White Blood Cell Conditions

Question 1

Describe the appearance of neutrophils and their function

Answer 1

2-3 lobes of the nuclei, light staining with lobed nucleus. Involved in responding to BACTERIAL infections

Question 2

Describe the appearance of eosinophils and their function

Answer 2

Have a red brick colour staining with two nuclei and are involved in responding to PARASITES (e.g. helminths)

Question 3

Describe the appearance of basophils and their function

Answer 3

Rarely seen in blood film but cytoplasm is highly granular and is involved in allergies as it’s the equivalent to mast cels in the blood

Question 4

Describe the appearance of monocytes and their function

Answer 4

Largest of the granulocytes with a kidney-bean shaped nucleus, and matures in tissues to become a macrophage

Question 5

Describe the appearance of lymphocytes and their function

Answer 5

Large nucleus: cytoplasm ratio (very little cytoplasm visible) and involved in adaptive immunity

Question 6

What are macrocytes and what may cause this?

Answer 6

Red cells with an increased MCV, due to liver disease or B12/folate deficiency

Question 7

What are target cells and what may cause this?

Answer 7

Red cells with a ‘target-like’ appearance due to liver disease, haemoglobinopathies or iron deficiency

Question 8

What are pencil cells and what may cause this?

Answer 8

These are where the red cells appear thin and pencil-shaped due to iron-deficiency

Question 9

What are ecchinocytes and what may cause this?

Answer 9

These are star-shaped red cells due to liver disease

Question 10

What are microcytes and what may cause this?

Answer 10

Red cells with a reduced MCV due to iron-deficiency or thalassaemia

Question 11

What are spherocytes and what may cause this?

Answer 11

Spherical red cells due to hereditary spherocytosis, or autoimmune haemolytic anaemia.

Question 12

What may the presence of red cell fragments in a blood film represent?

Answer 12

Diffuse intravascular coagulation (DIC) or cardiac prosthetic valves

Question 13

What are elliptocytes and what may cause this?

Answer 13

Thicker versions of pencil cells present due to hereditary elliptocytosis

Question 14

What are tear drop poikilocytes are what may cause this?

Answer 14

These are red cells that are tear-drop shaped due to myelofibrosis

Question 15

What are Howell-Jolly bodies and what may cause this?

Answer 15

Remnant of DNA in red cell due to hyposplenism or post-splenectomy

Question 16

How would a malarial parasite present in a blood film?

Answer 16

Look’s similar to an engagement ring within the red blood cells.

Question 17

What is the mode of inheritance for hereditary ellpitocytosis?

Answer 17

Autosomal dominant

Question 18

What is hereditary elliptocytosis?

Answer 18

Where there is a defect leading to failure of spectrum heterodimers to self-associate into heterotetramers so the normal bi-concave disc doesn’t form.

Question 19

How does the genetic profile affect the severity of hereditary elliptocytosis?

Answer 19

Homozygous (or doubly heterozygous) have severe haemolytic anaemia, whereas those who are heterozygous tend to have no ill effects until discovered under routine examination

Question 20

What is immune thrombocytopenia purpura (ITP)?

Answer 20

Usually appears as spontaneous skin purport and mucosal bleeding that tends to affect women 15-50 and bone marrow has increased levels of megakaryocytes.

Question 21

In a 23-year-old woman with easy bruising, heavy periods, petechial haemorrhages around her ankles and microcytic anaemia, what is the likely cause?

Answer 21

Iron-deficiency anaemia due to chronic blood loss and immune thrombocytopenia purport for the petechial haemorrhages and easy bruising.

Question 22

What are the characteristic blood film signs post-splenectomy or with hyposplenism?

Answer 22

Irregularly contacted red cells, target cells, Howell-Jolly bodies

Question 23

Why does whooping cough cause a lymphocytosis in children instead of a neutrophilia?

Answer 23

Whooping cough is caused by Bordetella pertussis bacteria which would cause a neutrophilia in adults but lymphocytosis often occurs in response to bacterial infections in children.

Question 24

A one-year-old boy presented with a recent respiratory tract infection. This had now developed into severe paroxysms of coughing. He has a normocytic anaemia with lymphocytosis. What is the likely diagnosis?

Answer 24

Whooping cough with bordetella pertussis, as bacterial infections in young children often lead to a lymphocytosis instead of a neutrophilia

Question 25

What are the histological characteristics of chronic lymphocytic leukaemia?

Answer 25

Polychromasia (reticulocytosis) and normocytic anaemia with lymphocytosis

Question 26

Outline the underlying pathophysiology of chronic lymphocytic leukaemia

Answer 26

There is clonal expansion of B-cells and the bone marrow is infiltrated by lymphocytes leading to it's failure and subsequently the development of anaemia, neutropenia and thrombocytopenia.

Question 27

What are promyelocytes?

Answer 27

Early granulocyte precursors characterised by bi-lobed nuclei and cytoplasmic granulation

Question 28

What is acute promyelocytic leukaemia?

Answer 28

A type of acute myeloid leukaemia characterised by the presence of a t(15:17) translocation and the presence of DIC (disseminated intravascular coagulation)

Question 29

Which form of leukaemia is a t(15:17) translocation and DIC characteristic of?

