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Basic Tissues Lectures #27 Leukocytes by Dr. Despina Sitara 2/2 /!" Slide 1 Cover Dr. Despina Sitara Slide 2 Leukocytes White lood Cells !W Cs" Dr. Despina Sitara #k$ so today %e&re 'onna discuss the other type of blood cells$ the %hite blood cells$ or leukocytes. These are the least nu(erous blood cells that are found in the blood. )nlike red blood cells$ they retain their nuclei$ red blood cells are %ithout nucleus. So %hite blood cells have both nucleus and cytoplas(. The cytoplas( is the site for protein synthesis. The nucleus is the site for chro(atin$ %hich carries the D*+$ carries the 'enetic (essa'e$ trans(itted fro( the nucleus to the cytoplas( by ,*+. +lso$ unlike the red blood cells$ the %hite blood cells do not function %ithin the bloodstrea($ but they travel fro( one re'ion of the body to another. -n fact %hat happens is they leave the bloodstrea( and they (i'rate throu'h the vessel %alls to tissue$ and this is a process called Diapedesis. The function of the %hite blood cells is to defend the body a'ainst forei'n substances. Slide . Diapedesis Dr. Despina Sitara This is a cartoon that sho%s this process of Diapedesis. /ere you have a tissue and this is the blood vessel$ and these cells here are various leukocytes$ various %hite blood cells. They can (ove throu'h the intact vessel %alls to the surroundin' body tissue. Slide 0 Types of White lood Cells !W Cs" Dr. Despina Sitara There are t%o 'roups of %hite blood cells dependin' on %hether they have 'ranules in the cytoplas( or not. These are called 'ranulocytes %hen they D# have 'ranules in the cytoplas($ or a'ranulocytes$ %hen they do *#T have 'ranules in their cytoplas(. There are . types of 'ranulocytes. These are the neutrophils$ the eosinophils$ and the basophils. +nd there are t%o types of a'ranulocytes$ %ith no 'ranules in the cytoplas( and these are the ly(phocytes and the (onocytes. *o% both 'ranulocytes and a'ranulocytes possess so(e kind of 'ranules that they are not specific and these are kno%n as lysoso(es. Slide 1 2 Criteria for Leukocyte -dentification Dr. Despina Sitara So in order for the different %hite blood cell types to be identified$ one has to look at the cell si3e and shape. The nuclear si3e$ %hich is the nucleus to cytoplas( ratio$ nuclear shape$ cytoplas(ic stainin'$ and cell inclusions$ %hether they have 'ranules or not. Slide 4 2 5ranulocytes Dr. Despina Sitara

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Slide 6 2 *eutrophils Dr. Despina Sitara So no% %e&re 'onna talk about leukocytes. 7irst in the list are the neutrophils. The neutrophils are the (ost nu(erous in the bloodstrea(. They are produced in the bone (arro%$ then they e8it the bone (arro% and they only spend about 921: hours in the circulation before they reach a tissue that they tar'et. They have about 1:212(( in dia(eter$ that&s ho% they sho% in a blood s(ear. +nd one of the (a;or characteristics you see a neutrophil here$ is that they have the nucleus is se'(ented$ and it contains so(e%here bet%een 221 se'(ents. These se'(ents are called lobes. This is a typical neutronphil %ith 2 se'(ents. These se'(ents are ;oined by a thin chro(atin strand$ and because the neutrophils have (ultiple lobes$ they&re (ulti lobed in their nucleus$ they are also called poly(orphonuclear leukocytes. The nu(ber of lobes in nucleus of a neutrophil increases %ith a'e. +nother characteristic of the neutrophil nucleus$ in the fe(ales$ is that there is this s(all appenda'e that looks like a dru(stick and this is the arr ody$ %e talked about this in the 'enetics lecture. This is condensed inactive < chro(oso(e. /o%ever$ this arr body is not evident in all cells. The cytoplas( of neutrophils contains 'ranules$ and they stain li'ht pink. Slide 9 2 *eutrophils Dr. Despina Sitara There are . types of 'ranules in the cytoplas( of neutrophils. These are a3urophilic$ because they stain blue %ith an a3ure stain. These are nor(ally lysoso(es they are they lar'est and the fe%est$ and they contain en3y(es that they are bactericidal. They also contain specific 'ranules$ these are called also secondary 'ranules$ these are the s(allest and the (ost nu(erous$ and they also contain en3y(es that they are bactericidal. The third kind of 'ranules in the cytoplas( of neutrophils are the tertiary 'ranules. These contain en3y(es that they are kno%n to facilitate Diapedesis$ the (ove(ent of the %hite cells$ of the neutrophils fro( the blood vessel %alls to the tissues. The function of the neutrophils are to defend the body a'ainst bacterial and fun'al infection$ they are a(on' the first cells that are recruited to the site of infection. The process is