LEUKOPENIA
✿ Neutropenia
✧ Impaired production
☼ familial (benign) neutropenia
☼ benign ethnic neutropenia
☼ chronic idiopathic neutropenia
☼ congenital neutropenias
☼ nutritrional deficiencies (folate, b12, copper)
☼ hematologic disorders (pnh, large granular lymphocyte leukemia
☼ immunodeficiencies (x-linked hyper-IgM, agammaglobulinemia, cvid, scid)
☼ immunosuppressants
✧ Autoimmune disorders
☼ autoimmune neutropenia
☼ systemic lupus erythematosus (sle)
☼ rheumatoid arthritis / felty
☼ sjogren syndrome
✧ Infection
☼ viral (ebv, cmv, hhv-6, hepatitis, hiv, measles, rubella, dengue fever, colorado tick fever)
☼ bacterial (bartonella, shigella, tularemia)
☼ rickettsial (ehrlichiosis, anaplasmosis)
✧ Drugs
☼ antithyroids (carbimazole, methimazole, ppu)
☼ psychotropics (phenothiazines, clopazine)
☼ cardiovascular (ticlopidine, procainamide)
☼ nsaids (indomethacin)
☼ antibiotics (penicillin, sulfonamide, dapsone)
☼ gi (sulfasalazine, h2 blockers)
☼ antimalarials (quinine)
☼ iron chelators (deferipone)
☼ cocaine, heroine (laced w/ levamisole)
✧ Redistribution (margination)
☼ primary splenic neutropenia
☼ hypersplenism
✧ Direct cell damage
☼ hemodialysis
✿ Lymphocytopenia
✧ Idiopathic cd4+ T lymphocytopenia
✧ Congenital immunodeficiencies
☼ scid
☼ common variable immune deficiency
☼ wiskott-aldrich syndrome
☼ ataxia-telangiectasia
☼ good syndrome
☼ hepatic venoocclusive disease with immunodeficiency
☼ cartilage hair hypoplasia syndrome
✧ Infection
☼ viral (hiv, sars, west nile encephalitis, hepatitis, influenza, herpesvirus, measles)
☼ bacterial (tb, typhoid, brucella)
☼ rickettsial (ehrlichiosis, anaplasmosis)
☼ parasitic (acute malaria)
☼ fungal (histoplasmosis)
✧ Immune-mediated processes
☼ systemic vasculitis
☼ connective tissue disorders (sle, ra, sjogren)
☼ granuloma (sarcoidosis, wegener)
☼ msk (myasthenia gravis, dermatomyositis)
☼ gi (celiac disease, severe acute pancreatitis)
☼ drug/toxin (stevens-johnson, silicosis)
✧ Nutritional deficiencies
☼ zinc deficiency
☼ alcohol abuse
✧ Drugs
☼ immunosuppressants
☼ chemotherapy
✧ Direct cell damage
☼ advanced cancer (lymphoma, carcinoma)
☼ radiotherapy
☼ hemodialysis
✧ Removal from the body
☼ thoracic duct leak or drainage
☼ stem cell or platelet apheresis
☼ protein-losing enteropathy
✧ Redistribution to tissues
☼ thermal injury
☼ s/p surgery
✿ Monocytopenia
✧ MonoMAC syndrome or Emberger syndrome
✧ Hematologic disorders
☼ pancytopenia/aplastic anemia
☼ hairy cell leukemia
☼ chronic lymphocytic leukemia
✧ Drugs
☼ glucocorticoids
☼ cytokines (tnf-α, ifn-α)
✧ Direct cell injury
☼ severe thermal injury
☼ radiotherapy
☼ hemodialysis
✿ Eosinopenia
✧ Acute bacterial or viral infection
✧ Glucocorticoids
✧ Eosinophil peroxidase deficiency
✿ Pancytopenia
✧ Marrow failure
☼ congenital (fanconi, dyskeratosis congenita)
☼ hematologic (wiskott aldrich syndrome, shwachman-diamond syndrome, amegakaryocytic thrombocytopenia, gata2 deficiency, pnh, hlh)
☼ autoimmune disorders (sle, ra)
☼ infection (parvovirus b19, ebv, cmv, hiv, hcv)
☼ drugs (chemo, sulfonamide, nsaids, antithyroids, anticonsulvants, gold, arsenic)
☼ toxin (benzene, organophosphate)
☼ radiation
☼ necrosis (sickle cell, sepsis, arsenic, mets)
✧ Marrow infiltration
☼ malignancy (leukemia, lymphoma, myeloma, macroglobulinemia, metastatic disease)
☼ granuloma (sarcoidosis, tb, fungus)
☼ fibrosis (myelofibrosis, hiv)
☼ lipid deposition (gaucher, niemann-pick)
☼ oxalosis
✧ Ineffective hematopoeisis
☼ myelodysplastic syndrome (mds)
☼ nutritional deficiencies (malnutrition, etoh abuse, folate, b12, copper deficiencies)
✧ Splenic sequestration (hypersplenism)
☼ malignancy (lymphoma, leukemia, mets)
