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Wbc disoders practical

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Practical briefing for year 1 M.B.,B.S Students in Unikl,RCMP

Published in: Health & Medicine
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Wbc disoders practical

  1. 1. LEUKEMIA
  2. 2. Leukemia Leukaemias are diseases in which abnormal proliferation of haemopoietic cells causes progressively increasing infiltration of the bone marrow
  3. 3. Learning outcomes  Define and Classify Leukemia  Classify Acute Myeloid leukemia by using revised FAB classification  Discuss the etiology, pathogenesis , clinical manifestation, blood and bone marrow morphology of ALL,AML,CLL,CML.
  4. 4. LEUKEMIA Acute Leukemia Acute lymphoblastic leukemia (ALL) Acute Myeloid Leukemia (AML) Chronic Leukemia Chronic lymphocytic leukemia(CLL) Chronic Myeloid leukemia (CML)
  5. 5. Blood picture of Acute Leukemia Total WBCs count ranges between subnormal to markedly elevated values The majority >20% of leucocytes are blast cells Lymphoblasts with condensed nuclear chromatin, small nucleoli, and scant agranular cytoplasm
  6. 6. Blood picture of Acute Leukemia Anaemia normochromic normocytic characteristically progressive and severe with anisocytosis and poikilocytic, sometimes with mild polychromasia Thrombocytopenia is also extremely common, often being severe, with platelet counts well below
  7. 7. BLAST The very basic morphological features of typical myeloblasts, lymphoblasts, and monoblasts are similar
  8. 8. The most life saving thing you can learn today is how to recognize a blast! Large cells -10 and 18 µm Round or oval HUGE NUCLEUS Prominent NUCLEOLI (stain LIGHTER not DARKER than the rest of the nucleus ) Basophilic cytoplasm Vacuolation of both cytoplasm and nucleus
  9. 9. Acute lymphoblastic leukemia (ALL) Lymphoblasts with condensed nuclear chromatin, small nucleoli, and scant agranular cytoplasm
  10. 10. Blood picture of Acute lymphoblastic leukemia (ALL) Total WBCs count ranges between markedly elevated increased The majority >20% of leucocytes are Lymphoblasts with condensed nuclear chromatin, small nucleoli, and scant agranular cytoplasm
  11. 11. Bone marrow aspirate shows neoplastic promyelocytes with abnormally coarse and numerous azurophilic granules. Other characteristic findings include cell that contains multiple needle-like Auer rods Acute myeloid leukemia (AML) FAB M3 Auer ‘s rod
  12. 12. 1. Describe the morphology of the cells in the blood smear. 2. 2. State the diagnosis consistent with the above blood picture. Blood picture of Acute myeloid leukemia (AML)
  13. 13. Auer ‘s rod Auer ‘s rod Blood picture of Acute myeloid leukemia (AML) FAB M3
  14. 14. Blood picture of Acute Myeloid leukemia (AML) FAB M3 Total WBCs count ranges between markedly elevated increased The majority >20% of leucocytes are promyelocytes with abnormally coarse and numerous azurophilic granules and prominent nucleoli. Some promyeloblasts contain multiple needle-like Auer rods
  15. 15. Lab features Other lab features : NAP(neutrophil alkaline phophtase activity score) reduced Serum B12 and transcobalamin increased Serum uric acid increased Lactate dehydrogenase increased Cytogenetic : Philadelphia chromosome t(9,22)
  16. 16. Chronic Myeloid leukemia (CML) Peripheral blood smear shows marked leucocytosis with the presence of whole spectrum of myeloid cells including many mature neutrophils, some metamyelocytes, and a myelocyte and basophilia
  17. 17. Peripheral blood film Anaemia Leukocytosis (usu >25 x 109/L, freq> 100 x 109/L WBC differential shows granulocytes in all stages of maturation Basophilia thrombocytosis Chronic Myeloid leukemia (CML)
  18. 18. Chronic Lymphocytic leukemia (CLL) SMUDGE CELLS large numbers of small round lymphocytes with scant cytoplasm and smudge cells (disrupted cells )and spherocytes Nucleated RBC spherocytes
  19. 19. Chronic Lymphocytic Leukemia (CLL) Blood pictures peripheral blood smear shows increased small lymphocytes condensed chromatin and scant cytoplasm A characteristic finding is the presence of disrupted tumor cells (smudge cells) and the presence of spherocytes (hyperchromatic, round erythrocytes) A nucleated erythroid cell is present
  20. 20. •peripheral lymphocytosis (>200,000) •increased susceptibility to bacterial infection (most frequent cause of death) •may associated with autoimmune hemolytic anemia Chronic Lymphocytic Leukemia (CLL)
  21. 21. Neutrohil leucocytosis in severe infection : Increase in total count &presence of of immature cells known as SHIFT TO THE LEFT
  22. 22. more marked than usual  LEUKEMOID BLOOD PICTURE many immature granulocytes appear in the blood simulating a leukemia (leukemoid reaction)
  23. 23. Leukemoid Reaction Marked increase in neutrophils. >50,000 x109 Shift to left  immature forms. Severe infection, trauma, bone marrow infiltration Looks like leukemia* (no blasts)
  24. 24. 1. Describe the morphology of the cell (pointed with arrow) in the photomicrograph provided. Name the cell. A photomicrograph of a tissue section of an enlarged lymph node obtained from 51 years old man is provided

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