that %hen a (icrobe or a forei'n anti'en invades the body$ the neutrophils (ove to the site of infection by a process called che(ota8is. Then they en'ulf$ they invade the (icrobes by a process called pha'ocytosis$ and finally$ they release to8ic substances that they are stored in the 'ranules and they kill the forei'n anti'en or the (icrobe. -n the case of hi'h neutrophil counts$ for e8a(ple this is a condition called neutrophilia$ this happens usually in infections= (ore neutrophils are recruited to fi'ht the infection. /o%ever %hen neutrophils values drop belo% nor(al values$ this is a condition called neutropenia$ it is serious condition because the person the individual is (ore susceptible to infection and bacterial sepsis because there are not enou'h neutrophils to fi'ht the infection. Slide > 2 +bnor(al *eutrophils Dr. Despina Sitara *o% several conditions can cause so(e abnor(alities in neutrophils. 7or e8a(ple$ deficiency in vita(in 12 or folic acid can cause hyperse'(entation of the nucleus of a neutrophil$ like you see here$ so the neutrophils have 4 or (ore lobes. This is because both vita(in 12 and folic acid are i(portant for D*+ synthesis$ and in their deficiency there is a failure for D*+ to synthesi3e properly. +lso there are conditions %here there is a defect in chro(atin synthesis such as

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(yelodysplasia$ and this leads to the failure of the lobes to se'(ent properly$ and %e have hyperse'(entation as you see here only 2 lobes instead of the nor(al .$ 0$ or 1. +nother condition is for e8a(ple after infection or infla((ation there is increased 'ranulation in the cytoplas($ as you can see here in the third slide$ and also cytoplas(ic vacuolation. The increased 'ranulation it sho%s that there is increased activity of the neutrophil$ that is %hat 'ives a%ay that there (ust be an infection or infla((ation$ and actually the vacuoles are clear sides %here (aterial has been pha'ocyti3ed$ so that also sho% increased activity after infection or infla((ation. /o%ever$ increased 'ranulation (ay also be seen in so(e nor(al conditions for e8a(ple durin' pre'nancy. Slide 1: 2 ?osinophils Dr. Despina Sitara ?osinophils are the second type of 'ranulocytes$ they have the sa(e si3e as neutrophils$ they are produced in the bone (arro%$ then they are release to the blood strea( %here they spend about 021 hours before they (ove to the surroundin' tissues. Their characteristic is that they only have 2 lobes$ it&s a bi2lobed nucleus$ and %hat 'ives it a%ay and (akes it distinct fro( the other 'ranulocytes are these lar'e oran'e red cytoplas(ic 'ranules that they cover the entire surface area. These are acidophilic 'ranules$ and they contain en3y(es and also lysoso(es that have the cytoto8ic effect to destroy parasites. Slide 11 2 ?osinophils Dr. Despina Sitara ?osinophils$ their (ain function is to fi'ht parasitic infections. They also$ these 'ranules help to neutrali3e hista(ine in aller'ic reactions. They have a si(ilar (ode of action like the neutrophils$ they respond to invaded (icrobe by che(ota8is$ then they pha'ocyti3e it and kill it %ith release of their 'ranules. Like - ;ust (entioned$ their (ain function is to defend the body a'ainst parasitic infections@infestations$ and also assist to da(pen the aller'ic reactions. -ncreased eosinophil nu(bers is kno%n as eosinophilia$ and usually seen in conditions such as asth(a and parasitic infections. Slide 12 2 asophils Dr. Despina Sitara The third type of 'ranulocytes are the basophils. These are the least nu(erous. So(eti(es you have to e8a(ine (ore than hundred %hite blood cells in order to find one basophil$ so they are rare. They also have the sa(e si3e as neutrophils. They have a lobed S2shaped nucleus$ %hich is not al%ays obvious because the entire cell is covered %ith lar'e dark purple2stainin' cytoplas(ic 'ranules. That&s also a characteristic of basophils that&s ho% %e identify the($ lar'e dark purple2stainin' cytoplas(ic 'ranules. There are t%o types of 'ranulesA specific 'ranules that contain hista(ine$ and also other substances such as slo% reactin' substance +. These are i(portant for vasodilation$ and these 'ranules a lot of ti(es are that (any that they pushed a'ainst the peri(eter of the cell$ and 'ive the basophil kind of a rou'h appearance. -t&s not totally round$ it&s sort of rou'h around the ed'es. +nd they also have a3urophilic 'ranules %hich are not specific$ and those are the 'ranules. S# there are so (any 'ranules that are pushed to the ed'e of the cytoplas( so that it 'ives it this sort of uneven appearance$ it&s the 'ranules they are pushed$ they are so (any. These are (ostly the specific 'ranules.

