WBC Disorder
Neutrophilia (neutrophilic leukocytosis ) : increase in circulating neutrophil above the upper normal limit , seen in:Acute infection (bacterial, fungal, spirochates)
Tissue necrosis.
Intoxication e.g. uremia, diabetic ketoacidosis, drug.
Acute bleeding.
Leukemia, myeloproliferative disorder.
Neutropenia: when absolute count is reduced below the lower normal limit, it predispose to infection.
Causes:
Certain infection: typhoid, brucellosis, influenza& other viral disease.Drug & toxin that cause B.M aplasia.
Megaloblastic anemia.
A plastic anemia.
Lymphocytosis:
Certain infection as: viral infection , typhoid fever, T.bchronic lymphocytic leukaemia .
Eosinophilia:
Allergic disorder as asthma, urticaria, hay fever.
Parasitic infection.
Skin disorder as pemphigus.
Malignant tumors.
Basophilia:
Chronic myeloid leukemia.Urticaria pigmentosa.
Ulcerative colitis.
Leukemias: A group of disorders characterized by malignant transformation of white blood forming cells in the bone marrow.
In general leukemia classified on the basis of cell types into myeloid & lymphoid & on the onset of disease each may be acute or chronic.
Acute:
Acute myeloid leukemia (AML)Acute lymphoblastic leukemia (ALL)
Chronic:
Chronic myelocytic leukemia (CML)
Chronic lymphocytic leukemia (CLL)
Etiology :The exact etiology is not well known however certain factors are blamed
Ionizing radiation: seen in people expose to occupational radiation exposure, patient receive radiation therapy& Japanese survive after atomic bomb explosion.
Chemical carcinogenic as benzene.
Certain drug as alkylating agents has increase risk of AML.
Infection: infection by HTLV-1 cause T-cell leukemia.
Genetic factors: there is a high concordance rate among identical twins, also acute leukemia occur with increase frequency with some congenital disease as downs syndrome.
Acute lymphoblastic leukaemia( ALL):
Clinically: most commonly seen in children.Feature due to B.M failure:
Feature of anemia.
Bleeding tendency due to thrombocytopenia in the form of spontaneous bruises, petechiae & bleeding from gum.
Infection due to leucopenia & include infection of the mouth, throat, skin, respiratory tract,.ect.
Feature due to organ infiltration:
Pain & tenderness of the bone.
Lymphadenopathy more common in ALL.
Splenomegaly
Hepatomegaly.
Sign of CNS involvement( headache, vomiting & blurring of vision)
Laboratory finding
CBP:
Hb: decrease with normo chronic normocytic anemia.
WBC: usually elevated but normal or even reduce WBC doesn't exclude leukemia , with characteristic blast cell which is large cell with vesicular nucleus with 1-2 nucleoli ,the cytoplasm is basophilic & a granular.
Platelet: reduce
B.M: hyper cellular& blast cell form > 30% of the cell with marked decrease of all haemopoietic elements.
Special stain (PAS is +ve ).
Acute myeloid leukemia:
Seen mainly in young adultClinically same as ALL with few exception such as CNS & lymph node involvement is rare in AML while gingival hyper trophy is common.
Laboratory finding:
Same as ALL but :* it show myeloblast ( instead of lymphoblast ) which has 2-5 nucleoli, the cytoplasm may contain eosinophilic rod called aurs body.
* Special stain (sudan black) is +v
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Chronic myeloid leukemia:
CML affect adult between 25 60 years.
It associated with the presence of abnormal chromosome (Philadelphia chromosome which represent translocation of long arm of chromosome 22 to chromosome 9)
Clinically : during chronic phase there is anaemia , splenomegaly ,fever , loss of weight & night sweating )
Laboratory diagnosis :
RBc : anemia of normochromic normocytic ,
WBC: marked leukocytosis with shift to left ( presence of myelocyte & metamyelocyte & even blast cell )& basophilia .
Platelets : normal .
Chronic lymphocytic leukaemia :
* affect elderly age group.
*clinically ; generalize lymphadenopathy ,hepatosplenomegaly ,
feature of anaemia , bleeding tendency & repeated infection .
* CBP ;
Rbc : normochromic normocyticWBC : marked leuckocytosis mainly of mature lymphocyte .
Platelets : reduce INCLUDEPICTURE "G:\\JPEG5\\HEME019.JPG" \* MERGEFORMATINET