Integrative S3

Question 1

Neutrophil

Eosinophil

Basophil

Answer 1

Neutrophil: usually 3-5 segments nucleus with neutrophilic granules in the cytoplasm (pink-blue granules).

Eosinophil: usually 2 segments nucleus with eosinophilic granules in the cytoplasm (red granules).

Basophil: usually 2 segments nucleus with basophilic granules in the cytoplasm (dark-blue granules).

Question 2

Monocyte

Lymphocyte

Answer 2

Monocyte: larger cell, mononuclear cell, convoluted nucleus, usually with no granules in the cytoplasm (grey cytoplasm).

Lymphocyte: small cell, mononuclear cell, round nucleus, usually with no granules in the cytoplasm (basophilic cytoplasm).

Question 3

What is the absolute neutrophil and lymphocyte count ?

Answer 3

Example:

Total WBC count is 6 x 10 9 /L.

Neutrophils 60 %. Lymphocytes 34 %. Monocytes 4 %. Eosinophils 2 %. Basophils 0 %.

What is the absolute neutrophil and lymphocyte count ?

Answer:

– Absolute neutrophil count = 6 x 60 = 3.6 x 10 9 /L.

– Absolute lymphocyte count = 6 x 34 = 2.04 x 10 9 /L

Question 4

Normal differential WBC count in adult is:

Answer 4

Neutrophils
 Lymphocytes 
Monocytes 
Eosinophils 
Basophils

40-80 %. 
20-40 %. 
2-10 %. 
1-5 %. 
0-1 %.

Question 5

WBC disorder could be:

Answer 5

Benign WBC disorder:

• Abnormal WBC count.
• Abnormal WBC function.
• Infectious Mononucleosis Syndromes

Malignant WBC disorder:

• Acute leukemias.
• Chronic leukemias.
• Myeloma.
• Lymphomas.

Question 6

Neutrophilia Definition& Causes

Answer 6

Definition: When neutrophil percentage > 80% of total WBC or absolute count > 8 x 109 /L.

Causes:

• Physiological: vigorous exercise, pregnancy and newborn.
• Pathological:
• Acute pyogenic bacterial infection, virus, fungal and parasitic infections.
• Rheumatic and autoimmune diseases.
• Hematological and non-hematological malignancy.
• Inflammation, tissue necrosis and metabolic disorders.
• Drugs: steroid and epinephrine.
• Acute hemorrhage or hemolysis

Question 7

Leukemoid reaction:

Left shifting:

Answer 7

Leukemoid reaction: it reactive and excessive leukocytosis usually > 50 × 109/L, characterize by immature cells in peripheral blood and associated with severe infections, severe hemolysis and metastatic cancers. Mainly occurs in children.

mean the presence of WBC precursor (immature cells) in the blood which should be still in the BM.

Question 8

Neutropenia definition & causes

Answer 8

Definition: When neutrophil percentage < 40% of total WBC or absolute count < 2 x 109 /L.

Causes:

• Benign familial.
• Congenital neutropenia like Kostmann’s syndrome .
• Secondary to viral infections and fulminated bacterial infections.
• Autoimmune disease.
• Drug induced; most common adult cause of isolated neutropenia.
• Bone marrow defect for any cause.

Question 9

Lymphocytosis

Lymphopenia

Answer 9

Definition: When lymphocyte percentage > 40% of total WBC or absolute count > 4 x 109 /L.

Causes:

• Acute viral infections.
• Chronic infections like tuberculosis.
• Autoimmune disorders and drug allergy.
• Lymphomas or leukemias.

Lymphopenia: When lymphocyte percentage < 10% of total WBC or absolute count < 1 x 109 /L.

It may occur with immune deficiency, some acute viral or bacterial infections

Question 10

Eosinophilia

Answer 10

Eosinophil percentage > 5 % of total WBC or absolute count > 0.5 x 109/L.

Causes:

• Allergic disorders.
• Parasitic infestation.
• Drug reactions.
• Hematological diseases like in CML.
• Hodgkin disease.

Question 11

Basophilia

Answer 11

• Allergic and inflammatory disorders.
• Endocrinopathy as hypothyroidism.
• Viral infection as chicken pox.
• Iron deficiency anemia.
• Malignant association as CMPDs.

