abnormalities of wbc

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ABNORMALITIES of the WHITE BLOOD CELLS Jose R. Villarino, RMT

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Page 1: Abnormalities of WBC

ABNORMALITIES of the WHITE BLOOD CELLS

Jose R. Villarino, RMT

Page 2: Abnormalities of WBC

Possible answers: A. NEUTROPHILS B. LYMPHOCYTES C. PATHOLOGIC D. PHYSIOOGIC E. 20-40 % F.

5000-10000/cumm G. 0-3 % H. MALARIA I. AZUROPHILIC

GRANULES

J. ASTHMA K. AUER ROD L. PELGER HUET M. TOXIC

GRANULES N. LEUCOPENIA O. PARASITISM P. SCARLET FEVER Q. DOHLE BODIES R. BASKET CELLS

Page 3: Abnormalities of WBC

WBC Normal values: WBC Count = 5,000 – 10,000/cu mm or 5 – 10 x 109/L Differential Count: Neutrophil = 50 – 70 %

Segmenter = 50 – 65 % ; Stab = 0 – 5 %

Eosinophil = 0 – 3 % Basophil = 0 – 1 % Lymphocytes = 20 – 40 % Monocytes = 2 – 6 %

Page 4: Abnormalities of WBC

Quantitative abnormalities

Leucocytosis – substantial increase in the WBC count.

- Physiologic increase (no trauma/injury) - Pathologic increase

(trauma/pathology) Leucopenia – substantial decrease in

the WBC count. N.V. = 5,000 – 10,000/cu mm

Page 5: Abnormalities of WBC

Differential Count

Neutrophil 50 – 75 %

segmenter 50 – 65 %

stab 0 – 5 %

Eosinophil 0 – 3 %

Basophil 0 – 1 %

Lymphocyte 20 – 40 %

Monocyte 2 – 6 %

Page 6: Abnormalities of WBC

The 5 WBC types

Page 7: Abnormalities of WBC

Neutrophilia (> 7 – 8 x109/L)

Infections, Inflammation, Metabolic disorders

Acute hemorrhage, corticosteroids Stress, post-surgery, burns, HDN Lithium drugs, neoplasms

Page 8: Abnormalities of WBC

Neutropenia (<1.75 – 1.8109/L)

Decreased production - Inherited/acquired stem cell disorder - Benzene toxicity, cytotoxic drugs Increased destruction - Immune mechanism, sequestration BM depression, IM, varicella, Typhoid SLE, hepatitis or any viral infections

Page 9: Abnormalities of WBC

Eosinophilia (> 0.7 x 109/L)

Allergic disorders (asthma) Parasitic infections (nematodes) Skin disease (eczema) Hodgkin’s disease Scarlet Fever Pernicious anemia

Page 10: Abnormalities of WBC

Eosinopenia (< 0.05 x 109/L)

Stress due to trauma or shock Mental distress Cushing’s syndrome ACTH administration

Page 11: Abnormalities of WBC

Basophil (0.3 x 109/L)

BASOPHILIA Chronic myelocyic leukemiaPolycythemia veraHodgkin’s disease

BASOPENIA HyperthyroidismPregnancy

Page 12: Abnormalities of WBC

Lymphocytosis (>4.0 x 109/L)

Viral infections ( German measles ) Infectious Mononucleosis (kissing

dis.) Mumps (parotitis), pertussis Tuberculosis, syphilis,

thyrotoxicosis

Page 13: Abnormalities of WBC

Lymphopenia

Congestive heart failure, SLE Renal failure Advanced Tuberculosis High levels of adrenal

corticosteroids

Page 14: Abnormalities of WBC

Monocytosis (>0.9 x 109/L)

SBE, Syphilis, Tuberculosis Protozoan infections Mycotic or fungal infections Malaria, Systemic lupus

erythematosus Rheumatoid arthritis

Page 15: Abnormalities of WBC

Monocytopenia

Lymphocytic leukemia Aplastic anemia

Page 16: Abnormalities of WBC

QUALITATIVE CHANGES-WBC

Morphologic abnormalities involving either the nucleus or cytoplasm

Functional abnormalities

Inherited or Acquired Examination of peripheral blood or a

bone marrow evaluation

Page 17: Abnormalities of WBC

The White blood cells:

