-
Describe a myeloblast
- No cytoplasmic granules
- Round/oval nucleus with fine reddish-purple staining chromatin
- Dark blue cytoplasm
- 2-5 nucleoli
-
Describe a promyelocyte
- Cytoplasm has large, nonspecific/primary granules containing myeloperoxidase
- Round/oval nucleus with slightly carsening chromatin
- 1-3 nucleoli
-
Describe a myelocyte
- Prominent golgi apparatus - clear area located in the cytoplasm next to the nucleus
- Cytoplasm has specific/secondary granules that contain hydrolytic enzymes, including alkaline phosphatase and lysozyme
-
What is the first stage where granulocyte types can be differentiated into eosinophil, basophil, or neutrophil?
Myelocyte
-
What granulocyte makes up 13% of the nucleated cells in the bone marrow?
Neutrophilic myelocyte
-
Describe a metamyelocyte
- Nucleus is indented in a kidney bean shap and has coarse, clumped chromatin
- Nuclear indent is less than half the width of the hypothetical round nucleus
- Cytoplasm is pink and filled with pale blue to pink specific/secondary granules
-
What granulocyte makes up 16% of the nucleated cells in the bone marrow?
Neutrophilic metamyeloctye
-
Describe the Band neutrophil
- Nucleus is a "C" or "S" shaped with coarse, clumped chromatin lacking segmentation
- Nuclear indent is greater than half the width of a hypothetical round nucleus
- Cytoplasm is pink and filled with pale blue to pink specific/secondary granules
-
What is the reference range of Band neutrophil?
- Bone marrow: 12%
- Peripheral blood: 0-5%
-
Describe a segmented neutrophil
- 3-5 lobes
- Cytoplasm is piink and filled with small, pale blue to pink specific/secondary granules
-
What is the reference range for a segmented neutrophil?
- Bone marrow: 12%
- Peripheral blood: 50-80%
-
Describe an eosinophil
Cytoplasm contains large, bright red-orange, secondary granules that contain enzymes and proteins
-
Describe a basophil
- Cytoplasm contains large, purple-black, secondary granules that contain heparin and histamine
- Granules may be numerous and obscure the nucleus, or they may "wash out" in staining
-
What is the reference range of an eosinophil?
Peripheral blood: 5%
-
What is the reference range of a basophil?
Peripheral blood: 0-1%
-
Where do blasts, promyelocytes, and myelocytes divide and for how long?
- In the bone marrow mitotic pool
- 3-6 days
-
Where do metamyelocytes, bands, and segmented neutrophils mature, and for how long?
- In the bone marrow post-mitotic pool
- 6 Days
-
What included in the marginating granulocyte pool and what do they do?
- Mainly neutrophils
- Adheres to vessel walls
-
What do neutrophils do in response to antigenic stimulation?
Neutrophils diapedese into tissues from the marginating pool in response to antigenic stimulation
-
What attracts neutrophils to the site of inflammation?
- Chemotactic factors, which include:
- Complement
- Bacterial products
- Injured tissue
- Hemostatic components
-
What helps neutrophils recognize a substance as foreign?
Opsonins such as IgG and complement component C3b
-
What involves neutrophil attachment to the foreign object formation of a vacuole around it, and neutrophilic degranulation to release lytic enzymes (respiratory burst) in an effort to kill the organism?
Phagocytosis
-
How do blood and tissue cells in the body undergo cell death?
-
How is necrosis induced?
Induced by extracellular forces such as lethal chemical, biological, or physical events
-
What is the termed for programmed cell death?
Apoptosis
-
How does apoptosis occur?
Due to extracellular or intracellular processes that depend on a signal
-
What are toxic changes in neutrophils associated with?
- Bacterial infection
- Growth factor therapy
-
What are Dohle bodies?
Small oval inclusions (RNA) located in the cytoplasm that stain light blue
-
What do eosinophils respond to?
- Parasitic infections (because they express Fc receptors for IgE)
- Modulate the allergic response (releasing substances that can neutralize products released by basophils and mast cells)
-
What do basophils do?
- Express membrane receptors for IgE
- Once activated, degranulation releases histamine - initiating the classic signs of immediate hypersensitivity reactions (Type I)
- Release a chemotactic factor that attracts eosinophils to the site
-
Which granulocyte initiates the classic signs of immediate hypersensitivity reactions (Type I)?
