This document provides information on interpreting complete blood count (CBC) results, including descriptions of various blood cells and abnormalities. It discusses malaria parasites that can be identified on peripheral blood smears using Giemsa stain. Thick and thin blood films are compared in their ability to detect malaria parasites and species. Appearances of Plasmodium falciparum and Plasmodium vivax in blood films are illustrated. Additional tests for detecting malaria parasites and antigens are also summarized.
Lymphoproliferative disorders DR MASOUD 2022.pptxmasoud53
overview presentation about lymphoproliferative disorders for medicine students. it is with easy pattern. it covers all subjects of this disease, either malignant or benign types
acute leukemia
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
3. Malaria
Giemsa stain are used, identifies species and life cycle
stages
Paresitemia is quantifiable
Threshold of detection thin film: 100 parasites/ L, thick
film: 2-20 parasite/L
Thick film Thin film
• Lysed RBCs
• Larger volume
• 0.25microliter / 100 fields blood
element more concentrated
• Good screening for positive or
negative parasitemia and
parasite density difficult to
diagnose species
• Fixed RBCs
• Single layer
• Smaller volume
• 0.005 microliter blood required
• Good species differentiation
• Requires more time to ready
A. Peripheral smear
4. Appearance of P.falciparum in the blood films
Ring or trophozoite
Many cells infected –
same with more than
one parasite
Red cell size unaltered
Parasite is often attatch
to the margin of the host
cell: called as accole
form (arrow)
Schizont
Very rarely seem except
in cerebral malaria
A single brown pigment
dot along with 18-32
merozoites
Gamatocyte
Sickle shape “cresent”
Matuer gametocyte is
about 1.5 times larger
than RBC harbouring it
Microgamatocyte:
Broader, shorter, blunt
ends. Cytoplasm light
blue
Macrogamatocytes:
Longer, narrower,
pointed ends.
Cytoplasm deep blue
5. Appearance of P. vivex in film
Ring or trophozoite
Many cells infected –
same with more than
one parasite
Unoccupied portion by
parasite shows a dotted
or stripped appearance
“Schuffner’s dot”
Schizont
Represent the full grown
trophozoite
Contain 12-24 merozoits
Arranged in the form of
rosette with yellow
brown pigment at the
center
Gamatocyte
Certain schizont get
modified and result in
sexual forms. Merozoite
arising from single schizont
are either all males or
females
Microgamatocyte:
Spherical. Cytoplasm light
blue
Macrogamatocytes:
spherical. Cytoplasm
deep blue
6. B. Flouroscien Microscopy
Dyes detect RNA and DNA contents of parasite
Nucleic material not normally seen in RBCs without
parasitemia
C. Quantative Buffy Coat (QBC)(Becton
Dickenson)
Flouroscien microscopy after centrifuge
More sensitive than light microscopy
Useful for screening large number of samples
Quick and saves times
7. D. Malarial serology – antibody detection
Antibodies to asexual parasite appears some days to invasion of
RBCs and may persists for months
Positive test indicate past infection
Not useful for treatment decisions
Valuable epidemiological tools
E. Malarial serology – antigen
detection
Immunological assey to detect specific antigens
Monoclonal and polyclonal antibodies used in antigen
capture tests
Specific species and pan specific antibody
Cross reactivity with other immunological conditions
8. Malarial antigen detection - RDTs
Feature PfHRP 2 PLDH
Principle Use monoclonal antibodies
Detect HRP of Pf
Use monoclonal and polyclonal
antibodies
Advantage • Threshold for parasite detection
ad low as 10 parasites/ microliter
• Does not react with other species
• Threshold for parasite detection ≥
100 parasite/ microliter
• Can detect all parasite
Disadvantages • Sensitivity and specificity
decreases as low as 10 parasite /
microL
• May remain positive upto 14 days
posttreatment
• Cannot detect mixed infection
• Sensitivity and specificity decreases
< 100 parasite/ microliter
Sensitivity and
specificity
• Sensitivity 94-100%
• Specificity 88-100%
• Sensitivity pf 88-98%, pv 84-94%
• Specificity pf 93-99%,pv 99-100%
9. G. Real time PCR
Molecular technique to identify parasite genetic materials
Threshold for detection 1.1 parasite/µL if whole blood is used, if filter
paper used it is 2 parasite/ parasite/µL
Species diagnosis present
F. Polymerase chain reaction
10. H. Automation based malaria technique
Hematological parameter and their different combination predict
presence of malaria
Low platelet count as strongest predictors, variable MPW, normal to low
Plateletcrit and PDW
TLC can be increase or decrease. Leukopenia more seen
Normocytic normochromic anemia, low Hb, decrease RBC count raised
ESR, low MCV, MCH, MCHC
Intracellular pigments can also be detected
11.
