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Hematalogy Lecture > Unit 1: Review of Normal Blood Cell Maturation > Flashcards

Unit 1: Review of Normal Blood Cell Maturation Flashcards

1
Q

Leukopoiesis

A

is the production and proliferation of white blood cells,
with the exception of lymphocytes, in the bone marrow, lymph
nodes, & thymus.

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2
Q

Myelopoiesis (granulocytopoiesis)

A

refers to the production of
neutrophils, eosinophils, and basophils

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3
Q

Lymphopoiesis

A

refers to the production of lymphocytes

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4
Q

There are 5 main types of WBCs (in order of their predominance in
the N. adult)

A

-Neutrophils (Segs) 50-70%
* Lymphocytes (Lymphs) 18-42%
* Monocytes (Monos) 2-11%
* Eosinophils (Eos) 1-3%
* Basophils (Basos) 0-2%

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5
Q

Granulocytes

A

(develop only in bone marrow)
Includes: Segs, Eos, Basos, and Monos

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6
Q

Lymphocytes or Mononuclears

A

(develop in the bone marrow
and lymphoid tissue)
Includes: Lymphs, and NK cells

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7
Q

Mononuclears

A

Mononuclears can have very fine granules; it’s just that they are not
granulocytes, which all have large, noticeable granules & segmented
nuclei.

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8
Q

As defense against foreign (“non-self”) invaders via

A
  • Ab production by immunocytes (i.e., lymphs.)
  • Cytokine production by lymphocytes (aka.
    lymphokines.)
  • Inflammatory mediator production by segs &
    monos.
  • Phagocytosis (i.e., granulocytes and mononuclear
    cells)
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9
Q

As a normal cell matures
* Overall:

A
  • cell size decreases
  • nuclear chromatin pattern becomes denser
  • nucleoli disappear
  • amount and color of cytoplasm changes
  • size of nucleus decreases greater than the size of the cell (N:C ratio)
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10
Q

Cytoplasmic Maturation

A
  • deep blue color (high RNA content) pales
  • granules may appear
  • amount increases
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11
Q

Nuclear Maturation:

A

-nucleus decreases in size (exits entirely in RBCs!)
* chromatin becomes more condensed or clumped
* color changes from reddish to bluish-purple
* nucleoli may decrease in # or become absent

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12
Q

Erythron

A

the collection of all stages of erythrocytes throughout the body

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13
Q

Hypoxia

A

diminished availability of oxygen to the body tissues
* Occurs when the oxygen tension in the cells is decreased

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14
Q

The role of RBCs is to

A

Carry oxygen

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15
Q

Erythropoietin Production and Regulation

A

EPO is produced primarily in the kidney in response to - Degree of blood oxygenation

it functions to maintain normal RBC mass

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16
Q

Erythropoietin

Initiates a cascade of events that lead to increased RBCs in circulation

A
  • Allows early release of reticulocytes
  • Increases number of mature erythrocytes
  • Reduces marrow transit time
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17
Q

Pronormoblast (Rubriblast or Proerythroblast) - “Blast”

Cell size

N:C ratio

nucleus shape

Note

A
  • Cell size: 12-20 μm
  • Nucleus: contains nucleoli & fine chromatin;
    round to slightly oval shape.
    High N:C ratio (8:1)
  • Cytoplasm: very basophilic (high RNA content, lots of organelles),
    with the lighter-staining perinuclear area around Golgi (not always visible)
    Note: BFU-E for 1 week » CFU-E for 1 week » Pronormoblast for ~24 hrs.
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18
Q

Basophilic Normoblast

Cell size

Nucleus:

N:C ratio

Cytoplasm-

A

(Prorubricyte /Erythroblast)

  • Cell size: 10-15 μm
  • Nucleus: round, coarser chromatin; no visible
    nucleoli

N:C ratio decreasing to 6:1

  • Cytoplasm: temporarily even more basophilic (royal
    blue); Golgi may be visible as light area near nucleus.
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19
Q

Polychromatic normoblast

(Rubricyte/Polychromatic
erythroblast)

