We have our differences, yes.
We have different cultures, of course.
We look different to one another, sure.
But we’re all traveling through the
cosmos on the same spacecraft, Earth.
We are truly one world, one people.
we can’t destroy ship for hatredness.
Jim Rohn, responding to US Terrorist attack
WBC Disorders:
Dr. Venkatesh M. Shashidhar
Senior Lecturer in Pathology
Fiji School of Medicine
Normal Blood Film:
White Blood Cells:
CBC - WBC Histogram:
WBC disorders:
Reactive increase in number – “philias”
Neutrophilia – Bacterial sepsis
Lymphocytosis – viral, Immune
Eosinophilia – Allergy & Parasites.
Decreased number – “penias”
Neutropenia, Lymphopenia &
Eosinopenia, Pancytopenia
Drugs, viral infections, Radiation,
chemotherapy etc.
Neutrophilia:
Toxic Granulation:
Leukemoid Reaction:
Lymphocytosis:
Lymphocytosis - Virocytes:
"To live a creative life, we
must lose our fear of being
wrong."
- Joseph Chilton Pearce
Neoplastic Disorders:
Hemato-Oncology
Dr. Venkatesh M. Shashidhar
Senior Lecturer in Pathology
Fiji School of Medicine
Introduction:
No Benign Neoplasms – All are
considered malignant or premalignant.
Neoplastic Cells flood blood stream –
Leukemia.
Commonly arise in marrow (myelo/ly)
or Lymphnode (lymphoid),
Spread to blood & other RES tissues
rarely to other organs
Symptoms are due to deficient normal
hemopoiesis. RBC, WBC & Plt.
WBC Neoplastic disorders
Leukemias Bone marrow, blood, blast cells
Acute/Chronic & Myeloid/Lymphoid
AML / ALL & CML / CLL
Lymphomas – Lymph nodes, tumor
Hodgkins -
Non-Hodgkins. Myeloma
Premalignant conditions:
Myeloproliferative syndromes (MPS)
Myelodysplastic syndromes (MDS)
Leukemia - Clinical Features
Anemia (low RBC)
Fever - Infections (low WBC)
Bleeding tendency (low PLT)
Tender bones, lymphadenopathy,
spleenomegaly etc. (Leukemic infiltration)
Leukemia Classification
Acute Leukemias:
Acute Myeloid Leukemia - AML
AML M0, M1, M2, M3, M4, M5, M6 & M7
Acute Lymphoid Leukemia - ALL
ALL - L1, L2 & L3 - maturity
Chronic Leukemias:
Chronic Myeloid Leukemia- CML
Chronic Lymphoid Leukemia - CLL
Platelet Coagulation
Petechiae, Purpura Hematoma, Joint bl.
AML-M5 - Gum Hypertrophy:
ALL:Cervical Lymphadenopathy
Organomegaly
Mediastinal Lymphadenopathy - ALL
ALL-Acute Lymphocytic Leuk.
Common in Children.
FAB classification L1, L2 & L3
CD10 +ve, Pre B cell type common.
Growth failure, Fever, Anemia
Lymphadenopathy, bleeding.
Moderate Hepatosplenomegaly
ALL-L1
ALL-L2
ALL-L3
AML-Acute Myeloid Leuk.
Adults common
FAB classification - M0 to M7.
Anemia, Fever, Bleeding
Hepatosplenomegaly moderate
No significant lymphadenopathy
AML-M0 - Undifferentiated:
AML-M2 - with maturation
AML-M3 - Auer Rods
AML-M4 - Myelomonocytic
AML-M6 : Erythroleukemia
AML-M7 : Megakaryocytic
Chronic Myeloid Leukemia
Middle age 40-60y
Philadelphia chromosome, t(9:22)
Anemia, Fever & Bleeding
Marked leucocytosis – >50,000 (abnormal)
Marked splenomegaly, Hepatomegaly
Chronic Myeloid Leukemia:
Chronic Lymphocytic Leukemia
Elderly age
Anemia, fever & bleeding – slow over years.
Lymphocytosis & Lymphadenopathy
Spleen, & liver enlargement
Common B cell (CD5 +ve)
CLL
CLL – Blood Film
"Creativity is inventing,
experimenting, growing,
taking risks, breaking
rules, making mistakes,
and having fun."
--Mary Lou
Cook
Lymphoma
Lymphoma
Tumors of lymphoid tissue
Lymphadenopathy
Fever
Hodgkins lymphoma
Non-hodgkins lymphoma
Right neck mass
Lymphoma
Row of
enlarged
lymph nodes
Hodgkins Lymphoma:
Children & adults – double peak.
Lymphadenopathy, painless, firm
Fever, Eosinophilia
Reed-Sternberg cells - B lymphocytes.
? Viral etiology
Splenomegaly
Spleen
Hodgkins lymphoma
Non-Hodgkins Lymphoma:
Fever, anemia, infections
Marked Lymphadenopathy
No RS cells or eosinophilia
Large group of different lymphomas
Clinical – low, intermediate & high grade.
Cell type – B cell, T cell, Histiocyte & other
Histology – Follicular & diffuse.
NHL- Histologic types
Diffuse - & - Follicular
NHL- Histologic types
Small – Intermed. – Large
Myeloma:
Old age
Malignancy of Plasma cells – B lymphocytes
Lytic bone lesions.
Marked antibody production – Monoclonal
Hyper gammaglobulinemia – blindness
Immunodeficiency – infections
Myeloma – Bone Marrow
Premalignant conditions
MPS
MDS
Myeloproliferative Syndromes:
Neoplasms, Slow, Chronic, Proliferation - ?Bgn
Increased, Functionally abnormal cells.
Extramedullary hemopoiesis - Organomegaly
Progress to Leukemia – end stage.
Classification:
Polycythemia rubra vera (PV)
Chronic Myeloid Leukemia (CML)
Essential Thrombocythemia (ET)
Myelofibrosis (MF)
MPS: Classification
Blood Film
Plenty of
Platelets
Megakaryocyte
MPS : E.T. Bleeding
MPS - P. Rubra Vera (PV)
MPS : E.T. Thrombocytosis
BM & PS
MPS : M.F. Organomegaly
MPS : MF - Radio Iron Study
Myelodysplastic Syndromes:
Excess proliferation in marrow.
But functional & Structural abnormality
Ineffective Myelopoiesis.
Peripheral pancytopenia.
Also known as Refractory Anemia’s
Not responding to hematenics.
Myelodysplastic Syndromes:
FAB classification
RA : Refractory Anemia (Blasts <1%)
RARS : RA with Ring Sideroblasts (<1%)
RAEB : RA with excess blasts (<5%)
RAEB in T : RAEB in transformation (>5%)
MDS - Dysplastic Erythroblasts
MDS: - Ring Sideroblast
Summary:
Leukemias – Starts in marrow spread to blood
Anemia, infections & Bleeding
Enlargement of Liver, Spleen lymphnodes
Acute/Chronic & Myeloid & Lymphoid.
Lymphomas – Tumors of lymphnodes.
Fever & lymphadenopathy
Types - Hodgkins & non- hodgkins, special types.
Premalignant conditions
MDS: Myelodysplastic syn – Less & Dysplastic
MPS: Myeloproliferative dis -Excess & abnormal
3 R’s of success:
Respect for self,
Respect for others and
Responsibility for all your actions.
