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Clinical Microscopy > Leukocytes > Flashcards

Leukocytes Flashcards

1
Q

These are colorless nucleated cells that circulate in the peripheral blood that seve as main line of defense against foreign antigens and are also called as white blood cells

A

Leukocytes

*found in bone marrow, peripheral blood, tissues

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2
Q

Leukocytes for antibody production and other activities of the immune response

A

immunocytes

lymphocytes

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3
Q

leukocytes which engulf and destroy

A

phagocytes

Neutrophils, eosinophils, basophils, monocytes

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4
Q

two major lineages of leukoycte formation

A

→ Myeloid: RBCs, platelets, granulocytes, monocytes

→ Lymphoid: Lymphocytes, NK cells

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5
Q

These are formed in the red bone marrow

A

Granulocytes, monocytes and few lymphocytes

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6
Q

These are formed in the lymph tissues

A

lymphocytes and plasma cells

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7
Q

formation of granulocytes within the bone marrow

A

Granulopoiesis

*Life span after release
→ 4-8 hours in blood
→ 4-5 days in tissues

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8
Q

What inhibits granulopoiesis?

A

→ Inhibited (negative feedback) by mature granulocytes and

the bone marrow microenvironment

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9
Q

When is granulopoiesis increased?

A

→ Increase ten-fold in patients with sustained infections or other inflammatory conditions

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10
Q

Genesis of lymphocytes

A

→ Lymphoblasts become T and B lymphocytes
→ Continuously enter blood and drain from lymphatic systems
→ In a few hours, goes back to tissues by diapedesis
→ Life span: weeks to months

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11
Q

What are the routine methods for identifying types of leukocytes?

A

→ Peripheral blood smear

→ Wright’s stain

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12
Q

[granulocytes in wright stain] basic; pink and reacts with eosin (-) which is an acidic dye

A

Eosinophils

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13
Q

[granulocytes in wright stain] Basophil reaction

A

acidic; purple-blue; reacts with methylene blue (+) which is a basic dye

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14
Q

[granulocytes in wright stain] neutrophil reaction

A

neutral; light pinkish purple or pink-tan

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15
Q

granulocytes and non-granulocytes

A 
Granulocytes (also polymorphonuclear)
Neutrophil 62%
Eosinophils 2.3%
Basophils 0.4%
Non-granulocytes (also mononuclear)
Monocyte 5.3%
Lymphocyte 30%
(plasma cells)
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16
Q

Criteria for identifying leukocytes

A 
• Cell size
• Nucleus-cytoplasm ratio (N/C)
→ High ratio: nucleus occupies most cell area with only small rim of cytoplasm
→ Low ratio: nucleus small in relation to volume of cytoplasm
• Cytoplasm characteristics
→ Color of background
→ Presence or absence of granules
→ Color and size of granules
• Nuclear characteristics
→ Shape
→ Color
→ Chromatin pattern
→ Presence or absence of nucleoli
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17
Q

a high ratio of nucleus-cytoplasm indicates

A

nucleus occupies most cell area with only small

rim of cytoplasm

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18
Q

size of neutrophils

A

uniform, 12-15 micrometers

nucleus with 2-5 lobes joined by solid filament

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19
Q

movement of neutrophils

A

amoeboid motion using pseudopodium (phagocytic)

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20
Q

life span of neutrophils

A

9-10 days (depends on passing from BM to PB into tissues)

  • BM-mitotic: 2-3 days; maturation and storage: 5-7 days
  • PB: 7 hours (circulating and marginal neutrophil pools)
  • tissues:2-3 days
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21
Q

mitotic “neutrophils” in bone marrow

A

myeloblasts, promyelocytes and myelocytes

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22
Q

[neutrophils] maturation and storage at bone marrow

A

metamyelocytes, bands and segmented

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23
Q

Maturation of neutrophils

A

Myeloblast, Promyelocyte,

Myelocyte, Metamyelocyte, Band Cell, Neutrophil Granulocyte

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24
Q

factor driving neutrophil maturation

A

G-CSF

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25
Q

characterizes maturation

A

→ Decreasing N/C ratio

→ Increasing granule production and nuclear segmentation

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26
Q

These precursors are confined to the bone marrow and with basophilic cytoplasm

A

Myeloblast (scant basophilic c.; in patients with myeloid leukemia, numerous myeloblasts)
Promyeloblast (bc with multiple azurophilic granules)
Myelocyte (abundant pink cytoplasm with azurophilic and specific ganules)

