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PATH Heme-Onc > Hematopoiesis & Normal Blood Cell Morphology > Flashcards

Hematopoiesis & Normal Blood Cell Morphology Flashcards

1
Q

what immune tissue is considered “myeloid tissue” vs “lymphoid tissue”?

A
  • myeloid tissue: bone marrow + cells derived from it (= the origin of all lymphoid precursors)
  • lymphoid tissue: thymus + lymph nodes + spleen
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2
Q

myeloid neoplasms are derived from?

A

all arise in the bone marrow, but may secondarily involve lymphoid tissue

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3
Q

what are the sites of hematopoiesis in the fetus throughout pregnancy?

A
  • 0-2 months: yolk sac in the AGM (intra-embryonic aorta-gonad-mesonephros) region
  • 2-7 months: liver + spleen
  • 5-9 months: bone marrow
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4
Q

what are the sites of hematopoiesis after birth?

A

= bone marrow (throughout entire life)

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5
Q

discuss how the hematopoietic nature of bone marrow evolves throughout adulthood

A
  • infancy and childhood: ALL marrow is hematopoietic = 100% cellularity
  • puberty & adulthood
    • hematopoietic marrow restricted to proximal ends of femur + humeri
      • cellularity calculated by: 100 - age +/- 20%
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6
Q

how is bone marrow cellularity calculated?

A

100-age +/- 20%

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7
Q
  • characterize the following cells based on CD34 expression, recognizability, relation to lineage, other properties
A

all express CD34 & are morphologically unrecognizable:

  • hematopoietic stem cells
    • capable of self renewel
    • produce multilineage progeny
  • multilineage progenitor cells
    • give rise to single OR limited limited lineage progenitor cells
  • progenitor cells
    • irreversible lineage commitment

variable CD34 expression, first recognizable cell:

  • blast cell. also, shows immuno-phenotype or cytochemistry of lineage
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8
Q

which hematopoietic cell is first to commit irreversibly to a lineage?

what is its CD34 expression & recognizability?

A

progenitor cells

  • express CD34
  • morphologically unrecognizable
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9
Q

what are the important characteristics of a blast cell?

A
  • FIRST recognizable cell in a lineage
  • has VARIABLE expression of CD34
  • shows immunotype or cytochemistry of lineage
  • last cell to be mitotically active
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10
Q

discuss the stages of erythropoiesis - what characteristics are seen at each stage?

A
  • pro-erythroblast
    • _Hb first presen_t at this stage
    • cytoplasm deeply basophillic
    • large, spherical nucleus
  • basophilic erythroblast
    • cytoplasm still deeply basophilic
    • nucleus smaller / denser chromatin
  • poly-chromatophilic erythroblast
    • last stage of mitotic activity
    • cytoplasm is pink-blue
    • nucleus has checkerboard chromatin
  • ortho-chromatophilic erythroblast
    • post-mitotic
    • cytoplasm pink
    • nucleus gets extruded
  • reticulocyte
    • anucleate
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11
Q

which erythroblast precursors have mitotic activity?

A
  • pro-erythroblast
  • basophilic erythroblast
  • polychromatic erythroblast (last stage with mitosis)
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12
Q

which erythroblast precursor has the largest nucleus?

A

proerythrocyte

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13
Q

which erythrocyte precursors have basophillic cytoplasm?

A
  • pro-erythroblast (pro-normoblast)
  • basophilic erythroblast
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14
Q

which erythroblast precursor has pink-blue cytoplasm and why is this?

A
  • the polychromatophilic erythroblast
    • hemoglobin (pink) to basophil (blue) - d/t first evidence of Hb production
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15
Q

which erythrocyte precursors are post-mitotic?

A
  • ortho-chromatophilic erythroblast (first one)
  • reticulocyte
  • mature RBC
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16
Q

which erythroblast precursor has a nucleus with “checkerboard” chromatin

A

polychromatic erythroblast

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17
Q

which erythroblast precursor is anucleate?

A

reticulocyte (nucleus ingested by macrophages during ortho-chromatophilic erythroblast)

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18
Q

which erythroblast precursor is anucleate?