Nucleus details: - Mononuclear or

Polymorphonuclear Granules present: - Granulocytic or Agranulocytic Function: - Phagocytic or Immunocytic

Page 18: Abnormalities of WBC

Abnormal granulocyte morphology (acquired)

Toxic granulation, cytoplasmic vacuole

Dohle bodies (Amato bodies) Azurophilic granules Hypersegmentation

Page 19: Abnormalities of WBC

Pathological Leucocytes

Page 20: Abnormalities of WBC

Abnormal granulocyte morphology

(inherited) Alder-Reilly anomaly - dense

azurophilic granules, mucopolysaccharoidoses

May-Hegglin anomaly - Giant platelets, Dohle-bodies like inclusions seen even in monocytes

Pelger Huet anomaly – failure of normal segmentation of nucleus, bi-lobed nucleus or stab forms only,

“pince-nez nucleus”

Page 21: Abnormalities of WBC

Alder Reilly anomaly

Page 22: Abnormalities of WBC

May-Hegglin anomaly

Page 23: Abnormalities of WBC

Pelger Huet anomaly

Page 24: Abnormalities of WBC

Continuation: Chediak Steinbrinck Higashi syndrome –

large lysosomes containing hydrolases and other enzymes. There is anemia,thrombocytopenia, leucopenia and increased susceptibility to infection. There is partial albinism & photophobia.

Also seen in Aleutian mink, mice, cat, cattle & killer whale as caused by abnormal WBCs.

Page 25: Abnormalities of WBC

Chediak Higashi syndrome

Page 26: Abnormalities of WBC

Other abnormalities: Smudge or basket cells – squash-

degenerated nucleus of WBCs Jordan’s anomaly – fat-containing

vacuoles in WBC cytoplasm, Ichthyosis Twinning deformity Auer rod – rod-like structure seen in

the cytoplasm of myeloblasts, diagnostic for Acute myeloblastic leukemia (AML)

Page 27: Abnormalities of WBC

Variants of the Lymphocytes

Plasmacytoid lymphocyte or Turk’s irritation cell

Downey cell (atypical lymphocyte) Transformed lymphocyte (reticular

or pyroninophilic cell) Reider cell – “clover-leaf like

nucleus” Plasma cells

Page 28: Abnormalities of WBC

Reactive lymphocytes

Page 29: Abnormalities of WBC

Downey cell

Hallmark cell seen in cases of Infectious mononucleosis (kissing disease)

Atypical lymphocyte (stress lymphocyte)

“ballerina skirt cell”

Page 30: Abnormalities of WBC

Infectious Mononucleosis

Page 31: Abnormalities of WBC

Plasma cells

Ovoid or fibrillary shaped Eccentric location of nucleus Perinuclear halo “cart-wheel pattern or spoke of the

wheel pattern of nucleus” basophilic cytoplasm

Page 32: Abnormalities of WBC

Comparative morphology of plasma cells, lymphocytes and NRBC

Page 33: Abnormalities of WBC

Inherited abnormalities involving Monocyte-macrophage group

MUCOPOLYSACCHAROIDOSES - Hunter syndrome, Hurler’s disease LIPIDOSES – lipid accumulation - Gaucher’s disease – accumulation of

glucocerebroside due to lack of beta-glucosidase enzyme

- Neimann Pick disease – sphingomyelin and cholesterol accumulation due to lack of the enzyme sphingomyelinase

Page 34: Abnormalities of WBC

Monocyte-macrophage abnormality

Page 35: Abnormalities of WBC

WBC functions Neutrophil – phagocytic Eosinophil – phagocytic and

damage to larval stages of parasite. Basophil – storage of histamine,

involved in immediate hypersensitivity reaction.

Monocyte – phagocytic, cellular and humoral immunity

Page 36: Abnormalities of WBC

Functions….

