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White Blood Cells

White Blood Cells. Dr. Mansour Aljabry Assistant Professor & Consultant Hematologist. Hematopoiesis. Hematopoiesis is the process of life long production, multiplication & specialization of blood cells in the bone marrow.

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White Blood Cells

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  1. White Blood Cells Dr. Mansour Aljabry Assistant Professor & Consultant Hematologist

  2. Hematopoiesis • Hematopoiesis is the process of life long production, multiplication & specialization of blood cells in the bone marrow. • It begins with the most basic blood cell, the stem cell or “pluripotent hematopoietic stem cell” (PHSC). Differentiation Proliferation HSC (mother)

  3. Lymphoid Progenitor Hematopoietic stem cell Granulocytic-Monocytic Progenitors Monocytes Myeloid Progenitor ErythroidProgenitor Megakaryocytic –Erythroid Progenitors

  4. Hematopoietic growth factors : • Hormones that regulate the proliferation and differentiation of HCS. • Can be administered clinically to stimulate the hematopoiesis : • -G-CSF in severe neutropenia • -EPO in Sever anemia

  5. PAX-5 Lymphoid Progenitor T-bet Hematopoietic stem cell G-CSF SCF FLT3-L Granulocytic-Monocytic Progenitors M-CSF Monocytes EPO Myeloid Progenitor ErythroidProgenitor Megakaryocytic –Erythroid Progenitors Thrombopoietin

  6. Normal ranges • WBC count 4-11 x 109/L

  7. Neutrophil • Phagocytic cell contain a nucleus divided into 2–5 lobes with pale granulated cytoplasm. • stain a neutral pink (Basophils dark blue while eosinophil is bright red). • They are short lived(≈6 days) and highly motile.

  8. Chemotaxis: Migration toward sites of infection or inflammation through detectionof IL-8 ,TNFγ &C5a Neutrophil extracellular traps(NETs): are web-like structures of DNA and fiber that trap and kill microbes extracellularly Superoxide Hydrogen peroxide • Lysozyme •  NADPH oxidase • Myeloproxidase (MPO)

  9. Neutrophil

  10. Neutrophilia Marginal pool (tissues) Circulating pool (blood)

  11. Causes of neutrophilia

  12. Leukemoid reaction • Leukocytosis(mainly neutrophilia with left shift) due to physiological response to stress or infection. • Common with : sever or chronic infection ,sever hemolysis & metastatic cancers. • Associated with: Toxic granulation ,Vaculation & Dohle bodies.

  13. Left shift Vaculation Döhle bodies Toxic gran. S. neutrophil

  14. Neutropenia • Lower limit of normal is 1.5 × 10⁹/L • Sever neutropenia : ≤0.5 × 10⁹/L

  15. Lymphocytes • Small WBC having spherical nucleus surrounded by a thin layer of non granular cytoplasm. • Fundamental importance in the immune system (Innate &Adaptive)

  16. Lymphocyte (B or T) NK Lymphocyte Reactive looking Atypical looking

  17. Lymphocytosis • 1- Viral infection : • Infectious mononucleosis ,cytomegalovirus ,rubella, hepatitis, adenoviruses, varicella…. 2- Some bacterial infection: (Pertussis ,brucellosis …) 3- Other conditions: Allergic drug reactions, splenectomy, dermatitis ,hyperthyroidism metastatic carcinoma….) 4- Chronic lymphocytic leukemia (CLL) 5-Other lymphomas: Mantle cell lymphoma ,Hodgkin lymphoma…

  18. Lymphocytopenia

  19. Monocytes • Large, phagocytic WBC, having a single well-defined nucleus and very fine granulation in the cytoplasm. • Represents about 2-9% of WBC • Matures into different types of macrophages at different anatomical locations (skin, spleen, liver …..)

  20. Monocytes Monocytosis Monocytopenia 1- Chronic infection : (TB , Brucellosis..) 2-Autoimmune :SLE.. 3-Chronic neutropenia 4-Acute leukemia (AML M5) 5-Chronic Myelomonocytic leukemia Hairy cell leukemia Selective monocytopenia:

  21. Eosinophil • Granular leukocyte having a nucleus with two lobes and cytoplasm containing bright red coarse and round granules . • Major functions : • 1-Antiparasitic and bactericidal activity, • 2-Participating in immediate allergic reactions, • 3-Modulating inflammatory responses. 

  22. Eosinophilia Causes: C H I N A Connective tissue diseases Helminthic parasitic infections Idiopathic: Hypereosinophilic syndrome Neoplasia: eosinophilic leukaemia, lymphoma or MPN Allergy 23

  23. Basophil • Phagocytic leukocyte of characterized by numerous coarse bluish-black granules of variable size. • Mature to tissue mast cells. • Functions of Basophils • - Major role in immediate allergic reaction (IgE) • - Anticoagulant activity (Heparin) • - Vasodilatation (Histamine)

  24. Basophilia 1-Neoplasia (CML, mastocytosis, basophilic leukaemia, MPN) 2-Hypothyroidism 3-Some viral infections (Chickenpox) 4-Inflammatory conditions 5-Drugs (IL3, oestrogen) 6-Hyperlipidaemia 25

  25. leukoerythroblastic picture • Bone marrow response in which nucleated red blood cells and immature leukocytes are released in the blood • Causes: • Metastatic neoplasm • Primary Myelofibrosis • Severe hemolysis (Thalassemia major) • Severe infection ( Miliary TB)

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