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27
Q

[Precursor cells of neutrophils]

most immature large cells and comprise 3% of nucleated cells (15-20 micrometers with 7-5:1 N/C ratio)

A

Myeloblast

  • may contain auer rods
  • round nuclei with clefts (one or more nucleoli)
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28
Q

[Precursor cells of neutrophils]

These are seen in blood in pathologic states

A

Promyeloblast (<2%)*
Myelocyte (10%)
Metamyelocyte (15-20%)- in response to stress
Band cell??

*with fine chromatin and distinct nucleoli

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29
Q

[Precursor cells of neutrophils] smaller cells (10-18 micrometers) with slightly indented nucleus, no nucleolus, with chromatin clumping

A

Myelocyte

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30
Q

[Precursor cells of neutrophils] Nucleus is indented, lacks nucleolus, with condensed chromatin with rare azurophilic or pink (primary) and many specific (secondary) granules are present

A

Metamyelocyte

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31
Q

[Precursor cells of neutrophils] comprise 1-3% of peripheral wbcs, smaller, 10-15 micrometers with many shaped nucleus and twisted/folded on itself (sausage/s/u like) with condensed nuclear chromatin with abundant pink cytoplasm with neutrophilic specific granules with few azurophilic granules

A

Band cell

*numerous = losing battle

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32
Q 
→ Predominant white blood cell
→ 10 to 15 micrometers in diameter
→ N:C ratio= 1:3
→ Nucleus is segmented or lobulated (2 to 5 lobes)
§ Connected by a thin filament
§ Condensed nuclear chromatin
§ Pale cytoplasm with specific granules
A

Segmented Neutrophils

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33
Q

Function of neutrophils

A
  • It mediates immune response against infectious agents.

* It has granules which aid in killing bacteria

34
Q

neutrophil granules which are smaller electron lucent and contain lactoferrin and lysozyme wc are formed in myelocytes

A

Secondary/specific granules

35
Q

neutrophil granules with gelatinase and alkaline phosphatases

A

Tertiary

36
Q

large, round, red-pink neutrophil granules which are formed in promyelocyte

A

Primary/Azurophilic

37
Q

These are found in primary granules

A

myeloperoxidase (can kill), elastase, lysozyme, cathepsin G, acid hydrolases

38
Q

neutrophil granules wc are considered as secretory vesicles

A

quaternary

39
Q

Mechanism of attacking and destroying bacteria by neutrophils

A

→ Enter the tissue spaces by diapedesis
→ Move through tissue spaces by amoeboid motion
→ Attracted to inflamed areas by chemotaxis
→ Engulf offending agent through phagocytosis
→ Granules discharge their contents (Hydrogen peroxide superoxide) into vacuole to digest

40
Q

These are <1% of WBCs which are characterized by its ability to be stained by basic dyes (purple- black)

A

basophils

  • 10-15 micrometers
  • band/lobed nucleus
41
Q

When are basophils increased in blood?

A

during myeloproliferative neoplasms, hypersensitivity reactions, hypothyroidism, iron deficiency and renal disease

42
Q

When are basophil progenitor cells increased?

A

atopic persons

*same maturation as neutrophils but nucleus does not segment

43
Q

These are factors which play a key role in basophil production

A

→ IL3 (main cytokine)

→ GM-CSF, IL4, IL5, stem cell factor

44
Q

Functions of basophils

A
  • Mediates allergic or hypersensitivity reactions
  • Granules contain histamine, mucopolysaccharides, peroxidase, chymase, tryptase, Charcot-Leyden crystal protein, PAF, and ECF-A
  • Some phagocytic activity
  • Role in host defense against helminths
45
Q

How do basophils mediate allergic or hypersensitivity reactions?

