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Pathology of WBC Disorders

Note this is at basic level for 2nd year medical students & Allied Health students.

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Pathology of WBC Disorders

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  1. Pathology of WBC Disorders Aspire to become good, not great....Greatness is like a passing cloud,temporary.- Sai Baba - Divine Discourse, July 16, 2001.

  2. Pathology ofWBC disordersDr. Shashidhar Venkatesh MurthyA/Prof. & Head of Pathology2013: MB2-HRM-Week 7 Pathology ofWBC disordersDr. Shashidhar Venkatesh MurthyA/Prof. & Head of Pathology2013: MB2-HRM-Week 7

  3. HRM-Wk7: Fever, bleeding & Back pain Mr M.S. 45y, man. Presents to ED: “Verybad lower back pain, nothing helping it”. History:• Feels unwell? - Very• Fever? Yes, I think so; intermittent• Easy bruising -Yes, bruises last few weeks. Examination:• Slim, unwell, pale, Multiple Bruises• Liver & Spleen enlarged – mild.• Lymph nodes enlarged neck & axilla. HRM-Wk7: Fever, bleeding & Back pain Mr M.S. 45y, man. Presents to ED: “Verybad lower back pain, nothing helping it”. History:• Feels unwell? - Very• Fever? Yes, I think so; intermittent• Easy bruising -Yes, bruises last few weeks. Examination:• Slim, unwell, pale, Multiple Bruises• Liver & Spleen enlarged – mild.• Lymph nodes enlarged neck & axilla.

  4. Learning Objectives: WBC in health & disease - overview. Classification & Common WBC disorders. Congenital, Reactive & Cancer. Clinical features. Pathogenesis Laboratory diagnosis Blood morphology• Features (3-4).• Line diagram. Management - brief.TOP 10 WBC Disorders:• Leukopenia:1. Neutropenia2. Lymphopenia.3. Pancytopenia• Leucocytosis:4. Neutrophilia5. Eosinophilia6. Lymphocytosis – IM7. Lymphadenitis.• Neoplastic disorders (cancer)9. Lymphoma10. Leukemia (AML/ALL,CML/CLL) Learning Objectives: WBC in health & disease - overview. Classification & Common WBC disorders. Congenital, Reactive & Cancer. Clinical features. Pathogenesis Laboratory diagnosis Blood morphology• Features (3-4).• Line diagram. Management - brief.TOP 10 WBC Disorders:• Leukopenia:1. Neutropenia2. Lymphopenia.3. Pancytopenia• Leucocytosis:4. Neutrophilia5. Eosinophilia6. Lymphocytosis – IM7. Lymphadenitis.• Neoplastic disorders (cancer)9. Lymphoma10. Leukemia (AML/ALL,CML/CLL)

  5. Teaching Plan & Staff: Introduction to WBC disorders:• Shashidhar Venkatesh Murthy. Clinical Cases: GLS 1st hour.• Ian Irving, Haematologist, TSVH. Microscopy Tutorial: GLS 2nd hour.• Shashidhar Venkatesh Murthy. Synthesis Session: Keepad Q&A disc.• Shashidhar Venkatesh Murthy.Mon9amTue1pmTue2pmThu1pm Teaching Plan & Staff: Introduction to WBC disorders:• Shashidhar Venkatesh Murthy. Clinical Cases: GLS 1st hour.• Ian Irving, Haematologist, TSVH. Microscopy Tutorial: GLS 2nd hour.• Shashidhar Venkatesh Murthy. Synthesis Session: Keepad Q&A disc.• Shashidhar Venkatesh Murthy.Mon9amTue1pmTue2pmThu1pm

  6. GLS SESSION

  7. 8y child with Asthma & multiple scaly skin lesions.Image shows blood film appearance. ? Cause1. Viral Infection2. Allergic reaction3. Malaria.4. Bacterial infection.5. Fungal infection.1 2 3 4 50 0 000SYNTHESIS SESSION 8y child with Asthma & multiple scaly skin lesions.Image shows blood film appearance. ? Cause1. Viral Infection2. Allergic reaction3. Malaria.4. Bacterial infection.5. Fungal infection.1 2 3 4 50 0 000SYNTHESIS SESSION

  8. I am here for you….Email: venkatesh.shashidhar@jcu.edu.auvmshashi@gmail.comNeed personal guidance? Email me for an appointment.Office Tel: 4781 4566Office location – MS136Emergency?(exam time) Mob: 0416 933 704 I am here for you….Email: venkatesh.shashidhar@jcu.edu.auvmshashi@gmail.comNeed personal guidance? Email me for an appointment.Office Tel: 4781 4566Office location – MS136Emergency?(exam time) Mob: 0416 933 704

  9. Small minds discuss peopleAverage minds discuss eventsGreat minds discuss solutionGenius silently acts! Small minds discuss peopleAverage minds discuss eventsGreat minds discuss solutionGenius silently acts!

