100 Typical WBC reference range = 4000 to /ul

Percentage counts vs. absolute counts it is much more useful to talk about absolute cell counts than "percentage counts" you can estimate the absolute count by multiplying the total WBC count x the % for a particular cell

Percentage counts vs. absolute counts WHY it is much more useful to talk about absolute cell counts than "percentage counts" 70% of neutrophils = neutropenia if total white count is 2000 (2000*0.70=1400) 70% of neutrophils = granulocytosis if total white count is (50.000*0.70= )

Neutrophils – Maturation

Leukocytosis – left shift presence of early mature white cells in the peripheral blood early mobilisations from the bone marrow

„Right shift”

Leukopenia Abnormal decrease in the number of leukocytes (WBC) <4000/  l Depression of neutrophils (neutropenia) or lymphocytes (lymphopenia)

Neutropenia/agranulocytosis Neutropenia <1500/  l neutrophils Agranulocytosis – extremely low levels of neutrophils <500/  l

Neutropenia - CAUSES Suppression of granulopoiesis –aplastic anemia –marrow infiltration(cancers)/myelofibrosis –MDS –cancer chemotherapy, radiation, megaloblastic anemias –Vit b12/foliate deficiency –Infections: TBC, TYPHOID FEVER, Brucellosis, tularemia, measles, infectious mononucleosis, malaria, viral hepatitis, HIV, leishmaniasis

Neutropenia - CAUSES Excess destruction or accelerated removal of neutrophils –Autoimmune  antineutrophil antibodies, –Autoimmune  SLE, rheumatoid arthritis –hypersplenism –drugs as haptens – methyldopa, phenylbuthazone, phenothiazines –Wegener granulomatosis Changes in Peripheral pooling : -Acute endotoxemia (sepsis) -Hemodialysis -Cardiopulmonary bypass

Neutropenia = think DRUGS! ALKYLATING Busulfan chlorambucil cyclophosphamide ANTIMETABOLITES methotrexate 6-mercaptopurine 5-flucitosine ANTIBIOTICS penicyllins chloramphenicol sufonamides anti-TBC macrolides almost any ANTI-THYROID (all) thiouracil ANTIPSYCHOTICS promazine risperidone meprobamate clozapine ANTICONVULSANTS carbamazepine phenytoin diazepam valproic acid NSAID ibuprofen aspirin ANTIVIRALS AZT Acyclovir Gancyclovir Allopurinol Colchicine Thiazides Quinine Arsenic

Lymphopenia (lymphocytopenia) (<1000/  l) is less common than neutropenia think of: –hereditary immunodeficiency –radiotherapy, chemotherapy –Cushing's syndrome –corticosteroid therapy –Hodgkin’s disease –chronic diseases: TB, lupus –HIV infection (loss of CD4) –Viral disease

Leukocytosis – neutrophilia 10000> /  l>7500/  l ↑ PRODUCTIONDE-MARGINATION IdiopathicEpinephrine/steroids/NSAID Drug-induced – steroids!Stress/excitement/exercise/sex Infection – BACTERIAL, fungal Myeloproliferative diseaseOTHER Surgery/MI ↑ BONE MARROW RELEASE Metastatic cancers Steroids!ketoacidosis Acute infectionARF BurnsPoisoning, acute Lithum Heamorrhage/haemolysis

Leukocytosis leukemoid reaction WBC >50.000/  l „left shift” leukemoid reaction: –leukocyte alkaline phosphatase LAP –toxic granulation says "infection", not "leukemia" CML: –absolute basophil count –Philadelphia chromosome

Leukocytosis – lymphocytosis >4000/  l chronic inflammatory states (brucellosis) acute viral infections (hepatitis, CMV, EBV = infectious mononucleosis) rarely in bacterial infections - pertussis parasite infections - toxoplasmosis lymphoid malignancies (CLL)

Eosinophilia >350/  l allergic disorders/hypersensitivity Bronchial asthma parasitic infections Drug allergy – aspirin, suphonamides, penicyllins, cephalosporins malignancy – CML, tumors (lung, stomach, ovary, placenta), Hodgkin’s Lymphoma adrenal insufficiency (Addison’s disease) Collagen vascular diseases - rheumatoid athritis, periarteritis nodosa Idiopathic hypereosynophilic syndrome

Neoplastic proliferation of WBC Lymphomas Leukemias Plasma cell dyscrasias (multiple myeloma)

Myeloproliferative disorder (Chronic myeliod leukaemia, CML)

Myeloproliferative disorder Czerwienica prawdziwa (Polycythemia Rubra Vera)

Zespół mielodysplastyczny Niedokrwistość oporna na leczenie, ze zwiększoną anizocytozą i liczbą retikulocytów Obecne erytroblasy 28/100 WBC Neutrocytopenia z odmłodzeniem komórkowym

Zespół mielodysplastyczny Niedokrwistość oporna na leczenie, ze zwiększoną anizocytozą i liczbą retikulocytów Obecne erytroblasy 28/100 WBC Neutrocytopenia z odmłodzeniem komórkowym

Pancytopenia po chemioterapii poprzedzającej transplantację szpiku Leukopenia, agranulocytoza, limfocytopenia niedokrwistość małopłytkowość

Eozynocytoza i monocytoza w przebiegu choroby pasożytniczej leukocytoza eozynocytoza monocytoza

Przewlekła białaczka limfatyczna (komórki B) Leukocytoza Limfocytoza z obecnością atypowych limfocytów Niedokrwistość Małopłytkowość

Mononukleoza zakaźna Względna limfocytoza z obecnością reaktywnych limfocytów Względna monocytoza Zwykle leukocytoza (WBC do 30 10e9/L, z bezwzględną limfocytozą Odsetek limfocytów często >60%, a niekiedy ok. 90%. Tendencja do niedokrwistości niedobarwliwej