12. Filaria
Lymphatic – wucheria, Brugia
Subcutaneous: Loa loa
Sereous: Mansonella
Sample collection between 10 pm to 4 am
Appearance of microfilaria
Measurement 290x7micron
Covered with sheath
Nuclei present all over but not at the tip of tail
Neclei are brolen at different point serving as
lamdmark for identification
13. Babesia
Parasite are intracellular amastigote form. Essential
parasite of RE System
Amastigote form are seen in monocytes, less
commonly neutrophils
Leishmania
Infect mice. Transmitted in between host by
ticks
Infected humans may be asymptomatic, but in
asplenic host fever, myalgia, haemolysis can be
seen
Maltase cross seen in PS
14. Trypanosoma Cruzi- Chagas disease
Trypanomastigote in peripheral blood
Amastigote in striated muscles
16. White blood cells
The term leuckocyte is derived from Greek word leukos = white and
cyte = cells.
However blood plasma appears green if there is large amounts of
neutrophils in the sample, due to haem containing enzyme
Myleoperoxidase
Normal counts
Age Count
Birth 4-40 x 109/L
4 years 5-15 x 109/L
Adult 4-11 x 109/L
17. Types
Granulocyte (polymorphonuclear) Agranulocyte (mononuclear)
Contain membrane bound granules, which
stains differently with stains
Apparently absent granules, but contain
non specific azurophilic granules
E.g.
Neutrophils
Basophil
Esionophil
E.g.
Lymphocyte
Monocyte
Macrophage
18. Leukocytosis
High count usually indicate
1. Increase production of WBC to fight infection
2. Reaction to drug that enhance WBC production
3. Disease of marrow, causing high production of WBC
4. An immune system disorder that increase WBC
19. Leukocytosis Leukopenia
Acute and chronic infections
Polycythemia vera
Rheumatoid arthritis
Drugs
Allergy
ALL
AML
CLL
CML
Hairy cell leukamia
Smoking
Stress
Tissue damage such as burns
Lymphoma Spillage
Measles
Myleofibrosis
Chemotherapy or radiotherapy
Sepsis
Typhoid
Malaria
Tuberculosis
Dengue
Folate deficiency
Drugs like antipsychotic
Aplastic anemia
HIV and AIDS
SLE
Hodkins lymphoma
Rickettsial infections
Pseudo-leucopenia Seen during the onset of infections due to
marginated WBC
20.
21. Band cells
Usually constitute <5-10% of white blood cells
An increase in number of band cell and other immature neutrophils
is called a “ shift to left” can be seen in
Severe infections, sepsis
Non infectious inflammatory disease
Pregnancy
22. Causes of increased neutrophil: ANC >75000/cumm
1. Physiologic increase (Demargination)
• Release of cell in marginal pool
• Stress leukocytosis
• Exercise, Seizure
• Anxiety, Epinephrine
2. Acute infections
3. Tissue injury and inflammation
• Collagen vascular disease
• Hypersensitivity
• Burns
4. Myeloproliferative disorders: myeloid leukemia, polycythemia vera
5. Medications: Corticosteroid, lithium
6. Misc.: Sickle cell anemia, acute hemorrhage
Causes of Neutopenia
1. Decrease or ineffective production
• Aplastic anemia
• Drug
• Deficiency – vitamin B12, Folic acid
• Myelodysplastic syndrome
• Inherited disorder – Kostamann
synd.
2. Increased removal from circulation
• Immunological – SLE, Drugs
• Hypersplenism
23. Hematological Scoring System
(HSS): Neonatal Sepsis
HSS can be very useful to differentiate the infected from non-infected infants
It has high sensitivity and specificity
An immature to total neutrophil ratio [I:T] along with degenerative changes >
immature to mature [I:M] is the most sensitive indicator of sepsis in infant
Immature include: promyleocyte, myleocyte, metamyleocyte and band cells
Degenerative changes: vacuolization, toxic granules and Dohle bodies.
