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CP3 Medicine > HAEM - Leucocytes and neutrophils > Flashcards

HAEM - Leucocytes and neutrophils Flashcards

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1
Q

Fct neutrophils

A

Ingest and kill bacterial, fungal and cellular debris

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2
Q

Fct lymphocyte s

A

Produce antibodies for cell mediated immunity

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3
Q

Fct eosinophils

A

Role in allergic reactions

Defense of parasitic infection

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4
Q

Fct monocytes

A

Precursor tissue macrophages

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5
Q

Fct basophil

A

Release histamine in inflammatory reactions

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6
Q

Role spleen (5)

A

Reservoir of RBC
Site of B lymphocyte + antibody production
Reservoir platelets
Reservoir macrophages
Removes antibody coated bacteria and blood cells

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7
Q

Neutrophilia DDx >10 (5)

A 
bacterial infection 
Tissue damage - MI.PE, burn 
Physiological - exercise, during preg 
CCS + inflamm - Gout, RA, UC, Chron's 
Malig - CML/solid tumour
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8
Q

Neutropenia DDx <1.5 (7)

A 
Viral infection + severe bacterial infection - sepsis /typhoid 
Autoimmunity - commonly SLE
Felty's syndrome 
Black people 
Alcohol + other drugs. Methotrexate
ELA2 gene mutation 
BM failure
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9
Q

Neutropenic sepsis

A

Severe neutropenia leading to sepsis

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10
Q

Agranulocytosis

A

Complete abscence of circulating neutrophils

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11
Q

Which med is agranulocytosis a common SE of?

A

Carbimazole

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12
Q

Lymphocytosis DDx >5 (4)

A

Viral infections
Chronic infections - TB/toxoplasmosis/syphillis
Lymphoproliferative - CLL/some lymphomas
Post splenectomy

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13
Q

Lymphopenia DDx (5)

A 
HIV/autoimmunity 
CCS + inflamm - CT disease 
Chemotherpy + lymphoma
Renaal failure 
Transient - recent infection
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14
Q

Hx points - abnormal WCC (8)

A 
Age 
Duration Sx 
W loss >10% 6m
Drenching night sweats 
Unexplained fever 
Systemic disease - RA
Evidence malig 
Lymphadenopathy >6w + >2cm
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15
Q

Possible Ix - abnormal WCC (6)

A 
Blood film 
Immunophenotyping 
USS/CT
Microbiology 
LN biopsy 
BM biopsy
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16
Q

What are the 2 lineages a multipotent cell can go down

A

Common myeloid progenitor

Common lymphoid progenitor

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17
Q

Cells the common myeloid progenitor can DDx into (5)

A 
Erythrocyte
Mast cell 
Megakaryocytes 
Neutrophil 
MOnocyte
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18
Q

What do megakaryocytes further divide into

A

Platelets

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19
Q

What do common lymphoid progenitor cells DDx into

A

B cell
T cell
NK cell

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20
Q

What is immature cells in peripheral blood a sign of?

A

That the marrow is stressed

Hence pre-leukaemic

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21
Q

ALL

A

Malignancy of lymphoid cells of B/T lineage –> uncontrolled proliferation of immature blast cells, BM failure and tissue infiltration

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22
Q

Who gets ALL

A

Children - 3-7y/o

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23
Q

Which syndrome is ALL more common in?