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Slide 1. 2 asophils Dr. Despina Sitara So like all the other %hite blood cells$ they are produced in the bone (arro%$ they circulate for a fe% hours in the blood and then they (i'rate to the tissues. Their (ain function is to initiate infla((atory processes and they&re involved in anaphylactic hypersensitivity and infla((atory reactions. When a forei'n anti'en invades the body$ this tri''ers a release of an i((uno'lobulin ?$ -'?$ and this -'? binds to the basophil surface receptors$ and causes the cell$ the basophil to de'ranulate and release its contents $ %hich are infla((atory (ediators %hich are the hista(ine and the S,S2+ to the surroundin' tissues. -ncreased basophil nu(bers are obviously seen in aller'ic reactions and so(e chronic infla((atory disorders. Slide 10 2 +'ranulocytes Dr. Despina Sitara The second type of %hite blood cells are the a'ranulocytes$ the ones that do not contain specific 'ranules. Slides 11 B 14 2 Ly(phocytes Dr. Despina Sitara Ly(phocytes belon' to this cate'ory$ these are the second (ost nu(erous cells. They also have the sa(e si3e as neutrophils$ but so(eti(es they (ay be s(aller or lar'er. They have an irre'ular outline$ and around this dark blue nucleus %hich is usually off the center of the cell$ and al(ost fills the cell. +nd they have a pale blue cytoplas(. These are so(e pictures of ly(phocytes so you can actually see %hat -&( talkin' about. The nucleus is dark purple. This is a ly(phocyte$ this is a ly(phocyte$ and this is a ly(phocyte$ -&ll 'et back to the different types in a (inute$ but the nucleus stains a lot darker than the cytoplas( %hich is (uch li'hter as you can see for e8a(ple here and here and even here. So there are . types of ly(phocytes dependin' on their si3e$ the a(ount of cytoplas( that they have$ and the presence or absence of cytoplas(ic 'ranules. - kno% - said that these do not have 'ranules$ but they don&t have specific 'ranules. So the s(all ly(phocytes are the (ost nu(erous$ they have a dense ho(o'enous nucleus$ %hich accounts for (ore than >:C of the total si3e of the cell. That&s a s(all ly(phocytes as you can see here$ it&s (ostly nucleus$ and very little cytoplas(. -t can also be (ediu($ these are less dense$ the nucleus is so(e%hat hetero'eneous$ and the nucleus to cytoplas( ratio is about 9:. +nd then there are lar'e ly(phocytes$ %hich can be 'ranular or a'ranular$ no 'ranules$ and the nucleus to cytoplas( ratio is about 0:24:. These are t%o lar'e ly(phocytes here$ that&s the nucleus %ith the cytoplas($ this one does not have any 'ranules in the cytoplas($ but this one does. Slide 16 2 Ly(phocytes Dr. Despina Sitara They ly(phocytes are produced in the bone (arro% but also they&re produced in another or'an called thy(us. They circulate in the bloodstrea( and then they enter the ly(phoid tissue$ these are the ly(ph nodes$ the spleen and then the tonsils. Their function is an i((une response$ they help the i((une response of the body$ and then there are . functional typesA the T cells$ the cells$ and the natural killer cells. The T cells are the (ost nu(erous in the body$ they differentiate in the thy(us$ that&s %hy they&re the T cells$ and they are helpin' in the cell (ediated i((unity. The cells

