by SHAH SUNIL K. (BOND KING)

1. ABNORMALITIES of the
WHITE BLOOD
CELLS
Jose R. Villarino, RMT

2. Possible answers:
 A. NEUTROPHILS  J. ASTHMA
 B. LYMPHOCYTES  K. AUER ROD
 C. PATHOLOGIC  L. PELGER HUET
 D. PHYSIOOGIC  M. TOXIC
 E. 20-40 % GRANULES
 F. 5000-10000/cumm  N. LEUCOPENIA
 G. 0-3 %  O. PARASITISM
 H. MALARIA  P. SCARLET FEVER
 I. AZUROPHILIC  Q. DOHLE BODIES
GRANULES  R. BASKET CELLS

3. WBC Normal values:
 WBC Count = 5,000 – 10,000/cu mm or
5 – 10 x 109/L
 Differential Count:
 Neutrophil = 50 – 70 %
Segmenter = 50 – 65 % ; Stab = 0 – 5 %
 Eosinophil = 0 – 3 %
 Basophil = 0 – 1 %
 Lymphocytes = 20 – 40 %
 Monocytes = 2 – 6 %

4. Quantitative abnormalities
 Leucocytosis – substantial increase in
the WBC count.
- Physiologic increase (no trauma/injury)
- Pathologic increase (trauma/pathology)
 Leucopenia – substantial decrease in
the WBC count.
 N.V. = 5,000 – 10,000/cu mm

5. Differential Count
Neutrophil 50 – 75 %
segmenter 50 – 65 %
stab 0–5%
Eosinophil 0–3%
Basophil 0–1%
Lymphocyte 20 – 40 %
Monocyte 2–6%

6. The 5 WBC types

7. Neutrophilia
(> 7 – 8 x109/L)
 Infections, Inflammation, Metabolic
disorders
 Acute hemorrhage, corticosteroids
 Stress, post-surgery, burns, HDN
 Lithium drugs, neoplasms

8. Neutropenia
(<1.75 – 1.8109/L)
 Decreased production
- Inherited/acquired stem cell disorder
- Benzene toxicity, cytotoxic drugs
 Increased destruction
- Immune mechanism, sequestration
 BM depression, IM, varicella, Typhoid
 SLE, hepatitis or any viral infections

9. Eosinophilia
(> 0.7 x 109/L)
 Allergic disorders (asthma)
 Parasitic infections (nematodes)
 Skin disease (eczema)
 Hodgkin’s disease
 Scarlet Fever
 Pernicious anemia

10. Eosinopenia
(< 0.05 x 109/L)
 Stress due to trauma or shock
 Mental distress
 Cushing’s syndrome
 ACTH administration

11. Basophil (0.3 x 109/L)
BASOPHILIA Chronic myelocyic leukemia
Polycythemia vera
Hodgkin’s disease
BASOPENIA Hyperthyroidism
Pregnancy

12. Lymphocytosis
(>4.0 x 109/L)
 Viral infections ( German measles )
 Infectious Mononucleosis (kissing dis.)
 Mumps (parotitis), pertussis
 Tuberculosis, syphilis, thyrotoxicosis

13. Lymphopenia
 Congestive heart failure, SLE
 Renal failure
 Advanced Tuberculosis
 High levels of adrenal corticosteroids

14. Monocytosis
(>0.9 x 109/L)
 SBE, Syphilis, Tuberculosis
 Protozoan infections
 Mycotic or fungal infections
 Malaria, Systemic lupus erythematosus
 Rheumatoid arthritis

15. Monocytopenia
 Lymphocytic leukemia
 Aplastic anemia

16. QUALITATIVE CHANGES-
WBC
 Morphologic abnormalities involving
either the nucleus or cytoplasm
 Functional abnormalities
 Inherited or Acquired
 Examination of peripheral blood or a
bone marrow evaluation

17. The White blood cells:
 Nucleus details:
- Mononuclear or Polymorphonuclear
 Granules present:
- Granulocytic or Agranulocytic
 Function:
- Phagocytic or Immunocytic

18. Abnormal granulocyte
morphology (acquired)
 Toxic granulation, cytoplasmic vacuole
 Dohle bodies (Amato bodies)
 Azurophilic granules
 Hypersegmentation

19. Pathological Leucocytes

20. Abnormal granulocyte
morphology (inherited)
 Alder-Reilly anomaly - dense
azurophilic granules,
mucopolysaccharoidoses
 May-Hegglin anomaly - Giant platelets,
Dohle-bodies like inclusions seen even
in monocytes
 Pelger Huet anomaly – failure of normal
segmentation of nucleus, bi-lobed
nucleus or stab forms only,
“pince-nez nucleus”

21. Alder Reilly anomaly

22. May-Hegglin anomaly

23. Pelger Huet anomaly

24. Continuation:
 Chediak Steinbrinck Higashi syndrome –
large lysosomes containing hydrolases and
other enzymes. There is
anemia,thrombocytopenia, leucopenia and
increased susceptibility to infection. There is
partial albinism & photophobia.
 Also seen in Aleutian mink, mice, cat, cattle &
killer whale as caused by abnormal WBCs.

