benign leukocytoses

Benign LeukocytosesKristine Krafts, M.D.

• Neutrophilia

• Lymphocytosis

• Basophilia

• Monocytosis

• Eosinophilia

Benign Leukocytoses

• Neutrophils fight infection, participate in inflammatory responses

• Bone marrow• Most neutrophils live here• All stages of maturation

• Blood• Only 5% of all neutrophils are here• Normally only segmented neutrophils• Half are marginated

Neutrophilia

• Mature (lots of segmented neutrophils)

• Immature (lots of immature neutrophils)

Types of Neutrophilia

Mature neutrophilia

• Bacterial infection

• Inflammation

• Physiologic things• Stress• Hormones

Causes of Mature Neutrophilia

• Toxic granulation

• Döhle bodies

• cytoplasmic vacuolization

Clues to Bacterial Infection

Sometimes, bacterial infections produce “toxic” changes in neutrophils!

Normal neutrophil(top left)

Neutrophil with toxic granulation

Promyelocyte

Döhle bodies

Cytoplasmic vacuolization

Immature neutrophilia

• Bacterial infection

• Inflammation

• Severe anemia

• Something filling up the marrow

Causes of Immature Neutrophilia

• Left shift

Two Forms of Immature Neutrophilia

blast promyelocyte myelocyte band segmented neutrophilmetamyelocyte

Left shift

• Left shift

• Leukoerythroblastotic reaction

Two Forms of Immature Neutrophilia

Leukoerythroblastotic reaction

• Left shift

• Leukoerythroblastotic reaction• Sometimes due to severe anemia• Sometimes due to something

filling up the bone marrow

Two Forms of Immature Neutrophilia

• Lymphocytes fight infection, participate in immunologic responses

• Normal lymphocyte count• Varies a lot with age!• Bigger normal range in infants

• Normal immunophenotype in blood• T cells: 80%• B cells: 15%• NK cells: 5%

Lymphocytosis

• Mature (lots of mature lymphocytes)

• Reactive (lots of funny-looking lymphocytes)

Types of Lymphocytosis

Mature lymphocytosis

• Infectious lymphocytosis

• Bordetella pertussis

• Transient stress

Causes of Mature Lymphocytosis

Reactive lymphocytosis

Downey cells

IIIIII

• Infectious mononucleosis

• Pediatric viral infections

• Viral hepatitis

• Immune disorders

Causes of Reactive Lymphocytosis

• Basophilia• CML• CML• CML

Other Benign Leukocytoses

•Basophilia

• Basophilia

• Eosinophilia• Drugs• Asthma• Skin diseases• Parasites

Other Benign Leukocytoses

•Eosinophilia

• Basophilia

• Eosinophilia

• Monocytosis• Infection• Autoimmune disease• Malignancy

Other Benign Leukocytoses

•Monocytosis