Lab investigation of the Full Blood count and WBC disorders

Question 1

Where does blood cell production occur ?

Answer 1

Haematopoiesis takes place in the bone marrow within long bones.

Maturation occurs in the bone marrow
Once mature, blood cells leave BM + enter the peripheral blood.

Question 2

What are the different types of WBC ?

Answer 2

Lymphocytes 
Monocyte
Eosinophil
Basophil
Neutrophil

Question 3

What are the three types of blood cells produced ?

Answer 3

RBC
WBC
Platelets

Question 4

Which mature cells are found in peripheral blood?

Answer 4

RBC
Lymphocytes (T-lymphocyte, B-lymphocyte)
Monocyte
Eosinophil
Basophil
Neutrophil
Platelets

Question 5

Describe Haematopoiesis

Answer 5

The process begins with multipotent haematopoietic stem cells (hemocytoblast)

This gives rise to the common myeloid progenitor + common lymphoid progenitor.

The common myeloid progenitor forms Megakaryoblast =Thrombocytes , Proerythroblasts=Erythrocytes, Myeloblast=Basophil/Neutrophil/Eosinophil (Granulocytes)
/Monocyte, mast cells

The common lymphoid progenitor forms :
Small lymphocyte=B/T lymphocytes
/natural killer cells

• Haemocytoblast divides to give 2 stem cells
• 1 stem cell self-renews. The other stem cell receives specific chemical signals to go down 1 of 2 pathways - lymphoid stem cell pathway/myeloid stem cell pathway.
• Myeloid stem cell pathway = myeloid stem cell divides to give (see slide 3 diagram, repeatedly draw out pathway to understand + memorise)

Question 6

BM contains the __________ of blood cells that ________ to become _____________________

Answer 6

• committed progenitors
• differentiate
• the mature cells that enter peripheral blood

Question 7

What are some components in a Full Blood count ?

Answer 7

-Hb: concentration of Haemoglobin
-HCT (haematocrit): Percentage of blood volume as RBC (percentage of the blood tube that is basically blood usually use Hb to reflect this, 40-50%)
-RBC (red blood cell count) another reflection of the Hb
-MCV (Mean cell Volume): Average size of RBC
-MCH (Mean Cell Hb): Average haemoglobin content of RBC
-RDW (red cell distribution width): Range of deviation around RBC size
more varied cell size = higher RDW (e.g. B12/folate D)
If RBCs are monomorphic (each RBC is same shape/size) = low RDW
-Reticulocyte count (doesn’t come with FBC has to be requested) - baby RBC and it is used to see if the bone marrow is working
(Iron deficient patients MCV low MCH low so not much Hb but weirdly for B12 folate deficient patients they ae big and have less RBC but their MCHC (concentration of Hb in each cell is usually normal.)
-Blood film - to view cell morphology
-WBC
-Platelets - platelet count + size

Question 8

What is the WBC result?

Answer 8

Total WBC count + differential WBC count (compare numbers of diff. types of WBC -
Neutrophils ,lymphocytes,Monocytes,Basophils and Eosinophils) - their %

Question 9

What does a Blood film show ?

Answer 9

Morphology (Are the cells normal ?)
RBC-Size,Colour (central pallor = indicates Hb content),Shape (round, teardrop, elliptocytes, poikilocytosis), Polychromasia (blue cytoplasm = ⬆ RNA, HA), Inclusions (Heinz bodies)

WBC-Number,Normal morphology,Immature cells present?,Abnormal Cells,Inclusions?

Question 10

What is polychromasia?

Answer 10

This is a disorder where there s an abnormal amount of immature RBC this means they stain differently

Question 11

What us Poikilocytosis ?

Answer 11

This is when RBC have different shapes

Question 12

What is Anisocytosis ?

Answer 12

This is when the RBC are unequal in size

Question 13

Describe the blood film of iron deficiency anaeima

Answer 13

Ovalocytes/elliptocytes
Pale cell-Hypochromic
Scrappy cells
Different shapes +sizes
Microcytic hypchromic anaemia 
Anisocytosis (unequal sizes)

Question 14

Describe the blood film of Macrocytic Megaloblastic anaemia

Answer 14

Macrocytic cells -bigger size
Central pallor is big =Hypochromic
Different shapes -Tear drop

Caused by Vitamin b12 deficieny
Gastrectomy-No intirnsic factor being produced by parietal cells in stomach
Cannot uptake B12
Not taking supplements

Question 15

Describe Acquired haemolytic anaemia blood film

Answer 15

Spherocytes -Round cells with no central pallor = not biconcave
Polychromasia-Many baby RBCs(reticulocytes
Nucelated RBC

Antibody which destroys the patients RBC in intravascular space
Patient is jaundiced due to cells dying quickly and releasing bilurubin

Question 16

Sickle cell anaemia Blood film?

Answer 16

Contains sickled cells (Long and moon shape)
Target cells (Centarl pallor with dot in the middle (haemoglobinopathies - HbSS /HbSC),

Question 17

Tear drop poikilocytosis Blood film?

Answer 17

Tear drop cells(Infiltration of bone marrow -scarring /cancer)
Malignant diseases
Myelofibrosis(scarring)

The lady has a large spleen

Question 18

Neutrophil Leucocytosis?

Answer 18

This is when there are too many RBC and WBC and can be due to infection/dehydration as the concentration of WBC increase.
The bone marrow makes lots of cells but there is no specific reason.

Question 19

What is Acute myeloblastic leukaemia

Answer 19

This is when blast cells are present,
The results will show very high WBC count
The high WBC is due to high blast cells (leukemia cells )

Question 20

What is seen in a chronic granulocytic leakumia blood film ?

Answer 20

All stages of cell maturation are represented
Fatal
Huge WBC count and most are flagged as neutrophils because you have all stages of maturation

Question 21

BM contains the __________ of blood cells that ________ to become _____________________

Answer 21

• committed progenitors
• differentiate
• the mature cells that enter peripheral blood

Question 22

What is microcytic hypochromic ?

Answer 22

Small cells lacking in colour.

Thalassaemia /Iron deficiency

Question 23

What is Normocytic normochromic

Answer 23

Normal sized cells normal colour- renal failure,anaiaof chronic disease, aplastic anaemia, SCD

Question 24

What is Macrocytic normochromic?

Answer 24

This is large cells with normal colour

Vit B12 deficiency, folic acid deficiency.

Question 25

Anisocytosis =

Poikilocytosis =

Answer 25

Anisocytosis = RBCs are diff. sizes
Poikilocytosis = RBCs are diff. shapes