A
  • Cell size: 10-12 μm
  • Nucleus: round, sometimes eccentric, smaller, with
    coarser chromatin
    N:C ratio of 4:1
  • Cytoplasm: opaque, violet-blue or grayish color (due to
    Hgb synthesis) polychromasia
  • (NOTE: Last stage capable of mitosis.)
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20
Q

Orthochromic normoblast

A
  • (Metarubricyte/Orthochromic
    erythroblast)
  • Cell size: 8-10 μm
  • Nucleus: pyknotic (degenerated nuclear chromatin);
    eventually extruded
    N: C ratio of 1:2
  • Cytoplasm: polychromasia
  • NOTE: This stage is typically called a “nucleated red”, & the WBC count must be corrected if 5 or
    more of these are present on a 100 cell WBC differential, because automated analyzers mistake
    them for white blood cells!
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21
Q

Erythroblasts (NRBC) stain

A

Wright-Giemsa Stain

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22
Q
  • Reticulocyte - “Retic“
A
  • Cell size: 7-9 μm (nearly normal!)
  • Nucleus: none present
  • Cytoplasm: varying degrees of polychromasia
    (variation in cytoplasmic color, usually a
    bluish tinge; may still have basophilic stippling.
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23
Q

Reticulocyte - “Retic

Resides in marrow for

A

1 day, then peripheral blood for 1 day, then retained in the spleen for
pitting and polishing for a few days, then released as a mature cell

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24
Q

RETICULOCYTE
(Retic)
Normal ranges:

A

Adults 0.5 - 2.0 %
Children 1.0 - 3.0 %
Newborns 2.0 - 6.0 %

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25
Q

New Methylene Blue

A

Retic Stain

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26
Q

Erythrocyte

A
  • Cell size: 7 - 8 μm
  • Nucleus: none present
  • Cytoplasm: has distinctive central pallor; no protein
    or Hgb made; no mitochondria present
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27
Q

Erythrocyte

Lifespan ? = __________
Travels how far in that time? = __________120 day

A

120 days

300 miles

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28
Q

Neutrophilic Maturation

CFU-S, or hematopoietic stem cell (HSC)

A

-Cluster of Differentiation (CD) 34 antigen
* Undergoes stimulation, mitosis, and maturation in a stem cell (CFU-GEMM)
that’s specific for myeloid cells

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29
Q

Neutrophilic Maturation

CFU-GEMM

A
  • CD34 and CD33 antigens
  • Matures into CFU-GM
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30
Q

Neutrophilic Maturation

CFU-GM

A
  • ILs and CSFs control the stability of cell numbers and their functions
  • Matures into a myeloblast
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31
Q

Colony Stimulating Factors

Multi-CSF

Sources and functions

A

(i.e., IL-3) production is stimulated by
endotoxin released from infection
* Source – secreted by marrow fibroblasts, T-lymphs,
macrophages, and monocytes
* Function – stimulates regeneration, maturation, and
differentiation of multipotential and unipotential stem cells

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32
Q

Colony Stimulating Factors

GM-CSF

Sources and functions

A

is important for myeloid maturation in the
marrow
* Source – secreted by T-lymphs, marrow fibroblasts,
marrow endothelial cells and monocytes
* Function – stimulates neutrophils, eosinophils, and
monocyte growth

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33
Q

Colony Stimulating Factors (cont.)

G-CSF

Sources and functions

A

is a more specific granulocyte growth factor
* Source – monocytes, marrow fibroblasts and endothelial
cells
* Function – stimulates neutrophils, and enhances functional
response of neutrophils

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34
Q

Colony Stimulating Factors (cont.)

