Download White blood cells and their disorders

White blood cells and their
disorders
Dr K Hampton
Haematologist
Royal Hallamshire Hospital
Normal white cells
• Mature cells circulate in blood
• Produced from immature precursor cells in
the bone marrow, derived from stem cells.
• Rate of production under hormonal control
by series of growth factors.
Neutrophils
• Most numerous white cell, lifespan 10 hours
• Phagocytose and kill bacteria
• Release chemotaxins and cytokines,
important in inflammatory response
• Lack of number or function results in
recurrent bacterial infections
Monocytes
• Produced in bone marrow, transit through
blood for 20 hours and enter tissues as
macrophages
• Some become dendritic cells that present
antigens to the immune system
Basophils
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Relatively rare in peripheral blood
Migrate to tissues to become mast cells
Contain granules of histamine
Surface IgE
Important in immunity and allergy
Eosinophils
• Also rare in peripheral blood
• Impotant in inflammation and allergic
responses
• Special role in protection against parasites
Lymphocytes
• Vital to immunity
• Some generate antibodies against specific
foreign antigens, eg bacteria, viruses
• Other have phenomenon of immunological
memory, generates immunity and allow
vaccination
B lymphocytes
• Named after Bone marrow
• Differentiate into plasma cells and produce
immunoglobulins when stimulated by
expose to a foreign antigen
T lymphocytes
• Named after Thymus
• Some are helper cells (CD4)
• Some are cytotoxic cells (CD8)
• Aid B cells in antibody generation and also
responsible for cellular or cell mediated
immunity
Immunodeficiency
• Congential or acquired immunodeficiency very
serious condition, often fatal
• Congenital immunodeficiency treated with bone
marrow transplant or gene therapy
• HIV virus causes AIDS due to infecting CD4
lymphocytes and leads to opportunistic infections
Bacterial infections
• Result in neutrophilia: increase in
neutrophils
• Engulf and kill bacteria
• Failure results in overwhelming infection
• Can aid neutrophil response with G-CSF, a
specific growth factor for neutrophils
Viral infections
• Response by lymphocytes
• Generate immunoglobulins and memory
cells
• Usually only have infection once
• Severe infections like hepatitis B and
Meningococcus C can be prevented by
vaccination: generates memory B cells
Acute leukaemia
• Proliferation of primitive precursor cells
usually only found in bone marrow
• Proliferation without differentiation
• Replaces normal bone marrow cells, leads
to: anaemia: palor and lethargy
neutropenia: infection
thrombocytopenia: bleeding
Acute myeloblastic leukaemia
(AML)
• Malignant proliferation of the precursor
myeloblasts in the bone marrow
• Disease primarily of adults: 50% survive 5 years
• Treatment is with cyclical high dose
chemotherapy and possibly bone marrow
transplantation
Acute lymphocytic leukaemia
(ALL)
• Malignant proliferation of the lymphoblast
precursor cells in the bone marrow
• Disease primarily of childhood: 80% cure
• Treated with cyclical chemotherapy over 23 years, CNS specific treatment
Transplantation only if relapse
High grade lymphoma
• Classified as Hodgkins disease and Non-Hodgkins
lymphoma (NHL)
• Disease usually of lymph nodes that spreads to
liver, spleen, bone marrow and blood
• Needs aggressive curative chemotherapy
• Localised disease may be treatable with
radiotherapy
Chronic leukaemia
• Malignant proliferation with differentiation
• Overproduction of mature cells, not
precursor blast
• Untreated has better prognosis, hence called
chronic, commoner in older age
Chronic lymphocytic leukaemia
• Proliferation of mature lymphocytes,
usually B lymphocytes
• Lymphocytosis in blood, lymphadenopathy,
splenomegaly
• Prognosis measured in years to decades,
treatment with out patient chemotherapy
Chronic myeloid leukaemia
• Proliferation of mature myeloid cells:
neutrophils, also basophils and eosinophils
• Philadelphia chromosome, t9:22 specific
chromosomal translocation
• Can be cured by bone marrow
transplantation in younger age group
Low grade leukaemia
• Chronic proliferation of mature lymphoid
cells of lymph node origin
• Disease principally of elderly, survival
years to decades
• Treatment, when necessary, = out patient
chemotherapy
Multiple myeloma
• Malignant proliferation of plasma cells in
bone marrow
• Plasma cells are B lymphocytes that
produce immunoglobulin
• Myeloma has monoclonal immunoglobulin
in serum and urine
Multiple myeloma
• Lytic lesions in bones, with pain or pathological
fracture
• Hypercalcaemia with thirst, polyurea and
confusion, due to bone resorption
• Hyperviscosity due to immunoglobulin
• Renal failure