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Y2 - HAEM > Physiology of blood cells and haematological terminology > Flashcards

Physiology of blood cells and haematological terminology Flashcards

1
Q

From where anatomically, do blood cells of all types originate?

A

Bone marrow

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2
Q

Qualitatively describe the stem cell hierarchy for blood cell development

A
  • Multipotent lymphoid-myeloid stem cells (multipotent haemopoietic stem cells)
  • This then either differentiates into myeloid stem cell / precursor or lymphoid stem cells
  • The myeloid stem cell / precursor then differentiates into granulocyte-monocyte, erythroid or megakaryocyte cells
  • Granulocytes (basophils, eosinophils and neutrophils) and monocytes are derived from myeloid stem cells via a myeloblast intermediate
  • Proerythroblasts from the myeloid lineage → erythroblasts → erythrocytes
  • Megakaryocytes give rise to platelets
  • Monocytes give rise to macrophages
  • Meanwhile the lymphoid stem cell differentiates into T-cells, B-cells or NK cells
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3
Q

What are 2 essential stem cell characteristics?

A
  1. Ability to self-renew
  2. Ability to produce mature progeny
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4
Q

Describe the maturation pathway past the myeloid stem cell / precursor stage to get to erythrocyte production

A
  1. Myeloid stem cell / precursor gives rise to a proerythroblast
  2. Proerythroblast gives rise to erythroblasts
  3. Erythroblasts give rise to erythrocytes
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5
Q

What are common cellular features of ‘-blasts’?

A
  • Large nuclei
  • Little cytoplasm
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6
Q

How does the appearance of the cytoplasm change throughout red cell differentiation?

A

The cytoplasm goes from dark blue to a more pink colour, as the mature red cell is completely pink

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7
Q

What is the process of producing red blood cells called?

A

Erythropoeisis

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8
Q

Erythropoeisis requires the presence of ….. which is synthesised mainly in the ….. …… cells of the ….. in response to ….., but is also partly made in the ….. ….. and ….. …..

A

Erythropoeisis requires the presence of erythropoeitin which is synthesised mainly in the juxtaglomerular interstitial cells of the kidneys in response to hypoxia, but is also partly made in the liver hepatocytes and interstitial cells

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9
Q

What is the process of triggering increased erythropoiesis?

A
  1. Hypoxia is detected by juxtaglomerular interstitial cells in the kidneys
  2. This stimulates increased erythropoeitin synthesis
  3. This increases bone marrow activity
  4. This leads to increased erythrocyte production
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10
Q

Where, and in what cells are erythropoeitin synthesised?

A
  1. Kidneys mainly - in the juxtatubular interstitial cell
  2. Liver - in the hepatocytes and interstitial cells
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11
Q

What is the lifespan of erythrocytes?

A

120 days

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12
Q

What is the maturation pathway for production of granulocytes and monocytes and what is needed for this pathway to occur (in the presence of what substances)?

A

Multipotent haemotopoietic stem cell (multipotent lymphoid-myeloid stem cell) gives rise to a myeloblast, which in turn gives rise to granulocytes and monocytes in the presence of cytokines such as G-CSF, M-CSF, GM-CSF and various interleukins

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13
Q

How long does the neutrophil granulocyte survive in the circulation before migrating to tissues?

A

7-10 hours

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14
Q

What is the main function of neutrophil granulocytes and how does it carry out this function?

A

Defence against infection - it phagocytoses and then kills micro-organisms

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15
Q

What does the nucleus of the neutrophil look like?

A

Multi-lobed nucleus (2-5)

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16
Q

What precursor are eosinophil granulocytes derived from?

A

Myeloblasts - this is the precursor to all granulocyte cells (neutrophil, eosinophil, basophils)

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17
Q

What spends longer in the circulation, neutrophils or eosinophils?

A

Eosinophils spend less time in the circulation than the neutrophil

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18
Q

What is the main function of eosinophils?

A

Defence against PARASITIC infection

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19
Q

What does the nucleus of the eosinophil look like?

A

2 lobes

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20
Q

What cell is the precursor to basophils?

A

Myeloblast precursors to the basophil granulocyte

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21
Q

What is the function of basophils?

A

Role in allergic response

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22
Q

What does the basophil look like and what does the nucleus look like?

A

Many deep-blue staining granules and a bi-lobed nucleus but the nucleus is hard to see through the granules

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23
Q

How long do monocytes spend in the circulation?