  10. . 10Normal Blood Cells:NeutrophilBasophilEosinophilLymphocyteNon granular, MononuclearsSpecific ImmunityGranulocytes, PolymorphsNon-Specific Immunity

  11. . Normal WBC Production:

  12. . Normal Granulopoiesis: CSFStimulatebone marrowto produceWBC.What are the Clinical applications of G-CSF?

  13. . Lab: CBC - WBC Histogram:AbsoluteCount% / Differential Count

  14. . WBC Absolute counts in disease:Penia PhiliaNeutroPenia PhiliaEosinoPenia cytosisMonoPenia cytosisLympho

  15. . Leukopenia: Neutropenia Reduction in granulocytes:• Decreased Production – Marrow.• Increased destruction – drugs, immune When severe – Agranulocytosis. Clinical features:• Infections – chills, fever, fatigue, ulcers.

  16. . Leukocytosis: Neutrophilia Increased granulocytes:• Acute inflammation, Bacterial infections. When severe – Leukemoid reaction. Clinical features:• Infections or Trauma - fever, fatigue.

  17. . Lymphocytosis: Infectious Mononucleosis Increased Lymphocytes:• Chronic Inflam, Viral, fungal, TB etc. Large lymphocytes, more cytoplasm. Irregular,indented by RBC – also known as virocyte Clinical features: Chronic fever, lymphadenopathy.

  18. . Neutrophilia:Acute inflammation (Bacterial, trauma, immune, etc)

  19. . Toxic Granulation & Left shift:Acute inflammation Bacterial, trauma, immune, etcBand forms & Phagocytic granules in cytoplasm

  20. . Leukemoid Reaction: Marked increase inneutrophils. >50,000 x109 Shift to left  immatureforms. Severe infection, trauma,bone marrow infiltration. Looks like leukemia*(no blasts)

  21. . Your failure may prove to bean asset, provided you try toknow why you failed !--Napoleon Hill

  22. . Lymphadenitis: Reactive. Acute or Chronic. Infections, Immune & Cancers. Increased large irregular lymphoid follicleswith normal archetecture. (mantle zone). Lymphadenitis: Enlarged lymphnodes dueto inflammation or infecitons. Painful. Lymphadenopathy – any enlargement, butcommonly used for Cancers – Painless.

  23. . Reactive lymphadenitisDark zoneLight zoneMantle zoneMacrophageTingible bodyMacrophage

  24. . Hemato-oncology: Blood Cancer Cancer of blood forming – stem cells (Blasts). Leukemia – ‘White’ ‘blood’ – excess WBC. Starts in bone marrow or lymphatic tissue. Spread to blood & other ‘RES’ tissues only.(Liver, Spleen & lymphnodes) Two Major types: Myeloid & Lymphoid. Two clinical presentaiton: Acute / Chronic. Many subtypes* – due to several differentmutations – personalized medicine *

  25. . The goal of mankind is knowledge, whichis inherent in man. No knowledge comesfrom outside: it is all inside. What manlearns is really what he “discovers” bytaking the cover off his own soul.- - Swami Vivekananda„Education‟… from Eduse (latin) to bring out..!„Doctor‟ … from Dokere‟ (latin) to teach…!

  26. . LymphoblastLeukemia: Cancer of Blast cells.AcuteMyeloidLeukemiaAcute Lymphatic LeukemiaChronic LeukemiaChronic Leukemia

  27. . Normal – Acute - Chronic LeukNormalChronic Myeloid LeukemiaAcute Myeloid Leukemia

  28. . Hematologic Neoplasms: Classification Leukemias: Bone marrow, blood, Blasts• Duration: Acute/Chronic• Cell of Origin: Myeloid/Lymphoid• AML / ALL & CML / CLL Lymphomas: – Lymph nodes, tumor• Hodgkins & Non-Hodgkins. Premalignant conditions:• Myeloproliferative syndromes (MPS)• Myelodysplastic syndromes (MDS)

  29. . Leukemia: Clinical Features Cancer of Bone marrow – Excess blasts. Decreased Haemopoiesis:• Erythropoiesis – Anemia - RBC• Leukopoiesis – Infections - WBC• Thrombopoiesis – Bleeding. PLT Bone marrow expansion/destruction:• Bone pains. Extraneous hemopoiesis / spread:• Splenomegaly• Hepatomegaly• Lymphadenopathy. (more in lymphatic malignancy)