A

→ Liberate heparin (anticoagulant), histamine, bradykinin, serotonin and leukotrienes
→ Role in immediate hypersensitivity reactions (w/ specific receptors for IgE)
→ Role in delayed type hypersensitivity reactions (T cells activate basophils to release histamine)

46
Q

These are 1-4% of all WBCs whose granules stain deeply with orange-red eosin who survive longer in tissues than neutrophils found mostly in skin and mucosal surfaces of RT and GIT

A

Eosinophils

  • 10-15 micrometers with NC ratio 1:3 and 2 or more lobed nucleus connected by thin filament
  • same neutrophil maturation
47
Q

common progenitor of eosinophil, neutrophil and basophil

A

CFU-GM

48
Q

This induces eosinophil formation, enhances function and prolonged survival

A

IL5 growth factor

*other factors: IL1, IL3, IL9

49
Q

differentiate immature vs mature eosinophils

A
  • Immature: large blue granules

* Mature: refractive orange specific granules

50
Q

[Precursors of the Mature Eosinophil]
• immature or juvenile
• Horseshoe shaped nucleus

A

Eosinophilic band

51
Q

[Precursors of the Mature Eosinophil]
→ No cell division
→ Indented nucleus
→ Acidophilic granules

A

Eosinophilic metamyelocyte

52
Q

[Precursors of the Mature Eosinophil]
→ Primary and secondary granules
→ Round nucleus with coarse chromatin

A

Eosinophilic myelocyte

53
Q

[Precursors of the Mature Eosinophil]
→ Mature
→ Lobulated nucleus with chromatin thread

A

Eosinophil segmented

54
Q

functions of eosinophils

A

• Role in response to parasitic infections and allergic conditions
• Phagocytosis
• Respond to chemotactic factors
→ In immediate hypersensitivity, eosinophils drawn by
basophils and mast cells
• Immunomodulation of hypersensitivity reactions
→ Histaminases and arylsulfatase for the breakdown of enzymes
• Destruction of parasitic helminthes
→ Major basic protein function as a cytotoxin

55
Q

These comprise <1% of bone marrow cells, 0-10% in PB; largest of all leukocytes N:C=65-80%

A

Monocytes

*round with smooth margins or pseudopod-like cytoplasmic extensions with abundant light-blue cytoplasm with fine pink azurophilic granules

56
Q

Nucleus of monocytes

A

Large, bilobed, kidney shaped or U shaped nucleus with moderately clumped chromatin
*no nucleolus

57
Q

Life span of monocytes

A 
→ In BM - same progenitor cell with neutrophils
• Promonocyte first recognizable cell
• 30 – 48 hours
→ In peripheral blood
• 70 hours
→ In tissues
• Differentiate into macrophages
• Remain for several months
58
Q

monocytes are precursors of

A

most macrophages and dendritic cells

59
Q

Precursor cells of moncytes

A

Monoblast

Promonocyte

60
Q 
[Precursor cells of moncytes]
→ Actively dividing
→ More irregular nuclear contour
→ Less basophilic cytoplasm
§ Gray-blue cytoplasm with uniformly distributed azurophilic granules
→ Indented or lobulated nucleus
A

Promonocyte

61
Q

[Precursor cells of moncytes]
→ 12 – 20 microns
→ Moderate basophilic, agranular cytoplasm
→ May show pseudopod formation
→ Round / oval nuclei with fine chromatin and 1 – 4 large prominent nucleoli
§ May show indentations
→ N:C ratio: 4:1 to 3:1

