The document discusses abnormalities of white blood cells, including quantitative abnormalities like leukocytosis and leukopenia as well as qualitative abnormalities involving the nucleus or cytoplasm of white blood cells. Some examples of qualitative abnormalities discussed include Pelger-Huet anomaly, Chediak-Steinbrinck-Higashi syndrome, and Auer rods. The types of white blood cells are described along with causes of conditions like neutrophilia, eosinophilia, lymphocytosis, and monocytosis. Inherited and acquired morphological and functional abnormalities of white blood cells are also summarized.

1. ABNORMALITIES of the
WHITE BLOOD
CELLS
Jose R. Villarino, RMT

2. Possible answers:
 A. NEUTROPHILS  J. ASTHMA
 B. LYMPHOCYTES  K. AUER ROD
 C. PATHOLOGIC  L. PELGER HUET
 D. PHYSIOOGIC  M. TOXIC
 E. 20-40 % GRANULES
 F. 5000-10000/cumm  N. LEUCOPENIA
 G. 0-3 %  O. PARASITISM
 H. MALARIA  P. SCARLET FEVER
 I. AZUROPHILIC  Q. DOHLE BODIES
GRANULES  R. BASKET CELLS

3. WBC Normal values:
 WBC Count = 5,000 – 10,000/cu mm or
5 – 10 x 109/L
 Differential Count:
 Neutrophil = 50 – 70 %
Segmenter = 50 – 65 % ; Stab = 0 – 5 %
 Eosinophil = 0 – 3 %
 Basophil = 0 – 1 %
 Lymphocytes = 20 – 40 %
 Monocytes = 2 – 6 %

4. Quantitative abnormalities
 Leucocytosis – substantial increase in
the WBC count.
- Physiologic increase (no trauma/injury)
- Pathologic increase (trauma/pathology)
 Leucopenia – substantial decrease in
the WBC count.
 N.V. = 5,000 – 10,000/cu mm

5. Differential Count
Neutrophil 50 – 75 %
segmenter 50 – 65 %
stab 0–5%
Eosinophil 0–3%
Basophil 0–1%
Lymphocyte 20 – 40 %
Monocyte 2–6%

6. The 5 WBC types

7. Neutrophilia
(> 7 – 8 x109/L)
 Infections, Inflammation, Metabolic
disorders
 Acute hemorrhage, corticosteroids
 Stress, post-surgery, burns, HDN
 Lithium drugs, neoplasms

8. Neutropenia
(<1.75 – 1.8109/L)
 Decreased production
- Inherited/acquired stem cell disorder
- Benzene toxicity, cytotoxic drugs
 Increased destruction
- Immune mechanism, sequestration
 BM depression, IM, varicella, Typhoid
 SLE, hepatitis or any viral infections

9. Eosinophilia
(> 0.7 x 109/L)
 Allergic disorders (asthma)
 Parasitic infections (nematodes)
 Skin disease (eczema)
 Hodgkin’s disease
 Scarlet Fever
 Pernicious anemia

10. Eosinopenia
(< 0.05 x 109/L)
 Stress due to trauma or shock
 Mental distress
 Cushing’s syndrome
 ACTH administration

11. Basophil (0.3 x 109/L)
BASOPHILIA Chronic myelocyic leukemia
Polycythemia vera
Hodgkin’s disease
BASOPENIA Hyperthyroidism
Pregnancy

12. Lymphocytosis
(>4.0 x 109/L)
 Viral infections ( German measles )
 Infectious Mononucleosis (kissing dis.)
 Mumps (parotitis), pertussis
 Tuberculosis, syphilis, thyrotoxicosis

13. Lymphopenia
 Congestive heart failure, SLE
 Renal failure
 Advanced Tuberculosis
 High levels of adrenal corticosteroids

14. Monocytosis
(>0.9 x 109/L)
 SBE, Syphilis, Tuberculosis
 Protozoan infections
 Mycotic or fungal infections
 Malaria, Systemic lupus erythematosus
 Rheumatoid arthritis

15. Monocytopenia
 Lymphocytic leukemia
 Aplastic anemia

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

18. Abnormal granulocyte
morphology (acquired)
 Toxic granulation, cytoplasmic vacuole
 Dohle bodies (Amato bodies)
 Azurophilic granules
 Hypersegmentation

19. Pathological Leucocytes

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”

21. Alder Reilly anomaly

22. May-Hegglin anomaly

23. Pelger Huet anomaly

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.

25. Chediak Higashi syndrome

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

28. Reactive lymphocytes

29. Downey cell
 Hallmark cell seen in cases of
Infectious mononucleosis (kissing
disease)
 Atypical lymphocyte (stress
lymphocyte)
 “ballerina skirt cell”

30. Infectious Mononucleosis

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

32. Comparative morphology of plasma
cells, lymphocytes and NRBC

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

34. Monocyte-macrophage
abnormality

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.

40. Non-clonal disorders of WBC
Function disorders
Defective chemotaxis, phagocytosis,
defective killing, CGD, myeloperoxidase
deficiency
Quantitative disorders
Neutropenia, agranulocytosis,
Leukemoid reaction, Infectious mono

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 Myelocyte, metamyelocyte &
leukemia neutro
Acute lymphoblastic lymphoblasts
leukemia
Chronic lymphocytic Small mature lymph
leukemia
Erythroleukemia > 50% of the nucleated cells
Di Guglielmo syndrome 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