series lecture in clinical hematology for medical student Prof. Waseem Al Tameemi Al Nahrain University college of medicine

1. HEMATOLOGY COURSE
Introduction
2nd
23th feb.2017
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2. Learning objectives
 ✓ Recognize the different types of leucocytes
(myeloid cells & lympoid cells).
 ✓ List the normal values for neutrophils,
eosinophils, basophils, and monocytes in
normal peripheral blood
 ✓ Be familiar with terms of leukoerythroblastic
picture and leukemoid reaction
 ✓ Identify conditions that cause increase or
decrease for each of them.
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3. The white blood cells
(leucocytes):
 Phagocytes
 innate immune system,
1. Granulocytes: (neutrophils,
eosinophils , basophils) and
2. monocytes
 Lymphocytes
 adaptive immune response,
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4. Leucocyte
 Mediate host defense
 Modulate the immune response
 The relative proportion
 The absolute number
 ―ANC‖—absolute neutrophil count
 – Philia, – cytosis
 – Penia
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6. Leukocytes: White Blood Cells
Involved in
fighting infection,
combating allergic
reactions, and
immune
responses.
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7. myeloblast
neutrophil
promyelocyte myelocyte
Band formmetamyelocyte
eosinophil
basophil
The first recognizable granulocyte in the marrow is the myeloblast
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8. Neutrophils
 maturation within 5 days in BM
 stay 6-10 hours in the circulation
before being removed, mainly by
the spleen.
 Myeloblast, promyelocyte,
Myelocytes or metamyelocytes are
normally only found in the marrow
 if appear in the circulation :
 infection or neoplastic states or
BM stimulation.
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9. Left shift WBC
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10. Clinical applications of
G‐CSF
1. Neutropenia :
A. Post‐chemotherapy,
B. Post-radiotherapy
C. stem cell transplantation (SCT)
2. Severe benign neutropenia :
 congenital cyclic neutropeniaand
 acquired neutropenia
3. Myelodysplasia and aplastic anaemia.
4. Peripheral blood stem cell
mobilization.
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11. Leukoerythroblastic reaction
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The abnormal appearance of immature
precursors of both cell lines
in the peripheral blood

12. Leukoerythroblastic reaction
 a serious disturbance of marrow function
 The WBC count may be increased,
normal, or decreased
 BM metastasis
 MF
 Leukemia (AML,CML)
 MM
 Reactive states ( hemorrhage or hemolysis )
 Corticosteroid therapy
 Indication of bone marrow study
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13. Neutrophils
 the most common white
blood cells in the blood
of adults.
 approximately 65 %
 2-5 segments nuclei
and granules in their
cytoplasm.
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14.  Phagocytizing
offending organisms
 releasing toxic
oxygen
 antimicrobial
proteins
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15. Neutrophilic leukocytosis
 total WBC >>11,000/mm³
(11 X109/L )
 absolute neutrophil count (ANC) of
more than 7500/mm³(7.5 × 109/L)
 more than 70% neutrophils
 Granulocytosis = neutrophilia
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16. Neutrophilic leukocytosis
 Physiological
 Smoking
 Acute Infection
(bacterial ,fungal)
 Inflammation
 Necrosis
 Acute hemoarrhge
or hemolysis
 Metabolic
 Malignancy
 Drugs
(Glucocorticoids
,tetracycline,
epinephrine
,Lithium , G-CSF )
 Heatstroke
 Down syndrome
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17. Leukemoid reaction
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 Excessiv reactive leukocytosis
 30,000- 50,000/mm³ (30-50 x109/L(