Answer 29

Acute promyelocytic leukaemia

Question 30

Why does treatment of acute promyelocytic leukaemia with chemotherapy have to be done with care?

Answer 30

Chemotherapy aggravates the DIC ad therefore multiple platelet transfusions and replacement of clotting factors with fresh frozen plasma have to be used.

Question 31

How would acute pro-myelocytic leukaemia appear on a full blood count?

Answer 31

Normocytic anaemia (due to bone marrow infiltration), reduced leucocytes generally with increased pro-myelocytes, decreased platelets (due to DIC and marrow infiltration) and increased clotting and reduced availability of factors.

Question 32

What is myelofibrosis?

Answer 32

Extensive scarring of the bone marrow which affects the production of blood cells

Question 33

A 64-year-old woman presented with tiredness and left-sided abdominal discomfort. On examination she had an enlarged live and massive splenomegaly. There were occasional granulocyte precursors and a circulating erythroblast in the blood film. What is the likely diagnosis?

Answer 33

Primary myelofibrosis with extramedullary haemaopoiesis

Question 34

What are the characteristic features of primary myelofibrosis?

Answer 34

Leucoerythroblastic anaemia with massive splenomegaly

Question 35

What mutation is associated with primary myelofibrosis?

Answer 35

JAK 2 in the haematopoietic precursor cells.

Question 36

What is 'multiple myeloma'?

Answer 36

A form of cancer where there is clonal proliferation of plasma cells in the bone marrow with presence of monoclonal antibodies or light chains in the serum-urine with associated tissue damage.

Question 37

What are the characteristic signs of a multiple myeloma?

Answer 37

Rouleaux formation, background staining and macrocyclic anaemia with monoclonal antibodies (paraproteins)

Question 38

A 20-year-old male was admitted with sudden onset of left-sided chest pain and a productive cough with purulent sputum. They had neutrophilia, increased monocytes and reduced lymphocytes. What is the likely diagnosis?

Answer 38

There is neutrophilia, which is likely to be indicative of a bacterial infection, as well as infiltration of monocytes and reduction in lymphocytes, therefore the diagnosis will be bacterial, and is therefore bacterial pneumonia.

Question 39

25-year-old woman was admitted via the Casualty Department with increasing difficulty with breathing. She had increased neutrophils and eosinophils. What is the likely diagnosis?

Answer 39

Eosinophilia is more pronounced and therefore it is likely she is having an acute asthma attack

Question 40

An 18-year-old female presented to her general practitioner with a sore-throat and general malaise. On examination she had cervical lymphadenopathy and an inflamed throat with a temperature of 39°C. They have increase neutrophils and increased reactive and non-reactive lymphocytes. What is the likely diagnosis?

Answer 40

This patient has lymphocytosis and their diagnosis would be infectious mononucleosis.

Question 41

A 62-year-old male was admitted for the repair of an inguinal hernia. On examination he was found to have mild generalised lymphadenopathy. He has a normocytic anaemia, reduced platelets and neutrophils with increased levels of lymphocytes. What is the likely diagnosis?

Answer 41

The patient has lymphocytosis, normocytic anaemia, mild neutropenia and thrombocytopenia and this leads to a diagnosis of chronic lymphocytic leukaemia.

Question 42

What are the characteristic signs of chronic lymphocytic leukaemia (CLL)?

Answer 42

Lymphocytosis, normocytic anaemia, mild neutropenia and thrombocytopenia.

Question 43

What are the characteristics of chronic myeloid leukaemia?

Answer 43

Granulocytosis, normocytic anaemia and mild thrombocytosis

Question 44

A 45-year-old man presented with general malaise, night sweats and discomfort in the left hypochondrium. On examination he had palpable liver and spleen. He had a increased granulocytes, lymphocytes and reduced platelets. What is the likely diagnosis?

Answer 44

Chronic myeloid leukaemia

Question 45

A 12-year-old girl presented with increasing tiredness and easy bruising. She has normocytic anaemia, reduced platelets and increased blast cells (leucocytosis). What is the likely diagnosis?

Answer 45

Acute lymphoblastic leukaemia

Question 46

What are the characteristics of acute lymphoblastic leukaemia (ALL)?

Answer 46

Normocytic anaemia, thrombocytopenia and leucocytosis (increased blasts)

Question 47

What are the characteristics of acute myeloid leukaemia?

Answer 47

Macrocytic anaemia, thrombocytopenia and leucocytosis (increased blasts)

Question 48

A 65-year-old woman presented with increasing breathlessness, spontaneous bleeding from her gums and easy bruising. They had macrocyclic anaemia, thrombocytopenia and leucocytosis. What is the likely diagnosis?

Answer 48

Acute myeloid leukaemia

Question 49

What are the characteristics of sickle cell disease/anaemia?

Answer 49

Polychromasia (reticulocytosis), sickle cells and splenic atrophy features

Question 50

A 26-year-old black woman was admitted with severe pain in her hip. She has normocytic anaemia and increased platelets. What is the likely diagnosis?

Answer 50

Sickle cell anaemia

Question 51

Which form of leukaemia is associated with the philadelphia chromosome?

Answer 51

Chronic myeloid leukaemia

Question 52

What is the philadelphia chromosome?

Answer 52

Genetic abnormality of chromosome 22