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differentiate in the bone (arro%$ that&s %hy they are called cells. They&re not that (any$ about 11C of total ly(phocytes. They differentiate to beco(e plas(a cells$ %hich then assist in hu(oral i((unity. *atural killer cells$ like the na(e su''ests$ they are pro'ra((ed to kill forei'n and virally infected cells$ also so(e tu(or cells. These are the least nu(erous$ about 121:C$ they&re also involved in cell (ediated i((unity. There lar'er than the T cells and cells$ and they also contain lar'e cytoplas(ic 'ranules. Slide 19 2 Ly(phocytes Dr. Despina Sitara ?levated or decreased levels of ly(phocytes can be caused by infection$ %hether this is bacterial or viral doesn&t (atter$ any kind of these infections. -ncreased nu(ber of ly(phocytes is called ly(phocytosis$ usually seen in so(e sort of leuke(ia$ like chronic ly(phoid leuke(ia$ and decreased nu(bers of ly(phocytes is a condition called ly(phopenia$ and they&re seen in conditions such as ly(pho(a or so(e stressful illnesses such as (yocardial infarction or pneu(onia. Slide 1> 2 Donocytes Dr. Despina Sitara Donocytes are the lar'est nor(al cells in the blood. They have a lar'e lobed kidney shaped nucleus$ or at least %ith a distinctly cleft$ and usually it off the center. They have lar'e 'ray2blue cytoplas(. They (ay have vacuoles$ or not$ and they contain so(e a3urophilic 'ranules. These are also nonspecific 'ranules. Slide 2: 2 Donocytes Dr. Despina Sitara They stay in the blood strea( for a very short ti(e$ then they (i'rate to the tissues %here they (ature and they beco(e pha'ocytic (acropha'es. They defend the body a'ainst bacterial and fun'al infections$ but also they can in'est$ break do%n dead cells or a'ed cells. Durin' the infla((ation$ durin' an infla((ation$ the (onocyte leaves the blood vessels by Diapedesis$ (oves to the site of infla((ation$ there is transfor(s into a tissue (acropha'e and pha'ocytosis the bacteria or other cells or cellular debris. The (acropha'es secrete cytokines that activate infla((atory responses$ and they also are responsible for proliferation (aturation of other cells. -ncreased nu(ber of (onocytes is called (onocytosis. *o%$ - don&t need you to kno% for e8a(ple %hat this is that caused increased or decreased ly(phocytes or eosinophils$ but - %ould like you to kno% ho% this$ the na(e of the disease$ for e8a(ple ly(phocytosis$ %hat does it (ean$ if it (eans increased or decreased nu(ber of cells. Slide 21 2 Classification of W C Disorders Dr. Despina Sitara S# the %hite blood cell disorders are classified by t%o %aysA %hether they are Euantitative or Eualitative$ %hether there are chan'es in the nu(ber of %hite blood cells$ or there are chan'es in (orpholo'y or function. -n ter(s of nu(erical chan'es$ this is %hat you need to kno%A %hen there is a decrease in the nu(ber of cells$ the suffi8 is penia. 7or e8a(ple$ ly(phopenia$ less ly(phocytes= neutropenia$ less neutrophils. When there is an increase in the nu(ber of %hite blood cells$ the suffi8 %ould be either cytosis$ cythe(ia$ or philia. 7or e8a(ple$ neutrophilia$ increased nu(ber of neutrophils$ ly(phocytosis$ increase nu(ber of ly(phocytes. White blood cell disorders can also be classified as beni'n$ these are called non2neoplastic$ neoplas( is

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another ter( for tu(or$ or non2cancerous. They are also classified as (ali'nant$ or neoplastic or cancerous. Slide 22 2 Disorders of W Cs Dr. Despina Sitara S# this is ;ust %hat - said about the nu(erical chan'es. Leukopenia is a decreased nu(ber of 'enerally speakin' %hite blood cells. *eotropenia$ decreased nu(ber of neutrophils. Ly(phopenia$ decreased nu(ber of ly(phocytes. Leukocytosis$ is the increased nu(ber of %hite blood cells in 'eneral. *o% they can be increased nu(ber of neutrophils$ that&s neutrophilia= increased nu(ber of eosinophils$ that&s eosinophilia= increased nu(ber of basophils$ that&s basophilia= increased nu(ber of ly(phocytes$ ly(phocytosis= or increased nu(ber of (onocytes$ (onocytosis. Slide 2. *on2neoplastic W C disorders Dr. Despina Sitara S# the ne8t fe% slide %ill be on non2neoplastic %hite blood cell disorders$ non2cancerous= beni'n. Slide 20 2 *eutropenia Dr. Despina Sitara *eutropenia is the (ost co((on type of leukopenia$ the neutrophil nu(bers drop belo% the nor(al values. That (akes the individual susceptible to bacterial and fun'al infections because there are not (any neutrophils to fi'ht off the infection$ and they can be caused by decreased or defective production= accelerated re(oval or destruction of the neutrophils$ or it can be dru' induced. Slide 21 2 *eutropenia Dr. Despina Sitara Si'ns and sy(pto(s$ of course$ infections$ because there aren&t (any to fi'ht off the infection. +nd also in so(e cases you see so(e ulcerative necroti3in' lesions of the (outh$ skin and 5- tract. The pro'nosis is poor$ because usually the individual has so (any infections that death occurs at so(e point fro( these over%hel(in' infections. So of course treatin'$ findin' the cause of this condition$ treatin' the infection is the (ost effective type of treat(ent. Slide 24 2 *eutrophilia Dr. Despina Sitara The opposite condition is neutrophilia$ increased nu(ber of neutrophils above nor(al values. This can result fro( %ither the bone (arro% (akin' (ore neutrophils$ or there is an increased (obili3ation of neutrophils fro( the bone (arro% to the blood strea($ or there is a decreased e'ress to the tissues. The causes of all these can be so(e infections$ also can be non2infectious causes$ ;ust as for e8a(ple infla((atory conditions$ cancer$ burns$ so(e dru's$ etc. Slide 26 2 *eutrophilia Dr. Despina Sitara -n the blood s(ear$ in cases of neutrophilia$ %e see to8ic 'ranulation$ it (eans increased 'ranulation of the cytoplas($ and also cytoplas(ic vacuoles. Clinical features involve infections that lead to abscesses$ tonsillitis$ (enin'itis$ etc. Slide 29 ?osinophilia

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Dr. Despina Sitara ?osinophilia is another for( of beni'n leukocytosis. The neutrophil nu(bers are increased above nor(al. The causes for this can be various aller'ic reactions or parasitic infections. Flease re(e(ber that eosinophils are i(portant and they&re recruited in cases of parasitic infestations. There are the only cells$ %hite blood cells that are prone to parasitic infections. Si'ns and sy(pto(s$ - don&t think you need to really %orry about that$ but of course these are in cases of asth(a$ vascular disease$ skin rash$ a'ain (ana'e(ent deter(ined the underlyin' cause$ don&t bother about this too (uch. Corticosteroids is a type of dru' that decreases the blood eosinophil nu(bers by interferin' %ith their release fro( the bone (arro% to the blood strea(. Slide 2> Leukocytosis 2 Donocytosis Dr. Despina Sitara Donocytosis$ that&s elevation in the (onocyte count. The (onocytes are fro( the bone (arro%$ and they play$ as - (entioned before$ a role in nor(al i((unity. Causes for (onocytosis usually infla((ation so(e sort of infla((atory condition$ an infection. So(eti(es cancer and connective tissue disorders. Slide .: Leukocytosis 2 Ly(phocytosis Dr. Despina Sitara Ly(phocytosis$ there&s an increase in ly(phocyte count above nor(al. )sually result fro( increased (obili3ation fro( the tissues to the blood$ or there is an increased production of ly(phocytes. Causes can be various types of infections$ viral$ bacterial$ or aller'ic dru' reaction. So(eti(es it can be due to reaction to physical stress$ or so(e types of cancer. Slide .1 -nfectious (ononucleosis Dr. Despina Sitara *o% this is a disease that you should pay attention to. -nfectious (ononucleosis$ this is a for( of ly(phocytosis. -t is also kno%n as (ono or 'landular fever$ or the kissin' disease because it spreads throu'h saliva. -t can also be spread by snee3in' and cou'hin'. -t is induced by a virus called ?pstein arr virus. #$ease remember this. This is a type of herpes virus$ it infects epithelial cell and cells. *o% it is interestin' because >1C of population of all of us$ %e are e8posed by the a'e of 0: to this virus$ but (ost of us are asy(pto(atic. /o%ever$ the