A

Several days

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24
Q

What do monocytes and their nuclei look like?

A
  • Large cells
  • Kidney bean shaped nucleus
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25
Q

Describe the function of monocytes

A
  • Monocytes migrate to tissues where they develop into macrophages and other phagocytic cell types
  • Macrophages also store and release iron
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26
Q

Outline the maturation pathway for platelet formation

A
  1. Multipotent lymphoid-myeloid stem cell gives rise to…
  2. Myeloid stem cell / precursor which gives rise to
  3. Megarkaryocytes which give rise to…
  4. Platelets
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27
Q

How long do platelets survive in the circulation, and what will that mean upon taking aspirin?

A
  • About 10 days
  • Taking aspirin will partly destroy the function of the platelets in circulation, so function doesn’t completely normalise until the platelets are replenished in 10 days
28
Q

Outline the function of platelets

A

Platelets have a role in primary haemostasis and they contribute phospholipid, which promotes blood coagulation

29
Q

Which cells do lymphoid stem cells give rise to ?

A

Lymphocytes:

  • T-cells
  • B-cells
  • NK cells
30
Q

1) Outline the circulation pathway of lymphocytes
2) What is the intravascular lifespan of lymphocytes?

A

1) Lymphocytes recirculate to lymph nodes and other tissues and then back to bloodstream
2) Intravascular life span is very variable

31
Q

Define asinocytosis

A

‘Red cells show more variation in SIZE than is normal’

32
Q

Define poikilocytosis

A

Red cells show more variation in SHAPE than is normal

33
Q

1) Define microcytosis
2) Define microcyte
3) What is microcytic anaemia?

A

1) ‘Red cells are smaller than normal’
2) A small RBC
3) An anaemia with small RBCs

34
Q

1) Define normocytosis
2) What is normocytic anaemia?

A

1) Normal sized RBCs
2) Anaemia with normal sized RBCs

35
Q

1) Define macrocytosis
2) Define macrocyte
3) What is macrocytic anaemia

A

1) ‘Red cells are larger than normal’
2) Small RBCs
3) An anaemia with large RBCs

36
Q

What type of cell do you use as a reference measure to measure the size of erythrocytes against to determine micro/macrocytosis?

A

Lymphocytes

37
Q

What is central pallor and what causes it?

A
  • Where normal cells have roughly a third of the diameter which is pale
  • This is a result of the disc shape of the RBCs - the centre has less haemoglobin and is therefore paler
38
Q

1) Define hypochromia
2) What causes hypochromia?
3) Hypochromia and … often go together

A

1) A condition characterised by RBCs have a larger area of central pallor than normal
2) Lower haemoglobin content and concentration and a flatter cell
3) Hypochromia and microcytosis often go together

39
Q

1) Define hyperchromia
2) What causes hyperchromia?

A

1) A condition characterised by RBCs lacking central pallor
2) Due to thicker or abnormally shaped RBCs

40
Q

What are the only 2 important types of hyperchromatic cells, describe what they look like and describe what causes these types of cells to arise (and in what conditions if applicable)?

A
  1. Spherocytes
  • Spherical shape with round, regular outline and with lack of central pallor
  • Results from loss of cell membrane without loss of an equivalent amount of cytoplasm - forming a spherical cell shape
  • Hereditary spherocytosis
  1. Irregularly contracted cells
  • Irregular in outline and smaller than normal cells, with lack of central pallor
  • Results from oxidant damage to the cell membrane and to the haemoglobin
41
Q

Define polychromasia, and what does polychromasia indicate?

A
  • ‘An increased blue tinge to the cytoplasm of a red cell’
  • Indicates cells are young - e.g. reticulocytes
42
Q

1) What is a reticulocyte?
2) Name a reticulocyte stain, and how this stain precipitates?
3) What will this reticulocyte stain display?

A

1) RBCs younger than mature RBCs
2) Methylene blue - precipitates as a network or ‘reticulum’
3) Polychromasia

43
Q

Detecting polychromasia or increased number of reticulocytes gives you similar information, which is more reliable?

A
  • Counting reticulocytes is more reliable
44
Q

List 6 types of Poikilocytes?

A
  1. Spherocytes
  2. Irregularly contracted cells
  3. Sickle cells
  4. Target cells
  5. Elliptocytes
  6. Fragments
45
Q

1) What are target cells?
2) In what conditions do target cells appear?

