Page 132 - Essential Haematology

118 / Chapter 8 White cells: Granulocytes and monocytes

9
Leucoerythroblastic r eaction Middle East where 1.5 × 10 /L is normal (see
below). When the absolute neutrophil level falls
This is characterized by the presence of erythroblast below 0.5 × 10 /L the patient is likely to have

9
and granulocyte precursors in the blood (Fig 8.9 ). recurrent infections and when the count falls to less
It is caused by metastatic infi ltration of the marrow than 0.2 × 10 /L the risks are very serious, particu-
9
or certain benign or neoplastic blood disorders larly if there is also a functional defect. Neutropenia
(Table 8.3 ).
may be selective or part of a general pancytopenia
(Table 8.4 ).
Neutropenia

The lower limit of the normal neutrophil count is Table 8.4 Causes of neutropenia.

9
2.5 × 10 /L except in black people and in the
Selective neutropenia
Congenital
Kostmann ’ s syndrome
Acquired
Drug - induced
Anti - infl ammatory drugs (phenylbutazone)
Antibacterial drugs (chloramphenicol, co -
trimoxazole, sulfasalazine, imipenem)
Anticonvulsants (phenytoin, carbamazepine)
Antithyroids (carbimazole)
Hypoglycaemics (tolbutamide)
Phenothiazines (chlorpromazine, thioridazine)
Psychotropics and antidepressants (clozapine,
mianserin, imipramine)
Miscellaneous (gold, penicillamine, mepacrine,
frusemide, deferiprone)

Figure 8.9 Leucoerythroblastic blood fi lm. This shows Benign (racial or familial)

an erythroblast, promyelocyte, myelocyte and
Cyclical
metamyelocytes in a patient with metastatic breast
carcinoma in the bone marrow. (Courtesy of Dr J.E. Immune
Pettit.) Autoimmune
Systemic lupus erythematosus
Felty ’ s syndrome
Table 8.3 Causes of leucoerythroblastic Hypersensitivity and anaphylaxis

blood fi lm
Large granular lymphocytic leukaemia
Metastatic neoplasm in the marrow (see p. 242)
Primary myelofi brosis Infections
Viral (e.g. hepatitis, infl uenza, HIV)
Acute and chronic myeloid leukaemia Fulminant bacterial infection (e.g. typhoid, miliary
Myeloma, lymphoma tuberculosis)

Miliary tuberculosis Part of general pancytopenia (see Table 22.1 )
Bone marrow failure
Severe megaloblastic anaemia
Splenomegaly
Severe haemolysis
HIV, human immunodefi ciency virus.
Osteopetrosis