Confirmation by Blood Culture
24. Hematological Scoring System (HSS)
Criteria Abnormality Score
WBC <5000/microL
>25000 at birth
>30000-(12-24h)
>21000 day 2 onwards
1
1
1
1
Total PMN count No mature PMN seen
Increase/ destruction
2
1
Immature PMN count Increased 1
Immature: total PMN ratio Increased 1
Immature: mature PMN ratio >0.3 1
Degenerative changes in PMN Toxic granules/ Vacuoles 1
Platelet count <150000 microL 1
Score Interpretation
<2 Sepsis is unlikely
3-4 Sepsis is possible
>5 Sepsis or infrction is very likely
25. Cytokinin
Myeloid precursor in bone marrow
Cell
Cell is altered
White cells more
readly exits marrow
Increase
phagocytic activity
Cytoplasmic
inclusions may
appear
Enhanced enzyme
production and
packing resulting in
large granules
Toxic vacoulisation
Left
shift
Dohle
bodies
Increase
phagocytic activity
Cytoplasmic
inclusions may
appear
Left
shift
Toxic vacoulisation
26. Toxic granulation and vacuolization
Indicate the presence of increased granules that are larger and
more basophilic in normal
Seen in
Severe infection
Aplastic anemia
Burns
Malignancy
Treatment with CSF
Pregnancy
27. Dohle bodies
Composed of rough endoplasmic reticulum and glycogen granules
Small blue grey inclusion seen in neutrophil usually in periphery
Seen in
Infections
Inflammatory disorders
Pernicious anemia
Myeloproliferative disorders
Myelodysplastic disorders
Cancer chemothrapy
28. Hypersegmentation
Exists when > 5% of neutrophils have 5 or more lobes
Seen in folate and vitamin B12 deficiency
Myeloproliferative disorders
Myelodysplastic disorders
29. Pelger Huet anamoly
70-90% neutrophils have
hypolobulated, rounded nuclei, with
condense chromatine
A thin strand connect the lobes giving
rise to pince-nez (spectacle) shape, or
a larger bridge give rise to peanut
shape.
Heridetery hypolobulation has no
significance
Acquired (Pseudo Pelger Huet)
anamoly, common in myelodysplastic
and myeloproliferative disorders
30. Auer Rods
Seen in myeloid blast of acute leukemia
They are fused lysosomes and contain lysosomal
enzyme and large crystalline inclusions, seen in
the cytoplasm of leukemic blast
They are virtually pathognomic of myeloid
leukemia
31. Leukamoid reactions
Leukamoid reaction is a haematological
disorder that simulates leukemia due to high
WBC counts and presence of some immature
leukocytes. In leukamoid reaction the cells
are not clonally derived.
Persistant neutrophilia with cell count of
>30000-50000/microL is called myeloid
leukamoid reaction
Leukamoid alkaline phosphate score (LAP-
score) can differentiate leukamoid reaction
from CML. LAP score is raised in leukamoid
reaction whereas decreased in CML
32. Some causes of leukamoid reaction
Causes Myelocytic Lymphocytic Monocytic
Infections Endocarditis
Pneumonia
septicemia
Leptospirosis etc.
Infectious mononucleosis
Pertusis
Varicella
Tuberculosis
Tuberculosis
Toxic conditions Burns
Poisoning -mercury
Eclampsia
Neoplasia Ca Colon
Embryonal carcinoma of
kidney
Carcinoma of stomach
Carcinoma of breast
Others Acute haemorrhage
Acute haemolysis
Dermatitis herpitiformis
33. Eosinophils
Cells having large dinstintive red orange specific
granules in cytoplasm, which contain histamine
and other substances
Lives 6-12 hours in circulation, migrate into tissues
Normal range: 1-4% of total WBCs
Absolute count: 12-500cells/ microliter
Diurnal variation – related to cortisol level: lowest
in morning, highest in evening
34. Eosinophilia Eosinopenia
Mild 700-1500
• Allergic rhinitis
• Extrinsic asthma
• Mild drug reaction
• immunodeficiency
Usually related to increased steroids
Cushing syndrome
Drugs
ACTH, epinephrine, thyroxine
Acute bacterial infections
Moderate 1500-5000
Parasitic disease
Intrinsic asthma
Pulmonary Eosinophilia syndrome
Marked >5000
Trichinella
Hookworm
Toxocara canis
Severe drug reaction
Eosinophilic leukamia
35. Basophils
Contain large purplish granules, granules obscuring the nucleus
Releases bradykinin, heparin, serotonin, histamine
Mediates allergic reactions
