B11 - leukocytes: production and function Flashcards

1
Q

Granulopoiesis

A
  • The process by which cells that have granules are made in the bone marrow
    • HSC (haemopoietic stem cells) undergoes specific differentiation in response to cytokines (cell hormones) with orderly sequence of maturation
      ○ HSC express CD34 - a marker of haemopoietic stem cells
    • Early precursors adjacent to bony trabeculae
    • Maturing forms deeper in marrow space
    • Nuclear maturation and cytoplasmic granulation
    • Controlled as to number and where in the marrow it takes place
    • Most immature cell is next to the trabecular bone
    • Mature cells away from the trabecular bone - released into the blood vessels in the bone marrow and then circulate in the blood
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2
Q

Neutrophils

A
  • Most common granulocytic - cells with granules

- Majority of the white blood cells in blood stream

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3
Q

neutrophil development stages

A
  1. Myeloblast
    2. Promyelocyte
    3. Myelocyte
    4. Metamyelocyte
    5. Band form
    Neutrophil
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4
Q
  • Neutrophil maturation
A

○ Reduction in size
○ Contain fine granules (azurophilic) - acquire granules
§ Present early are primary granules, as the cell mature further they become specific to that lineage and become secondary granules
○ Neutrophil nucleus segments (2-5 segments)
§ Nucleus goes from being round, to ovoid, to bent and then segmented
§ Vit B or folate deficiency causes hyper segmentation
○ females have drumstick-like appendage
○ Neutrophil made in the bone marrow released in blood migrates through endothelial cells to tissue
○ 9-15 micrometres diameter
○ phagocytic function
§ Engulf invading pathogen, discharge granule contents to kill the invading pathogen

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5
Q

nuetrophil granule contents

A

○ Primary - formed at promyelocyte stage, electron dense

○ Secondary - formed at myelocyte stage of differentiation

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6
Q

neutrophil number and life span

A

○ Number in blood varies by:
§ Age, gender, ethnicity
§ Caucasians, Chinese, Indians: comparable neutrophil counts
§ Ethnic neutropenia occurs - lower baseline set because the neutrophils sit against the edge of the blood cell wall, when a blood sample is taken from the middle of the blood vessel - neutrophils are equally as effective in these individuals - does not impact ability to combat infection
○ Mature neutrophil migrate from BM to blood
§ Migrates through the sinusoidal endothelium
§ Lifespan in PB: 7.2 hours
§ Don’t spend much time in the blood - use it as a transport system
§ Appear in secretions and tissues
§ Survive outside the blood for up to 30 hours

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7
Q

neutrophil number in blood varies by

A

§ Age, gender, ethnicity
§ Caucasians, Chinese, Indians: comparable neutrophil counts
§ Ethnic neutropenia occurs - lower baseline set because the neutrophils sit against the edge of the blood cell wall, when a blood sample is taken from the middle of the blood vessel - neutrophils are equally as effective in these individuals - does not impact ability to combat infection

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8
Q

mature neutrophil migrate from BM to blood

A

§ Migrates through the sinusoidal endothelium
§ Lifespan in PB: 7.2 hours
§ Don’t spend much time in the blood - use it as a transport system
§ Appear in secretions and tissues
§ Survive outside the blood for up to 30 hours

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9
Q

neutrophil function

A

○ Attracted to and move to sites of infections
○ Adhere to the foreign particle via receptors
○ Pseudopodia form and encircle the particles
○ Ingest foreign particles
○ Phagosome forms
○ Fusion of 1&2 granules
○ Granule contents discharged
○ Bacteria killed
○ Phagocytose invading pathogens and then form a vesicle around it, pseudopods totally engulf what it taken in, granule contents are discharged into phagocytic vesicle and pathogen killed

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10
Q
  • Reactive neutrophilia - appropriate
A

○ Increased granulation ‘toxic’
○ Dohle bodies
○ Cytoplasmic vacuoles - neutrophils are doing their job, being phagocytic
○ Increase to 10-50 x 10^9 L
○ Higher than 50: may be cancer
○ ‘left shift’ - immature cells usually in the bone marrow coming out into the blood
○ Caused by
§ Infection - bacterial or viral
§ Acute inflammation
§ Stress, exertion
§ Pregnancy
§ Malignancies eg. Hodgkin’s lymphoma
§ Surgery, trauma, tissue damage or infarction
§ Steroids, cytokines (administered following chemotherapy)

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11
Q

bacterial infections

A
  • Fever, lethargy
    • Hypercellular bone marrow - responding by making more neutrophils
    • Acute, chronic infections
    • Localised: skin, tonsil, bone
    • Generalised:
      ○ Hypotension, fluid shift
      ○ Organ failure
    • Heamotological response
      ○ Bone marrow granulocytic hyperplasia
      ○ Blood neutrophilia, left shift, toxic granulation dohle bodies
    • Staph, strep, neisseria etc.
    • Blood count
      ○ Leucocytosis
      ○ Neutrophilia 10-50 x 109
      ○ Mild thrombocytosis 400-500 x 109
      ○ Thrombocytopenia in severe infections
      § Disseminated intravascular coagulation - DIC
      § Thrombocytopenia accompanying marked neutrophilia indicates severe sepsis
      ○ Chronic bacterial infections eg. Osteomyelitis
      § May have mild anaemia
      □ Due to anaemia of chronic inflammatory process
      § May have mild monocytosis
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12
Q

