This document summarizes leukocytic disorders including leukocytosis, leukopenia, and leukemoid reactions. It describes the normal ranges and causes of increased or decreased white blood cell counts affecting neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Morphological variations and pathological conditions associated with each cell type are also outlined. The document concludes by defining leukemoid reactions, describing myeloid and lymphoid subtypes, and differentiating these reactions from actual leukemia.

1. Leukocytic Disorders
(Leukocytosis, Leukopenia & Leukaemoid reaction)
Dr. B.R. Sonwane,
M.D. (Path)
Asso. Professor

2. Leukocytic Disorder
(Leukocytosis, Leukopenia & Leukaemoid reaction)
Introduction
- Leucocytosis –acute inflammation
- Count ranges 15000-20000/cumm.
- Bacterial infection- Neutrophilia
- Viral infection- Lymphocytosis
- Parasitic infection- Eosinophilia
- Typhoid fever- Acute inflammation- relative
lymphocytosis with neutropenia.

3. Mature Leukocytes in
Health & Disease
 P.S.- Mature Leukocytes (P-L-E-M-B).
 WBC count- Higher in Infants & Children.
 Diurnal variation- Afternoon – Slightly .
 TLC- High in pregnancy following delivery
returns to normal within week.

4. MORPHOLOGY OF
INDIVIDUAL CELLS
Don’t hesitate to ask morphology of any cells.

5. Polymorhonuclear Leukocyte
(Neutrophil, Microphage)
2-5 lobes
Granular (violet /
pink) Cytoplasm
Size 12-15 µm

6. FUNCTIONS
 Chemo-taxis
 Phago-cytosis
 Killing of micro-organism by O2 dependent & O2
independent pathway
MORPHOLOGICALVARIATION
 Count
 Defective morphology
 Defective function

7. Count
(Neutrophil Leukocytosis, Neutrophilia )
Neutrophil count above 7500/cumm – Neutrophilia
i. Acute infections: Pneumonia, salphingitis,
Appendicitis, abscess etc.
ii. Other inflammation: Tissue damage resulting from
burn, operation, Myocardial infarction.
iii. Intoxication: Diabetic keto-acidosis, eclampsia,
poisoning by chemicals & drugs.
iv. Acute haemolysis
v. Disseminated malignancy
vi. Myelo-proliferative disorders: Myeloid leukaemia&
metaplsia, Polycythemia vera.
vii. Misce: Following steroid therapy & idiopathic
neutropenia.

8. Count
(Neutropenia)
Neutrophil count < 2500/cumm- Neutropenia –
Recurrent infection
i. Certain infection: Typhoid, Malaria, Vural hepatitis,
measles.
ii. Overwhelming bacterial infection: Pt with TB &
septicaemia.
iii. Drugs, chemical & Physical agents- Induce BM
depression leads to Neutropenia. These are Anti-
metabolites, benzene, ionizing radiation.
Antibacterial : Chloramphenicol, septran.
Anti-convulsant, anti-thyroid and anti-malignant
drugs.
iv. Cahexia & debility

9. vii. Certain haematological & other diseases:
Pernicious anaemia, aplastic anaemia &
cirrhosis of liver etc.
viii.Anaphylactoid shock
ix. Certain rare disorder like herditory, congenital
& familial etc.
Slow and Steady win the race!

10. Morphological Variations
 Toxic granules: Bacterial infection
 Vacuoles: Septicaemia, bacterial infection.
 Dohle bodies: Bacterial infection.
 Nuclear abnormality
i. Sex chromatin: 2-3 % (polymorphs) seen in female sex
ii. Drum stick: 1 µm across attached to lobe
( 2X chromosomes)
i. Shift to left:  lobes i.e. band & stab with few
myelocytes. Severe infection, LE reaction or
leukaemia.
ii. Shift to right: lobes > 5, Megaloblastic anaemia,
uremia, sometimes in leukaemia.
iii. Pelger Huet anomaly: Inherited disorder. Lobes 1-2.
Rod like or dumbell or spectacle.

11. Defective Functions
Defective Chemotaxis: Congenital abnormality
“ Lazy Platelet” syndrome. Cortico-steroid therapy,
Aspirin ingestion, alcoholism & in myeloid leukaemia.
Defective phagocytosis: Lack of opsonization. Sickle cell
anaemia, after spleenectomy.
Defective killing: Chronic granulomatous disease,
Chediak-Higashi syndrome, Myeloid leukaemia.

12. Lymphocyte
Dark basophilic cytoplasm
Round oval nucleus
Small 9-12 µm
Polymorph
Large Size 12-16 µm
Faint blue cytoplasm

13. Two types of Lymphocytes:
1. T lymphocytes Cell mediated
2. B Lymphocytes Humoral
FUNCTION OF (T) LYMPHOCYTES
1.Cellular immune reaction: Mediated by subsets of
cytotoxic T cells CD3+, CD8+.
2. Immuno-regulatory function: By helper T cells
FUNCTION OF (B)LYMPHOCYTES
B –lymphocytes & their derivatives are engaged with
specific immunoglobulin synthesis.

