1. Aspire to become good, not great....Greatness is like a passing cloud,temporary.- Sai Baba - Divine Discourse, July 16, 2001.

2. Pathology ofWBC disordersDr. Shashidhar Venkatesh MurthyA/Prof. & Head of Pathology2013: MB2-HRM-Week 7 3. HRM-Wk7: Fever, bleeding & Back pain Mr M.S. 45y, man. Presents to ED: Verybad lower back pain, nothing helping it. History: Feels unwell? - Very Fever? Yes, I think so; intermittent Easy bruising -Yes, bruises last few weeks. Examination: Slim, unwell, pale, Multiple Bruises Liver & Spleen enlarged mild. Lymph nodes enlarged neck & axilla. 4. Learning Objectives: WBC in health & disease - overview. Classification & Common WBC disorders. Congenital, Reactive & Cancer. Clinical features. Pathogenesis Laboratory diagnosis Blood morphology Features (3-4). Line diagram. Management - brief.TOP 10 WBC Disorders: Leukopenia:1. Neutropenia2. Lymphopenia.3. Pancytopenia Leucocytosis:4. Neutrophilia5. Eosinophilia6. Lymphocytosis IM7. Lymphadenitis. Neoplastic disorders (cancer)9. Lymphoma10. Leukemia (AML/ALL,CML/CLL) 5. Teaching Plan & Staff: Introduction to WBC disorders: Shashidhar Venkatesh Murthy. Clinical Cases: GLS 1st hour. Ian Irving, Haematologist, TSVH. Microscopy Tutorial: GLS 2nd hour. Shashidhar Venkatesh Murthy. Synthesis Session: Keepad Q&A disc. Shashidhar Venkatesh Murthy.Mon9amTue1pmTue2pmThu1pm 6. GLS SESSION 7. 8y child with Asthma & multiple scaly skin lesions.Image shows blood film appearance. ? Cause1. Viral Infection2. Allergic reaction3. Malaria.4. Bacterial infection.5. Fungal infection.1 2 3 4 50 0 000SYNTHESIS SESSION 8. I am here for you.Email: venkatesh.shashidhar@jcu.edu.auvmshashi@gmail.comNeed personal guidance? Email me for an appointment.Office Tel: 4781 4566Office location MS136Emergency?(exam time) Mob: 0416 933 704 9. Small minds discuss peopleAverage minds discuss eventsGreat minds discuss solutionGenius silently acts! 10. 10Normal Blood Cells:NeutrophilBasophilEosinophilLymphocyteNon granular, MononuclearsSpecific ImmunityGranulocytes, PolymorphsNon-Specific Immunity 11. Normal WBC Production: 12. Normal Granulopoiesis: CSFStimulatebone marrowto produceWBC.What are the Clinical applications of G-CSF? 13. Lab: CBC - WBC Histogram:AbsoluteCount% / Differential Count 14. WBC Absolute counts in disease:Penia PhiliaNeutroPenia PhiliaEosinoPenia cytosisMonoPenia cytosisLympho 15. Leukopenia: Neutropenia Reduction in granulocytes: Decreased Production Marrow. Increased destruction drugs, immune When severe Agranulocytosis. Clinical features: Infections chills, fever, fatigue, ulcers. 16. Leukocytosis: Neutrophilia Increased granulocytes: Acute inflammation, Bacterial infections. When severe Leukemoid reaction. Clinical features: Infections or Trauma - fever, fatigue. 17. Lymphocytosis: Infectious Mononucleosis Increased Lymphocytes: Chronic Inflam, Viral, fungal, TB etc. Large lymphocytes, more cytoplasm. Irregular,indented by RBC also known as virocyte Clinical features: Chronic fever, lymphadenopathy. 18. Neutrophilia:Acute inflammation (Bacterial, trauma, immune, etc) 19. Toxic Granulation & Left shift:Acute inflammation Bacterial, trauma, immune, etcBand forms & Phagocytic granules in cytoplasm 20. Leukemoid Reaction: Marked increase inneutrophils. >50,000 x109 Shift to left immatureforms. Severe infection, trauma,bone marrow infiltration. Looks like leukemia*(no blasts) 21. Your failure may prove to bean asset, provided you try toknow why you failed !--Napoleon Hill 22. Lymphadenitis: Reactive. Acute or Chronic. Infections, Immune & Cancers. Increased large irregular lymphoid follicleswith normal archetecture. (mantle zone). Lymphadenitis: Enlarged lymphnodes dueto inflammation or infecitons. Painful. Lymphadenopathy any enlargement, butcommonly used for Cancers Painless. 23. Reactive lymphadenitisDark zoneLight zoneMantle zoneMacrophageTingible bodyMacrophage 24. Hemato-oncology: Blood Cancer Cancer of blood forming stem cells (Blasts). Leukemia White blood excess WBC. Starts in bone marrow or lymphatic tissue. Spread to blood & other RES tissues only.(Liver, Spleen & lymphnodes) Two Major types: Myeloid & Lymphoid. Two clinical presentaiton: Acute / Chronic. Many subtypes* due to several differentmutations personalized medicine * 25. The goal of mankind is knowledge, whichis inherent in man. No knowledge comesfrom outside: it is all inside. What manlearns is really what he discovers bytaking the cover off his own soul.