• Course title : Hematology (1)• Course code : MLHE-201• Supervisor : Prof.Dr Magda Sultan

Date : 24/10/2013

• Outcome

• The student will know :

• Total & differential leucocytic count

• Absolute & relative counts

• Quantitative & qualitative WBC abnormalities.

White Blood Cell Disorders

White Cell Maturation

Leucocytes (white blood cells)• Phagocytes

- Granulocytes

.Neutrophils

.Eosinophils

.Basophils

- Mononuclear phagocytic cells

.Monocytes

• Lymphocytes

- B cells & T cells

PB Neutrophils

PB Staff

PB Basophils

PB Eosinophils

PB Monocytes

PB Lymphocytes

White Blood Cell Disorders

Classification : -Disorders of cell number Terminology: .cytosis/philia (increase in number) .cytopenia (decrease in number) -Disorders of function & morphology

Normal Total Leucocytic Count

For an adult ( male or female)

Normal reference range:

4,000 – 11,000 / cmm

Relative vs Absolute values

• Total White Blood Cell Count (TWBC)

• Differential count : gives the relative

percentage of each white blood cell.

• Absolute value : gives the actual

number of each white blood cell/cmm.

Calculation

Absolute Count = TWBC x Percent

eg: If TWBC = 6,000 /cmm

Neutrophils = 60 %

So Absolute neutrophilic count =

6,000 x 60 / 100 = 3,600 /cmm

Disorders of Cell Number

• Leucocytosis :

an increased number of leucocytes

in the peripheral blood >11,000 /cmm

• Leucopenia :

a reduced white cell count

( < 4,000 /cmm )

Leucocytosis

• Causes :

- Neutrophilia ( commonest cause ).

- Eosinophilia .

- Basophilia .

- Lymphocytosis .

- Monocytosis .

Neutrophilia

Definition :

Increase in the number of neutophils

and/or its precursors > 7,000/cmm

Causes of Neutrophilia

• Infections (pyogenic bacteria)

• Inflammations produced by :

Toxins,infectious agents,neoplasms or burns .

• Following haemorrhage. Reactive changes :

Left shift , toxic granulation , high LAP score.

Causes of Neutrophilia (cont.)

• Chronic granulocytic leukaemia

• Other myeloproliferative disorders

Diagnosis :

Low LAP score .

Philadelphia chromosome .

PB Neutrophilia

Left Shift

Left Shift

High LAP Score

Eosinophilia

• Definition : An increase in the total number of eosinophils in the peripheral blood more than 400/cmm . If eosinophilic count is > 600/cmm further investigations are required.

Causes of Eosinophilia• Allergy Atopic ,drug sensitivity & pulmonary eosinophilia .• Infections Parasites ,recovery from infection• Malignancy Hodgkin’s disease , NHL & MPD

• Skin disorder• Drugs• GIT disorders • Hypereosinophilic syndrome

Eosinophilia

Basophilia

• Definition Increased basophils in the peripheral blood >

100/cmm- Most commonly associated

with: .Hypersensitivity reactions to drugs or food .Inflammatory conditions e.g RA,ulcerative

colitis. .Chronic myeloid leukaemia & MPD

Basophilia

Lymphocytosis

• Definition :

An increase above normal in the number

of circulating lymphocytes ( > 4,000/cmm)

Causes of Lymphocytosis

• Acute infections: Infectious mononucleosis,

acute infectious lymphocytosis,mumps,

rubella,pertussis .

• Chronic infections: tuberculosis,syphilis,

brucellosis,infectious hepatitis .

• Thyrotoxicosis (usually only relative)

• Chronic lymphocytic leukaemia

Lymphocytosis

Infectious Mononucleosis• Caused by Epstein-Barr Virus (EBV)

• Bood picture shows leucocytosis with absolute lymphocytosis and increased

number of atypical lymphocytes .

• Diagnosis :

- Monospot test .

- EBV serology .

Infectious Mononucleosis

Monocytosis

• Definition :

A monocytosis is present when the

peripheral monocyte numbers rise

above 800/cmm .

Causes of Monocytosis

• Chronic bacterial infections : tuberculosis,bacterial endocarditis, brucellosis.• Other infections :malaria,Kala-azar, trypanosomiasis,typhus……..• Hodgkin’s disease .• Monocytic & myelomonocytic leukaemia

Monocytosis

Leucopenia

• Total white blood count lower than the

reference range for age is defined as

leucopenia ( < 4,000/cmm for an adult )

• The major contribution to a leucopenia

usually comprises a reduction of PB

neutrophils .

Causes of Leucopenia• Infections : -Viral as infectious hepatitis,influenza, rubella and others . -Bacterial as typhoid fever,brucellosis, miliary TB . -Rickesttial and protozoal infections .• Drugs : Selective neutropenia,Agranulocytosis, Aplastic anaemia

Causes of Leucopenia(cont.)

• Megaloblastic anaemia• Hypersplenism• Leucoerythroblastic anaemia(Multiple Myeloma,metastatic carcinoma….)• Acute leukaemia • Myelodysplasia• Aplastic anaemia

Causes of Leucopenia(cont.)

• Cyclical neutropenia• Chronic idiopathic neutropenias• Paroxysmal nocturnal hemoglobinuria• Ionizing radiation & cytotoxic drugs• Miscellaneous conditions : myxoedema,anaphylactoid shock, hypopituitarism & SLE

• Student name :

Title :

Training Questions :

Mention the different causes of leucocytosis

How to calculate the absolute count?

Define neutrophilia.

Reference book:

-Essential Hematology .

-Dacie

Assignement : Student name :

Quantitative white cell disorders. مجيد حميد االله عبد حميدقطب رشاد السعيد دعاء

داود وليم داود ديناالرازق عبد الرافع عبد ديناعيسي لطفي رافت رامي

الشرقاوي احمد محمد رانياقمري محمد سعد رحاب

محمدين شاكر محمود رحابغنيم اللطيف عبد مسعد رحمه

فراج الله عبد رشاد ابراهيم رشاد

Eosinophils . درويش ابراهيم محمود محمد رضويالزمراني محمد ابراهيم فتحي رنا

فرج يعقوب راوبين روزاليينالنحراوي فريج السيد ريهام

الحناوي كمال سامي ريهامبركه محمد علي مصباح ريهام

جاسم نصيف ليث زيديوسف عسران ربيع سارهياسين عباس زكريا سامحعمران احمد محمد سامر