Course title : Hematology (1)

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• Course title Hematology (1)
• Course code MLHE-201
• Supervisor Prof.Dr Magda Sultan
• Date 24/10/2013

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• Outcome
• The student will know
• Total differential leucocytic count
• Absolute relative counts
• Quantitative qualitative WBC abnormalities.

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White Blood Cell Disorders
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White Cell Maturation
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Leucocytes (white blood cells)

• Phagocytes
• - Granulocytes
• .Neutrophils
• .Eosinophils
• .Basophils
• - Mononuclear phagocytic cells
• .Monocytes
• Lymphocytes
• - B cells T cells

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PB Neutrophils
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PB Staff
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PB Basophils
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PB Eosinophils
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PB Monocytes
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PB Lymphocytes
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White Blood Cell Disorders

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

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Normal Total Leucocytic Count

• For an adult ( male or female)
• Normal reference range
• 4,000 11,000 / cmm
• 
  

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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.

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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

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Disorders of Cell Number

• Leucocytosis
• an increased number of leucocytes
• in the peripheral blood gt11,000 /cmm
• Leucopenia
• a reduced white cell count
• ( lt 4,000 /cmm )

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Leucocytosis

• Causes
• - Neutrophilia ( commonest cause ).
• - Eosinophilia .
• - Basophilia .
• - Lymphocytosis .
• - Monocytosis .

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Neutrophilia

• Definition
• Increase in the number of neutophils
• and/or its precursors gt 7,000/cmm

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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.

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Causes of Neutrophilia (cont.)

• Chronic granulocytic leukaemia
• Other myeloproliferative disorders
• Diagnosis
• Low LAP score .
• Philadelphia chromosome .

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PB Neutrophilia
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Left Shift
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Left Shift
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High LAP Score
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Eosinophilia

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

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Causes of Eosinophilia

• Allergy
• Atopic ,drug sensitivity pulmonary
• eosinophilia .
• Infections
• Parasites ,recovery from infection
• Malignancy
• Hodgkins disease , NHL MPD
  
• Skin disorder
• Drugs
• GIT disorders
• Hypereosinophilic syndrome

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Eosinophilia
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Basophilia

• Definition
• Increased basophils in the peripheral blood gt
  100/cmm
• Most commonly associated with
  .Hypersensitivity reactions to drugs or food
  .Inflammatory conditions e.g RA,ulcerative
• colitis.
• .Chronic myeloid leukaemia MPD

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Basophilia
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Lymphocytosis

• Definition
• An increase above normal in the number
• of circulating lymphocytes ( gt 4,000/cmm)

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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

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Lymphocytosis
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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 .

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Infectious Mononucleosis
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Monocytosis

• Definition
• A monocytosis is present when the
• peripheral monocyte numbers rise
• above 800/cmm .

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Causes of Monocytosis

• Chronic bacterial infections
• tuberculosis,bacterial endocarditis,
• brucellosis.
• Other infections malaria,Kala-azar,
• trypanosomiasis,typhus..
• Hodgkins disease .
• Monocytic myelomonocytic leukaemia

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Monocytosis
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Leucopenia

• Total white blood count lower than the
• reference range for age is defined as
• leucopenia ( lt 4,000/cmm for an adult )
• The major contribution to a leucopenia
• usually comprises a reduction of PB
• neutrophils .

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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

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Causes of Leucopenia(cont.)

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

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Causes of Leucopenia(cont.)

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

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• Student name
• Title

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• Training Questions
• Mention the different causes of leucocytosis
• How to calculate the absolute count?
• Define neutrophilia.
• Reference book
• -Essential Hematology .
• -Dacie

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Assignement Student name
Quantitative white cell disorders. ???? ??? ????? ???? ???? ???? ?????? ???? ??? ???? ???? ???? ???? ???? ??? ?????? ??? ?????? ???? ???? ???? ???? ????? ???? ???? ???????? ???? ??? ???? ???? ???? ????? ???? ?????? ???? ???? ??? ?????? ???? ???? ??????? ???? ??? ???? ????
Eosinophils . ???? ???? ????? ??????? ????? ??? ???? ??????? ???? ???????? ???????? ?????? ????? ??? ????? ????? ???? ???????? ????? ???? ???? ??????? ????? ????? ??? ???? ???? ??? ??? ???? ???? ???? ???? ????? ???? ???? ????? ???? ????? ???? ???? ???? ?????