WBCs Flashcards
Nucleated cells that function in body defense
WBCs (White Blood Cells)
Reference range for adult WBC count
4.5 to 11.0 X 10⁹/L (SI) [or 4,500 to 11,000 /mm³ (conventional)]
Reference range for newborn WBC count
13.5 to 38.0 X 10⁹/L (SI) [or 13,500 to 38,000 /mm³ (conventional)]
Predominant WBC in adults
Neutrophils
Predominant WBC in children <4 years
Lymphocytes
Most valuable and reliable criterion for WBC maturity
Nuclear chromatic pattern
Granulocytes classification
Basophils, Eosinophils, Neutrophils
Agranulocytes classification
Lymphocytes, Monocytes
Polymorphonuclear WBCs
Basophils, Eosinophils, Neutrophils
Mononuclear WBCs
Lymphocytes, Monocytes
Phagocytic WBCs
Basophils, Eosinophils, Neutrophils, Monocytes
Immunocytes classification
Lymphocytes (B and T cells)
Granulocytic series maturation
Nuclear chromatin condenses, nucleoli disappear, cytoplasm becomes less basophilic, specific granules appear
Granulocytic series nuclear changes during maturation
Nucleus indents and becomes segmented, overall cell size decreases (except promyelocyte)
Size and characteristics of myeloblasts
14 to 20 μm, earliest recognizable granulocytic precursor, 0 to 3% of nucleated cells in bone marrow
Type I myeloblasts characteristics
Nucleus occupies most of the cell, very little cytoplasm, slightly basophilic cytoplasm, fine nuclear chromatin, 2-4 visible nucleoli, no visible granules
Type II myeloblasts characteristics
Dispersed primary (azurophilic) granules in cytoplasm (≤20 granules per cell)
Type III myeloblasts characteristics
Darker chromatin, more purple cytoplasm, >20 granules that do not obscure the nucleus, rare in normal bone marrow, seen in acute myeloid leukemias
Size and characteristics of promyelocyte
16 to 25 μm, 1 to 5% of nucleated cells in bone marrow, larger than myeloblast, round to oval nucleus, often eccentric
Hof in promyelocyte
Hollow in cytoplasm where nucleus lodges, present in normal promyelocytes, absent in malignant promyelocytes of acute promyelocytic leukemia
Cytoplasm characteristics of promyelocyte
Evenly basophilic, filled with primary (azurophilic/nonspecific) granules
Nucleoli in promyelocyte
1 to 3 nucleoli, may be obscured by granules
Synthesis of primary granules begins in which cell?
Promyelocyte (TYPE II MYELOBLAST - BEST ANSWER)
Last stage of granulocyte maturation capable of mitosis
Myelocyte
Synthesis of secondary (specific) granules occurs in which stage?
Myelocyte
Early myelocyte appearance
Patches of grainy pale pink cytoplasm representing secondary granules in Golgi area (Dawn of Neutrophil)
Late myelocyte appearance
Smaller than promyelocytes, nucleus with more heterochromatin, nucleoli difficult to see
Stage after myelocyte
first stage of nuclear indentation
Characteristic appearance of metamyelocyte nucleus
Peanut or kidney bean shape with indentation <1/2 of nuclear width
Synthesis of tertiary granules (gelatinase granules) begins in which stage?
Metamyelocyte
Stage after metamyelocyte
first appearance in peripheral blood
Appearance of band cell nucleus
Elongated, curved, or sausage-shaped with rounded ends
Difference between band cell and segmented neutrophil
Filaments NOT present in band cells
Recommendation for reporting bands in peripheral blood
Include in neutrophil counts, not separate category
Increase in neutrophil level in the blood
Neutrophilia
Conditions associated with neutrophilia
Bacterial infections, appendicitis, rheumatoid arthritis, pancreatitis, colitis, MI, severe hemolysis, trauma, parasites, lithium, chemicals, drugs, myelogenous leukemia, venoms, actinomyces fungi
Cause of physiologic neutrophilia (Pseudoneutrophilia)
Shift of marginated cells to the circulatory pool (exercise, temp changes, nausea, pregnancy, stress)
Decrease in neutrophil level in the blood
Neutropenia
Conditions associated with neutropenia
Overwhelming infections, splenomegaly, hemodialysis, copper deficiency, alcoholism, babies born to hypertensive mothers, chemical toxicity, marrow replacement, nutritional deficiencies, cytotoxic drugs
Extreme neutropenia (Agranulocytosis) neutrophil count
<0.5 x 10^9/L
Drugs associated with agranulocytosis (extreme neutropenia)
Amidopyrine, cephalosporin
Increased level of eosinophils in the blood
Eosinophilia
Conditions associated with eosinophilia
Asthma, hay fever, psoriasis, eczema, scarlet fever, eosinophilic leukemia, parasitic infections
Moderate to severe eosinophilia is most commonly associated with
Helminthic infections (parasitic worms including nematodes, trematodes, cestodes)
Decreased level of eosinophils in the blood
Eosinopenia
Conditions associated with eosinopenia
ACTH administration, autoimmune disorders, steroid therapy, stress, sepsis, acute inflammatory states
Parasitic infection with highest eosinophil count
Trichinosis (T. spiralis)
Increased basophil count in the blood is called
Basophilia
