Abnormalities of WBC
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Abnormalities of WBC

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by SHAH SUNIL K. (BOND KING)

by SHAH SUNIL K. (BOND KING)

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Abnormalities of WBC Abnormalities of WBC Presentation Transcript

  • ABNORMALITIES of the WHITE BLOODCELLS Jose R. Villarino, RMT
  • Possible answers: A. NEUTROPHILS  J. ASTHMA B. LYMPHOCYTES  K. AUER ROD C. PATHOLOGIC  L. PELGER HUET D. PHYSIOOGIC  M. TOXIC E. 20-40 % GRANULES F. 5000-10000/cumm  N. LEUCOPENIA G. 0-3 %  O. PARASITISM H. MALARIA  P. SCARLET FEVER I. AZUROPHILIC  Q. DOHLE BODIES GRANULES  R. BASKET CELLS
  • WBC Normal values: WBC Count = 5,000 – 10,000/cu mm or 5 – 10 x 109/L Differential Count: Neutrophil = 50 – 70 % Segmenter = 50 – 65 % ; Stab = 0 – 5 % Eosinophil = 0 – 3 % Basophil = 0 – 1 % Lymphocytes = 20 – 40 % Monocytes = 2 – 6 %
  • Quantitative abnormalities Leucocytosis – substantial increase in the WBC count. - Physiologic increase (no trauma/injury) - Pathologic increase (trauma/pathology) Leucopenia – substantial decrease in the WBC count. N.V. = 5,000 – 10,000/cu mm
  • Differential CountNeutrophil 50 – 75 % segmenter 50 – 65 % stab 0–5%Eosinophil 0–3%Basophil 0–1%Lymphocyte 20 – 40 %Monocyte 2–6%
  • The 5 WBC types
  • Neutrophilia (> 7 – 8 x109/L) Infections, Inflammation, Metabolic disorders Acute hemorrhage, corticosteroids Stress, post-surgery, burns, HDN Lithium drugs, neoplasms
  • Neutropenia (<1.75 – 1.8109/L) Decreased production - Inherited/acquired stem cell disorder - Benzene toxicity, cytotoxic drugs Increased destruction - Immune mechanism, sequestration BM depression, IM, varicella, Typhoid SLE, hepatitis or any viral infections
  • Eosinophilia (> 0.7 x 109/L) Allergic disorders (asthma) Parasitic infections (nematodes) Skin disease (eczema) Hodgkin’s disease Scarlet Fever Pernicious anemia
  • Eosinopenia (< 0.05 x 109/L) Stress due to trauma or shock Mental distress Cushing’s syndrome ACTH administration
  • Basophil (0.3 x 109/L)BASOPHILIA Chronic myelocyic leukemia Polycythemia vera Hodgkin’s diseaseBASOPENIA Hyperthyroidism Pregnancy
  • Lymphocytosis (>4.0 x 109/L) Viral infections ( German measles ) Infectious Mononucleosis (kissing dis.) Mumps (parotitis), pertussis Tuberculosis, syphilis, thyrotoxicosis
  • Lymphopenia Congestive heart failure, SLE Renal failure Advanced Tuberculosis High levels of adrenal corticosteroids
  • Monocytosis (>0.9 x 109/L) SBE, Syphilis, Tuberculosis Protozoan infections Mycotic or fungal infections Malaria, Systemic lupus erythematosus Rheumatoid arthritis
  • Monocytopenia Lymphocytic leukemia Aplastic anemia
  • QUALITATIVE CHANGES-WBC Morphologic abnormalities involving either the nucleus or cytoplasm Functional abnormalities Inherited or Acquired Examination of peripheral blood or a bone marrow evaluation
  • The White blood cells: Nucleus details: - Mononuclear or Polymorphonuclear Granules present: - Granulocytic or Agranulocytic Function: - Phagocytic or Immunocytic
  • Abnormal granulocyte morphology (acquired) Toxic granulation, cytoplasmic vacuole Dohle bodies (Amato bodies) Azurophilic granules Hypersegmentation
  • Pathological Leucocytes
  • Abnormal granulocyte morphology (inherited) Alder-Reilly anomaly - dense azurophilic granules, mucopolysaccharoidoses May-Hegglin anomaly - Giant platelets, Dohle-bodies like inclusions seen even in monocytes Pelger Huet anomaly – failure of normal segmentation of nucleus, bi-lobed nucleus or stab forms only, “pince-nez nucleus”
  • Alder Reilly anomaly
  • May-Hegglin anomaly
  • Pelger Huet anomaly
  • Continuation: Chediak Steinbrinck Higashi syndrome – large lysosomes containing hydrolases and other enzymes. There is anemia,thrombocytopenia, leucopenia and increased susceptibility to infection. There is partial albinism & photophobia. Also seen in Aleutian mink, mice, cat, cattle & killer whale as caused by abnormal WBCs.
  • Chediak Higashi syndrome
  • Other abnormalities: Smudge or basket cells – squash- degenerated nucleus of WBCs Jordan’s anomaly – fat-containing vacuoles in WBC cytoplasm, Ichthyosis Twinning deformity Auer rod – rod-like structure seen in the cytoplasm of myeloblasts, diagnostic for Acute myeloblastic leukemia (AML)
  • Variants of the Lymphocytes Plasmacytoid lymphocyte or Turk’s irritation cell Downey cell (atypical lymphocyte) Transformed lymphocyte (reticular or pyroninophilic cell) Reider cell – “clover-leaf like nucleus” Plasma cells
  • Reactive lymphocytes
