Leukocytosis

1. 1 Leukocytosis BY: Jehad Abdullah

2. Leukocytosis Leukocytosis  is a white blood cell count above the normal range in the blood. 2

3. It is frequently a sign of an inflammatory response,  most commonly the result of infection, and is observed in certain parasitic infections. It may also occur after strenuous exercise, convulsions such as epilepsy, emotional stress, pregnancy and labour, anesthesia, and epinephrine administration. 3

4. There are five principal types of leukocytosis: Neutrophilia  (the most common form) Lymphocytosis Monocytosis Eosinophilia Basophilia 4

5. Neutrophilia Neutrophilia  (or  neutrophil leukocytosis ) describes a high number of  neutrophil granulocytes  in blood. 5

6. Causes : Neutrophils are the primary  white blood cells  that respond to a  bacterial   infection , so the most common cause of neutrophilia is a bacterial infection, especially  pyogenic infections . [2] Neutrophils are also increased in any acute  inflammation , so will be raised after a  heart attack ,  other  infarct  or  burns . 6

7. Causes :cont Some drugs, such as  prednisone , have the same effect as  cortisol  and Adrenaline  epinephrine , causing marginated neutrophils to enter the blood stream.  Nervousness  will very slightly raise the neutrophil count because of this effect. A neutrophilia might also be the result of a  malignancy .  Chronic myelogenous leukemia  (CML or chronic myeloid leukaemia) is a disease where the blood cells proliferate out of control. These cells may be neutrophils. Neutrophilia can also be caused by  appendicitis  and  splenectomy . 7

8. Eosinophilia Eosinophilia  is a condition in which the  eosinophil  count in the  peripheral blood  exceeds 0.45×10 9 /L (450/μl) 8

9. Causes : Allergic  disorders Asthma Hay fever Drug allergies Allergic skin diseases Pemphigus Dermatitis herpetiformis Parasitic infections Some forms of  malignancy Hodgkin's lymphoma Some forms of  Non-Hodgkin lymphoma Systemic autoimmune diseases [8]  (e.g.  SLE ) Some forms of  vasculitis Cholesterol embolism  (transiently) 9

10. Basophilia Basophilia  is a condition where the  basophil  quantity is abnormally elevated (more than 10 10  basophils per liter of blood). 10

11. Causes : A- Allergy or inflammation 1. Drug, food, inhalant hypersensitivity 2. diabetes mellitus 3. Estrogen administration B. Infection Chicken pox , Influenza , Smallpox , Tuberculosis , Iron deficiency c. Exposure to ionizing radiation 11

12. Monocytosis Monocytosis  is an increase in the number of  monocytes  circulating in the blood 12

13. Causes Infections:  tuberculosis ,  brucellosis ,  listeriosis ,  subacute bacterial endocarditis ,  syphilis , and other viral infections and many  protozoal  and  rickettsial  infections (e.g.  kala azar ,  malaria ,  Rocky Mountain spotted fever ). Blood and immune causes: chronic  neutropenia  and  myeloproliferative disorders . 13

14. Autoimune diseases and  inflammatory bowel disease . Malignancies:  Hodgkin's disease  and certain  leukaemias , such as  chronic myelomonocytic leukaemia  (CMML) and  monocytic leukemia . 14

15. Lymphocytosis Lymphocytosis  is an increase in the number or proportion of  lymphocytes  in the  blood Reactive lymphocytes: Used to describe transformed or benign lymphocytes. 15

16. causes Lymphocytosis is a feature of  infection , particularly in children. In the elderly, lymphoproliferative disorders, including  chronic lymphocytic leukaemia and  lymphomas , often present with  lymphadenopathy  and a lymphocytosis. 16

17. Causes:cont acute  viral  infections, such as  infectious mononucleosis ,  hepatitis   some  protozoal  infections, such as  toxoplasmosis  and American trypanosomiasis ( Chagas disease ) chronic intracellular bacterial infections such as  tuberculosis chronic lymphocytic leukemia acute lymphoblastic leukemia lymphoma 17

18. 18 Leukopenia

19. Leukopenia Leukopenia  (also known as  leukocytopenia , or  leucopenia , from  Greek  λευκό - white and πενία -deficiency) is a decrease in the number of  white blood cells  (leukocytes) found in the  blood , which places individuals at increased risk of  infection .

