cause abnormal Neutrophils counts?
Present in BM and blood and tissue
Live 2/3 days in tissue
BUT 50% are marginated-not counted in the FBC
numbers-can change in minutes if demarginated, Hours if early BM release, or days-classical increase (up to 3x in infection)
overall can be dure to: infection, tissue inflam (colitis), physical stress, adrenaline, corticosteroids, Underlying neoplasia, malignant neutrophilia (myeloproliferative disroders, CML)
What do neutrophils look like in infections vs in leukemia?
In infection, neutrophilia, abnormal looking neutrophils with white spots in vacuole and toxic granulation -usually very sick
In leukemia-See precursors of myeloid maturations (like band cells), neutrophilia too, -very CML
What causes eosinophilia?
Reactive-parasites, allergy, drugs, neoplasms (hodgkins lymphomas, t cell lymphomas), Hypereosinophilic syndrome, asthma
Malignant chronic eosinophilic leukemia (Fusion gene)
Eosinophilia (chronic)can cause organ damage
What do eosinophils look in patients?
Esosinophilia-not specially abjormal
If malignant-then usually looking wrong and having precorsors
With MCEL-fusion gene measure in blood
What causes monocytosis?
Can be seen in certain inflammatory infection (Tb, typhoid, Viral (CMV, Varicella), sacroidosis) or from Chronoc myelocytosis leukemia)
What causes lymphocytosis? what are the first thing needed to be differentiated? How do you differentiate them?
very common after 60yo
Are they mature (reactive, or primary disroder) or immature (primary disorder (leukemia.lymphoma)
If mature: Blood fild measure them-in reactive-see different types of lympho, as polyclonal
In malignant-monomorphic population of cell (all look the same
If immature-always malignant (lymphoma or leukemia)
How do you differentiate in mature lymphocytosis between reactive and malignant?
usual causes of reactive-smoking, infectiom, EBV, CMV, infection hepatittis, rubella, herpes
AID (but sometime lymphopenia), neoplasia, sarcoidosis
In infectious mononucleosis-atypical lymphocytes - pateint is also very symptomatic (with red falgs like sweating)-but other cell lineages arent affected, best way to see not malginant
Look at blood film-monomorphic (malignant)-only kappa or lambda chains ONLY or polymorphic (reactive)-mix of kappa/lamda light chains
