The white cells 1: granulocy es,

monocytes and their benign

disorders
 The white blood cells (leucocytes) may be
:divided into two broad groups
the phagocytes-1
Granulocytes, which include three
types of cell-neutrophils (polymorphs), eosinophils
and basophils-together with monocytes comprise
the phagocyte
immunocytes-2
Note : Only mature
phagocytic cells and lymphocytes are found in
normal peripheral blood
 Granulopoiesis
The blood granulocytes and monocytes are formed
in the bone marrow from a common precursor cell
In the granulopoietic series progenitor
:cells which are
myeloblasts, promyelocytes and myelocytes
form a proliferative or mitotic pool of cells
while the
metamyelocytes, band and segmented granulocytes
make up a post-mitotic maturation compartment

Large numbers of band and segmented

neutrophils are held in the marrow as a 'reserve
.pool' or storage compartment
 In the bone marrow

normally contains more myeloid cells than erythroid

cells in the ratio of 2 : 1 to 12 : 1
the largest proportion being neutrophils and
.metamyelocytes
In the stable or normal state, the bone marrow storage
compartment contains 10-15 times the number of
.granulocytes found in the peripheral blood
,Following their release from the bone marrow
granulocytes spend only 6-10 h in the circulation
before moving into the tissues where they
perform their phagocytic function
 In the blood stream

there are two pools usually of about equal

:size
the circulating pool (included in the blood count)
and the marginating pool (not included in
.)the blood count
It has been estimated that they
spend on average 4-5 days in the tissues before they
are destroyed during defensive action or as the
.result of senescence
 Control of granulopoiesis: myeloid
growth factors
Many growth factors are involved in this
: maturation process including
interleukin-1 (IL-1)
IL-3
,IL-5 (for eosinophils)
IL-6
IL-11
granulocytemacrophage colony stimulating factor (GM-
CSF)
granulocyte CSF (G-CSF)
 Function of growth factors
The growth factors stimulate proliferation and
differentiation and also affect
the function of the mature cells on which they act
e.g. Increased granulocyte and monocyte
production in response to an infection is induced
by increased production of growth factors from
stromal cells and T lymphocytes, stimulated by
endotoxin, IL-1 or tumour necrosis factor (TNF)
 The normal function of neutrophils and
:monocytes may be divided into three phases
Chemotaxis (cell mobilization and migration) The
phagocyte is attracted to bacteria or the site of
.inflammation by chemotactic substances
,Phagocytosis The foreign material (e.g. bacteria
fungi) or dead or damaged cells of the host are
Phagocytosed
Killing and digestion This occurs by oxygen dependent
.and oxygen-independent pathways
 Functional Disorders of Phagocytic Leucocytes

12
 Disorders characterised by neutrophil dysfunction
:Impaired adhesion .1 Diab
Congenital leucocyte Hod
adherence deficiency lepr
(Deficiency of CD11/CD18 Imp
surface glycoproteins) :killi
Drugs: corticosteroids, Chro
alcohol dise
:Impaired motility .2 Mye
Hyperimmunoglobulin E Ched
syndrome Leuk
Chediak-Higashi syndrome
13
 Benign disorders
of granulocyte morphology

Pelger-Huet anomaly In this uncommon-1

condition bilobed neutrophils are found in
the peripheral blood. Occasional
.unsegmented neutrophils are also seen
.Inheritance is autosomal dominant
May-Hegglin anomaly In this rare condition-2
the
neutrophils contain basophilic inclusions of RNA
.in the cytoplasm
There is an associated mild thrombocytopenia
.with giant platelets
.Inheritance is autosomal dominant
The Chediak-Higashi syndrome is inherited-3
,in an autosomal recessive manner
and there are giant granules in the neutrophils,
eosinophils,monocytes and lymphocytes
accompanied by
neutropenia, thrombocytopenia and
.marked hepatosplenomegaly
disorders may be associated with severe
.disease
Common morphological abnormalities
Hypersegmented forms occur in megaloblastic
Anaemia

.Dahle bodies and toxic changes in infection

The 'drumstick' appears on the nucleus of
a proportion of the neutrophils in normal
females
and is caused by the presence of two X
.chromosomes
Pelger cells are seen in the benign congenital
abnormality but also in patients with acute
myeloid leukaemia or myelodysplasia
Shift to the left: increase in the number of
band forms and the occasional presence
of more primitive cells in the peripheral
.blood
Leukoerythroblastic picture: a presence of
a shift to left plus nucleated RBC in the
.peripheral blood
 Causes of leucoerythroblastic
blood film
Metastatic neoplasm in the marrow
Primary myelofi brosis
Acute and chronic myeloid leukaemia
Myeloma, lymphoma
Miliary tuberculosis
Severe megaloblastic anaemia
Severe hemolysis
Osteopetrosis
22
 Causes of leucoerythroblastic
blood film
Metastatic neoplasm in the marrow
Primary myelofi brosis
Acute and chronic myeloid leukaemia
Myeloma, lymphoma
Miliary tuberculosis
Severe megaloblastic anaemia
Severe hemolysis
Osteopetrosis
23
 The Leukomoid Reaction
a reactive excessive leukocytosis with the presence of
immature cells (myeloblasts, promyelocytes and
.myelocyte) in the peripheral blood
In other words (leukocytosis + left shift). Usually it is a
neutrophil leukocytosis. It can be lymphoid
: Causes
Severe infection
Severe haemolysis
Metastatic cancer