INTRODUCTION.

The five types of leucocytes found in peripheral blood are;

neutrophils, eosinophils and basophils (which are all called
granulocytes) and lymphocytes and monocytes (which are called
agranulocytes).

Disorders can be classified as; leucopenia (Low white cell count) and
leukocytosis (high white cell count)
Eosinophil Basophil Neutrophil Lymphocyte

Monocyte
 LEUCOPENIA

This can occur either in all the white cell lineages or a single cell
lineage usually neutropenia and lymphocytopenia.
It can occur in isolation or in combination in reduction of all the 3
hematological lineages i.e. pancytopenia.
 NEUTROPENIA.
Neutropenia is defined as a circulatory neutrophil count below
1.5109/l.
A virtual absence of neutrophils is called agranulocytosis.
 Causes
Infection: viral, bacterial (e.G. Salmonella), protozoal (e.G. Malaria)
Drugs e.g. Sulphonamides, carbimazole, phenytoin, cimetidine,
ranitidine, chlorpropamide, zidovudine .
Autoimmune: connective tissue disease
Alcohol
Bone marrow infiltration: leukemia, myelodysplasia
Congenital: Kostmanns syndrome
 CLINICAL MANIFESTATIONS
Ranges from being asymptomatic to a life threatening
septicemia.
A neutropenia <0.5x109/L is a risk to bacterial infection;
Fever is the first and often only manifestation of infection.
A sore throat, perianal pain or skin inflammation may be
present.
 INVESTIGATIONS
The blood film shows marked neutropenia.
The appearance of the bone marrow will indicate whether the
neutropenia is due to depressed production or increased
destruction of neutrophils.
Neutrophil antibody studies are performed if an immune
mechanism is suspected.
 TREATMENT
Antibiotics should be given as necessary to patients with acute
severe neutropenia.
If the neutropenia seems likely to have been caused by a drug, all
current drug therapy should be stopped. Recovery of the neutrophil
count usually occurs after about 10 days.
G-CSF is used to decrease the period of neutropenia after
chemotherapy and hemopoietic transplantation.
Steroids and high-dose intravenous immunoglobulin are used to
treat patients with severe autoimmune neutropenia and recurrent
infections.
 LYMPHOPENIA
This is an absolute lymphocyte count of less than 1 109/L .
Although minor reductions may be asymptomatic, deficiencies in
cell-mediated immunity may result in infections (with organisms
such as fungi, viruses and mycobacteria) and a propensity to
lymphoid and other malignancies (particularly those associated with
viral infections such as EBV, HPV, HHV-8)
Causes
Inflammation: connective tissue disease
Lymphoma
Renal failure
Sarcoidosis
Drugs: corticosteroids, cytotoxics
Congenital: severe combined immunodeficiency
HIV infection
 LEUKOCYTOSIS
This is an increase in the total number of circulating WBCs in the
body.
Usually due to increase in a specific cell type.
An increase in a single type of white cell (e.g. Eosinophils) may not
increase the total white cell count above the upper limit of normal
and will only be apparent if the differential of the white count is
examined
 NEUTROPHILIA/NEUTROPHIL LEUKOCYTOSIS
A rise in the number of circulating neutrophils to >10109/L.
It can result from an increased production of cells from the bone
marrow or redistribution from the marginated pool.
The normal neutrophil count depends upon age, race and certain
physiological parameters.
With any tissue necrosis there is a release of various soluble factors,
causing a leukocytosis.
Interleukin 1 is also released in tissue necrosis and causes a
pyrexia.
The pyrexia and leucocytosis accompanying a myocardial
infarction are a good example of this and may be wrongly attributed
to infection
A leukemoid reaction (an overproduction of white cells, with many
immature cells) may occur in severe infections, tuberculosis,
malignant infiltration of the bone marrow and occasionally after
haemorrhage or hemolysis.
In leucoerythroblastic anaemia, nucleated red cells and white cell
precursors are found in the peripheral blood.
Causes include marrow infiltration with metastatic carcinoma,
myelofibrosis, osteopetrosis, myeloma, lymphoma
Causes
Infection: bacterial, fungal
Trauma: surgery, burns
Infarction: myocardial infarct, pulmonary embolus, sickle-cell
Crisis
Inflammation: gout, rheumatoid arthritis, ulcerative colitis, Crohns
disease
Malignancy: solid tumours, Hodgkin lymphoma
Myeloproliferative disease: polycythemia, chronic myeloid
Leukemia
Physiological: exercise, pregnancy
Drugs e.g. corticosteroids.
 EOSINOPHILIA
A high eosinophil count of more than 0.5 109/L.
Is usually short lived.
Eosinophil infiltration can damage many organs (e.g. Heart, lungs,
gastrointestinal tract, skin, musculoskeletal system); therefore
evaluation of eosinophilia includes not only the identification of any
underlying cause and its appropriate treatment, but also assessment
of any related organ damage.
 In primary eosinophilia, the levels of eosinophils are persistently
raised e.g. in Myeloproliferative disorders.

Causes.
Allergy: hay fever, asthma, eczema
Infection: parasitic
Drug hypersensitivity: e.G. Gold, sulphonamides
Vasculitis, e.g. ChurgStrauss syndrome, granulomatosis with
polyangiitis (Wegeners granulomatosis)
Malignancy: solid tumours, Hodgkins lymphomas
Primary bone marrow disorders: myeloproliferative disorders,
Hypereosinophilic syndrome (HES), acute myeloid leukemia.
Miscellaneous, such as: hypereosinophilic syndrome sarcoidosis
hypoadrenalism eosinophilic gastroenteritis
 BASOPHILIA
Basophils are usually <1x109/L.
Causes.
Myeloproliferative disease: polycythaemia, chronic myeloid
leukaemia
Inflammation: acute hypersensitivity, ulcerative colitis, crohns
disease
Iron deficiency
 MONOOCYTOSIS
These are levels of monocytes >0.8x109/L.
Causes.
Infection: bacterial (e.G. Tuberculosis, Infective endocarditis)
Inflammation: connective tissue disease, ulcerative colitis, Crohns
disease
Malignancy: solid tumours, chronic myelomonocytic leukaemia
Chronic neutropenia
 LYMPHOCYTOSIS
Lymphocyte count > 5x109/L.
Causes.
Infection: viral (EBV, CMV AND HIV )bacterial (e.G. Bordetella
pertussis) and also chronic infections due to TB and toxoplasmosis.
Lymphoproliferative disease: chronic lymphocytic leukaemia,
Lymphoma
Post-splenectomy