1. Blood cells Disorders Leucocytosis: Neutophilia: Dr. Rania Alhady
A raised WBCs count.
Due to elevation of a single lineage.
Neutophilia:
Physiologic causes: Pregnancy, newborns, after parturition or after exercise.
Pathological causes: 1- Infections: pyogenic bacteria. 2- Neoplasia: all types. 3- Hge / haemolysis. 4- Corticosteroids.
Dr. Rania Alhady

2. Leucocytosis Dr. Rania Alhady
Left shift: A "left shift" refers to the presence of increased proportions of younger, less well differentiated neutrophils and neutrophil-precursor cells in the blood. A severe neutrophilia with left shift is referred to as a leukemoid reaction. Neutophilia may be associated with the presence of toxic granulations and Dohle bodies.
Dr. Rania Alhady

3. Leucocytosis Eosinophilia: Dr. Rania Alhady
Eosinophilia is a condition in which the eosinophil count in the peripheral blood exceeds 450/ cm in P.B.
Causes:
1- Allergic disorders
Asthma
Drug allergies
Allergic skin diseases
2- Parasitic infections
3- Some forms of malignancy
Hodgkin's lymphoma
Some forms of Non-Hodgkin lymphoma
3- Systemic autoimmune diseases (e.g. SLE)
Dr. Rania Alhady

4. Leucocytosis Monocytosis: Basophilia: Dr. Rania Alhady
An increase in the number of monocytes circulating in the blood
Causes:
Chronic inflammation: tuberculosis, syphilis and malaria
Blood and immune causes: Myeloproliferative disorders.
Malignancies: Certain leukaemias, such as chronic myelomonocytic leukaemia (CMML) and monocytic leukemia.
Basophilia:
Infections: Pox virus (chicken pox, small pox)
Neoplasia: MPD (myeloproloferative disorders).
Dr. Rania Alhady

5. Leucocytosis Lymphocytosis: Dr. Rania Alhady
Increase in the number or proportion of lymphocytes in the blood.
Causes:
1. Infections:
Acute viral infections: infectious mononucleosis (glandular fever), hepatitis, herpes virus, and Cytomegalovirus infection
Acute bacterial infections: T.B., scarlet fever, typhoid fever.
Protozoal infections: toxoplasmosis and malaria
Chronic lymphocytic leukemia (CLL).
Acute lymphoblastic leukemia (ALL).
Lymphocytosis, peripheral blood smear
Dr. Rania Alhady

6. Leucopenia Leucopenia: Neutropenia: Dr. Rania Alhady Classification:
Reduced total leucocytic count.
Neutropenia:
Reduced neutrophil count < 2000 / cm
Classification:
Classify the severity of neutropenia based on the absolute neutrophil count (ANC) measured in cells per microliter of blood:
Mild neutropenia: minimal risk of infection
Moderate neutropenia: moderate risk of infection
Severe neutropenia: severe risk of infection.
Signs and symptoms
Neutropenia can go undetected, but is generally discovered when a patient has developed severe infections or sepsis.
Fevers and frequent infections. These infections can result in conditions such as mouth ulcers, diarrhea, a burning sensation during urinating, or a sore throat.
Dr. Rania Alhady

7. Leucopenia Dr. Rania Alhady Causes of Neutropenia:
Causes can be divided into the following groups:
Decreased production in the bone marrow due to:
Aplastic anemia
Cancer, particularly blood cancers
Certain medications
Radiation
Blood film with a striking absence of neutrophils,
Increased destruction: leaving only red blood cells and platelets
Autoimmune neutropenia: (occur with: SLE, R.A., Hodgkin disease, Felty syndrome)
{Felty syndrome: R.A., splenomegally, prominent neutropenia, lymphopenia}
Chemotherapy treatments, such as for cancer and autoimmune diseases
Dr. Rania Alhady

8. Leucopenia Dr. Rania Alhady Drugs induced neutopenia:
Medications are very common cause of neutropenia. such a Flecainide (anti-arrhythmic drug)
Once drugs stopped, neutrophil recovery in 4 -7 days occur provided that precursors cells are normal.
Congenital neutropenia syndromes: 1- Kostmann‘s Syndrome:
Severe chronic neutropenia with frequent pyogenic infections.
Eosinophil and basophils are normal or increased.
Progression of leukemia (Very poor prognosis)
Marrow transplantation may be curative.
Dr. Rania Alhady

9. Leucopenia Dr. Rania Alhady 2-Chediak-Higashi Syndrome:
Oculocutaneous albinism
Photophobia
Sun sensitivity
Neuropathy
Recurrent Infections, esp Staph aureus
Granules in granulocytes, monocytes and
lymphocytes
Treatment: BMT
3- Reticular Dysgenesis:
Thymic aplasia.
Inability to produce neutrophil.
Patient die at early age from bacterial and viral infections.
BMT should be considered
Dr. Rania Alhady

10. Thrombocytopenia Thrombocytopenia or thrombopenia: Dr. Rania Alhady
is a relative decrease of platelets in blood
Symptoms and signs:
Bruising, particularly purpura in the forearms, petechia (pinpoint hemorrhages on skin and mucous membranes), nosebleeds and/or bleeding gums.
PURPURA Defined as:
- A purplish discoloration of the skin and mucous
membrane due to subcutaneous and sub mucous
extravasation of blood.
- Purpura may be due to deficient and defective
platelets or due to an unexplained increase in
capillary fragility
Dr. Rania Alhady

11. Thrombocytopenia Dr. Rania Alhady Causes: (I) Immune Thrombocytopenia:
Increased platelets destruction:
(I) Immune Thrombocytopenia:
1. Auto-Abs
ITP (Immune Thrombocytopenic Purpura)
2ry to SLE & AIDS
2. Allo-Abs
Post- transfusion
Post- natal
Post transplatation
3.Drug – induced:
e.g. Quinin, sulphonamide
Dr. Rania Alhady

12. Thrombocytopenia Dr. Rania Alhady (II) Non – Immune Thrombocytopenia:
1. Excess platelet consumption (DIC)
2. TTP- HUS
3. Sever burn or snake venom
4. Structural platelet defects (short life span)
Immune thrombocytopenic purpura (ITP):
Immune disorder characterized by:
Thrombocytopenia.
B.M.: normal with normal megakaryocytes in number, or even increased number with defective budding.
Evidence of Abs against platelets
Spleen in NOT enlarged.
Dr. Rania Alhady

13. Thrombocytopenia Dr. Rania Alhady Childhood type Adulthood type
Acute post infection
Insidious
Onset
Spontanous remission
No spontaneous remission
Remission
Just palpable spleen(normal for age)
No enlarged spleen
Spleen
Minimal bl. Loss.
Good health.
Purpura, Epistaxis,
menorrehia.
Clinical Picture
The same+Atypical lymphocytes
Eosinophilia
Decreased plat. No.
Normal WBC
Laboratory
P.B.
Prolonged
B.T.
The same+ eosinophilia
Increased megas & immature forms
B.M.
Dr. Rania Alhady

14. Thrombocytopenia Dr. Rania Alhady
Thrombotic Thrombocytopenic Purpura. Hemolytic – Uremic Syndrome:
1. Idiopathic TTP-HUS:
A syndrome characterized by:
1. Neurological abnormalities
2. Thrombocytopenia
3. Microangiopathic hemolytic anemia
4. Renal involvement
5. Fever
2. 2ry TTP-HUS: Causes:
1. Pregnancy
2. Cancer assiociated
3. Drugs e.g. Cyclosporin
4. Marrow Transplantation
Dr. Rania Alhady