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White Blood Cell Disorders. Jonathan Ben-Ezra, M.D. Professor of Pathology MCV Campus of VCU. White Blood Cells. Infection fighting cells of blood Excess causes tissue infiltration/leukostasis 4.4- 5.9 x 10 6 /L (M) 3.8 -5.2 x 10 6 /L (F) Several Types of Cells Granulocytes Lymphocytes

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white blood cell disorders

White Blood Cell Disorders

Jonathan Ben-Ezra, M.D.

Professor of Pathology

MCV Campus of VCU

white blood cells
White Blood Cells
  • Infection fighting cells of blood
  • Excess causes tissue infiltration/leukostasis
  • 4.4- 5.9 x 106/L (M)
  • 3.8 -5.2 x 106/L (F)
  • Several Types of Cells
    • Granulocytes
    • Lymphocytes
    • Monocytes
granulocytes
Granulocytes
  • Produced in the Bone Marrow
  • Neutrophils
    • Life span of 8 hours
    • Bacteriocidal
  • Eosinophils
  • Basophils
  • Approximately 2/3 of WBCs in Blood
granulocytes4
Granulocytes
  • Increased in Bacterial Infection
    • May see early forms (left shift)
  • Increased in Myeloid Leukemia
lymphocytes
Lymphocytes
  • B cells
    • Antibody production
  • T cells
    • Fight viral infection
  • Morphologically can’t distinguish between the two
  • Approximately 30% of WBCs in PB
  • Increased in viral infections and lymphoid leukemia
monocytes
Monocytes
  • Become tissue macrophages
  • Involved in phagocytosis
  • Approximately 15% of WBCs in PB
leukemia
Leukemia
  • Neoplastic Proliferations of WBCs in Blood and Bone Marrow
    • Anemia, infection, bleeding
  • Acute Leukemias
    • Blast (precursor) cells
    • Rapidly fatal if not treated
  • Chronic Leukemias
    • More mature cells
    • Longer life expectancy
acute lymphoblastic leukemia
Acute Lymphoblastic Leukemia
  • Proliferation of lymphoblasts
    • anemia, thrombocytopenia, increased WBC
    • lymphadenopathy/splenomegaly
  • B- or T-cell
    • flow cytometry
  • TdT+
  • Most common leukemia of childhood
acute myelogenous leukemia
Acute Myelogenous Leukemia
  • Proliferation of myeloblasts
    • anemia, thrombocytopenia, increased WBC
  • Myeloid, monocytic, RBC, or megakaryocytic
    • flow cytometry
    • myeloperoxidase +, TdT-
  • Auer rod
  • Over age of 20
chronic myelogenous leukemia
Chronic Myelogenous Leukemia
  • 1 of myeloproliferative diseases (PV, ET)
  • Proliferation of more mature granulocytes
    • normal to increased platelet count
    • anemia
  • Splenomegaly
  • t(9;22) (bcr-abl) (Philadelphia chromosome)
chronic myelogenous leukemia16
Chronic Myelogenous Leukemia
  • Long chronic phase
  • Blast crisis
  • Hydroxyurea, interferons
  • Bone marrow transplantation
myelofibrosis
Myelofibrosis
  • Marrow becomes fibrotic
    • extramedullary hematopoiesis
    • dry tap
  • Teardrop RBC
  • Myeloproliferative, toxin, infection
chronic lymphocytic leukemia
Chronic Lymphocytic Leukemia
  • Proliferation of small mature B-lymphocytes
    • flow cytometry (monoclonal Kappa or lambda)
  • Lymphadenopathy
    • relationship to small lymphocytic lymphoma
  • May have Ab production and AIHA
  • 50% 5-year survival
multiple myeloma
Multiple Myeloma
  • Neoplasm of plasma cells
    • monoclonal protein in serum (SPEP)
    • Proteinuria (Bence-Jones) (UPEP)
  • Lytic lesions in bones
    • fractures
  • Anemia, increased globulin
    • Rouleaux formation
  • Renal failure/ amyloidosis
infectious mononucleosis
Infectious Mononucleosis
  • Acute infection with EBV
  • Adolescent/Young Adult
  • Fever, sore throat, splenomegaly, fatigue
  • Heterophile antibodies
  • Usually self limited
lymphomas
Lymphomas
  • Nodal based malignant proliferations of lymphoid cells
  • Hodgkin’s disease
  • Non-Hodgkin’s lymphoma
    • follicular vs. diffuse
    • small vs. large cell
  • Staging
low grade nhl
Low grade NHL
  • Small lymphocytic lymphoma
    • nodal counterpart for CLL
  • Follicular lymphomas
    • B-cell
    • t(14;18)
    • failure of apoptosis
high grade nhl
High Grade NHL
  • May be nodal or extranodal
  • May be T- or B-cell
  • Adults or pediatric
  • Large cell lymphoma
  • Burkitt’s lymphoma
    • t(8;14)
    • related to EBV
  • Lymphoblastic lymphoma
extranodal marginal zone b cell lymphoma of mucosa associated lymphoid tissue malt
Extranodal Marginal Zone B-cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT)
  • Proliferation of mucosal associated lymphoid tissue
  • Small lymphoid cells, with/out abundant cytoplasm
  • May transform to large cell lymphoma
  • Median survival of 8 years
extranodal marginal zone b cell lymphoma of mucosa associated lymphoid tissue malt35
Extranodal Marginal Zone B-cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT)
hodgkin lymphoma
Hodgkin Lymphoma
  • Bimodal age distribution
  • Related to EBV
  • Reed Sternberg cell
    • other background inflammatory cells
  • Radiation, chemotherapy, or BMT
hodgkin lymphoma37
Hodgkin Lymphoma
  • Nodular Lymphocyte Predominant
  • Nodular Sclerosis
  • Mixed Cellularity
  • Lymphocyte Depleted
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