Overview Blood leukocyte Normal value of cell type

Overview § Blood leukocyte § Normal value of cell type § Neutrophil § § Granulocytogenesis, Maturation, circulation Neutropenia Neutrophilia Abnormal neutrophil function § Monocyte § Monocytogenesis, Mononuclear phagocyte system § Monocytosis § Eosinophilia § Eosinopenia

Blood leukocyte Cell type Neutrophil Band Proportion (%) 45 -74% Mean (cells/μL) 3650 95% CI 1830 -7250 0 -4% Lymphocyte 16 -45% 2500 1500 -4000 Monocyte 4 -10% 430 200 -950 Eosinophil 0 -7% 150 0 -700 Basophil 0 -2% 30 0 -150

Pelger-Hüet anomaly N Band E L

Cytokine regulation of granulocytic progenitor Key factor: GM-CSF G-CSF

Transciptional regulation of hematopoiesis

Neutrophil

Production in only BM § Distrubution § 90% in BM § 2 -3% in PB § Remainder in tissue § Removal § Macrophage in lung and spleen

Maturation § Granules § Primary (azurophil) § Secondary (specific) § Toxic (Döhle bodies) § Segmentation § Excessive ≥ 5 § Bilobed § Pelger-Hüet anomaly

Maturation phase

Marrow release and circulating compartments 6 -10 days 6 -7 hours 1 -4 days

Marrow release and circulating compartments selectin intergrin Marginated pool

Neutropenia

Causes of Neutropenia

Neutropenia § Severity § § <200: no inflammation, normal flora 감염흔함 <500/microliter: severe 500 -1000/microliter: moderate 1000 -2000/microliter: mild § Ex § Iatrogenic, anticancer drug, hapten § 5 -7일에 호전, 10일에 완쾌 § Never try diagnositc invasive challenge § Lab § CBC, DC, BM exam § Tx § § § Aggressive culture, broad spectrum antibiotics, I & D Care oral hygiene G-CSF Prophylactic antibiotics: septrim for PCP, antifungal Granulocyte trunsfusion

Neutrophilia Vigorous exercise, Excitement, Stress

Causes of Neutrophilia

Abnormal Neutrophil Function

Abnormal neutrophilic function § Inflammation is often depressed § Recurrent and severe bacterial and fungal infections § Aphthous ulcers, upper and lower resp tract infection, bone infection § Sepsis, meningitis: rare

Mononuclear phagocytes

Mononuclear phagocyte system

Big eaters, macrophage § Macrophages- bone marrow, lymph nodes (e. g. tingible body macrophages in the germinal centers), spleen, cerebrospinal fluid, serosal cavities (pleural and peritoneal) § Kupffer cells- hepatic littoral cell § Microglia cells- brain § Alveolar and interstitial macrophages- lung § Osteoclasts- bone marrow § Langerhan's cells- epidermis § Epithelioid cells and giant cells- granulomas

Monocytosis § Chronic inflammation § § § § Tb, brucellosis Subacute bacterial endocarditis Malaria RMSF, Kala azar Sarcoidosis Collagen vascular disease Regional enteritis, Crohn’s disease § Malignancy, leukemia, MPN

Monocytopenia § Stress § Glucocorticoid § Acute infection § Aplstic anemia § AML, HCL § Chemotherapy

Eosinophil

Eosinopenia § Stress § Glucocorticoid § Acute infection