2. Possible answers:
■ A. NEUTROPHILS
■ B. LYMPHOCYTES
■ C. PATHOLOGIC
■ D. PHYSIOOGIC
■ E. 20-40 %
■ F. 5000-10000/cumm
■ G. 0-3 %
■ H. MALARIA
■ I. AZUROPHILIC
GRANULES
■ J. ASTHMA
■ K. AUER ROD
■ L. PELGER HUET
■ M. TOXIC GRANULES
■ N. LEUCOPENIA
■ O. PARASITISM
■ P. SCARLET FEVER
■ Q. DOHLE BODIES
■ R. BASKET CELLS
16. 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
17. The White blood cells:
■ Nucleus details:
- Mononuclear or Polymorphonuclear
■ Granules present:
- Granulocytic or Agranulocytic
■ Function:
- Phagocytic or Immunocytic
20. 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”
24. 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.
26. 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)
27. 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
31. 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
33. Inherited abnormalities involving
Monocyte-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
35. 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
36. Functions….
■ Lymphocytes – immune leucocytes
■ a)humoral b) lymphokines c) cytotoxic
- Not obligate end cells
- Heterogenous group of cells
- Destined to migrate
37. PHAGOCYTOSIS process
■ Motility – random movement and
directed movement
■ Recognition
■ Ingestion
■ Degranulation or release of granules
■ Microbial killing
38. 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
39. 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.
41. Clonal (neoplastic) disorders
of 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
42. 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
43. 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.
44. 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.
45. 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.
46. 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
47. 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
48. Examples :
Acute myeloid leukemia myeloblast
Chronic myelogenous
leukemia
Myelocyte, metamyelocyte &
neutro
Acute lymphoblastic
leukemia
lymphoblasts
Chronic lymphocytic
leukemia
Small mature lymph
Erythroleukemia
Di Guglielmo syndrome
> 50% of the nucleated cells
are erythroblasts
49. 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
