This document provides an overview of white blood cell disorders, including common conditions such as neutropenia, lymphocytosis, leukemia, and lymphoma. It begins with an introduction to normal white blood cell production and classification. Key points covered include the clinical features and pathogenesis of various leukopenias and leukocytoses. Classification systems for hematologic neoplasms such as leukemia subtypes (AML, ALL, CML, CLL) and lymphomas (Hodgkins, Non-Hodgkins) are summarized. Premalignant conditions like myeloproliferative disorders and myelodysplastic syndromes are also briefly outlined.

1. Aspire to become good, not great....
Greatness is like a passing cloud,
temporary.
- Sai Baba - Divine Discourse, July 16, 2001.

2. Pathology of
WBC disorders
Dr. Shashidhar Venkatesh Murthy
A/Prof. & Head of Pathology
2013: MB2-HRM-Week 7

3. HRM-Wk7: Fever, bleeding & Back pain
 Mr M.S. 45y, man. Presents to ED: “Very
bad lower back pain, nothing helping it”.
 History:
• Feels unwell? - Very
• Fever? Yes, I think so; intermittent
• Easy bruising -Yes, bruises last few weeks.
 Examination:
• Slim, unwell, pale, Multiple Bruises
• Liver & Spleen enlarged – mild.
• Lymph nodes enlarged neck & axilla.

4. Learning Objectives:
 WBC in health & disease - overview.
 Classification & Common WBC disorders.
 Congenital, Reactive & Cancer.
 Clinical features.
 Pathogenesis
 Laboratory diagnosis
 Blood morphology
• Features (3-4).
• Line diagram.
 Management - brief.
TOP 10 WBC Disorders:
• Leukopenia:
1. Neutropenia
2. Lymphopenia.
3. Pancytopenia
• Leucocytosis:
4. Neutrophilia
5. Eosinophilia
6. Lymphocytosis – IM
7. Lymphadenitis.
• Neoplastic disorders (cancer)
9. Lymphoma
10. Leukemia (AML/ALL,CML/CLL)

5. Teaching Plan & Staff:
 Introduction to WBC disorders:
• Shashidhar Venkatesh Murthy.
 Clinical Cases: GLS 1st hour.
• Ian Irving, Haematologist, TSVH.
 Microscopy Tutorial: GLS 2nd hour.
• Shashidhar Venkatesh Murthy.
 Synthesis Session: Keepad Q&A disc.
• Shashidhar Venkatesh Murthy.
Mon
9am
Tue
1pm
Tue
2pm
Thu
1pm

6. GLS SESSION

7. 8y child with Asthma & multiple scaly skin lesions.
Image shows blood film appearance. ? Cause
1. Viral Infection
2. Allergic reaction
3. Malaria.
4. Bacterial infection.
5. Fungal infection.
1 2 3 4 5
0 0 000
SYNTHESIS SESSION

8. I am here for you….
Email: venkatesh.shashidhar@jcu.edu.au
vmshashi@gmail.com
Need personal guidance? Email me for an appointment.
Office Tel: 4781 4566
Office location – MS136
Emergency?(exam time) Mob: 0416 933 704

9. Small minds discuss people
Average minds discuss events
Great minds discuss solution
Genius silently acts!

10. 10
Normal Blood Cells:
Neutrophil
Basophil
Eosinophil
Lymphocyte
Non granular, Mononuclears
Specific Immunity
Granulocytes, Polymorphs
Non-Specific Immunity

11. Normal WBC Production:

12. Normal Granulopoiesis: CSF
Stimulate
bone marrow
to produce
WBC.
What are the Clinical applications of G-CSF?

13. Lab: CBC - WBC Histogram:
Absolute
Count
% / Differential Count

14. WBC Absolute counts in disease:
Penia PhiliaNeutro
Penia PhiliaEosino
Penia cytosisMono
Penia cytosisLympho

15. Leukopenia: Neutropenia
 Reduction in granulocytes:
• Decreased Production – Marrow.
• Increased destruction – drugs, immune
 When severe – Agranulocytosis.
 Clinical features:
• Infections – chills, fever, fatigue, ulcers.