A

Monoblast

62
Q

Functions of monocytes

A

• Part of innate immune system (Replenish macrophages and dendritic cells)
• Produce numerous regulatory cytokines
• Phagocytosis
• Chemotactic factors that attract monocytes
(Ag-Ab complexes, complement components, factors released by activated T lymphocytes)
• Differentiates to macrophages
→ Greater killing potency
→ APCs
→ Release various substances for inflammatory response, complement system, and pyrogens
• Granules

63
Q

Granules of lymphocytes contain

A 
→ Variety of lysosomal enzymes
• Acid phosphatase, β-glucoronidase, lysozyme, lipase, peroxidase
• Nonspecific esterases
→ Lysozyme released continuously
• Bacteriolytic enzyme
• Enhance effect of phagocytosis
• Potential antineoplastic effect
64
Q

These non-obligate end cells are distributed 15-60% in peripheral blood

A

Lymphocytes

  • heterogenous and pre-destined to migrate
  • size: 7-9 microns to 10-18 microns N/C: 1.5:1
65
Q

Nucleus characteristics of lymphocytes

A

→ Oval and slightly indented
→ Nuclear chromatin: markedly condensed
→ Nucleoli are absent and a definite nuclear membrane is present

66
Q

cytoplasm characteristics of lymphocytes

A

→ Light blue to blue with a perinuclear clear zone around the nucleus
→ Few azurophilic granules

67
Q

Where do lympocytes originate from?

A

bone marrow

68
Q

[Maturation of lymphocytes] Where does terminal differentiation of mature lymphocytes occur?

A

secondary lymphoid organs

69
Q

T or F: B:T cell ratio: proportion of B cells decreases as T cells
increases

A

true
→ Children: 2:1
→ 4 to 5 years old: 1:4-5
→ Adult levels are reached during adolescence

70
Q

Precursor cells of lymphocytes

A

lymphoblast (N/C: 6:1)
prolymphocyte (N/C: 5:1)

*both 10-18 microns in diameter

71
Q

[Precursor cells of lymphocytes] Round shape and stains reddish-purple nucleus with fine, well-distributed nuclear chromatin with one or more nucleoli present

A

lymphoblast

  • Deep blue cytoplasm with a frequent perinuclear clear zone
72
Q

[Precursor cells of lymphocytes] Oval and slightly indented nucleus with coarse and slightly clumped nuclear chromatin with one light blue nucleolus usually present

A

prolymphocyte

*Light blue to dark blue cytoplasm with few red-purple (azurophilic) granules

73
Q

functions of lymphocytes

A

• Play a major role in the maintenance of health and disease
→ Humoral immune response: Mature B cells
→ Cell-Mediated immune response: T/ NK cells
• Antigen recognition and generation of appropriate immune response
→ T cells: regulatory and effector functions
→ B cells: differentiate into plasma cells
→ NK cells: recognize and lyse tumor and virus-infected cells

74
Q

Provides relative percentage of each type of white blood cell and helps reveal abnormal WBC populations

A

WBC differential count

  • Each differential adds up to 100%
  • Specimen: Whole blood in EDTA
75
Q

Advantages of absolute count over relative counts

A

→ Gives more meaningful information
→ Useful for monitoring
→ Abnormal conditions can be identified

76
Q

Methods of WBC differential count

A 
Automated differential (uses fluorescence flow cytometry and electrical impedance;1000s)
Manual dbc (visual
examination of peripheral blood smear by trained personnel;1000-2000)
77
Q

What are difficult to identify in both methods of WBC differential count?

A

Band neutrophils and immature granulocytes

*also monocytes and basophil counts

78
Q

Disadvantage of both methods

A

cannot identify small numbers of abnormal cells and most difficult in id lymphoma cells and reactive lymphocytes

79
Q

→ Precision-made slide for performing manual cell counts with the aid of a microscope

A

Hemacytometers

80
Q

When are hemacytometers used?

see WBC count tinatamad na ako

A

→ Automated cell counters and hematology analyzers are unavailable
→ Blood cell counts are extremely low
→ To get a cell count for body fluids(spinal fluid, joint fluid, semen counts, and other bodily fluids)

Clinical Microscopy (10 decks)

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