HIM12 WBC.benign .pdf

Benign white cell disorders  maryranules ~ Yess cytoplasm Prerequisite knowledge: Types of wbc and their function  scattered (b) Cytoplasm than cytoplasm bi...

Benign white cell disorders  maryranules ~ Yess cytoplasm Prerequisite knowledge: Types of wbc and their function  scattered (b) Cytoplasm than cytoplasm bigger lymphocyte V BEN  Learning outcomes: Define leukocytosis, leucopenia, leukaemoid reaction and leukoerythroblastosis. State the common conditions associated with the above conditions. Recognize and differentiate the morphology changes Identify reactive cell morphology associated with viral infection and compare with normal lymphocytes morphology. Compare and contrast leukaemoid reaction from Chronic Myeloid Leukaemia based on laboratory data. White blood cells disorder-benign Leukocytosis White Blood Cells Leukopenia White blood cells Abnormal morphology Leukaemoid reaction Leukoerythroblastic picture  ↑ WBC ↓ WBC Leukocytosis Leukopenia Types: Types: Neutrophilia Neutropenia Lymphocytosis Lymphophenia > agranulocytes Monocytopenia Monocytosis Eosinophilia Eosinopenia d4 reading Basophilia * No basophils started at zero. BEN"-philia" 1. Neutrophilia (4) Causes : Bacterial infection Inflammation Metabolic disorder Acute haemorrhage Drugs Neoplasm CML  nuclear in * 3-5 neutrophils 1. Neutrophilia Neutrophils count 7.5x109/l. Characterized : Left shift immature precursor > - can be seen Toxic granulation & vacuolation Neutrophil Alkaline Phosphatase(NAP) score Dohle bodies (light blue-gray inclusions located in the peripheral cytoplasm) *immature precursor can be seen in bloods  Dohle body Toxic granulation ↑ too much bluish ~ Vacuolization Left shift  2. Neutropenia (t) Neutrophils count fall below 2.5x10 9/l risk of infection < 0.5x10 9/l Types: - Selective - Only neutrophils ( neutropenia) - Pancytopenia (commonly> - all lineages Anemia, neutropenia, thrombocytopenia rais pit 2. Neutropenia Causes: Congenital – Kostmann’s syndrome * rare Acquired; - common Drugs – chlorampenicol, phenytoin. carbimazole Bone marrow failure- aplastic anemia, megaloblastic anemia Infections - typhoid, TB 3. Lymphocytosis (4) Lymphocytes Causes : count 4.0x109/l. Acute infections (viral infection) Rubella, pertussis, infectious mononucleosis Chronic infections Tuberculosis, syphilis Thyrotoxicosis CLL ALL 4. Lymphopenia (N) Lymphocytes count falls below 1.5x109/l Causes : Cytotoxic drugs. Irradiation * HIV infection 5. Monocytosis (4) Monocytes count 1.0x109/l. Infrequent conditions Causes : chronic bacterial infection eg: TB Some viral infections especially children Connective tissue diseases : RA, SLE 6. Monocytopenia rare Monocyte count < 0.2 x 10 /l Not easy to establish due to low number of monocyte Cause : - Following prednisolone therapy. 7. Eosinophilia in eosinophils count 0.4x109/l Causes Allergic condition – asthma, aczema Parasitic infection like hookworm infestation Drugs sensitivity Hypereosinophilic syndrome 8. Eosinopenia Eosinophils count < 0.04 x 10 /l Causes: Any stressful situation which result in the release in the of - adrenal corticoid - 9. Basophilia Uncommon condition Basophils count 0.1x109/l Causes chicken pox infection Severe hypothyroidism. 10. Atypical lymphocytes and abnormal cize * various shaped , not really In respond to viral infection. Eg: Infectious mononucleosis Lymphocytes become activated.  sided I als most Morphology : -bluish cytoplasm -irregular cytoplasm / nucleus  resemble of malignancy (leukaemia 11. Leukaemoid reaction - Reactive condition Characterized : Immature white cells (shift - to the left Neutrophil Alkaline Phosphatase score Cause : severe infection Need to differentiate from Chronic Myeloid Leukaemia (CML) by NAP - score 11. Leukaemoid reaction Leukaemoid reaction: CML: Toxic granulation NAP score Dohle bodies Philadelphia chromosome : NAP score t(9;22) - - ~ neutrophilia Bcr-abl gene 12. Leukoerythroblastic ( C picture Similar to leukaemoid monunus reaction but in addition there are presence of norme erythroblasts. - Causes: Reactive : Haemolysis, ↳ turuse RB2) nuners of severe haemorrhage manighant chas Bone marrow infiltration :Lymphoma, Leukaemia, Multiple Myeloma Anomalies (morphology alteration) Can be clinically significant such as Chediak Higashi's or Insignificant anomalies such as Pelger Huet anomaly and May Hegglin anomaly.  Anomalies (morphology alteration) 1. Chediak-Higashi Giant granules in the white cells impair normal function Autosomal recessive Cneutrophils) Recurrent infection albinism, , easily bruising 2. May Hegglin anomaly Rare Autosomal dominant Basophilic inclusion Associated – giant platelet & thrombocytopenia : purpura and bleeding - Qualitative pit d/o , a Pl , and thrombocy to penih inclusion granulocyte v/ epistaxis - present , brudy , benorrhagia , early bleeding 3.Pelger Huet anomaly Bilobed nucleus Adven't affect is f(x) , just appearance Autosomal dominant Clinically normal.