- - Swami VivekanandaEducation from Eduse (latin) to bring out..!Doctor from Dokere (latin) to teach! 26. LymphoblastLeukemia: Cancer of Blast cells.AcuteMyeloidLeukemiaAcute Lymphatic LeukemiaChronic LeukemiaChronic Leukemia 27. Normal Acute - Chronic LeukNormalChronic Myeloid LeukemiaAcute Myeloid Leukemia 28. Hematologic Neoplasms: Classification Leukemias: Bone marrow, blood, Blasts Duration: Acute/Chronic Cell of Origin: Myeloid/Lymphoid AML / ALL & CML / CLL Lymphomas: Lymph nodes, tumor Hodgkins & Non-Hodgkins. Premalignant conditions: Myeloproliferative syndromes (MPS) Myelodysplastic syndromes (MDS) 29. Leukemia: Clinical Features Cancer of Bone marrow Excess blasts. Decreased Haemopoiesis: Erythropoiesis Anemia - RBC Leukopoiesis Infections - WBC Thrombopoiesis Bleeding. PLT Bone marrow expansion/destruction: Bone pains. Extraneous hemopoiesis / spread: Splenomegaly Hepatomegaly Lymphadenopathy. (more in lymphatic malignancy) 30. Leukemia Clinical features:Bleeding - PetechiaeLymphadenopathyHepatosplenomegalyInfections - Candidiasis 31. Leukemia Classification Acute Leukemias: weeks to months. Acute Myeloid Leukemia AML - Adults Many Subtypes: M0, M1 to M7 Acute Lymphoid Leukemia ALL - Children Many Subtypes: L1, L2 & L3 Chronic Leukemias: Years. Chronic Myeloid Leukemia- CML- Adults Chronic Lymphoid Leukemia - CLL Old age Many subtypes: 32. ALL - AML 33. Acute Leukemia: AML/ALL - BlastsNorm. LymphocyteBlastBlastNorm. RBCNorm. LymphocyteNorm. RBCBlastNormal 34. Self-pity is an opiate!--Napoleon Hill 35. Lymphoma Definition: Tumour of lymphoid tissue Etiology: Idiopathic, Genetic, Infective. Clinical: Lymphadenopathy, weight loss, Fever. Two Major Types: & many subtypes. Hodgkins lymphoma (HL) RS cells. Non-Hodgkins lymphoma (NHL) no RS cells. B cell, T cell & Histiocytic lymphoma. 36. Lymphoma Row of enlarged lymph nodes 37. Hodgkins LymphomaBig binucleate cancer cells known asReed Sternberg Cells (RS cells) 38. Non-Hodgkins Lymphoma: Large group of lymphatic neoplasms. Clinical: Fever, anemia, infections,Lymphadenopathy. Spleen+/-. No RS cells or eosinophilia Complex names and classification. Cell type B, T & Histiocytic B commonest Clinical low, intermediate & high grade. Histology Follicular & diffuse. Special types: Burkitts lymphoma, Myeloma,Waldenstroms macroglobulinemia, lennerts, 39. Non Hodgkins LymphomaLow, Intermediate & High grade. 40. Burkitts lymphoma: large B cell NHL Endemic in Africa Epstein Barr Virus(EBV) B Cell Lymphoma. Dark large Blymphocytes (malignant)with plenty of palemacrophages. (Starrysky pattern). 41. Multiple Myeloma: Malignancy of Plasma cells(Mature B lymph, Ab) Old age, males common. Marrow, LN, Blood. Multiple, punched out Lytic bonelesions (Osteolysis) Hyper gammaglobulinemia Monoclonal antibody peak serum protein electrophoresis. Immunodeficiency infections. 42. "Creativity is inventing,experimenting, growing, takingrisks, breaking rules, makingmistakes, and having fun.-- Mary Lou Cook 43. Myeloproliferative Disorders.Myelodysplastic Syndromes.(Precanceraous stage of blood cancers) 44. Myelo Proliferative Disorders: Excess Proliferation, Neoplastic, Old age. Organomegaly Liver & Spleen enlarged. Hypercellular BM & Leukocytosis. 4 types: Excess RBC (polycythemia vera) Excess WBC (CML) Excess Plt (Essential Thrombocythemia) Excess Fibroblast (Myelofibrosis). Mixed types common, end in leukemia. 45. Polycythemia Rubra Vera (PV)Hypercellular Marrow,Red skin & Hepatosplenomegaly 46. ET - Blood Film & clinical.Plenty ofPlateletsMegakaryocyte 47. Myelo Dysplastic Syndromes: Dysplastic Proliferation (abnormal cells) Neoplastic, old age, unexplained anemia. Abnormal cells destroyed in bone marrow. Hypercellular BM & Leukopenia, anemia. Commonly known as Refractory Anemia. Many subtypes, Mild to severe dysplasia. Increasing blasts poor prognosis. Transforms to acute leukemia. 48. Summary: Reactive Leukocytosis. Neutrophilia, Eosinophilia, Lymphocytosis. Reactive Leukopenia. Neutropenia, lymphopenia. Leukemias Cancer of Blasts. AML/ALL, CML/CLL Lymphomas Tumors of lymphoid tissue Hodgkins & Non- Hodgkins (HL, NHL) Premalignant conditions MPS & MDS: 49. 3 Rs of success:Respect for self,Respect for others &Responsibility for your actions.