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Haematology I > Leucocytes > Flashcards

Leucocytes Flashcards

1
Q

Total leucocyte count reference range is:

A

4 – 11 x 109/L

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2
Q

What is the reference range for neutrophils, and what proportion of WBC do they constitute?

A

2 – 6.8 x 109/L (40 – 80%)

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3
Q

What is the reference range for lymphocytes, and what proportion of WBC do they constitute?

A

1 – 4 x 109/L (25 - 35%)

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4
Q

What is the reference range for monocytes, and what proportion of WBC do they constitute?

A

0.2 – 1.0 x 109/L (2 – 10%)

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5
Q

What is the reference range for eosinophils, and what proportion of WBC do they constitute?

A

0 – 0.5 x 109/L (0 – 5%)

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6
Q

What is the reference range for basophils, and what proportion of WBC do they constitute?

A

0 – 0.2 x 109/L (0 - 2%)

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7
Q

List two features of neutropaenia.

A

Highly motile cells and high risk of serious infections

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8
Q

True or false: neutrophilia is rarer than neutropaenia.

A

False

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9
Q

List three pathological causes of neutrophilia.

A

Acute infection, drugs, and acute haemorrhage

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10
Q

The ________ ___________ of neutrophils is thought to be due to impaired cytoplasmic maturation, in the effort to rapidly generate large numbers of granulocytes.

A

Toxic granulation

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11
Q

What are Döhle bodies?

A

Single or multiple blue cytoplasmic inclusions,
that are about 1-2µm long. They represent remnants of rough endoplasmic reticulum from earlier maturational stages. They are associated with myeloid ‘left shifts’, and are seen in conjunction with toxic granulation

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12
Q

The term ‘_________ ________’ applies to chronic neutrophilia with marked leucocytosis (>25 x 109/L).

A

Leukaemoid reaction

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13
Q

A ______________ picture indicates severe disruption of the marrow, and is common in myelofibrosis (primary or secondary).

A

Leucoerythroblastic

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14
Q

_________ _________ anomaly is an autosomal dominant disorder whereby granulocyte nuclei fail to segment normally. Most granulocytes have bi-lobed nuclei, resembling bands. Cell function is normal. An acquired or ‘pseudo-Pelger-Huët’ anomaly is seen in myelodysplastic disorders and following drug therapy, and may accompany leukaemia and certain infections. Chromatin shows intense clumping, to help differentiate these cells from myelocytes,

A

Pelger-Huët

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15
Q

_______________ is usually observed in allergic disorders or parasitic infection, or in asthma, eczema, drug treatment.

A

Eosinophilia

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16
Q

___________ may result from viral, fungal, rickettsial, and protozoal infections.

A

Monocytosis

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17
Q

______________ occurs most frequently during viral infections and only rarely in bacterial infection, except Bordatella pertusis.

A

Lymphocytosis

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18
Q

Collectively, haematological malignancies account for approximately ___% of all cancers, with a considerably higher (greater than threefold) proportion of childhood cancers.

A

8

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19
Q

_____________ anaemia is a mutation in the FA genes that normally helps repair DNA damage.

A

Fanconi’s

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20
Q

Wiscott-Aldrich Syndrome involves mutations in the WAS gene, which affects the ability of _______ _______ to relay signals from the surface to the cytoskeleton.

A

Blood cells

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21
Q

True or false: radiation is leukaemogenic.

A

True

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22
Q

__________ involve ‘gain-of-function’ mutations.

A

Oncogenes

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23
Q

_______-__________ are involved in a variety of important cellular processes e.g., cell-signalling pathways, directing cellular growth, differentiation and proliferation.

A

Proto-oncogenes

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24
Q

Tumour-suppressor genes cause ‘loss-of-function’ _____________.

A

Mutations

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25
Q

________ is a protein that interacts signalling pathways involved with cycle arrest, DNA repair, and apoptosis.

A

p53

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26
Q

The term ‘aneuploid’ refers to:

A

Abnormal (odd) number of chromosomes, not a multiple of 23.

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27
Q

__________ alterations (does not affect DNA sequence but results in a change in gene expression, e.g., methylation).

A

Epigenetic

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28
Q

___________ play a role in regulating gene expression.

A

MicroRNAs

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29
Q

______________ chromosome, t(9;22) BCR/ABL, is associated with CML.

A

Philadelphia

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30
Q

t(15;17), retinoic acid receptor is associated with _______ _________ __________

A

Acute myeloid leukaemia

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31
Q

MicroRNAs _____________ gene expression.

A

Downregulate

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32
Q

_____________ stains granules of granulocytes.

A

Myeloperoxidase

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33
Q

Sudan Black B stains _______ in granules.

