White Blood Cells Abnormalities PDF

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Discussed by Ma'am Christy Gonzales, RMT, MPH...

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WHITE BLOOD CELLS ABNORMALITIES Granulocytic Disorders • Quantitative Abnormalities • Morphological Abnormalities • Qualitative Abnormalities QUANTITATIVE ABNORMALITIES Leukocytosis • Neutrophilia • Eosinophilia • Basophilia • Monocytosis

Leukopenia • Neutropenia • Eosinopenia • Basopenia • Monocytopenia

BASOPHILIA • > 0.075 × 109/L • number of circulating basophils is not remarkably affected by factors such as time of day, age, and physical activity • Causes: • Hormones • Ulcerative colitis • Hyperlipidemia • Some viral infections • Chronic sinusitis • CML • Polycythemia Vera

LEUKOCYTOSIS •  in the conc. or % of any of the leukocytes in the PB • Neutrophils or lymphocytes: most common cause • Causes: •  movement of immature cells out of BM’s proliferative compartment •  mobilization of cells from the MSC of BM to PB •  movement of mature cells from MP to CP •  movement of mature cells from circulation to tissue

MONOCYTOSIS • significant absolute in circulating monocytes • Causes: • Infections • Hematological disorders • Fever of unknown origin • Tissue macrophages • Inflammatory bowel • Response to foreign antigens disease • RA

NEUTROPHILIA • in the number of neutrophils • Causes: • present in some forms of leukemia and nonmalignant conditions • Physical stimuli: o Heat and cold o Vigorous exercise o Surgery o Nausea o Burns o Vomiting o Stressful activities • Drugs and hormones

LEUKOPENIA • Neutrophils 

EOSINOPHILIA • Persistently and significantly numbers of eosinophils • Causes • Active allergic disorders (Asthma & Hay Fever) • Dermatoses • Nonparasitic infections • Forms of leukemia • Parasitic infections • Patients with significant vacuolization and degranulation • Charcot-Leyden crystals

NEUTROPENIA • reduction in the number of circulating neutrophils • Causes: • Bone marrow injury or infiltration • Nutritional deficiencies • Cyclic neutropenia • Increased destruction or utilization of neutrophils • Entrapment in the spleen • Transient causes: • Acquired disorder • Viral infections • Congenital causes: • Congenital agranulocytosis of the Kostmann type • Myelokathexis – inability of granulocytes to be released in peripheral circulation • Reticular dysgenesis • Type IB glycogen storage disease • Transcobalamin-II deficiency

EOSINOPENIA • rare, stress-related condition • Causes: • Glucocorticosteroid • Result of acute bacterial or viral inflammation

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CHEDIAK-HIGASHI SYNDROME • Autosomal recessive trait seen in children and young adults • Gigantic, Peroxidase (+) deposits • Abnormal lysosomal development in neutrophils, monocytes and lymphocytes. • Neutrophils o Abnormal reaction o Impaired chemotaxis o Delayed killing of ingested bacteria • Patients suffer from frequent infections • not efficient bacteriocidal cells

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ALDER-REILLY INCLUSIONS • Autosomal recessive trait; Peroxidase (–) • Purple-red particles from precipitated mucopolysaccharides • Neutrophils, eosinophils, and basophils • Monocytes and lymphocytes • Resemble very coarse toxic granulation • Seen in: • Hurler • Hunter • Maroteaux-Lamy types of genetic mucopolysaccharidosis

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DÖHLE BODY • Aggregates of rough endoplasmic reticulum (RNA) • Single or multiple, light blue–staining inclusions • Near the periphery of the cytoplasm. • Neutrophils, monocytes or lymphocytes • Causes: o Infections o Burns o Drug Therapy • Döhle body–like inclusions: large poorly granulated platelet

BASOPENIA • Causes: • Hormones o Corticotropin o Progesterone • Thyrotoxicosis MONOCYTOPENIA