20. Leukopenia Lymphopenia is less common; in addition to congenital immunodeficiency diseases, it is most commonly observed in specific settings, such as advanced HIV infection, following therapy with glucocorticoids or cytotoxic drugs, autoimmune disorders, malnutrition, and certain acute viral infections. Only the more common leukopenias involving granulocytes will be discussed further here.

21. Pathogenesis. (1) Inadequate or ineffective granulopoiesis is observed in the setting of: 1. Suppression of myeloid stem cells, as occurs in aplastic anemia and a variety of infiltrative marrow disorders (tumors, granulomatous disease, etc.); in these conditions, granulocytopenia is accompanied by anemia and thrombocytopenia.

22. Pathogenesis. 2. Suppression of committed granulocytic precursors due to exposure to certain drugs. Drugs are responsible for most of the significant neutropenias . Certain drugs, such as alkylating agents and antimetabolites used in cancer treatment, produce agranulocytosis in a predictable, dose-related fashion. Because such drugs cause a generalized suppression of the bone marrow, production of erythrocytes and platelets is also affected

23. Neutropenia subtype of leukopenia, refers to a decrease in the number of circulating  neutrophil granulocytes , the most abundant white blood cells. The. 23

24. Pseudoleukopenia can develop upon the onset of infection. The leukocytes (predominately neutrophils, responding to injury first) start migrating towards the site of infection and can be scanned at the site of infection. Their migration causes bone marrow to produce more WBCs to combat infection as well as to restore the leukocytes in circulation, but as the blood sample is taken upon the onset of infection, it contains low amount of WBCs, which is why it is called "pseudoleukopenia". 24

25. lymphopenia Lymphocytopenia , or  lymphopenia , is the condition of having an abnormally low level of  lymphocytes  in the blood.  Lymphocytopenia may be present as part of . The opposite is  lymphocytosis , which refers to an excessive level of lymphocytesa  pancytopenia , when the total numbers of all types of blood cells are reduced. 25

26. 26 Lymphoma

27. Lymphoma Lymphomas are a malignant proliferation of lymphocytes – either B or T 3% of all cancers in the US result from lymphomas The lymphomas are classified by the appearance of malignant lymphocytes on biopsy of tumor 3 categories Low-grade Intermediate-grade High-grade 27

28. Functional Presentation of Lymphoma People present with swollen, growing lymph glands (nodal disease) or tumors in other organs (extramodal disease) Person can be asymptomatic Common B symptoms include fever, drenching night sweats, loss of 10% of body weight, and pruritis (severe itching) 28

29. Skin Lymphoma and Shoulder Lymphoma 29

30. 30 Leukemia

31. Leukemias Acute immature cells aggressive short course abrupt onset symptoms include anemia infections bleeding bone pain enlarged lymph nodes Chronic mature cells less aggressive longer course insidious onset symptoms include fatigue pallor night sweats infections splenomegaly hepatomegaly 31

32. Leukemia Acute leukemia is characterized by an abnormal proliferation of immature white blood cells, called blasts or progenitor cells Two main forms of acute leukemia Acute lymphoblastic leukemia A cancer at the earliest stages of lymphocyte maturation Occurs more often in the young Acute nonlymphoblastic leukemia Usually a malignancy of the myeloblast More common in adults 32

33. Functional Presentation of Leukemia People with leukemia present with signs and symptoms of low red blood cell count (anemia), decreased white blood cells (granulocytopenia) with infection and fever, and a low platelet count (thrombocytopenia) with bleeding People will usually present critically 33

34. Physical appearance of leukemia Specific lesions (leukemia cutis) are localized or disseminated infiltrations of the skin by malignant leukemic cells which may involve all layers of the skin. Chemotherapy needed for treatment of Leukemia usually results in hair loss 34

35. Treatment of Leukemia The course of treatment includes red blood cell transfusions to correct the anemia, treatments for infections caused by the lack of mature white blood cells, platelet transfusions to stop any bleeding, and starting chemotherapy to kill the leukemia cells Once chemotherapy stops, tumor cells die, the normal stem cells in the marrow that are resistant to chemotherapy divide, and their progeny cells mature and repopulate the marrow over the next 3 weeks 35

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