A

reticulocyte (nucleus ingested by macrophages during ortho-chromatophilic erythroblast)

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19
Q

poly-chromatophilic erythroblast in terms of

  • nucleus / mitotic status
  • cytoplasm color
A
  • last stage of mitotic activity
  • FIRST EVIDENCE of HB PRODUCTION: cytoplasm is pink-blue
  • nucleus has checkerboard chromatin
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20
Q

ortho-chromatophilic erythroblast in terms of

  • nucleus / mitotic status
  • cytoplasm color
A
  • post-mitotic
  • cytoplasm pink
  • nucleus gets extruded
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21
Q

outline the stages of granulopoiesis - what characteristics are seen at each stage?

A
  • myeloblast
    • large nucleus - oval shaped
    • NO GRAULES - clear cytoplasm
  • promyelocyte
    • largest nucleus - oval shaped
    • 1st stage of azurophilic granules
  • myelocyte
    • smaller nucleus +/- indentation
    • 1st stage of specific granules (neutrophilic, eosinophilic, basophilic)
    • last stage of mitotic activity
  • metamyelocyte
    • bean shaped nucleus
    • no mitotic activity
  • band form
    • horseshoe shaped nucleus
    • contains specific granules of only one type
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22
Q

which granulocyte precursor is the largest in the lineage?

A

pro-myleocyte (second stage)

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23
Q

which granulocyte precursors have mitotic activity?

A
  • myeloblast
  • pro-myeloblast
  • myelocyte (last one)
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24
Q

which granulocyte precursors are NOT mitotically active?

A
  • metamyelocyte (first one)
  • band form

= nucleoli not seen

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25
Q

which is the first granulocyte precursor to contain azurophilic granules?

A

promyelocyte

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26
Q

which granulocyte precursor is the first to contain specific granules?

A

myelocyte

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27
Q

which granulocyte precursor is the first to contain only one specific granule?

A

band form

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28
Q

myelocyte

  • nucleus
  • granule status
  • mitosis
A
  • smaller nucleus +/- indentation
  • 1st stage of specific granules (neutrophilic, eosinophilic, basophilic)
  • last stage of mitotic activity
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29
Q

metamyelocyte

  • nucleus
  • granule status
  • mitosis
A
  • bean shaped nucleus
  • specific granules
  • no mitotic activity (first stage) = nucleoli not seen
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30
Q

band form granulocyte

  • nucleus
  • granule status
  • mitosis
A
  • horseshoe shaped nucleus
  • contains specific granules of only one type - are small & evenly distributed
  • no mitosis
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31
Q

label this photo & point out important features of cells

A
  • bl: myeloblast
    • largest nuclei / high nuclei: cytoplasm ratio
    • clear cytoplasm b/c NO granules
  • pro: promyelocyte
    • largest cell
    • smaller nuclei than myeloblast
    • presence of granules (non-specific/primary)
  • my: myelocyte
    • smaller than promyelocyte
    • presence of specific (secondary) granules)
  • met: metamyelocyte
    • smaller than myelocyte
    • slight indentation
  • band form
    • smallest
    • horseshoe shape
    • small, evenly distributed granules - only one type of specific (secondary) granule present
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32
Q

label this photo

A

size: promyelocyte > myelocyte > metamyelocyte > band cell

33
Q

identify this photo & note important features

A
  • band form
    • no mitosis
    • horseshoe shape
    • small, evenly distributed granules - only one type of specific (secondary) granule present
34
Q
A

mature neutrophil

  • nucleus separated into distinct lobes connected by a narrow filament
  • granules evently distributed
35
Q

identify the cell & note important features

A

monocytes

  • largest cell in normal peripheral blood
    • tho, smaller than a promyelocyte, which could be present in pathological conditions)
  • single nucleus - indented/ lobulated / horseshoe shape
36
Q

identify the cell & note important features

A

eosinophils

  • bilobed nucleus
  • cytoplasmic granules are RED STAINING. spherical & evening distributed
37
Q
A

basophil

  • nucleus w/ various shapes
  • cytoplasmic granules are DARK-BLUE BLACK and unevenly distributed
38
Q

discuss the presence of monocytes & their precursors in the blood

A
  • monocytes - under normal conditions, largest cell in peripheral blood
  • precursors (monoblasts & promocytes) are NOT typically seen in the blood
39
Q
A

lymphocytes

40
Q

what are erythroid islands?

