HEMATOLOGY Flashcards
Blood cell production, maturation, and death occur in organs of the
reticuloendothelial system (RES)
reticuloendo-thelial system (RES) includes:
bone marrow, spleen, liver, thymus, lymph nodes
Mesoblastic (yolk sac) phase begins at
19 days gestation
First cell to be produced
Primitive nucleated erythroblast
Embryonic hemoglobins includes:
Portland
Gower I
Gower II
Begins at 6 weeks gestation with production of mainly red blood cells, but also granulocytes, monocytes, and megakaryocytes.
Hepatic (Liver) Phase
Begins around the fifth month of gestation, with the bone marrow producing mainly granulocytes
Myeloid/Medullary phase
A normal ratio of M:E (myeloid:erythroid)
3:1or 4:1
Alpha- and gamma-globin chain production predominates at birth, forming
Hgb F
Myeloid/Medullary Phase hemoglobin present:
Hgb F
Hgb A(1)
Hgb A.2
In newborn, —- of bone marrow is active red marrow
80-90%
Young adult (age 20): — of bone marrow is active
60%
In young adult, hematopoiesis is confined to the proximal ends of large flat bone namely:
bones
pelvis
sternum
Older adult (age 55): percentage of active bone marrow
40%
Normocellular— Marrow percentage of hematopoietic cells
30-70%
Marrow has >70% hematopoietic cells.
Hypercellular/hyperplastic
Marrow has <30% hematopoietic cells
Hypocellular/hypoplastic
Marrow has few or no hematopoietic cells.
Aplastic
Differentiate into either B or T lymphocytes in response to cytokines/lymphokines/interleukins/ CSFs/growth factors
Lymphoid
Gives rise to the multipotential progenitor CFU-GEMM
Myeloid
Committed Progenitor Cell: CFU MEG
Growth Factors/ Interleukins: Thrombopoietin, GM-CSF
Mature cells:
Thrombocytes
Committed Progenitor Cell: CFU GM, CFU M
Growth Factors/ Interleukins: GM CSF, M-CSF, IL3
Mature cells:
Monocytes
Committed Progenitor Cell: CFU GM, CFU G
Growth Factors/ Interleukins: GM CSF, G CSF, IL3
Mature cells:
neutrophils
Committed Progenitor Cell: BFU E, CFU E
Growth Factors/ Interleukins: Erythropoietin, GM-CSF, IL-3
Mature cells:
Erythrocytes
Committed Progenitor Cell: CFU-Eo
Growth Factors/ Interleukins: GM CSF, IL-3, IL-5
Mature cells:
Eosinophils
Committed Progenitor Cell: CFU-Ba
Growth Factors/ Interleukins: IL3, IL4
Mature cells:
BASOPHILS
Primary lymphoid tissue
Bone Marrow
Thymus
Secondary lymphoid tissue
lymph nodes
spleen
gut-associated tissue (Peyer’s patches)
WBC reference range (SI units)
4.0-11.0 x 10^9/L
include neutrophils, eosinophils, and basophils
granulocytes
the first to reach the tissues and phagocytize (destroy) bacteria
neutrophils
lymphocyte that provide cellular immunity
T lymphocytes
develop into plasma cells in the tissue and produce antibodies needed for humoral immunity
B lymphocytes
destroy tumor cells and cells infected with viruses
NK lymphocytes
modulate the allergic response caused by basophil degranulation
Eosinophil
mediate immediate hypersensitivity reactions (type I, anaphylactic)
Basophils
Blood cell production within the bone marrow
Medullary hematopoiesis
Blood cell production outside the bone marrow
Extramedullary hematopoiesis
Erythropoietin is produced mainly by the
kidneys
Earliest RBC, size up to 20 |xm, with an N:C ratio of 8:1
1-3 nucleoli, nucleus has dark areas of DNA
Chromatin is fine and uniform, and stains intensely
Deep blue cytoplasm with no granules
Pronormoblast (rubriblast)
Size up to 16 jjim with an N:C ratio of 6:1
Centrally located nucleus with 0-1 nucleoli
Chromatin is coarsening.
Cytoplasm is less blue but intensely basophilic (RNA).
Basophilic normoblast (prorubricyte)
Size up to 12 (Jim with an N:C ratio of 4:1
Eccentric nucleus with no nucleoli
Chromatin shows significant clumping.
Begins to produce hemoglobin, resulting in gray-blue cytoplasm
Polychromatophilic normoblast (rubricyte)
Size up to 10 fxm with an N:C ratio of 0.5:1
Eccentric nucleus with small, fully condensed (pyknotic) nucleus; no nucleoli
Pale blue to salmon cytoplasm
Hemoglobin synthesis decreases
Orthochromic normoblast (metarubricyte)
Size up to 10 um
contains no nucleus but has mitochondria and ribosomes
Last stage to synthesize hemoglobin
Last stage in bone marrow before release to the blood
Reticulocyte
Reticulocyte reference ranges are —— for adults
0.5-1.5%
Size range is 6-8 (Jim.
Round, biconcave discocyte
Salmon with central pallor (clearing in the center)
Mature erythrocyte
Erythrocytes reference range for female:
4.0-5.4 X 10^12/L
Erythrocytes reference range for male:
4.6-6.0 X 10^12/L
Usually orthochromic normoblasts (metarubricyte) but can appear in any erythrocytic stage of maturation
Associated with thalassemia major, sickle cell anemia, and other hemolytic anemias, erythroleukemia, and myeloproliferative disorders
Nucleated RBCs (nRBCs, nucRBCs)
Small, round DNA fragments (0.5-1.0 µm in diameter) usually one per cell, but can be multiple
d.Seen in sickle cell anemia, beta-thalassemia major, and other severe hemolytic anemias, megaloblastic anemia, alcoholism, post-splenectomy
Howell-Jolly bodies
Multiple, tiny, fine, or coarse inclusions (ribosomal RNA remnants) evenly dispersed throughout the cell; “blueberry bagel” appearance
Seen in thalassemias, megaloblastic anemias, sideroblastic anemia, lead poisoning, and alcoholism
Basophilic stippling
Small, irregular, dark-staining iron granules usually clumped together at periphery of the cell
Seen in sideroblastic anemia, hemoglobinopathies, thalassemia, megaloblastic anemia, myelodysplastic syndrome (RARS)
Pappenheimer bodies
Thin, red-violet, single to multiple ringlike structures that may appear in loop or figure-eight shapes
Seen in megaloblastic anemia, myelodysplastic syndromes, lead poisoning
Cabot rings
Condensed, intracellular, rod-shaped crystal
Seen in hemoglobin C or SC disease, but not in trait
Hemoglobin C crystals
1-2 blunt, fingerlike projections extending from the cell membrane
Seen in hemoglobin SC disease
Washington monument
Hemoglobin SC crystals
Multiple inclusions ranging in size from 0.3 to 2.0 µm
Invisible with Wright’s stain; must use a supravital stain to visualize
Seen in G6PD deficiency, beta-thalassemia major, Hgb H disease, unstable hemoglobinopathies, drug-induced anemias
Heinz bodies
Most common in the US; prevalent in infants, children, pregnancy, elderly with poor diets, and chronic blood loss
Iron deficiency anemia
Laboratory: Microcytic/hypochromic anemia
low serum iron, ferritin, hemoglobin/hematocrit, and reticulocyte count
high RDW and TIBC
smear shows ovalocytes/pencil forms
Iron Deficiency Anemia
Clinical symptoms: Fatigue, dizziness, pica, stomatitis, glossitis, koilonychia
Iron Deficiency Anemia