Disorders of leucocytes and platelets

• Leucocytes are made of :neutrophils, T and B

lymphocytes, natural killer (NK) cells, monocytes,
eosinophils, and basophils
• Normal leucocyte account is between 4-11x10
(9)/l,neutropils 45-75%, lymphocytes 16–45%,
monocytes 4–10%, eosinophils 0–7%, and
basophils 0–2%
• colony-stimulating factors (CSFs) and interleukins
(Ils) control their growth and maturation
 neutrophils
• Fight bacterial infection
• Neutrophillia-elevated level of neutrophil >7500/microl
– Infection-bacteria
– Inflammation-burns,myocardial infarction,PE,connective tissue
disorder
– Drugs and toxin-smoking,corticosteroids,beta agonist,acute
poisoning
– Marrow stimulation-haemolytic
anemia,thrombocytopenea,haemorrhage
– Neoplasm-primary eg myeloproliferative or paraneoplastic eg
lung cancer
– Misc-diabetic ketoacidosis,execrise,disseminated maliganncy
• Leukamoid reaction->50,000/ul,not due to leukamia.
 neutropenea
• If <1000/ul risk of common bacterial infection e.g
pneumonia rise
• <500/ul control of endogenous microbiota /normal flora
lost
• <200 no local inflammatory response
• Causes are
– depressed production eg drugs like cancer
chemotherapy,antibiotics eg penicllin,NSAIDS,thyroid drugs
etc,aplastic anemia,bone marrow infiltration,B12
deficiency,infections eg TB,typhoid
– Destruction in autoimmune disease,antineutrophils
antibody,spleen,drugs as hapten
– increased peripheral or peripheral pooling-
haemodialysis,severe bacterial infection
 Lymphocyte
• Lymphocytosis is Level >4000-5000
• Causes
– Infection-viral
– Hypersensitivity eg drugs,serum sickness
– Stress e cardiac emergency
– Autoimmune-rheumatoid,SLE
– Neoplasm-leukamia,lymphoma
 eosinophilia
• Eosinophils >500cells/microl
• Causes
– Infection-helminths,parasites
– Allergy-asthma,rhinitis
– Connective tissue disease-churg strauss,rheumatoid arthritis
– Drugs-allergic reaction
– Neoplams-myeloproliferative disorder
– Endocrine-addisons disease
– idiopathic hypereosinophilic syndrome with multi-organ
dsfunction eg liver,kidney,heart from local deposition of toxic
eosinophil proteins such as eosinophil cationic protein and
major basic protein
– Eosinophilia-malgia syndrome-
 Monocytosis and basophillia
• Level >500cells/microl
• Causes of monocytosis
– Infection-tuberculosis,subacute bacterial
endocarditis,fungi
– Neoplasm-CML,hodgkins disease
– Inflammattory-IBD,collagen vascular disease,sarcoid
• Causes of basophillia
– Neoplasm-myeloproliferative,hodgkins
– Inflammation/allergy-IBD,asthma
– Others-haemolytic anemia,splenectomy
 Platelets
• Normal 150-45O,000/ul
• Thrombocytopenea(<150k) and bleeding risk
– >100000 no risk increased bleeding
– 50K-100K risk with major trauma can proceed
with major surgery
– 20-50k risk with minor trauma or surgery
– <20k –risk of spontanous bleeding
– <10k risk of severe,life threatening bleeding
 Etiology of thrombocytopenea
• Decreased production
– Aplastic anemia,marrow infiltartion by tumor
– Leukamia
– Vitamin B12 deficiency
• Increased destruction
– Immune mediated
• Primary eg immune mediated thrombocytopenea
• Secondary-HIV,HSV,connective tissue disease,
– Non immune mediated eg disseminated intravscular
coagulopathy,hemolytic uremic syndrome,PET/eclampsia
• Abnormal pooling-splenomegally
 Work up
• History and physical examination-associated
symptoms suggestive of
leukamia,drugs.lymphnode,splenomegally
• Complete blood count/hemogram-isolated vs
multilineage
• Peripheral blood smear-large
platelets,schistocyte due to breakdown,limited
platelets in low production
• If anemia-LDH,retic count,haptoglobin,bilirubin to
detect hemolysis.also coagulation profile
• Bone amrrow for unexplained thrombocytopnea
 Primary immune mediated
thrombocytopenic purpura(ITP)
• Isolated thrombocytopenea from immune mediated
platelets destruction unlike secondary which is
associated with drugs or underlying disease e.g
leukamia
• Work up-isolated thromboctopenea <100k
• Peripheral smear-large platelets
• Rule out other etiologies eg
HAV/HCV/HIV/HBV/ANA/antiphospholipid antibodies
• Present as spontanous mucocutaneous bleeding
• Treatment if <50k with prednisone 1mg/kg,other
immunosuppressant eg azathioprine,splenectomy,IVIG
• Other cause of thrombocytopenea
– Heparin induced-type 1 and 2
– Haemolytic uremic syndrome-bloody diarrhoea
due to shiga toxin from Enterohaemorrhagic E.Coli
causing renal dysfunction,thrombocytopenea and
haemolytic anemia.
– Thombotic thrombocytopenic purpura-as HUS but
plus neurological symptoms and fever