M-CSF

Sources and functions

A

(i.e., CSF-1) is the primary monocytic growth
factor
* Source – secreted by mature monocytes, marrow
fibroblasts, and marrow endothelial cells
* Function – stimulates macrophages and the release of G-
CSF from monocytes. Stimulates the release of tumor
necrosis factor (TNF), interferon, and IL-1 from
macrophages

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35
Q

Myeloblast: “-blast”

cytoplasm

A

dark blue to blue cytoplasm

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36
Q

Myeloblast: “-blast”

what may begin to appear

A

Primary granules may begin to appear

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37
Q

Myeloblast: “-blast”

Chromatin

A

lacy, smooth, delicate, & uniformly distributed chromatin

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38
Q

Myeloblast: “-blast”

_____ distinct nucleoli

A

1-2 distinct nucleoli

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39
Q

Myeloblast: “-blast”

Cell size

A

A large cell (15-20 μm)

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40
Q

Myeloblast: “-blast”

N:C ratio

A
  • high N:C ratio of 4:1 (so not much cytoplasm)
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41
Q

Myeloblast: “-blast”

_________ normal in bone marrow (none are normal in peripheral blood
(p.b.)

A

1-2% normal in bone marrow (none are normal in peripheral blood
(p.b.)

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42
Q

Myeloblast: “-blast”

Express antigens

A

CD13 and CD33

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43
Q

Myeloblast: “-blast”

Using light microscopy, it’s hard for

A

non-experts to differentiate myeloblasts/monoblasts / lymphoblasts

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44
Q

Promyelocyte: “Pro-”

large, prominent, reddish-purple _______

A

primary granules (described as
azurophilic)*

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45
Q

Promyelocyte: “Pro-”

dark blue to blue _______

A

cytoplasm

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46
Q

Promyelocyte: “Pro-”

uniformly distributed

A

chromatin

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47
Q

Promyelocyte: “Pro-”

N:C ratio of

A

3:1

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48
Q

Promyelocyte: “Pro-”

less distinct __________

A

nucleoli, but still may be present

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49
Q

Promyelocyte: “Pro-”

It may be larger than ________

A

blast form (approx. 20 μm)

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50
Q

Promyelocyte: “Pro-”

_________ % normal in bone marrow, none normal in p.b

Primary =

A

2-5%

Thus used to help distinguish blasts from pros.
(Primary = pro = red-purple)

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51
Q
  • Myelocyte: “Myelo-”

Pinkish _________

A

pinkish secondary/specific granules now visible*; 1o granules less visible
“Specific = Secondary

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52
Q
  • Myelocyte: “Myelo-”

Dawn of neutrophilia”

A

occurs: specific granules tend to form in Golgi area causing pink arc

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53
Q
  • Myelocyte: “Myelo-

__________ losing blue color due to decreased RNA synthesis

A

cytoplasm losing blue color due to decreased RNA synthesis

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54
Q
  • Myelocyte: “Myelo-”

nucleus more

A

condensed, with chromatin clumped; nucleus starting to “round up”
with one flatter side

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55
Q
  • Myelocyte: “Myelo-”

N:C ratio of

A

2:1

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56
Q
  • Myelocyte: “Myelo-”

_________ % normal in bone marrow, none normal in p.b.

A

<10% normal in bone marrow, none normal in p.b.

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57
Q
  • Myelocyte: “Myelo-”

Myelocytes have greatest morphological variation of all the ______________

A

Neutrophils

Thus used to help tell pros from myelocytes!

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58
Q

Primary/Nonspecific or Azurophilic

A

Red-purple color= Become light blue as cell mature

mostly visible in (blast &) Start at myelocyte stage Appear very late stages
promyelocyte stages

Lysosomes; contains lysozyme, acid hydrolases, myeloperoxidase (MPO)*, proteases, & superoxide

Stain pos. for peroxidase

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59
Q

Secondary/Specific or Neutrophilic

A

Color: Pale lavender-pink

Start at myelocyte stage Cause “dawn of neutrophilia

Lysosomes; contain lysozyme, Lactoferrin**, collagenases, & complement activators

But no peroxidase

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60
Q

Tertiary granules

A

Color- Invisible on Wright’s stain)

blue-purple with
special LAP*** stain

Appear very late stages

Lysosomes; contain lysozyme, DAF, gelatinase, & LAP

NO peroxidase

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61
Q

Metamyelocyte: “Meta-”

kidney-bean or peanut-shaped ________

A

nucleus

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62
Q

Metamyelocyte: “Meta-”

nuclear chromatin

A

more coarsely clumped

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63
Q

Metamyelocyte: “Meta-”

cytoplasm uniformly

A
64
Q

Metamyelocyte: “Meta-”