Eosinophils

A
  • Granulocytic
    • Similar to neutrophil, nucleus does not have more than 3 segments
    • Granules are more orange (eosinophilic - loving eosin dye)
    • Eosinophilic differentiation (specific granules) at myelocyte
      ○ Same as the neutrophil
      ○ Have their own set of specific granules
      ○ Different granules means they stain a different colour
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13
Q

eosinophil morphology

A

§ Slightly larger that neutrophils
○ Cytoplasm packed with large round granules
○ Red-orange with Romanowsky stains
○ 2-lobed nucleus

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14
Q

eosinophil lifespan and function

A

○ Granule contents: phospholipases, hoistaminase, ribonuclease, b-glucoronidase, cathepsin, collagenase (don’t memorise)
○ Motile cells: respond to chemotactic agents, phagocytose and kill microorganisms, slower at ingesting and killing bacteria than neutrophils
○ Involved with allergy: role in regulating immediate-type hypersensitivity reactions
○ Eosinophilia: allergy, drugs, asthma, dermatitis, parasites, neoplastic, hayfever
- Because they are only in the bloodstream for a short period of time, after they have been treated the eosinophil count returns to normal within a matter of hours

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15
Q

Basophils

A
  • Deeply stained deep purple granules that overly the nucleus
  • Most infrequent leukocyte (0.1x10^9)
  • Diameter of 12 micro meters
  • Large round purple black cytoplasmic granules that overly the nucleus
  • Nucleus has two segments
  • Cell surface receptors for IgE, IgG, C5a
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16
Q

basophils function

A
  • Role in immediate-type hypersensitivity reactions
    • Role in immune response to parasites
    • Release histamine on activation
    • A major source of IL-4 role in immunity
    • Basophilia: chronic myeloid leukemia (increase in basophils in blood and bone marrow, don’t have any granules as normal) - cause them to look like neutrophils, but they’re actually abnormal hypo-granular basophils
    • We don’t know what they do - normal blood film might not present a basophil
17
Q

monocytes

A
  • Some have granules - 10%
    • Horseshoe nucleus with indentation
    • 2-8% of white cells
    • Maturation from stem cell - monoblast - monocyte
    • Diameter 15-30 micro meters
    • Maturation from stem cell - monoblast, monocyte
    • Diameter 15-30 micro meters
    • Cytoplasm: grey, few granules, vacuoles
    • Blood average T of 70 hours - a bit longer than most cells
    • Maturation to macrophage in tissue (months/years) - reticuloendothelial system
      ○ In spleen and liver
    • 3.6 times more marginated than circulating cells in PB
18
Q

monocyte function

A

○ Granules - own set of enzymes
○ Role is phagocytosis and killing
○ Monocytosis
§ Increase monocyte count is rare - usually for chronic infections
§ TB - tuberculosis - patients with HIV
§ Chronic infections/ inflammation
§ Chronic myelomonocytic leukaemia
§ Myodisplasia - dysfunctional bone marrow, elderly people
□ Increase in monocytes in the blood, don’t look normal

19
Q

monocytosis

A

§ Increase monocyte count is rare - usually for chronic infections
§ TB - tuberculosis - patients with HIV
§ Chronic infections/ inflammation
§ Chronic myelomonocytic leukaemia
§ Myodisplasia - dysfunctional bone marrow, elderly people
□ Increase in monocytes in the blood, don’t look normal

20
Q

Lymphocytes

A
  • Don’t have granules
  • Smallest white blood cell
  • Vary in size
  • Round with round nucleus and blueish cytoplasm
  • Immune cells
  • Immunocologically competent cells
  • B produced in bone marrow, T start in bone marrow and then migrate to thymus
  • Produced in bone marrow and thymus
  • BM: 10-15% of BM cells, T:B ratio = 6:1
21
Q

Patients with lymphocytic or lymphoblastic leukemia will have far more B cells

A
  • Because b cells are functional in trying to make immunoglobulin - they are more activated and therefore likely to have a mutation leading to a malignancy, usually happening in the lymph node
22
Q

® Epstein barr virus infection EBV - mono

A

◊ Most common
◊ Low platelet count, immune mediated haemolytic anaemia, bone marrow failure - rare
◊ Usually just a mild infection that resolves and is self limiting
◊ Teenagers and young adults
◊ Lassitude, fever, pharyngitis, lymphadenopathy, hepatosplenomegaly
◊ Thrombocytopenia is common
◊ Haemolytic anaemia (immune-mediated, spherocytes)
◊ Blood film: virally infected B lymphocytes and activated reactive T lymphocytes
◊ Dutch skirting - scalloped blue edge (enhanced blue/basophilia)
◊ Mononucleosis
◊ Occurring in young people

23
Q

® Cytomegalovirus CMV

A

◊ Similar clinical features to EBV
◊ Pharyngitis and lymphadenopathy: rare
◊ Ages 20-50 years
◊ Virus infects the neutrophils, which spread the infection to the macrophages
◊ Reactive T-lymphocytes morphologically indistinguishable from EBV
◊ Reactive T lymphocytes in the blood
◊ Thrombocytopenia is common

24
Q

® Varicella

A

◊ Common in young children may occur in adults
◊ Thrombocytopenia
◊ Reactive T lymphocytes in the peripheral blood
◊ Activated T lymphocytes closely resemble those in EBV and CMV infections

25
Q

® Viral hepatitis

A

◊ Hepatitis A and B cause mononucleosis like syndrome
◊ Reactive lymphocytes on the blood film
◊ Morphology is different - cells are larger with more cytoplasm