Circulate for few hours(6-12) then migrates into tissue
Range 0.5-2%, absolute count 6-200 /microloiter
Basophilia - causes
Hypothyroidsm
CML
Ulcerative colitis
Polycythemia vera
Uticaria
Chickenpox
Splenectomy
36. Monocytes
Agranulocytes, contain greyblue granules
Life span 8hrs-30days, migrate in tissue and became macrophage
Monocytosis Monocytopenia
>700 /mcL or >12% WBC
• Viral infections
• Tuberculosis
• Sub acute bacterial endocarditis
• Collagen disease
• Chronic inflammation
• Stress
• Infectious mononucleosis
• Sarcoidosis
• Autoimmune
• SLE
• Rheumatoid disease
Hairy cell leukemia
Aplastic anemia
38. Platelets
Thrombopoiesis take place
in bone marrow
1 megakaryocyte produce
4000 platelets
Normal platelet are about
1.3 micron, blue grey,
contain fine, purple to pink
granules
Red cell to platelet ratio : 10-
40:1
Life span 9-12 days
Range : 1.5-4.5 lakhs/microL
39. Thrombocytopenia
Grade 1- counts is between 75,000 -150,000
Grade 2- counts is 50,000 < 75,000
Grade 3 – 25,000 to < 50,000
Grade 4 - < 25,000
40. Thrombocytopenia
Decrease production Increase destruction Abnormal distribution
• TAR syndrome
• Amegakaryocytic
thrombocytopenia
• Aplastic anemia
• Myelodysplatic synd
• Bome marrow
hypoplasia or
infiltration
• Ineffective
thrombopoisis due to
folate deficiency
• Heridietery
• May Hegglin
anamoly
• Wiskott Aldrich
Syndome
• Immune mediated
• SLE
• ITP
• Drugs like heparin
• HIV
• Posttransfudion
purpura
• Non immune
• Severe bleeding
• DIC
• Vasculitis
• vWD
• TTP
• HUS
Hypersplenism
Dilutional, due to
massive transfusion
41. Pseudo- thrombocytopenia
(artifactual)
A. EDTA induced platelet agglutination
This is invitro phenomenon due to presence if auto antibodies against a
crypt antigen on the GP IIb/ IIIa receptor, when calcium is chelated by
EDTA, the GPIIb/IIIa get exposed and causes agglutination of platelets
Occurs in 1% of hospitalized patients
No evidence of abnormal haemostasis
Confirmed by sampling on citrated blood
B. Platelet satellitsm: platelet rossete formed around the neutrophil or
any other cells. These satellite platelets are not counted by
counter. It is caused by EDTA dependent antiplated and
antineutrophil IgG antibodies. It is not associated with any disease
42. C. Cold agglutinin: temperature dependent phenomenon. Sample has to
be warm to 37 degree C to get accurate platelet count
D. Giant platelet or Megakaryocyte: platelet larger than 36fl is counted
as red cell in counter, resulting in low platelet count
Mean platelet volume is increase in giant platelets
Young platelets are usually larger
Causes of large platelets include:
Hereditary – Bernard Soulier Syndrome, Benign Mediterranean
macrothrombocytopenia
Acquired – immune thrombocytopenia purpura
Myeloproliferative syndrome
Myleodysplasia
DIC
TTP
Partially clotted specimen: some platelets get consumed
43. Thromboasthenia: Platelets with normal count but abnormal
function, leading to episodes of bleeding
(A) Inherited : (B) Acquired
1. Aggregation defect: Glanzmann
thrombosthenia, congenital
afibrinogenemia
2. Platelet adhesion defect: Bernard Soulier
syndrome, vBD
3. Signaling pathway defect: defect in
calcium mobilization, thromboxane
synthetase deficiency,cyclooxygenase and
lipoxygenase deficiency
4. Agonist receptor defect: thromboxane
receptor deficiency
5. Secretion defects: Chediak Higasi synd,
storage pool disease, Wiskott Aldrich synd,
Grey platelet syndrome
1. Essential thrombocytopenia
2. Uremia
3. Antiplatelet antibodies
4. Myeloproliferative disorders
5. Polycythemia vera
6. CML
7. Acute leukemia
8. Myleodysplastic syndrome
9. vWD
10.Liver disorders
44. Thrombocytosis
Myleoproliferative disorders Transfer from extravascular pool Thrombocytosis secondary to
Essential thrombocytosis
Idiopathic myleofibrosis
Polycythemia vera
Chronic granulomatous
leukemia
Splenectomy
Exercise
Epinephrine
Iron deficiency
Infections
Hemolysis
Malignancy
Acute blood loss
45. Mean platelet volume - MPV
Measurment that describe the average size of the platelet in the
blood.
