LEUKOPENIA<br />Abnormally LOW WBC <br />
NEUTROPENIA, AGRANULOCYTOSIS<br />
NEUTROPENIA<br />Reduction in the number of granulocytes in PBS <br />  (peripheral blood smear)<br />< 2000/uL<br />Mild ...
AGRANULOCYTOSIS<br />Marked reduction in neutrophil count<br />Disappearance of neutrophil precursors in the bone marrow<b...
PATHOGENESIS:<br />1. INEFFECTIVE GRANULOPOIESIS <br />2. ACCELERATED REMOVAL OR DESTRUCTION OF NEUTROPHILS<br />
Multipotent Progenitors<br />Commited Precursors<br />Late <br />Precurosors<br />Mature <br />Form<br />
INEFFECTIVE GRANULOPOIESIS<br />Suppression of hematopoietic stem cells<br />Aplastic anemia<br />Infiltrative d/o<br />Su...
Defective precursor cells susceptible to death while in BM<br />Megaloblastic anemia<br />Genetic defect  impaired granul...
Immune mediated<br />Idiopathic<br /> Autoimmune<br />Drugs<br />Splenic sequestration<br />20 to enlargement of spleen<br...
Most common cause is DRUG TOXICITY<br />Alkylating drugs/ Anti-metabolites<br />Generalized suppresion of BM  Agranulocyt...
S/S  Related to infection<br />Malaise, chills, fever<br />Marked weakness & fatigue<br />Death in severe agranulocytosis<...
Broad spectrum antibiotic<br />G-CSF , a growth factor that stimulates production of granulocytes from BM<br />Given follo...
LEUKOCYTOSIS<br />INCREASE IN NUMBER OF WBC <br /><ul><li> REACTIVE
FIRST SIGN OF NEOPLASTIC GROWTH	 OF  WBC </li></li></ul><li>Pathogenesis<br />
CAUSES:<br />
CAUSES:<br />
ACUTE NONSPECIFIC LYMPHADENITIS<br />
Reactive changes to:<br />Microbe , Cell debris, Foreign matter<br />Localized – Regional LN<br />Generalized Lymphadenopa...
Enlarged <br />Tender to touch<br />Fluctuant if (+) abscess<br />Draining sinuses to skin <br />Suppurative necrosis<br /...
CHRONIC NONSPECIFIC LYMPHADENITIS<br />MORPHOLOGIC TYPES<br />
Activation of Humoral response<br />Rheumatoid arthritis<br />Early stage of HIV<br />Must be differentiated from Follicul...
Morphology<br />
Trigger the Cellular Immune responses<br />Reactive changes in T cell region of LN<br />PARACORTICAL AREA EXPANSION<br />E...
PARACORTICAL LYMPHOID HYPERPLASIA<br />
Distention of lymphatic sinusoids <br />Non-specific<br />Particularly prominent in LN draining cancers<br />Represent hos...
Sinus Histiocytosis<br />
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Neutropenia, Agranulocytosis

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Neutropenia, Agranulocytosis

  1. 1. LEUKOPENIA<br />Abnormally LOW WBC <br />
  2. 2. NEUTROPENIA, AGRANULOCYTOSIS<br />
  3. 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. 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. 5. PATHOGENESIS:<br />1. INEFFECTIVE GRANULOPOIESIS <br />2. ACCELERATED REMOVAL OR DESTRUCTION OF NEUTROPHILS<br />
  6. 6. Multipotent Progenitors<br />Commited Precursors<br />Late <br />Precurosors<br />Mature <br />Form<br />
  7. 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. 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. 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. 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. 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. 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. 13. LEUKOCYTOSIS<br />INCREASE IN NUMBER OF WBC <br /><ul><li> REACTIVE
  14. 14. FIRST SIGN OF NEOPLASTIC GROWTH OF WBC </li></li></ul><li>Pathogenesis<br />
  15. 15.
  16. 16.
  17. 17.
  18. 18. CAUSES:<br />
  19. 19. CAUSES:<br />
  20. 20. ACUTE NONSPECIFIC LYMPHADENITIS<br />
  21. 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. 22. Enlarged <br />Tender to touch<br />Fluctuant if (+) abscess<br />Draining sinuses to skin <br />Suppurative necrosis<br />Clincal Presentation:<br />
  23. 23. CHRONIC NONSPECIFIC LYMPHADENITIS<br />MORPHOLOGIC TYPES<br />
  24. 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. 25. Morphology<br />
  26. 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. 27. PARACORTICAL LYMPHOID HYPERPLASIA<br />
  28. 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. 29. Sinus Histiocytosis<br />
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