Conditions associated with basophilia
Immediate hypersensitivity reactions, hypothyroidism, ulcerative colitis, estrogen therapy
Decreased basophil count in the blood is called
Basopenia
Conditions associated with basopenia
Acute infections, stress, hyperthyroidism, increased glucocorticoids, chronic urticaria
Stage of neutrophil maturation
Myeloblast, Promyelocyte, Myelocyte, Metamyelocyte, Band, Segmented
N:C ratio in Myeloblast
0.16736111111111107
N:C ratio in Promyelocyte
0.12569444444444455
N:C ratio in Myelocyte
2:1 to 1:1
N:C ratio in Metamyelocyte
0.04236111111111107
N:C ratio in Band
0.04236111111111107
N:C ratio in Segmented
0.04236111111111107
Nuclear chromatin in Myeloblast
Reticular
Nuclear chromatin in Promyelocyte
Smooth
Nuclear chromatin in Myelocyte
Slightly clumped
Nuclear chromatin in Metamyelocyte
Clumped
Nuclear chromatin in Band
Very clumped
Nuclear chromatin in Segmented
Densely packed
Cytoplasm amount in Myeloblast
Scanty
Cytoplasm amount in Promyelocyte
Slightly increased
Cytoplasm amount in Myelocyte
Moderate
Cytoplasm amount in Metamyelocyte
Moderate
Cytoplasm amount in Band
Abundant
Cytoplasm amount in Segmented
Abundant
Cytoplasm color in Myeloblast
Medium blue
Cytoplasm color in Promyelocyte
Moderate blue
Cytoplasm color in Myelocyte
Blue-pink
Cytoplasm color in Metamyelocyte
Pink
Cytoplasm color in Band
Pink
Cytoplasm color in Segmented
Pink
Stage in Lymphocytic series
Lymphoblast, Prolymphocyte, Mature Lymphocyte
Size of Lymphoblast
15 to 20 μm
Size of Prolymphocyte
15 to 18 μm
Size of Small Mature Lymphocyte
6 to 9 μm
Size of Large Mature Lymphocyte
17 to 20 μm
N:C ratio in Lymphoblast
0.16736111111111107
N:C ratio in Prolymphocyte
4:1 to 3:1
N:C ratio in Small Mature Lymphocyte
4:1 to 3:1
N:C ratio in Large Mature Lymphocyte
0.08402777777777781
Small lymphocyte characteristics
Predominant type in normal adult blood, composed mostly of nucleus, scanty cytoplasm
Increased level of lymphocytes in blood
Lymphocytosis
Decreased level of lymphocytes in blood
Lymphopenia/Lymphocytopenia
Conditions associated with lymphocytosis
Infectious mononucleosis, Infectious lymphocytosis, Cytomegalovirus infection, Acute viral hepatitis, Bordetella pertussis infection, Brucellosis, Toxoplasmosis, Acute HIV infection
Conditions associated with lymphocytopenia
Aplastic anemia, AIDS, SARS, Ethanol abuse, Zinc deficiency
Plasma cells (10 to 28 µm)
Final maturation stage of B lymphocytes
Plasma cell nucleus characteristics
Small, oval, and eccentric; tortoise shell, cartwheel, or clock face appearance
Plasma cell cytoplasm characteristics
Dark blue, sea blue, or cornflower in color; may contain Russel bodies with immunoglobulins
Most common malignant disease of plasma cells
Plasma cell myeloma (multiple myeloma)
Monocytic series stages
Monoblast, Promonocyte, Mature Monocyte
Monoblast size
12 to 20 µm
Promonocyte size
12 to 20 µm
Mature Monocyte size
12 to 18 µm
Monoblast N:C ratio
0.16736111111111107
Promonocyte N:C ratio
3:1 to 2:1
Mature Monocyte N:C ratio
2:1 to 1:1
Monocyte characteristics
Slightly immature cell (immature macrophage)
Increased (↑) level in blood
Monocytosis
Decreased (↓) level in blood
Monocytopenia
Associated conditions of monocytosis
Tuberculosis, Subacute Bacterial Endocarditis, Syphilis, Protozoal and rickettsial infections (malaria, typhus), Brucellosis, Typhoid, Gaucher disease, Hodgkin’s disease, Collagen vascular diseases (lupus erythematosus), Gastrointestinal disease, Surgical trauma
Associated condition of monocytopenia
Aplastic anemia, Overwhelming infections in immunocompromised patients, Hemodialysis, Epstein-Barr virus infection, Steroid therapy
Passing through blood to tissues
Diapedesis
Macrophages
Size: 40 to 50 μm
Macrophages origin
Derived from monocytes found in tissues
Macrophages functions
Phagocytosis, Synthesize nitric oxide (cytotoxic against viruses, bacteria, fungi, protozoa, helminths, tumor cells), Release interleukin 1 (stimulates T lymphocytes), Produce transcobalamin II (primary transport factor for vitamin B12)
Transcobalamin II function
Vitamin B12 transport in the blood, binds vitamin B12 after it is liberated from intrinsic factor in the enterocyte
Vitamin B12 plasma binding
10 to 30% of vitamin B12 bound to transcobalamin II (holoTC), 75% bound to transcobalamin I and III (haptocorrins)
Active form of Vitamin B12
Holotranscobalamin (holoTC), the metabolically active form
Liver
Kupffer cells
Lungs
Alveolar macrophages (Dust cells)
Kidneys
Renal macrophages (Mesangial cells)
Brain
Microglial cells
Skin
Langerhans cells (different from pancreatic Islet of Langerhans)
Spleen
Splenic macrophages (Littoral cells)
Intestines
Intestinal macrophages
Peritoneum
Peritoneal macrophages
Synovial tissue
Type A cells
Reproductive organs
Reproductive organ macrophages
Bone
Osteoclast
Placenta
Hoffbauer cells
Lymph nodes
Dendritic cells