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Leukocytosis

BY: Jehad Abdullah

Leukocytosis

►Leukocytosis is a white blood cell count

above the normal range in the blood.

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►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.

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There are five principal types of leukocytosis:

►Neutrophilia (the most common form)

►Lymphocytosis

►Monocytosis

►Eosinophilia

►Basophilia

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Neutrophilia

►Neutrophilia (or neutrophil leukocytosis)

describes a high number of neutrophil granulocytes in blood.

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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.

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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.

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Eosinophilia

►Eosinophilia is a condition in which

the eosinophil count in the peripheral blood exceeds 0.45×109/L (450/μl)

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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)

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Basophilia

►Basophilia is a condition where

the basophil quantity is abnormally elevated (more than 1010 basophils per liter of blood).

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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

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Monocytosis

►Monocytosis is an increase in the number

of monocytes circulating in the blood

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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.

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►Autoimune diseases and inflammatory bowel disease.

►Malignancies: Hodgkin's disease and certain leukaemias, such as chronic myelomonocytic leukaemia (CMML) and monocytic leukemia.

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Lymphocytosis

Lymphocytosis is an increase in the number or

proportion of lymphocytes in the blood

Reactive lymphocytes: Used to describe transformed or benign lymphocytes.

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causes

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

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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

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Leukopenia

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.

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.

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.

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

Neutropenia

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

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►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".

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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.

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Lymphoma

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 categoriesLow-grade

Intermediate-grade

High-grade

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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)

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Skin Lymphoma and Shoulder Lymphoma

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Leukemia

Leukemias

►Acuteimmature cells

aggressive

short course

abrupt onset

symptoms include►anemia

► infections

►bleeding

►bone pain

►enlarged lymph nodes

►Chronicmature cells

less aggressive

longer course

insidious onset

symptoms include► fatigue

►pallor

►night sweats

► infections

►splenomegaly

►hepatomegaly

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Leukemia

►Acute leukemia is characterized by an abnormal proliferation of immature white blood cells, called blasts or progenitor cells

►Two main forms of acute leukemiaAcute 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

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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

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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

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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

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