evaluation of peripheral blood
DESCRIPTION
Evaluation of Peripheral blood. Huang Jinwen Sir Run Run Shaw Hospital. Automated hematology instrumentation. WBC differential Advia 2120. Monocytes. Neutrophils. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/1.jpg)
Evaluation of Peripheral blood
Huang Jinwen
Sir Run Run Shaw Hospital
![Page 2: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/2.jpg)
Automated hematology instrumentation
![Page 3: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/3.jpg)
WBC differential Advia 2120
peroxidase
cell
size Neutrophils (pink) and eosinophils
(yellow) containing the most perox activity are found to the right. Cells with little or no perox cluster to the left, such as lymphocytes/basophils (blue) and large unstained cells (blasts, variant and atypical lymphocytes, light blue). Monocytes (green) contain a small amount of perox and are located between the neutrophils and large unstained cells. Noise is indicated in the lower left hand corner (white).
Neutrophils
eosinophils
Monocytes
Lymphocytes
blasts
![Page 4: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/4.jpg)
Red cell size distribution curves in hereditary
sideroblastic anemia
Presence of two populations of red cells A broad population of red cells, varying markedly in size, with the majority of the cells being microcytic.
![Page 5: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/5.jpg)
Comparison between automated optical
and immunologic platelet counts
The majority of the data points well outside of the 95 percent confidence limits are above the best-fit line, suggesting that the optical method is more prone to overestimate platelet counts than the immunologic method in this range.
![Page 6: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/6.jpg)
Optimal area for review
Suboptimal blood smear
Normal peripheral blood smear Rouleaux in myeloma
![Page 7: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/7.jpg)
Definition and mechanisms of leukocytosis and neutrophilia
![Page 8: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/8.jpg)
WBC Count
• The normal limit in adults: 4.400 to 11.0. (4.0 to 10.0) x109/L
• Leukocytosis: NL + 2SD, or> 11.0 x109/L
• Hyperleukocytosis or leukemoid reaction: > 50.0 x109/L
• Neutrophilic leukocytosis: >11.0 x109/L, + ANC>7,700 x109/L
• ANC = WBC x percent (PMNs + bands) ÷ 100
![Page 9: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/9.jpg)
Neutrophilic leukocytosis
• It commonly seen in
• It can also occur in
• Neutrophilia
Infection,
Stress,
Smoking,
Pregnancy,
Following exercise.
Chronic myeloproliferative disorders,
Chronic myeloid leukemia
![Page 10: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/10.jpg)
Lymphocytic leukocytosis
• WBC 11.0 X109/L, an absolute lymphocyte count > 4.8 X109/L .
• Infectious mononucleosis and pertussis
• Lymphoproliferative disorders, such as the acute and chronic lymphocytic leukemias
![Page 11: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/11.jpg)
Monocytic leukocytosis
• WBC> 11.0 x109/L, an absolute monocyte > 0.8 x109/L.
• Acute and chronic monocytic variants of leukemia
• Acute bacterial infection or tuberculosis
• Monophilia.
![Page 12: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/12.jpg)
Eosinophilic and basophilic leukocytosis • WBC>11.0 x109/L, an absolute eosinophil > 0.45 x109/L
or basophil >0.2 x109/L
• Eosinophilic leukocytosis can be seen in
• Basophilic leukocytosis is a distinctly unusual condition,
Chronic leukemia,
Solid tumors,
Infection with parasites, Allergic reactions,
Following treatment with IL-2
Basophilic or Mast cell variants of acute or chronic leukemia
![Page 13: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/13.jpg)
Regulation of neutrophil counts
PMN development
![Page 14: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/14.jpg)
Detection of infection or inflammation
band count ≥20
left-shift
cytoplasmic vacuoles
Dohle bodies, Toxic granulation
![Page 15: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/15.jpg)
The leukocyte alkaline phosphatase score
• LAP is high in
• LAP is low in
Infection
InflammationPolycythemia vera
Chronic myeloid leukemia Paroxysmal nocturnal hemoglobinuria
![Page 16: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/16.jpg)
Definitions of neutropenia
• Mild neutropenia: ANC 1.0 ~1.5 X109/L
• Moderate neutropenia: ANC 0.500 ~1.0 X109/L
• Severe neutropenia: ANC < 0.5 X109/L
![Page 17: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/17.jpg)
Neutropenia and hospitalization for infection
![Page 18: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/18.jpg)
Etiology of isolated neutropenia
• Acquired neutropenias• Postinfectious neutropenia• Drug-induced neutropenia and agranulocytosis• Primary immune disorders• Hypersplenism• Bone marrow disorders• Congenital neutropenias• Myeloperoxidase deficiency
![Page 19: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/19.jpg)
NIH grading of hematologic toxicity
of chemotherapy
![Page 20: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/20.jpg)
Fever in the neutropenic adult patient with cancer
![Page 21: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/21.jpg)
Risk Factors of Fever
■ A rapid decline in ANC or ANC <0.1 X109/L
■ Prolonged duration of neutropenia (>7 to 10 days)
■ Leukemic induction
■ Cancer not under control
■ Comorbid illnesses requiring hospitalization
■ Use of central venous catheters
■ Disruption of mucosal barriers
■ Use of monoclonal antibodies
![Page 22: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/22.jpg)
INFECTIONS IN FEBRILE NEUTROPENIA
■ A majority of patients had occult bacterial infections
■ An infectious source identified in ~ 30 %
■ Bacteremia documented ~25%
■ ~80% of identified infections arised from patients‘
own endogenous flora.
![Page 23: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/23.jpg)
Symptoms and a physical examination daily
![Page 24: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/24.jpg)
Laboratory studies • CBC with differential, transaminases, bilirubin, amylase an
d electrolytes, a chest radiograph, and cultures.
• Two or more blood cultures, sputum Gram stain and culture, and urine Gram stain and culture.
• Pulmonary infiltrates frequently can not produce sputum; a more invasive approach including bronchoscopy or open lung biopsy.
• Lumbar puncture is not usually recommended.
![Page 25: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/25.jpg)
Blood cultures
• One set /day for a stable fever pattern.
• Two or three sets initially and to wait 48 to 72 hours to repeat blood cultures.
![Page 26: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/26.jpg)
Chest radiographs
■ Findings are often minimal or absent even in patients with pneumonia. ■ Findings may develop along with an increase in symptoms as the neutropenia begins to resolve.
![Page 27: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/27.jpg)
Chest CT scanning
CT should be ordered for the patients with pulmonary symptoms.
![Page 28: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/28.jpg)
Colony stimulating factors
■ CSF reported to decrease the duration of neutropenia, fever, and hospitalization.
■ CSF have not been shown to decrease mortality.
■ These agents should not be used routinely for patients with fever and neutropenia.
■ It may be appropriate to consider their use in critically ill patients.
![Page 29: Evaluation of Peripheral blood](https://reader031.vdocuments.site/reader031/viewer/2022012916/5681302b550346895d95bee7/html5/thumbnails/29.jpg)
THANKS