Leucocytosis:A raised WBCs count.Due to elevation of a single lineage.

Neutophilia:A) Physiologic causes:

Pregnancy, newborns, after parturition or after exercise.

B) Pathological causes:1- Infections: pyogenic bacteria.2- Neoplasia: all types.3- Hge / haemolysis.4- Corticosteroids.

Blood cells Disorders

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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.

Leucocytosis

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Leucocytosis

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Eosinophilia: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 infections3- Some forms of malignancy

• Hodgkin's lymphoma• Some forms of Non-Hodgkin lymphoma

3- Systemic autoimmune diseases (e.g. SLE)

Monocytosis: An increase in the number of monocytes circulating in the bloodCauses: 1. Chronic inflammation: tuberculosis, syphilis and malaria2. Blood and immune causes: Myeloproliferative disorders.3. Malignancies: Certain leukaemias, such as chronic myelomonocytic leukaemia (CMML) and

monocytic leukemia.

Basophilia:Causes:• Infections: Pox virus (chicken pox, small pox)• Neoplasia: MPD (myeloproloferative disorders).

Leucocytosis

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Lymphocytosis: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

2. Chronic lymphocytic leukemia (CLL).

3. Acute lymphoblastic leukemia (ALL). Lymphocytosis, peripheral blood smear

Leucocytosis

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Leucopenia:Reduced total leucocytic count.

Neutropenia:Reduced neutrophil count < 2000 / cmClassification:

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.

Leucopenia

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Causes of Neutropenia:Causes can be divided into the following groups:

I. 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,

II. 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

Leucopenia

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III. 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.

IV. 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.

Leucopenia

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Leucopenia

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2-Chediak-Higashi Syndrome: Oculocutaneous albinism

Photophobia Sun sensitivity

Neuropathy Recurrent Infections, esp Staph aureus Granules in granulocytes, monocytes and lymphocytes Treatment: BMT3- Reticular Dysgenesis: Thymic aplasia. Inability to produce neutrophil. Patient die at early age from bacterial and viral infections. BMT should be considered

Thrombocytopenia or thrombopenia :is a relative decrease of platelets in bloodSymptoms 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 mucousextravasation of blood.

-Purpura may be due to deficient and defectiveplatelets or due to an unexplained increase in capillary fragility

Thrombocytopenia

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Causes: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

Thrombocytopenia

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Thrombocytopenia

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(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.

Thrombocytopenia

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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 lymphocytesEosinophilia

Decreased plat. No. Normal WBC

LaboratoryP.B.

Prolonged Prolonged B.T.

The same+ eosinophilia

Increased megas & immature forms

B.M.

Thrombocytopenia

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Thrombotic Thrombocytopenic Purpura. Hemolytic – Uremic Syndrome:1. Idiopathic TTP-HUS:A syndrome characterized by:

1. Neurological abnormalities2. Thrombocytopenia3. Microangiopathic hemolytic anemia4. Renal involvement5. Fever

2. 2ry TTP-HUS: Causes:1. Pregnancy2. Cancer assiociated3. Drugs e.g. Cyclosporin4. Marrow Transplantation