Systemic Causes of Haematological Changes #1

White Cell Changes

Neutrophilia
> 7.5
- Bacterial infection - localised (eg abscess), disseminated (eg septicaemia)
- Inflammation/necrosis - eg MI, vasculitis
- Malignant disease
- Myeloprofilerative disease - eg CML
- Metabolic disease eg uraemia, gout
- Corticosteroid Tx

Leukaemoid reaction
WBC > 50 nt fr leukaemia
Lymphocytes/Neutrophils +/- immature forms
- Severe infections - bacterial eg pneumonia
- Viral - eg infectious mononucleosis
- Severe haemorrhage/haemolysis
- Malignant disease
- Intoxications - eg burns, eclampsia

Ix
BM aspirate/trephine Bp
BM cytogenetics
BM film - Np Granulocytes/Myelocytes
(NB identical to CML, therefore test for Philadelphia chromosone)

Leukoerythroblastic change
Blood shows - nucleated RBCs & primitive WBCs
- Marrow invasion - eg metastatic tumour, Hm malignancy (eg myeloma/lymphoma), fibrosis
- Severe illness - eg trauma, septicaemia, massive haemolysis

Ix
BM trephine biopsy

Neutropenia
< 2
Isolated/pancytopenia

Isolated
- Drugs eg phenylbutazone, co-trimoxazole, carbimazole, anti-psychotics
- Racial
- Congenital eg Kostmann's syndrome, cyclic
- Infections eg hepatitis, typhoid, TB, malaria
- AI eg Felty's, SLE, idiopath

Pancytopenia
- MF - any cause (aplastic anaemia, megaloblastic anaemia, irradiation, malignant infiltration)
- Hypersplenism

Eosinophilia
> 0.5
- Allergies eg asthma, drugs, hayfever
- Parasites eg ankylostoma, ascaris, filaria
- Skin eg eczema, psoriasis, dermatitis herpetiformis
- Malignancy eg Hodgkin's disease
- Inflammatory disease eg sarcoidosis, PAN
- Hypereosinophilic syndrome
- Eosinophilic leukaemia

Hx - for travel, Dx, allerg
Ex - skin, lungs, joints
Ix - as above, stool examination (parasites), RhF, CXR

Lymphocytosis
> 3.5
- Acute infection - *viral eg rubella, mumps, infectious mononucleosis
- Chronic infection - TB, brucellosis, hepatitis
- Thyrotoxicosis
- CLL
- Other Leuks & Lymphomas

Hx - viral illness/night sweats/WL
Ex - throat, LNs, liver, spleen

Viral serology - EBV