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

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

3. White Blood Cell Disorders

4. White Cell Maturation

7. Leucocytes (white blood cells) Phagocytes - Granulocytes.Neutrophils.Eosinophils.Basophils - Mononuclear phagocytic cells.Monocytes Lymphocytes - B cells & T cells

8. PB Neutrophils

9. PB Staff

10. PB Basophils

11. PB Eosinophils

12. PB Monocytes

13. PB Lymphocytes

14. White Blood Cell Disorders Classification : -Disorders of cell number Terminology:.cytosis/philia (increase in number).cytopenia (decrease in number) -Disorders of function & morphology

15. Normal Total Leucocytic Count For an adult ( male or female) Normal reference range: 4,000 – 11,000 / cmm

16. 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.

17. 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

18. Disorders of Cell Number Leucocytosis : an increased number of leucocytes in the peripheral blood >11,000 /cmm Leucopenia : a reduced white cell count ( < 4,000 /cmm )

19. Leucocytosis Causes : - Neutrophilia ( commonest cause ). - Eosinophilia. - Basophilia. - Lymphocytosis. - Monocytosis.

20. Neutrophilia Definition : Increase in the number of neutophils and/or its precursors > 7,000/cmm

21. 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.

22. Causes of Neutrophilia (cont.) Chronic granulocytic leukaemia Other myeloproliferative disorders Diagnosis : Low LAP score. Philadelphia chromosome.

23. PB Neutrophilia

24. Left Shift

26. High LAP Score

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

28. Causes of Eosinophilia Allergy Atopic,drug sensitivity & pulmonary eosinophilia. Infections Parasites,recovery from infection Malignancy Hodgkin’s disease, NHL & MPD Skin disorder Drugs GIT disorders Hypereosinophilic syndrome

29. Eosinophilia

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

31. Basophilia

32. Lymphocytosis Definition : An increase above normal in the number of circulating lymphocytes ( > 4,000/cmm)

33. 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

34. Lymphocytosis

35. 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.

36. Infectious Mononucleosis

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

38. Causes of Monocytosis Chronic bacterial infections : tuberculosis,bacterial endocarditis, brucellosis. Other infections :malaria,Kala-azar, trypanosomiasis,typhus…….. Hodgkin’s disease. Monocytic & myelomonocytic leukaemia

39. Monocytosis

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

41. 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

42. Causes of Leucopenia(cont.) Megaloblastic anaemia Hypersplenism Leucoerythroblastic anaemia(Multiple Myeloma,metastatic carcinoma….) Acute leukaemia Myelodysplasia Aplastic anaemia

43. Causes of Leucopenia(cont.) Cyclical neutropenia Chronic idiopathic neutropenias Paroxysmal nocturnal hemoglobinuria Ionizing radiation & cytotoxic drugs Miscellaneous conditions : myxoedema,anaphylactoid shock, hypopituitarism & SLE

44. Student name : Title :

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

46. Assignement :Student name : Quantitative white cell disorders.حميد عبد الاله حميد مجيد دعاء السعيد رشاد قطب دينا داود وليم داود دينا عبد الرافع عبد الرازق رامي رافت لطفي عيسي رانيا محمد احمد الشرقاوي رحاب سعد محمد قمري رحاب محمود شاكر محمدين رحمه مسعد عبد اللطيف غنيم رشاد ابراهيم رشاد عبد الله فراج Eosinophils. رضوي محمد محمود ابراهيم درويش رنا فتحي ابراهيم محمد الزمراني روزاليين راوبين يعقوب فرج ريهام السيد فريج النحراوي ريهام سامي كمال الحناوي ريهام مصباح علي محمد بركه زيد ليث نصيف جاسم ساره ربيع عسران يوسف سامح زكريا عباس ياسين سامر محمد احمد عمران