25. Chediak Higashi syndrome

26. Other abnormalities:
 Smudge or basket cells – squash-
degenerated nucleus of WBCs
 Jordan’s anomaly – fat-containing
vacuoles in WBC cytoplasm, Ichthyosis
 Twinning deformity
 Auer rod – rod-like structure seen in the
cytoplasm of myeloblasts, diagnostic for
Acute myeloblastic leukemia (AML)

27. Variants of the Lymphocytes
 Plasmacytoid lymphocyte or Turk’s
irritation cell
 Downey cell (atypical lymphocyte)
 Transformed lymphocyte (reticular or
pyroninophilic cell)
 Reider cell – “clover-leaf like nucleus”
 Plasma cells

28. Reactive lymphocytes

29. Downey cell
 Hallmark cell seen in cases of
Infectious mononucleosis (kissing
disease)
 Atypical lymphocyte (stress
lymphocyte)
 “ballerina skirt cell”

30. Infectious Mononucleosis

31. Plasma cells
 Ovoid or fibrillary shaped
 Eccentric location of nucleus
 Perinuclear halo
 “cart-wheel pattern or spoke of the
wheel pattern of nucleus”
 basophilic cytoplasm

32. Comparative morphology of plasma
cells, lymphocytes and NRBC

33. Inherited abnormalities involving
Monocyte-macrophage group
 MUCOPOLYSACCHAROIDOSES
- Hunter syndrome, Hurler’s disease
 LIPIDOSES – lipid accumulation
- Gaucher’s disease – accumulation of
glucocerebroside due to lack of beta-
glucosidase enzyme
- Neimann Pick disease – sphingomyelin
and cholesterol accumulation due to
lack of the enzyme sphingomyelinase

34. Monocyte-macrophage
abnormality

35. WBC functions
 Neutrophil – phagocytic
 Eosinophil – phagocytic and damage to
larval stages of parasite.
 Basophil – storage of histamine,
involved in immediate hypersensitivity
reaction.
 Monocyte – phagocytic, cellular and
humoral immunity

36. Functions….
 Lymphocytes – immune leucocytes
 a)humoral b) lymphokines c) cytotoxic
- Not obligate end cells
- Heterogenous group of cells
- Destined to migrate

37. PHAGOCYTOSIS process
 Motility – random movement and
directed movement
 Recognition
 Ingestion
 Degranulation or release of granules
 Microbial killing

38. Inherited functional
abnormalities
 Job’s syndrome – defective directed
movement, characteristic “cold boils”
 Lazy leucocyte syndrome – both
random & directed movements are
defective
 Chediak Higashi syndrome – failure to
release the granules

39. Non-neoplastic (non-clonal)
disorders of the WBC
 Include a) growth regulation
abnormalities, b) leukemoid reaction
(an increased proliferative response to
various stimuli) including bone marrow
aplasia and hypoplasia and
c) qualitative leucocyte disorders (both
acquired & inherited) characterized by
deficiency of leucocyte function.

40. Non-clonal disorders of WBC
Function disorders
Defective chemotaxis, phagocytosis,
defective killing, CGD, myeloperoxidase
deficiency
Quantitative disorders
Neutropenia, agranulocytosis,
Leukemoid reaction, Infectious mono

41. Clonal (neoplastic) disorders
of WBC
 Derived from a single precursor cell with
all the affected cells (progeny) showing
features of deviation from the precursor
cell.
 Myeloproliferative disorders
 Lymphoproliferative disorders
 Immunoproliferative disorders

42. Leukemoid reaction
 High WBC count = <50000/cu mm
 Toxic granulation & Dohle bodies
 Predominant band forms
 LAP score = >100
 Negative for Philadelphia chromosome
- Translocation of genetic material from
long arm of Chromosome 22 to Ch 9

43. Hodgkin’s disease
 Belongs to a group of malignant
disorders referred as Lymphomas
 Lymphomas involved abnormal lymph
node enlargement with replacement or
alteration in its histologic characteristic
 The neoplastic cell involved is known as
the Reed-Sternberg cell. Mostly
appears as binucleated with the 2
halves of the cell appearing as mirror
images.

44. Hematopoietic malignancy
 Defined as growth or proliferation of
one or more clones of abnormal cells.
These cells don’t respond to normal
control and even produce substances
inhibiting growth of normal cells.
 These malignancy may be manifested
in the peripheral blood as in cases of
anemia and thrombocytopenia.

45. Leukemias
 In the case of WBC, these malignant cells
may or may not circulate in the peripheral
blood. Hence, WBC count may be increased
or otherwise.
 Should these abnormal cells be present both
in the bone marrow and the peripheral blood,
the term leukemia is used.
 Aleukemic leukemia – if only confined to the
marrow and do not circulate.

46. Classification of the leukemias
 According to the stem cell line involved
- Myeloid – involves the granulocytes,
monocytes, RBCs and
megakaryocytes. Also known as
myeloproliferative disorders or
nonlymphocytic leukemias.
- Lymphoid – involving the B or T cells
and may be a leukemia or lymphoma

47. Classification of leukemias
 According to duration (life span)
- Acute – days to weeks (3 months)
- greater than 30 % blasts forms
- Chronic – more than a year (1-2 years)
- less than 10 % blast forms

48. Examples :
Acute myeloid leukemia myeloblast
Chronic myelogenous Myelocyte, metamyelocyte &
leukemia neutro
Acute lymphoblastic lymphoblasts
leukemia
Chronic lymphocytic Small mature lymph
leukemia
Erythroleukemia > 50% of the nucleated cells
Di Guglielmo syndrome are erythroblasts

49. Comments on the leukemias:
 AML – most common form of acute
leukemias in first few months of life, in
middle aged group and later years
 CML – more common in young & elders
 ALL – seen among children 2 – 10 y.o.
 CLL – common among > 60 years old