A

pink with pinky-purple 20 granules (aka. ?
_____Specific___)

(1o granules still present but don’t stain as intensely)

65
Q

Metamyelocyte: “Meta-”

N:C ratio of

A

1.5: 1

66
Q

Metamyelocyte: “Meta-”

_______ % normal in bone marrow, none normal in p.b.

A

12-25 %

67
Q

Metamyelocyte: “Meta-”

_________ becomes indented

A

Nucleus

68
Q

Band: “band”

% present

Constitutes ____ % of BM

Shape

Possess full _______

Shift to the ______

A
  • normal in small %’s in p.b., at about 5-10% in normal adults
  • Constitutes 40% normal in bone marrow
  • curved, band-like nucleus (C or S shape) with no segmentation
  • Possess full motility, active adhesion properties, and some phagocytic ability
  • A maturation “shift to the left” occurs when neutrophil bands are increased
    in p.b., in comparison to the number of segs
69
Q

Segmented (polymorphonuclear) Neutrophil (PMN): “Poly-”or
“Seg-”

Comprises

Nucleus is

Shift to the right

A
  • comprise 50-70% of total WBC population in normal adult p.b.
  • Nucleus continues indentation to form segments, a lobed nucleus
  • Cell is completely functional
  • should have _2-5_____ lobes
  • A maturation “shift to the right” occurs w/ increased number of segs, or
    hypersegmentation (>5 lobes)
    ]
70
Q

Neutrophil time of maturation

A

For a neutrophil, about 10 days from myeloblast to maturation.

71
Q

Granulocytes reside in

A

3 main areas of the body, moving from
1) bone marrow to
2) p.b. to
3) tissues (& movement from endothelium to tissues does not
reverse itself.)

72
Q

In the bone marrow, granulocytes have three functions:

A
  • Proliferation (i.e. myeloblasts, promyelocytes, and myelocytes)
  • Mitotic pool – 2 to 3 days
  • Maturation (i.e. metamyelocytes and bands)
  • Storage (bands and polymorphonuclear leukocytes)
  • Storage pool – 5 to 7 days

Bone marrow holds 4-10 day supply of WBCs – about 25x amount in circulation!

73
Q

Granulocyte “Functional Pools”

A

Process of moving from bone marrow to tissues can speed up under
stress (physical or emotional), causing “shift to the left”: an accelerated release
of immature forms into the p.b.

74
Q
  • In the bloodstream, granulocytes enter & then divide up
    equally between two other functional pools:
A
  • Circulating Pool (CP) – These are counted in a WBC count
  • Marginating Pool (MP) - Lies against the endothelial lining of
    blood vessels
75
Q

Granulocyte Pools (cont.)

There’s constant exchange between these
2 pools.

A

There’s constant exchange between these
2 pools.

Marginating cells can be mobilized
into p.b. circulating pool during stress or
exercise

76
Q

Granulocyte Pools (cont.)

  • Movement from MP to CP accounts for the elevated
    WBC count seen in crying children or highly stressed-
    out adults, due to the effects of hormone?
A

epinephrine

77
Q

Granulocyte Pools (cont.)

Granulocytes stay in p.b. about

A

6-10 hrs., then move
randomly into tissues via? __diapedesis_______, perform their
job (1-5 days), & die.

78
Q

Granulocyte Pools (cont.)

process in which they squeeze through tight
junctions between

A

Endothelial cells of the blood
vessel walls, & exit into the tissues. Once in the
tissues, they do not return!

79
Q

Phagocytosis

Primary phagocyte

A

are monocytes & neutrophils, but eos &
Basos ARE capable of limited phagocytosis!

80
Q

Phagocytosis

Five steps:

A
  • Directed Motility (Migration) M
  • Recognition & Attachment R
  • Ingestion & Phagocytosis I
  • Degranulation/Digestion & Killing D (K)
  • Exocytosis E
81
Q

Phagocytosis

Step One: Directed Motility (Migration)

Chemotaxis =

A

process of phagocytic movement along
gradient of increasing [chemotaxin] (molecules generated
by infection &/or inflammation.)

