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Diagnostic Hematology for postgraduate laboratory

students

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Diagnosis and Evaluation of WBC Disorders


Lesson 1
Introduction
Blood volume: 5-6 liter/70 kg. 50 to 60% of the blood volume is liquid
Blood components= plasma and cells
The cells of the blood can be divided into
1-Erythrocytes (red blood cells),
2-leukocytes (white blood cells) of various types
3- Platelets.
Leukocyte (White Blood Cells)
Types
Granular cells
Agranular cells
Granulocytes divided into
neutrophils :(with faintly staining granules),
eosinophils :(with large reddish or eosinophilic granules)
basophils :(with large dark blue or basophilicgranules).
Agranulocytes divided into
lymphocytes
monocytes
-------------------------------------------White Blood Cells- Granular cells
1-Neutrophils
Neutrophils are the most common type of WBCs in adults. Two main types normally described.
Segmented neutrophils
Band neutrophils
*Segmented neutrophils (segs, also called polymorphonuclear neutrophil (PMNs)
-----------------White Cell Terminology Relating to Quantitative White Cell Changes
Neutrophilia Increase in segmented neutrophils
Leukocytosis Increase in white cells
Left shift Increase in bands and metamyelocytes in the peripheral smear; seen in response to
infection
Leukemoid reaction Exaggerated response to infection; resulting in high white count and
increased numbers of metamyelocytes, bands, and possibly younger cells
----------------------------White Cell Terminology Relating to Quantitative White Cell Changes
Leukopenia: decrease of the leukocytes count lower the normal absolute value (normal absolute
values: 4000-10000/cum)
White Blood Cells (WBC): Type of blood cells existing in the peripheral blood
DLC: it is the percentage % of each nucleated blood cell in the peripheral blood
Neutrophilia : it is an increase of the DLC and absolute count of neutrophils e.g Acute bacterial
infections e.g. abscesses
---------------------------------------------------------------------------------------------------------Developed by Dr.Abdulrazzaq Othman Alagbare MDCP

Diagnostic Hematology for postgraduate laboratory

students

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Neutropenia : it is the decrease of the DLC and absolute count of neutrophils. e.g:aplastic
anemia,
Monocytosis: An absolute increase in monocytes count and DLC e.g. tuberculosis
Basophilia : An absolute increase in basophils count and DLC e.g: Some allergies
---------------------------White Cells Abnormality qualitative
Left shift of neutrophils: Immature neutrophils and precursor cells seen, e.g. band cells,
metamyelocytes and sometimes myelocytes Commonly seen in acute bacterial infections and
inflammatory conditions
toxic granulation,
toxic vacuolization
Hypersegmentation of neutrophils Hypersegmentation of neutrophils: Nucleus of more than 5%
of neutrophils has 5 or more distinct lobes Commonly seen in megaloblastic anaemia (due to
folate or vitamin B12 deficiency)
-----------------Lymphocytes
Lymphocytosis: An absolute increase in lymphocytes count and DLC e.g. whooping cough
Lymphopenia: An absolute deccrease in lymphocytes count and DLC --HIV/AIDS
Reactive (atypical) lymphocytes : Irregularly shaped larger than normal lymphocytes with a
less dense nucleus (may contain nucleoli). Abundant blue cytoplasm, often appearing dark blue
and folded at periphery of cell e.g mononucleosis, cytomegalovirus infection,
---------------------Types of DLC
DLC: it is the percentage % of each nucleated blood cell in the peripheral blood
1-Normal DLC: the DLC within normal
2-abnormal DLC
Increase or decrease of any type of the DLC cells
Presence of abnormal cells (blasts, NRBC, others)
Absolute count :it is the actual number of each type of white blood cells included in the DLC

---------------------------------------------------------------------------------------------------------Developed by Dr.Abdulrazzaq Othman Alagbare MDCP

Diagnostic Hematology for postgraduate laboratory

students

----------------------------------------------------------------------------------------------------------------------------------

HEMODIAGRAM
For the study of leukocytes abnormalities
Laboratory Evaluation of Possible Neutrophil Disorder we must do
1. Complete blood count and differential count
2. Review of blood smear
---------------------------------------------------------------------------------------------------------Developed by Dr.Abdulrazzaq Othman Alagbare MDCP

Diagnostic Hematology for postgraduate laboratory

students

----------------------------------------------------------------------------------------------------------------------------------

3. Nitroblue tetrazolium test and stain for myeloperoxidase


4. Expression of CD18, CD11a, CD11b, or CD11c by flow cytometry
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---------------------------------------------------------------------------------------------------------Developed by Dr.Abdulrazzaq Othman Alagbare MDCP