It is indicator weather bonemarrow is manufacturing platelets
normally or there is some kind of production pressure
MPV has inverse relation with platelet count
change in mean platelet volume without any change in platelet
count may be early indicator of bone marrow problem
Platelet are considered large when 49-8 micron diameter and giant
when equals RBCs
Normal range – 7.4-10.4fL
46. Increase MPV (megathrombocytes) Decrease MPV
ITP
TTP
Bernard Soulier synd
May Hagglin disease
Sepsis - recovery phase
Heart valve prosthesis
Myelodysplasia
Sickle cell anemia
Hyperthyroidsm
Aplastic anemia
Wiskott Aldrich syndrome
TAR synd
Storage pool disease
Megaloblastic anemia
Hypersplenism
Note: in general platelets are large when thrombocytopenia results from increased
destruction and small with disorders of diminished production.
If platelet count is low and MPH is high the risk of bleeding is comparatively less as
larger platelets have multifold better hemostatic capacity than normal size
platelet.
47. Platelet distribution width (PDW)
Compares uniformity and heterogeneity of platelet size; as RDW
Increased in
Essential thrombocytopenia
Aplastic anemia
Megaloblastic anemia
CML
Chemotherapy
Fragmented RBCs
PDW is a relative good tool to distinguishessential thrombocythemia
(PDW increase) from reactive thrombocytosis (PDW normal)
48. Plateletcrit
It is the volume percentage that platelets match on total blood
volume of blood, and it is directly related to the total volume of the
platelets and MPV
Normal Range 0.110-0.280
50. Manual vs Automation hematology
Manual with Neubauer chamber are used mainly used
where there is economic considerations and non
availability of automation
Disadvantages of manual counting
Cell identification:
mostly between lymphocyte, monocytes, band cells
Segmented form and abnormal cells
Lymphocytes may be over estimated and monocytes may be
underestimated
Cell distribution error : increased cell concentration along
edges and also bigger cells
Statistical sampling errors
51. Automated counters provides a 3
or 5 or 7 part differential count
3 part differentiation 5 part differentiation 7 part differentiation
1. Granulocytes or larger cells
2. Lymphocyte or smaller cells
3. Monocytes or mid cell
population
1. Neutrophils
2. Eisonophils
3. Basophils
4. Lymphocytes
5. Monocytes
6. A sixth category “large”
unstained cells, include
cells larger than normal
and lacks peroxidase
activity- atypical
lymphocytes and other
abnormal cells
Include 5 part
• Large immature cells- blast
and immature granulocytes
• Atypical lymphocytes
52. Cell counter – basic principle
Inventor - Wallace Coulter
Electrical impedence principle of cell counting: The cell size are
counted by detecting and measuring changes in the electrical
resistance when a particle passes through a small aperture.
Mathematically
V=RxC V-voltage, C – current, R= resistance
53. The electrical system : circuitry, sequence controls, transformers
The hydraulic system : aspirating unit, dispenser, diluents, mixing
chambers, flow cells, aperture bathes and haemoglobinometre
Pneumatic system : vacuum and pressure devices
Computer system
Cell counter – basic components
54. Radiofrequency principle of cell counter
This employ high voltage electromagnetic currents, which can estimate the cell
size based on cellular density and nuclear volume
It measures the conductivity and the conductivity is altered by nuclear to
cytoplasmic ratio, nuclear density, granulation.
VCS principle of cell counter
VCS= volume, conductivity, scatter
Direct current – measures the size of the leukocytes based upon its volume
Conductivity – HF radiowaves measures conductivity of the cells
Scatter – laser light beam evaluates the surface feature, structure, shape,
granularity and reflectivity
55. Coincidental or Recirculation errors
If more than 1 cell passes through the counting aperture at the
same time and is counted as one cell, this is called coincidental
error
56. Advantages of automated cell
counters
No inter-observer variability
No slide distribution errors
Eliminate statistical error
Many parameter are available e.g. RDW, histogram
More efficient and time effective
High level of precision and accuracy