HEMATOLOGY

BENIGN WHITE CELL DISORDER

Dr Thuy
Feb 21 2017

 Presenting antigen together with

WBC- dendritic cells
 composed of: 5. LYMPHOCYTES
o Granulocytes  Small cell with high cytoplasmic ratio
o Monocytes  Sometimes has abundant cytoplasm
o Lymphocytes  Divided to
 Distinguished by the way the pick up o T cells
Romanovs stain o B cells
 Distinctive granulations in the cytoplasm o Natural killer cells
*cant be distinguished morphologically
rete *skin and LN- predominantly B cells
*peripheral blood- Tcells (80%)
Bcells(20%)

NORMAL DISTRIBUTION OF WHITE CELLS

CBC
 White cells parameters include the total
WBC
 Differential count – merely enumeration of
100 cells divided into different
morphologies

GRANULOCUTES
1. NEUTROPHILS
 Most abundant
 60-70% of WBC
 Eliminate mass forming
microorganisms
 1 line of defense
st

2. EOSINOPHILS *to properly interpret white cells- must be able to

 Golden brown granules relate the total white cell count with the differential
 Eliminate large parasites count to come up with the absolute values
o Eg helminthes
 Part of sensitivity reaction with  ABSOLUTE COUNT-determines if one has
basophils lymphopenia eosinophilia neutrophilia
3. BASOPHILS o multipy WBC count\ differential
count
 Secrete substances that mediate
o convert percentage to decimal
inflammatory conditions - HISTAMINES
points
o Neutropenianeutrophilia- referring
MONONUCLEARS
to absolute count not differential
4. MONOCYTES
count
 Abundant cytoplasm
 Ground glass cytoplasm
 Bean shaped nucleus
 Enters tissues as macrophages

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Neutrophils and monocytes has a common
progenitor cell- both destined to be tissue cells
 Travel in the bone marrow and transiently
stays in the peripheral blood and enters the
tissues where they engage agent
STAGES OF MONOCYTE MATURATION
 Becomes macrophages upon entering the
tissues
•Primary granules ( Azurophilic) granules: HBP,
Neutrophil Elastase, Cathepsin G, Protease 3,
Azurocidin, Myeloperoxidase
 Responsible for the killing effect of the
neutrophils
 Expressed during the promyelocytic state
• Secondary granules: Lysozymes, Alkaline
Phosphatase, Collagenase, Vit B12 binding protein,
Lactoferrin
• Tertiary granules: Gelatinase, Cathepsin B,
Cathepsin D, βDGlucoronidase, α-Mannosidase,
Plasminogen activator, MMP-9
 Expressed during the late phase of the
maturation of the cells
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*different granules are expressed differently from
different stages of maturation
*used todifferentiate different types of myeloid
leukemia
*like RBC cells the granulocytes lymphocytes and
monocytes are derived from the hematopoietic stem
cells
*differentiate into common myeloiod(granulocyte
monocyte system) and common lymphoid cells
(lymphocytes)
Process of production are affected by different
cytokines acting in different stages of differentiation-
 some has multiple effect- influence
maturation of different blood cells
 other specific- granulocyte monocyte
distribulting factor- responsible for
maturation and activation of cells destined
to be granulocytes and monocytes
cytokines
 Some manufactured using recombinant
technology
 Some has found clinical application
o Eg granulocyte colloid stimulating
factor- used to rescue people who
has severe neutropenia sepsis etc
BONE MARROW
 Most WBC under light microscopy are –
PRECURSUR CELLS(morphologically
recognizable cells)
o Very few progenitor cells
 Most of the cells in the bone marrow are
sort of a storage component
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  The one that circulates and found in the BV
system are divided into:
o Circulating neutrophils – measured
when prescribing blood count
o Marginating neutrophils-adherent
in the endothelial cells

Clinical Applications of G-CSF

-responsible for increasing or stimulating
granulocyte production
 Post-chemotherapy, radiotherapy or
stem cell transplantation
 Severe neutropenia
 Severe infection
 Peripheral blood stem cell harvesting

*neutrophils
 derived from the bone marrows stem cells
 generally attracted to the site of the
inflammation by means of different
chemokines
 enter circulation and move out by use of
diapedesis- use of different techniqes
 squeeze to the endothelial cells by
diapedesis
 further augmented by the fact that during
the inflammatory response the other cells
are secretes cytokines that further attract
neutrophils to the site of injury-
INFLAMMATORY RESPONSE eg rubor tumor
calor etc
 once inflammatory response are near the
site of the microorganism- they destroy
microorganism by RESPIRATORY BURST
 often times in the process of destroying the
organism- they also destroy the
surrounding tissues
Disorders of Granulocytes & Monocytes
• Qualitative
– Chemotaxis (cell mobilization and migration)
– Phagocytosis
– Killing and digestion
-rare
• Morphologic abnormalities
• Quantitative

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 *Part of post splenectomy syndrome

NEUTROPENIA

 phagocytose the organism

 form lysosymes – within the lysosymes the *if absolute neutrophil count is less than 1000- defer
respiratory burst primary occurs releasing chemotherapy
agents *drugs that commonly cause neutropenia-
antithyroid drugs- methymazole tapazolePTU

Clinical Features of Severe Neutropenia

• associated with
infections of mouth
and throat : painful
ulceration
• skin and anus maybe affected
• septicemia

EOSINOPHILIA

QUANTITATIVE ABNORMALITIES

NEUTROPHILIA
 Bacterial infection
 Inflammation and tissue necrosis
 Metabolic disorders
 Neoplasms
 Acute hemorrhage and hemolysis
 Drugs (steroids; lithium; tetracycline) *absolute eosinophil count- greater then 500
 Myeloproliferative disorders *causes of eosinophilia are quite difficult to find
 Treatment with myeloid growth factors *increase in myoproliferative disorders
* increase in eosinophils- unknown clinical
 Rare inherited disorders
significance
 Asplenia More significant if increased than low

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BASOPHILIA
-More significant if increased than low

LYMPHOCYTOSIS

-chronic lymphocytic leukemia- defined as

monoclonal lymphocytosis of greater than 5000

MONOCYTOSIS

- chronic bacterial infection

 Eg chronic TB
LEUKOERYTHROBLASTIC REACTION

-important changes in the peripheral blood smear

Increase in white cell with a shift to the left in the
differential count
-shift to the left- immature cells
-accompanied by presence of nucleated RBC
-Presence of tear drop cells- suspect primary
myelofibrosis

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