White Blood Cell pathology Case 1 A 23 year old patient was admitted to the clinic with the following

complaints: progressive weakness , fever accompanied by chill , severe sweating , sore throat, painful swallowing .On examination :expressed pallor of the skin , the mucous linings are yellowish, there are multiple skin hemorrhages all over the body in the form of petechiae and acchymoses . There are necrotic ulcerative processes in the gum and floor mouth mucosa , moderate enlargement of the liver ,lien and some peripheral lymph nodes. Blood picture :Hb -60g/l, Er -2.0x 109 /L, Ret -0.2 % , Leu-8.0 x 109 /L, RES -40 mm/h, Leuk. Diff .count (%): blasts -89,bas -0, eos-0 ,neutr: myel -0, metamyel -0,segm -5 ,lymph -5 , monoc -1.All cytochemical stain reactions of blast are negative. 1.What kind of blood pathology is described in this case? acute leucosis,low Hg,low erythrocytes,low blast,mechanism is ve 2. Give full explanation of your diagnosis. myelotoxic agranucytosis b'coz low level of thrombocytes,low lymphocytes n reactive lymphocytosis.....this related to...aplastic anemia--->drugs ,radiation,toxic agents 3. Explain the mechanism of clinical features in this patient. low level of neutrophil leads to neurotic stamotitis because of pneumorulosis.all stem cells inhibited>panscytopenia. 4. Why are stain cytochemical reactions negative in this case & what are they used for? because of hyperplasia;so more young cells that are not fully differentiated.

Case 2 A woman aged 29 is admitted to the clinic with the following complaints : nonproductive cough and ulceration of the gum mucosa. On examination : necrotic stomatitis and pneumonia are represented by poor symptoms : liver and spleen are not enlarged. There is petechial rash and several ecchymoses on her skin. Blood picture : Hb 180g/l, Er 3.6 x 10/l, Thro 49 x 109/l, Ret 0.1%, Leu 1.3 x 109/l, RES 28 mm/h. Leuk dif count (%) : bas 0,eos 0, neutr : metamyel 0, band 0, segm 21, lymp 78, monoc 6. In the blood smear : moderate anisocytosis and poikilocytosis. There are toxic granules in erythrocytes and the signs of nuclear pyknosis in leukocytes. There are no signs of lymphoid infiltration in the bone marrow aspirate but somewhere hematopoietic cells are replaced by fat cells. Question 1. What disease does the patient have? Myelotoxic agranulocytosis Explain your diagnosis.

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low leukocytes count leukopenia low erythrocytes count hypoxia,anemia hemorrhage syndrome petechial rash and several ecchymoses found on skin nonproductive cough and ulceration of the gum mucosa necrotic stomatitis and pneumonia

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What are the pathogenetic mechanisms of the described necrotic stomatitis, pneumonia and hemorrhagic syndrome? necrotic stomatitis,pneumonia and hemorrhagic syndrome are due to poor leukocyte response therefore there is massive growth of microorganism in the body List the possible causes of this disease and its prognosis. Possible causes may be hereditary @ aquired ( radiation,x-ray,chemotherapy,virus ) Prognosis Case 3 A25 y/o woman comes to her doctor with d following complaints; attack of sneezing with profuse nose secretion, itching in d nose & eyes, profuse tear secretion & gripes in d eyes, photophobia. From history: similar conditions have been observed for last four years from the start of june to end of july. Blood picture: Hb- 140g/l, Er-4.2 x 1012/l, Thro- 250 x 109/l, Ret-0.7%, Leu-9 x 109/l. Leuk diff count (%): bas-0, eos-14, neut: metamyel-0, band-4, segm-0, lymph-7, monoc-5, RES-0mm/h.

1. Make a conclusion abt possible alterations in the describes blood pictures? Eosinophilia & lymphopenia 2. What is the diagnosis? Allergy to pollens. Bronchial asthma, hypersensitivity type 1.

3. What is mechanism of alterations in d blood & their pathogenetic role? Mast cell release eosinophils chemotactic factor (in response to hypersensitivity) Increase eosinophils Increase PGE2 Enzymes released to destroy mediators of mast cell& inhibition of its degranulation.

Case 4 46 yr old, male c/o: Weakness, sweating, pain in the left part of the abdomen, palpitation, dyspnea. From time to time felt a chill and his temp rose to 38-390 C Blood picture : Hb: 74.4g/l

RBC: 3.2x1012/l Thrombocytes: 60x109/l Reticulocytes: 0.3% Leukocytes: 430x109/l

Leukocytes differential count: bas: 6 eos: 9 myeloblasts: 4 promyelocytes: 7 neut: myel:17 meta myel: 23 band : 0 segmental : 13 lymph : 1 monocytes: 0 Blood smears: anisocytosis, poikilocytosis, and anisochromia of RBC. 1. What kind of blood pathology is described? Typical early; basophils & eosinophils Pathology: chronic myeloid leukemia, existence of myeloblast in peripheral blood. 2. Explain your diagnosis: In peripheral blood, we can see the existence of myeloblast (4). Temp increase = fever Habituate to infection - eosinophils-basophil association; aplasia of cells & doesnt function properly. 3. What are the mechanism of anemia and thrombocytopenia in this case? specific & non specific resistance to organism Hyperplasia of myeloid will inhibit other stem cells Pain in left part of abdomen= splenomegally

Case 5 A 24 year old patient was admitted to the clinic with the following complaints: Fatigue, easy tiredness, weakness, dizziness, heart palpitation, dyspnea at rest On examination: all the skin is pale, there is puffiness of the face and multiple hemorrhages all over the body. The spleen and liver are not enlarged Blood picture: Hb 50g/l, eryt 1.5 x 1012/l, thro 25x 109/l, ret 0%, leu 1.3 x 109/l, RES 34 mm/h Leuk dif count(%): bas 0, eos 0, neut: metamyel 0, band 1, segm 16, lymph 80, monoc 3 In the blood smear: anisocytosis,poikilocytosis, toxic inclusion in neutrophils. Serum iron 40mol/l, bilirubin 19mol/l

In the bone marrow aspirate there are no signs of neoplastic lymphoid infiltration, but the signs of increased non effective erythropoeisis are found 1. Colour index: Hb x 3 divide by 3 first number in erythrocyte count 50x3/150= 1 (normal is 0.85-1.05) 2. Diagnosis: anemia,aplastic myelotoxic agranulocytosis Reticulocyte are absent- aplastic Leucopenia(low leuko), neutropenia Relative lymphocytosis Anemia( due to Hb n erytr low) Toxic inclusions in neutrophil Decreased local vessel wall- due to intoxication Thrombocytopenia lead to multiple hemorrhage. Leukocyte 1.3 =100% X=80% So X < normal aka Absolute Lymphocytosis No neoplastic lymphoid found in bone marrow aspirates. 3. Mechanism of hemorrhagic syndrome in patient thrombocyte & damage of primary hemostasis. 4. Cause of myelotoxic agranulocytosis Cytotoxic( toxic chemicals eg: benzene) Drug Damage purine and thimidine synthesis Radiation Sepsis Chemotherapy Viruses Causes can be divided into the following groups: Decreased production in the bone marrow: hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia) cancer certain medications radiation Vitamin B12 or folate deficiency. Increased destruction: Aplastic anemia autoimmune neutropenia. Chemotherapy Marginalisation and sequestration: Hemodialysis There is usually a mild neutropenia in viral infections 5. Modern pattern of treatment There is no ideal therapy for this, but recombinant G-CSF (granulocyte-colony stimulating factor) can be effective in chemotherapy patients and some other causes. Case 7 A patient, aged 56 years old was admitted to d clinic with d following complaints: weakness sweating fever (temp abt 37-37.5 C) On examination: pallor of d skin peripheral lymph nodes enlarged but at d same time they were soft painless & werent connected to each other lien was moderately enlarged Blood picture: Hb 60g/l Er 2.0 x 1012/l Thro 104 x 109/l Ret 0.1 % Leu 81 x 109/l Leuk diff count (%): bas 0 eos 0

neut: metamyel 0 band 1 segm 14 lymph 84 monoc 1 In the thin blood smear: anicytosis, poikilocytosis, single Humprechts shadows. There are 50% of lymphocytes in d bone marrow aspirate. Serum iron 39.4 mol/l, serum bilirubin 68.4 mol/l. Direct comb test is +ve. Questions: 1. What is the diagnosis? - Chronic lympholeukemia (CLL) 2. Give a detailed explanation of your diagnosis - single Humprechts shadows (early disturbance of blast cell) - patient aged is 56 years old (CLL onset after 55 y/o) - Er 2.0 x 1012/l anemia - Thro 104 x 109/l thrombocytopenia - Leu 81 x 109/l leukocytosis - 50% of lymphocytes in d bone marrow aspirate (normal cell is 30% only) 3. What is the mech of anemia of this patient? a) inhibition of erythropoesis result from hyperplasia of lymphoid stem cell. b) Direct Comb test = +ve autoimmune hemolytic anemia ( increase level of serum ion & increase serum bilirubin) Case 8 30 yr old patient was admitted to the clinic with following complaints: High body temperature,chill,sore throat. History : patient have been taking ampicillin (semisynthetic penicillin) for one week prior to admission because of influenza. Blood analysis: Hb-135g/l RBC- 4.5x102/l Ret-0.6% Leu- 1.2x109/l Leu differential count (%): Bas-0 Eos-0 Neutr:metamyel-0 Band- 2 Segmen-13 Lymphocytes-70 Monocytes-16 Bone marrow ratio of fat cells/cellular elements is normal.

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What is the disease of this patient? Agranulocytosis autoimmune What are possible causes and mechanism of this disease? Hapten(ampillicin) binds to protein membrane, becomes antigen, release antibody, increase IgG concentration, opsonization, hypersensitivity type 2,activation of NK cells and compliment system (membrane attack complex etc). Immune destroy only 1 type of cells (eg neutrophils) RBC, thrombocytes remain normal Give an explanation of the clinical manifestation of the disease and its unfavorable complications. nonspecific resistance of organism Habituate to secondary infection.

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