Basophils
-
How can you tell the difference between pseudoneutrophilia and neutrophilia caused by a disease?
Pseudoneutrophilia has NO toxic changes and NO shift to the left
-
When bone marrow reserves are released into the blood, how much can the WBC count increase?
Up to 50 x 109/L
-
When does the bone marrow release its' reserves to increase the WBC count in the blood?
- Bacterial infections
- Other infections
- Tissue destruction
- Drugs
- Toxins
- Growth factor
-
What condition:
Blood picture mimics chronic myelogenous leukemia
Benign, extreme response to a specific agent or stimulus
Neutrophilic leukemoid reaction (NLR)
-
What condition:
Presence of immature leukocytes and immature erythrocytes in the blood
Occurs in marrow replacement disorders, such as myelofibrosis
Leukoerythroblastic reaction
-
What is a decrease in the absolute number of neutrophils?
Neutropenia
-
What occurs when neutropenia worsens?
Risk of infection
-
What are the causes of neutropenia, when dealing with the bone marrow?
- Chronic or severe infection depletes available neutrophil reserves - use exceeds bone marrow production
- Hypersplensim causes neutrophils to be removed from circulation
- Bone marrow injury (aplastic anemia), bone marrow infiltration (leukemia, myelodysplastic syndromes, or metastatic cancer, bone marrow suppression by chemicals or drugs (chemotherapy)
- DNA synthesis defects due to vit B12 or folate defeciency
- Many viral infections are associated neutropenia
-
What clinical conditions are associated with eosinophilia?
- Parasitic infections
- Allergic reactions
- Chronic inflammation
- Chronic myelogenous leukemia - including early maturation stages
- Hodgkin disease
- Tumors
-
What clinical conditions are associated with eosinopenia?
- Acute inflammation
- Inflammatory reactions that cause release of glucocorticosteroids and epinephrine
-
What clinical conditions are associated with basophilia?
- Type I hypersensitivity reactions
- Chronic myelogenous leukemia, including early maturation stages
- Polycythemia vera
- Relative transient basophilia can be seen in patients on hematopoietic growth factors
-
What clinical conditions are associated with basopenia?
- Inflammatory states
- Following immunologic reactions
-
What condition:
Both sex-linked and autosomal recessive inheritance with the ratio affected males to females being 6:1
Morphologically normal, but functionally abnormal because of enzyme deficiency that results in an inability to degranulate, which causes inhibitied bactericidal function
Fatal early in life
Chronic granulomatous disease (CGD)
-
What condition:
Autosomal recessive disorder causes large, gray-green, peroxidase positive granules in the cytoplasm of leukocytes
Abnormal fusion of primary and secondary neutrophilic granules
Both morphologically and functionally abnormal leukocytes
WBCs unable to degranulate and kill invading bacterial
Patients will present with photophobia and skin hypopigmentation
Fatal early in life
Chediak-Higashi syndrome
-
What is characterized by 5 or more lobes in the neutrophil?
Hypersegementation
-
What clinical conditions are associated with hypersegmentation?
Megaloblastic anemia due to Vit B12 or folic acid deficiency
-
What refers to a tendency in neutrophils to have 1 or 2 lobes?
Hyposegmentation
-
What clinical conditions are associated with hyposegmentation?
- Pelger-Huet anomaly
- Psuedo Pelger-Huet
- May be anomaly or shift to the left
-
What condition:
Autosomal dominant inheritance
Nucleus dumbbell or peanut shaped - referred to as "pine-nez"
Must differentiate from a left shift to the left associated with an infection
This condition has no toxic changes
Pelger-Huet anomaly
-
What condition:
Acquired abnormality associated with myeloproliferative disorders and myelodysplastic syndromes
Can also be drug induced
Nucleus is usually round instead of dumbbell shape that is seen in the anomaly
Frequently accompanied by hypogranulation
Pseudo Pelger-Huet
-
What condition:
Autosomal dominant inheritance
Large, crystalline, Dohle-like inclusions in the cytoplasm of neutrophils on Wright's stain
Giant platelets
Thrombocytopenia
Clinical bleeding
May-Hegglin anomaly
-
What condition:
Autosomal recessive inheritance
Large azurophilic granules appear in the cytoplasm of all or only one cell line, granules contain degraded mucopolysaccharides due to an enzyme defect
Must differentiate from toxic granulation present in neutrophils only in infectious conditions
Alder-Reilly anomaly
|
|