MORPHOLOGICAL ABNORMALITIES • • • • • • • •

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Toxic granulation Chediak-Higashi syndrome Alder-Reilly Inclusions Döhle Body May-Hegglin Anomaly Hypersegmentation Pelger-Huët Anomaly Ehrlichia

Granules Inclusion Bodies Segmentation/Lobulation

TOXIC GRANULATION • Peroxidase (+) azurophilic granules • Fine or heavy dark granulation in bands and segmented neutrophils or monocytes • represent the precipitation of ribosomal protein (RNA) • caused by metabolic toxicity within the cells • graded on a scale of 1+ to 4+ • Causes: • Severe bacterial infection • Burns • malignant disorders • drug therapy

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MAY-HEGGLIN ANOMALY • Presence of Döhle body–like inclusions • Neutrophils, eosinophils, and monocytes • Coexist with: o Large & poorly granulated platelets o Thrombocytopenia • Approximately 50% of patients do not have symptoms • Others have bleeding tendencies

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LE CELL • Neutrophil with large purple homogenous round inclusion

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HYPERSEGMENTATION • segmented neutrophils with > 5 lobes • Causes: (Macrocytosis) • Vitamin B12 or folic acid def. • Exists along with:  Pseudohypersegmentation • old segmented neutrophils

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PELGER-HUËT ANOMALY • Autosomal dominant disorder • Produces hyposegmentation of mature neutrophils • Nuclear shape: resemble a dumbbell or a pair of eyeglasses • Chromatin clumping and cytoplasmic maturation: normal • Due to abnormal nucleic acid metabolism • Pseudoanomaly • drug induced • maturational arrest associated with some acute infections • Function is normal • benign anomaly

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EHRLICHIA (BACTERIA) • Human granulocytic ehrlichiosis (HGE) • Caused by • Ehrlichia chaffeensis, E. ewingii • bacterium extremely identical to E. phagocytophila • Transmitted by: • lone star tick: Amblyomma americanum • black-legged tick: Ixodes scapularis • western black-legged tick: I. pacificus • form vacuole-bound colonies known as morulae

QUALITATIVE ABNORMALITIES Defective Locomotion and Chemotaxis Defects in Microbicidal Activity • CGD • MPO deficiency DEFECTIVE LOCOMOTION AND CHEMOTAXIS • Impaired leukocyte mobility • Rheumatoid arthritis • Cirrhosis of the liver • Chronic granulomatous disease • Defective locomotion or leukocyte immobility • Corticosteroids treatment • Lazy leukocyte syndrome • Defective chemotaxis • Diabetes mellitus • Sepsis • Chédiak-higashi anomaly • High levels of antibody IgE DEFECTS IN MICROBICIDAL ACTIVITY 1) Myeloperoxidase Deficiency • Alius-Grignaschi anomaly • Autosomal recessive genes • Absence of MPO enzyme from neutrophils and monocytes, but not eosinophils • MPO • Mediates oxidative destruction of microbes by H2O2 • Functional abnormality is not severe • Infections are not usually serious • Partial deficiency: • Acute and chronic leukemias, Myelodysplastic syndromes, Hodgkin disease, and Carcinoma 2) Chronic Granulomatous Disease • Rare disorder, X-linked trait or autosomal recessive • Neutrophils and monocytes ingest, but cannot kill catalase (+) org. • Leads to recurrent infections by cat. (+) org. On the 1st year of life • Do not generate O2−, produce H2O2, or consume O2 at an accelerated rate via HMP shunt • Respiratory burst is not activated • Free radical of reduced oxygen are not produce • Causes: • Severe def. or instability of leukocyte G6PD • (-) Nitroblue Tetrazolium (NBT) Screening Test

3) Functional Anomaly • Lactoferrin deficiency • Specific granules are reduced in quantity (Myelocyte) • Devoid of the specific granule protein • Causes: o Unresponsiveness to chemotactic signal o Diminished adhesiveness to surface particle • Results: • Pyogenic infections MONOCYTE-MACROPHAGE DISORDERS QUALITATIVE ABNORMALITIES • manifested as lipid storage diseases Macrophages • prone to accumulate undegraded lipid products • leads to an expansion of the reticuloendothelial tissue 1.

