Haematology for Dental Students - WBC Disorders

1. “Success is going from failure to
failure without loss of enthusiasm” !
– Winston Churchill

2. 2013: MB2-HRM-Week 7
Pathology of
WBC disorders
Dr. Shashidhar Venkatesh Murthy
A/Prof. & Head of Pathology

3. Diseases of WBC: Learning Objectives:
 Normal WBC.
 Reactive changes: (Philia.. / Penia..)
• Neutropenia, Agranulocytosis, Leukemoid reaction.
• Lymphadenitis, Lymphadenopathy.
 Neoplastic / Cancers:
• Leukemia – Acute, Chronic, Myeloid & Lymphoid.
• Lymphomas – Hodgkins & Non Hodgkins.
• Precancers: MPD, MDS.
 Books/Ref:
TOP 5 WBC disorders.
1. Reactive changes.
2. Leukemia.
3. Lymphoma.
4. MPD.
5. MDS.
Less  More

4. Small minds discuss people
Average minds discuss events
Great minds discuss solution
Genius silently acts!

5. 5
Normal Blood Cells:
Neutrophil
Non-Specific Immunity
Eosinophil
Basophil
Specific Immunity
Lymphocyte
Non granular, Mononuclears
Granulocytes, Polymorphs

6. Normal WBC Production:

7. Whatever you think, that you will be.
If you think yourselves weak,
weak you will be.
If you think yourselves strong,
strong you will be!
-- Swami Vivekananda

8. Leukocytosis: Neutrophilia
 Increased granulocytes:
• Trauma, Acute Infections, inflammation, Bacterial*
 When severe with immature forms – Leukemoid reaction.
 Clinical features:
• Fever, Fatigue, Inflammation.

9. Lymphocytosis: Infectious Mononucleosis
 Increased Lymphocytes: (Activated)
• Chronic Inf., Viral, fungal, TB etc.
 Large lymphocytes, more cytoplasm. Irregular, indented by
RBC – also known as atypical lymphocyte or virocyte
 Clinical features: fever, lymphadenopathy.

10. Leukopenia: Neutropenia
 Reduction in granulocytes:
• Decreased Production – Marrow aplasia, drugs,
• Increased destruction – drugs, immune,
• Congenital: CGD, Idiopathic, cyclical, Benign ethnic (common)
 When severe – Agranulocytosis (drugs, immune)
 Clinical features:
• Infections, oral ulcers with white thick pus (pseudo membrane) of
bacteria or fungus (candida common)

11. WBC Absolute counts in disease:
Penia Neutro Philia
Penia Eosino Philia
Penia Mono cytosis
Penia Lympho cytosis

12. WBC counts:

13. When your thinking is brilliant, you will be
brilliant, but if your thinking is not brilliant
you will not be brilliant, no matter how
brilliant you may think you are….!
-- Christian D. Larson
Fake it until you make it…!
-- Mohd. Ali. Boxer.

14. Lymphadenitis:
 Acute (painful) or Chronic
(painless)
 Infections, Immune & Cancers.
 Increased, large follicles with
pale germinal centre & mantle
zones (B cell proliferation* & apoptosis*)
 Lymphadenitis: Enlarged
reactive lymphnodes due to
stimulation (inflammation).
(Painful)
 Lymphadenopathy – any
enlargement, but commonly
used for Cancer spread.
(Painless)

15. Reactive lymphadenitis
Dark zone
Light zone
Mantle zone
Macrophage
Tingible body
Macrophage
B Lymphocyte proliferation* & apoptosis*

16. “When you see a good person,
learn from her/him. When you
see someone not so good,
reflect on your own weak
points.”
― Confucius.

17. Hemato-oncology: Blood Cancer - Summary
 Cancer of immature Blast cells. (Bone marrow common)
Leukemia:
• ‘White’ ‘blood’ – excess WBC, Starts in bone marrow  extends to
blood & hemopoietic Organs - Liver, Spleen & lymphnodes*
• Two Major types: Myeloid & Lymphoid.
• Two presentation: Acute / Chronic. (AML, ALL, CML CLL)
• Many subtypes* – different mutations personalized medicine*(MB3)
 Lymphoma:
• Solid tumour of lymphoid tissue – where ever lymphoid tissue.
• Hodgkins & Non-Hodgkins lymphoma. B cell type common.
• Many subtypes – clinically Low, Intermediate & High grade.
 Premalignant Disorders:
• MPD Myelo-Proliferative Dis: Excess proliferation, more abnormal cells.
• MDS Myelo-Dysplastic Syn.: Dysplastic (abnormal cells)  pancytopenia.

18. Leukemia: Clinical Features
 Cancer of Bone marrow Blasts – Excess WBC.
 Decreased Haemopoiesis:
• Erythropoiesis – Anemia - RBC
• Leukopoiesis – Infections - WBC
• Thrombopoiesis – Bleeding. PLT
 Bone marrow expansion/destruction:
• Bone pains.
 Extraneous hemopoiesis / spread:
• Splenomegaly
• Hepatomegaly
• Lymphadenopathy (more in lymphatic malignancy)

19. Leukemia Clinical features:
Bleeding - Petechiae
Lymphadenopathy
Hepatosplenomegaly
Infections - Candidiasis

20. Leukemia Classification
 Acute Leukemias: weeks to months.
• Acute Myeloid Leukemia – AML - Adults
• Many Subtypes: M0, M1 to M7
• Acute Lymphoid Leukemia – ALL - Children
• Many Subtypes: L1, L2 & L3
 Chronic Leukemias: Years, late age.
• Chronic Myeloid Leukemia- CML- Adults
• Chronic Lymphoid Leukemia - CLL –Old age.

