LabDx

11/3/99

 

http://edcenter.med.cornell.edu/CUMC_PathNotes/Hematopathology/Hematopahtology.html

 

Granulopoesis

Bone Marrow

• Unipotential Stem Cell
• Myeloblast
• Promyelocyte
• Myelocyte
• Mature neutrophil
• Metamyelocyte
• Band cell
• 14 days

Blood

• Neutrophil
• Marginated and in blood
• 8 hours

Connective Tissue

• Neutrophil
• 2 days

 

• Stress increases leukocytosis
• Chronic sympathetics
• Suppresses the immune system
• Stress either physical or psychological (emotional)
• Stress on any cell line can cause the marrow to increase production of that line to 5-6 times normal in a short time i.e. hours to a few days
• Reticuloendothelial system—monocyte/marcrophage circulating in the blood affects the distribution of blood cells from the marrow
• Stress mediated ds—coping w/the world—controlling your world instead of your world controlling you
• Monitor attitudes, thoughts and emotions so they are not immunocompromising

 

Characteristic of Normal Granulocytic Cells

• Polymorphonuclear leukocytes (PMNS)
• Cell size = 10-15 m; multi-lobed nucleus (3-4 lobes) separated by isthmus which should be less than ½ the width of the lobe; if the isthmus diameter is > and there are only 2 lobes, the cell is called a band neutrophil
• Many produced every day due to high utilization (1.6 ´10⁹ cells/kg/day)
• Normally circulate 6-7 hours and the life span is about 56 hours
• Cytoplasmic granules contain acid phosphatase, acid hydrolases, peroxidases, muramidase, lactoferrin and collagenase
• Eosinophils
• Small isthmus; bi-lobed nucleus sometimes obscured by granules
• Slightly larger than PMNS--~ 12-17 m
• Allergy, atopy (skin rxn) drug and parasite rxn
• Granules contain enzymes
• EM:  membrane-bound granules show a dense crystallized core
• After 30 count—neoplasm (lymphoma)
• Normal is ~ 4
• Most found in marrow and tissues; only 1% circulate
• Mean T (1/2) = 8 hr in periphery
• Basophils
• Larger than PMN or eosinophils; heavily granulated
• Larger, very basophilic granules contain histamine, chondroitin sulfates, leukotriene B, eosinophils-chemotactic factors
• Function: immediate hypersensitivity rxns—bind IgE
• Least common blood granulocyte
• Monocytes
• Diameter = 12-15m; (reniform) nucleus occupies ½ of the cell area is usually eccentrically placed
• Many fewer cytoplasmic granules than PMNs; granules stain both eosinophilic and basophilic and vary in size
• Cytoplasmic vacuolization
• Irregular nucleus and chromatin irregularly distributed
• Maturation takes 4-5 days; spends 1.5 days in circulation and then resides in tissues (RE tissue in spleen, Kupffer cells in liver, etc.) for up to 4 months
• EM: ruffling of plasma membrane
• Maturation sequence: monoblast, promonocyte, monocytes, immature macrophage (nucleolus prominent) mature Macrophage
• Infectious ds
• High—myelo proliferative ds (Hodgkin's ds, lymphoma)
• Reactive lymphocytic disorders
• Benign lymphocytic disorders; lymphocytosis
• Lymphocytes can have anomalies of both quality (neoplasm) and quantity (too few)
• Lymphocytosis
• Usually an acute viral infection
• Infectious mono (adults)
• Right shift early on
• 2 wks, WBC sky rocket (neutropnea, and lymphocytosis)
• Fever, lymphadenopathy, pharyngitis
• AIDS imitator
•  
• Infectious lymphocytosis (children)
• Mumps, chicken pox, German measles, viral hepatitis
• Chronic infections associated w/lymphocytosis are bacterial in origin
• TB
• Non-neoplastic causes of granulocytosis or neurophilic leukocytosis
• Bleeding and necrosis and inflammation do the exact same thing