White Blood Cell Disorders Question And Answers

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Disorders Of White Blood Cells Important Notes

1. Types of leukemia

Disorders Of White Blood Cells Types Of Leukemia

2. Syndromes associated with leukemia

  • Down’s syndrome
  • Bloom’s syndrome
  • Klinefilter’s syndrome
  • Wiskott-Aldrictis syndrome
  • Fanconi’s anemia

3. Infectious mononucleosis or glandular fever

  • Caused by Epstein Barr virus
  • Characterized by atypical leukocytes consisting of
    • Oval or horseshoe nuclei
    • Irregular nuclear chromatin
    • Basophilic foamy or vacuolated cytoplasm

Read And Learn More: Pathology Question And Answers

  • Diagnostic tests
    • Monospot test
    • Paul Bunnel test
      • The normal titer of agglutinin and hemolysin in human blood against sheep blood cells does not exceed 1:8
      •  In a positive Paul Bunnel test, the titer may rise to 1:4096

4. Agranulocytosis

  • Mostly occurs due to the ingestion of drugs like
    • Amidopyrine
    • Barbiturates
    • Chloramphenicol
    • Quinine
    • Sulfonamides
  • Features
    • Presence of infection in the oral cavity, GIT, genitourinary tract, respiratory tract, and skin
    • Oral manifestation
    • Necrotizing ulcerations of the oral mucosa, pharynx, tonsils
    • Rapid destruction of supporting tissues of the teeth

5. Cyclic neutropenia

  • It is characterized by periodic cyclic diminution of leukocytes
  • Cycle commonly occurs at every 3 weeks
  • Loss of alveolar bone around the teeth is an important oral manifestation

6. Disorders of neutrophil count

Disorders Of White Blood Cells Disorders Of Neutrophil Count

7. Leukaemoid reactions

  • It is defined as a reactive excessive leucocytosis in the peripheral blood resembling that of leukemia
  • It may be myeloid or lymphoid
  • The myeloid type is a more common form
  • Myeloid leukemoid reactions are seen in
    • Infections like staphylococcal pneumonia, TB, meningitis, diphtheria, sepsis, endocarditis
    • Intoxication
    • Malignant diseases like multiple myeloma
    • Severe hemorrhage and hemolysis
  • Lymphoid leukemoid reaction are seen in
    • Infections like infectious mononucleosis, cytomegalovirus infection, pertussis
    • Malignant diseases rarely produce it

8. Most commonly affected bones in multiple myeloma are:

  • Skull
  • Spine
  • Ribs
  • Pelvis

Disorders Of White Blood Cells Long Essays

Question 1. Classify leukemia. Describe the clinical picture, blood, and bone marrow findings in acute leukemia.
Answer:

Leukemia Classification:

1. Based on cell types predominantly involved.

  • Myeloid
  • Lymphoid.

2. Based on the natural history of the disease:

  • Acute
  • Chronic.

WHO classification of myeloid neoplasm:

1. Myeloproliferative Diseases:

  • Chronic myeloid leukaemia (CML], {Ph chromo¬some t(9;22) (q34;ll), BCR/ABL-positive}
  • Chronic neutrophilic leukemia
  • Chronic eosinophilic leukemia/ hypereosinophilic syndrome
  • Chronic idiopathic myelofibrosis
  • Polycythaemia vera (PV]
  • Essential thrombocythaemia (ET)
  • Chronic myeloproliferative disease, unclassifiable

2. Myelodysplastic/Myeloproliferative Diseases: Chronic myelomonocytic leukemia (CMML)

3. Myelodysplastic Syndrome (MDS):

  • Refractory anemia (RA)
  • Refractory anemia with ring sideroblasts (RARS)
  • Refractory cytopenia with multilineage dysplasia (RCMD)
  • RCMD with ringed sideroblasts (RCMD-RS)
  • Refractory anemia with excess blasts [RAEB-1)
  • RAEB-2
  • Myelodysplastic syndrome unclassified (MDS-U)
  • MDS with isolated del 5q

