Lectuer1 Part 2 Flashcards by Rawan Albalawi

What do we mean by Benign?

It’s no malgnincy disorders

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we have two methods to notice any change in leukocytes what are they ?

Quantitative and Qualitative

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Quantitative mean? and what Terminology we use it ?

Change in number

Cytosis / philia
Increase in number

Cytopenia/penia
Decrease in number

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Qualitative

mean?

changes in Morphologic or Functional

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if the total WBC is 25,000, the absolute

value (40% of 25,000) calculate the absolute value?

Calculation: absolute count= Total WBC x percent
25,000*40=100,000/100=10,000

ياحلوات هنا مره مهم تعرفون الformula تضربون القيم وبالنهاية تقسمون الناتج على 100

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differentiation in WBC to 3 specific cells? please mentioned the names with examples?

1-Leucocytes
Phagocytes

Granulocytes

Neutrophils

Basophils

Eosinophils

2-Lymphocytes
B-cells T-cells

3-Mononuclear phagocytic cells

Monocytes

Macrophage and denderetic
cells

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What the difference between LEUCOCYTOSIS and LEUCOPENIA?

LEUCOCYTOSIS //
Raised TWBC above 11.0 x 109/L in adults, due to elevation of any of a single lineage.

Note: elevation of the minor cell
populations can occur without a rise in the total white cell count.

LEUCOPENIA//

TWBC lower than 4.5 x 109/L in elevation of any of a single lineage.

Leucopenia may affect one or more lineages and it is possible to be severely neutropenic or lymphopenic without a reduction in total white cell count.

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What the difference between Granulocytosis and Agranulocytosis?

*Granulocytosis
Increase in the count of all or one of the granulocytic component:
Ex:
Neutrophils 
Basophils 
Eosinophils

*Agranulocytosis
Decrease in the count of all or one granulocytic component

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Definition of NEUTROPHILIA ?

Increase in the number of neutrophils and / or its precursors

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True or false
In adults count<7.5 x 109/L but the counts are shape
dependent

False /
adults count >7.5 x 109/L but the counts are age
dependent
ضروري تعرفون انها تعتمد على العمر والعدد

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Mention the Causes of Neutrophilia ?

Infection • 
Inflammatory conditions
• Neoplasia 
• Metabolic conditions
Uraemia 
Acidosis 
Haemorhage

Corticosteroids
Marrow infiltration/fibrosis
Myeloproliferative disorders

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NEUTROPHILIA have two types …………………and ………………

Acute Neutrophilia and Chronic neutrophilia

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Causes of Chronic neutrophilia?

Long term corticosteroid therapy
Chronic inflammatory reactions
Infections or chronic blood loss Infections
Less common organisms e.g poliomyelitis

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Acute Neutrophilia is ………………………………

Mobilized rapidly by stress, suggested by adrenaline stress

test; due to reduced neutrophil adhesion

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Causes of Acute Neutrophilia ?

Bacterial infection 
Stress 
Exercise
Slower rise when cells are released from the bone marrow
storage pool
Steroid 
Infections

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True or false

Steroids reduces the passage to the tissues

True

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Leukemoid reactions have 3 important point to diagnosis?

neutrophilia with marked leucocytosis (>20 x 109/L)

NEUTROPHILIA >50,000 x109

The usual feature is the shift to the left of myeloid cells

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Causes of Leukemoid reactions

include?

Infections
Marrow infiltration,
Systemic disease (e.g.: Acute liver failure)

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NEUTROPENIA is ………………

Neutropenia is an absolute reduction in the number of

circulating neutrophils: Reduction in granulocytes:

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Reduction in granulocytes can be …………………or ……………………

Decreased Production – Marrow.
• Increased destruction – drugs, immune
ا

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Mention the mild and Moderate and Severe range to NEUTROPENIA and any ranges effect on agranulocytosis ?

Mild (1- 1.5 x 109/L)
Moderate (0.5 – 1 x 109/L)
Severe (<0.5 x 109/L) agranulocytosis
Sever is effect in agranulocytosis process

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✅❌

Symptoms are present with the neutrophil count above 1 x 109/L

❌

Symptoms are rare with the neutrophil count above 1 x 109/L

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commonest kind of infection is …………………

relatively uncommon kind of infection is …….

Bacterial infections are the commonest. Fungal, viral and parasitic infection are relatively uncommon.

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Causes of Neutropenia?

• Racial 
• Congenital 
• Marrow aplasia 
• Marrow infiltration 
• Megaloblastic anemia
 • Acute infections
Typhoid, Miliary TB, viral hepatitis
• Drugs 
• Irradiation exposure 
• Immune disorders 
• Hypersplenism (splenomegaly)

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EOSINOPHILIA is ?

Increase in the eosinophil count must prompt for further | investigation (>0.6 x 109/L)

The causes of eosinophilia ?

Allergy Atopic, drug sensitivity and pulmonary eosinophilia Infection Parasites, recovery from infections Malignancy Hodgkin’s disease and myeloproliferative disorders Drugs Skin disorders Gastrointestinal disorders Hypereosinophilic syndrome

Hypereosinophilic syndrome • Criteria of diagnosis ?

