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Benign LeukocytosesKristine Krafts, M.D.

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• Neutrophilia

• Lymphocytosis

• Basophilia

• Monocytosis

• Eosinophilia

Benign Leukocytoses

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• 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

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• Mature (lots of segmented neutrophils)

• Immature (lots of immature neutrophils)

Types of Neutrophilia

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Mature neutrophilia

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Immature neutrophilia

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• Infection (bacterial)

• Inflammation

• Physiologic things• Stress• Hormones

Causes of Mature Neutrophilia

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• Seen only in infection!

• Toxic granulation, Döhle bodies, cytoplasmic vacuolization

• Scariest: cytoplasmic vacuolization

Toxic Changes

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Normal neutrophil(top left)

Neutrophil with toxic granulation

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Promyelocyte

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Döhle bodies

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Cytoplasmic vacuolization

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• Infection (bacterial)

• Inflammation

• Severe anemia

• Something filling up the marrow

Causes of Immature Neutrophilia

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• Left shift

Three Forms of Immature Neutrophilia

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blast promyelocyte myelocyte band segmented neutrophilmetamyelocyte

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Left shift

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• Left shift

• Leukemoid reaction

Three Forms of Immature Neutrophilia

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• Left shift

• Leukemoid reaction

• Leukoerythroblastotic reaction

Three Forms of Immature Neutrophilia

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Leukoerythroblastotic reaction

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• Left shift

• Leukemoid reaction

• Leukoerythroblastotic reaction• Due to something malignant• Due to something benign

Three Forms of Immature Neutrophilia

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• 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

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• Mature (lots of mature lymphocytes)

• Reactive (lots of funny-looking lymphocytes)

Types of Lymphocytosis

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Mature lymphocytosis

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Reactive lymphocytosis

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• Infectious lymphocytosis

• Bordetella pertussis

• Transient stress

Causes of Mature Lymphocytosis

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• Infectious mononucleosis

• Pediatric viral infections

• Viral hepatitis

• Immune disorders

Causes of Reactive Lymphocytosis

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Downey cells

IIIIII

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• Basophilia• CML• CML• CML

Other Benign Leukocytoses

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•Basophilia

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• Basophilia

• Eosinophilia• Drugs• Asthma• Skin diseases• Parasites

Other Benign Leukocytoses

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•Eosinophilia

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• Basophilia

• Eosinophilia

• Monocytosis• Infection• Autoimmune disease• Malignancy

Other Benign Leukocytoses

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•Monocytosis

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