4. Acute Myeloid Leukaemia (AML):

  • AML with recurrent cytogenetic abnormalities
    • AML with t(8;21)(q22;q22)
    • AML with abnormal bone marrow eosinophils {inv(16][pl3q22]}
    • Acute promyelocytic leukaemia {tC15;17](q22;ql2)}
    • AML with llq23 abnormalities (MLL)
  • AML with multilineage dysplasia
    • With prior MDS
    • Without prior MDS
  • AML and MDS, therapy-related
    • Alkylating agent-related
    • Topoisomerase type 2 inhibitor-related
    • Other types
  • AML, not otherwise categorized
    • AML, minimally differentiated
    • AML without maturation
    • AML with maturation
    • Acute myelomonocytic leukemia (AMML)
    • Acute monoblastic and monocytic leukemia
    • Acute erythroid leukemia
    • Acute megakaryocytic leukemia
    • Acute basophilic leukemia
    • Acute panmyelosis with myelofibrosis
    • Myeloid sarcoma

5. Acute Biphenotypic Leukaemia

Acute Leukemia: It is a leukemia characterized by predominant undifferentiated leucocytes precursors

Acute Leukemia Clinical Features:

Disorders Of White Blood Cells Acte Leukemia Cilinal Features

Acute Leukemia Blood Picture:

  • Moderate reticulocytosis
  • Normochromic anemia
  • Increased platelet count
  • WBCs count is more than 100000 per microlitre

Acute Leukemia Bone Marrow Examination:

  • Cellularity- Bone marrow is hypercellular
  • It shows predominantly myeloblasts and premyelo¬cytes
  • Leukemic cells are demonstrated by Romanowsky stains
  • Erythropoiesis shows
    • Reduced erythropoietic cells
    • Dyserythropoiesis,
    • Megaloblastic features
    • Ring sideroblasts
    • Megakaryocytes

Question 2. Define leukemia. Describe the etiology, clinical features, blood, and bone marrow picture of chronic myeloid leukemia.
Answer:

Leukemia: leukemia are a group of disorders arising from the malignant transformation of hematopoietic cells leading to an increased number of white blood cells in blood and/or bone marrow.

Chronic myeloid leukemia:

Chronic myeloid leukemia Etiology: It is a myeloproliferative disorder.

  • Occurs as a result of the malignant transformation of plea- potent stem cells leading to the accumulation of a large number of immature leukocytes in the blood.
  • Radiation exposure and genetic factors have been implicated in the development of CML

Chronic myeloid leukemia Clinical features:

  • Onset is usually slow, initial symptoms are often non-specific example: weakness, pallor dyspnoea, and tachycardia.
  • Symptoms due to hypermetabolism such as weight loss, anorexia, and night sweats.
  • Splenomegaly is almost always present and is frequently massive. In some patients, it may be associated with acute pain due to splenic infarction.
  • Bleeding tendencies such as bruising, epistaxis, menorrhagia, and hematomas may occur.
  • Visual disturbance, neurologic manifestations.
  • Juvenile CML is more often associated with lymph node enlargement than splenomegaly.

Peripheral blood picture of CML:

  • Leucocyte count is elevated often > 1,00,000 cells/pl.
  • Circulating cells are predominantly neutrophils, metamyelocytes, and myelocytes but basophils and eosinophils are also prominent.
  • A typical finding is an increased number of platelets (thrombocytosis).
  • Anaemia is usually of moderate degree and is normocytic, normochromic in type. Normablasts may be present occasionally.
  • A small portion of myeloblasts usually < 5% are seen.

Bone marrow examination:

  • Cellularity – Hyper cellular with total/partial re-placement of fat spaces by proliferating myeloid cells.
  • Myeloid cells -Myeloblasts are only slightly increased.
  • Erythropoiesis -Normoblasts but there is a reduction in erythropoietic cells.
  • Megakaryocytes – Conspicuous but are usually smaller in size than normal.
  • Increase in number of phagocytes.

Disorders Of White Blood Cells Short Essays

Question 1. Leukocytosis
Answer:

Leukocytosis is an increase in the number of white cells & is common in a variety of reactive inflammatory states caused by microbial and non-microbial stimuli.

Leukocytosis Causes: Leukocytosisare relatively non-specific and can be classified on the basis of particular white cell series affected as follows:

Causes of Leukocytosis: Leukocytosis are relatively non-specific and can be classified on the basis of particular white cells series affected as follows:

1. Neutrophilic leucocytosis.

  • Cute bacterial infections especially those caused by pyogenic organisms.
  • Sterile inflammation caused by tissue necrosis (myocardial infarction, burns)

2. Eosinophylic leucocytosis (eosinophilia)

  • Allergic disorders such as asthma, hay fever
  • Allergic skin diseases, for example., pemphigus, dermatitis herpetiform.
  • Parasitic infestations
  • Drug reactions
  • Certain malignancies, for example., Hodgkin’s disease and some non-hodking’s lymphomas.
  • Collagen vascular disorders and some vasculitis.

