Clinical Hematology II
HML2143
1
LO3: Classify normal and abnormal leucocytes and
explain the abnormalities seen in peripheral blood
leucocytes in systemic and infectious diseases.
Week 6:
• Describe the abnormalities seen in peripheral blood leukocytes in
systemic and infectious disease.
2
Content
Leukocytes abnormalities
Abnormalities Of Leucocytes
• The changes can be:
•
1. Quantitative - more or less WBCs count than normal
2.
3. Qualitative - Cells changed in appearance
- Cells present that are not normally found in the peripheral blood
1. Neutrophils
(a) Quantitative Changes
1) Neutrophilia: Increased number of neutrophils; Causes:
1. Non-pathological: stress, exercise, medications, trauma, childbirth, surgery.
2. Pathological: infection (particularly bacterial), inflammation, malignancy of
BM, leukaemia
3.
2) Neutropenia: Decreased number of neutrophils; Causes:
1. Folate/B12 deficiency
2. Acute infection
3. Cytotoxic drugs and radiation
4. Some forms of leukaemia
1. Neutrophils
b) Qualitative Changes:
• Cells altered in appearance
1. Infection: toxic granulation and Dohle bodies and younger cells “left
shift” (myelocytes, metamyolocytes, stab cells)
2. Leukaemia: many young cells including blasts
Dohle bodies: Remnants of rough
3. B12/folate deficiency: hypersegmented cells endoplasmic reticulum.
• Hypersegmented cells
# Young forms & toxic # Chronic Myeloid Leukaemia # Hypersegmented
changes in bacterial CML [Myelocytes, neutrophils in
infection; metamyelocytes, band forms, B12/folate deficiency
“Shift to Left” blast cells (myeloblast)]
2. EOSINOPHILS
• Eoinophilia:
1. Allergy: usual
2. Parasitic infection: usual with most parasites
3. Skin diseases: sometimes
4. Cancer: sometimes mainly Chronic myeloid leukaemia (CML)
3. BASOPHILS
• Basophilia: Uncommon.
Some malignancies & leukaemia mainly CML
4. MONOCYTES “Monocytosis”
• Increased: “chronic infection”
1. Tuberculosis, Septicaemia & in Monocytic leukaemia
5. LYMPHOCYTES
Quantitative:
A. Increased: # Viral infections in children & sometimes adults
# Whooping cough
# Chronic Lymphocytic Leukaemia CLL
B. Decreased:: # Acute systemic disease e.g. uremia
# Hepatitis A
• Qualitative: Alteration in appearance of Lymphocytes:
1) Reactive lymphocyte Glandular fever & other viral infections
•
Atypical lymph in Virocytes
Atypical lymph in Glandular Fever
2) PLASMA CELLS
• Not usually seen in the peripheral
blood
•
• Can be seen in some conditions, in
1. Children with viral infections
2. or Multiple Myeloma
•
WBCs Parameters Of Routine CBC
1) Total WBCs count: (4.0 - 11.0)×103 /µL →→(WBC×109 /L )
2) Differential count: the counting of 100 WBCs & classify them to their
different types according to the morphology:
• Neutrophil→ 65%
• Lymph → 25% Absolute count:
Relative count: Actual number of each type of
• Mono → 6%
diff count expressed cell
• Eosino→ 2%
as percentage % (e.g., neutrophils × 10 9 /L)
• Baso → 1 %
• Band → 1%
Note: ANC :Absolute Neutrophil Count:
Includes neutrophil + bands
Interpretation
• Total WBCs Count: ↑ (Leukocytosis ) & ↓ (Leukopenia)
• Differential count:
• Neutro: ↑ (neutrophilia in bacterial infection)
↓ (neutropenia in viral infection or long term drug administration)
• Lymph: ↑ (Lymphocytosis in viral infection and CLL)
↓ (Lymphopenia in long-term drug administration or immune
deficiency)
• Mono : ↑ (Monocytosis in Leukemia & chronic infection)
• Eosino: ↑ (Eosinophilia in allergy or parasitic infection)
• Baso : ↑ (Basophilia in Leukemia CML)
• Band : ↑ (Bacterial infection called “ left shift”)
• Convert diff to absolute:
Absolute= Diff × total count/ 100
• e.g., Given the Diff count of neut= 65% and total WBCs count = 4,0 × 109 /L .
What is the Absolute neutrophil count ?
• Absolute Neutrophil count= 65/100 × 4 = 2.6 × 109 /L 109 /L
•
• Convert absolute to diff
Diff = Absolute × 100/ total count
• e.g., Given the Absolute Neutrophil count= 2.6 × 109 /L and total WBCs count
= 4,0 × 109 /L . What is the Differential count of neutrophil?
• Diff count of neutrophil= 2.6 × 100/ 4= 65%
Exercise:
●
WBC ●
RBC ●
Hb ●
Hct ●
MCV ●
MCH ●
MCH ●
Plts
●
(109/L) ●
(1012/ ●
(g/dl) ●
l/l ●
(fl) ●
(pg) C ●
(109/
L) ●
(g/dl) l)
●
2.4 ●
4.42 ●
11.3 ●
0.33 ●
89 ●
26 ●
35.4 ●
25
● ● ● ●
What is the absolute number of the ●
Neut % ●
Lymp ●
Mono ●
Eos ●
Baso
following cells in (109/L)?
1- Neutrophil h% % % %
2- Basophil ●
3- Lymphocytes
●
4 ●
91 ●
4 ●
1 ●
0
●
Exercise:
●
WBC ●
RBC ●
Hb ●
Hct ●
MCV ●
MCH ●
MCH ●
Plts
●
(109/ ●
(1012/ ●
(g/dl) ●
l/l ●
(fl) ●
(pg) C ●
(109/
L) L) ●
(g/dl) l)
●
14.7 ●
4.44 ●
13.3 ●
0.39 ●
88 ●
26 ●
35.4 ●
225
● ● ● ●
• Calculate the Differential or
relative count of cells given: ●
Neut ●
Lymph ●
Mono ●
Eos ●
Baso
1- Neutrophil (109/L) (109/L) ●
(109/L) ●
(109/ ●
(109/L)
2- Lymphocyte
L)
3- Basophil
●
3.5 ●
3.1 ●
7.1 ●
0.5 ●
0.5
●
References
• McKenzie, Shirlyn/ Landis-Piwowar; Kristin/ Williams, Lynne (2019). Clinical Laboratory Hematology. 4 th
Ed. Pearson Education. ISBN 9780134709239
•
• Kaushansky/ et al, (2016) Williams Hematology, 9th Ed. McGraw-Hill. ISBN 9780071833011
•
• Lewis, S., Bain, B., Bates, I. (2012) Dacie and Lewis, Practical Haematology, 11th Ed., Churchill
Livingstone Elsevier. ISBN: 978-0-7020-3407-7
•
• Hoffbrand, A., Moss, P. (2011) Essential Haematology, 6th Ed. Wiley Blackwell. ISBN: 978-1-4051-9890-5
• Moss, Paul, Pettit, Hoffbrand. Essential Haematology, 5th Ed. Blackwell Science. 2006. ISBN:
9781405136495
•
• Moore, Gary/ Knight, Gavin (2013) Essential Haematology, Oxford University Press ISBN: 9780191666711
•
•
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