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Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
Neutropenia, Agranulocytosis
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Neutropenia, Agranulocytosis

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  • 1. LEUKOPENIA
    Abnormally LOW WBC
  • 2. NEUTROPENIA, AGRANULOCYTOSIS
  • 3. NEUTROPENIA
    Reduction in the number of granulocytes in PBS
    (peripheral blood smear)
    < 2000/uL
    Mild 1000-2000/uL
    Moderate 500-1000/uL
    Severe (agranulocytosis) <500/uL
    DEFINITION:
  • 4. AGRANULOCYTOSIS
    Marked reduction in neutrophil count
    Disappearance of neutrophil precursors in the bone marrow
    Absence or less than 500/uL of pmns
  • 5. PATHOGENESIS:
    1. INEFFECTIVE GRANULOPOIESIS
    2. ACCELERATED REMOVAL OR DESTRUCTION OF NEUTROPHILS
  • 6. Multipotent Progenitors
    Commited Precursors
    Late
    Precurosors
    Mature
    Form
  • 7. INEFFECTIVE GRANULOPOIESIS
    Suppression of hematopoietic stem cells
    Aplastic anemia
    Infiltrative d/o
    Suppression of committed granulocytic precursors
    Alkylating drugs – generalized effect
    Idiosyncratic reaction – Chloramphenicol
  • 8. Defective precursor cells susceptible to death while in BM
    Megaloblastic anemia
    Genetic defect  impaired granulocytic differentiation : Kostmann syndrome
    INEFFECTIVE GRANULOPOIESIS
  • 9. Immune mediated
    Idiopathic
    Autoimmune
    Drugs
    Splenic sequestration
    20 to enlargement of spleen
    Increased peripheral utilization
    Overwhelming infection
    ACCELERATED REMOVAL/DESTRUCTION
  • 10. Most common cause is DRUG TOXICITY
    Alkylating drugs/ Anti-metabolites
    Generalized suppresion of BM  Agranulocytosis
    Predictable
    Dose related
    Chlorpromazine/ Phenothiaxines
    Toxinc effect on granulocytic precursors in BM
    Thiouracil/Sulfonamides/ Aminopyrine
    Antobody mediated destruction of mature neutrophils
    Autoantibodies against neutrophil specific antigens
    Suppression of marrow granulocytic progenitors by products of neoplastic cell
    Agranulocytosis:
  • 11. S/S Related to infection
    Malaise, chills, fever
    Marked weakness & fatigue
    Death in severe agranulocytosis
    Neutrophil count < 500/mm3
    CLINICAL COURSE:
  • 12. Broad spectrum antibiotic
    G-CSF , a growth factor that stimulates production of granulocytes from BM
    Given following chemotx
    Withdrawing or tapering dose of drug
    Treatment:
  • 13. LEUKOCYTOSIS
    INCREASE IN NUMBER OF WBC
    • REACTIVE
    • 14. FIRST SIGN OF NEOPLASTIC GROWTH OF WBC
  • Pathogenesis
  • 15.
  • 16.
  • 17.
  • 18. CAUSES:
  • 19. CAUSES:
  • 20. ACUTE NONSPECIFIC LYMPHADENITIS
  • 21. Reactive changes to:
    Microbe , Cell debris, Foreign matter
    Localized – Regional LN
    Generalized Lymphadenopathy
    Systemic Viral infection – Children
    Bacteremia
    Prominence of Lymphoid Follicles with Large germinal center, Debris, Macrophages, Necrosis, Suppuration
    Features:
  • 22. Enlarged
    Tender to touch
    Fluctuant if (+) abscess
    Draining sinuses to skin
    Suppurative necrosis
    Clincal Presentation:
  • 23. CHRONIC NONSPECIFIC LYMPHADENITIS
    MORPHOLOGIC TYPES
  • 24. Activation of Humoral response
    Rheumatoid arthritis
    Early stage of HIV
    Must be differentiated from Follicular Lymphoma
    Germinal center B-cells are (+) for BCL2 stain
    FOLLICULAR HYPERPLASIA
  • 25. Morphology
  • 26. Trigger the Cellular Immune responses
    Reactive changes in T cell region of LN
    PARACORTICAL AREA EXPANSION
    EFFACED THR FOLLICLES
    Drugs – Dilantin
    Acute viral infxn
    IM
    Viral Vaccine
    PARACORTICAL LYMPHOID HYPERPLASIA
  • 27. PARACORTICAL LYMPHOID HYPERPLASIA
  • 28. Distention of lymphatic sinusoids
    Non-specific
    Particularly prominent in LN draining cancers
    Represent host immune reaction to cancer
    Sinus Histiocytosis
  • 29. Sinus Histiocytosis

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