A

Lipids

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34
Q

_________ ______ ________ stains glycogen.

A

Periodic Acid Schiff

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35
Q

Acid phosphatase - shows characterising staining in __-_____.

A

T-ALL

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36
Q

In _______ _________ _________, the cells can be identified by using antibodies directed against markers, such as CD13, CD117, etc..

A

Acute myeloid leukaemia

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37
Q

____________ __-_______ ______________ detects extra copies of genetic material.

A

Fluorescent in-situ hybridisation

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38
Q

True or false: acute leukaemia often goes into remission, but may have a relapse.

A

True

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39
Q

__________ leukaemia is an aggressive disease, with predominantly blast cells, some mature forms, and very few intermediate stage cells.

A

Acute

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40
Q

Chronic leukaemia is less aggressive, with a predominance of more __________ cells, with <20% blasts.

A

Mature

41
Q

Acute leukaemia (AL) is defined as the presence of >20% __________ in the blood or bone marrow.

A

Blasts

42
Q

The classic triad of leukaemia is anaemia, ______________ and bleeding due to reduced levels of normal blood cells.

A

Infection

43
Q

List the three main forms of B-lymphoblastic leukaemia.

A

B-lymphoblastic leukaemia/lymphoma with translocations( t(9;22)(q34;q11.2); BCR-ABL 1)

B-lymphoblastic leukaemia/lymphoma with hyperdiploidy

B-lymphoblastic leukaemia/lymphoma with hypodiploidy

44
Q

List three clinical features of leukaemia.

A

Bone marrow failure, neutropaenia, and thrombocytopaenia

45
Q

True or false: normochromic-normocytic anaemia is often observed in acute leukaemia.

A

True

46
Q

List the main forms of AML.

A

AML with recurrent genetic abnormalities

APL with t(15,17) (q22;q12); PML-RARA (acute promyelocytic leukaemia)

AML with myelodysplasia-related changes (significant dysplasia)

AML, therapy related (previous chemotherapy)

AML, not otherwise specified is categorised according to morphology, cytochemistry and immunophenotype (old FAB classification) (no common genetic abnormalities)

AML with minimal differentiation (no granules in cytoplasm of blasts)

AML without maturation (mostly myeloblasts (Auer rods))

Acute myelomonocytic leukaemia (increase in immature neutrophils and monocytes in the bone marrow)

Acute monoblastic/monocytic leukaemia (increase in immature monocytes)

Acute erythroid leukaemia (immature cells of the erythroid lineage present)

Acute megakaryoblastic leukaemia (abnormal megakaryoblasts)

47
Q

What are some clinical features of CML?

A

Bruising, epistaxis, and splenomegaly

48
Q

True or false: leucocytosis and increased basophils are characteristic of CML.

A

True

49
Q

CML bone marrow studies will be hypercellular, with a predominance of ___________ cells.

A

Myeloid

50
Q

CML will have a low leucocyte ___________ ____________ score.

A

Alkaline phosphatase

51
Q

CML will, in terms of molecular biology, be Ph chromosome-positive or BCR/____-positive.

A

ABL

52
Q

True or false: CML will never convert to AML.

A

False

53
Q

_____________ syndromes are serious and relatively common; they are most common in the elderly population.

A

Myelodysplastic

54
Q

List the five main types of myelodysplastic syndrome.

A

MDS with single lineage dysplasia
MDS with ring sideroblasts (MDS-RS)
MDS with multilineage dysplasia
MDS with excess blasts
MDS with isolated del(5q)

55
Q

What is the scientific term for a reduction in one or more cell lines?

A

Cytopaenia

56
Q

In some myelodysplastic syndrome varients, ring ____________ are seen in the bone marrow, due to presence of iron-loaded mitochondria.

A

Sideroblasts

57
Q

Giant, ______________ platelets are often observed in myelodysplastic syndromes.

A

Hypogranular

58
Q

In myelodysplastic syndromes, usually a macrocytic, sometimes ____________, picture is observed.

A

Dimorphic

59
Q

Anisocytosis, poikilocytosis, _____________ stippling, Howell-Jolly bodies, and NRBC may be observed in myelodysplastic syndrome.

A

Basophilic

60
Q

True or false: there is considerable overlap between leukaemias and lymphomas.

A

True

61
Q

List the two most common variants of lymphoma.

A

Hodgkin’s and non-Hodgkin’s

62
Q

B-cell __________ correspond to stages of maturation.

A

Neoplasms

63
Q

Pre-cursor B cells that are produced and mature in the bone marrow may undergo ___________, or develop into mature B cell.

A

Apoptosis

64
Q

B cells that have acquired a mutation give rise to B cell ________________ _____________.

A

Lymphoblastic leukaemia

65
Q

Upon encountering ___________, B lymphocytes undergo blast transformation in the lymph nodes to form effector lymphocytes.

