Leukocytes Benign Disorders
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Leukocytes Be nign Disorders
Normal Peripheral Blood Formation of Phagocytes in Bone Marrow Leukocytes Differential Counts
Leukocytes
(4-11 x���/L)
Absolute
(x���/L)
Relative
(%)
Neutrophils 2.5 - 7.5 34 – 75
Eosinophils 0.04 - 0.4 0 – 5
Basophils 0.01 - 0.1 0 - 3
Lymphocytes 1.5 - 3.0 20 - 45
Monocytes 0.2 - 0.8 3 - 10
White Blood Cells
Neutrophils Eosinophils Basophils Monocytes Lymphocytes
2-5 Lobes of dense Nucleus Bi-lobed Nucleus Occasionally seen Largest WBC
Nucleus slightly indented with
clumped chromatin
Smallest WBC
Large condensed nucleus
Pale cytoplasm with irregular
outlines
Coarse cytoplasmic granules
(More deeply red staining)
Dark cytoplasmic granules
overlying nucleus
(contain Heparin, Histamine)
Cytoplasm is abundant
Sky Clue in colour
Contains many fine vacuoles
& granules
Scanty bluish cytoplasm
Many azurophilic granules
1° granules (promyelocyte)
• Myeloperoxidase, Acid
Phosphatase, Hydrolases
2° granules (specific granules)
• Collagenase, Lactoferin,
Lysozyme
Role in
Allergic responses
Defence against parasites
Removal of fibrin forme d during
inflammation
Become mast cells in tissues
Have IgE attachment sites &
degranuatlion associated with
histamine release
Lifespan in Blood – 6 -10h
1° defence against infection
↑ in response to
Bacterial infection/
inflammatory disease
BM disorders (eg. CML)
↑ associated with
Allergic reaction
Parasite infections
Chronic skin Infections
Cancers
↑ associated with
Cancers
Allergic reactions
Infections
Radiation exposure
↑ associated with
Recovery from acute infection
Viral illness
Parasitic infections
Collagen disease
Cancers
↑ seen in
Most viral infections
Bacterial infections
Cancers
Graves’ disease
↓ as a result of
Severe infection
Response to medications
(chemotherapy)
↓ associated with
Stress
Steroid exposure
Anything – suppress WBC prod.
↓ associated with
Stress reactions
Allergic reactions
Hyperthyroidism
Prolonged steroid exposure
↓ associated with
HIV infection
Rheumatoid arthritis (RA)
Steroid exposure
Cancers
↓ seen in
Steroid exposure
Cancers
Immunodeficiency
Renal failure
Lupus
Variations of Neutrophils
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Qualitative Benign Disorders
Morphologic changes
Functional defects in ≥ 1 WBC types
Chediak-Higashi Syndrome
Inherited Morphological & Functional Abnormalities
Rare Autosomal Recessive disorder
Giant Granules (in cytoplasm)
Neutrophils
Eosinophils
Monocytes
Lymphocytes
Accompanied by Neutropenia
Thrombocytopenia
Hepatosplenomegaly
Netrophils have Deficiency of Antimicrobial proteins
Disordered in Degranulation/ Chemotaxis
Pelger-Huet Anomaly
Inherited Morphological Abnormalities
Benign Autosomal Dominant
Bi-Lobe d Neutrophils
May-Hegglin Anomaly
Inherited Morphological Abnormalities
Rare, Autosomal Dominant
Neutrophil contain large Basophilic inclusions of RNA similar: Dohle bodies
Neutrophil Hypersegmentation
Morphological Abnormalities
Rare Autosomal Dominant condition
Neutrophil function is essentially Normal
Seen in Megaloblastic Anaemia
Quantitative Disorders
Total Leukocytes Description of cells
↑ (Leukocytosis) ↑ (Philia)
↓ (Leukopenia) ↓ (Penia)
Leukocytosis
↑ Leukocytes ( >11 x10�/L)
Physiologic Pathologic
Stress Disease
Exercise Tissue Damage
Epinephrine
≥ 1 Leukocytes can be responsible
Often due to ↑ Neutrophils
Mechanism of Leukocytosis (due to ↑ in)
Neutrophil count (Neutrophilia)
Lymphocyte count (Lymphocytosis)
Monocyte count (Monocytosis)
Eosinophils count (Eosinophilia)
Basophils count (Basophilia)
Other Causes of Benign Leukocytes Disor der
Eosinophilia Eosinope nia
Allergic disorders (Asthma, Hay Fever) Stress (Release of Epinephrine)
Tissue parasite infection Aftermath of Acute Inflammation
Dermatoses (Eczema)
Drugs
Basophilia Basope nia
Hyperlipidemia Hyperthyroidism
Small Pox/ Chicken Pox Acute Stress
Chronic Sinusitis
Ulcerative Colitis
Monocytosis (↑ Cell Damage cases) Monocytope nia
Recovery from Acute Infection Prednisone Therapy
Tissue Trauma
Bacterial Endocarditis
TB
Collagen Disorders (RA, SLE)
Post Splenectomy
(Monocytes busy cleaning up
Neutrophils)
Inflammatory Bowel Disease
Monocyte Disorders