  30. . Leukemia Clinical features:Bleeding - PetechiaeLymphadenopathyHepatosplenomegalyInfections - Candidiasis

  31. . Leukemia Classification Acute Leukemias: weeks to months.• Acute Myeloid Leukemia – AML - Adults• Many Subtypes: M0, M1 to M7• Acute Lymphoid Leukemia – ALL - Children• Many Subtypes: L1, L2 & L3 Chronic Leukemias: Years.• Chronic Myeloid Leukemia- CML- Adults• Chronic Lymphoid Leukemia - CLL –Old age• Many subtypes:

  32. . ALL - AML

  33. . Acute Leukemia: AML/ALL - BlastsNorm. LymphocyteBlastBlastNorm. RBCNorm. LymphocyteNorm. RBCBlastNormal

  34. . Self-pity is an opiate!--Napoleon Hill

  35. . Lymphoma Definition: Tumour of lymphoid tissue Etiology: Idiopathic, Genetic, Infective. Clinical: Lymphadenopathy, weight loss, Fever. Two Major Types: & many subtypes. Hodgkins lymphoma (HL) – RS cells. Non-Hodgkins lymphoma (NHL) – no RS cells.• B cell, T cell & Histiocytic lymphoma.

  36. . Lymphoma Row of enlarged lymph nodes

  37. . Hodgkins LymphomaBig binucleate cancer cells known asReed Sternberg Cells (RS cells)

  38. . Non-Hodgkins Lymphoma: Large group of lymphatic neoplasms. Clinical: Fever, anemia, infections,Lymphadenopathy. Spleen+/-. No RS cells or eosinophilia Complex names and classification.• Cell type – B, T & Histiocytic “B commonest”• Clinical – low, intermediate & high grade.• Histology – Follicular & diffuse.• Special types: Burkitts lymphoma, Myeloma,Waldenstroms macroglobulinemia, lennert‟s,

  39. . Non Hodgkins LymphomaLow, Intermediate & High grade.

  40. . Burkitt‟s lymphoma: large B cell NHL Endemic in Africa Epstein Barr Virus(EBV) B Cell Lymphoma. Dark large Blymphocytes (malignant)with plenty of palemacrophages. (Starrysky pattern).

  41. . Multiple Myeloma: Malignancy of Plasma cells(Mature B lymph, Ab) Old age, males common. Marrow, LN, Blood. Multiple, punched out Lytic bonelesions (Osteolysis) Hyper gammaglobulinemia Monoclonal antibody peak –serum protein electrophoresis. Immunodeficiency  infections.

  42. . "Creativity is inventing,experimenting, growing, takingrisks, breaking rules, makingmistakes, and having fun.-- Mary Lou Cook

  43. . Myeloproliferative Disorders.Myelodysplastic Syndromes.(Precanceraous stage of blood cancers)

  44. . Myelo Proliferative Disorders: Excess Proliferation, Neoplastic, Old age. Organomegaly – Liver & Spleen enlarged. Hypercellular BM & Leukocytosis. 4 types:• Excess RBC (polycythemia vera)• Excess WBC (CML)• Excess Plt (Essential Thrombocythemia)• Excess Fibroblast (Myelofibrosis). Mixed types common, end in leukemia.

  45. . Polycythemia Rubra Vera (PV)Hypercellular Marrow,Red skin & Hepatosplenomegaly

  46. . ET - Blood Film & clinical.Plenty ofPlateletsMegakaryocyte

  47. . Myelo Dysplastic Syndromes: Dysplastic Proliferation (abnormal cells) Neoplastic, old age, unexplained anemia. Abnormal cells destroyed in bone marrow. Hypercellular BM & Leukopenia, anemia. Commonly known as Refractory Anemia. Many subtypes, Mild to severe dysplasia. Increasing blasts – poor prognosis. Transforms to acute leukemia.

  48. . Summary: Reactive Leukocytosis.• Neutrophilia, Eosinophilia, Lymphocytosis. Reactive Leukopenia.• Neutropenia, lymphopenia. Leukemias – Cancer of Blasts.• AML/ALL, CML/CLL Lymphomas – Tumors of lymphoid tissue• Hodgkins & Non- Hodgkins (HL, NHL) Premalignant conditions• MPS & MDS:

  49. . 3 R’s of success:Respect for self,Respect for others &Responsibility for your actions.

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