1. Leukocytosis. Leukopenia.
The State Education Institution of Higher Professional Training
The First Sechenov Moscow State Medical University
under Ministry of Health of the Russian Federation
 Department of Pathophysiology
Leukocytosis. Leukopenia.
Lecture presentation
Professor Pirozhkov S.V.
education year

2. Pluripotent stem cell of hematopoiesis
Scheme of hematopoiesis
Lymphocyte
Lymphoid stem cell
Erythrocyte
Erythroblast
CFU eryth.
Pluripotent stem cell of hematopoiesis
Myeloblast
Neutrophil
CFU g/m
Monoblast
Мonocyte
Myeloid stem cell
CFU eosin.
Eosinoblast
Eosinophil
CFU basoph.
Basophiloblast
Basophil
Platelets
CFU mega.
Megakaryoblast
Megakaryocyte

3. Stages of neutrophilic myelopoiesis
Cell Stage Characteristics
Myeloblast The nucleus with the nucleoli
Large cell,
primary granules appear
Promyelocyte
Myelocyte Secondary granules
appear
Metamyelocyte Bean-like nucleus
Band Condensed
neutrophil band-like nucleus
Segmented Condensed
neutrophil segmented nucleus

4. Composition of granules in neutrophils
■ Primary (azurophil) granules:
myeloperoxidase
lyzozyme
cationic protein
acid hydrolase
elastase
nonspecific collagenase
defensines
cathepsin G
phospholipase А2
■ Secondary (specific) granules:
lactoferrin
alkaline phosphotase
collagenase type IV
leukocyte adhesive molecules
plasminogen activator AG

5. Functional disorders of leukocytes
DISORDERS OF THE LEUKOCYTE SYSTEM
QUANTITATIVE
QUALITATIVE
Leukocytosis
Leukopenia
Functional disorders of leukocytes
> 9*109 cells/L of blood
< 4*109 cells/L of blood
Nuclear shifts

6. Types of leukocytosis based on their biological significance
Physiological
Pathological
Protective/adaptive
Functional

7. Leukocytosis MECHANISMS OF LEUKOCYTOSIS
Mobilization from the marginal pool in the vessels (demargination)
Increased mobilization from the bone marrow pool
Stimulation of leukopoiesis
Hemoconcentration
“True” leukocytosis
“False” leukocytosis

8. Causes of the stimulation of hematopoiesis
● Infection causes by:
bacteria
fungi
viruses (less commonly)
● Inflammatory process:
burns
acute myocardial infarction
allergy
vasculitis
● Myeloproliferative diseases

9. Types of nuclear shift to the left
◙ Hyporegenerative:
increase in band neutrophils in the peripheral
blood > 6%
slight leukocytosis in the range of 10-11*109/l
◙ Regenerative:
increase in band neutrophils and emergence of metamyelocites
moderate leukocytosis in the range of 13-18*109/l
◙ Hyperregenerative:
considerable increase in band neutrophils, large amount of metamyelocytes, emergence of myelocytes
leukocytosis in the range of 20-25*109/l

10. Causes of increased mobilization of leukocytes from the marginal pool in the vessels (demargination)
► Use of medicines:
epinephrine
glucocorticoids
non-steroidal untiinflammatory drugs
► Psychological and physical stress
►Hereditary deficit of adhesive molecules on the surface of leukocytes

11. Basophilia - > 0.2*109 basophils/l of blood
● occurs rarely, usually indicates the presence of myeloproliferative disease
Monocytosis > 1*109 monocytes/l of blood
● chronic infection (tuberculosis etc.)
● bacterial endocarditis
● rickettsiosis, malaria
● vasculitis (SLE etc.)
● inflammatory diseases of the intestine (ulcerative colitis)
Lymphocytosis > 4*109 lymphocytes/l of blood
● accompanies monocytosis in many diseases associated with chronic stimulation of the immune system (tuberculosis, brucellosis etc.)
● viral infections (HAV, Epstein-Barr virus, cytomegalovirus)

12. Leukopenia МECHANISMS OF LEUKOPENIA
Intense destruction of leukocytes in the circulation or hematopoietic organs
Redistribution in the vessels
Impairment of leukopoiesis
Hemodilution
Increased utilization of leukocytes or loss in the external media
“False” leukopenia
“True” leukopenia

13. Manifestations and negative consequences of neutropenia
● Malaise, fever
● Weakness, fatigue
● Severe infections (when the leukocytes counts < 0.5*109/l)
● Ulcerative-necrotic lesions of the mucous membrane of the gingivae, oral cavity and pharynx (agranulocytic pharyngitis)
● Skin infection – small superficial pyogenic abscesses (furunculosis), bacterial invasion of the dermis (cellulitis)

14. Disorders of the function of granulocytes/monocytes:
Abnormal adhesion/aggregation
Abnormal microbicidal activity, processing and presentation of antigens
Abnormal chemokinesis/chemotaxis or ability to change shape (deformability)