Blood Cells Abnormalities PDF

Blood cells abnormalities  Reactive (Non-malignant) Increased Decreased Quantitative Ly...

Blood cells abnormalities  Reactive (Non-malignant) Increased Decreased Quantitative Lymphoproliferative Disease Non-reactive (malignant) WBC disorders Myeloproliferative Disease Qualitative With Morphologic Morphologic Changes Normal Morphology Abnormality 1. Non-malignant disorders of leukocytes 1.1 Quantitative granulocytic 1.1.1 Neutrophilia Definition Normal neutrophil count is 2000-7000 cells/µL. Increase in circulating neutrophils (adults) (>7.5x109/L; but usually not >3000/pL [>3.Ox109/L]) Etiology Associated with infection : especially bacterial infection e.g., pneumococcal sepsis. Inflammation e.g., rheumatoid arthritis and ulcerative colitis. Injury e.g., surgery and burn. Malignancy e.g., lung and breast cancer. Medications e.g., steroids and GCSF.( granulocyte colony stimulating factor). Metabolic: uraemia and gout, exercise, post-splenectomy Other: post exercise, seizures, haemolysis and pregnancy, pregnancy. Mechanisms for neutrophilia Increased bone marrow production & release (eg, bacterial infection). Increased neutrophil egress from bone marrow storage to peripheral blood (associated with some drugs & autoimmune disorders). Redistribution of marginating to circulating neutrophils (may be seen in strenuous exercise or with epinephrine). Peripheral blood findings 1. Neutrophilic left shift (bands, metamyelocytes, myelocytes). 2. Toxic changes to neutrophils. 3. Toxic granulation. 4. Döhle bodies. 5. Vacuolation. 6. Elevated leukocyte alkaline phosphatase score (NAP/LAP) > 150. ❖ Neutrophilic leukemoid reaction: A leukemoid reaction is an increase in the white blood cell count, which can mimic leukemia. It is characterized by a neutrophil count > 50,000/mcL (> 50 × 10 9 /L) not caused by malignant transformation of a hematopoietic stem cell1. The reaction is actually due to an infection (sepsis, haemolysis) or another disease and is not a sign of cancer. Blood counts often return to normal when the underlying condition is treated. Peripheral blood findings : CBC/Smear: leucocytosis (rarely > 100,000/μL) with neutrophilia (no eosinophilia or basophilia). NAP score: low (4.Ox109/L) in adults & approximately >8900/pL in children. Etiology Reactive process resulting from infection or inflammation. Associated with numerous conditions to include viral infections (eg, infectious mononucleosis, cytomegalovirus, human immunodeficiency virus(HIV), hepatitis, measles, mumps), toxoplasmosis. Lymphocytes also increased in hematologic malignancies such as acute lymphoblastic leukemia ,chronic lymphocytic leukemia & the leukemic phase of non-Hodgkin lymphoma. Peripheral blood findings Lymphocytes may be morphologically mature & normal or appear reactive (atypical, variant). Reactive Lymphocytes : Normal lymphocytes morphology: small size, rounded nucleus with dense chromatin and rim of cytoplasm. Features of reactive lymphocytes: Larger in size. Irregular nucleus with moderately fine chromatin and may show nucleolus. Abundant cytoplasm showing darker (burnt) edges indented by the surrounding red cells. Reactive lymphocytosis is seen in: EBV, CMV and toxoplasmosis 1.2.1.2 Lymphocytopenia Definition Decrease in circulating lymphocytes