Post on 02-Nov-2014
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“Success is going from failure to failure without loss of enthusiasm” !
– Winston Churchill
Pathology ofWBC disorders
Dr. Shashidhar Venkatesh MurthyA/Prof. & Head of Pathology
2013: MB2-HRM-Week 7
Diseases of WBC: Learning Objectives:
Normal WBC. Reactive changes: (Philia.. / Penia..)
• Neutropenia, Agranulocytosis, Leukemoid reaction.• Lymphadenitis, Lymphadenopathy.
Neoplastic / Cancers: • Leukemia – Acute, Chronic, Myeloid & Lymphoid.• Lymphomas – Hodgkins & Non Hodgkins.• Precancers: MPD, MDS.
Books/Ref:
TOP 5 WBC disorders.1. Reactive changes.2. Leukemia.3. Lymphoma.4. MPD.5. MDS.
Less More
Small minds discuss people
Average minds discuss events
Great minds discuss solution
Genius silently acts!
5
Normal Blood Cells:
Neutrophil
Basophil
Eosinophil
Band
Lymphocyte
Monocyte
Plt
Non granular, Mononuclears
Specific Immunity
Granulocytes, Polymorphs
Non-Specific Immunity
Normal WBC Production:
Left Shift
Whatever you think, that you will be. If you think yourselves weak,
weak you will be. If you think yourselves strong,
strong you will be!
-- Swami Vivekananda
Leukocytosis: Neutrophilia Increased granulocytes:
• Trauma, Acute Infections, inflammation, Bacterial*
When severe with immature forms – Leukemoid reaction. Clinical features:
• Fever, Fatigue, Inflammation.
Lymphocytosis: Infectious Mononucleosis
Increased Lymphocytes: (Activated)• Chronic Inf., Viral, fungal, TB etc.
Large lymphocytes, more cytoplasm. Irregular, indented by RBC – also known as atypical lymphocyte or virocyte
Clinical features: fever, lymphadenopathy.
Leukopenia: Neutropenia Reduction in granulocytes:
• Decreased Production – Marrow aplasia, drugs, • Increased destruction – drugs, immune, • Congenital: CGD, Idiopathic, cyclical, Benign ethnic (common)
When severe – Agranulocytosis (drugs, immune)
Clinical features:• Infections, oral ulcers with white thick pus (pseudo membrane) of
bacteria or fungus (candida common)
WBC Absolute counts in disease:Penia PhiliaNeutro
Penia PhiliaEosino
Penia cytosisMono
Penia cytosisLympho
WBC counts:
When your thinking is brilliant, you will be
brilliant, but if your thinking is not brilliant
you will not be brilliant, no matter how
brilliant you may think you are….! -- Christian D. Larson
Fake it until you make it…! -- Mohd. Ali. Boxer.
Lymphadenitis: Acute (painful) or Chronic
(painless) Infections, Immune & Cancers. Increased, large follicles with
pale germinal centre & mantle zones (B cell proliferation* & apoptosis*)
Lymphadenitis: Enlarged reactive lymphnodes due to stimulation (inflammation). (Painful)
Lymphadenopathy – any enlargement, but commonly used for Cancer spread. (Painless)
Reactive lymphadenitis
Dark zone
Light zone
Mantle zone
Macrophage
Tingible bodyMacrophage
B Lymphocyte proliferation* & apoptosis*
“When you see a good person, learn from her/him. When you see someone not so good, reflect on your own weak points.”
― Confucius.
Hemato-oncology: Blood Cancer - Summary
Cancer of immature Blast cells. (Bone marrow common)
Leukemia: • ‘White’ ‘blood’ – excess WBC, Starts in bone marrow extends to
blood & hemopoietic Organs - Liver, Spleen & lymphnodes* • Two Major types: Myeloid & Lymphoid. • Two presentation: Acute / Chronic. (AML, ALL, CML CLL) • Many subtypes* – different mutations personalized medicine*(MB3)
Lymphoma: • Solid tumour of lymphoid tissue – where ever lymphoid tissue.• Hodgkins & Non-Hodgkins lymphoma. B cell type common.• Many subtypes – clinically Low, Intermediate & High grade.
Premalignant Disorders:• MPD Myelo-Proliferative Dis: Excess proliferation, more abnormal cells.• MDS Myelo-Dysplastic Syn.: Dysplastic (abnormal cells) pancytopenia.
Leukemia: Clinical Features Cancer of Bone marrow Blasts – Excess WBC. Decreased Haemopoiesis:
• Erythropoiesis – Anemia - RBC• Leukopoiesis – Infections - WBC• Thrombopoiesis – Bleeding. PLT
Bone marrow expansion/destruction:• Bone pains.
Extraneous hemopoiesis / spread:• Splenomegaly• Hepatomegaly• Lymphadenopathy (more in lymphatic malignancy)
Leukemia Clinical features:
Bleeding - Petechiae
Lymphadenopathy
HepatosplenomegalyInfections - Candidiasis
Leukemia Classification Acute Leukemias: weeks to months.
