ABNORMALITIES of the

WHITE BLOOD
CELLS
Jose R. Villarino, RMT

Possible answers:

A. NEUTROPHILS
B. LYMPHOCYTES
C. PATHOLOGIC
D. PHYSIOOGIC
E. 20-40 %
F. 5000-10000/cumm
G. 0-3 %
H. MALARIA
I. AZUROPHILIC
GRANULES

J. ASTHMA
K. AUER ROD
L. PELGER HUET
M. TOXIC
GRANULES
N. LEUCOPENIA
O. PARASITISM
P. SCARLET FEVER
Q. DOHLE BODIES
R. BASKET CELLS

WBC Normal values:

WBC Count = 5,000 10,000/cu mm or

5 10 x 109/L
Differential Count:
Neutrophil = 50 70 %
Segmenter = 50 65 % ; Stab = 0 5 %
Eosinophil = 0 3 %
Basophil = 0 1 %
Lymphocytes = 20 40 %
Monocytes = 2 6 %

Quantitative abnormalities
Leucocytosis substantial increase in
the WBC count.
- Physiologic increase (no trauma/injury)
- Pathologic increase (trauma/pathology)
Leucopenia substantial decrease in
the WBC count.
N.V. = 5,000 10,000/cu mm

Differential Count
Neutrophil
segmenter
stab

50 75 %
50 65 %
05%

Eosinophil

03%

Basophil

01%

Lymphocyte
Monocyte

20 40 %
26%

The 5 WBC types

Neutrophilia
(> 7 8 x109/L)

Infections, Inflammation, Metabolic

disorders
Acute hemorrhage, corticosteroids
Stress, post-surgery, burns, HDN
Lithium drugs, neoplasms

Neutropenia
(<1.75 1.8109/L)
Decreased production
- Inherited/acquired stem cell disorder
- Benzene toxicity, cytotoxic drugs
Increased destruction
- Immune mechanism, sequestration
BM depression, IM, varicella, Typhoid
SLE, hepatitis or any viral infections

Eosinophilia
(> 0.7 x 109/L)

Allergic disorders (asthma)

Parasitic infections (nematodes)
Skin disease (eczema)
Hodgkins disease
Scarlet Fever
Pernicious anemia

Eosinopenia
(< 0.05 x 109/L)

Stress due to trauma or shock

Mental distress
Cushings syndrome
ACTH administration

Basophil (0.3 x 109/L)

BASOPHILIA

Chronic myelocyic
leukemia
Polycythemia vera
Hodgkins disease

BASOPENIA

Hyperthyroidism
Pregnancy

Lymphocytosis
(>4.0 x 109/L)

Viral infections ( German measles )

Infectious Mononucleosis (kissing
dis.)
Mumps (parotitis), pertussis
Tuberculosis, syphilis,
thyrotoxicosis

Lymphopenia

Congestive heart failure, SLE

Renal failure
Advanced Tuberculosis
High levels of adrenal
corticosteroids

Monocytosis
(>0.9 x 109/L)

SBE, Syphilis, Tuberculosis

Protozoan infections
Mycotic or fungal infections
Malaria, Systemic lupus
erythematosus
Rheumatoid arthritis

Monocytopenia

Lymphocytic leukemia
Aplastic anemia

QUALITATIVE CHANGESWBC

Morphologic abnormalities involving

either the nucleus or cytoplasm
Functional abnormalities
Inherited or Acquired
Examination of peripheral blood or a
bone marrow evaluation

The White blood cells:

Nucleus details:
- Mononuclear or
Polymorphonuclear
Granules present:
- Granulocytic or Agranulocytic
Function:
- Phagocytic or Immunocytic

Abnormal granulocyte
morphology
(acquired)

Toxic granulation, cytoplasmic

vacuole
Dohle bodies (Amato bodies)
Azurophilic granules
Hypersegmentation

Pathological Leucocytes

Abnormal granulocyte
morphology
(inherited)

Alder-Reilly anomaly - dense

azurophilic granules,
mucopolysaccharoidoses
May-Hegglin anomaly - Giant
platelets, Dohle-bodies like inclusions
seen even in monocytes
Pelger Huet anomaly failure of
normal segmentation of nucleus, bilobed nucleus or stab forms only,
pince-nez nucleus

Alder Reilly anomaly

May-Hegglin anomaly

Pelger Huet anomaly

Continuation:

Chediak Steinbrinck Higashi syndrome

large lysosomes containing hydrolases
and other enzymes. There is
anemia,thrombocytopenia, leucopenia
and increased susceptibility to infection.
There is partial albinism & photophobia.
Also seen in Aleutian mink, mice, cat,
cattle & killer whale as caused by
abnormal WBCs.

