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.