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Leukocytes White Blood Cells

Formation of WBCs
Leukocytes are formed in the red marrow of many bones. They can also be formed in lymphatic tissue. They live for about 13-20 days.

Myelocytic Maturation Series


Myeloblast Promyelocyte Myelocyte Metamyelocyte Band Neutrophil Segmented Neutrophil

Myelopoeisis

HSC: hemopoeitic stem cell, HPG: hemopoeitic progenitor cells, CMP: committed myeloid progenitor cell, CLP: committed lymphoid progenitor cells, CFU: colony forming unit

White Blood Cells

WBC Numbers
Doctors look at WBC numbers. If number goes up there is some kind of infection . Clinics will count the number of WBCs in a blood sample, this is called differential count. A decrease in the number of white blood cells is leukopenia. An increase in the number of white blood cells is leukocytosis.

White Blood Cells


Per l blood Total WBC count Neutrophils Lymphocytes
50 - 70% 20 - 40%

Per l of blood
5,000 10,000 2,000 7,000 1,000 4,000

Monocytes
Eosinophils Basophils

1 6%
1 5% 0 2%

50 600
50 500 0 - 100

WBCs
Five Types Classified according to the presence or absence of granules and the staining characteristics of their cytoplasm. Leukocytes appear brightly colored in stained preparations, they have a nuclei and are generally larger in size than RBCs.

Type of WBCs

Granulocyteshave large granules in their cytoplasm


Neutrophils Eosinophils Basophils

Granulocytes
Eosinophils Large, numerous granules Nuclei with two lobes 2-5% of WBC count Found in lining of respiratory and digestive tracts Important functions involve protections against infections caused by parasitic worms and involvement in allergic reactions Secrete anti-inflammatory substances in allergic reactions

Granulocytes
Basophils
Least numerous--.5-1% DiapedesisCan leave blood vessels and enter tissue space Contain histamineinflammatory chemical

Granuloctyes
Neutrophils Stain light purple with neutral dyes Granules are small and numerous course appearance Several lobes in nucleus 65% of WBC count Highly mobile/very active DiapedesisCan leave blood vessels and enter tissue space Phagocytosis (eater), contain several lysosomes

Types of WBCs
Agranulocytesdo not have granules in their cytoplasm
Lymphocytes Monocytes

Agranulocytes
Lymphocytes Smallest WBC Large nuclei/small amount of cytoplasm Account for 25% of WBC count Two typesT lymphocytesattack an infect or cancerous cell, B lymphocytesproduce antibodies against specific antigens (foreign body)

Agranulocytes
Monocytes
Largest of WBCs Dark kidney bean shaped nuclei Highly phagocytic

White blood cells disorders


I. Leukocytosis

increased number of leucocytic count above upper range of normal(11,000/mm3 in adult).

Neutrophilia

1. 2. 3. 4. 5.

Neutrophils > 7.5 x 109/L


Acute pyogenic infection Tissue damage: Truma or infarction Malignancy Myeloproliferative disorders : CML Drugs: digitalis, Cortison. Myeloproliferative disorders (CML)

NEUTROPHILIA

Eosinphilia
Eosinphils > 4 x109/L ( 0.04- 0.4 X109/L). Causes:

1. 2. 3. 4. 5.

Allergic diseases parasitic diseases Recovery from acute infection certain skin diseases Drug sensitivity

Basophilia

Basophils > 0.1 x 109/L (N: o.o1-o.1x109/L). Causes: Myeloproliferative disorders (MPD)e.g. CML.

Moncytosis
Monocytes > 0.8x 109/L (N: 0.2-0.8x109/LCauses: Causes: Chronic bacterial infection e.g. brucllosis, typhoid.

Lymphocytosis
Relative Lymphocytosis: PMN leucocytes are decreased, so the lymphocytes are relatively increased.

Causes: 1. Viral infection CMV Measels 2. Bacterial infection Pertusis Brucellosis 3. Chronic lymphocytic leukemia 4. Lymphoma

Leucopenia

I.
1.

Decrease in leucocytic count below 4000/mm neutropenia: <2000/mm Causes: Drugs: anti inflammatory anti bacterial anti malarial

2. Infection:
Viral: Hepatitis, HIV Bacterial: brucellosis some fungal infections

Agranulocytosis
Marked reduction of neutrophils below 500/mm.

Lymphopenia
1. 2. Lymphocytes <1500/mm Causes: Irradiation Steroids and Immunosuppressive drugs

Infectious Mononucleosis
Caused by EBV Clinical picture: sore throat, fever, Lymphadenopathy splenomegaly.

Laboratory findings: Absolute lymphocytosis with atypical lymphocytes.

Neoplastic Proliferation of White Cells

Leukemia Malignant neoplasm of the hematopoietic stem cells BM replaced by unregulated, proliferating, immature neoplastic cells blood leukemia enter spleen, lymph nodes

Neoplastic Proliferation of White Cells


Classification of Leukemia A. According to cell type and state of cell maturity
Lymphocytic immature lymphocytes and their progenators Myelocytic pluripotent myeloid stem cells and interferes with maturation of all granulocytes, RBC and platelets

B.

Acute or Chronic
Acute immature cells (blast) Chronic well differentiated leukocytes

Classification of leukemias
Acute Myeloid origin
Acute Myeloid Leukemia (AML)

Chronic
Chronic Myeloid Leukemia (CML)

Lymphoid origin

Acute Lymphoblastic Leukemia (ALL)

Chronic Lymphocytic Leukemia (CLL)

ALL
nave B-lymphocytes Plasma cells T-lymphocytes

Lymphoid progenitor

AML
Hematopoietic stem cell Myeloid progenitor Neutrophils Eosinophils Basophils Monocytes Platelets

Red cells

Acute Leukemia

Acute Lymphocytic Leukemia (ALL)

Most common leukemia in children (80%) Treatable and potentially curable Classified according to lymphocytes and state of maturations

ALL

Acute Myleocytic Leukemia (AML)


Acute Non-lymphocytic Leukemia (ANLL)

Most common in adults; >50% 60years old

Acute Myeloid Leukemia


accumulation of blasts in the marrow

Auer rods in AML

Chronic Leukemia

Classification of CL.
There are two types:
1-chronic myeloid leukemia. 2-chronic lymphoid leukemia.

Chronic Myeloid Leukemia.

Definition of CML:
Is a clonal disorder of a pluripotent stem cell and is classified as one of the myeloproliferative disorder.

CML

Chronic lymphocytic Leukemia:

CLL

Splenomegaly & hepatomegaly

Investigation:
CBC: Wbc: Diff:lymphocytosis Anemia:normocytic normochromic anemia Platelets : thrombocytepenia may occur.

Good Luck!..