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Monocytic disorders • Gaucher disease • Niemann-Pick disease

GAUCHER DISEASE • seen in children • Mild: relatively normal life • Severe: die prematurely • Def. of β-glucocerebrosidase o splits glucose glucosylceramide o cerebroside accumulates in histiocytes • Gaucher cells • rarely found in the PC • large, with 1-3 eccentric nuclei and wrinkled cytoplasm • RES •  Erythrocytes and Leukocytes • Infiltration into the BM NIEMANN-PICK DISEASE • Similar to Gaucher disease • Seen in infants and children • Def. Of the enzyme that cleaves phosphoryl choline from sphingomyelin  sphingomyelin accumulates • Pick cell • same appearance to the Gaucher cell • Foamy cytoplasm appearance

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TART CELL • Monocyte with ingested lymphocyte • Rough and unevenly stained • Mistaken as LE cell LYMPHOCYTIC DISORDERS

GENERAL VARIATIONS IN LYMPHOCYTE MORPHOLOGY 1. VARIANT LYMPHOCYTES • Atypical lymphocytes, Downey cells, reactive or transformed lymphocytes, lymphocytoid or plasmacytoid lymphocytes, and virocytes • Healthy persons: 5% or 6%  Morphological evidence of normal immune mechanism •

 numbers: • IM • viral pneumonia & viral hepatitis

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Characteristics: •  overall size • enlarged nucleus • nuclear shape: lobulated or monocytoid • chromatin pattern: fine to coarse • 1-3 nucleoli • abundant, foamy and vacuolated cytoplasm • gray to light blue or intensely blue cytoplasm • presence of granules

SPECIFIC LYMPHOCYTE MORPHOLOGICAL VARIATIONS 1. BINUCLEATED LYMPHOCYTES • seen in viral infections • > 5% • either lymphocytic leukemia or leukosarcoma 2. REIDER CELLS • similar to normal lymphocytes except that the nucleus is notched, lobulated, and cloverleaf-like • seen in: • Chronic Lymphocyte Leukemia • artificially produced through blood smear preparation • can be an artifact

3. VACUOLATED LYMPHOCYTES • associated with: • Niemann-Pick disease • Tay-Sachs disease • Hurler syndrome • Burkitt lymphoma • Vacuoles can also be seen in: • variant lymphocytes • reaction to viral infections, radiation, and chemotherapy 4. SMUDGE CELLS/ BASKET CELLS • natural artifact in the preparation of a blood smear • bare nuclei of lymphocytes and neutrophils • Increased fragility of cells • contributes to the increased percentage of smudge cells • seen in: • increased proportions in lymphocytosis (CLL) 5. DOWNEY CELLS • Type I • Turks irritation cell • with block of chromatin •

Type II • IM cells • Round mass of chromatin • Ballerina skirt appearance

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Type III • Vacuolated • Swiss chief or Moth eaten appearance

6. SEZARY CELLS • Round lymph cell with nucleus that is grooved or convoluted • Sezary syndrome • Mycosis fungoides 7. HAIRY CELL • Lymphocyte with hair-like cytoplasmic projections surrounding the nucleus • Hairy cell leukemia

PLASMA CELLS ABNORMALITIES 1. GRAPE OR MOTT CELLS • cytoplasm is completely filled with Russell bodies • Plasma cell with vacuoles • Large protein globules • Multiple myeloma 2. FLAME CELLS • cytoplasm stains a bright-red color • contains increased quantities of glycogen or intracellular deposits of amorphous matter • Associated with: • Increased Ig • Multiple myeloma PLASMA CELL DISORDRES • Viral disorders • Allergic conditions • Chronic infections • Collagen diseases • Plasma cell dyscrasias • increased plasma cells or completely infiltrate BM o Waldenstrom Macroglobulinemia o Multiple myeloma...