☼ autoimmune (sarcoidosis, felty, sle)
☼ infection (mononucleosis, hepatitis, tb, brucella, malaria, kala-azar, histoplasmosis)
☼ storage (gaucher, niemann-pick)
☼ cirrhosis
☼ hemolysis
✧ Destruction
☼ microangiopathy (dic, ttp/hus, vasculitis)
LEUKOCYTOSIS
✿ Neutrophilia
✧ Increased production
☼ neutrophillic leukemia
☼ idiopathic neutrophillic leukocytosis
☼ chronic hereditary neutrophillia
☼ leukocytic adhesion deficiency
☼ myeloproliferative disorders (pv, et)
☼ metastatic cancer
☼ drugs (g-csf, gm-csf, retinoic acid)
✧ Increased release from marrow
☼ infection (bacterial, miliary tb)
☼ autoimmune (vasculitis, rheumatoid, kawasaki, ibd, gout, dermatitis, sweet syndrome)
☼ ischemia (mi, pe)
☼ cell injury (sickle cell crisis, chronic hemolysis, pancreatitis, burns, smoking)
☼ endocrine (thyroid storm, hypercortisolism)
☼ pregnancy (eclampsia, post partum)
☼ rebound from agranulocytosis s/p tx
☼ drugs (lithium, glucocorticoids)
✧ Redistribution (demargination)
☼ hyposplenism or asplenia
☼ acute physical or emotional stress
☼ catecholamines (epinephrine)
✿ Lymphocytosis
✧ Neoplasm
☼ leukemias (lymphocytic, prolymphocytic, lymphoblastic, hairy cell leukemia, adult t-cell leukemia, large granular lymphocyte)
☼ lymphocytosis (monoclonal b-cell, persistent polyclonal b-cell, natural killer cell)
☼ lymphoma (non-hodgkin, mantle cell, follicular, splenic marginal zone)
☼ thymoma
✧ Infection
☼ viral, bacteria, parasitic
✧ Inflammation
☼ drug hypersensitivity / dress
☼ malignancy
☼ chronic infection
☼ smoking
✧ Redistribution
☼ hyposplenism or asplenia
☼ acute physical stress
✿ Monocytosis
✧ Neoplasm
☼ monocytic leukemias
☼ myelomonocytic leukemias
☼ lymphoproliferative disorders (leukemias)
☼ solid tumors (colon ca mets, sarcoma)
✧ Hematologic disorders
☼ chronic idiopathic monocytosis
☼ neutropenia
☼ immune hemolytic anemia
☼ idiopathic thrombocytopenic purpura
☼ post agranulocytic recovery
☼ post splenectomy
☼ pseudolymphoma syndrome
✧ Infection
☼ chronic bacterial (tb, subacute endocarditis, resolution of infection, syphillis, brucellosis)
☼ viral (cmv, varicella-zoster, influenza)
✧ Inflammation
☼ connective tissue disorders (sle, ra)
☼ vasculitis (pan, gca, kawasaki)
☼ sarcoidosis
☼ gi (ibd, celiac, alcoholic liver)
☼ heart (mi, post cabg)
✧ Other
☼ wiskott-aldrich syndrome
☼ depression/ anxiety
☼ arathon running
☼ growth factors (gm-csf, g-csf, m-csf)
✿ Eosinophilia
✧ Neoplasm
☼ primary hypereosonophilic syndromes
☼ eosinophilic leukemia
☼ myeloproliferative disorders
☼ systemic mastocytosis
☼ lymphomas
☼ carcinomas
✧ Infection
☼ parasitic (helminths, scabies, protozoas)
☼ fungal (aspergillosis, coccidio, histoplasmo)
☼ viral (hiv, htlv)
✧ Allergy / Autoimmune / Inflammation
☼ drug hypersensitivity / dress
☼ connective tissue disorders (sle, ra)
☼ vasculitis (churg-strauss, wegener)
☼ skin (dermatomyositis, atopic dermatitis)
☼ upper respiratory (allergic rhinitis)
☼ lung (asthma, eosinophilic pneumonia)
☼ gi (eosinophilic esophagitis, gastroenteritis)
☼ heart (hypersensitivity myocarditis)
☼ renal (interstitial nephritis, cystitis)
☼ cns (eosinophilic meningitis)
✧ Other
☼ hyper-IgE syndrome
☼ transplant rejection
☼ adrenal insufficiency
☼ cholesterol embolization
☼ chemical reaction
☼ idiopathic hypereosinophilic syndrome
✿ Basophilia
✧ Neoplasm
☼ basophilic leukemia
☼ myeloproliferative diseases
☼ carcinomas
✧ Infection
☼ viral (influenza, chickenpox, smallpox)
☼ mycobacterial (tuberculosis)
✧ Inflammation
☼ igE-mediated hypersensitivity
☼ juvenile rheumatoid arthritis
☼ ulcerative colitis
✧ Endocrinopathy
☼ hypothyroidism
☼ diabetes mellitus
☼ estrogen therapy
✧ Other
☼ iron deficiency
☼ radiation