virus lin'ers in inactive for( in the %hite blood cells until it 'ets reactivated and then that %ould lead to infectious (ononucleosis. +bout - %ould say (aybe .:20:C of individuals in their lifeti(e %ill develop (ononucleosis. Slide .2 -nfectious (ononucleosis Dr. Despina Sitara There is an increase in the ly(phocyte nu(ber$ it&s a type of ly(phocytosis$ and there are also chan'es in the ly(phocyte (orpholo'y. The ly(phocytes are very lar'e$ the patients don&t have the s(all type of ly(phocytes. The ly(phocytes are lar'e. They have pri(itive nuclei %ith defused chro(atin pattern and nucleoli. So(eti(es the nucleus is$ has lobes$ and the cytoplas( is lar'e. So in the blood s(ear these are identified as atypical ly(phocytes. The dia'nosis is throu'h co(plete blood count %here the ly(phocyte nu(bers are really hi'h. The blood s(ear %ill sho% atypical ly(phocytes. +nd in the case of suspected (ononucleosis$ a Donospot screenin' test has to be carried out$ %hich %ill detect the antibody for(ed after the

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infection and also the pri(ary care physician or %hoever does the test has to test for the ?pstein arr virus antibody. Slide .. -nfectious (ononucleosis Dr. Despina Sitara The clinical features last bet%een 024 %eeks so it&s not so(ethin' that 'oes a%ay in a fe% days. The individual is very sick$ fever fati'ue$ sore throat$ s%ollen painful ly(ph nodes$ and he(atoslpleno(e'aly and skin rash. Why it is a difficult disorder is because it has co(plications. Dany individuals develop ;aundice$ and hepatitis and even ruptured spleen. There is no specific treat(ent$ they don&t 'ive any dru's$ the individual has to rest and for the sore throat so(e 'ar'le %ith salt %ater. Slide .0 *eoplastic W C disorders Dr. Despina Sitara The last part of the %hite blood cell disorders are the neoplastic$ these are the (ali'nant %hite blood cell disorders. Slide .1 *eoplastic W C disorders Dr. Despina Sitara The (ost co((on are the leuke(ias %hich are divided into acute leuke(ias and chronic leuke(ia. ?ach one of these types dependin' on %hich blood cells is infected they are divided into acute ly(phocytic ly(phoblastic leuke(ia$ or acute (yeloid @ (yelo'enous leuke(ia. The sa(e %ith chronic leuke(ia they can be divided into Chronic ly(phocytic leuke(ia$ or chronic (yeloid @ (yelo'enous leuke(ia. +nother type of (ali'nant %hite blood cell disorders are the ly(pho(as$ (ost co((on ones are the non2/od'kin&s ly(pho(a$ or /od'kin&s ly(pho(a @ /od'kin&s disease. +nd another type of (ali'nant %hite blood cell disorders are the plas(a cell disorders %hich include the (ultiple (yelo(a. Slide .4 Leuke(ias Dr. Despina Sitara Leuke(ias are (ali'nant disorders of the blood$ they are characteri3ed by uncontrolled proliferation of he(atopoietic cells in the bone (arro%. +cute leuke(ias have the characteristic of uncontrolled proliferation of i((ature blood cells$ these are called blasts. )sually the acute phase is rapid$ usually fatal$ and the individual survives less than 4 (onths$ because their bone (arro% function is i(paired. The chronic leuke(ias have uncontrolled of proliferation of (ature$ %ell differentiated blood cells. This is a lon' ter( disease$ the survival is lon'$ and the person doesn&t have obvious sy(pto(s$ (ostly it&s discovered accidentally throu'h a routine e8a(. Slide .6 Leuke(ias Dr. Despina Sitara The lab findin's the C C %ould sho% ane(ia and thro(bocytopenia$ but the (ost i(portant thin' to re(e(ber is the blood s(ear$ dependin' on %hether it is an acute or chronic for( of leuke(ia$ the blood s(ear %ill sho% an increase in i((ature ly(phoid or (yeloid cells$ the blasts in the case of acute leuke(ia= or increase of (ature ly(phoid or (yeloid cells in the case of chronic leuke(ias. What - %ant you to re(e(ber here of course because it&s a leuke(ia %ill be ly(phadenopathy$ hepatospleno(e'aly$ but there %ill also be bone and ;oint pain due to

