WBC Flashcards
Pelger-Huet anomaly morphology
Look: Decrease nuclear segmentation, Bilobed forms
coarse chromatin, Round nuclei
Gene: Lamin-beta-receptor gene
Alder-Reilly anomally
Look: Granules with large, dark staining —> Incomplete degration of lipids
Mutation at: a-L-iduronodase
Chediak-Higashi syndrom
Look: Abnormal fusion of granules, giant lysosomal granules
Caused by: Lysosomal traffic regulation protein defect.
Affect: Decrease phagocytosis, Increase infection
Gene: CHS1 LYST gene
May-Hegglin anomaly
Look: Large Dohle body-like inclusion.
Caused by: Precipitated myosin heavy chain
Affect: Megakaryocyte maturation
Gene: MYH9
Chronic granulomatous disease
Look: normal
Caused by: Decrease ability to produce superoxide, reactive oxygen
Affect: Increase bacterial, fungal infection
Mutation: NADPH oxidase complex: X-link, autosomal recessive
Gaucher disease
Look: normal or Crinkled paper
Caused by: Accumulation of unmetabolized sphingolipid
Affect: Increase serum phosphatase, thrombocytopenia, Anemia
Mutation: beta- glucocerebrosidase
During exercise/adrenaline, which pool has more neutrophils?
Circulation
During infection/endotoxin/steroids, which pools has more Neutrophils?
Marginated pool
What hormone stimulate PMN from BM to PB?
G-CSF
A function of secretory granules of PMN?
Strengthen PMN
Function and examples of tertiary granules?
Movement through collagen
Activate IL-8 for recruits other PMN.
Function of Neutrophils
Fastest response to bacteria
- Release lysozymes
- Release defensin protein (~ antibiotic and poke a hole)
- Release strong oxidants
Function of myeloperoxidase in PMN?
NADH in phagosomal —> Hypochlorite
What enzyme convert reactive oxygens to hypochlorite
Myeloperoxidase
What forms bactericidal molecules
Primary and secondary granules
Function of primary and secondary granules
Fuse to membrane and release to act as chemotactic agents:
- attract macrophage
- attract other PMN
Side effect of a fusion of 1st and 2nd granules
damage tissue
Cytokines of Eosinophils
GM-CSF, IL3, IL5
Transcription factor: GATA-1
Eosinophils degranulationa
Classical exocytosis
Compound exocytosis
Piecemeal degranulation
Cytolysis
Function of Eosinophils
Control helminth infection through:
MBP
Cationic proteins
Reactive oxygen species
Function of basophils in immunity
IgE synthesis induction
Allergic inflammation
Regulate Th2
Parasite infection
Function of Basophils in blood vessel
Angiogenesis
through VEGF
Mast cell
12-25 um, elliptical shape
Chromatin condense
N:C = 1:5
No nucleoli, division
Life span of Mast cell
MCP in BM and spleen
Precursor in PB and then move to tissue
Prominent in lung and intestine
Function of Mast cell
Allergic reaction effector cell
Inflammatory reaction
APC
Anti-inflammatory and immunosuppressive
Monocyte function
TLR trigger phagocytes Synthesis NO to kill organism Fc & complement recceptor — APC — Pick up debris and recycle RBC — Synthesis proteins Aid EPO
Two type of DC
- Conventional: secrete IL-12, found on skin/mucosal, migrate to lymp
- Plasmacytoid: secrete IFN, found on lymphoid tissue
Lymphocytes
8-15um Nu: oval, perinuclear zone Chromatin: coarse N:C = 2:1 (or 1:1) Cytoplasm: darkly basophilic, no granules
Incidence of B cells and T cells
BM: 0.2-2.8% B cells
PB: Rare B cells, mostly T cells
Pelger-Huet anomaly - gene affected
Autosomal
Mutation in Lamin-b- receptor gene
How many PMN get affected in Pelger-Huet Anomaly
Homo: all
Hete: 55-93% neutrophils
How many PMN get affected in pseudo PHA
Less than 38%
How much BM accounts for body weight?
3.4% - 5.9%
what cells in yellow marrow
Adipocytes
Function of Red marrow
Primary source of hematopoiesis
Produce 6 bil Blood cells/kg/day
Cytopenia
Decrease of cells
Cytosis
Increase of cells
Normal range of MCV
80-100 fL
Ref. range of MCH
26-32 pg
Ref. range of MCHC
32-36 g/dL
Rules of Three
Hgb x 3 = HCT +/- 3
Preparation for BM sample collection
CBC and differential < 24 hrs
Fasting at least 6 hrs
BM specimen collection site
Posterior super iliac crest
2nd favorite is Sternum
BM Aspirate for making smear
Wright stain: morphology, differential, M:E ration
Prussian blue: Iron study
BM Aspirate for tube collection
- EDTA: flow cytometry, molecular
- Heparin: cytogenetics
- Culture
- 10% formalin: histologic examination
Advantage of BM Aspirate
Make smear immediately
Easy stained
M:E ration calculating
Disadvantage of BM Aspirate
Small sample
Dry taps
Cellularity estimate is not correct (100% - the pt’s age)
Dry tap?
Fibrotic, acellular, or packed with leukemic cells marrow
—> Collect BM biopsy if dry tap
BM core biopsy
Cylindrical core of tissue
BM core biopsy standard:
Length: 1.5 cm
Fit in 10% formalin for histologic examination
Prepare BM biopsy if dry tap
- Make touch prep slides
2. Cut into 3 pieces: 1 in 10% formalin, 2 in RPMI medium
advantage of BM biopsy
No dry tap
Good for cellularity
Minimal sampling error
Disadvantage of BM’s biopsy
Loss morphological features
Complicated process
Hard to stain (too thick)
Hematoxylyn and eosin stain
Standard dye for core biopsy
Evaluate cellularity and hematopoietic cell distribution
