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Haematology for Dental Students - WBC Disorders

Haematology for Dental Students - WBC Disorders

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Haematology for Dental Students - WBC Disorders

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

  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 Macrophage Tingible body Macrophage Light zone Mantle zone 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: Lymphadenopathy Bleeding - Petechiae Infections - Candidiasis Hepatosplenomegaly

  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 CLL: Chronic Lymphatic Leukemia CML: Chronic Myeloid 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 NHL: Follicular Mixed Small & Large Cell HL: Nodular Sclerosis (common) 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:

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