MLS Unit 1 Exam

45% cells

red, blood, platelets

Hematopoeisis

ALL blood cells, so red and white blood cells but NOT platelets since they are not cells.

• fetal liver ——> RED bone marrow

• only accounts for 1% of bone marrow but the stem cells can regenerate in the bone marrow after an injury.

• Hematopoeisis also occurs in liver and spleen which is extramedullary usually when the bone marrow fails.

Pluripotent stem cells

are stimulated by cytokines, interleukins, and hormone

Myeloid

G - granulocytes (eosinophils, basophils, neutrophils)

E - Erythrocytes

M - megakaryocyte

M - macrophage

Macrophages

go to the spleen to mature

Megakaryocytes

stay in the bone marrow and the platelets are released into the bloodstream

Both T and B can be found

mostly in the lymph node but also in the peripheral blood

RBC

• begins as a nucleated cell within the bone marrow

As the RBC matures

• The cellular diameter decreases

•The nucleus becomes denser and smaller, and

•The nucleus is finally released from the cell (extruded) to

become an anuclear biconcave disk.

Erythroprotein

stimulates the pluripotent cell to become a committed erythroblast

• glycoprotein in response to low levels of oxygen hypoxia

  ● Accelerates the rate of mRNA and protein

  (hemoglobin) synthesis,

• Decreases the time for the maturation of

  orthochromatic normoblasts,

• Stimulates the premature release of

immature RBCs, reticulocytes and orthochromatic normoblasts,

from the bone marrow,

• Increases the rate of extrusion of an RBC

nucleus (enucleation) in the later stage of RBC maturation.

Orthochromic normoblast

nucleated RBC

Polychromatic erythrocyte

reticulocyte

• anucleated

Pronormoblast

Percent in bone marrow: 1%

● Hours in bone marrow: 12 hours

● Overall size: 12 to 20 micrometers

● Nucleus to cytoplasm ratio: 8:1

● Nucleus: Round to oval shape with 1 or 2 nucleoli;

chromatin has fine clumps

● Cytoplasm: Intensely blue

Basophilic normoblast

Percent in bone marrow: 1% to 4%

● Hours in bone marrow: 20 hours

● Overall size: 10 to 15 micrometers

● Nucleus to cytoplasm ratio: 10:1

● Nucleus: Some chromatin clumping, no (or 1) nucleoli

● Cytoplasm: deeper, richer blue than blast

Polychromatic normoblast

Percent in bone marrow: 10% to 20%

● Hours in bone marrow: 30 hours

● Overall size: 10 to 12 micrometers

● Nucleus to cytoplasm ratio: 4:1

● Nucleus: No nucleoli, clumpy chromatin

Orthochromic normoblast

Percent in bone marrow: 5% to 10%

● Hours in bone marrow: 48 hours

● Overall size: 8 to 10 micrometers

● Nucleus to cytoplasm ratio: 1 to 2

● Nucleus: Nucleus is almost or completely pyknotic;

incapable of DNA synthesis

● Cytoplasm: Pink-orange; slightly bluish hue

Polychromatic erythrocyte

After a few days in the bone marrow as

reticulocytes, the RBCs squeeze through an opening

in the endothelial lining of the marrow cavity and enter

the peripheral circulatory system.

● The number of reticulocytes (percentage) in the

peripheral blood is an indication of the degree of RBC

production by the bone marrow.

Reticulocyte

Become fully mature within 1 or 2 days in the circulating blood and all RNA disappears

24-48 hours in bone marrow.

bluish hue

Heme consists of two things

Fe2+, protophyrin ring

Porphyrin ring

is excreted from the body as bilirubin.

Carbaminohemoglobin

Hb returning to the lungs with CO2 from tissues

As erythrocytes age

• The concentration of cellular hemoglobin increases.

● Enzyme activity, particularly glycolysis, diminishes.

● When these changes reach a critical point, the RBC

is no longer able to move through the

microcirculation

Worn out RBCs

are removed by the mononuclear phagocytic system (spleen)

Extravascular catabolism

aged or abnormal RBCs are removed by splenic or

hepatic macrophages

● Normal physiologic function

Intravascular catabolism

• Destruction of RBCs within the blood vessels

● Normal in small amounts

● Abnormal ex. complement destruction, disseminated

intravascular coagulation, thrombotic

thrombocytopenic purpura, heart prosthetics

Increased hemoglobin present in intravascular catabolism

damage to kidney

Increased hemoglobin catabolism (intra- and

extravascular

can be seen with increased levels of birubilin (jaundice)

Sickle cell anemia

Hemolytic anemia

Mean Corpuscular Hemoglobin

indicates average weight of hemoglobin per cell (pg)

MCV range

80 - 100 fL

MCH range

27.5 - 33.2

MCHC

33.4-35.5

Normochromic-normocytic anemias

• peripheral blood film

• the cells are produced are normal but the NUMBER IS REDUCED

• Blood LOSS

Macrocytic anemia

hypersegmented mature neutrophils in the peripheral blood

Hypochromic microcytic anemia

• MOST common

• increased requirements during lactation, pregnancy, infancy

• has globin deficiencies

• Can also result from disorders in globin synthesis, porphyrin synthesis, and heme synthesis

Hypochromic-microcytic anemia - globin

Thalassemias, a group of inherited disorders of Hb

synthesis.

● Disorder in the rate of globin synthesis

● Must differentiate between 𝛂 or 𝛃 Thalassemia

● Alpha Thalassemia (1 - 4 gene deletion)

● Beta Thalassemia (1 or both gene mutatio

• thalassemia minor = INCREASED RBC

Hemolytic anemia

RDW is greatly increased in hemolytic anemia because of anisocytosis = and poikilocytosis.