Question 12

Monocytosis

Answer 12

• Chronic bacterial infections.
• Collagen vascular diseases.
• Chronic steroid therapy.
• Some malignancy.

Question 13

Infectious Mononucleosis Syndrome

Answer 13

A clinical syndrome, characterized by blood lymphocytosis with many reactive atypical lymphocytes.

In most instances an infectious agent lies behind this syndrome; mainly EBV infection, and so called infectious mononucleosis.

Question 14

Etiological Agents associated with monouncleosis syndrome are:

Answer 14

• Epstein-Barr virus (most common).
• Cytomegalovirus.
• HIV.
• Hepatitis viruses.
• Toxoplasma gondii.

Question 15

Clinical features: of infectious mononucleosis

Laboratory findings:

Answer 15

• Occur in minority of infected individuals, mainly it subclinical.
• Malaise, fatigue, headache, fever, lymphadenopathy, splenomegaly, hepatomegaly, pharyngitis, and tonsillitis.
• CBC showing absolute lymphocytosis, with many atypical reactive lymphocytes appear on peripheral blood.
• Serology for heterophil antibody using Paul-Bunnell test or monospot test.

Question 16

What is Leukemia

Answer 16

Leukemia is the malignancy of WBC and usually associated with high WBC count so called leukemia (mean white color blood).

Classification:

• Acute leukemia

1. Acute Lymphoid Leukaemia (ALL)
2. Acute Myeloid Leukemia (AML)

• Chronic leukemia:

1. Chronic Lymphoid Leukaemia (CLL)
2. Chronic Myeloid Leukemia (CML)

Question 17

Acute leukemia

Pathogenesis

Answer 17

Definition: is a clonal disorder, characterized by abnormal proliferation of blast cells in the bone marrow and spillage into the peripheral blood and other organs. Acute leukemia by definition mean blast cells ≥ 20 % of cells in peripheral blood or BM according to WHO diagnostic criteria.

Acute leukemia are characterized by genetic defect at level of stem cells or progenitor cells leading to proliferation without maturation of blast cells.

Question 18

Etiology of AL:

Answer 18

unknown, but with several factors in association: • Irradiation.

• Chemicals.
• Genetic factors.
• Chronic clonal hematological disorders.
• Oncogenic viruses.

Question 19

Classification of Acute Leukemias

Answer 19

1. Acute Lymphoid Leukaemia (ALL): defect in the line of lymphocytes with proliferation of lymphoblast.
2. Acute Myeloid Leukemia (AML): defect in the line of granulocytes with proliferation of myeloblast.

According to morphology and cytochemistry of blast cells, acute leukemia may be subclassify into:

ALL: L1, L2, and L3.

AML: M0, M1, M2, M3, M4, M5, M6, and M7.

Question 20

Clinical features: of AL

Answer 20

• Acute leukemia of rapid acute presentation.
• Childhood acute leukemia (<15 yrs) mainly of ALL type while adult acute leukemia (>15 yrs) mainly of AML type.
• Features of anemia (due to marrow infiltration by blast cells).
• Bleeding (thrombocytopenia due to marrow infiltration by blast cells).
• Infections (reduce in normal WBC due to marrow infiltration by blast cells).
• LAP, mediastinal enlargement, organomegaly more with ALL.
• CNS involvement and testicular infiltration more with ALL.
• Gum hypertrophy more with AML.
• DIC is a special feature of AML-M3.

Question 21

Principle methods in acute leukemia diagnosis:

Answer 21

CBC and blood film (required to all cases):

• Usually anemia and thrombocytopenia.
• WBC usually markedly increased may reach 200-300 x 109 /L, but may be normal or decrease.
• Majority of leucocytes on film are blasts cells.

BM examination (required to all cases): showing extensive infiltration of BM by blasts cells.

Question 22

Other investigations used in indicated cases to confirm the diagnosis, subtyping of leukemia and prognostic significant like:

Answer 22

• Cytochemistry (stain the blast cells with chemical stains to differentiate their types).
• Cytogenetics (chromosomal analysis).
• Molecular analysis (genetic study).
• Immunophenotyping (study the antigens on malignant cells).
• Electron microscope.

Question 23

Treatment of acute leukemia

Answer 23

o Supportive management.

o Chemotherapy.

o BM or stem cell transplantation.