Page 332 - Concise Pathology for Exam Preparation ( PDFDrive )

12 Haematology 317

Q. Enumerate the disorders of WBCs.

Ans. The main disorders of WBCs are: Leukocytosis: Increase in the number of circula-
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ting leukocytes beyond the upper limit of normal (. 11,000/mm ; normal range 4000–
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11,000/mm )
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Leucopenia: Total leukocyte count below the lower limit of normal (, 4000/mm )
Leukoerythroblastic reaction: Presence of immature WBCs as well as nucleated red cells
in the peripheral blood
Leukaemoid reaction: Markedly increased leukocyte count with the presence of immature
white cells in the peripheral blood but nonleukaemic in origin
Q. Write briefly on the quantitative disorders of neutrophils.

Ans. Neutrophilia is defined as absolute peripheral neutrophil count more than 7500/mm .
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Causes of Neutrophilia:
1. Acute infections: Furuncles, abscesses, tonsillitis, appendicitis, otitis media, os-
teomyelitis, cholecystitis, salpingitis, meningitis and peritonitis caused by Gram-
positive cocci, (eg, staphylococci, streptococci, pneumococci, meningococci and gono-
cocci), Escherichia coli, Pseudomonas aeruginosa, Actinomycosis, certain fungi (eg,
Coccidioides immitis), spirochetes and viruses (rabies, poliomyelitis, herpes zoster and
varicella), rickettsiae and parasites.
2. Noninfectious causes: Burns, postoperative state, acute myocardial infarction, acute
attacks of gout, acute glomerulonephritis, rheumatic fever and collagen vascular
diseases, Hodgkin lymphoma and solid tumours.
Neutrophilia may be accompanied by a shift to the left and the presence of toxic gran-
ules and Döhle bodies.
(a) Toxic granules: Dark blue/purple granules in the cytoplasm of neutrophils. They
represent azurophilic granules and result from impaired cytoplasmic maturation
during accelerated generation of neutrophils.
(b) Döhle bodies: Pale inclusion bodies in the periphery of cytoplasm of neutrophils,
which represent rough endoplasmic reticulum.
Neutropenia is defined as a reduction in the number of neutrophils to less than 2000/mm .
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Its causes include drugs (antimicrobials, analgesics and cytotoxic drugs), infections (septicae-
mia, military tuberculosis, HIV, influenza and infectious mononucleosis), immune neutropenia
(Felty syndrome, SLE and neonatal isoimmune neutropenia), megaloblastic anaemia, hyper-
splenism, aplastic anaemia and bone marrow replacement (leukaemias, myeloproliferative
disorders, MDS, myeloma and lymphoma).

Q. Write briefly on quantitative disorders of eosinophils.

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Ans. Eosinophilia is defined as the absolute eosinophil count exceeding 600/mm .
Causes of Eosinophilia
• Parasitic infestations: Ascariasis, toxocara, filariasis, strongyloidosis and trichinosis
• Pulmonary disorders:
• Loeffler syndrome: Transient lung infiltrates on X-ray chest, eosinophilia and cough
caused due to migration of helminthic larva through the lungs
• Tropical pulmonary eosinophilia: Seen in filaria endemic regions; characterized by
cough with wheezing, lung infiltrates and eosinophilia
• Type I hypersensitivity reactions: Hay fever, asthma, urticaria and rhinitis
• Malignancies: Hodgkin disease, chronic myeloid leukaemia and eosinophilic leukaemia
• Drugs: Penicillin and iodides
• Idiopathic hypereosinophilic syndrome (persistent high eosinophilia . 1500/mm
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for more than 6 months without any identifiable cause and with the evidence of organ
involvement and dysfunction due to cytokines released from eosinophilic granules)
• Collagen vascular diseases: Rheumatoid arthritis and Churg–Strauss syndrome
• Skin diseases: Atopic dermatitis, Bullous pemphigoid and eczema
Eosinopenia is caused by steroid administration, acute stress and Cushing syndrome.
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