heme quiz 3

neutrophils

-WBCs

-first line of defense

-innate immunity

-phagocytic

-responsive in bacterial infections

eosinophils

-WBC

-phagocytic

-defense from infections and allergies

basophils

-WBC

-response to allergic rxns

-chromic myelocytic anemia

monocytes

-WBC

-adaptive cellular immunity

-produce cytokines (innate immunity)

-phagocytic

-antigen presenting cell (APC)

lymphocyte

-WBC

-cellular and humoral (adaptive) immunity

-T, B (Ag pres), and NK cells

-defense in viral infections

innate

-immunity type

-non-specific and immediate defense

-do not require prior exposure to fight

-neutrophils, macrophages, NK cells, eos, monos

adaptive

-immunity type

-specific defense

-requires prior exposure for recognition (memory cells)

-antigen presenting cells

-T and B cells, monos

bone marrow

location of immature cells for storage and maturation

peripheral blood

where mature cells are stored and/or circulate

tissue

primary site of granulocytes and macrophages

lymph fluid

-primary site of lymphocytes

-nodes and thymus

myelopoiesis

production of segs, eos, basos, and monos

stem cells

pool of uncommitted cells

mitotic proliferation

-pool of cells

-in bone marrow

-5-7 days growing and dividing (7-10 for blast to mature seg)

-committed cells

storage-maturation

-pool of cells

-in bone marrow

-includes bands and mature segs

-marginate to get to PB

6-10 hours

time spent in peripheral blood by mature neutrophil

marginating

mature segs stored on tissue or vascular walls in PB

diapedesis

-seg migration to tissue from PB

-squeeze between endothelial cells to get to tissue and stay there

granulocytes

segs, basos, eos

myeloblast, promyelocyte, myelocyte, metamyelocyte, band, seg

neutrophil maturation

myeloblast

-round bluish nucleus with visible chromatin strands

-smooth nuclear membrane

-nucleoli

-blue cyto

-no granules (may contain Auer rods)

-myeloid markers: CD13 and CD33

-1-2% in BM; none in PB

-15-20 um

1-2

% of myeloblasts in bone marrow

promyelocyte

-coarse chromatin

-nucleoli

-blue cytoplasm

-primary granules red-purp with myeloperoxidase

-1-5% BM; none in PB

-20 um (larger than blast)

1-5

% of promyelocytes in BM

myelocyte

-nucleus smaller with clumpy, unevenly stained

-no primary granules

-secondary granules reddish and contain lactoferrin, collagenase, lysozyme

-6-17% of BM

-none in PB (unless extreme left shift)

-smaller than pro <20 um

lactoferrin, collagenase, lysozyme

bactericide(s) in myelocyte secondary granules

6-17

% myelocytes in BM

myeloperoxidase

bactericide(s) in promyelocyte primary granules

metamyelocyte

-indented nucleus (kidney bean), possibly eccentric

-1:1 cytoplasm:nucleus

-light blue cytoplasm

-granules secondary and pinkish

-15-20% of BM

-can see in PB if left shift

-10-18 um

15-20

% of metamyelocytes in BM

band

-nucleus indented more than half its width

-secondary granules pink with alkaline phosphatase

-10-32% in BM

-0-5% in PB

-9-16 um

10-32

% of bands in BM

0-5

% of bands in PB

alkaline phosphatase

main neutrophil bactericide(s)

polymorphonuclear

what PMN stands for (neutrophils)

segmented neutrophil (seg)

-aka PMN

-nucleus lobed (2-5), chromatin purple and small and clumped

-secondary granules pink or neutral and contain alkaline phosphatase

-10-30% in BM

-40-80% of WBCs in adult PB

-12-15 um

10-30

% of mature segs in BM

40-80

% of mature segs in adult PB (out of WBC pop)

eosinophils

-bi-lobed nucleus

-secondary granules large and round and contain hydrolytic enzymes (acid phosphatase and histamine)

-most reside in tissue (can migrate between PB and tissue)

-0-7% of WBCs in PB

0-7

% of eos of WBCs in PB

basophils

-secondary granules large and violet blue, contain heparin and histamine

-0-2% of WBCs in PB

0-2

% of basos of WBCs in PB

monoblast, promonocyte, monocyte

monocyte maturation

monoblast

-eccentric and possibly indented nucleus

-immature, lacy, purple chromatin

-1-2 nucleoli

-dark blue cyto

promonocyte

-indented or folded nucleus

-darker chromatin than blast, but still fairly loose

-can have vacuoles

monocyte

-nucleus deeply indented or folded (NOT segmented) - brain like

-”ground glass” granules red/purple with lysozyme and peroxidase

-light blue/dull grey cyto

-pseudopodic and phagocytic

-may contain vacuoles

-0-10% of WBCs in PB

-15-18 um

-CD14

lysozyme and peroxidase

bactericide(s) in monocyte granules

0-10

% of monocytes of WBCs in PB

macrophages

-nucleus clumped, circular mature looking, and may contain nucleoli

-phagocytic (like monos)

-granules azurophilic and contain acid phosphatase, beta glucuronidase, lysozyne, lipase, peroxidase

-cyto has vacuoles

-found primarily in tissues (body fluids)

-capable of cell division

-”fried eggs”

lymphocytes

-B cells, T cells, NK cells

-produced in primary lymphoid tissues, stored in secondary lymphoid tissues

-stimulated by IL and cytokines

-nucleus similar in size to RBCs, dark blue, coarse and dense

-little bit of cytoplasm, dark blue at periphery

-mostly agranular, but can by azurophilic

-15-40% of WBCs in PB (depends on age)