• Acute Myeloid Leukemia – AML - Adults • Many Subtypes: M0, M1 to M7
• Acute Lymphoid Leukemia – ALL - Children • Many Subtypes: L1, L2 & L3
Chronic Leukemias: Years, late age.• Chronic Myeloid Leukemia- CML- Adults
• Chronic Lymphoid Leukemia - CLL –Old age.
ALL children - AML adults
Leukemia Morphology:Normal Acute Leukemia AML/ALL
CML: Chronic Myeloid LeukemiaCLL: Chronic Lymphatic Leukemia
Leukemia Case:
JK 12y, Boy Presents to ED: “Very Sick, fever, back pain, nothing helping it”.
History: • Feels unwell? - Very• Fever? Yes, intermittent• Easy bruising -Yes,
Examination:• Slim, unwell, pale, Multiple Bruises• Liver & Spleen enlarged – mild.• Lymph nodes enlarged neck & axilla.
Any fool can know. The point is to understand !
-- Albert Einstein
Without Pathology, Medicine is quackery…!
Lymphoma Definition: Solid cancer of lymphoid tissue Clinical: Painless, immobile, Lymphadenopathy,
weight loss, Fever. Two Major Types: & many subtypes. Hodgkins lymphoma (HL) – Reed-Sternberg cells.
• B cell only. Types: Lymph. rich Mixed Ly. Poor. Non-Hodgkins lymphoma (NHL) – no RS cells.
• B cell, T cell & Histiocytic lymphoma.
Hodgkins Non Hodgkins
NHL: Diffuse Small Cell
NHL: Follicular Mixed Small & Large CellHL: Nodular Sclerosis (common)
Only RS cell Malignant All cells Malignant
"Creativity is inventing, experimenting, growing, taking risks, breaking rules, making
mistakes, and having fun. -- Mary Lou Cook
Burkitt’s lymphoma: large B cell NHL Endemic in Africa Epstein Barr Virus (EBV) B Cell Lymphoma. Dark large B lymphocytes
(malignant) with plenty of pale macrophages. (Starry sky pattern).
Multiple Myeloma: Malignancy of Plasma cells (Mature B
lymph, Ab) - Old age, males. Marrow, LN, Blood. Multiple, punched out Lytic bone
lesions (Osteolysis) Hyper gammaglobulinemia Monoclonal antibody peak – serum
protein electrophoresis. Immunodeficiency infections.
“The future belongs to those who believe in the beauty of their dreams.”
–Eleanor Roosevelt
Myelo Proliferative Disorders.Myelo Dysplastic Syndromes.
(Pre-canceraous stage of blood cancers)
MPD MDS
Marrow Proliferation with maturation.
Increased abnormal cells in blood – Leukocytosis.
4 major types (mixed types common). • Polycythemia Vera (RBC)• Chronic Myeloid Leuk. (WBC)• Essential Thrombocythemia
(PLT)• Myelofibrosis (Fibrosis)
Old age, Neoplastic proliferation of stem cells. Reduced normal marrow (RBC, WBC & PLT - anemia, infections & bleeding. Liver & Spleen enlarged.Usually transform to Acute leukemia at the end.
Marrow Proliferation with no maturation.
Decreased abnormal cells in blood. – Leukopenia.
4 major types.• RA (Refractory Anemia)• RARS• RAEB• RAEB in transformation.
Polycythemia Rubra Vera (PV)
Hypercellular Marrow, Red skin & Hepatosplenomegaly
Essential thrombocythemia
Plenty of
Platelets in blood
But clinical bleeding (abnormal platelets)
The goal of mankind is knowledge, which is inherent in man. No knowledge comes from outside: it is all inside. What man
'learns' is really what he “discovers” by taking the cover off his own soul.
- - Swami Vivekananda
‘Education’… from Eduse (latin) to bring out..!‘Doctor’ … from Dokere’ (latin) to teach…!
Summary: Reactive Leukocytosis:
• Neutrophilia, Eosinophilia, Lymphocytosis. Reactive Leukopenia:
• Neutropenia, lymphopenia, pancytopenia. Leukemia: – Blood Cancer (of Blasts in marrow)
• AML / ALL, CML / CLL Lymphoma: – solid Tumor of lymphoid tissue.
• Hodgkins & Non- Hodgkins Precancerous conditions:
• MPS (Leukocytosis) & MDS (leukopenia):
I am here for you….
Discussion Board: Questions & Answer others Q.Email: venkatesh.shashidhar@jcu.edu.au Need personal guidance? Email me for an appointment.
Office Tel: 4781 4566Office location – DB39-136 (Townsville)
The only person who never makes
a mistake is a person who
never does anything…!
- Theodore Roosevelt
38
3 R’s of success:
Respect for self, Respect for others &Responsibility for your actions.
Aspire to become good, not great.... Greatness is like a passing cloud, temporary. - Sai Baba - Divine Discourse, July 16, 2001.
Normal Blood Cells:
Normal Blood Cells: