WBC Disorders

Erwin Taher
Medical Faculty
Dept of Clinical Pathology
UISU
 Normal
 Pathology
 White cell disorders

 Non – neoplastic Abnormalities

 ↓in # - Penias & ↑ - Philias
 Neoplastic disorders
 Premalignant conditions
 Myelodysplastic syndromes
 Myeloproliferative disorders
 Malignant or Leukemias
 Acute & Chronic
 Myeloid & Lymphoid
 Hairy cell leukemia
 Plasma cell neoplasms
 Lymph node disorders
 Non – neoplastic or Inflammatory

 Acute Lymphadenitis

 Chronic Lymphadenitis

 Neoplastic or Lymphomas

 Hodgkin’s lymphoma

 Non- Hodgkin’s Lymphoma

 Miscellaneous
 Langerhans cell Histiocytosis

 Splenic disorders

 Disorders of thymus
 Total Leukocyte count
 Differential Leukocyte
count
 Basic functions of
Leukocytes
WBC - CBC
WBC :Non – neoplastic Abnormalities

 Penias (Leukopenia)
 Neutropenia – is most common and important
 low circulating neutrophil count

 <1500 cell/cu. mm – Neutropenia

 1000 cells/ cu. mm – worrisome

 500 cells/ cu. mm - serious infections

 100 cells/ cu. mm - life threatening ( also called

agranulocytosis)
WBC :Non – neoplastic Abnormalities
 Penias (Neutropenia)
 Causes
 ↓ or ineffective production

 Aplastic anemia
 Drugs
 Disorders – Vit. deficiencies ( B12, Folate)
 Myelodysplastic syndromes
 Inherited disorder – kostmann syndrome (defective
genes of granulocyte differentiation)
 ↑ removal from circulation
 Immunological – SLE, Drugs
 Hypersplenism
 ↑utilization – infections ( mainly Bacterial)
WBC :Non – neoplastic Abnormalities

 Neutropenia
 Most significant cause – Drugs

 May dose related or Idiosyncratic

 Act by marrow suppression (chlorpromazine) or

immunological (sulfa & Thiouracil)
 Morphology = marrow changes depend on underlying cause
 Hyperplasia of marrow if the cause is peripheral destruction

or ineffective poiesis
 Hypoplasia if it is due to Myelo- suppression
WBC :Non – neoplastic Abnormalities
Leukocytosis
 Leukocytosis Philias ( Example – Neutrophilia)
 Pathogenesis
 Precursor pool  storage pool peripheral blood
(Margination & circulating)  Tissue pool
 Mechanisms
 For Neutrophils
 ***Mostly from marrow storage pool – immediate
 Granulocytopoiesis from stimulation of marrow stem
cells by inflammatory mediators (IL-1, TNFα)
 For Eosinophils- IL-5

 For Lympho – IL-7

WBC :Non – neoplastic Abnormalities
Leukocytosis - Neutrophilia
WBC :Non – neoplastic Abnormalities
Leukocytosis
 Morphology
 # neutrophils &Toxic granulations ( abnormal azuriphilic

granules), Dhole bodies (Endoplasmic Reticulum) –like in

Kawasaki’s disease)
 Differential Diagnosis
 Leukemoid reaction (inflammation) from leukemia
WBC :Non – neoplastic Abnormalities
Leukocytosis -Toxic Granulation:
WBC :Non – neoplastic Abnormalities
Leukocytosis - causes
Neutrophilic Acute bacterial infections( pyogenic)
leukocytosis
Eosinophilic Allergic disorders such as asthma, hay fever, allergic
leukocytosis skin diseases parasitic infestations; drug
(eosinophilia) reactions; certain malignancies (e.g., Hodgkin
disease and some non-Hodgkin lymphomas);
Basophilic leukocytosis Rare, indicative of CML
(Basophilia)
Monocytosis Chronic infections (TB, SLE) inflammatory bowel
diseases (ulcerative colitis)
Lymphocytosis Accompanies monocytosis in many disorders viral
infections (e.g., hepatitis A, cytomegalovirus,
Epstein-Barr virus); Bordetella pertussis infection
WBC :Non – neoplastic Abnormalities
Leukocytosis -Lymphocytosis