Qualitative changes of the white cell take place either in the cytoplasm or the nucleus. These changes are classified as either inherited or acquired. Acquired defects are seen with much greater frequency than inherited abnormalities. Once a patient has developed an increased white count, toxic changes of the white cells usually occur due to stress during maturation and as a result of activity in the circulation or tissue. A
146 Part III • White Cell Disorders
Table 10.1 O White Cell Terminology
• Neutrophilia Increase in segmented neutrophils
• Leukocytosis Increase in white cells
• Left shift Increase in bands and metamyelocytes in the peripheral smear; seen in response to infection
• Leukemoid reaction Exaggerated response to infection; resulting in high white count and increased numbers of metamyelocytes, bands, and possibly younger cells
• Leukoerythroblastic picture Immature white cells, immature red cells, and platelet abnormalities seen in the peripheral smear careful and patient review of the peripheral smear of these individuals will reveal many of the changes discussed (Fig. 10.2).
The visible response of white cells to infection or inflammation occurs along two paths. As white cells increase, what is usually seen in the peripheral smear is either an increase in the number of segmented neu-trophils giving rise to a neutrophilia or a shift to the left, where younger cells are noted. In either of these cases, toxic changes such as toxic granulation, toxic vacuolization, or the presence of Dohle bodies may be observed and should be carefully sought.
Myeloid precursor in bone marrow W stimulated by cytokine
Enhanced enzyme production and packaging resulting in large granules
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