Lymphocytes – immune leucocytes a)humoral b) lymphokines c)

cytotoxic

- Not obligate end cells - Heterogenous group of cells - Destined to migrate

Page 37: Abnormalities of WBC

PHAGOCYTOSIS process

Motility – random movement and directed movement

Recognition Ingestion Degranulation or release of

granules Microbial killing

Page 38: Abnormalities of WBC

Inherited functional abnormalities

Job’s syndrome – defective directed movement, characteristic “cold boils”

Lazy leucocyte syndrome – both random & directed movements are defective

Chediak Higashi syndrome – failure to release the granules

Page 39: Abnormalities of WBC

Non-neoplastic (non-clonal) disorders of the WBC

Include a) growth regulation abnormalities, b) leukemoid reaction (an increased proliferative response to various stimuli) including bone marrow aplasia and hypoplasia and c) qualitative leucocyte disorders (both acquired & inherited) characterized by deficiency of leucocyte function.

Page 40: Abnormalities of WBC

Non-clonal disorders of WBC

Function disordersDefective chemotaxis, phagocytosis, defective killing, CGD, myeloperoxidase deficiency

Quantitative disorders Neutropenia, agranulocytosis,

Leukemoid reaction, Infectious mono

Page 41: Abnormalities of WBC

Clonal (neoplastic) disorders of WBC

Derived from a single precursor cell with all the affected cells (progeny) showing features of deviation from the precursor cell.

Myeloproliferative disorders Lymphoproliferative disorders Immunoproliferative disorders

Page 42: Abnormalities of WBC

Leukemoid reaction

High WBC count = <50000/cu mm Toxic granulation & Dohle bodies Predominant band forms LAP score = >100 Negative for Philadelphia chromosome - Translocation of genetic material from

long arm of Chromosome 22 to Ch 9

Page 43: Abnormalities of WBC

Hodgkin’s disease Belongs to a group of malignant

disorders referred as Lymphomas Lymphomas involved abnormal lymph

node enlargement with replacement or alteration in its histologic characteristic

The neoplastic cell involved is known as the Reed-Sternberg cell. Mostly appears as binucleated with the 2 halves of the cell appearing as mirror images.

Page 44: Abnormalities of WBC

Hematopoietic malignancy

Defined as growth or proliferation of one or more clones of abnormal cells. These cells don’t respond to normal control and even produce substances inhibiting growth of normal cells.

These malignancy may be manifested in the peripheral blood as in cases of anemia and thrombocytopenia.

Page 45: Abnormalities of WBC

Leukemias In the case of WBC, these malignant

cells may or may not circulate in the peripheral blood. Hence, WBC count may be increased or otherwise.

Should these abnormal cells be present both in the bone marrow and the peripheral blood, the term leukemia is used.

Aleukemic leukemia – if only confined to the marrow and do not circulate.

Page 46: Abnormalities of WBC

Classification of the leukemias According to the stem cell line involved - Myeloid – involves the granulocytes,

monocytes, RBCs and megakaryocytes. Also known as myeloproliferative disorders or nonlymphocytic leukemias.

- Lymphoid – involving the B or T cells and may be a leukemia or lymphoma

Page 47: Abnormalities of WBC

Classification of leukemias

According to duration (life span)- Acute – days to weeks (3 months) - greater than 30 % blasts forms- Chronic – more than a year (1-2

years) - less than 10 % blast forms

Page 48: Abnormalities of WBC

Examples :

Acute myeloid leukemia myeloblast

Chronic myelogenousleukemia

Myelocyte, metamyelocyte & neutro

Acute lymphoblasticleukemia

lymphoblasts

Chronic lymphocyticleukemia

Small mature lymph

ErythroleukemiaDi Guglielmo syndrome

> 50% of the nucleated cells are erythroblasts

Page 49: Abnormalities of WBC

Comments on the leukemias: AML – most common form of acute

leukemias in first few months of life, in middle aged group and later years

CML – more common in young & elders ALL – seen among children 2 – 10 y.o. CLL – common among > 60 years old