82
Q

Phagocytosis

Step One: Directed Motility (Migration)

Phagocytes have p.m. receptors to detect _______

A

chemotaxins/chemotactic factors, Abs, & fixed
complement. Thus they migrate through p.b. & diapedese
into tissues to reach site of infection/ inflammation

83
Q

Phagocytosis
* Step One: Directed Motility (Migration)

Who gets there first ________

A

Segs do

84
Q

Phagocytosis

Step Two: Recognition & Attachment

A

Opsonization facilitates recognition & attachment by
marking microorganisms for ingestion

85
Q

Phagocytosis

Step Three: Ingestion & Phagocytosis

A
  • In an amoeboid motion, phagocyte uses rapid
    microfilament rearrangement to extend pseudopodia &
    surround foreign particle . . .
  • Endocytose it,
  • And then form vacuole around it (called a phagosome).
86
Q
  • Step Four: Degranulation/Digestion (Killing)
A

WBC granules = tiny lysosomes containing lysozyme & acid hydrolases
such as myeloperoxidase (MPO); these fuse with phagosome membrane
to form a phagolysosome (functions as a ? _____Garbage disposal ________________)
* Bacterial killing occurs in the phagosome by processes that are either
oxygen-dependent or oxygen-independent

87
Q

Phagocytosis
* Step Four: Degranulation/Digestion (Killing)

Oxygen dependent

A
  • The burst is triggered by superoxide (generated from MPO) in primary
    granules (which are still present in a mature seg, just not visible.)
  • Segs’ 1 o granules color is? ___________
  • Segs’ 1 o granules specific or nonspecific? __________
88
Q
A
89
Q

Phagocytosis
* Step Four: Degranulation/Digestion (Killing)
Oxygen-independent killing

A
  • Accomplished by hydrogen ions (alters the pH), lysozymes , and
    bactericidal proteins (cleave segments of bacterial cell wall).
    garbage disposal
90
Q

Phagocytosis

  • Step Five: Exocytosis
A
  • Essentially consists of dumping trash left over from the battle!
    FYI: Degranulation can also be triggered when seg (or to a lesser
    extent, a mono) gets “hung up” on an atherosclerotic plaque inside a
    blood vessel, causing release of MPO & localized inflammatory
    reaction. Thus MPO & other markers of inflammation are gaining
    interest as possible CVD markers.
91
Q

Eosinophils

similar to

A

Structurally similar to neutrophils, but differ in their unique cytoplasmic
granules

92
Q

Eosinophils

Granule contents

A

2o granules = large red-orange lysosomes containing very
small [peroxidase] & some acid phosphatase. These granules contain mostly
crystalloid form of Major Basic Protein (MBP), which is lysine & arginine-rich (&
cytotoxic to Schisto-soma.) Granules may overlie nucleus, but usually don’t

93
Q

Eosinophils

cytoplasm is

A

Colorless

94
Q

Eosinophils

Nucleus stains

A

less blue than neutrophils, and can be segmented (mature) or
band-like (immature)

95
Q

Eosinophils move

A

Move very slowly, have less intracellular killing ability than segs

96
Q

Eosinophils function

A
  • Control parasitic infections (damage larval stages of parasitic
    helminthic worms: flukes, tapeworms, & roundworms).
  • Dampen hypersensitivity reactions (allergies).
97
Q

Eosinophils

Lifespan:

A

Eos remain < 1 week in p.b

98
Q

Basophil

Phagocytic ability much <

A

egs & eos. Classified only into immature or mature forms
(based upon degree of nuclear segmentation.)

99
Q

Basophil functions

A
  • Mediate inflammatory responses via IgE receptors on their plasma membrane
    (including allergies)
100
Q

Basophil

Granule contents

A

Large bluish-black lysosomes containing histamine and
heparin(released in allergic reactions). These are water-soluble, so may
disintegrate during staining (& so may appear as empty areas)

101
Q

BasophilGranules usually DO

A

overlie nucleus

102
Q

Monocytes

First function

A

The first major function is phagocytosis - even
though a monocyte’s speed of mobility is slow
compared to that of segs
* Even though the speed of mobility is slower,
phagocytosis is much quicker
* Require less opsonization, and phagocytosis can be
initiated by contact

103
Q

Monocytes minor role

A

Play a minor role in processing specific antigens
for lymphocyte recognition

104
Q

Monocytes

A mono in the tissues is no longer a mono, but
called a _________

A

macrophage, either free or fixed

105
Q

Monocytes Monos stay in p.b for

A

~ 3 d., then move into
tissues & stay several months or more.