A

Downs

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24
Q

Prognosis ALL

A

80% cure rate in kids <10

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25
Indicators - poor prognosis ALL (4)
Older ps Male B cell disease Philadelphia chromosome
26
Philadelphia chromosome
9:22
27
What is AML
Malignancy of blast cells fom marrow myeloid elements
28
RF AML (4)
Myeloproliferative disorders Previous chemotherapy IR Genetic syndromes
29
Median age PS AML
65
30
Prognosis AML
20% 3 y survival after chemo
31
Sx - acute leukaemia (6)
``` B Sx Bone pain Anaemia --> SOB on exertion, weakness Leukopenia --> rec infections Thrombocytopenia --> bleeding + bruising HS megaly ```
32
Ix Acute leukaemia
``` FBC Blood film - BLASTS CXR BM aspiration PET scan - mets U/E, LFT, cardiac fct ```
33
What is diagnostic Ix result for acute leukaemia
Blast cells on blood film
34
ALL - CXR findings
Mediastinum widening
35
General supportive management - acute leukaemia
``` Nurse Hickman line High kcal diet Freq blood + platelet transfusion Allopurinol Check blood/obs - signs infections ```
36
Use of ABx in acute leukaemias
If T>38' on 2 occasions >1hr | Cephalosporin + gentamicin until afebrile 72hrs
37
Why give allopurinal to patients with acute leukaemia
To prevent tumour lysis syndrome due to chemo
38
Specific Mx ALL
High dose chemo + 2 y maintenance therapy Consider transplant if poor prog/relapse
39
ALL cure if have Philadelphia chromosome
Transplant (BM)
40
Specific Mx AML
Intensive chemo
41
If poor prog AML - what Mx should be done
Allogenic marrow transplant after 1st round chemo
42
If intermediate prod AML - what Mx should be done
Autologous marrow transplant
43
Age - CML
40-60y/o
44
Which genetic linkage accounts for 95% cases CML
Philadelphia chromo
45
Sx CML
B Sx | Gout + abdo discomfort
46
O/E CML
Massive HS megaly | Signs anaemia /thrombocytopenia
47
Ix CML
FBC - WCC v high Blood film BM CT/PET
48
Blood film findings - CML
Spectrum myeloid cells
49
BM findings - CML
Hypocellular
50
Mx CML
Imantinib chemo | SC transplant
51
Prognosis CML
Median survival 6y
52
What are the 3 stages of CML
Chronic - few Sx for y Accelerated- incr Sx Blast transformation - features acute leukaemia + death
53
What is the most common leukaemia
CLL
54
M:F CLL
2:1
55
Median age of PS - CLL
70 y/o
56
Pathophysiology - CLL
Accumulation of mature B cells that have escaped apoptosis | Increased mass of immune competent cells --> BM failure
57
Sx CLL
Often none | Anaemic/infection prone
58
O/E CLL (2)
Large non-tender LN | HSmegaly
59
Ix CLL
FBC - raised lymphocytes | Blood film
60
Blood film results CLL
Smudge cells
61
Mx CLL
Symptomatic Tx only chemo Radiotherapy for HS megaly
62
How is prognosis of CLL determined
Rai stage
63
Rai stage 0 + prognosis
Lymphocytosis alone | > 13y
64
Rai stage 1 + prognosis
Lymphocytosis + lymphadenopathy 8 y
65
Rai stage 2 + prognosis
Lymphocytosis + HSmegaly | 5 y
66
Rai stage 3 + prognosis
Lymphocytosis + anaemia | 2 y
67
Rai stage 4 + prognosis
Lymphocytosis + thrombocytopenia | 1y
68
What is multiple myeloma
Malignant clonal proliferation of plasma cells . Single clone of plasma cells --> single Ig --> monoclonal band
69
Av age PS Multiple myeloma
70
70
Which population have increased prevelance of multiple myeloma
Afro-Carribbean
71
PS Multiple myeloma
Osteolytic bone lesions --> backache, patho fractures = hypercalcaemia BM failure --> infections, Sx anaemia + bleeding Renal impairment
72
Ix Multiple myeloma
