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Hematopoietic System- 1 Peripheral Blood. Linda F. Cunningham, MD January 2, 2003. Slides. ASCP 1.3 Normal Peripheral Blood Smear. Hematopoietic System Clinical Problems. Anemia Cytosis and Cytopenia Leukocytosis Thrombocytopenia Lymphadenopathy. Hematopoietic System. Blood Plasma

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hematopoietic system 1 peripheral blood

Hematopoietic System- 1Peripheral Blood

Linda F. Cunningham, MD

January 2, 2003

slides
Slides
  • ASCP 1.3 Normal Peripheral Blood Smear
hematopoietic system clinical problems
Hematopoietic SystemClinical Problems
  • Anemia
  • Cytosis and Cytopenia
    • Leukocytosis
    • Thrombocytopenia
  • Lymphadenopathy
hematopoietic system
Hematopoietic System
  • Blood
    • Plasma
    • Cells and Proteins
  • Bone Marrow
  • Lymphoid Organs
    • Lymph Nodes, Spleen, and Thymus
blood
Blood
  • Connective Tissue
  • Mesodermal Origin
  • Composition
    • Cells
    • Aqueous Plasma Matrix
      • Proteins
      • Organic and inorganic salts
integrated histology blood
Integrated HistologyBlood
  • Histology of red blood cells (RBCs, erythrocytes), white blood cells (WBCs, leukocytes), and platelets
  • Composition, biochemistry, and physiology of plasma proteins, inorganic salts, and organic compounds
    • Fibrinogen for clotting (coagulation)
slides7
Slides
  • ASCP 1.3 Normal Peripheral Blood Smear
medical histology laboratory tests
Medical HistologyLaboratory Tests

Collect blood (venipuncture) in tube without anticoagulant

  • clotting occurs, using clotting proteins and platelets
  • aqueous plasma becomes serum
  • serum is plasma without fibrinogen
  • serum is sample used to analyze proteins, glucose, etc
medical histology laboratory tests9
Medical HistologyLaboratory Tests

Collect blood in tube with an anticoagulant and centrifuge

  • Two (2) major layers form
    • Bottom solid cellular layer
      • Largest layer, red cells, bottom red layer
      • White cell, “buffy coat” small white/gray layer
      • Top layer, invisible thin platelet layer
    • Top aqueous plasma layer
medical histology
Medical Histology

Hematocrit

  • Volume occupied by red blood cells in the anti-coagulated centrifuged blood
  • Expressed as % of total volume of blood
  • Adult male reference range, 39 – 49%
  • Adult female reference range, 35 – 45%
blood cells
Blood Cells
  • Erythrocytes (RBCs)
  • Leukocytes (WBCs)
    • Granulocytes
      • Neutrophils
      • Eosinophils
      • Basophils
    • Monocytes
    • Lymphocytes
  • Platelets