A

collections of developing erythrocytes + macrophages in the bone marrow

42
Q
A

erythroid island

  • E = early erythroblasts
  • I = intermediate erythroblasts
  • L = late erythroblasts
43
Q

describe megakaryopoiesis

A

platelet generation

  • nucleus undergoes multiple mitotic divisions without cytoplasmic separation → giant polyploid cell → gets larger → sends cytoplasmic processes between endothelial cells → break into platelets
    • unlike granulocytes / RBCS: platelet gets larger as it matures
    • nuclei
      • present in pairs of two
      • attached to one another
44
Q

identify cell, note important features

A

platelet - 4 nuclei

45
Q

bone marrow & biopsy - indications

A
  • Diagnosis and follow-up of hematolymphoid neoplasms
  • Staging of lymphomas, some solid tumors
  • Investigation of unexplained blood abnormality
  • Fever of unknown origin, suspected bone marrow infections
  • Unexplained radiographic findings
  • Pre-transplantation workup
46
Q

contraindications for bone marrow & aspiration

A

Not meeting any of the criteria for having one done:

  • Diagnosis and follow-up of hematolymphoid neoplasms
  • Staging of lymphomas, some solid tumors
  • Investigation of unexplained blood abnormality
  • Fever of unknown origin, suspected bone marrow infections
  • Unexplained radiographic findings
  • Pre-transplantation workup
47
Q

tools for bone marrow aspiration & biopsy

A
  • bone marrow: jamshidi needles
  • bone aspiration: bone aspiration needles - smaller than jamshidi needles
48
Q

sites for obtaining bone marrow biopsies & aspirations

A
  • posterior illiac crest m/c
    • ant crest alternative
    • sternum - risky
49
Q

uses of bone marrow biopsies & aspirates

A
  • biopsies - for architectural relationships
  • aspirates - for cytological evaluation of individual cells
50
Q

list all the uses of bone marrow biopsies

A
  • good for determining architectural relationships: estimation of
    • estimation of:
      • total cellularity: 100 - age +/- 20%
      • distribution of hematopoietic elements
        • myeloid: erythroid relationships
    • evaluation:
      • fibrosis / infiltrating processes
      • bony / vascular abnormalities
51
Q

uses of bone marrow aspirates

A
  • cell counts & cytological evaluation of individual cells
    • nuclear details:
      • size
      • presence/absence of nucleoli
      • chromatin characteristics
      • maturity
    • cytoplasmic details
      • color, granularity, inclusions
52
Q

what are bone biopsies NOT good for?

A

for cytological details

53
Q

what are bone marrow aspirates NOT good for?

A

for determination of architectural relationships

54
Q

identify

characteristics, causes

A

normochromic normocytes

  • 7.5-8 um in size
  • zone of central pallor = middle ⅓ of cell
55
Q

identify

characteristics, causes

A

microcytes

  • characteristics
    • microcytic, hypochromic
      • < 7.5 um
      • hypochromic = zone of central pallor > ⅓
        • d/t lack of Hb → lack of color
  • causes
    • lead to Hb deficiency
      • iron issues
        • iron deficiency
        • sideroblast anemia - impaired iron metabolism in RBC
        • chronic anemic disease - cytokine issue; impaired macrophage-RBC hand off in RBC development
        • lead/heavy metal poisoning
      • thalassmia: can’t make globin chains
56
Q

identify

characteristics, causes

A

macrocytes

  • characteristics
    • > 8 uL
    • often OVAL in shape
    • color normal
  • causes
    • vitamin deficiencies
      • Vit-B12
      • folate
    • neoplasms
57
Q

identify

characteristics, causes

A

spherocytes

  • characteristics
    • spherical - loss of bio-concave shape → much less deformable
  • due to:
    • cytoskeletal defects
    • burns
    • post-transfusion
    • immune hemolytic anemia
58
Q

identify

characteristics, causes

A

target cells

  • characteristics - large, floppy cells with redundant membrane
  • cause - seen in hemoglobin C disease
59
Q

identify

characteristics, causes

A

acanthocytes

  • characteristics
    • spicules that are
      • unevenly distributed over surface
      • unequal length
  • causes
    • a-betalipoproteinemia
    • Liver disease
    • Malnutrition
60
Q