16. Leukocytosis: Neutrophilia
 Increased granulocytes:
• Acute inflammation, Bacterial infections.
 When severe – Leukemoid reaction.
 Clinical features:
• Infections or Trauma - fever, fatigue.

17. Lymphocytosis: Infectious Mononucleosis
 Increased Lymphocytes:
• Chronic Inflam, Viral, fungal, TB etc.
 Large lymphocytes, more cytoplasm. Irregular,
indented by RBC – also known as virocyte
 Clinical features: Chronic fever, lymphadenopathy.

18. Neutrophilia:
Acute inflammation (Bacterial, trauma, immune, etc)

19. Toxic Granulation & Left shift:
Acute inflammation Bacterial, trauma, immune, etc
Band forms & Phagocytic granules in cytoplasm

20. Leukemoid Reaction:
 Marked increase in
neutrophils. >50,000 x109
 Shift to left  immature
forms.
 Severe infection, trauma,
bone marrow infiltration.
 Looks like leukemia*
(no blasts)

21. Your failure may prove to be
an asset, provided you try to
know why you failed !
--Napoleon Hill

22. Lymphadenitis: Reactive.
 Acute or Chronic.
 Infections, Immune & Cancers.
 Increased large irregular lymphoid follicles
with normal archetecture. (mantle zone).
 Lymphadenitis: Enlarged lymphnodes due
to inflammation or infecitons. Painful.
 Lymphadenopathy – any enlargement, but
commonly used for Cancers – Painless.

23. Reactive lymphadenitis
Dark zone
Light zone
Mantle zone
Macrophage
Tingible body
Macrophage

24. Hemato-oncology: Blood Cancer
 Cancer of blood forming – stem cells (Blasts).
 Leukemia – ‘White’ ‘blood’ – excess WBC.
 Starts in bone marrow or lymphatic tissue.
 Spread to blood & other ‘RES’ tissues only.
(Liver, Spleen & lymphnodes)
 Two Major types: Myeloid & Lymphoid.
 Two clinical presentaiton: Acute / Chronic.
 Many subtypes* – due to several different
mutations – personalized medicine *

25. The goal of mankind is knowledge, which
is inherent in man. No knowledge comes
from outside: it is all inside. What man
'learns' is really what he “discovers” by
taking the cover off his own soul.
- - Swami Vivekananda
„Education‟… from Eduse (latin) to bring out..!
„Doctor‟ … from Dokere‟ (latin) to teach…!

26. Lymphoblast
Leukemia: Cancer of Blast cells.
Acute
Myeloid
Leukemia
Acute Lymphatic Leukemia
Chronic Leukemia
Chronic Leukemia

27. Normal – Acute - Chronic Leuk
Normal
Chronic Myeloid LeukemiaAcute Myeloid Leukemia

28. Hematologic Neoplasms: Classification
 Leukemias: Bone marrow, blood, Blasts
• Duration: Acute/Chronic
• Cell of Origin: Myeloid/Lymphoid
• AML / ALL & CML / CLL
 Lymphomas: – Lymph nodes, tumor
• Hodgkins & Non-Hodgkins.
 Premalignant conditions:
• Myeloproliferative syndromes (MPS)
• Myelodysplastic syndromes (MDS)

29. Leukemia: Clinical Features
 Cancer of Bone marrow – Excess blasts.
 Decreased Haemopoiesis:
• Erythropoiesis – Anemia - RBC
• Leukopoiesis – Infections - WBC
• Thrombopoiesis – Bleeding. PLT
 Bone marrow expansion/destruction:
• Bone pains.
 Extraneous hemopoiesis / spread:
• Splenomegaly
• Hepatomegaly
• Lymphadenopathy. (more in lymphatic malignancy)

30. Leukemia Clinical features:
Bleeding - Petechiae
Lymphadenopathy
Hepatosplenomegaly
Infections - Candidiasis

31. Leukemia Classification
 Acute Leukemias: weeks to months.
• Acute Myeloid Leukemia – AML - Adults
• Many Subtypes: M0, M1 to M7
• Acute Lymphoid Leukemia – ALL - Children
• Many Subtypes: L1, L2 & L3
 Chronic Leukemias: Years.
• Chronic Myeloid Leukemia- CML- Adults
• Chronic Lymphoid Leukemia - CLL –Old age
• Many subtypes:

