this presentation contain information about tow subjects neutropenia, definition, causes and grading also about the lymphocytopenia

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