Lecture 3: Hematopoiesis and Intro to Peripheral Blood Flashcards
Be able to draw the major hematopoietic lineages
Ok
Where does hematopoiesis occur?
early fetus - yolk sac middle fetus - liver birth - bone marrow before puberty - all skeleton after puberty - mostly axillary bone (torso and face)
What characterizes normal bone marrow histology ?
What happens to bone marrow cells as we age?
- “field of flowers”, no one cell type predominates
- becomes hypocellular and has more adipose tissue
What are the major Hematopoietic growth factors
CSF (myeloids)
Cytokines
EPO (RBCs)
TPO (platelets)
What do these do? Stem cell factor (SCF) IL3 IL6 IL2 IL2/6 together
- general stimulating factor
- general stimulating factor
- megakaryocyte and neutrophil production
- T cell growth factor
- B cell growth factor
What do these do?
GM-CSF
G-CSF
M-CSF
- formation of all leuks and reticulocytes
- stimulates neutrophil increase, used to treat neutropenia
- stimulates monocyte and macrophage increase
How does kidney disease cause anemia?
Kidney makes the EPO. If dysfunctional, can’t stimulate RBCs to mature = anemia
Progression stages of erythrocyte maturation
Be able to identify images of each stage
Proerythroblast - large and round, basophilic
Basophilic erythroblast - smaller, basophilic
Polychromatophilic erythroblast - basophilic ribosomes with eosinophilic cytoplasm
Normoblast - eosinophilic
Nucleated
What happens to reticulocyte count in hemolytic anemias?
Be able to identify reticulocyte image
Increased, with increased RDWs
Progressions stages of granulocyte maturation
Be able to identify images of each stage
Myeloblast - basophilic
Promyelocyte - more large granules
Myelocyte - lots of fine granules
Metamyelocyte - bean shaped eosinophilic nucleus
Be able to identify images of mature T cell and Plasma cell
Ok
Progression stages of platelet maturation
Be able to identify images of each stage
Megakaryoblast: large with kidney shaped basophilic nucleus
Megakaryocyte: large multilobal nucleus, endomitosis
Platelet: small platelets break off larger cell
Difference between monocyte, macrophage and activated macrophage
Monocyte: intravascular
Macrophage: enteres the intravascular space
Activated: specific cell macrophage (microglia, Kupffer, alveolar Ms, osteoclasts)
What do these measure? Hgb Hct RBC Reticulocyte percentage RDW
- conc of Hgb
- volume & % of RBCs
- number of RBCs
- % of RBCs that are reticulocytes
- width distribution
What do these mean? MCV (Mean corpuscular volume) MCH (Mean corpuscular hemoglobin) MCHC (Mean corpuscular hemoglobin concentration) RPI (Reticulocyte production index)
- average volume of RBC
- average mass of hgb
- conc of Hgb in given volume
- corrected reticulocyte %
Terminology: Anisocytosis Poikilocytosis Emia/Enia means? Cythemia/philia/cytosis means?
- increased RDW (size variation)
- more shape variation
- low
- high
Sx of Iron deficiency anemia
Causes of iron deficiency anemia
- fatigue/dizzy or weak, HA, pale/yellowness, arrythmia, SOB, CP, cold hands and feet
- diet (cow’s milk) or decreased absorption (sprue, gastrectomy), chronic iron or blood loss
Describe the blood smear of iron deficiency anemia
- microcytotic & hypochromic, increased RDW
- decreased MCV, MCH, MCHC, RBC, HCT and reticulocytes
- Poikilocytosis with eliptocytes and target cells (bulls-eye looking cells)
What types of anemia are caused by lack of iron?
Iron deficiency anemia
Anemia of chronic disease
Sideroblastic anemia
What type of anemia is caused by folate or B12 deficiency?
What type of anemia is caused by drugs?
- Macrocytic anemia»_space;> deficient DNA synthesis
- Aplastic anemia (via pancytopenia)
Hemoglobinopathies
G6PD deficiency
Autoimmune hemolytic anemia
- Hgb synthesis problems»_space;> RBC destruction
- inability to deal with oxidant stress > hemolysis
- autoantibodies destroying RBCs
What are the types of microcytic anemia?
ITAS
IDA
Thalassemia
Anemia of Chronic Dz
Sideroblastic anemia
What are the types of macrocytic anemia?
Megaloblastic anemia (low B9 or B12) Alcoholic liver dz
What are the types of normocytic anemia (with high reticulocyte count)?
GHAPS
G6PD deficiency Hereditary Spherocytosis Autoimmune Hemolytic Anemia Paroxysmal Nocturnal Hemoglobinuria Sickle-Cell anemia
*the rest is normo with low reticulocyte count