3. Basophilic leucocytosis (basophilia): Rare often indicates CML.

4. Monocytosis.

  • Chronic infections, ie.g., tuberculosis
  • Bacterial endocarditis
  • Rickettsiosis and malaria
  • Collagen vascular diseases, for example., systemic lupus erythematosus (SLE)
  • Inflammatory bowel diseases, for example., ulcerative coli¬tis

5. Lymphocytosis: Usually accompanies monocytosis in many disorders associated with it.

  • Chronic immunologic stimulation, for example., tuberculo¬sis, brucellosis and
  • Viral infections, for example., hepatitis A, cytomegalovirus, Epstein-Barr virus, and bordetella pertussis infections.

Question 2. Causes of neutrophilic leukocytosis
Answer:

  • Acute bacterial infections especially those caused by pyogenic organisms.
  • Sterile inflammation caused by tissue necrosis (myocardial infarction, burns)

Question 3. Agranulocytosis
Answer:

  • The term agranulocytosis is used to describe a state of severe neutropenia.
  • A reduction in the number of granulocytes in the blood is known as neutropenia.

Agranulocytosis Causes: Neutropenia can be caused by the following reasons.

  • Drug-induced: Anti-cancer, antibiotics, anticonvulsants, antithyroid drugs
  • Hematological disease: Aplastic anemia, acute leukemia, etc.
  • Infections: Malaria, TB, typhoid,
  • Autoimmune: Systemic lupus erythematosus
  • Congenital: Cyclic neutropenia.

Agranulocytosis Clinical features:

  • Initially patient develops malaise, chills, and fever, with subsequent marked weakness and fatiguability.
  • Massive growth of microorganisms due to inability to produce leukocyte response.
  • Infections are usually present as ulcerating, necrotizing lesions of the gingiva, the floor of the mouth, buccal mucosa, and other sites within the oral cavity known as agranulo¬cytic angina.
  • Lymphadenopathy and hepatosplenomegaly may be present.

Agranulocytosis Treatment:

  • Patients with neutropenia and fever must be sent to the hospital.
  • In severe infections, neutrophil transfusion must be done.
  • Broad-spectrum antibiotics and antifungal drugs are to be given.

Question 4. Leukemoid reaction
Answer:

  • Leukaemoid reaction is defined as the reactive excessive leucocytosis in peripheral blood resembling that of leukemia in the subject who does not have leukemia.
  • Leukaemoid reaction may be myeloid or lymphoid.

Myeloid leukemoid reaction:

  • The majority of leukemoid reactions involve the granulocyte series.
  • It may occur in infection, intoxication, malignant diseases, severe hemorrhages, and severe hemolysis.

Lymphoid leukemoid reaction: It is found in conditions such as infectious mononucleosis, whooping cough, chicken pox, measles, and tuberculosis.

Agranulocytosis Lab diagnosis:

  • Leukocytosis
  • Infective cases may show toxic granulation and Dohle bodies in the cytoplasm of neutrophils.

Question 5. Peripheral blood picture of acute lymphatic leukemia
Answer: Acute lymphatic leukemia shows

1. Anaemia:

  • Normochromic
  • Shows few nucleated cells

2. Thrombocytopenia: Platelet count decreases to 100000 cells

3. White blood cells:

  • WBC count is variable
  • It may exceed 100000 cells or may be less than that
  • Leukocytes appear as blasts cells

Disorders Of White Blood Cells Short Questions And Answers

Question 1. Eosinophilia
Answer:

  • An increase in the number of eosinophilic leukocytes is referred to as eosinophilia.
  • The causes of eosinophilia are as follows:
  • Allergic disorders: Bronchial asthma, urticarial, drug hypersensitivity
  • Parasitic infestations: Trichinosis, echinococcosis, intestinal parasitism.
  • Skin diseases: Pemphigus, dermatitis herpetiformis, erythema parasitism.
  • Certain malignancies: Hodgkin’s diseases and some non-Hodgkin’s lymphomas.
  • Pulmonary infiltration which eosinophilia syndrome
  • Irradiation.
  • Miscellaneous disorders: Sarcoidosis, rheumatoid arthritis, polyarteritisnodosa.