ASCP 1.08

slides12
Slides
  • ASCP 1.08 Normal Peripheral Blood Smear
integrated histology erythrocytes
Integrated HistologyErythrocytes
  • RBC size and shape
  • RBC membrane structure and proteins
  • RBC cytoplasmic components
  • RBC maturation and destruction in the circulation
  • RBC expected lifespan in the circulation
slides14
Slides
  • Histology 2-6.3 a, b, c: Mature red cell peripheral blood smear, disc. 7.5-7.8 micron, eosinophilic cytoplasmic hemoglobin staining; scanning EM; red cell cytoskeleton maintains shape
  • Robbins 320:rbc membrane
  • Rodak 29: Schematic red cell membrane
leukocytes granulocytes
Leukocytes- Granulocytes
  • Granules Composition and Function
    • PrimarySpecific Granules
      • Neutrophils, 60-70 %
      • Eosinophils, 2-4%
      • Basophils, 0-1% (Tissue Mast Cells)
    • Secondary Nonspecific Azurophilic Granules
  • Granulocyte Circulation and Migration
  • Tissue Inflammatory Cells
leukocytes granulocytes functional histology
Leukocytes-GranulocytesFunctional Histology
  • Granulocytes
    • Neutrophils
    • Eosinophils
    • Basophils
  • Inflammatory response with margination, emigration, tissue action
  • Phagocytes
    • Vacuoles and granules
    • Lysosomes
slides17
Slides
  • Histology 2-6.7 a, b: Neutrophil, multilobed nucleus, pale cytoplasm with few granules; EM granules
  • 2-6.10 a, b: Eosinophils, bilobed, bright red granules; EM granules with central dense crystalloid
  • 2-6.11 a, b, c: Basophils and Mast cells, large dark blue granules; Mast cells in tissue; EM histamine released from granules in cytoplasm
  • Pathology 1-5.3 a, b, c: Tissue neutrophils; margination and emigration
  • Histology 2-6.5: Neutrophil phagocytosis, ingest extracellular particles; primary granules lysosomal enzymes
monocytes functional histology
MonocytesFunctional Histology
  • Agranulocytes * (granules by EM)
  • Size
  • Cytoplasmic Components
    • Azurophilic granules are lysosomes
    • Phagocytes
  • Circulation and Migration
    • Macrophages (Histiocytes)
slides19
Slides
  • Histology 2-6.14: Monocyte, large cell, pale vacuolated cytoplasm, irregular nucleus
  • Harmening 1-32: Monocytes, variation; fine granules, vacuoles, gray-blue cytoplasm; pseudopods
  • Robbins 377: Tissue monocyte in case of TB Langerhan cell
lymphocytes integrated histology
LymphocytesIntegrated Histology
  • Size (small, medium, large)
  • Site of Differentiation and Maturation
  • Heterogeneous
  • Major Classes in Circulation
    • T lymphocytes (T cells) 80% of lymphocytes
    • B lymphocytes (B cells) 20% of lymphocytes
slides21
Slides
  • Histology 2-6.12 a, b: Small lymphocyte, 6-9 micron, basophilic cytoplasm (ribosomes) , high N/C ratio; EM
  • Harmening 1-36: Small mature; intermediate size; indented nucleus; large lymphocyte with granules
  • 1-40: Monocyte and Lymphocyte
  • 1.39: Lymphocyte and PMN
platelets integrated histology
PlateletsIntegrated Histology
  • Size
  • Number
  • Cytoplasmic Components
    • Granules
    • Tubular System
  • Function
    • Hemostasis
medical histology laboratory evaluation
Medical HistologyLaboratory Evaluation

Complete Blood Cell (CBC) count provides information about the absolute and relative numbers of blood cells in a specimen of blood.

medical histology complete blood cell count cbc
Medical HistologyComplete Blood Cell Count (CBC)
  • Red blood cell count, size, variation in size, and hemoglobin content
  • White blood cell count and differential into granulocytic cells, lymphocytes, monocytes, and abnormal cells
  • Platelet count
slides25
Slides
  • Histology 2-6.16 a, b, c, d: Platelets, 1.5-3.5 micron; cell membrane for adhesion, microtubules for aggregation; granules (alpha, dense, lysosomes)
  • 6.17 a, b: Platelet aggregation after adhering to damaged endothelium
medical histology cell counts
Medical Histology Cell Counts
  • Cytosis: increased