identify

characteristics, causes

A

echinocytes

  • characteristics
    • spicules that are
      • evenly distributed over RBC surface
      • short, blunt
  • causes
    • liver / rental disease
    • storage artifact
    • enzyme deficiency
61
Q

identify

characteristics, causes

A

stomatocytes

  • characteristics
    • = mouth cells: central zone of pallor is narrow / linear (not rond)
  • causes
    • alcohol therapy & alcoholic liver disease - m/c
    • also
      • hydroxyurea therapy
      • Rh null syndrome
      • myelodysplastic syndromes
62
Q

identify

characteristics, causes

A

schistocytes

  • characteristics
    • mechanical disruption of RBCs in the vasculature by fibrin strand
  • causes
    • vasculitis
    • mechanical heart valves
    • burns
    • toxins
63
Q

identify

characteristics, causes

A

sickle cells

  • characteristics - cells with pointed ends
    • Hb B-globin chain mutation: point mutation at position 6 replacing Glu (hydrophilic) with Val (hydrophobic) → aggregation
64
Q

what are the components of hemoglobin C disease

A
  • irregularly contracted cells
  • hemoglobin C crystals
  • target cells - “floppy” cells
  • spherocyte - spherical, no palor
65
Q

identify

characteristics, causes

A

hemoglobin C disease

  • characteristics
    • irregularly contracted cells - rust arrows
    • hemoglobin c crystals - *
    • target cells - black arrows
    • spherocyte - arrowheads
  • cause:
    • Hb B-globin chain mutation: point mutation at position 6 replacing Glu (hydrophilic) with Lys (hydrophobic) → aggregation
66
Q

heinz bodies

  • definition
  • cause
  • dx
  • sequelae
A
  • aggregates of denatured Hb adhered to the RBC cell membrane
  • cause - seen in G-6-P deficiency
  • dx - seen only on supravital dyes
  • sequelae - once plucked out of RBCs by spleen, remaining RBCs = “bite cells” (degmacytes)
67
Q

identify

characteristics, causes

A

bite cells (degmacytes)

  • characteristics
    • appear as if they have a “bite” taken out of them
    • on seen on wright-stained peripheral blood smear
  • cause - form after heinz bodies (hb-membrane protein aggregates d/t G-6-P deficiency) are removed by the spleen
68
Q

on what stains are heinz bodies / bite cells seen

A
  • heinz bodies - supravital stain (methylene blue)
  • bite cell - wright-stained peripheral blood smear
69
Q

identify

characteristics, causes

A

dacrocytes (tear-drop cells)

  • cause - fibrosis
    • primary - idiopathic myelofibrosis
    • also - myeloma / solid tumors
70
Q

identify

characteristics, causes

A

polychromasia

  • characteristics - blue-gray color of immature RBCs
  • cause - reticulocytosis: premature release of immature cells from marrow
    • regenerating marrow
    • hemolytic anemia
71
Q
A

polychromasia

wright-giemsa stain

72
Q

identify

characteristics, causes

A

= Howel-Jolly bodies

  • characteristic - small nuclear remnant present in RBC
  • cause
    • post-splenectomy state
    • anemias - hemolytic, megoblastic
73
Q

identify

characteristics, causes

A

pappenheimer bodies

  • characteristics - are iron-containing mitochondrial remnants
  • cause
    • sideroblastic anemia
    • post-splenectomy states
74
Q
A

basophillic stippling

RBCs composed of RNA (aggregates of lysosomes)

75
Q
A
  • irregular clumping of RBCs
  • cause - cold agglutination. IgM antibodies - often after m. tuberculosis infections) bind RBCs
    • type II hypersensitivity reaction
76
Q

identify

characteristics, causes

A
  • characteristics - RBCs stack like coins
  • cause - inc in certain + charge plasma proteins that > - charge from RBCs (glycophorins) → overwhelm zeta potential → agglutination
77
Q

post-splenectomy states can cause what kind of abnormal RBCs?

A
  • howell-jowell bodies: nuclear remnant
  • pappenheimer bodies: ferritin aggregates
78
Q

which abrormal RBC is normal in neonates?

A

howell-jowell bodies

PATH Heme-Onc (3 decks)

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