18. Leukemoid reaction
 Benign leukocytic proliferation
 a significant increase in immature
precursors in the peripheral blood
(myeloblast, myelocytes,
metamyelocytes, band) along with
increased numbers of mature forms.
 DDX: acute or chronic leukemia
 Severe infection, metastatic cancer,
hemolysis, burn.
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19. Eosinophils
 represent 1-6% of
the circulating WBC.
 involved in
 intracellular killing of
protozoa and
helminths
 allergic reactions
(e.g. atopy, asthma)
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20. Eosinophilic leukocytosis
 >> 500/mm³ (0.5x109/L )
 Allergy,hay fever, eczema,
asthma
 Parasitic infection
 Skin diseases
 Drug hypersensitivity ; sulpha,
gold
 Vasculitis:Churg Strauss
disease.
 Loffler’s syndrome
 Malignancy; lymphoma ,HES,
AML,CML
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21. Hypereosinophilic syndrome
HES
eosinophil count is elevated
(above 1.5 × 109/L) for over 6
months and associated with
tissue damage
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22. Basophils
 Less than 1% of WBC.
 Mast cells resemble
basophils (only found
in the tissues).
 They release histamine
 type I hypersensitivity
reaction and
 defense against parasites
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23. basophilic leukocytosis
 >> 100/mm³ (0.1 X109/L) .
 Causes:
 Viral infection: chicken pox
 Myeloproliferative disorders,
chronic myeloid leukemia ,
PRV, mastocytosis.
 Hypersensitivity reactions
 Inflammation (IBD)
 Hypothyroidism
 Post splenectomy
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24. Monocytes
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 2 to 10% of circulating WBCs.

25. Monocytes
 Main functions of macrophages:
1) Phagocytosis.
2) Facilitate wound healing.
3) Removal of senescent RBCs in
reticuloendothelial system
(spleen, liver and bone marrow).
4) Presentation of antigen to T
lymphocytes.
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26. Monocytic leukocytosis
 >> 800/mm³.
 tuberculosis,
brucella, malaria
 recovery stage of
chronic infections,
 CTD
 MDS, AML, solid
tumors, Hodgkin
lymphoma
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27. Lymphocytes
 T cells (80% of circulating
lymphoid cells)
 B cells
expression of immunoglobulin
light chains
 lifespan can vary from several
days to many years.
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28. Lymphocytic leukocytosis
 >> 3,500/mm³
( 3.5 X109/L )
 infections such as viral;
(infectious mononucleosis
,mumps , measles) and
bacterial; (pertussis, TB)
 lymphoproliferative disorders:
acute and chronic lymphocytic
leukemias, lymphoma
 post splenectomy
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29. Neutropenia
 < 1500/mm³. (1.5 X109/L)
 < 500/mm³ (0.5 X109/L)
 Agranulocytosis : neutropenia
 recurrent infections
 Bone marrow examination
 less than 0.2 × 109/L
 very serious
 Very significant risk of infection; fever should
always be managed on an inpatient basis with
parenteral antibiotics; few or no clinical signs of
infection
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30. The clinical features of
neutropenia:
 risk of infection, at the mouth and
throat.
 Painful necrotizing ulcers on oral
cavity , the anus and skin (boil,
abscess)
 The general symptoms :fever, chills,
malaise, weakness and fatigability.
 Septicaemia
 the infection will be severe & life threatening
within hours to few days
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31. The clinical features of
neutropenia:
 Commensal by normal
individuals may become
pathogens.
 (Staphylococcus epidermidis or
Gram‐negative organisms in the bowel)
 Candida and Aspergillus.
 Invasive bacterial or fungal infections
may occur in the organs like GIT, lungs
and urinary tract.
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32. Neutropenia
1. infections:
 Flu,Hepatitis B virus, Epstein-Barr virus and
HIV
 Enteric fever, brucellosis, and tuberculosis
 Malaria
2. Drugs: cytotoxic, carbimazole, sulphasalazine,
trimethoprim, carbamazapines,
3. Auto immune:SLE, Felty’s syndrome
4. Congenital: Kostmann’s syndrome,
Schwachman–Diamond
5. acute leukemia
6. bone marrow failure or infiltration
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33. Lymphopenia
 < 1000 /mm³ (1 X109/L).
 CTD, Renal failure, sarcoidiosis,
 steroid & radiation
 Hodgkin
 congenital severe Combined
Immune Deficiency
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