White Blood Cell Disorders

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Useful Nomenclature:

• "-philia," "-cytosis" = increase.

• "-penia" = decrease.

WBC qualitative disorders:

• Eg., Chediak-Higashi syndrome, selectin or CD11a/CD18 deficiency.

• Microbial infections.

• Growth failure in children.

• Gingivitis.

• Job's syndrome.

WBC quantitative disorders:

Neutrophilic leukocytosis:

• Increased neutrophil count.

• Caused by infection inflammation.

• Increased production of neutrophils.

Neutropenia:

• Decreased neutrophils.

• Immune destruction.

• Decreased production.

Eosinophilia:

• High eosinophil count.

• Type I hypersensitivity, helminthic infections, polyarteritis nodosa, Addison's disease.

Eosinopenia:

• Decreased eosinophil count.

• Hypercortisolism, corticosteroids destroy eosinophils.

Basophilia:

• Increased basophil count.

Lymphocytosis:

• Increased lymphocyte count.

• Viral or bacterial infections.

• Drugs; Graves' disease.

• Increased production.

Atypical lymphocytosis:

• Infections, drugs, etc.

Infections mononucleosis:

• Caused by EBV, which attaches to CD21 receptors on B cells; stays dormant in B cells.

• Fatigue, tonsillitis.

• + heterophil antibody test.

• + antiviral capsid test.

• Increased serum transaminases from hepatitis.

Lymphopenia:

• Decreased lymphocyte count.

• HIV.

• DiGeorge, SCID.

• Corticosteroids, radiation.

• Increased destruction; decreased production and release from lymph nodes.

Monocytosis:

• Chronic infection.

• Autoimmune disease.

Leukemias:

• Bone marrow disease that involves all cell lines.

• Caused due to chromosomal abnormalities, radiation, chemicals.

• Types: ALL, AML, CML, CLL.

• Block in stem cell differentiation.

Acute leukemia:

• Fever, bleeding, fatigue.

• Bone pain, tenderness.

• Anemia, thrombocytopenia.

• Metastatic disease: liver, CNS, lymph nodes, skin.

Chronic leukemia:

• Insidious onset.

• Involved: liver, lymph nodes.

• Thrombocytopenia, anemia.

Neoplastic myeloid disorders:

Chronic myeloproliferative disorders:

• Polycythemia vera, CML, myeloid metaplasia with myelofibrosis, essential thrombocytopenia.

• Findings: splenomegaly, bone marrow fibrosis, acute leukemia.

Types of Myeloid Disorders:

• Relative polycythemia: increased RBC count due to decreased plasma volume.

• Absolute polycythemia: ectopic EPO secretion; increased RBC count and mass.

• Polycythemia vera: clonal expansion of multipotent myeloid stem cells.

• Findings: splenomegaly, gout, hyperviscosity.

Chronic myelogenous leukemia:

• 40-60 years of age.

• Radiation, benzene.

• Neoplastic clonal expansion of pluripotential stem cells.

• t9:22 translocation of ABL proto-oncogene.

• Hepatosplenomegaly, generalized lymphadenopathy.

• Blast crisis.

• Platelet count is increased or decreased.

• Positive Philadelphia chromosome.

• BCR-ABL fusion gene.

• Decreased leukocyte alkaline phosphatase.

Myelofibrosis and myeloid metaplasia:

• Marrow fibrosis.

• Neoplastic cells produced.

• Massive splenomegaly and portal hypertension.

• Splenic infarcts.

• Tear-drop RBCs.

Essential thrombocytopenia:

• Megakaryocyte proliferation.

• Increased but nonfunctional platelets.

• Bleeding, splenomegaly.

• Thrombocytosis.

• Leukocytosis.

Myelodysplastic syndrome:

• Men 50-80 years old.

• Neoplastic stem cell disorders.

• Chromosomal abnormalities.

• Pancytopenia.

• Ringed sideroblasts.

Acute myelogenous leukemia:

• 15-59 years old.

• Abnormal chromosomes; eg., t(15;17).

• DIC, Auer rods in myeloblasts.

Acute lymphoblastic leukemia:

• Newborn to 14 years old.

• CALLA, CD10, TdT markers.

• T(12;21).

• Anemia with thrombocytopenia.

Adult T-cell leukemia:

• Associated with human T-cell leukemia virus (HTLV-1).

• Activated TAX gene inhibits TP53 suppressor gene.

• Proliferation of CD4 helper T-cells.

• Hepatosplenomegaly, lymphadenopathy; skin infiltration.

• Lytic bone lesions.

• Positive CD4; negative TdT.

Chronic lymphocytic leukemia:

• Over 60 years of age.

• "Smudge cells."

• Most common leukemia.

• Lymphadenopathy.

• Immune hemolytic anemia.

• Neutropenia.

• Anemia.

• Hypogammaglobulinemia.

Hairy cell leukemia:

• B-cell leukemia.

• Splenomegaly.

• No lymphadenopathy.

• Hepatomegaly (20%).

• Autoimmune vasculitis and arthritis.

• Pancytopenia.

• Leukemic cells have hair-like projections.

• Positive tartrate-resistant acid phosphatase stain (TRAP).

Additional Reading:

Basic Pathology

1. Cell Injury
2. Inflammation and Repair
3. Immunopathology
4. Water, Electrolyte, Acid-Base, Hemodynamic Disorders
5. Genetic and Developmental Disorders
6. Environmental Pathology
7. Nutritional Disorders
8. Neoplasia
9. Vascular Disorders
10. Heart Disorders
11. Red Blood Cell Disorders
12. White Blood Cell Disorders
13. Lymphoid Tissue Disorders
14. Hemostasis Disorders
15. Blood Banking and Transfusion Disorders
16. Upper and Lower Respiratory Disorders
17. Gastrointestinal Disorders
18. Hepatobiliary and Pancreatic Disorders
19. Kidney Disorders
20. Lower Urinary Tract and Male Reproductive Disorders
21. Female Reproductive and Breast Disorders
22. Endocrine Disorders
23. Musculoskeletal Disorders
24. Skin Disorders
25. Nervous System Disorders
26. Notes on Tissue Regeneration
27. A Table of Bleeding Disorders
28. FAQ on Structure and Function of Red Blood Cells
29. FAQ on Components of Blood
30. Notes on Hemostatic Mechanisms
31. What is Fever?
32. What is Edema?
33. FAQ on Blood Pressure
34. FAQ on principles of fluid and flow dynamics of Blood
35. Causes of Thrombocytopenia
36. Squamous cell carcinoma of head and neck mucosa
37. Four tumors which never metastasize to the brain
38. What is caustic injury?
39. What causes Peripheral Edema?

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