Leukocyte_disorders for undergraduate students

Leukocyte disorder

1. Leukocyte Disorders Dr. Nirmalya Chakrabarti Dept. of Pathology Malda Medical College, Malda

2. Competencies: PA 18.1.1: Enumerate causes of Leukocytosis, Lymphocytosis and Leukopenia. PA18.1.2: Define Leukemoid reaction. PA 18.1.3: List the differences between leukemoid reactin and chronic myeloid leukemia.

3. Leukocytosis and Leukopenia: Leukocytosis : an increase in the number of circulating leukocytes (total leukocyte count) above the upper level of normal. Leukopaenia : total leukocyte count below the lower limit of normal.

4. Neutrophilia: A n increase in the absolute neutrophil count above normal level (usually > 7,500/cu mm ). Most common cause of neutrophilia is acute bacterial infections , particularly Gram positive cocci .

5. PBS in neutrophilia due to bacterial infections : Shift to left: presence of band forms and occassional metamyelocytes . Toxic granules: dark blue of purple granules in cytoplasm. Döhle inclusion bodies : small, pale blue inclusion bodies in the periphery of cytoplasm. Cytoplasmic vacuoles.

6. Neutropenia: R eduction in the number of neutrophils in the peripheral blood below the normal level (<2000/ cmm ). Absolute neutrophil count (ANC) more than 1000/ cmm is usually considered as sufficient for phagocytic function of neutrophils . Common sites of infection in neutropaenia are skin, urinary tract, respiratory tract and oral cavity.

7. Eosinophilia: Increase in the absolute eosinophil count in the peripheral blood above 600/cu mm .

8. Basophilia: Absolute Basophil Count in Peripheral blood: >100/ cmm Conditions associated with Basophilia : chronic myeloproliferative disorders especially chronic myeloid leukaemia, basophilic leukaemia, IgE -mediated allergic disorders, ulcerative colitis, and hypothyroidism.

9. Monocytosis: Increase in the monocyte count above 1000/cu mm.

10. Lymphocytosis: Increase in the absolute lymphocyte count above upper limit of normal for age (>4000/cu mm in adults).

11. Leukoerythroblastic reaction: Presence of immature cells of neutrophil series and nucleated red blood cells in peripheral blood. Leukocyte count may be normal or raised. Bone marrow examination may be required to establish the underlying cause.

12. Leukemoid reaction: Presence of markedly increased leukocyte count (>50,000/cmm) and immature white blood cells in peripheral blood resembling leukaemia but occurring in non-leukemic conditions. 2 types: myeloid & lymphoid.

13. Myeloid type of leukemoid reaction: Blood picture resembles either acute or chronic myeloid leukemia Marked neutrophilic leucocytosis with presence of premature white cells of all stages (from myeloblasts to segmented neutrophils) may mimick chronic myeloid leukaemia (CML).

14. Lymphoid type of leukemoid reaction: Peripheral blood picture resembles that of acute or chronic lymphoid leukaemia. Differentiation of reactive lymphocytosis from chronic lymphocytic leukaemia may sometimes be difficult and patient may have to be followed up to decide whether lymphocytosis is transient or persistent.

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