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