14. Pathological variation
Count above 4000/cumm – Lymphocytosis
Count below 1500/cumm- Lymphopenia
LYMPHOCYTOSIS
1. Certain acute infection: Pertusis, viral hepatitis etc.
2. Certain chronic infection: Brucellosis, tuberculosis &
secondary syphilis.
3. Haemopoietic disorder: Lymphatic leukaemia, Heavy
chain disorder.
4. Reactive Convalescences from acute infection,
thyrotoxicosis and condition causing neutropenia.

15. Leucopenia
i. Most acute infection
ii. Severe bone marrow failure
iii. Cortico-steroid & immunosuppressive theray
iv. Wide spread irradiation.

16. MONOCYTES
Kidney shaped
nucleus
Ground glass
cytoplasm
Size 12-20 µm
Kidney shaped
nucleus
Ground glass
cytoplasm

17. Function & Morphological Variation
Function: Phagocytosis
Count: Count above 800/cumm – Monocytosis
1. Certain bacterial infection: TB, SABE & syphilis
2. Viral infection
3. Protozoal & ricketsial infection : Malaria, Typhus
fever, Kala Azar.
4. Convalescence from acute infection.
5. Haemopoietic disorders: Monocytic leukaemia,
lymphoma, myeloproliferative disorder, multiple
myeloma etc.
6. Malignancies: cancer of the ovary, stomach, breast.
7. Granulomatous disease: Sarcoidosis, IBD
8. Collagen & vascular diseases.

18. EOSINOPHIL
Dark pink granular
cytoplasm (Per-oxidase
positive)
Bi-lobed nucleus
Size 12-15 µm
Bi-lobed nucleus

19. Eosinophils are involved in reactions to foreign proteins
and to Ag- Ab reactions.
PATHOLOGIC VARIATIONS
Count above 400/cu mm – Eosinophilia
Count below 40 /cu mm – Eosinopenia
EOSINOPHILIA
i. Allergic: Bronchial asthma, urtecaria, hay fever, drug
hypersensitivity.
ii. Parasitic infection: Trichinosis, echinococosis,
intestinal parasitism.
iii. Skin infection: Pemphigus, dermatitis herpectiform
erythema multiforme.
iv. Loffler’s syndrome
v. Pulmonary infection with eosinophilia syndrome.

20. vii. Haemopoietic disorder: CML, Polycythemia
vera, HD, pernicious anaemia.
viii.Malignant diseases with metastasis.
ix. Irradiation
x. Miscellaneous disorder: Sarcoidosis,
polyarteritis nodosa, Rheumatoid arthritis.
EOSINOPENIA
1. Adrenal steroid
2. ACTH induce eosinopenia.

21. BASOPHIL
Dark basophilic
granules
Nucleus obscure by granules
RBC’s in the
background
Size 12-15 µ m

22. Pathological Variation
 The granules of basophil contains heparin,
histamine & 5-HT.
 In the tissue these cells become mast cells.
 Count above 100/cu mm – Basophilia.
BASOPHILIA
1. CML 6. After spleenectomy
2. Polycythemia vera 7. HD
3. Myelosclerosis 8. Urticaria pigmentosa
4. Myxoedema
5. Ulcerative colitis

23. LEUKAEMOID REACTION
 Definition: Reactive excessive leucocytosis in the P.S.
resembling that of leukaemia in a subject who does not
have leukaemia.
 Confusing blood picture, C/F of leukaemia (HS
megaly, LN pathy & haemorrhgae) are absent.
TYPES
1. Myeloid leukaemoid reaction
2. Lymphoid leukaemoid reaction

24. MYELOID LEUKAEMOID REACTION
CAUSES
1. Infection: Staphylococus pneumonae,
disseminated TB, meningitis, sepsis,
endocarditis.
2. Intoxication: Eclamsia, severe burn etc.
3. Malignant disease: Multiple myeloma, HD,
Myelosclerosis.
4. Severe haemorrhage & haemolysis.

25. Laboratory Diagnosis
1. TLC< 1,00,000 /cu mm.
2. Immature cells: Metamyelocytes, Myelocytes
(5-15%) & blast < 5% i.e. picture simulate of CML.
3. Infective cases may shows toxic granulation &
Dohle bodies in the cytoplasm of polymorphs.
4. NAP score : MLR CML
5. Additional features: Anaemia
Platelet count- N or 
Myeloid metaplasia of BM
Absence of infiltration of blast in organ & tissue.

26. LYMPHOID LEUKAEMOID REACTION
CAUSES
1. Infection: CMV, Whooping cough, TB,
infectious mononucleosis.
2. Malignant disease: Rarely produces LLR.
LABORATORY DIAGNOSIS
 TLC: < 1,00,000 / cu mm
 DLC: Mature small & large lymphocytes thus picture
simulates CLL.

27. Failure is not the crime but low aim is crime !
Thank You!
Dr. B.R.Ambedkar