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

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