21. ALL children - AML adults

22. Leukemia Morphology:
Normal Acute Leukemia AML/ALL
CML: Chronic Myeloid Leukemia
CLL: Chronic Lymphatic Leukemia

23. Leukemia Case:
 JK 12y, Boy Presents to ED:
“Very Sick, fever, back pain,
nothing helping it”.
 History:
• Feels unwell? - Very
• Fever? Yes, intermittent
• Easy bruising -Yes,
 Examination:
• Slim, unwell, pale, Multiple Bruises
• Liver & Spleen enlarged – mild.
• Lymph nodes enlarged neck & axilla.

24. Any fool can know.
The point is to understand !
-- Albert Einstein
Without Pathology, Medicine is quackery…!

25. Lymphoma
 Definition: Solid cancer of lymphoid tissue
 Clinical: Painless, immobile, Lymphadenopathy,
weight loss, Fever.
 Two Major Types: & many subtypes.
 Hodgkins lymphoma (HL) – Reed-Sternberg cells.
• B cell only. Types: Lymph. rich  Mixed  Ly.
Poor.
 Non-Hodgkins lymphoma (NHL) – no RS cells.
• B cell, T cell & Histiocytic lymphoma.

26. Hodgkins Non Hodgkins
NHL: Diffuse Small Cell
HL: Nodular Sclerosis (common) NHL: Follicular Mixed Small & Large Cell
Only RS cell Malignant All cells Malignant

27. "Creativity is inventing,
experimenting, growing, taking
risks, breaking rules, making
mistakes, and having fun.
-- Mary Lou Cook

28. Burkitt’s lymphoma: large B cell NHL
 Endemic in Africa
 Epstein Barr Virus (EBV)
 B Cell Lymphoma.
 Dark large B lymphocytes
(malignant) with plenty of
pale macrophages. (Starry
sky pattern).

29. Multiple Myeloma:
 Malignancy of Plasma cells (Mature B
lymph, Ab) - Old age, males.
 Marrow, LN, Blood.
 Multiple, punched out Lytic bone
lesions (Osteolysis)
 Hyper gammaglobulinemia
 Monoclonal antibody peak – serum
protein electrophoresis.
 Immunodeficiency  infections.

30. “The future belongs to those
who believe in the beauty of
their dreams.”
–Eleanor Roosevelt

31. Myelo Proliferative Disorders.
Myelo Dysplastic Syndromes.
(Pre-canceraous stage of blood cancers)

32. MPD MDS
Old age, Neoplastic proliferation of stem cells. Reduced normal marrow
(RBC, WBC & PLT - anemia, infections & bleeding. Liver & Spleen enlarged.
Usually transform to Acute leukemia at the end.
 Marrow Proliferation with
maturation.
 Increased abnormal cells in
blood – Leukocytosis.
 4 major types (mixed types
common).
• Polycythemia Vera (RBC)
• Chronic Myeloid Leuk. (WBC)
• Essential Thrombocythemia
(PLT)
• Myelofibrosis (Fibrosis)
 Marrow Proliferation with
no maturation.
 Decreased abnormal cells in
blood. – Leukopenia.
 4 major types.
• RA (Refractory Anemia)
• RARS
• RAEB
• RAEB in transformation.

33. Polycythemia Rubra Vera (PV)
Hypercellular Marrow,
Red skin & Hepatosplenomegaly

34. Essential thrombocythemia
Plenty of
Platelets in blood 
 But clinical bleeding (abnormal platelets)

35. The goal of mankind is knowledge, which
is inherent in man. No knowledge comes
from outside: it is all inside. What man
'learns' is really what he “discovers” by
taking the cover off his own soul.
- - Swami Vivekananda
‘Education’… from Eduse (latin) to bring out..!
‘Doctor’ … from Dokere’ (latin) to teach…!

36. Summary:
 Reactive Leukocytosis:
• Neutrophilia, Eosinophilia, Lymphocytosis.
 Reactive Leukopenia:
• Neutropenia, lymphopenia, pancytopenia.
 Leukemia: – Blood Cancer (of Blasts in marrow)
• AML / ALL, CML / CLL
 Lymphoma: – solid Tumor of lymphoid tissue.
• Hodgkins & Non- Hodgkins
 Precancerous conditions:
• MPS (Leukocytosis) & MDS (leukopenia):

37. I am here for you….
Discussion Board: Questions & Answer others Q.
Email: venkatesh.shashidhar@jcu.edu.au
Need personal guidance? Email me for an appointment.
Office Tel: 4781 4566
Office location – DB39-136 (Townsville)

38. The only person who never makes
a mistake is a person who
never does anything…!
- Theodore Roosevelt
38

39. 3 R’s of success:
Respect for self,
Respect for others &
Responsibility for your actions.

40. Aspire to become good, not great....
Greatness is like a passing cloud,
temporary.
- Sai Baba - Divine Discourse, July 16, 2001.

41. Normal Blood Cells:

42. Normal Blood Cells: