Abnormal White Blood Cell Counts

Question 1

What is pancytopenia

Answer 1

All lineages reduced

Question 2

What are the types of malignant haemopoeisis

Answer 2

Leukaemia (lymphoid, myeloid) = cancer of blood cells

Myelodysplasia = immature cells

Myeloproliferative = too many cells

Question 3

Where are neutrophils found and how do they develop

Answer 3

Found in the peripheral blood

1. myeloblast
2. promyelocyte
3. myelocyte
4. metamyelocyte
5. neutrophil (only one in the peripheral blood)

Question 4

How are cell numbers controlled

Answer 4

Different cytokines will increase different cell numbers

DNA dictates differentiation and proliferation of blood cells

Question 5

Which cytokines are involved in increasing cell numbers (erythroid, lymphoid and myeloid)

Answer 5

Erythroid - Erythropoietin
Lymphoid - IL2
Myeloid - G-CSF, M-CSF

Question 6

Which cells are found in the peripheral blood

Answer 6

Immunocytes - T, B and NK cells

Phagocytes - granulocytes (neutrophils, eosinophils, basophils) and monocytes

Question 7

Why may there be an increase WBC production

Answer 7

Reactive - infection or inflammation

Malignant - leukaemia or myeloproliferative

Question 8

Why may there be a decrease in WBC production

Answer 8

Impaired bone marrow function
  - Aplastic anaemia 
  - Post chemo
  - Metastatic cancer
  - Haematological cancer
B12 or folate deficiency

Question 9

Why may there be an increase in cell survival

Answer 9

Failure of apoptosis e.g. acquired cancer causing mutation in some lymphomas

Question 10

Why may there be a decrease in cell survival

Answer 10

immune breakdown

Question 11

What is the difference between primary and secondary causes of an elevated blood count

Answer 11

Primary = malignancy

Secondary = a normal response to stimulus

Question 12

There is an elevated blood count of mature cells and all lineages are raised. What is the possible cause

Answer 12

Response to infection (secondary)

Question 13

There is an elevated blood count of mature cells and only one lineage is raised. What is the possible cause

Answer 13

Response to infection (secondary)

Question 14

There is an elevated blood count of mature cells and lymphocytes raised. What is the possible cause

Answer 14

Either chronic lymphocytic leukaemia (primary) or a response to viral infection

Question 15

Describe the blood count of acute leukaemia

Answer 15

Elevated count of immature cells
Blasts are present
Platelets and Haemoglobin is low

Question 16

Describe the blood count of chronic myeloid leukaemia

Answer 16

mix of mature and immature cells

Question 17

Where are neutrophils found, what is their lifespan and what proportion are marginated

Answer 17

Present in bone marrow, blood and tissues
Life span = 2-3 days in tissues
50% circulating are marginated (stuck to vessels wall)

Question 18

What is the cause of neutrophilia that develops in minutes

Answer 18

demargination

Question 19

What is the cause of neutrophilia that develops in hour

Answer 19

Early release from BM

Question 20

What is the cause of neutrophilia that develops in days

Answer 20

Increased production (x3 in infection)

Question 21

What can cause primary neutrophilia

Answer 21

Myeloproliferative disorders (pre-malignant)

Chronic or acute myeloid leukaemia

Question 22

What can cause secondary neutrophila

Answer 22

Inflammation (e.g.colitis, pancreatitis)
Infection
Physical stress (adrenaline, corticosteroids)
Underlying neoplasia

Question 23

Give examples of infections which do not characteristically produce neutrophilia

Answer 23

Typhoid, brucella, and many viral infections

Question 24

What may cause primary eosinophilia

Answer 24

Chronic eosinophilic leukaemia

Question 25

What may cause secondary eosinophilia

Answer 25

Parasitic infestation Allergic or autoimmune diseases e.g. asthma, rheumatoid, polyarteritis Response to neoplasms e.g. Hodgkin’s lymphoma Hypereosinophilic syndrome

Question 26

What may monocytosis be seen in

Answer 26

Infections: tuberculosis, typhoid, brucella, VZV, CMV Sarcoidosis Chronic myelomonocytic leukaemia

Question 27

What can basophilia be caused by

Answer 27

Pox viruses

Question 28

What is the common name of infectious mononucleosis and what type of disease is it

Answer 28

Glandular fever/mono | Looks immature but is actually a reactive, infection induced lymphocytosis

Question 29

Describe the action of infectious mononucleosis in the body

Answer 29

1. Epstein-Barr virus (EBV) infects B lymphocytes using their CD21 receptor 2. The infected B cell proliferates and expresses EBV-associated antigens 3. Stimulation of a cytotoxic T lymphocyte (CTL) response 4. Resolves the acute infection but a lifelong sub-clinical infection remains.

Question 30

Describe what is detected in the Southern Blot Test

Answer 30

Ig and TCR genes undergo recombination in antigen-stimulated lymphocytes (B and T). Due to their primary monoclonal proliferation, all daughter cells have identical configurations of these genes