106
Q

Monocytes maturation

Monoblast

Same ___________ factors active for maturation, are involved in ___________
activity, suggesting link in certain malignant marrow diseases (i.e. __________)

A

Same stimulating factors active for maturation, are involved in osteoclast
activity, suggesting link in certain malignant marrow diseases (i.e. Multiple
Myeloma)

107
Q

Monocytes maturation

Monoblast

Usually seen with a single large

A

nucleolus

108
Q

Monocytes maturation

Monoblast

Strongly positive for

A

CD33

109
Q

Monocytes maturation

Monoblast

Weakly pos for

A

CD34

110
Q

Monocytes maturation

Monoblast

Also positive for

A

Also pos. for CD4 (seen in T-lymphs)

111
Q

Promonocyte

A

Capable of some phagocytosis, but lack range of activity

112
Q

Monocytes

  • Granule Contents
A
  • Monos contain MANY lysosomal enzymes: includes lysozyme (released
    continuously), acid phosphatase (where was alk. phosphatase?
    ______in 3 degree granules of segs___________), & a small amount of peroxidase (< &laquo_space;< seg contains!)
  • Monos also stain + for nonspecific esterases (NSEs.)
113
Q

Thus so far, where have we seen peroxidase in?

A

4+ in early segs , 2+ in later segs, 1+ in monos

114
Q

Monocytes description

A
  • Nucleus is indented or curved
  • Chromatin is lacy w/ small clumps
  • Largest-sized cell in p.b.
  • Phagocytic vacuoles are common
  • Regarded as a transitional cell
115
Q

Monocyte

A

variant / atypical lymphs or large bands. (Always look at
nuclear chromatin pattern: is it frilly or chunky?)

116
Q

Macrophage

As a mono leaves the circulation and enters the tissue, it evolves into

A

lysozyme-filled macrophage

117
Q

Macrophage

Undergo a sudden increase in

A

metabolic energy, phagocytic activity, lysosomes, IgG
surface receptors, and mobility

118
Q

Macrophage cytoplasm is

A

highly vacuolated and has foamy appearance

119
Q

Macrophage

Two categories

A

free and fixed
* Free macrophages are found in various sites of inflammation and repair, and body fluids
* Fixed macrophages are fund in specific sites of concentration (i.e., Kupffer cells, bone marrow, and
lymph nodes)
* Develop different minor characteristics depending upon the organ they occupy

120
Q

Monocytes and Macrophages function

Some macrophages are motile and respond to ________

Monocytes become immobilized by _______

Become activated to _______

A

as a
secondary line of defense to clean-up and remove
microbial organisms or cellular debris, and to remove
the bodies own aged and damaged cells
* Some macrophages are motile and respond to
chemotactic factors such as complement and factors from
activated lymphs
* Monocytes become immobilized by migration-inhibition
factor (MIF) released from activated lymphs
* Become activated to phagocytize by complement,
prostaglandins, or in response to previously phagocytized
material

121
Q

Monocytes and Macrophages perform many vital
functions

A defense against _______

Monocytes present and deliver _______

Have a role in the daily destruction of _______

Macrophages possess ______ activity.

