Here, we’ll take a look at
We’ll take a look at the spectrums
of quantitative WBC pathology.
Meaning to say, you could
have too much or too little.
Let’s first take a look at
a hierarchy of your WBCs.
Your total WBC count should
be between 4,500 to 11,000.
Your segmented neutrophil should be at
the highest at being approximately 56%.
come in second at 34%.
Monocytes at 4%.
Bands, let me pause
here for a second.
Understand that normally speaking,
you should have a little bit
of primitive neutrophil
in your circulation,
it being bands.
This is a normal WBC count,
Eosinophils at 3%, and
down in the basement,
your basophils will
be a measly 0.3%.
Now, what you want to keep in
mind is that for any reason,
if you find your WBC count to be elevated,
well, what exactly is causing
the WBC count to be increased?
Is it due to,
Maybe neutrophils are causing
the increase in WBC.
Is your patient suffering
That WBC count will be increased there
due to increase in eosinophils.
Please be able to properly walk through
the different causes of WBC count.
Our topic will go through leukocytosis,
neutrophilic leukocytosis, lymphocytosis.
Our focus mainly will be on neutrophilic
leukocytosis because of the
that we shall come to.
Now, remember when you say leukocytosis,
you’re talking about all
WBCs that are increased.
This may include neutrophilic,
may include lymphocyte,
or perhaps, monocytes.
On the other hand, meaning to say the
spectrum of quantitative disorders,
here, we’ll find a
decrease in WBC count.
This is then referred
as being leukopenia.
Now, if there is a drop in neutropenia,
what may then have caused this?
We’ll take a look.
Or maybe there is lymphopenia
as maybe seen with HIV.
Under quantitative disorders, let’s say
that there was a patient who had type 1.
HSR stands for hypersensitivity reaction,
or maybe invasive helminthic infection
such as ascaris lumbricoides.
Well, let’s say that the
patient, in fact, had
a type 1 type of allergy
or anaphylactic shock
in which there were isotypes switching with
the IgE then landing upon a mast cell.
This mast cell is then going to
release quite a bit of histamine.
In addition to that,
you have involvement of eosinophils with
allergies, a type 1 hypersensitivity.
Or you can have an invasive
helminth in which, let’s say, that
you have a patient that has
secondary to ascaris
At some point in time, you might have
in helminth that then passes through
your pulmonic system
or respiratory system.
When this occurs, you
should know as well
that the granules within eosinophil,
if you remember correctly,
contain major basic protein.
Major basic protein is the particular
“enzyme” within the granule of an eosinophil,
which we’re seeing
here in the picture.
Take a look at it, please.
It is rather pinkish,
and this is then going to release major
basic protein to combat the helminth.
If you have myeloproliferative disorders,
I want you to take a look at
the color here of this cell,
and I’d like for you to compare the color
of this cell to the one on the left.
Both of these are granulocytes.
However, totally different responsibility.
On your right, let’s say that one
of your myeloproliferative disorder
had the translocation
of 9 and 22.
And you should know the
chronic myelogenous leukemia,
which is the topic we’d
take up in a little bit,
may result in increased
number of all myeloid cells.
And we say myeloid cells, you
should be referring to all cells
except your lymphocytes, T-cells,
B-cells, and natural killer cells.
My point is this, if you find basophilia
taking place in your patient,
maybe perhaps, high
on your differential,
it should be myeloproliferative disorder
such as chronic myelogenous leukemia.
Let’s say that your patient is
suffering from a viral infection,
or maybe your patient has
a whooping cough type of issue.
Obviously, I’m referring to pertussis.
Now, what’s interesting is the fact that
viral, you should quite be familiar with,
meaning to say that you have a
lymphocyte, as you see here,
and the lymphocyte with the nucleus being
approximate in size of this rounding RBCs,
well, you would bring up a lymphocyte
type of reaction, lymphocytosis.
But why is the bacteria here
known as bordetella pertussis?
Because bordetella pertussis inhibits the
entry of lymphocyte into a lymph node,
therefore, you would expect to
see absolute lymphocytosis.
What if you found monocytosis?
Well, in this case, you’re talking
about chronic inflammation.
In chronic inflammation,
remember, beyond the third day,
the neutrophils will undergo apoptosis,
and this will then be
replaced by your monocytes.
And then coming into a tissue, you
would then call these macrophages.
On this spectrum or on this end of the
spectrum of quantitative disorders,
this is an increase and increase and
increase of different types of WBCs.
Overall, giving the WBC an increased count,
but then depending as to
which particular WBC,
either a granulocyte or
agranulocyte or even a lymphocyte
is then giving you a
picture of leukocytosis.