Peripheral blood eosinophil >1.5 x 109/L Persistence of counts more than 6 months End organ damage Absence of any obvious cause for eosinophilia

what are the organs that dameged in Hypereosinophilic syndrome ?

``` Organ most commonly involved Heart Lung Skin Neurological ```

MONOCYTOSIS…………………

Absolute monocyte count is age dependent

✅❌ Count rarely exceeds <1.0 x 109/L

❌ Count rarely exceeds >1.0 x 109/L

Causes of monocytosis can be grouped as •

Infections Chronic infection (TB, typhoid fever, infective endocarditis) Recovery from acute infection • Malignant disease • Connective tissue disorders Ulcerative colitis, Sarcoidosis, Crohn’s disease

………………least common of the granulocytes

Basophils

Reference range for adult in BASOPHILIA

is 0 – 0.2 x 109/L

Causes of BASOPHILIA

Most commonly associated with hypersensitivity reactions to drugs or food • Inflammatory conditions e.g Rheumatoid arthritis (RA), ulcerative colitis are also sometime associated with basophilia • Myeloproliferative disorders • Chronic myeloid leukemia

The blood contain only few percent of total body of …………………

lymphocytes

✅❌ MONOCYTOSIS Have no marrow reserves

✅

Causes of monocytosis can be grouped as ?

Infections Chronic infection (TB, typhoid fever, infective endocarditis) Recovery from acute infection Malignant disease Connective tissue disorders Ulcerative colitis, Sarcoidosis, Crohn’s disease

Reference range for adult in Basophils

is 0 – 0.2 x 109/L

Alteration of lymphocyte counts can result from

The redistribution of lymphocytes Absolute increase of lymphocyte number Loss of lymphocytes Combination of these

causes of LY M P H O C Y T O S I S

Infections Viral infections Infectious mononucleosis ``` CytoMegaloVirus Rubella, hepatitis, adenoviruses, chicken pox ``` Bacterial infections Typhoid fever Protozoal infections Toxoplasmosis • Allergic drug reactions • Hyperthyroidism • Splenectomy • Serum sickness

✅❌ lymphocytosis is Non-malignant causes

✅

Infectious Mononucleosis caused by ………………virus

Epstein-Barr virus

✅❌ Saliva from infected person is the main contagion

✅

Virus infect……&……………

epithelial cells and B cells

✅❌ Infectious Mononucleosis in children under the age of 10 does not cause illness and result in life long immunity

✅

Clinical features of Infectious Mononucleosis

``` Fever , malaise, fatigue, sore throat, splenomegaly Blood picture shows leucocytosis ( 10 – 20 x 109/L) due to absolute increase in lymphocytes ```

Diagnosis Infectious Mononucleosis by

serological tests

✅❌ There is specific treatment for Infectious Mononucleosis

❌ | There is no specific treatment

Describe the shape of cell in Infectious Mononucleosis

Large lymphocytes, more cytoplasm. Irregular, indented by RBC – also known as virocyte

Explain Pelger-Huet anomaly morphology

Bilobed and occasional unsegmented neutrophils Autosomal recessive disorder

In Pelger-Huet anomaly what happens for chromatin?

chromatin is | coarsely clumped

Explain colors in Chediak-Higashi Syndrome | And where can we Found it?

Contain very large,reddish-purple or greenish-gray staining granules in the cytoplasm of granulocytes • In monocytes & lymphocytes, stain bluish-purple Fond in: anemia, neutropenia, thrombocytopenia

granules in Chediak-Higashi Syndrome represent …………………

abnormal lysosomes

Inherited condition Heavy, coarse blue-black granules of Baso Eisino Neutrophil (BEN) & sometimes lymphocytes & monocytes. write name of this anomaly

Alder-Reilly anomaly

Inherited anomaly affecting neutrophils and platelets • Larger than usual Dohle-like bodies • Giant bizarre platelets is present & function may be abnormal write name of this anomaly?

May-Hegglin Anomaly

LEUCOCYTES BENIGN DISORDERS Qualitative changes (MORPHOLOGY) It Have 4 morphology are Acquired what are they ?

Toxic granulation Dohle bodies Pelger cells Hypersegmented neutrophils

Explain morphology of Toxic granulation and where can we found it ?

Dark blue-black cytoplasmic granules in neutrophil • Thought as primary granules • Show inc.alkaline phosphatase activity • Found in: acute infections drug poisoning burns

Explain morphology of Dohle Bodies | and where can we found it ?

Single or multiple light blue or gray areas in cytoplasm of neutrophils • RER & represent failure of cytoplasm to mature • Found in: infections poisoning burns following chemotherapy

Explain morphology of Hypersegmented Neutrophils | and where can we found it ?

Neutrophils with six or more lobed nucleus • Represents an abnormality in maturation of neutrophil • Acquired(in megaloblastic erythropoiesis) or inherited(Undritz anomaly) • Found in: pernicious anemia folic acid deficiency chronic infections

Explain morphology of Vacuolated neutrophi | and where can we found it ?

Degeneration of cytoplasm begins to acquire holes or as result of active phagocytosis • May reflect increased lysosomal activity • Found in: septicemia severe infection

Explain morphology of Giant Neutrophils | and where can we found it ?

Can be seen occasionally in normal peripheral blood smear • Larger than normal neutrophils and generally hyperlobulated • Found in frequency of 1 in every 20,000 neutrophils but increase in disease states