A

1) Cells with an accumulation of haemoglobin in the middle of the central pallor

2)

  • Obstructive jaundice
  • Liver disease
  • Haemoglobinopathies
  • Hyposplenism
46
Q

1) What are elliptocytes?
2) In what conditions do elliptocytes appear?

A

1) Elliptical RBCs
2) Occur in:

  • Hereditary elliptocytosis (top pic)
  • Iron deficiency (bottom pic) - note that hypochromia also in iron deficiency elliptocytes so you can differentiate from cells from hereditary elliptocytosis
47
Q

1) What are sickle cells?
2) What is the pathophysiology of sickle cell?

A

1) Sickle-shaped RBCs
2) Result from polymerisation of haemoglobin S when it is present in a high concentration

48
Q

1) What are fragments and what do they look like?
2) Another name for fragments?

A

1) Fragments from fragmented RBCs. They still have the red colour and sometimes even the central pallor - its just a different shape
2) Schistocytes

49
Q

1) What is Rouleaux and what does it resemble?
2) What causes it?

A

1) Stack of RBCs that resembles a pile of coins
2) Alterations in plasma proteins - increased plasma proteins, pushing the cells together

50
Q

1) What is agglutinates and how does it look, including how it differs from how Rouleaux looks?
2) What causes agglutinates?

A

1) Irregular clumps of RBCs, as opposed to the tidy stacks seen in Rouleaux
2) Antibodies (often IgM) on CSM of the RBCs - these cause the cells to stick together

51
Q

1) What is a Howell-Joly body?
2) What do Howell-Joly bodies look like on a blood film?
3) What is the commonest cause of Howell-Joly bodies?

A

1) A nuclear remnant in a red cell
2) Precise and distinct dots
3) Lack of splenic function (hyposplenism) - the spleen should normally remove these tiny remaining bits of nuclear material

52
Q

Define leucocytosis

A

‘Too many white cells’

53
Q

Define leucopenia

A

‘too few white cells’

54
Q

Define neutrophilia

A

‘Too many neutrophils’

55
Q

Define neutropenia

A

‘Too few neutrophils’

56
Q

Define lymphocytosis

A

‘Too many lymphocytes’

57
Q

Define eosinophilia

A

‘Too many eosinophils’

58
Q

Define thrombocytosis

A

‘Too many platelets’

59
Q

Define thrombocytopenia

A

‘Too few platelets’

60
Q

Define erythrocytosis

A

‘Too many RBCs’

61
Q

Define reticulocytosis

A

‘Lots of reticulocytes’

62
Q

Define lymphopenia

A

Decrease in number of lymphoctyes

63
Q

1) How do lymphocytes generally look normally and how do atypical lymphocytes look?
2) How does the appearance of atypical lymphocytes differ to that of blasts?
3) In what condition are atypical lymphocytes often seen, and in this case, what is an alternative name given to them?

A

1) Small and round with a large nucleus and little cytoplasm

2)

  • HUGE nuclei and LOADS of cytoplasm
  • Different to blasts because blasts only have huge nuclei and little cytoplasm

3) Glandular fever → infectious mononucleiosis - atypical mononuclear cell

64
Q

Describe the change in appearance of cells in the maturation pathway to forming neutrophils

A
  1. Start off with a big cell with a big nucleus and then loads of granules appear
  2. Then the nucleus shrinks more and more
  3. Nucleus becomes squashed to assume a ‘band shape’ in band form neutrophil precursors
  4. The nucleus then segments to be multi-lobed
65
Q

1) What is left-shift in neutrophil development?
2) What does left-shift indicate?

A

1) An increase in non-segemented neutrophils (many band-form neutrophil precursors) or the presence of lots of neutrophil precursors in the blood
2) Suggests you are fighting an infection because it shows the bone marrow is chucking out lots of lymphocytes

66
Q

1) What is toxic granulation
2) How does it appear in a blood film?
3) Give 1 physiological cause and 3 pathological causes

A

1) Heavy granulation of neutrophils
2) Dense arrangement of granules

3)

Physiological:

  • Pregnancy

Pathological:

  • Infection
  • Inflammation
  • Tissue necrosis
67
Q

1) What are hypersegmented neutrophils?
2) What causes these?

A

1) Increase in the average number of neutrophil lobes or segments

2)

  • Vitamin B12 deficiency
  • Folic acid deficiency

Y2 - HAEM (11 decks)

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