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(arro% e8pansion because the (arro% %ill be producin' so (any cells it %ill e8pand$ that %ill push it to%ards the ends of bones and that %ill cause the bone and ;oint pain. There is so(e 'in'ival bleedin' and so(e other parts of the body like the brain or the posterior palate bleedin'. The cause so(eti(es is unkno%n so(eti(es is 'enetic or e8posure to radiation or cytoto8ic dru's. Fro'nosis it depends on the type of leuke(ia$ could be lon' in chronic leuke(ia could be lon' survival$ but in case of acute leuke(ia could be short$ and because of infection or bleedin'. Treat(ent for leuke(ias are radiation che(otherapy bone (arro% transplantation in so(e cases. Slide .9 +cute Ly(phocytic@Ly(phoblastic Leuke(ia !+LL" Dr. Despina Sitara S# acute ly(phocytic ly(phoblastic leuke(ia$ +LL$ the proliferatin' cell is a pri(itive ly(phoid cell$ a ly(phoblast$ that (akes sense (ore %hen %e talk about bone (arro% blood cell develop(ent. This is the (ost co((on for( of leuke(ia in children under the a'e of 11$ and the principal cause of cancer deaths in children$ %ith the bi' incidence a'e at 0. -t&s treatable and potentially curable$ and half the children bet%een the a'es of 221: are cured. /o%ever there is poor pro'nosis in the adults$ and here is a s(ear %here it sho%s all these cells$ these are ly(phoblasts$ and +LL is classified accordin' to ly(phocytes and state of (aturation. -t can be sta'e 1$2$.$0 or 1$ dependin' on %hether the increased proliferation is in the early cell$ pre2 $ (ature $ early T$ or (ature T cell. Slide .> +cute Dyeloid @ Dyelo'enous Leuke(ia !+DL" Dr. Despina Sitara +cute (yeloid leuke(ia$ +DL$ the proliferatin' cell is the pri(itive (yeloid cell$ is the (yeloid cells$ it occurs at all a'es fro( neonatal to adult. The incidence increases %ith a'e$ but it&s the (ost co((on acute leuke(ia in adults. -t accounts for only 2:C of acute leuke(ia in children$ and here is a thin' that you need to re(e(ber$ is in blood s(ear the cytoplas( contains inclusion called +uer rods. This little line here$ this is %hat an +uer rod is$ this is a dia'nostic for +DL. So once this is seen$ this is indicative of this type of leuke(ia. Slide 0: Chronic Ly(phocytic Leuke(ia !CLL" Dr. Despina Sitara Chronic ly(phocytic leuke(ia$ the proliferatin' cells are (ature$ but inco(petent ly(phocytes. They don&t (ake antibody to response to forei'n anti'ens. +nd the proliferatin' ly(phocytes are usually >1C ly(phocytes. -t accounts for about 2@. of the chronic leuke(ias$ it&s (ost co((on in patients in individuals over the a'e of 4:. The (ale to fe(ale ratio are 2 to 1$ (ore (ales are affected than fe(ales. The early sta'es are asy(pto(atic$ but then the later sta'es sho% sy(pto(s like ly(phadenopathy$ hepatospleno(e'aly$ so(e %ei'ht loss$ etc. The C C count of course its leukocytosis$ because there are (ore %hite blood cells there $and the blood s(ear sho%s increased s(all ly(phocytes$ these are all s(all ly(phocytes. The treat(ent is che(otherapy and bone (arro% transplantation. The survival usually is bet%een 024 years. Slide 01 Chronic (yeloid @ (yelo'enous Leuke(ia !CDL" Dr. Despina Sitara Chronic Dyeloid Leuke(ia$ the proliferatin' cell in this case is a ste( cell. This is an i((ature he(atopoietic cell that 'ives rise to all the other types of

