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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.

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Leukocytosis. Leukopenia.

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  1. 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. 2015-2016 education year

  2. Scheme of hematopoiesis Lymphocyte Lymphoid stem cell Erythrocyte Erythroblast CFUeryth. Pluripotent stem cell of hematopoiesis Myeloblast Neutrophil CFUg/m Monoblast Мonocyte Myeloid stem cell CFUeosin. Eosinoblast Eosinophil CFUbasoph. Basophiloblast Basophil Platelets CFUmega. 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. AG Composition of granules in neutrophils ■Primary (azurophil) granules: • myeloperoxidase • lyzozyme • cationicprotein • acid hydrolase • elastase • nonspecific collagenase • defensines • cathepsin G • phospholipase А2 ■Secondary (specific)granules: • lactoferrin • lyzozyme • alkaline phosphotase • collagenase typeIV • leukocyte adhesive molecules • plasminogen activator • phospholipase А2

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

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

  7. MECHANISMS OF LEUKOCYTOSIS Leukocytosis Mobilization from themarginal pool in the vessels (demargination) Increased mobilization fromthe bone marrow pool Stimulationof 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% • slightleukocytosisin the range of 10-11*109/l ◙Regenerative: • increase in band neutrophils and emergence of metamyelocites • moderate leukocytosisin the range of 13-18*109/l ◙Hyperregenerative: • considerable increase in band neutrophils, large amount of metamyelocytes, emergence of myelocytes • leukocytosisin 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-steroidaluntiinflammatory drugs ►Psychological and physical stress ►Hereditary deficitof adhesive molecules on the surface of leukocytes

  11. Basophilia->0.2*109 basophils/lof 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 diseasesof the intestine (ulcerativecolitis) Lymphocytosis->4*109 lymphocytes/lof blood ● accompanies monocytosis in many diseases associated with chronic stimulation of the immune system (tuberculosis, brucellosisetc.) ● viral infections (HAV, Epstein-Barr virus, cytomegalovirus)

  12. МECHANISMS OF LEUKOPENIA Leukopenia Intense destructionof leukocytes in the circulationor 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 andpharynx(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 abilityto change shape (deformability)

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