Chediak Higashi syndrome

Other abnormalities:

Smudge or basket cells squashdegenerated nucleus of WBCs

Jordans anomaly fat-containing
vacuoles in WBC cytoplasm, Ichthyosis
Twinning deformity
Auer rod rod-like structure seen in
the cytoplasm of myeloblasts,
diagnostic for Acute myeloblastic
leukemia (AML)

Variants of the
Lymphocytes

Plasmacytoid lymphocyte or Turks

irritation cell
Downey cell (atypical lymphocyte)
Transformed lymphocyte (reticular or
pyroninophilic cell)
Reider cell clover-leaf like nucleus
Plasma cells

Reactive lymphocytes

Downey cell

Hallmark cell seen in cases of

Infectious mononucleosis (kissing
disease)
Atypical lymphocyte (stress
lymphocyte)
ballerina skirt cell

Infectious Mononucleosis

Plasma cells

Ovoid or fibrillary shaped

Eccentric location of nucleus
Perinuclear halo
cart-wheel pattern or spoke of the
wheel pattern of nucleus
basophilic cytoplasm

Comparative morphology of
plasma cells, lymphocytes and
NRBC

Inherited abnormalities
involving Monocytemacrophage group

MUCOPOLYSACCHAROIDOSES
- Hunter syndrome, Hurlers disease
LIPIDOSES lipid accumulation
- Gauchers disease accumulation of
glucocerebroside due to lack of betaglucosidase enzyme
- Neimann Pick disease sphingomyelin
and cholesterol accumulation due to
lack of the enzyme sphingomyelinase

Monocyte-macrophage
abnormality

WBC functions

Neutrophil phagocytic
Eosinophil phagocytic and damage
to larval stages of parasite.
Basophil storage of histamine,
involved in immediate
hypersensitivity reaction.
Monocyte phagocytic, cellular and
humoral immunity

Functions.

Lymphocytes immune leucocytes

a)humoral b) lymphokines c)
cytotoxic

- Not obligate end cells

- Heterogenous group of cells
- Destined to migrate

PHAGOCYTOSIS process

Motility random movement and

directed movement
Recognition
Ingestion
Degranulation or release of
granules
Microbial killing

Inherited functional
abnormalities

Jobs syndrome defective directed

movement, characteristic cold
boils
Lazy leucocyte syndrome both
random & directed movements are
defective
Chediak Higashi syndrome failure
to release the granules

Non-neoplastic (nonclonal) disorders of the

WBC
Include a) growth regulation

abnormalities, b) leukemoid reaction

(an increased proliferative response to
various stimuli) including bone marrow
aplasia and hypoplasia and
c) qualitative leucocyte disorders (both
acquired & inherited) characterized by
deficiency of leucocyte function.

Non-clonal disorders of
WBC
Function disorders
Defective chemotaxis, phagocytosis,
defective killing, CGD,
myeloperoxidase deficiency
Quantitative disorders
Neutropenia, agranulocytosis,
Leukemoid reaction, Infectious mono

Clonal (neoplastic)
disorders of WBC

Derived from a single precursor

cell with all the affected cells
(progeny) showing features of
deviation from the precursor cell.
Myeloproliferative disorders
Lymphoproliferative disorders
Immunoproliferative disorders

Leukemoid reaction
High WBC count = <50000/cu mm
Toxic granulation & Dohle bodies
Predominant band forms
LAP score = >100
Negative for Philadelphia chromosome
- Translocation of genetic material from
long arm of Chromosome 22 to Ch 9

Hodgkins disease

Belongs to a group of malignant

disorders referred as Lymphomas
Lymphomas involved abnormal lymph
node enlargement with replacement or
alteration in its histologic characteristic
The neoplastic cell involved is known
as the Reed-Sternberg cell. Mostly
appears as binucleated with the 2
halves of the cell appearing as mirror
images.

Hematopoietic malignancy

Defined as growth or proliferation of

one or more clones of abnormal cells.
These cells dont respond to normal
control and even produce substances
inhibiting growth of normal cells.
These malignancy may be manifested
in the peripheral blood as in cases of
anemia and thrombocytopenia.

Leukemias

In the case of WBC, these malignant

cells may or may not circulate in the
peripheral blood. Hence, WBC count
may be increased or otherwise.
Should these abnormal cells be present
both in the bone marrow and the
peripheral blood, the term leukemia is
used.
Aleukemic leukemia if only confined to
the marrow and do not circulate.

Classification of the
leukemias
According to the stem cell line involved
- Myeloid involves the granulocytes,
monocytes, RBCs and megakaryocytes.
Also known as myeloproliferative
disorders or nonlymphocytic leukemias.
- Lymphoid involving the B or T cells
and may be a leukemia or lymphoma

Classification of leukemias
According to duration (life span)
- Acute days to weeks (3 months)
- greater than 30 % blasts forms
- Chronic more than a year (1-2
years)
- less than 10 % blast forms

Examples :
Acute myeloid leukemia

myeloblast

Chronic myelogenous
leukemia

Myelocyte, metamyelocyte
& neutro

Acute lymphoblastic
leukemia

lymphoblasts

Chronic lymphocytic
leukemia

Small mature lymph

Erythroleukemia
Di Guglielmo syndrome

> 50% of the nucleated

cells are erythroblasts

Comments on the
leukemias:

AML most common form of acute

leukemias in first few months of life, in
middle aged group and later years
CML more common in young & elders
ALL seen among children 2 10 y.o.
CLL common among > 60 years old