Serve as important effector cells by secreting ________

A
  • A defense against microorganisms
  • Monocytes present and deliver IL-1 (a T-lymphocyte
    activating factor) to specific membrane surface receptor
    sites
  • Have a role in the daily destruction of aged blood cells,
    denatured plasma proteins, and lipids
  • Macrophages possess heme oxidase activity, which
    enables them to break down hemoglobin, and store iron
  • Serve as important effector cells by secreting IL-1, and
    regulators and complement, coagulation, and Kinin
    cascades
122
Q

Lymphoid Maturation

  • The 2 Primary Lymphoid Organs:
A
  • Bone marrow & thymus (“BMT”)
  • Lymphocyte production from these sites is continuous & Ag-independent.
    These send partially differentiated lymphs to The Secondary Lymphoid Tissues .
123
Q

Lymphoid Maturation

The Secondary Lymphoid Tissues

A
  • The Secondary Lymphoid Tissues:
  • Lymph nodes, spleen, tonsils, & MALT (Mucosal Associated
    Lymphoid Tissues in respiratory & GI tracts, such as Peyer’s patches
    (in ? __The small intestines _________________).
  • These act as main repositories for already differentiated lymphs
124
Q
  • Lymphoblast “blast”
A
  • Small to medium sized cell
  • Round-to-oval nucleus containing loose chromatin and one or more active
    nucleoli
  • Cytoplasm is scanty and has basophilia in proportion to amount of RNA
125
Q
  • Prolymphoblast “Pro”
A
  • Clumped chromatin
  • Cytoplasm is more abundant than blast, but deeply basophilic
126
Q

Lymphocyte Characteristics

Size

A
  • Can vary in size from 9 μm to 15 μm
  • Small (resting) lymphs - 7-10 μm; scanty cytoplasm, large N:C ratio.
  • Large lymphs - 11-25 μm; have abundant cytoplasm
127
Q

Lymphocyte Characteristics

A
  • Both have round or oval nuclei
  • Chromatin appears blocked or “smudgy”
  • Cytoplasm stains blue; may include some azurophilic granules
  • Both types are NORMAL
128
Q

Small Lymphocyte
Wright-Giemsa Stain

size

color of cytoplasm

Plays a big role in the

A
  • 8-12μm in diameter with high N:C ratio
  • nucleus is round with coarse, dense
    chromatin
  • cytoplasm is weakly basophilic,
    homogenous and clear without inclusions
  • plays a big role in the body’s immune
    response, particularly in viral infections
129
Q

Large Lymphocyte
Wright-Giemsa Stain

Size

nucleus appears

Cytoplasm is

Plays a big role

A
  • 12-16μm in diameter with an irregular
    outline
  • nucleus can appear irregular and the
    chromatin is not as coarse as in small
    lymphocytes
  • cytoplasm is abundant and tends to be light
    blue
  • plays a big role in the body’s immune
    response, particularly in viral infection
130
Q

Plamsa cells

A

secrete Igs. & responsible for
antibody production

131
Q

B-cells

A
  • Differentiation occurs in the adult bone marrow
  • Seen primarily in p.b. as small, resting lymphs.
  • Upon Ag exposure in the 2o lymphoid tissues, these
    enlarge, differentiate into
132
Q

two types of B cells

A
  1. Plasma cells - secrete Igs. & responsible for
    antibody production
  2. Memory cells
133
Q

T cells act in 2 major roles:

Effector cells

5 major types of “not-self pathogens”?

Example of T cell

A

Effector cells - responsible for cell-
mediated immunity: defense vs. which
5 major types of “not-self pathogens”?
viruses, fungi, bacteria, parasites, & tumor cells

  • Ex., Cytotoxic T cells (Tcyto ) – usually CD8+.
    Destroy Ag-specific target cells on contact.
134
Q

T cells act in 2 major roles (cont.)

Regulatory cell

A

induce or suppress proliferation /
differentiation of effector cells; for example

135
Q

T cells act in 2 major roles (cont.)

Regulatory cell

Helper/ Induced T cells

A

TH ) - CD4+. Induce other
lymph to carry out certain functions (Ex., inducing B
cells to produce Abs.)

136
Q

T cells act in 2 major roles (cont.)

Regulatory cell

Delayed hypersensitivity T cells (TD )

A

pro-duce
chemotactic lymphokines in response to Ags.

137
Q

T cells act in 2 major roles (cont.)

Regulatory cell

  • Suppressor T cells (TS) -
A

CD8 +; regulate humoral &
cell-mediated responses. (Not solely suppressive,
despite name.)

