Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date :...

46
Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013

Transcript of Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date :...

Page 1: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

• Course title : Hematology (1)• Course code : MLHE-201• Supervisor : Prof.Dr Magda Sultan

Date : 24/10/2013

Page 2: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

• Outcome

• The student will know :

• Total & differential leucocytic count

• Absolute & relative counts

• Quantitative & qualitative WBC abnormalities.

Page 3: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

White Blood Cell Disorders

Page 4: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

White Cell Maturation

Page 5: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.
Page 6: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.
Page 7: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Leucocytes (white blood cells)• Phagocytes

- Granulocytes

.Neutrophils

.Eosinophils

.Basophils

- Mononuclear phagocytic cells

.Monocytes

• Lymphocytes

- B cells & T cells

Page 8: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

PB Neutrophils

Page 9: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

PB Staff

Page 10: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

PB Basophils

Page 11: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

PB Eosinophils

Page 12: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

PB Monocytes

Page 13: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

PB Lymphocytes

Page 14: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

White Blood Cell Disorders

Classification : -Disorders of cell number Terminology: .cytosis/philia (increase in number) .cytopenia (decrease in number) -Disorders of function & morphology

Page 15: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Normal Total Leucocytic Count

For an adult ( male or female)

Normal reference range:

4,000 – 11,000 / cmm

Page 16: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Relative vs Absolute values

• Total White Blood Cell Count (TWBC)

• Differential count : gives the relative

percentage of each white blood cell.

• Absolute value : gives the actual

number of each white blood cell/cmm.

Page 17: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Calculation

Absolute Count = TWBC x Percent

eg: If TWBC = 6,000 /cmm

Neutrophils = 60 %

So Absolute neutrophilic count =

6,000 x 60 / 100 = 3,600 /cmm

Page 18: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Disorders of Cell Number

• Leucocytosis :

an increased number of leucocytes

in the peripheral blood >11,000 /cmm

• Leucopenia :

a reduced white cell count

( < 4,000 /cmm )

Page 19: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Leucocytosis

• Causes :

- Neutrophilia ( commonest cause ).

- Eosinophilia .

- Basophilia .

- Lymphocytosis .

- Monocytosis .

Page 20: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Neutrophilia

Definition :

Increase in the number of neutophils

and/or its precursors > 7,000/cmm

Page 21: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Causes of Neutrophilia

• Infections (pyogenic bacteria)

• Inflammations produced by :

Toxins,infectious agents,neoplasms or burns .

• Following haemorrhage. Reactive changes :

Left shift , toxic granulation , high LAP score.

Page 22: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Causes of Neutrophilia (cont.)

• Chronic granulocytic leukaemia

• Other myeloproliferative disorders

Diagnosis :

Low LAP score .

Philadelphia chromosome .

Page 23: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

PB Neutrophilia

Page 24: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Left Shift

Page 25: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Left Shift

Page 26: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

High LAP Score

Page 27: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Eosinophilia

• Definition : An increase in the total number of eosinophils in the peripheral blood more than 400/cmm . If eosinophilic count is > 600/cmm further investigations are required.

Page 28: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Causes of Eosinophilia• Allergy Atopic ,drug sensitivity & pulmonary eosinophilia .• Infections Parasites ,recovery from infection• Malignancy Hodgkin’s disease , NHL & MPD

• Skin disorder• Drugs• GIT disorders • Hypereosinophilic syndrome

Page 29: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Eosinophilia

Page 30: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Basophilia

• Definition Increased basophils in the peripheral blood >

100/cmm- Most commonly associated

with: .Hypersensitivity reactions to drugs or food .Inflammatory conditions e.g RA,ulcerative

colitis. .Chronic myeloid leukaemia & MPD

Page 31: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Basophilia

Page 32: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Lymphocytosis

• Definition :

An increase above normal in the number

of circulating lymphocytes ( > 4,000/cmm)

Page 33: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Causes of Lymphocytosis

• Acute infections: Infectious mononucleosis,

acute infectious lymphocytosis,mumps,

rubella,pertussis .

• Chronic infections: tuberculosis,syphilis,

brucellosis,infectious hepatitis .

• Thyrotoxicosis (usually only relative)

• Chronic lymphocytic leukaemia

Page 34: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Lymphocytosis

Page 35: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Infectious Mononucleosis• Caused by Epstein-Barr Virus (EBV)

• Bood picture shows leucocytosis with absolute lymphocytosis and increased

number of atypical lymphocytes .

• Diagnosis :

- Monospot test .

- EBV serology .

Page 36: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Infectious Mononucleosis

Page 37: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Monocytosis

• Definition :

A monocytosis is present when the

peripheral monocyte numbers rise

above 800/cmm .

Page 38: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Causes of Monocytosis

• Chronic bacterial infections : tuberculosis,bacterial endocarditis, brucellosis.• Other infections :malaria,Kala-azar, trypanosomiasis,typhus……..• Hodgkin’s disease .• Monocytic & myelomonocytic leukaemia

Page 39: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Monocytosis

Page 40: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Leucopenia

• Total white blood count lower than the

reference range for age is defined as

leucopenia ( < 4,000/cmm for an adult )

• The major contribution to a leucopenia

usually comprises a reduction of PB

neutrophils .

Page 41: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Causes of Leucopenia• Infections : -Viral as infectious hepatitis,influenza, rubella and others . -Bacterial as typhoid fever,brucellosis, miliary TB . -Rickesttial and protozoal infections .• Drugs : Selective neutropenia,Agranulocytosis, Aplastic anaemia

Page 42: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Causes of Leucopenia(cont.)

• Megaloblastic anaemia• Hypersplenism• Leucoerythroblastic anaemia(Multiple Myeloma,metastatic carcinoma….)• Acute leukaemia • Myelodysplasia• Aplastic anaemia

Page 43: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Causes of Leucopenia(cont.)

• Cyclical neutropenia• Chronic idiopathic neutropenias• Paroxysmal nocturnal hemoglobinuria• Ionizing radiation & cytotoxic drugs• Miscellaneous conditions : myxoedema,anaphylactoid shock, hypopituitarism & SLE

Page 44: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

• Student name :

Title :

Page 45: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Training Questions :

Mention the different causes of leucocytosis

How to calculate the absolute count?

Define neutrophilia.

Reference book:

-Essential Hematology .

-Dacie

Page 46: Course title : Hematology (1) Course code : MLHE-201 Supervisor : Prof.Dr Magda Sultan Date : 24/10/2013.

Assignement : Student name :

Quantitative white cell disorders. مجيد حميد االله عبد حميدقطب رشاد السعيد دعاء

داود وليم داود ديناالرازق عبد الرافع عبد ديناعيسي لطفي رافت رامي

الشرقاوي احمد محمد رانياقمري محمد سعد رحاب

محمدين شاكر محمود رحابغنيم اللطيف عبد مسعد رحمه

فراج الله عبد رشاد ابراهيم رشاد

Eosinophils . درويش ابراهيم محمود محمد رضويالزمراني محمد ابراهيم فتحي رنا

فرج يعقوب راوبين روزاليينالنحراوي فريج السيد ريهام

الحناوي كمال سامي ريهامبركه محمد علي مصباح ريهام

جاسم نصيف ليث زيديوسف عسران ربيع سارهياسين عباس زكريا سامحعمران احمد محمد سامر