  • Downey cell Hallmark cell seen in cases of Infectious mononucleosis (kissing disease) Atypical lymphocyte (stress lymphocyte) “ballerina skirt cell”
  • Infectious Mononucleosis
  • Plasma cells Ovoid or fibrillary shaped Eccentric location of nucleus Perinuclear halo “cart-wheel pattern or spoke of the wheel pattern of nucleus” basophilic cytoplasm
  • Comparative morphology of plasmacells, lymphocytes and NRBC
  • Inherited abnormalities involvingMonocyte-macrophage group MUCOPOLYSACCHAROIDOSES - Hunter syndrome, Hurler’s disease LIPIDOSES – lipid accumulation - Gaucher’s disease – accumulation of glucocerebroside due to lack of beta- glucosidase enzyme - Neimann Pick disease – sphingomyelin and cholesterol accumulation due to lack of the enzyme sphingomyelinase
  • Monocyte-macrophageabnormality
  • WBC functions Neutrophil – phagocytic Eosinophil – phagocytic and damage to larval stages of parasite. Basophil – storage of histamine, involved in immediate hypersensitivity reaction. Monocyte – phagocytic, cellular and humoral immunity
  • Functions…. Lymphocytes – immune leucocytes a)humoral b) lymphokines c) cytotoxic- Not obligate end cells- Heterogenous group of cells- Destined to migrate
  • PHAGOCYTOSIS process Motility – random movement and directed movement Recognition Ingestion Degranulation or release of granules Microbial killing
  • Inherited functional abnormalities Job’s syndrome – defective directed movement, characteristic “cold boils” Lazy leucocyte syndrome – both random & directed movements are defective Chediak Higashi syndrome – failure to release the granules
  • Non-neoplastic (non-clonal)disorders of the WBC Include a) growth regulation abnormalities, b) leukemoid reaction (an increased proliferative response to various stimuli) including bone marrow aplasia and hypoplasia and c) qualitative leucocyte disorders (both acquired & inherited) characterized by deficiency of leucocyte function.
  • Non-clonal disorders of WBCFunction disorders Defective chemotaxis, phagocytosis, defective killing, CGD, myeloperoxidase deficiencyQuantitative disorders Neutropenia, agranulocytosis, Leukemoid reaction, Infectious mono
  • Clonal (neoplastic) disordersof WBC Derived from a single precursor cell with all the affected cells (progeny) showing features of deviation from the precursor cell. Myeloproliferative disorders Lymphoproliferative disorders Immunoproliferative disorders
  • Leukemoid reaction High WBC count = <50000/cu mm Toxic granulation & Dohle bodies Predominant band forms LAP score = >100 Negative for Philadelphia chromosome - Translocation of genetic material from long arm of Chromosome 22 to Ch 9
  • Hodgkin’s disease Belongs to a group of malignant disorders referred as Lymphomas Lymphomas involved abnormal lymph node enlargement with replacement or alteration in its histologic characteristic The neoplastic cell involved is known as the Reed-Sternberg cell. Mostly appears as binucleated with the 2 halves of the cell appearing as mirror images.
  • Hematopoietic malignancy Defined as growth or proliferation of one or more clones of abnormal cells. These cells don’t respond to normal control and even produce substances inhibiting growth of normal cells. These malignancy may be manifested in the peripheral blood as in cases of anemia and thrombocytopenia.
  • Leukemias In the case of WBC, these malignant cells may or may not circulate in the peripheral blood. Hence, WBC count may be increased or otherwise. Should these abnormal cells be present both in the bone marrow and the peripheral blood, the term leukemia is used. Aleukemic leukemia – if only confined to the marrow and do not circulate.
  • Classification of the leukemias According to the stem cell line involved- Myeloid – involves the granulocytes, monocytes, RBCs and megakaryocytes. Also known as myeloproliferative disorders or nonlymphocytic leukemias.- Lymphoid – involving the B or T cells and may be a leukemia or lymphoma
  • Classification of leukemias According to duration (life span)- Acute – days to weeks (3 months) - greater than 30 % blasts forms- Chronic – more than a year (1-2 years) - less than 10 % blast forms
  • Examples :Acute myeloid leukemia myeloblastChronic myelogenous Myelocyte, metamyelocyte &leukemia neutroAcute lymphoblastic lymphoblastsleukemiaChronic lymphocytic Small mature lymphleukemiaErythroleukemia > 50% of the nucleated cellsDi Guglielmo syndrome are erythroblasts
  • Comments on the leukemias: AML – most common form of acute leukemias in first few months of life, in middle aged group and later years CML – more common in young & elders ALL – seen among children 2 – 10 y.o. CLL – common among > 60 years old