Leukocytosis, neutrophilia, lymphocytosis, erythrocytosis

  • Cytopenia: decreased

Pancytopenia = all

Leukopenia = Low WBC count

Neutropenia = Low neutrophil count

Lymphocytopenia

leukocytosis
Leukocytosis
  • Leukocytosis is a condition in which the leukocyte count is higher than the reference range
  • Usually affects a specific type of leukocyte- neutrophil, basophil, eosinophil, lymphocyte
slides28
Slides
  • Leukocytosis
  • Neutrophilic
leukocytosis29
Leukocytosis
  • Reactive
    • Infections, inflammation, necrosis
    • Others
  • Malignant
    • Leukemia (uncontrolled proliferation of leukocytes, causing an accumulation of leukemic cells in bone marrow and blood)
    • Others
slides30
Slides
  • Reactive = Benign = Self-Limiting
    • ASCP 1-04 and 1-07 Neutrophilia
    • ASCP 3-43 Monocytosis
    • ASCP 3-26, 3-27, 3-33 Lymphocytosis
    • Essential #138 IM
slides31
Slides
  • ASCP 400X Neutrophils
    • 1.43 Normal
    • 3.1 Reactive
    • 6.1 Chronic Myelocytic Leukemia
  • ASCP Monocytosis
    • 3.43
  • ASCP Lymphocytosis
    • 1.12
medical histology differential wbc count
Patient

WBC=100, 000

Neutrophils 86%

86,000

Lymphocytes 4%

4000

Reference Range

4,000 -10,000

50 – 60%

1800 – 7000

30 – 40%

1500 - 4000

Medical Histology Differential WBC Count
medical histology differential wbc count33
Medical Histology Differential WBC Count
  • Leukocytosis
  • Neutrophilic leukocytosis (Neutrophilia)
  • Absolute lymphocyte count within reference range

What is the most likely cause?

slide
Slide
  • Harmening 15-2 Neutrophilia due to a bacterial infection (septicemia)
medical histology differential wbc
Patient

WBC=100, 000

Neutrophils 7%

7,000

Lymphocytes 93%

9300

Reference Range

4000 -10,000

50 – 60%

1800 – 7000

30 – 40%

1500 - 4000

Medical Histology Differential WBC
medical histology differential wbc36
Medical Histology Differential WBC
  • Leukocytosis
  • Lymphocytosis
  • Absolute neutrophil count within reference range

What is the most likely cause?

slide37
Slide
  • ASCP 3-40 Lymphocytosis
medical histology peripheral blood
Medical HistologyPeripheral Blood
  • Review histology of peripheral blood and give clinical examples of specific leukocytosis
  • Give examples of a reactive leukocytosis, acute leukemia, and chronic leukemia
    • Histology is important for the recognition of maturation of leukemic cells
medical histology thrombocytopenia
Medical Histology Thrombocytopenia
  • Decreased platelets
    • Interrupt blood coagulation and prevent hemostasis
    • Bleeding complications
    • The degree of thrombocytopenia determines the risk for bleeding due to minor trauma, risk of spontaneous bleeding, and severe bleeding
medical histology thrombocytopenia40
Medical Histology Thrombocytopenia
  • Decreased platelets
    • Interrupt blood coagulation and prevent hemostasis
    • Bleeding complications
    • The degree of thrombocytopenia determines the risk for bleeding due to minor trauma, risk of spontaneous bleeding, and severe bleeding
medical histology anemia
Medical Histology Anemia

Decrease in the total number of circulating erythrocytes and/or a decrease in the quality or quantity of hemoglobin.

Number and severity of the symptoms depend upon the body’s ability to compensate for the reduced oxygen carrying capacity of the blood.

medical histology anemia42
Medical Histology Anemia
  • Decreased Production ( Look in the Bone Marrow)
    • Hemoglobin synthesis
    • DNA synthesis and nuclear maturation
    • Stem cell defects
    • Bone marrow infiltration
medical histology anemia43
Medical Histology Anemia
  • Acute Blood Loss (Hemorrhage)
  • Increased Destruction (Hemolysis)
    • Membrane abnormality
    • Cytoplasmic enzyme abnormality
    • Hemoglobin abnormality
    • RBC environment (Extracellular)
medical histology anemia morphology
Medical HistologyAnemia-Morphology
  • Erythrocyte size = -cytic
    • Normocytic, macrocytic, microcytic
  • Hemoglobin content= -chromic
    • Normochromic, hypochromic
slide45
Slide
  • Normal red blood cells = normocytic for comparison
slides46
Slides
  • Rodak # 86 Iron Deficiency Microcytic
  • ASCP 4-16 Iron Deficiency Microcytic
  • ASCP 4- 20 Macrocytic with Lymphocyte
  • ASCP 4.12 Anisocytosis