A

Antigen

66
Q

B cells may acquire abnormality while proliferating in the __________ _____-.

A

Mantle zone

67
Q

B cells may enter the ____________ _________, where somatic hypermutations occur (GC neoplasms), and they switch from coding polyreactive antibodies into clones that express specific antibodies.

A

Germinal centres

68
Q

List two types of post-germinal centre cells.

A

Plasma cells and memory B cells

69
Q

True or false: chronic lymphocytic leukaemia is not a post-germinal centre neoplasm.

A

False

70
Q

T cell progenitors leave the bone marrow and enter the thymus where they develop into ________naïve T cells.

A

Naïve

71
Q

If an abnormality is acquired in either the bone marrow or ___________, T lymphoblastic leukaemia/lymphoma may develop.

A

Thymus

72
Q

When T cells leave the thymus and encounter antigen they undergo ________ ______________, and develop into memory and effector T cells.

A

Blast transformation

73
Q

If an abnormality is acquired in ____________ ____________ ________, there may be peripheral (mature) T cell lymphoma/leukaemia.

A

Peripheral lymphoid tissue

74
Q

List two forms of neoplasms, other than Hodgkin’s lymphoma.

A

Precursor T cell neoplasm and mature T cell neoplasm

75
Q

Give three mature B cell neoplasms.

A

B cell prolymphocytic leukaemia
Hairy cell leukaemia
Plasma cell myeloma

76
Q

B cell chronic lymphocytic leukaemia (CLL) has a peak incidence in what age group?

A

60-80 years

77
Q

List three aetiological features of B cell chronic lymphocytic leukaemia.

A

Familial association, prolonged lifespan of B cells, and impaired apoptosis

78
Q

In B-CLL, failure of apoptosis is associated with _________________ of a known suppressor of apoptosis.

A

Upregulation

79
Q

State three clinical features of B-CLL.

A

Features of anaemia, thrombocytopaenia, and neutropaenia, lymphadenopathy, and immunosuppression

80
Q

Lymphocytosis (>5 x 109 /l, up to 300 x 109 /l), N/N anaemia (may develop due to autoimmune haemolysis), and thrombocytopaenia are laboratory findings of which neoplasm?

A

B cell chronic lymphocytic leukaemia

81
Q

List three feature that might be seen on a B-CLL blood film.

A

Smudge cells, less than 20% blasts, and inconspicuous nucleoli

82
Q

List two features of B-CLL immunophenotyping

A

B cells will have surface CD19+
Weak expression of surface IgM or IgD (monoclonal)

83
Q

_________________ replacement of normal marrow may be observed on in the bone marrow in B-CLL.

A

LymphocytiC

84
Q

True or false: translocations and trisomies, but not deletions, are seen in B-CLL.

A

False

85
Q

In B-CLL, immunoglobulin will have ____________ concentration, and will be more marked with advanced disease.

A

Reduced

86
Q

List three forms of treatment for B-CLL.

A

Immunochemotherapy (biological therapy), such as antiCD20 (Rituximab), chemotherapy, and radiation

87
Q

Malignant cells accumulate in lymph nodes, in a phenomenon known as _____________________.

A

Lymphadenopathy

88
Q

The ______________ _______ occurs when malignant cells spill over into the blood.

A

Leukaemic phase

89
Q

What is Hodgkin’s lymphoma characterised by?

A

Presence of Reed-Sternberg (RS) cells

90
Q

True or false: Hodgkin’s lymphoma arises from T cells.

A

False

91
Q

With what previous infection is Hodgkin’s lymphoma associated?

A

Epstein-Barr virus, and particularly infectious mononucleosis

92
Q

Hodgkin’s lymphoma has a ______ cure rate.

A

High

93
Q

Non-Hodgkin’s lymphoma is usually derived from ___ cells.

A

B

94
Q

True or false: the aetiology of non-Hodgkin’s lymphoma is poorly understood.

A

True

95
Q

______________ reflects the synthesis of Ig from a single clone of plasma cells, and is sometimes non-malignant.

A

Paraproteinaemia

96
Q

Paraproteinaemia is characterised by a _____________ immunoglobulin (Ig) band in the serum.

A

Monoclonal

97
Q

Define multiple myeloma.

A

Neoplastic proliferation of lymphocytes (B cells)

98
Q

Give three characteristics of multiple myeloma.

A

Accumulation of plasma cells in the bone marrow

Presence of monoclonal protein in the serum

Related organ or tissue damage (bone pain is a common presenting feature)

99
Q

Giant _____________ platelets, with functional problems, are observed is myelodysplastic syndrome.

A

Hypogranular

Haematology I (4 decks)

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