NON MALIGNANT WBC

• Neutropenia:

  • Increased rate of removal or destruction of peripheral blood neutrophils
  • Fewer neutrophils released from the Bone Marrow to the blood, decreased production or ineffective hematopoiesis
  • Decreased ratio of circulating versus marginal pool of neutrophil
  • Combination of these factors
• Congenital Neutropenia:

  • Severe congenital neutropenia of agranulocytosis (lymphocyte) of the Kostmann type
  • Myelokathexis:
  • Prevention of neutrophil from going out of the storage pool
  • Inability to release mature granulocytes to the blood
• Acquired Neutropenia:

  • Cyclic Neutropenia:
  • Selective apoptotic death of neutrophil progenitors
  • At 21 or 12 to 36 day period
  • Lasts for 3 to 10 days
• Chronic Benign Neutropenia:

  • Reduced myeloid reserve
  • Reduced mitotic pool size
  • Reduced concentration of neutrophils
• Drug Induced Neutropenia:

  • Most common
  • Drug induced agranulocytosis
  • Chemotherapy, alcoholism
• Immune Neutropenia:

  • Neonatal Alloimmune Neutropenia (NAN):
  • Blood at neonate goes to mother, mother then releases antibody (IgG) which destroys neutrophil of neonate
  • Father: Human Neutrophil Antigen —> fetus/neonate HNA
  • Mother: X Antigen
• Spurious or False Neutropenia:

  • EDTA-induced neutrophil adherence to erythrocytes
  • Disintegration of neutrophil over time prior to testing
  • Disruption of abnormally fragile leukocytes (leukemic WBC) during preparation of the blood for testing
  • Neutrophil aggregation
• Eosinopenia:

  • Can be difficult to detect because the reference interval is low (less population in circulation)
  • Often accompanies other cytopenias in conditions that result in marrow hypoplasia
• Basopenia:

  • Acute infections
  • Hyperthyroidism
  • Increased glucocorticoids
• Monocytopenia:

  • Steroid therapy and hemodialysis and in sepsis
  • Profound source of monocytopenia: Hairy Cells
  • Viral infections: Epstein Barr Virus (EBV)
• Lymphocytopenia:

  • Immunodeficiency = Lymphocytopenia
  • Destructive:
  • Radiation, chemotherapy, corticosteroids
  • Debilitative:
  • Starvation, aplastic anemia, terminal cancer, collagen, vascular disease, renal failure
  • Infections:
  • Viral hepatitis, influenza, typhoid fever, Tuberculosis
  • AIDS Associated:
  • Depletion of T helper cells / CD4+ cells
  • Abnormal lymphatic circulation:
  • Intestinal lymphangiectasia, obstruction, CHF
• Quantitative Disorder: Leukocytosis:

  • Increase in the concentration or percentage of any leukocytes in the peripheral blood/circulation
  • Causes of Leukocytosis:
  • Increase movement of immature cells from the BM proliferative compartment
  • Increased mobilization from maturation-storage compartment to circulating pool
  • Increased movement from marginating pool to circulating pool
  • Decreased movement from circulation to the tissue
• Neutrophilia:

  • Increase in Neutrophils that result from a reaction to a physiologic or pathologic processes
  • CSF (G-CSF) to stimulate CFU-G increases in neutrophils
  • Stress of greater severity or infection of endotoxin or corticosteroids
  • Increased inflow of cells to the blood from the marrow maturation/storage pool
• Immediate Neutrophilia:

  • Caused by physiologic processes
  • Shift neutrophilia or Pseudoneutrophilia
  • Redistribution of the marginated granulocyte
  • Transient: 20-30 minutes
• Acute & Chronic Neutrophilia:

  • Pathologic Processes
  • Acute Infection:
  • Overcompensation of outflow of cells from maturation-storage
  • Granulocytic hyperplasia
  • Chronic Neutrophilia:
  • Severe infection
  • Decreased CGP and MGP
  • Increased numbers of early neutrophil precursors
• Eosinophilia:

  • Cytokine stimulation (IL-3 and IL-5)
  • Parasitic infections: helminths (tissue involvement)
  • Allergic reactions: asthma, rhinitis, urticaria and atopic dermatitis
• Chronic Eosinophilic Leukemia:

  • Chronic myeloproliferative disease of unknown etiology
  • Clonal proliferation of eosinophilic precursors
  • Persistently elevated number of eosinophils in blood, bone marrow or peripheral tissues
• Basophilia:

  • Myeloproliferative disease
  • Allergic reactions: food, drugs
• Philia Reference Range: greater than 0.15 x 10^9 /L
• Not remarkably affected by time of the day, age, and physical activity (unlike neutrophil)
• Associated with myeloproliferative disease
• Can be elevated in allergic reactions to food, drugs, foreign proteins, and bee stings
• Linked to infectious diseases such as variola and varicella
• Seen in chronic hemolytic anemia, especially post-splenectomy
• Related to inflammatory conditions like collagen vascular disease and ulcerative colitis
• Also associated with hypothyroidism and radiation therapy
• Thyroid Hormones: Inversely Proportional
• Increase in basophils leads to a decrease in thyroid hormones
• This relationship can result in Polycythemia Vera
• Monocytosis Reference Range: Adult: greater than 1.0 x 10^9 /L, Neonates: greater than 3.5 x 10^9 /L
• Caused by infections such as tuberculosis, subacute bacterial endocarditis, syphilis, and protozoan infections
• Can be seen in recovery from neutropenia
• Associated with hematologic conditions like leukemias, myeloproliferative neoplasms, lymphomas, and multiple myeloma
• Linked to inflammatory conditions including collagen vascular disease, chronic ulcerative colitis, sprue, myositis, and polyarteritis
• Also present in other conditions like solid tumors, immune thrombocytopenic purpura, and sarcoidosis
• Lymphocytosis Reference Range: Children between 2 weeks and 8 to 10 years old, Greater than 10.0 x 10^9 /L in adults
• Higher lymphocyte counts in children compared to adults
• Caused by infections such as viral infections, pertussis, tuberculosis, toxoplasmosis, and rickettsial infections
• Associated with chronic inflammatory conditions like ulcerative colitis and Crohn’s disease
• Seen in immune-mediated conditions like drug sensitivity, vasculitis, graft rejection, Grave’s disease, and Sjögren’s syndrome