1. Consultant Hematologist
White Blood Cells
Dr. Mansour Aljabry
Assistant Professor &
Consultant Hematologist

2. Hematopoiesis
Hematopoiesis is the process of life long production, multiplication & specialization of blood cells in the bone marrow.
It begins with the most basic blood cell, the stem cell or “pluripotent hematopoietic stem cell” (PHSC).
Differentiation
Proliferation
HSC
(mother)

3. Hematopoietic stem cell Megakaryocytic –Erythroid Progenitors
Lymphoid
Progenitor
Hematopoietic stem cell
Granulocytic-Monocytic Progenitors
Monocytes
Myeloid Progenitor
Erythroid Progenitor
Megakaryocytic –Erythroid Progenitors

4. Hematopoietic growth factors :
Hormones that regulate the proliferation and differentiation of HCS.
Can be administered clinically to stimulate the hematopoiesis :
-G-CSF in severe neutropenia
-EPO in Sever anemia

5. Hematopoietic stem cell Megakaryocytic –Erythroid Progenitors
PAX-5
Lymphoid
Progenitor
T-bet
Hematopoietic stem cell
G-CSF
SCF
FLT3-L
Granulocytic-Monocytic Progenitors
M-CSF
Monocytes
EPO
Myeloid Progenitor
Erythroid Progenitor
Megakaryocytic –Erythroid Progenitors
Thrombopoietin

6. Normal ranges WBC count 4-11 x 109/L Absolute count (x109/L)
Differential count %
Cells
50-70
Neutrophils
20-44
Lymphocyte
2-9
Monocytes
0-0.7
0-6
Bands
0-0.5
0-5
Eosinophils
0-0.2
0-2
Basophils

8. Neutrophil
Phagocytic cell contain a nucleus divided into 2–5 lobes with pale granulated cytoplasm.
stain a neutral pink (Basophils dark blue while eosinophil is bright red).
They are short lived(≈6 days) and highly motile.

9. Chemotaxis: Migration toward sites of infection or inflammation through detection of IL-8 ,TNFγ &C5a
 Neutrophil extracellular traps(NETs): are web-like structures of DNA and fiber that trap and kill microbes extracellularly
Superoxide
Hydrogen peroxide
Lysozyme
 NADPH oxidase
Myeloproxidase (MPO)

10. Neutrophil

11. Neutrophilia
Marginal pool (tissues)
Circulating pool (blood)

12. Causes of neutrophilia
Neoplastic
Benign
Chronic Myeloid leukemia
Bacterial infection (Pyeogenic)
Polycythemia vera,Essential Thrombocythemia
Inflammation and tissue necrosis
Chronic Myelomonocytic Leukemia
Acute hemorrage or hemolysis
Non hematological Neoplasms
Steroid therapy (inhibits margination)
G-CSF treatment
Rare inherited disorders
Aspleni

13. Leukemoid reaction
Leukocytosis(mainly neutrophilia with left shift) due to physiological response to stress or infection.
Common with : sever or chronic infection ,sever hemolysis & metastatic cancers.
Associated with: Toxic granulation ,Vaculation & Dohle bodies.

14. Left shift
Vaculation
Döhle bodies
Toxic gran.
S. neutrophil

15. Neutropenia Lower limit of normal is 1.5 × 10⁹/L
Sever neutropenia : ≤0.5 × 10⁹/L
Part of general pancytopenia
Selective neutropenia
Bone marrow failure
Congenital : - Kostmann syndrome
- Benign neutropenia ,
- Cyclical neutropenia
Chemotherapy
Drug induced
Acute Leukemia
Autoimmune (SLE)
Lymphoma
Viral infection (hepatitis ,HIV)
Metastatic carcinoma
Some Bacterial infections(Typhoid)

16. Lymphocytes
Small WBC having spherical nucleus surrounded by a thin layer of non granular cytoplasm.
Fundamental importance in the immune system (Innate &Adaptive)

17. Lymphocyte
(B or T)
NK Lymphocyte
Reactive looking
Atypical looking

18. Lymphocytosis 1- Viral infection :
Infectious mononucleosis ,cytomegalovirus ,rubella, hepatitis, adenoviruses, varicella….
2- Some bacterial infection:
(Pertussis ,brucellosis …)
3- Other conditions: Allergic drug reactions, splenectomy, dermatitis ,hyperthyroidism metastatic carcinoma….)
4- Chronic lymphocytic leukemia (CLL)
5-Other lymphomas:
Mantle cell lymphoma ,Hodgkin lymphoma…

19. Lymphocytopenia Part of general pancytopenia Selective Lymphocytopenia
Bone marrow failure
Bacterial or fungal sepses
Chemotherapy or radiotherapy
Post operative state
Acute Leukemia
Post steroid therapy
Lymphoma
Immunodeficiency (congenital or acquired)
Metastatic carcinoma
Autoimmune disorders (SLE..)

20. Monocytes
Large, phagocytic WBC, having a single well-defined nucleus and very fine granulation in the cytoplasm.
Represents about 2-9% of WBC
Matures into different types of macrophages at different anatomical locations (skin, spleen, liver …..)

21. Monocytes Monocytosis Monocytopenia (TB , Brucellosis..)
1- Chronic infection :
(TB , Brucellosis..)
2-Autoimmune :SLE..
3-Chronic neutropenia
4-Acute leukemia (AML M5)
5-Chronic Myelomonocytic leukemia
Hairy cell leukemia
Selective monocytopenia:

22. Eosinophil
Granular leukocyte having a nucleus with two lobes and cytoplasm containing bright red coarse and round granules .
Major functions :
1-Antiparasitic and bactericidal activity,
2-Participating in immediate allergic reactions,
3-Modulating inflammatory responses. 

23. Eosinophilia Causes: C H I N A Helminthic parasitic infections
Connective tissue diseases
Helminthic parasitic infections
Idiopathic: Hypereosinophilic syndrome
Neoplasia: eosinophilic leukaemia, lymphoma or MPN
Allergy 23 23

24. Basophil
Phagocytic leukocyte of characterized by numerous coarse bluish-black granules of variable size.
Mature to tissue mast cells.
Functions of Basophils
- Major role in immediate allergic reaction (IgE)
- Anticoagulant activity (Heparin)
- Vasodilatation (Histamine)

25. Basophilia 1-Neoplasia (CML, mastocytosis, basophilic leukaemia, MPN)
2-Hypothyroidism
3-Some viral infections (Chickenpox)
4-Inflammatory conditions
5-Drugs (IL3, oestrogen)
6-Hyperlipidaemia 25 25

26. leukoerythroblastic picture
Bone marrow response in which nucleated red blood cells and immature leukocytes are released in the blood
Causes:
Metastatic neoplasm
Primary Myelofibrosis
Severe hemolysis (Thalassemia major)
Severe infection ( Miliary TB)

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