``` FBC Blood film ESR - raised U/E - deranged Ca - raised ALP - norm Electrophoresis - paraprotein MC band Urine Bence Jones protein +ve Skeletal XR BM biopsy >10% clonal plasma cells ```
73
Blood film finding multiple myeloma
Rouleaux formation
74
FBC finding multiple myeloma
Normochromic normocytic anaemia | Leukopenia
75
Skeletal XR finding multiple myeloma
Pepper pot skull
76
If BM biopsy in Multiple myeloma yields <10% plasma clone cells, what is the diagnosis
MGUS
77
Mx multiple myeloma
Supportive Chemo/radiotherapy BM SC transplant if <70
78
Prognosis multiple myeloma
3-4y
79
What is lymphoma?
Malignant proliferation of lymphocytes
80
% lymphoma which are Hodgkins lymphoma
15%
81
What are Hodgkins lymphoma defining characteristic
Reed-Sternburg cells
82
Age range Hodgkin's lymphoma
20-35
83
RF Hodgkin's lymphoma (4)
Affected sibling EBV SLE Obesity
84
Sx Hodgkin's lymphoma (3)
Enlarged, non-tender rubbery LN B Dx Mass effects/direct extension Sx from mediastinal LN
85
What can induce LN pain in pt with Hodgkin's lymphoma?
Alcohol
86
O/E - Hodgkin's lymphoma (4)
Lymphadenopathy Anaemia Cahexia HS megaly (50%)
87
How is Non-Hodgkin's lymphoma different from Hodgkins
W/o presence Reed-Sternburg cells
88
Peak age Non-Hodgkin's lymphoma
70
89
High grade Non-Hodgkin's lymphoma
Divide rapidly PPS rapid onset lymphadenopathy > aggressive Better prognosis if ID'd
90
Low grade Non-Hodgkin's lymphoma
Divide slowly > Insidious Widely disseminated at diagnosis + incurable
91
Sx Non-Hodgkin's lymphoma (4)
Superficial lymphadenopathy (75%) Extranodal Sx - oropharynx, skin, CNS, gut, lung B Sx BM failure
92
Ix Non-Hodgkin's lymphoma (6)
``` FBC, ESR, U+E Ca2+ Film LDH LN excision biopsy Staging CT ```
93
Mx Non-Hodgkin's lymphoma
Chemo/radiotherapy Or Chemo-radiotherapy
94
Poor prognostic factors non-hodgkin's (3)
>60 Disseminated disease Raised LDH
95
Staging for lymphomas
Ann Arbor
96
What is meant by myeloproliferative disorders
Clones of SC proliferate in BM | yet retain ability to differentiate
97
What is essential thrombocytosis
Clonal proliferation of megacaryocytes --> persistently raised platelets
98
Sx essential thrombocytosis
Often astmp Microvascular occlusion Bleeding aa/vv thrombosis
99
What is polycythaemia rubra vera
Malig proliferation of clone derived from 1 pluripotent marrow cell --> erythroid progenitor offspring which don't req EPO to avoid apoptosis
100
Consequence of PCV on the blood
XS prod RBC, WBC and platelets --> hyperviscosity + thrombotic complications
101
Diagnosis PCV (2)
Incr red cell mass | JAK2 mutation
102
PS PCV
``` Thrombosis rarer: hyperviscocity Sx: headache, dizzy, tinnitus, facial plethora, erythromelalgia Splenomegaly Gout ```
103
Tx PCV
Venesection | Low dose aspirin
104
How to DDx 1' and 2' PCV
In 2' (e.g. b.c hypoxia//renal disease), only RBC count is raised
105
What is primary myelofibrosis
Hyperplasia of megakaryocytes --> XS platelet derv'd GF --> marrow fibrosis + metaplasia
106
Sx primary myelofibrosis
B Sx Abdo discomfort (from massive HS megaly) BM failure
107
What is aplastic anaemia
Rare SC disorder --> pancytopenia and hypoplastic marrow
108
Cause aplastic anaemia
Autoimmune - Dx, viruses, irradiation | Fanconi syndrome
109
Sx aplastic anaemia
BM failure
110
Diagnosis aplastic anaemia
BM biopsy
111
Mx aplastic anaemia
Blood product transfusion | Immunosuppression
112
extra Tx aplastic anaemia - younger pt
Allogenic BM transplant may cure

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