White blood cells

• What information does a full blood count give you?

  • haemoglobin
  • haematocrit
  • mean cell volume
  • red cell count
• What is contained within blood?

  • plasma
  • white blood cells and platelets
  • red blood cells
• What is the white blood cell differential?


  The proportions of the different white blood cell types
• What can the WBC differential indicate?


  • Evidence of different types of infection and their response to treatment
  • 'atopic' conditions - like asthma, eczema, hayfever
  • Leukaemia
  • Marrow infiltration
  • Side effects of chemotherapy - marrow suppression
• What are the different types of WBC?


  • Neutrophil
  • Eosinophil
  • Basophil
  • Monocyte
  • Lymphocyte
• In automated WBC counting, what do the different axes of the scattergram measure?


  Florescence - measures nucleic acid component of cell

  Side scatter - measures nuclear and granule complexity
• What is a flow cytometry test and how does it work?


  sorts out which cells are which.

  • works by adding antibodies to the sample and if the cell has a receptor for that specific antibody, the antibody will stick on the surface
  • The antobodies have been stained with a dye, this allows you to see which antibodies have attached themselves to which cells
• What is cytogenetics and how does it work?


  • A way of looking at DNA within the cell
  • Uses metaphase (when cells shorten before division) analysis to look for specific mutations using gene sequencing or gene probes
• In the bone marrow, towards what do blood cells typically mature?

  The venus sinosoid
• What is bone marrow examination used for?


  To assess the number and type of normal/abnormal cells

  • normally taken from the posterior iliac crest of pelvis (sternum is an option)
• Describe the features and function of neutrophils.


  • Most common form of granulocyte (cell that has granules in)
  • Short lifespan - 8 to 10 hours
  • Don't recognise specific antigens - part of 'innate immunity'
  • bacteria are ingested and killed by enzymes in granules - eg lysozyme
  • Rise as an acute response to bacterial infection, inflammation, malignancy
• What is chemotaxis?


  A chemical signal that encourages a cell to migrate from within a blood vessel into the tissues.
• What is a cytokine?


  • large group of cell signalling molecules
• What is a chemokine?


  • smaller subset that cause cell migration
• Describe the structure and function of eosinophils?


  • second most common type of WBC
  • Granules are pink/orange in colour as eosin stains the granules
  • growth of these cells is stimulated by interleukin - 5
  • Granules contain major basic protein - different to neutrophils
  • Attracted to particular tissue by chemokines
• When would you see a big rise in the numbers of eosinophils in the blood?


  Most commonly seen in atopy (genetic tendency to develop allergic diseases)

  • Eczema
  • asthma
  • hayfever

  when someone has a flare of these allergens then the numbers in the blood flare up too.
• Describe the structure and function of basophils (mast cells when in the tissue)


  • Make up less than 1% of of total WBC
  • Dark basophilic granules contain histamine, leukotrienes, proteases and heparin
  • Play a role in phagocytosis - major role in anaphylaxis - hypersensitivity reaction
  • Cell surface receptor IgE - the binding of the antigen produces degranulation following chemotaxis
• What is anaphylaxis?


  • Type 1 allergic reaction
  • immune system releases a flood of chemicals that cause the body to go into shock
  • can cause swelling of the mouth and throat which can hinder and stop breathing
  • To help anaphylaxis - adrenaline is given to the system - this causes the blood vessels to relax and open up allowing for more efficient oxygen delivery and breathing
• Describe the structure and function of lymphocytes


  • Make up 20 - 40 % of WBC
  • differentiate early from other marrow derived cells
  • divide into T lymphocytes (thymus) and B lymphocytes (bone marrow or bursae)
  • Long life span in blood/marrow/lymph nodes
  • T and B cells rise in response to viral infections and in chronic lymphocytic leukaemia
• What are lymphocytes like in resting and activated states?


  Resting;

  • slightly bigger than red blood cells

  Activated;

  • Bigger
  • blue cytoplasm - due to losts of RNA
• What is the structure and function of the monocytes (macrophages when in the tissue)


  • have vacuoles containing hydrolases and myeloperoxidase
  • ingest material (phagocytosis) and present peptides to T - cells ie antigen presenting cells (APC)
  • Play a role in killing mycobacteria and fungi and intracellular organisms eg listeria
• What is innate immunity?


  Natural defense mechanisms that are present at birth and provide immediate protection against pathogens.

  • innate immunity;
  • neutrophil
  • basophil
  • eosinphil
• What are the differences between chronic and acute myeloid leukaemia?


  • presentation
  • pace of disease
  • molecular mechanism
  • method of treatment
  • outcome
• Describe the process of chronic myeloid leukaemia


  Occurs in all age groups

  Symptoms;

  • anaemia
  • large spleen
  • bone pain

  Typically a chronic phase and then accelerated and blast phase

  95% of cases have an identical cytogenetic and molecular mutation
• What is typical in the blood in Chronic myeloid leukaemia?


  Fewer red blood cells

  More white blood cells and plasma
• What is the chromosome abnormality in chronic myeloid leukaemia?


  Philadelphia chromosome - shortened

  • translocation - brings together two different genes which causes the disease to occur
• What is the treament drug if you have the chromosal defect and chronic myeloid leukaemia?


  Imatinib - binds with active site of kinase - prevents this from phosporylysing other proteins - prevents the tumor from occurring
• What is acute myeloid leukaemia?


  • more common with increasing age
  • Presents with symptoms of;
  • marrow failure - not producing normal cells
• What is the treatment for acute myeloid leukaemia?


  • diverse cytogenetic changes so there is no single traget for chemotherapy
  • chemotherapy - wipes out the entire marrow and then letting the stem cells create new marrow
  • intensive treatment - long hospital stay
• Treatment survival of ACL?


  • decreases with age
  • worse cytogenetics
  • less ability to withstand treatment
  • fewer transplant options
  • depends on the type of cytogenetic change you have