• Classified as acquired or congenital

Anisocytosis

Difference in size

poikilocytosis.

difference in shape of membrane

Most severe form of G6PD deficiency is

acute hemolytic anemia, exposed to a drug or have an infection

Band features

Overall size: 10 to 16 micrometers

● Nucleus to cytoplasm ratio: 1:1

● Nuclear characteristics: Elongated, curved

● Cytoplasmic characteristics: Specific blue-pink

granules

Band neutrophils

The band neutrophil is a younger form of the mature

neutrophil.

● Band neutrophils resemble segmented cells except for

the shape of the nucleus. An increase in their numbers

is significant.

Characteristics of neutrophils

• contain several digestive enzymes that are able to destroy many types of bacteria.

• The cells are capable of random locomotion and

can be directed to an area of infection by the

process of chemotaxis.

• They move back and forth between the general

blood circulation and the walls of the blood

vessels, where they accumulate.

Eosinophil

Overall size: 10 to 16 micrometers

● Nucleus to cytoplasm ratio: 1:1

● Nuclear characteristics: Distinct lobes (usually bilobed, occasional three lobes)

● Cytoplasmic characteristics: Orange (acidophilic) granules

• Slightly larger than neutrophils,

• active in allergic reactions and

certain parasitic infections, especially those

involving parasitic invasion of the tissue

Basophil

Overall size: 10 to 16 micrometers

● Nucleus to cytoplasm ratio: 1:1

● Nuclear characteristics: Distinct lobes, but can vary in shape (lobular to slightly indented)

● Cytoplasmic characteristics: Blue-black granules

• irregularly shaped nucleus

• cytoplasm is usually colorless

Monocyte

Mature monocyte

• Overall size: 12 to 18 micrometers

• Nucleus to cytoplasm ratio: 2:1 to 1:1

Monocytes remain in the peripheral blood for hours to days after leaving the bone marrow.

● They are motile, phagocytic cells, but they do not die after they engage in phagocytic activity (neutrophils do die)

• indented nucleus

• auzurophilic granules

Lymphocyte

Overall size

• Small: 6 to 9 micrometers

• Large: 17 to 20 micrometers

• Nucleus to cytoplasm ratio

• Small: 4:1 to 3:1

• Large: 2:1

• Nuclear characteristics: Round or oval

• Cytoplasm characteristics: Light blue; few

azurophilic granules may be presen

B lymphocyte

generation of mature, end stage, non-motile cells

Auer rods

Slender, rod-shaped bodies found in the

cytoplasm of myeloblasts or monoblasts

Leukamoid reaction

Leukamoid reaction: primary cells affected are neutrophils, a shift to the left so more immature cells. NON-malignant, NO blasts

Barr bodies

Small knob attached to neutrophil nucleus;

thought to be an inactivated X chromosome

May-Heggelin anomaly

Blue inclusion bodies seen in neutrophils

Chediak Higashi Syndrome

Syndrome is inherited, rare, autosomal recessive, close relatives, decrease in phagocytosis

Acute myelocytic (acute non-lymphoblastic

leukemia, ANLL) leukemia (AML

Blast # greater than or equal to 20%

Chronic myeloproliferative disorders, including

chronic myelogenous leukemia (CML

Blast # less than 20%. Chronic can become acute

Acute lymphoblastic leukemia

Typically in younger populations

Malignant changes - changes other than leukemia

• Plasma cell dyscrasias such as multiple

myeloma

• Hodgkin disease

• Non-Hodgkin malignant lymphomas

• Unusual tumors

Hemostasis

balances numerous interdependent coagulation factors that prevent bleeding

• thrombus plug

Primary hemostasis

FOrmation of a platelet plug

Secondary hemostasis

• blood clot

• thrombus

• stop the bleeding

Unbalanced hemostatic system

Thrombosis

platelet-derived growth factor.

The endothelium of blood vessels is repaired and maintaine

Normal Platelet Count

150-450×10^9 /L

Thrombocytopenia causes

Heparin therapy, alcoholic liver disease, after the use of extracorporeal circulation

Echhysmosis

Excessive bruising

Petechiae

Small hemmoraghic spots

Quantitative platelet disorders are caused by

drug-induced dysfunction most commonly due to aspirin

ingestion,

● uremia due to renal dysfunction,

● liver disease,

● acquired or inherited von Willebrand disease or

● paraneoplastic platelet dysfunction associated with plasma cell

dyscrasias, e.g., multiple myeloma

Factor 1

Fibrinogen

Factor 2

Prothormbin

Factor 3

Tissue thromboplastin

Factor 4

Ionized calcium

Factor 5

Labile Factor

Factor 6

Factor Va

Factor 7

Proconvertin

Factor 8

Antihemophilic factor

Factor 8:vWF

Von Willebrand Factor

Factor 8

Stuart Power Factor

Factor 11

Plasma Thromboplastin anticedant

Factor 12

Hageman Factor

Factor 13

Fibrin stabilizing factor

Vascular system and the coagulation cascade are in

constant states

Platelets form receptors that bind to…

fibrin

What will happen if the clot were not allowed to breakdown?

blockage, stroke, restricted blood flow

Hemostatic mechanism

the entire process by which bleeding from an injured blood vessel is controlled and finally stopped

aPTT range

25-38

PT INR

0.8-1.2

Hemophilia A

VIII Deficiency

Hemophilia B

IX deficiency

Hemophilia A range

Normal adult: 55–170 U/dl

• Normal infant: 93–302 U/d