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he(atopoietic$ of blood cells. The CDL results in (yeloid (arro% hyperplasia. This type of leuke(ia accounts for only 1@. of chronic leuke(ias. +nd youn' adults bet%een the a'e of 1:22: and (iddle a'e 1:24: years. #ne thin' to re(e(ber$ this is a 'eneric disorder$ its due to Fhiladelphia chro(oso(e (utation$ %hich is a translocation bet%een chro(oso(e > and 22. Slide 02 Chronic (yeloid @ (yelo'enous Leuke(ia !CDL" Dr. Despina Sitara +lso$ it&s the only leuke(ia that has t%o phases. There is a chronic phase that lasts so(e%here bet%een .21 years$ and the individual has no sy(pto(s$ and then unfortunately beco(es acute. So$ that lasts about 220 (onths$ and there is an increase in blasts$ in early i((ature cells$ in the blood and bone (arro%. The individual in this sta'e is called that he has Gblast crisisH. There is no response to treat(ent$ and there is ane(ia$ there is spleno(e'aly and various infections. The treat(ent is bone (arro% transplantation$ and can only be effective durin' the chronic phase. Durin' the acute phase it %ill have no response. Slide 0. Ly(pho(as Dr. Despina Sitara Ly(pho(as are solid tu(ors that arise in ly(phoid tissues$ but then they can spreads in other solid tissues in blood and the bone (arro% also. -t&s the third (ost co((on (ali'nancy in children. There are t%o types of ly(pho(as$ non2 /od'kin&s ly(pho(a$ and /od'kin&s ly(pho(a or else called /od'kin&s disease. Slide 00 /od'kin&s Ly(pho(a @ Disease Dr. Despina Sitara /ere is an individual %ith /od'kin&s ly(pho(a. There are t%o types there is the classic and the nodular. >1C of the individuals affected %ith ly(pho(as have the classic for(. The dia'nostic for this is the presence of ,eed Sternber' cells. This is indication for ly(pho(a. They are rare cells. The cause is unkno%n$ so(eti(es is 'enetic so(eti(es is environ(ental such as for a(ple ?pstein ar virus %hich is the virus for (ononucleosis$ and the clinical feature is like you see in this picture here$ is enlar'e(ent of the ly(ph nodes$ usually in the neck . Treat(ent is che(otherapy and radiation. Slide 01 *on2/od'kin&s Ly(pho(a Dr. Despina Sitara *on2/od'kin&s ly(pho(a is the other type of ly(pho(a$ is associated %ith chronic infla((atory diseases for e8a(ple rheu(atoid arthritis$ it often develops after or'an transplantation because the patient is i((une2suppressed. The causes e8actly are unkno%n but also can be 'enetic chro(oso(al translocations$ can be a cause for non2/od'kin&s ly(pho(a$ can be also viral$ ?pstein arr virus and /-I can cause non2/od'kin&s ly(pho(a. )sually they are cell ly(pho(a$ so it&s the cell that causes it$ and very rarely it&s a T cell ly(pho(a. There is ly(phadenopathy$ their ly(ph nodes are s%ollen$ and hepatospleno(e'aly$ the liver and the spleen are enlar'ed. The treat(ent of the early sta'e is radiation$ and the late sta'e is a co(bination of radiation and che(otherapy$ and so(eti(es later (aybe bone (arro% transplantation is carried out. Slide 04 Dultiple (yelo(a

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Dr. Despina Sitara +nd last disease is (ultiple (yelo(a$ %hich is the third (ost co((on he(atolo'ic (ali'nancy after leuke(ia and ly(pho(a. Dore (ales are affected than fe(ales. The patients are usually bet%een 1:24: years old. There is bone pain because of the e8pansion of the (arro%$ hypercalce(ia and renal disease. -t starts in the bone (arro% by the presence of lar'e nu(bers of plas(a cells$ and these plas(a cells accu(ulate in the bone (arro%$ they e8ert pressure on the %alls and that causes the bone fractures and the bone pain. Slide 06 Dultiple (yelo(a Dr. Despina Sitara The plas(a cells produce a specific type of abnor(al proteins$ these are the ence2Jones. #nce the ence2Jones are found in the urine$ this is dia'nostic. S# if there is a Euestion %hat kind of proteins are found in (ultiple (yelo(a$ the ans%er is ence Jones proteins. The sy(pto(s are fati'ue$ %eakness$ all the usual sy(pto(s of the (ali'nant disorders. +nd the treat(ent is local radiation on the bones$ and che(otherapy to reduce the pro'ression of the disease.

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