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WBC Morphologic Defect
WBC Morphologic Defect
INTRODUCTION
Leukopoiesis has five stages of NON-MALIGNANT LEUKOCYTE
maturation from myeloblast I, II, III DISORDERS
o TYPE I – few to no
Originate from an underlining changes
cytoplasmic granules in number an morphology of WBCs
o TYPE II – less than 20/30
cytoplasmic granules Qualitative Defects
o TYPE III – many cytoplasmic
granules, more associated MORPHOLOGICAL DEFECT
with leukemic process
In promyelocyte stage “start of NUCLEAR ABNORMALITIES
differentiation” for eosinophil (Charcot
Leyden crystals) there is a detectable A. Pelger-Huet Anomaly (PHA)
amount of a primary granules and the Otherwise known as True PHA /
start of secondary granules production. Congenital PHA
Both myeloblast and promyelocyte is Inheritance pattern is autosomal
dominant
still in mitotic pool or (proliferation)
Decreased number of nuclear
The myelocyte stage is called “dawn segmentation (bilobed/unilobed)
of neutrophilia” detectable amount of Neutrophil has 2 lobulation or no lobule
primary granules production, secondary at all
granules, and start of tertiary granules Round, dumbbell shape of nucleus
production. It is still capable of mitosis Mutation in Lamin B-receptor
The metamyelocyte stage there is a o Plays a major role in
sufficient amount of primary granules, leukocyte nuclear shape
secondary granules, tertiary granules changes that occurs during
and start of secretory granules normal maturation
production. There is also a start of o Hyposegmentation in
indentation ‘kidney bean shape’. It is neutrophil
no longer capable of mitosis HETEROZYGOUS PHA
The band cell there is a sufficient o Only 1 gene is inherited
amount of granules and secretory o The nucleus of neutrophils
granules. It has prominent lobulation are round, ovoid, peanut-
“sausage shape or horse- shoe shape shaped
nucleus”. This cell will mature to o Bilobed form
eosinophil, basophil, neutrophil etc. o 55% – 93% of neutrophils are
Mature WBC cells will be released to affected.
circulation from bone marrow HOMOZYGOUS PHA
o 50% goes to marginating pool o Nucleus appears to be round
(adheres to blood vessel and no peanut shape nucleus
walls) o 100% neutrophils are affected
o 50% circulates in the body o Could be mistaken as
Basophils has three notable granule lymphocyte or blast cell
secretions o The neutrophils appear
o Heparin abnormal but normal in
o Eosinophil chemotactic factor function
A (calls for eosinophil that has PSEUDO PHA
histaminase to neutralize o Morphologically speaking, the
histamine action) neutrophils has
o Histamine (vasodilation and hyposegmentation but has no
bronchoconstriction) causes mutation with Lamin B-
histamine if excessive receptor gene
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TRANSCRIBER | Mary Kaye
A. Alder-Reilly Anomaly
Autosomal recessive
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TRANSCRIBER | Mary Kaye
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TRANSCRIBER | Mary Kaye
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TRANSCRIBER | Mary Kaye
o TYPE I cytoplasm
Non-neuropathic/
Adult
Childhood to o PSUEDO-GAUCHER CELLS
adulthood onset Result of excessive cell
Cells in blood and turn-over and
tissues contain overwhelming of
vacuoles glucocerebrosidase
Hepatosplenomegaly enzyme
Skeletal Abnormalities Found in BM of patients
Neurodegeneration (-) with: Thalassemia, CML,
Death is variable AML
Treatment: Enzyme
Replacement Therapy
with Recombinant
Glucocerebrosidase,
Stem cell transplant
2. Niemann-Pick Disease
Autosomal recessive
Deficient in sphingomyelinase
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TRANSCRIBER | Mary Kaye
T-LYMPHOCYTE ABNORMALITY
A. Digeorge Syndrome
o Subsequent build-up of Absence or underdevelopment of
sphingomyhelin in the liver, thymus
kidneys, and lungs (brain is Markedly decreased number of T
also affected in type A) lymphocytes
o Niemann-pick cell in BM Microdeletion in 22q11
o Disease is often fatal in 3 Complete DiGeorge Syndrome: also
years of age known as athymic anomaly
o Type A: <5% normal
sphingomyelinase activity B-LYMPHOCYTE ABNORMALITY
o Type B: 10-20% normal
sphingomyelinase activity A. Sex- Linked Agammaglobulinemia (XLA)
TYPE C
o Milder form than A and B B-cell disease most frequently caused
o Decreased in cholesterol by mutation in the gene encoding for:
exffluxinf from the o Bruton Tyrosine Kinase
intracellular Recurrent bacterial infection
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TRANSCRIBER | Mary Kaye
B. Leukoerythroblastic Reaction
Presence of neutrophils, nucleated red
blood cells, and teardrop cells in the
blood sample
Possible presence of space occupying
AND B- LYMPHOCYTE ABNORMALITY lesions in the bone marrow
Strongly associated with Primary
A. Severe Combined Immunodeficiency Myelofibrosis
(SCID)
Neutropenia
More common type of combined B and o Decrease in the absolute
T lymphocyte abnormality
neutrophil count below
May be alike with HIV 2.0x109/L (white adults) and
Mutation: SCID IL-2 gamma chain below 1.3x109/L (black adults)
receptor o The risk of infection increases
Results in depletion of T cells, B cells as the ANC lowers, especially
and NK cells below 1.0x109L
o Agranulocytosis – refers to
B. Wiskott-Aldrich Syndorme neutrophil count of less than
Mutation in gene WASp 0.5x109/L
Clinical Findings:
o Low levels or absence of 1. Alloimmune Neonatal
Wiskott-Aldrich protein Neutropenia
o Immunodeficiency Maternal IgG crosses the
o Eczema placenta and binds to
o Thrombocytopenia neutrophil-specific
antigens inherited from
Quantitative Defects the father
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TRANSCRIBER | Mary Kaye
BASOPHIL
Basophilia is defined as an absolute
basophil count greater than 0.15x109/L
Normal relative: 0-2
Normal absolute: .2 - .02
Most common cause of basophilia: is
CML
Non-malignant causes of Basophilia
o Allergic rhinitis
o Hypersensitivity to drugs or
food
o Chronic infections
o Hypothyroidism