WBC disorders Non neoplastic

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					We have our differences, yes. We have different cultures, of course. We look different to one another, sure. But we’re all traveling through the cosmos on the same spacecraft, we are truly one world, one people. we can’t destroy ship for hatredness.
Jim Rohn, responding to US Terrorist attack

HEMATOLOGY:
WBC - Disorders

Dr. Venkatesh M. Shashidhar
Senior Lecturer in Pathology Fiji School of Medicine

Normal Blood Film:

White Blood Cells:

CBC - WBC Histogram:

WBC disorders:
. Reactive increase in number – “philias”  Neutophilia – Bacterial sepsis  Lymphocytosis – viral infections  Eosinophilia – Allergy & Parasites. 2. Decreased production – “penias”  Neutropenia, Lymphopenia & Eosinopenia, Pancytopenia  Drugs, viral infections, Radiation, chemotherapy etc.

WBC Neoplastic disorders
Leukemias Bone marrow, blood, blast cells
Acute / Chronic & Myeloid / Lymphoid  AML / ALL & CML / CLL


Lymphomas – Lymph nodes, tumor
Hodgkins  Non-Hodgkins. Myeloma


Premalignant conditions:
Myeloproliferative syndromes (MPS)  Myelodysplastic syndromes (MDS)


Neutrophilia:

Toxic Granulation:

Leukemoid Reaction:

Virocytes:

Neoplastic disorders
Leukemias Lymphomas Premalignant conditions

Haematological Neoplasia:
Leukemia
Acute & Chronic  Myeloid & Lymphoid


Lymphoma
Hodgkins & Non-Hodgkins  High grade & Low grade


Premalignant Conditions
Myeloproliferative syndromes (MPS)  Myelodysplastic syndromes (MDS)


Leukemia Classification
Acute Leukemias:


Acute Myeloid Leukemia - AML


AML M0 to M7 on maturity ALL - L1, L2 & L3 - maturity



Acute Lymphoid Leukemia - ALL


Chronic Leukemias:
Chronic Myeloid Leukemia- CML  Chronic Lymphoid Leukemia - CLL


Leukemia - Clinical Features
Anemia (low RBC) Fever - Infections (low WBC) Bleeding tendency (low PLT) Tender bones, lymphadenopathy, spleenomegaly etc. (Leukemic infiltration)

Organomegaly

AML-M5 - Gum Hypertrophy:

ALL:Cervical Lymphadenopathy

Mediastinal Lymphadenopathy - ALL

ALL-Acute Lymphocytic Leuk.

Common in Children. FAB classification L1, L2 & L3 CD10 +ve, Pre B cell type common. Growth failure, Fever, Anemia Lymphadenopathy, bleeding. Moderate Hepatosplenomegaly

ALL-L2

AML-Acute Myeloid Leuk.
Adults common FAB classification - M0 to M7. Anemia, Fever, Bleeding Hepatosplenomegaly moderate No significant lymphadenopathy

AML-M2 - with maturation

AML-M3 - Auer Rods

AML-M4 - Myelomonocytic

Chronic Myeloid Leukemia
Middle age 40-60y Philadelphia chromosome, t(9:22) Anemia, Fever & Bleeding Marked leucocytosis – >50,000 (abnormal) Marked splenomegaly, Hepatomegaly

Chronic Myeloid Leukemia:

Chronic Lymphocytic Leukemia
Elderly age Anemia, fever & bleeding – slow over years. Lymphocytosis & Lymphadenopathy Spleen, & liver enlargement Common B cell (CD5 +ve)

CLL

CLL – Blood Film

Lymphoma

Lymphoma
Tumors of lymphoid tissue Lymphadenopathy Fever Hodgkins lymphoma Non-hodgkins lymphoma

Right neck mass

Lymphoma

Row of enlarged lymph nodes

Hodgkins Lymphoma:
Children & adults – double peak. Lymphadenopathy, painless, firm Fever, Eosinophilia Reed-Sternberg cells - B lymphocytes. ? Viral etiology

Splenomegaly

Spleen

Hodgkins lymphoma

Non-Hodgkins Lymphoma:
Fever, anemia, infections Marked Lymphadenopathy No RS cells or eosinophilia Large group of different lymphomas
Clinical – low, intermediate & high grade.  Cell type – B cell, T cell, Histiocyte & other  Histology – Follicular & diffuse.


NHL- Histologic types

Diffuse - & - Follicular

NHL- Histologic types

Small – Intermed. – Large

Myeloma:
Old age Malignancy of Plasma cells – B lymphocytes Lytic bone lesions. Marked antibody production – Monoclonal Hyper gammaglobulinemia – blindness Immunodeficiency – infections

Myeloma – Bone Marrow

Myelodysplastic syndromes:
Also known as refractory anemia Bone marrow dysplasia Formed Abnormal cells degenerate Pancytopenia After years transforms to leukemia

MDS - Dysplastic Erythroblasts

Myeloproliferative Disorders:
Excess proliferation of abnormal cells Marked organomegaly – spleen & liver. Problems are due to excess cells General Classification:
Polycythemia vera – (RBC)  Chronic Myeloid Leuk (WBC)  Essential thrombocythemia (PLT)  Myelofibrosis (Fibroblasts)


Blood Film
Plenty of Platelets Megakaryocyte

MPS : E.T. Bleeding

MPS - P. Rubra Vera (PV)

Summary:
Leukemias – Starts in marrow spread to blood
Anemia, infections & Bleeding  Enlargement of Liver, Spleen lymphnodes  Acute/Chronic & Myeloid & Lymphoid.


Lymphomas – Tumors of lymphnodes.
Fever & lymphadenopathy  Types - Hodgkins & non- hodgkins


Premalignant conditions
Myelodysplastic syndromes -Refractory An  Myeloproliferative disorders -Excess proliferation


3 R’s of success:

Respect for self, Respect for others and Responsibility for all your actions.


				
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posted:4/27/2008
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