This document discusses various conditions related to abnormalities in white blood cell counts, including leukopenia (low white blood cell count) and leukocytosis (high white blood cell count). It provides details on specific types of leukopenia such as agranulocytosis and cyclic neutropenia. It also covers causes and clinical manifestations of these conditions as they relate to the oral cavity. Additionally, it discusses leukocytosis and associated diseases like infectious mononucleosis and various forms of leukemia.

4. 1. Leukopenia
a) Agranulocytosis
b) Cyclic neutropenia
c) Chedik – Higashi Syndrome

5. 2. Leukocytosis
a) Neutrophilia
b) Eosinophilia
c) Basophilia
d) Lymphocytosis
e) Monocytosis
f) Infectious Mononucleosis
g) Leukemia

6. Leukopenia
- Abnormal reduction in no. WBC in
peripheral blood stream
- Mainly occur due to decrease count of
granulocyte’s

7. Causes of Leukopenia
a) Infections
b) Haemopoietic disorders
c) Chemical agents
d) Physical agents
e) Anaphylactoid shock
f) Diseases of unknown etiology /
congenital

8. Agranulocytosis
( granulocytopenia, neutropenia, maliganant
leukopenia )
- Decrease no. of granulocytes
- this is classified as
1. Primary granulocytosis-etiology is unknown
2. Secondary granulocytosis-cause is recognised

9. Etiology
- Ingestion of any one of considerable
variety of drugs and infections
- Kostmann syndrome allergic
phenomenon
- Idiosyncracy

10. Clinical Features
- Occur at any age, majority – adult
women, workers in hospitals
- Symptom : Fever , malaise ,prostration,
systemic infections.
- Seen in jaundice cases rapidly progress
hence death occur within a week.

12. Oral Manifestation
- Necrotizing ulceration of oral mucosa,
tonsils, hemorrhage occur
- Tooth extraction contraindicated
- Excess salivation

13. Necrotizing ulceration of gingiva

14. Histological features
- Lack of development of normal
granular leucocytes
- No PMN reaction with bacteria
- Necrosis begins from sulcus of gingiva
spread up to alveolar bone cause rapid
destruction

15. Immature neutrophils

16. Laboratory Findings
- WBC count < 2000 cells/cumm
- Almost absence of granulocytes
- RBC & platelet count are normal, anemia
present
- In bone marrow –
myleocytes, metamyleocytes &
promyleocytes absent
- Cell maturation -arrest

17. Treatment & prognosis
- No specific t/t
- Withdrawal of causative drug &
Administration of antibiotic drug to control
Infection have good prognosis

18. Cyclic Neutropenia
- Unusual form of agranulocytosis
characterized by a periodic or cyclic
diminution in circulating bone marrow
maturation arrest
- Etiology is unknown
- Idiophatic neutropenia associated with
severe persistent gingivitis

19. Clinical Features
- Occur at any age, majority – children
- Symptom : Fever , malaise , stomatitis,
lymphadenopathy, systemic infections.

20. Necrotizing
ulceration with
severe bone loss
Necrotic gingiva

21. Oral Manifestation
- Severe gingivitis, reversible stomatitis
- In children's, loss of supporting bone
around teeth
- Necrotizing ulceration of oral mucosa,
tonsils

22. Radiographic Features
- Mild to severe loss of superficial
alveolar bone
- In children's prepubertal periodontisis

24. Laboratory Findings
- Sign & symptoms in periodic function
at every 3 weeks
- Patient exhibit normal blood count
decrease neutrophils
Treatment & Prognosis
- No specific T/T, splenectomy beneficial
- Patient may suffer this disease for
several years

25. Chediak – Higashi Syndrome
- It is autosomal recessive
immunodeficiency disorder
characterized by abnormal intracellular
protein transport
Clinical Features
- Bleeding , often fatal in childhood due to
non-malignant lymphohistocytic
- Abnormal functioning of PMN involve
skin & RS

26. Oral Manifestation
- Severe gingivitis, ulceration, glossitis
- Periodontal breakdown, defective
leucocyte function
Most commonly seen
In Albinism patient

27. Laboratory Findings
- Giant abnormal granules in peripheral
circulating Leucocyte in marrow
- Dhole bodies & pancytopenia some
times present
Treatment & Prognosis
- No specific treatment
- Often fatal death occur before child
reach age 10 years

29. Leukocytosis
- Abnormal increase in the no.of
circulating WBC
- pathological condition
- In this the transient peripheral
plasmocytosis occur which is not
commonly found

30. 1) Neutrophilia : Acute infection, coronary
thrombosis, acute homorrhage, myleoid metaplasia
2) Eosinophilia : Allergic disorders, myleocytic
leukemia
3) Basophilia : C.M.L, Splenectomy
4) Lymphocytosis : Acute infection, congenital
syphilis, Lympholytic leukemia
5) Monocytosis : Bacterial infection, Lymphoma
,C.M.L

31. Infectious Mononucleosis
- Caused by EPESTIN BARR VIRUS
- Cha. By consisting
fever,pharyngitis,adenopathy
- This virus transmitted by intimate
contact with body secretion, hense
called as kissing Disease

33. Clinical features
-Epidemic form-fever,lymphadenopathy
-splenomegaly,tonsilitis,hepatitis
Oral manifestation
-no specific but sec.lesions occur,acute
gingivitis & stomatitis
-petechial hemorrages of soft palate near
junction-early manifetation sign
-palatine petechiae

34. Pinpoint petechial hemorrahages

35. Lab findings
- ESR is eleveted, WBC are commonly
increases
- Lymphocytosis->50%
Treatment
- Bed rest & adequate diet

36. Leukemia
- Defination: progressive overproduction
of WBC which usually appear in
circulating blood in an immature form
- It’s unco-ordinated considered as ‘ True
Malignant Neoplasm’
- Etiology: unknown
- But mostly as viral origin(EBV –
leukomogenic virus)

38. - It is classify as
1:lymphoid leukemia
2:myeloid leukemia
eg; acute myleoid leukemia
Acute Subacute Chronic
<6 months >=< 1 yr >1year
- Philadelphia chromosome-80-95% pt
with chronic myleoid leukemia
- Mongoloids h’ve 15-20 times greater
chance of acute form of leukemia

39. Clinical feature
Acute Chronic
Childs & young adult adults
weakness, swelled Lymph
nodes, petechiae
Patient have excellent
health
decrease megakaryocyte systemic organs enlarged,
decreased salivary
secretion, papules form,
osteomyelitis

41. Lab findings
Acute: B.T & C.T. increased
leukocyte count eleveted upto
1,00,000 cu/mm but its immature
Chronic: anemia & thrombocytopenia
WBC count eleveted upto 5,00,000
Cu/mm may form chronic dyscrasia

42. Oral manifestation
-In both chronic & acute condition oral
lession occur at 87% in monocytic leukemia,
23% lymphoid leukemia
- Primary seen
gingivitis,hemorrage,petechiae,ulceration
- severe cases,teeth almost hidden,bleed
Easily,necrosis
-Rapid loosening of teeth due to destruction
Of bone

43. Severe gingival
hyperplasia
Loosening of teeth

44. Hidden of teeth

45. Treatment
- Chemotherapeutic drugs, radiation
therapy & corticosteroid recomanded
- Lymphocytic leukemia most fatal