Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan

1. Course title : Hematology (1) • Course code : MLHE-201 • Supervisor : Prof.DrMagda 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

25. 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