138
Q

Natural Killer (NK) cells

Type of larger what

A

type of large granular
lymphocyte, or LGL (LGL is a descriptive term derived
from flow cytometry studies; it may NOT be
obviously granular on Wright’s stain!)

139
Q

NK cells lyse

A

Lyses some tumor cells & virus-infected cells

140
Q

Natural Killer (NK) cells majority are ______ positive

A

D56+ CD16+

141
Q

Nk cells note

A

Not all LGLs seen in p.b. are NK cells, but some are. You
couldn’t tell unless you did flow analysis

142
Q

LGL also _______

A

(also “atypical” due to number of granules

143
Q

Cells That Confuse Lymphocyte ID

Blasts

A
  • Large lymphs may be similar in size to blasts, & occa-
    sionally may even contain nucleoli
144
Q

Cells That Confuse Lymphocyte ID

Monocytes

A
  • Have lacy chromatin (with brain-like convolutions); the
    nucleus is not stained as darkly as it does in lymphs.
    Monocyte cytoplasm tends towards blue-gray, & has an
    opaque, “ground-glass appearance.”
145
Q

Cells That Confuse Lymphocyte ID

Rubricytes/polychromatic normoblasts

A

Similar in size to lymphs, but rubricyte cytoplasm has a
grayish-blue appearance, whereas lymph cytoplasm is a
clearer blue. Also, rubricyte chromatin is much denser
than lymphocytes’ chromatin.

146
Q

Lymphocytosis definition

normal range

A

absolute ↑ in # of circulating lymphs above
normal range:
* ↑ 4.0 x 10 3/uL in adults
* ↑ 9.0 x 10 3/uL in children (Note difference!)

147
Q
A
147
Q

Lymphopenia

A

absolute ↓ in # of circulating lymphs below
normal range
(due to ↓ production, alterations in lymph traffic, and/or ↑
lymph destruction.)

148
Q

Morphology of Reactive/Atypical Lymphs

Type one

A

– some call this “Plasmacytoid lymph”
* Smallest of the atypicals (9-20 um).
* Variable basophilic cytoplasm; vacuolated, may contain
granules.
* “Foamy” or “frilly” nuclear appearance, but chromatin still
dense. Most likely a triggered (i.e., immunocompetent) B
cell.
* Classically, this is type most commonly confused with
monocytes, but it can also appear in an easier to ID form .
. .

149
Q

Morphology of Reactive/Atypical Lymphs

Type 2

A

aka. “Downey cells”.
* These are the classical reactive or atypical lymphs
* Classically seen in Infectious Mononucleosis!
* Abundant cytoplasm, irregularly- shaped & edges
indented by surrounding structures.
* Overall “fried egg” or “flared skirt” type of
appearance.
* No nucleoli

150
Q

Morphology of Reactive/Atypical Lymphs

Type III

A

Largest of the atypicals (12-35 um).
* Vacuolated, very basophilic cytoplasm.
* Immature chromatin with nucleoli!
* So how do you tell these highly reactive lymphs (reactive
lymphocytosis) from blasts (in a malignant
lymphocytosis)?

The extreme pleomorphism of the reactive lymphs -
a malignant lymphocytosis looks more clonal, with
a more homogeneous cell population.

151
Q

Plasma cells –

Generally smaller then

abundant deep blue

Eccentrically located what

A

generally smaller
than Type III atypicals (10-28 um).
* Abundant, deep blue, & agranular cytoplasm.
* Eccentrically located nucleus.
* General “cometary” type appearance.

152
Q

Thrombocyte maturation

A

Megakaryoblast
Promegakaryocyte
Basophilic/Granular Megakaryocyte
Megakaryocyte

153
Q

Thrombocyte
Wright-Giemsa Stain

A
  • A normal platelet measures 1,5–3 μm in
    diameter.
  • round or oval in EDTA-anticoagulated blood.
    In blood films made directly from capillary
    blood they appear aggregated.
  • Thrombocytes are fragments of the of the
    megakaryocyte cytoplasm.
  • Platelet size is of diagnostic significance
    particularly when considered in relation to
    the platelet count.
  • Thrombocytes play a big role in the body
    coagulation process
154
Q
A

Hematalogy Lecture (35 decks)

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