Question 2. Blood picture in chronic myeloid leukemia
Answer:

  • Leucocyte count is elevated often > 1,00,000 cells/Bll.
  • Circulating cells are predominantly neutrophils, metamyelocytes, and myelocytes but basophils and eosinophils are also prominent
  • The typical finding is an increased number of platelets (thrombocytosis).
  • Anaemia is usually of moderate degree and is normocytic, normochromic in type. Normablasts may be present occasionally.
  • A small portion of myeloblasts usually < 5% are seen.

Question 3. Peripheral smear layer findings in acute leu¬kemia
Answer:

1. Anaemia:

  • Always present generally severe, progressive, and normochromic.
    • A moderate reticulocytosisupto 5% and a few nucleated red cells may be present.

2. Thrombocytopenia:

  • Platelet count < 50,000/pl
    • When the platelet count is below 20,000/01 serious spontaneous haemorrhagic episodes develop.
    • Acute promyelocytic leukemia may be associated with a serious coagulation abnormality called dis-seminated intravascular coagulation.

3. White blood cells:

  • In advanced cases, WBC > 1,00,000/pl
    • The majority of leucocytes in the peripheral blood are blasts and there is often neutropenia due to mar¬row infiltration by leukemic cells.

Question 4. Burkitt’s lymphoma
Answer:

  • Burkitt’s lymphoma is a rare type of non-Hodgkin’s lymphoma (NHL).
  • Epstein-Barr virus (EBV) and HIV are associated with the development of Burkitt’s lymphoma.
  • This is the most rapidly progressive tumor first described in African children.
  • Most patients present with lymphadenopathy and abdominal mass.
  • It has a tendency to metastasize to the CNS.
  • Treatment should be initiated promptly with intensive chemotherapy. Prophylactic chemotherapy is also given. 70-80% of patients may be cured.

Question 5. Multiple myeloma
Answer: Multiple myeloma is a malignant disease arising from the neoplastic transformation of plasma cells of mono-clonal origin

Multiple Myeloma Clinical Features:

  • Age- in older age
  • Anaemia
  • Bone pain
  • Infections
  • Pathological fractures
  • Renal failure
  • Spinal cord compression

Multiple Myeloma Investigations:

  • Bence- Jones proteins in urine
  • Reversal of serum albumin/globulin ratio
  • Increase in total serum proteins

Multiple Myeloma Treatment:

  • Radiotherapy
  • Biphosphonates
  • Autologous peripheral cell transplantation
  • Administration of thalidomide and proteasome inhibi¬tors
  • Chemotherapy includes:
    • Melphalan
    • Cyclophosphamide
    • Doxorubicin
    • Dexamethasone

Diseases Of Cardiovascular Disorders Important Notes

1. Clinical patterns of angina

  • Stable or typical angina
  • Prinzmetal’s variant angina
  • Unstable or crescendo angina

2. Forms of Creatine phosphokinase

  • CK-MM-Derived from skeletal muscle
  • CK-BB-Derived from the brain and lungs
  • CK-MB-Derived from cardiac muscle

3. TypesofischaemicheartdiseaseJHD

  • Stable angina
  • Unstable angina
  • Chronic IHD
  • Myocardial infarction
  • Sudden ischaemic death

Diseases Of Cardiovascular Disorders Short Question And Answers

Question 1. Hyperlipidemia
Answer:

  • Hyperlipidaemia is a major risk factor for atherosclerosis
  • It occurs due to
    • Diabetes mellitus
    • Myxoedema
    • Nephritic syndrome
    • Von Gierke’s disease
    • Xanthomatosis
    • Familial hypercholesterolemia
  • Dietary regulation and administration of cholesterol-lowering drugs have beneficial effects on reducing the risk of ischaemic heart diseases

Question 2. Atheromatous plaques
Answer: A fully developed atherosclerotic lesion is called atheromatous plaque

Atheromatous plaques Appearance:

1. Gross appearance

  • Appear as white to the yellowish-white lesion
  • Size-1-2 cm in diameter
  • Appears raised on the surface

2. Cut surface

  • Shows luminal surface as a firm, white fibrous cap
  • The central core is composed of yellow to yellow-white soft material called atheroma

3. Microscopic

  • The fibrous cap is covered by endothelium
  • It is composed of smooth muscles, dense connective tissue, and extracellular matrix
  • The cellular area contains macrophages, foam cells, lymphocytes and smooth muscle cells
  • The deeper central soft core consists of extracellular lipid material, cholesterol cleft, Fibrin, neurotic debris, and lipid-laden foam cells

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