32. ALL - AML

33. Acute Leukemia: AML/ALL - Blasts
Norm. Lymphocyte
Blast
Blast
Norm. RBC
Norm. Lymphocyte
Norm. RBC
Blast
Normal

34. Self-pity is an opiate!
--Napoleon Hill

35. Lymphoma
 Definition: Tumour of lymphoid tissue
 Etiology: Idiopathic, Genetic, Infective.
 Clinical: Lymphadenopathy, weight loss, Fever.
 Two Major Types: & many subtypes.
 Hodgkins lymphoma (HL) – RS cells.
 Non-Hodgkins lymphoma (NHL) – no RS cells.
• B cell, T cell & Histiocytic lymphoma.

36. Lymphoma Row of enlarged lymph nodes

37. Hodgkins Lymphoma
Big binucleate cancer cells known as
Reed Sternberg Cells (RS cells)

38. Non-Hodgkins Lymphoma:
 Large group of lymphatic neoplasms.
 Clinical: Fever, anemia, infections,
Lymphadenopathy. Spleen+/-.
 No RS cells or eosinophilia
 Complex names and classification.
• Cell type – B, T & Histiocytic “B commonest”
• Clinical – low, intermediate & high grade.
• Histology – Follicular & diffuse.
• Special types: Burkitts lymphoma, Myeloma,
Waldenstroms macroglobulinemia, lennert‟s,

39. Non Hodgkins Lymphoma
Low, Intermediate & High grade.

40. Burkitt‟s lymphoma: large B cell NHL
 Endemic in Africa
 Epstein Barr Virus
(EBV)
 B Cell Lymphoma.
 Dark large B
lymphocytes (malignant)
with plenty of pale
macrophages. (Starry
sky pattern).

41. Multiple Myeloma:
 Malignancy of Plasma cells
(Mature B lymph, Ab)
 Old age, males common.
 Marrow, LN, Blood.
 Multiple, punched out Lytic bone
lesions (Osteolysis)
 Hyper gammaglobulinemia
 Monoclonal antibody peak –
serum protein electrophoresis.
 Immunodeficiency  infections.

42. "Creativity is inventing,
experimenting, growing, taking
risks, breaking rules, making
mistakes, and having fun.
-- Mary Lou Cook

43. Myeloproliferative Disorders.
Myelodysplastic Syndromes.
(Precanceraous stage of blood cancers)

44. Myelo Proliferative Disorders:
 Excess Proliferation, Neoplastic, Old age.
 Organomegaly – Liver & Spleen enlarged.
 Hypercellular BM & Leukocytosis.
 4 types:
• Excess RBC (polycythemia vera)
• Excess WBC (CML)
• Excess Plt (Essential Thrombocythemia)
• Excess Fibroblast (Myelofibrosis).
 Mixed types common, end in leukemia.

45. Polycythemia Rubra Vera (PV)
Hypercellular Marrow,
Red skin & Hepatosplenomegaly

46. ET - Blood Film & clinical.
Plenty of
Platelets
Megakaryocyte

47. Myelo Dysplastic Syndromes:
 Dysplastic Proliferation (abnormal cells)
 Neoplastic, old age, unexplained anemia.
 Abnormal cells destroyed in bone marrow.
 Hypercellular BM & Leukopenia, anemia.
 Commonly known as Refractory Anemia.
 Many subtypes, Mild to severe dysplasia.
 Increasing blasts – poor prognosis.
 Transforms to acute leukemia.

48. Summary:
 Reactive Leukocytosis.
• Neutrophilia, Eosinophilia, Lymphocytosis.
 Reactive Leukopenia.
• Neutropenia, lymphopenia.
 Leukemias – Cancer of Blasts.
• AML/ALL, CML/CLL
 Lymphomas – Tumors of lymphoid tissue
• Hodgkins & Non- Hodgkins (HL, NHL)
 Premalignant conditions
• MPS & MDS:

49. 3 R’s of success:
Respect for self,
Respect for others &
Responsibility for your actions.