-cells short and long lived

-7-10 um

-variation when reactive

15-40

% of lymphs of WBCs in PB

bone marrow

-primary lymphoid tissue for B cell development

-pro B → pre B → immature B cell

-Ag independent maturation only

-Ig gene rearrangement

secondary lymphoid tissue

-location of Ag dependent B cell maturation

-contact with Ag → divide and mature → memory (storage) or effector cells (plasma cells that make Ab)

-mature cell markers: CD 19, 20, 22 and HLADR

B cells

mature cell markers CD 19, 20, 22, and HLADR

lymph nodes, spleen, mucosal tissue

secondary lymphoid tissues

thymus

-primary lymphoid tissue of T cell dev

-Ag independent

-pro T → pre T → immature T cell

-self-Ag presentation

• reaction → apoptosis

• no reaction → secondary development

secondary lymphoid tissue

-Ag dependent maturation of T cell development

-cells not reactive to self-Ag pres in thymus

-mature to CD4 and CD8 effector cells

-markers CD 2, 3, 5, 7

T helper cells

mature cell markers CD 4 (and 2, 3, 5, 7)

cytotoxic T cells

mature cell markers CD 8 (and 2, 3, 5, 7)

NK cells

mature cell marker CD 56

reactive lymphocyte

-stimulated → responding

-inc cytoplasm volume

-nucleus not round

-may have nucleoli (even though mature nucleus)

-may have vacuoles or azurophilic granules

-increased basophilicity

-lots of variation

plasma cells

-nucleus small and round/oval

-cyto dark blue

-may have vacuoles

-hof: clearing near nulceus

-produced by B lymphs

-1% in BM

-none in PB

1%

% of plasma cells in BM

4.8-10.8 (x10³/uL)

total adult WBCs

RBC

precursors in BM decrease after birth

granulocyte

precursors in BM decrease during first month of life

lymphocyte

precursors in BM increase during first month of life

plasma cells

cells in BM appear at 6 months

flow cytometry

-method of measuring WBC relatives

-fluorescence vs side scatter

fluorescence

-y-axis of diff scattergram from flow cytometry

-related to cell size

side scatter

-x-axis of diff scattergram from flow cytometry

-related to cell complexity/granularity

segs and eos

-cells exhibit diurnal variation

-peak in afternoon

leukocytosis

-increased overall WBC

-WBC > 11000 /uL (11 ×10³/uL)

>11000/uL

WBC for leukocytosis

leukopenia

-decreased overall WBC

-WBC <3000-4000/uL (3-4 ×10³/uL)

<3000-4000/uL

WBC for leukopenia

relative

… WBC count expressed as % of cell type

absolute

… WBC count = (total WBC)(% cell type)

left shift

-increased immature neutrophils in PB

-mainly bands

-can be metas and myelos

leukemoid rxn

very high WBC due to reasons that are not leukemia

infection, leukemia, leukemoid rxn, inflammation

reasons for inc WBC count

monocytes

relative WBC in in resp to:

-cell damage

-chronic infection (MTB or syphilis)

-subacute bacterial endocarditis (chronic heart inner lining and valve infection)

-acute infection recovery

neutrophils

relative WBC inc in resp to:

-bacterial infections

eosinophils

relative WBC inc in resp to:

-parasitic infections

-allergies

basophils

relative WBC count inc in resp to:

-allergic rxns

-chronic myeloid leukemia (CML)

lymphocytes

relative WBC count inc in resp to:

-viral infections

corrected WBC

-if WBC contains NRBCs, must correct overcount by instrument

WBC(100) / (100+NRBC)

toxic granulation

-abnormal WBC morpho

-abundance of abnormally large, dark-staining, or primary granules in segs

-contain peroxidases and hydrolases

-seen in severe bacterial infections, chemo

toxic vacuolization

-abnormal WBC morpho

-large amount of vacuoles left from fighting infection

-seen in overwhelming inf

dohle bodies

-abnormal WBC morpho

-round/oval blue inclusions

-rRNA inclusions (strands of RER)

-seen in severe infections, burns, preg, chemo

infection

characterized by:

-inc WBC (>11000/uL)

-inc segs

-left shift

-morphological changes (dohle bodies, toxic vacuolization and granulation)

phagocytosis

mobility → recognition/attachment → ingestion → killing/digestion

mobility

-first step of phagocytosis

-chemotaxis and diapedesis

-Ab or complement “breadcrumbs”

recognition and attachment

-second step of phagocytosis

-recognition of pathogen or opsonized molec (complement, Ab) attached to pathogen

ingestion

-third step of phagocytosis

-pseudopod extension around pathogen followed by engulfment → phagosome

phagosome

cell that has ingested pathogen

oxygen dependent

-killing/digestion step of phagocytosis

-oxidative or respiratory burst using superoxide activation (NADPH)

oxygen independent

-killing/digestion step of phagocytosis

-lysosomes empty bactericidal molec into phagosome

neutropenia

-decrease in neutrophils

-WBC<1500/uL

-due to:

• viral infection (need other cells from BM)

• impaired release from BM to PB (aplastic anemia)

• increased destruction (bacterial)

  • maldistribution (overcrowding of monoclonal lines in BM in leukemia)

pancytopenia

-dec in all cells → WBCs, RBCs, and platelets

→ neutropenia, anemia, and thrombocytopenia

-aplastic anemia or chemo