Blood cells Disorders Leucocytosis: Neutophilia: Dr. Rania Alhady A raised WBCs count. Due to elevation of a single lineage. Neutophilia: Physiologic causes: Pregnancy, newborns, after parturition or after exercise. Pathological causes: 1- Infections: pyogenic bacteria. 2- Neoplasia: all types. 3- Hge / haemolysis. 4- Corticosteroids. Dr. Rania Alhady

Leucocytosis Dr. Rania Alhady Left shift: A "left shift" refers to the presence of increased proportions of younger, less well differentiated neutrophils and neutrophil-precursor cells in the blood. A severe neutrophilia with left shift is referred to as a leukemoid reaction. Neutophilia may be associated with the presence of toxic granulations and Dohle bodies. Dr. Rania Alhady

Leucocytosis Eosinophilia: Dr. Rania Alhady Eosinophilia is a condition in which the eosinophil count in the peripheral blood exceeds 450/ cm in P.B. Causes: 1- Allergic disorders Asthma Drug allergies Allergic skin diseases 2- Parasitic infections 3- Some forms of malignancy Hodgkin's lymphoma Some forms of Non-Hodgkin lymphoma 3- Systemic autoimmune diseases (e.g. SLE) Dr. Rania Alhady

Leucocytosis Monocytosis: Basophilia: Dr. Rania Alhady An increase in the number of monocytes circulating in the blood Causes: Chronic inflammation: tuberculosis, syphilis and malaria Blood and immune causes: Myeloproliferative disorders. Malignancies: Certain leukaemias, such as chronic myelomonocytic leukaemia (CMML) and monocytic leukemia. Basophilia: Infections: Pox virus (chicken pox, small pox) Neoplasia: MPD (myeloproloferative disorders). Dr. Rania Alhady

Leucocytosis Lymphocytosis: Dr. Rania Alhady Increase in the number or proportion of lymphocytes in the blood. Causes: 1. Infections: Acute viral infections: infectious mononucleosis (glandular fever), hepatitis, herpes virus, and Cytomegalovirus infection Acute bacterial infections: T.B., scarlet fever, typhoid fever. Protozoal infections: toxoplasmosis and malaria Chronic lymphocytic leukemia (CLL). Acute lymphoblastic leukemia (ALL). Lymphocytosis, peripheral blood smear Dr. Rania Alhady

Leucopenia Leucopenia: Neutropenia: Dr. Rania Alhady Classification: Reduced total leucocytic count. Neutropenia: Reduced neutrophil count < 2000 / cm Classification: Classify the severity of neutropenia based on the absolute neutrophil count (ANC) measured in cells per microliter of blood: Mild neutropenia: minimal risk of infection Moderate neutropenia: moderate risk of infection Severe neutropenia: severe risk of infection. Signs and symptoms Neutropenia can go undetected, but is generally discovered when a patient has developed severe infections or sepsis. Fevers and frequent infections. These infections can result in conditions such as mouth ulcers, diarrhea, a burning sensation during urinating, or a sore throat. Dr. Rania Alhady

Leucopenia Dr. Rania Alhady Causes of Neutropenia: Causes can be divided into the following groups: Decreased production in the bone marrow due to: Aplastic anemia Cancer, particularly blood cancers Certain medications Radiation Blood film with a striking absence of neutrophils, Increased destruction: leaving only red blood cells and platelets Autoimmune neutropenia: (occur with: SLE, R.A., Hodgkin disease, Felty syndrome) {Felty syndrome: R.A., splenomegally, prominent neutropenia, lymphopenia} Chemotherapy treatments, such as for cancer and autoimmune diseases Dr. Rania Alhady

Leucopenia Dr. Rania Alhady Drugs induced neutopenia: Medications are very common cause of neutropenia. such a Flecainide (anti-arrhythmic drug) Once drugs stopped, neutrophil recovery in 4 -7 days occur provided that precursors cells are normal. Congenital neutropenia syndromes: 1- Kostmann‘s Syndrome: Severe chronic neutropenia with frequent pyogenic infections. Eosinophil and basophils are normal or increased. Progression of leukemia (Very poor prognosis) Marrow transplantation may be curative. Dr. Rania Alhady

Leucopenia Dr. Rania Alhady 2-Chediak-Higashi Syndrome: Oculocutaneous albinism Photophobia Sun sensitivity Neuropathy Recurrent Infections, esp Staph aureus Granules in granulocytes, monocytes and lymphocytes Treatment: BMT 3- Reticular Dysgenesis: Thymic aplasia. Inability to produce neutrophil. Patient die at early age from bacterial and viral infections. BMT should be considered Dr. Rania Alhady

Thrombocytopenia Thrombocytopenia or thrombopenia: Dr. Rania Alhady is a relative decrease of platelets in blood Symptoms and signs: Bruising, particularly purpura in the forearms, petechia (pinpoint hemorrhages on skin and mucous membranes), nosebleeds and/or bleeding gums. PURPURA Defined as: - A purplish discoloration of the skin and mucous membrane due to subcutaneous and sub mucous extravasation of blood. - Purpura may be due to deficient and defective platelets or due to an unexplained increase in capillary fragility Dr. Rania Alhady

Thrombocytopenia Dr. Rania Alhady Causes: (I) Immune Thrombocytopenia: Increased platelets destruction: (I) Immune Thrombocytopenia: 1. Auto-Abs ITP (Immune Thrombocytopenic Purpura) 2ry to SLE & AIDS 2. Allo-Abs Post- transfusion Post- natal Post transplatation 3.Drug – induced: e.g. Quinin, sulphonamide Dr. Rania Alhady

Thrombocytopenia Dr. Rania Alhady (II) Non – Immune Thrombocytopenia: 1. Excess platelet consumption (DIC) 2. TTP- HUS 3. Sever burn or snake venom 4. Structural platelet defects (short life span) Immune thrombocytopenic purpura (ITP): Immune disorder characterized by: Thrombocytopenia. B.M.: normal with normal megakaryocytes in number, or even increased number with defective budding. Evidence of Abs against platelets Spleen in NOT enlarged. Dr. Rania Alhady

Thrombocytopenia Dr. Rania Alhady Childhood type Adulthood type Acute post infection Insidious Onset Spontanous remission No spontaneous remission Remission Just palpable spleen(normal for age) No enlarged spleen Spleen Minimal bl. Loss. Good health. Purpura, Epistaxis, menorrehia. Clinical Picture The same+Atypical lymphocytes Eosinophilia Decreased plat. No. Normal WBC Laboratory P.B. Prolonged B.T. The same+ eosinophilia Increased megas & immature forms B.M. Dr. Rania Alhady

Thrombocytopenia Dr. Rania Alhady Thrombotic Thrombocytopenic Purpura. Hemolytic – Uremic Syndrome: 1. Idiopathic TTP-HUS: A syndrome characterized by: 1. Neurological abnormalities 2. Thrombocytopenia 3. Microangiopathic hemolytic anemia 4. Renal involvement 5. Fever 2. 2ry TTP-HUS: Causes: 1. Pregnancy 2. Cancer assiociated 3. Drugs e.g. Cyclosporin 4. Marrow Transplantation Dr. Rania Alhady