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• 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