The document discusses white blood cell (WBC) disorders, focusing primarily on leukopenia and neutropenia, including definitions, causes, classifications, symptoms, and diagnoses. It outlines various causes of leukopenia such as chemotherapy, radiation therapy, and leukemia, as well as classifications of neutropenia based on absolute neutrophil count. Additionally, it touches on the roles and abnormalities of lymphocytes in the immune response.

1. Developed by
Dr. Abdulrazzak Othman Alagbare
MD.Bhc.MSc –Hematolgy Lecturer
10/12/2010
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2. Definition: Is a decrease in
the number of circulating
white blood cells
(leukocytes) in the
peripheral blood lower than
4000/cells/µL (for adult)
Result of leukopenia?
increased risk for infection
Causes of leukopenia
1.Chemotherapy,
2.radiation therapy
3.leukemia (as malignant cells
overwhelm the bone
marrow),
4.myelofibrosis
5.aplastic anemia
6.Medications
Leukopenia

3. Pseudoleukopenia
Develop upon the onset of infection
Diagnosis of Leukopenia
Leukopenia can be identified with a complete blood
count

4. Neutropenia
• Neutropenia defined as an absolute neutrophil count
(ANC) (segmented + band neutrophils) less than
2000/ µl
 Patients with neutropenia are more susceptible to
bacterial infections
 Patients with fevers and frequent infections.
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5. Causes of Neutropenia
Decreased production in the bone marrow
Cases
1-aplastic anemia
2-medication
3-radition
4-B12 and folate dificiency
5- congenital neutropenia
6-viral infection
7-metastic cancer
Increased destruction
a) autoimmune neutropenia.
b) chemotherapy treatments,
c) autoimmune diseases
d) Sequestration in spleen
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6. • 1-Severe acute neutropenia
• 2-Chronic Neutropenia
• 3-Chronic idiopathic neutropenia
• 4-Cyclic neutropenia
• 5-Congenital neutropenia
• 6-Drug-induced neutropenia
• 7-Autoimmune neutropenia
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7. 1-Acute Neutropenia
Severe acute neutropenia: An autoimmune reaction where the
body produces antibodies to it's own neutrophils which results in
neutropenia
2-Chronic Neutropenia
A patient has chronic neutropenia if the condition lasts for
longer than 3 months.
3-Chronic idiopathic neutropenia
is a disorder in which the neutrophil count is less than 1.0 x
109/L, but results in few infections
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4-Cyclic neutropenia is characterized by periodic severe
neutropenia, (Often <200/L)
occurring in regular 21- to 30-day cycles.
5-Congenital neutropenia
a)Name: Kostmann's syndrome
b)Cause: autosomal recessive
c)Age: the first year of life
d)Severity: the patient has life threatening infections
6-Drug-induced neutropenia
7-Autoimmune neutropenia
a)Chronic
b)Autoimmune (antibodies directed against neutrophil antigens)

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Blood film with a striking absence of neutrophils, leaving only red blood cells and platelets

10. Neutropenia Classification - based on the absolute
neutrophil count (ANC)
Risk Category ANC
0 Within normal limits Normal
1 ≥1500 - <2000/mm³ Mild neutropenia
2 ≥1000 - <1500/mm³ Moderate neutropenia
3 ≥500 - <1000/mm³ Severe neutropenia
4 < 500/mm³ Agranulocytosis
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11. Signs and symptoms of neutropenia
Due to low ability to fight bacterial infections
1.severe infections or sepsis
2.Fever
3.Mouth ulcers ,
4.Diarrhea
5.Burning sensation when urinating
6.Sore throat
Diagnosis of
neutropenia
1. A full blood count (low ANC)
2. Bone marrow biopsy is often necessary
3. Antineutrophil antibodies
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12. Lymphocytes
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13. The primary function of lymphocytes is
immunologic:
1. Forming antibodies; and securing
immunity.
2. Recognizing what is foreign, (non-
self)
 Non-self or foreign substances may
appear as bacteria, cell substances,
proteins, or viruses
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14. 1. All leukocytes make a one-way trip between blood and tissues.
2. Lymphocytes only can recirculate between blood, tissue, and
lymph fluid.
3. Lymphocytes are the second most common type of
leukocyteso in adults (20–40% of WBC).
4. The lymphocyte number is higher in children between the ages of 1
and 4 to have a relative lymphocytosis
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15.  Resting lymphocytes
 Reactive “transformed lymphocytes,” “atypical
 lymphocytes,” or “viral lymphocytes”
 Large granular lymphocytes
 N.Killer cells
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16.  Is an increase in the number of lymphocytes in the blood
 Relative lymphocytosis is normal in children under age 2.
1. Infants: greater than 9000 per microliter
2. older children : greater than 7000 per microliter
3. adults : absolute lymphocytosis over 4000 per microliter
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17. Lymphocytopenia
 Infant: lower than 4000/cum
 Young children: lower than 3000/cum
 Adult: lower than 1000/cum
May be seen with
1. corticosteroid Rx, chemo Rx, irradiation,
2. Hodgkin's disease, HIV infection
3. In HIV infection the lymphopenia is largely due to a loss of CD4
positive T-helper lymphocytes
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Reactive lymphocytes:
a) Used to describe transformed or benign lymphocytes.
b) You should use the term “reactive”,
c) The word “atypical” is used to describe malignant-appearing cells.
d) A few reactive lymphocytes is not abnormal

19.  1-Pertussis or whooping cough
 2-Toxoplasmosis
 3-Brucellosis
 4-Infectious mononucleosis
 5- CMV
 6-Infectious lymphocytosis (coxsackie virus A or B6, echovirus, and adenovirus 12)
 7-HTLV-1 (Human T Lymphocyte virus)
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Infectious mononucleosis

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END OF THE LESSON