We have our differences, yes. We have different cultures, of course. We look different to one another, sure.

But were all traveling through the cosmos on the same spacecraft, Earth. We are truly one world, one people. we cant destroy ship for hatredness.
Jim Rohn, responding to US Terrorist attack

WBC Disorders:

Dr. Venkatesh M. Shashidhar

Senior Lecturer in Pathology Fiji School of Medicine

Normal Blood Film:

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White Blood Cells:

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CBC - WBC Histogram:

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WBC disorders:
Reactive increase in number philias Neutrophilia Bacterial sepsis Lymphocytosis viral, Immune Eosinophilia Allergy & Parasites. Decreased number penias Neutropenia, Lymphopenia & Eosinopenia, Pancytopenia Drugs, viral infections, Radiation, chemotherapy etc.
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Neutrophilia:

www.similima.com

Toxic Granulation:

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Leukemoid Reaction:

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Lymphocytosis:

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Lymphocytosis - Virocytes:

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"To live a creative life, we must lose our fear of being wrong."
- Joseph Chilton Pearce

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Neoplastic Disorders: Hemato-Oncology

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

Introduction:
No Benign Neoplasms All are considered malignant or premalignant. Neoplastic Cells flood blood stream Leukemia. Commonly arise in marrow (myelo/ly) or Lymphnode (lymphoid), Spread to blood & other RES tissues rarely to other organs Symptoms are due to deficient normal hemopoiesis. RBC, WBC & Plt.
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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)

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Leukemia - Clinical Features

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

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Leukemia Classification
Acute Leukemias:

Acute Myeloid Leukemia - AML

AML M0, M1, M2, M3, M4, M5, M6 & M7 ALL - L1, L2 & L3 - maturity

Acute Lymphoid Leukemia - ALL

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

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Platelet

Coagulation

Petechiae, Purpura

Hematoma, Joint bl.

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AML-M5 - Gum Hypertrophy:

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ALL:Cervical Lymphadenopathy

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Organomegaly

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Mediastinal Lymphadenopathy - ALL

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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

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ALL-L1

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ALL-L2

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ALL-L3

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AML-Acute Myeloid Leuk.

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

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AML-M0 - Undifferentiated:

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AML-M2 - with maturation

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AML-M3 - Auer Rods

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AML-M4 - Myelomonocytic

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AML-M6 : Erythroleukemia

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AML-M7 : Megakaryocytic

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Chronic Myeloid Leukemia

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

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Chronic Myeloid Leukemia:

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Chronic Lymphocytic Leukemia

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

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CLL

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CLL Blood Film

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"Creativity is inventing, experimenting, growing, taking risks, breaking rules, making mistakes, and having fun."
--Mary Lou Cook

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Lymphoma

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

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Right neck mass

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Lymphoma

Row of enlarged lymph nodes

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

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Splenomegaly

Spleen

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Hodgkins lymphoma

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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.

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NHL- Histologic types

Diffuse - & - Follicular

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NHL- Histologic types

Small Intermed. Large

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

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Myeloma Bone Marrow

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Premalignant conditions
MPS MDS

Myeloproliferative Syndromes:
Neoplasms, Slow, Chronic, Proliferation - ?Bgn Increased, Functionally abnormal cells. Extramedullary hemopoiesis - Organomegaly Progress to Leukemia end stage.

Classification:
Polycythemia rubra vera (PV) Chronic Myeloid Leukemia (CML) Essential Thrombocythemia (ET) Myelofibrosis (MF)

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MPS: Classification

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Blood Film
Plenty of Platelets Megakaryocyte

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MPS : E.T. Bleeding

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MPS - P. Rubra Vera (PV)

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MPS : E.T. Thrombocytosis

BM & PS
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MPS : M.F. Organomegaly

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MPS : MF - Radio Iron Study

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Myelodysplastic Syndromes:
Excess proliferation in marrow. But functional & Structural abnormality Ineffective Myelopoiesis. Peripheral pancytopenia. Also known as Refractory Anemias Not responding to hematenics.

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Myelodysplastic Syndromes:
FAB classification RA : Refractory Anemia (Blasts <1%) RARS : RA with Ring Sideroblasts (<1%) RAEB : RA with excess blasts (<5%) RAEB in T : RAEB in transformation (>5%)

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MDS - Dysplastic Erythroblasts

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MDS: - Ring Sideroblast

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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, special types.

Premalignant conditions
MDS: Myelodysplastic syn Less & Dysplastic MPS: Myeloproliferative dis -Excess & abnormal

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3 Rs of success:

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