Inherited Abnormalities of Neutrophils are also seen in Monocytes
(Originate from Common Stem Cell)
Chronic Granulomatous Disease (Defe ctive Respiratory Buss)
Chediak Higashi (Abnormal Lysosomes caused by Fusion of 1° Granules)
Alder Reilly Anomaly (Large Purple-Blue Granules)
Lymphocytes Disorders
Wiskott-Aldrich Syndrome
Severe Combined Immunodeficiency System (SCIDS)
DiGeorge Syndrome
X Linked Agammaglobulinemia
Ataxia Telangiactasia
Macrophage Disorders
Lipid Storage Diseases (cells unable to digest phagocytosed material complete)
Gaucher’s Disease
Niemann-Pick Diseases
Tay Sachs & Sandhoffs Diseases
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Neutrophilia
Neutrophilia/ Neutrophilic Leukocytosis
> 7.5 x10�/L
Pathophysiol ogy
Reaction mediated by
• Growth Factors (eg. G-CSF, GM-CSF, C-Kit Ligand)
• Adhesion molecules (eg. CD11b/ CD18)
• Cytokines (eg. IL-1, IL-3, IL-6, TNF)
Acute Chronic
Occur 4-5 h after pathologic stimulus Follows acute neutrophilia
↑ Cells Flow (BM → Peripheral) Left shift (BM release younger cells)
Bands, Metamyelocytes seen
1° 2°
Hereditary Infection
Chronic Idiopathic Stress
Familial Myeloproliferative Disease Chronic inflammation
Leukaemoid reactions associated with
congenital anomalies
Drugs
Non-Haematological Neoplasms
Leukocytes Adhesion Deficiency (LAD) Asplenia, Hyposplenism
Familial cord Urticaria, Leukocytosis
2° Neutrophilia
Bacterial Infections (most common)
Usually Absolute Neutrophilia
(10-19 x10�/L)
Morphological changes
Left shift
Vacuolation
Dohle Bodies
Toxic granulation
Leukaemoid Reaction
Reactive, Excessive Leukocytosis
Characterized by Presence of Immature cells
Many Bands, Metamyelocytes, Myelocytes (Left-shift)
Promyelocytes, Myeloblasts (occasionally seen)
Resembles CML but can be exclude d
No Philadelphia chromosome
Transient (Temporary)
Elevated Leukocyte Alkaline Phosphatase score
No Basophilia
Neutropenia
< 1.8 x10�/L
Can be due to
Impaired production by BM
Shift from circulating pool to marginated pool
↑ Peripheral destruction
<0.5 x���/L <0.2 x���/L
Likely to have recurrent infections Very serious risks
1° 2° (↑ common)
Inherited (Kostmann’s syndrome ) Drug Therapy
Acquired (Drug induced) Infection (Adult – common)
Cyclical Neutropenia
(Inherited Autosomal Dominant)
(Several days of Neutropenia with
infection followed by asymptomatic)
Immunologic Disorders
Idiopathic Neutropenia
Autoimmune Neutropenia
Familial (Benign, Chronic, Mild with
rare symptoms)
Infantile Genetic Agranulocytosis
(Rare, Congenital, Fatal disorder)
(Defective BM production of
Neutrophils)
Eosinophilia
> 0.5 x10�/L
Causes
Allergic Diseases
Parasitic Diseases
Recovery from Acute Infection
Skin Diseases (Psoriasis, Dermatitis, Urticaria)
Drug Sensitivity
Graph Versus Host Disease
HyperEosinophilic Syndrome (>1.5 x10�/L)
Treatment with GM-CSF
Lymphocytosis
Acquired, Quantitative
Self-Limited
Both B-cells, T-cells Affected
Function – Normal
Morphology – Heterogenous
Absolute (>3x���/L) Relative (>40%)
Viral Infections 2° to Neutropenia
May/ May Not Accompany
Leukocytosis
Causes Infections
• Viral Infections (Infectious Mononucleosis, CMV, Rubella, Hepatitis,
Adenoviruses, Chicken Pox, Dengue)
• Bacterial Infections (Pertussis, Healing TB, Typhoid Fever)
• Protozoal Infections ( Toxoplasmosis)
Allergic Drug Reactions
Hyperthyroidism
Splenectomy
Serum Sickness
Infectious Mononucle osis (IM)
Lymphocytosis
Accompanied by Leukocytosis
Caused by EBV (Epstein-Barr Virus) infecting B
Lymphocytes
Cytotoxic T cells Kill Infected B cells
Reactive Lymphocytes (Cytotoxic T cells) seen in
peripheral smear
Cytomegalovirus Infection
Leukocytosis (with Absolute Lymphocytosis)
Bordetella Pertussis Infection
Leukocytosis (with Absolute Lymphocytosis)
Due to redistribution of T Lymphocytes (Tissues → Circulation)
Lymphocytes are Small, Normal appearing Lymphocytes
Lymphocytic Leukaemoid Reaction
Peripheral smear shows ↑ Lymphocytes with Younger Lymphocytes seen
Can occur with TB, Chicken Pox, Bordetella Pertussis
Lymphocytopenia
Response to Stress, Corticosteroids
Immune Defi ciency Disorders – AIDS, SLE
After exposure to physical agents – Radiation
Administration of Cytotoxic Drugs
Infectious Hepatitis
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