2. Learning objectives
✓ Recognize the different types of leucocytes
(myeloid cells & lympoid cells).
✓ List the normal values for neutrophils,
eosinophils, basophils, and monocytes in
normal peripheral blood
✓ Be familiar with terms of leukoerythroblastic
picture and leukemoid reaction
✓ Identify conditions that cause increase or
decrease for each of them.
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3. The white blood cells
(leucocytes):
Phagocytes
innate immune system,
1. Granulocytes: (neutrophils,
eosinophils , basophils) and
2. monocytes
Lymphocytes
adaptive immune response,
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4. Leucocyte
Mediate host defense
Modulate the immune response
The relative proportion
The absolute number
―ANC‖—absolute neutrophil count
– Philia, – cytosis
– Penia
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8. Neutrophils
maturation within 5 days in BM
stay 6-10 hours in the circulation
before being removed, mainly by
the spleen.
Myeloblast, promyelocyte,
Myelocytes or metamyelocytes are
normally only found in the marrow
if appear in the circulation :
infection or neoplastic states or
BM stimulation.
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12. Leukoerythroblastic reaction
a serious disturbance of marrow function
The WBC count may be increased,
normal, or decreased
BM metastasis
MF
Leukemia (AML,CML)
MM
Reactive states ( hemorrhage or hemolysis )
Corticosteroid therapy
Indication of bone marrow study
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13. Neutrophils
the most common white
blood cells in the blood
of adults.
approximately 65 %
2-5 segments nuclei
and granules in their
cytoplasm.
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18. Leukemoid reaction
Benign leukocytic proliferation
a significant increase in immature
precursors in the peripheral blood
(myeloblast, myelocytes,
metamyelocytes, band) along with
increased numbers of mature forms.
DDX: acute or chronic leukemia
Severe infection, metastatic cancer,
hemolysis, burn.
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19. Eosinophils
represent 1-6% of
the circulating WBC.
involved in
intracellular killing of
protozoa and
helminths
allergic reactions
(e.g. atopy, asthma)
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22. Basophils
Less than 1% of WBC.
Mast cells resemble
basophils (only found
in the tissues).
They release histamine
type I hypersensitivity
reaction and
defense against parasites
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25. Monocytes
Main functions of macrophages:
1) Phagocytosis.
2) Facilitate wound healing.
3) Removal of senescent RBCs in
reticuloendothelial system
(spleen, liver and bone marrow).
4) Presentation of antigen to T
lymphocytes.
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27. Lymphocytes
T cells (80% of circulating
lymphoid cells)
B cells
expression of immunoglobulin
light chains
lifespan can vary from several
days to many years.
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28. Lymphocytic leukocytosis
>> 3,500/mm³
( 3.5 X109/L )
infections such as viral;
(infectious mononucleosis
,mumps , measles) and
bacterial; (pertussis, TB)
lymphoproliferative disorders:
acute and chronic lymphocytic
leukemias, lymphoma
post splenectomy
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29. Neutropenia
< 1500/mm³. (1.5 X109/L)
< 500/mm³ (0.5 X109/L)
Agranulocytosis : neutropenia
recurrent infections
Bone marrow examination
less than 0.2 × 109/L
very serious
Very significant risk of infection; fever should
always be managed on an inpatient basis with
parenteral antibiotics; few or no clinical signs of
infection
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30. The clinical features of
neutropenia:
risk of infection, at the mouth and
throat.
Painful necrotizing ulcers on oral
cavity , the anus and skin (boil,
abscess)
The general symptoms :fever, chills,
malaise, weakness and fatigability.
Septicaemia
the infection will be severe & life threatening
within hours to few days
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31. The clinical features of
neutropenia:
Commensal by normal
individuals may become
pathogens.
(Staphylococcus epidermidis or
Gram‐negative organisms in the bowel)
Candida and Aspergillus.
Invasive bacterial or fungal infections
may occur in the organs like GIT, lungs
and urinary tract.
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32. Neutropenia
1. infections:
Flu,Hepatitis B virus, Epstein-Barr virus and
HIV
Enteric fever, brucellosis, and tuberculosis
Malaria
2. Drugs: cytotoxic, carbimazole, sulphasalazine,
trimethoprim, carbamazapines,
3. Auto immune:SLE, Felty’s syndrome
4. Congenital: Kostmann’s syndrome,
Schwachman–Diamond
5. acute leukemia
6. bone marrow failure or infiltration
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