Normal WBC numbers: 5,000-10,000 total. Panic: under 500 or over 30,000. Lymphoid tissue is found in discrete, organized masses in LN's, thymus, spleen, tonsils, adenoids, Peyer patches. Other areas with smaller amounts: bone marrow, lungs, GI, other. LN's are easily accessible for examination. Things that elevate WBC's: -leukemic neoplasia -other malignancy -trauma, stress, hemorrhage -tissue necrosis -inflam -dehydration -thyroid storm -steroid drugs -splenectomy Causes of decreased WBC count: -drug toxicity (benzene, carbon tetrachloride--that smell from new shower curtains?) -bone marrow failure -severe infx -poor nutrition -marrow aplasia -autoimmune dz -hypersplenism -chemotherapy NORMALS NEUT 55-70% 2,500-8,000 absolute LYMPH 20-40% 1,000-4,000 MONO 2-8% 100-700 EOS 1-4% 50-500 BASOS 0-2% 25-100 (never let monkeys eat bananas: to remember cell types in order of occurrence) LEUKEMOID RXN = WBCs > 50,000 OR > 5% metamyelocytes SIX STAGES OF WBC MATURATION myeloblast --> promyelocyte --> myelocyte --> meta --> band --> seg --> hyperseg --NORMAL is seg in PB (50-70) --more bands is shift to left, usudt infx --more hypers is shift to right, usudt B12 or folate deficiency --myeloblast = blast = nongranular cytoplasm, red, round nucleus w/ nucleoli --promyelocyte = has granules --myelocyte = has large nucleus that takes up most of cell, granule color shows what kind of cell it will be (red->eo, clear->neut, blue->baso) --meta = has dented nucleus (0-1 in PB OK, over 5% = leukemoid rxn) --band = dent more than 1/2 diameter of nucleus (0-5 OK) --SEG = 3+ segments to nucleus, (50-70 in PB normal) --hyperseg (should be none in PB) --mostly we're talking about neutrophils here, because that's what you see most of! INCREASES NEUTROPHILS --infx --trauma --stress --inflam --metabolic dz --myelocytic leukemia --Cushings (increased cortisol) DECREASES NEUTROPHILS --overwhelming infx --VIRAL infx --aplastic anemia --radiation --Addisons (decreased cortisol) --chemo --poor nutrition LYMPHOCYTES = B cells, T cells, NK cells NORMALS T cell 60-85%, 800-2500 cells/mm3 T helper (CD4) 60-75%, 600-1500 T suppressor (CD8) 25-30%, 300-1000 B cell 4-25%, 100-450 NK cell 4-30%, 75-100 CD4/CD8 ratio: normally over 1, under 1 in AIDS INCREASES LYMPHS --some bact infx incl pertussis, TB --VIRAL INFX: CMV, HIV --lymphocytic anemia --mono/EBV --infectious hepatitis --Addison's DECREASES LYMPHS --non-lymphocytic leukemia --Hodgkin's dz --sepsis --immunodeficiency --SLE --drug therapy incl chemo, adrenocorticosteroids, radiation therapy MONOCYTES = blue/gray w/ ground glass cytoplasm INCREASES MONOS --some viral infx incl mono --chronic bact infx --TB --SBE = subacute bacterial endocarditis --syphillis --chronic ulcerative colitis --parasites: malaria --monocytic leukemia DECREASES MONOS --prednisone --HIV --hairy cell leukemia --aplastic anemia INCREASES EOSINOPHILS --parasitic infx --allergy, asthma, hay fever --Hodgkin's Dz --EOS myalgia --eczema --leukemia --autoimm. --ovarian cancer DECREASES EOS --Cushing's, stress, shock, increased cortisol --burns --overwhelming infx --corticosteroids FOUR PROTEINS THAT EOS HAVE TO KILL PARASITES: --peroxidase --EOS cationic prot --EOS derived neurotoxin --MBP (myeline basic prot??) BASOPHILS = mast cells in tissue, have granules containing heparin, histamine and serotonin INCREASES BASOS --polycythemia --granulocytic leukemia --chronic myelocytic leukemia (CML) --Hodgkin's lymphoma DECREASES BASOS --acute phase of infx --hyperthyroid --stress rxn --prolonged steroid therapy