HEMATOLOGY I (II)

RED MARROW

ACTIVE MARROW is also known as _______________

• Self renewal • Proliferation and Differentiation • Apoptosis

An an ideal environment of the HSC is the allowance for _______________

OSTEOCLAST

Bone resorption cell or destroying cells

OSTEOBLAST

Bone-forming cell

ALL blood cells are derived from a SINGLE PROGENTIOR STEM CELL

Describe the MONOPHYLETIC THEORY

The stem cell theory that suggests that each of the blood cell lineage is derived from its OWN UNIQUE STEM CELL

Describe the POLYPHYLETIC THEORY

YELLOW MARROW (ADIPOCYTES)

During RETROGRESSION, the red marrow is replaced by _______________

CELL GROWTH

EXTRACELLULAR MATRIX is essential for _______________

• Gower I • Gower II • Portland

Enumerate the EMBRYOGENIC HEMOGLOBINS

• Fibroblast • Adipocytes • Lymphocytes • Reticular cells • Endothelial cells • Monocyte/Macrophages • Osteoclast and Osteoblast

Enumerate the STROMAL CELLS

• Normocellular = 30-70% HSCs • Hypercellular/Hyperplastic = >70% HSCs (i.e. Myeloproliferative disorders) • Hypocellular/Hypoplastic = < 30% HSCs • Aplastic = Few to no HSCs

Enumerate the different types of MARROW CELLULARITY (Ratio of marrow cell to fats)

HEMATOPOIETIC STEM CELLS

Foundation of the adult hematopoietic system

10 YEARS

How long should BONE MARROW SPEARS be retained?

YELLOW MARROW

INACTIVE MARROW is also known as

RETROGRESSION

It is the process of replacing the active marrow by the adipocytes (yellow marrow)

PLURIPOTENT HEMATOPOIETIC STEM CELL

MONOPHYLETIC THEORY suggests that all blood cells are derived from a SINGLE PROGENITOR STEM CELL called _______________

PLURIPOTENT STEM CELLS

MULTIPOTENTIAL STEM CELLS are derived from

Limited to SPECIFIC type of stem cells to form tissues

MULTIPOTENTIAL STEM CELLS are limited to _______________

RED/ACTIVE MARROW

Marrow consisting of DEVELOPING BLOOD CELLS AND THEIR PROGENITORS

YELLOW/INACTIVE MARROW

Marrow that is composed primarily of ADIPOCYTES (fat cell), with UNDIFFERENTIATED MESENCHYMAL CELLS AND MACROPHAGES

Several days after fertilization

PLURIPOTENTIAL CELLS are present _______________

ANY type of cell, EXCEPT they CANNOT TURN INTO A FETUS

PLURIPOTENTIAL CELLS may develop into _______________

EMBRYOGENIC HEMOGLOBIN

PRIMITIVE ERYTHROBLAST, formed during the mesoblastic stage, are important in early embryogenesis to produce _______________?

ACTIVE MARROW

RED MARROW is also known as

STROMAL CELLS

Specialized cells that within the BM that provide PROTECTIVE and NOURISHING ENVIRONMENT to the HSCs

MESOBLASTIC STAGE/YOLK SAC

Stage of hematopoietic development that occurs AROUND THE 19TH DAY of embryonic development after fertilization?

Substances that make up the extacellular matrix

Stromal cells secrete _______________

First few hours after an ovum is fertilized

TOTIPOTENTIAL CELLS are present on _______________

ANY HUMAN CELL type including embryo into fetus

TOTIPOTENTIAL STEM CELLS may develop into ______________

• Clusters of developing erythroblasts, granulocytes, and monocytes colonizing the fetal liver, thymus, spleen, placenta and the bone marrow space in the final medullary phase • Production of MEGAKARYOCYTES

The HEPATIC PHASE of hematopoietic development is characterized by _______________ and what occurs?

MONOPHYLETIC THEORY

The stem cell theory that is the MOST WIDELY ACCEPTED

POLYPHYLETIC THEORY

The stem cell theory that suggests that each of the blood cell lineage is derived from its OWN UNIQUE STEM CELL

MULTIPOTENTIAL STEM CELLS

These cells are derived from pluripotent stem cells

PLURIPOTENTIAL STEM CELL

These cells are present SEVERAL DAYS after fertilization

TOTIPOTENTIAL STEM CELL

These cells are present in the first few hours after an ovum is fertilized

TOTIPOTENTIAL STEM CELL

These cells can develop into ANY human cell type including embryo into fetus

PLURIPOTENTIAL STEM CELL

These cells may develop into ANY type of cell, EXCEPT they CANNOT TURN INTO A FETUS

MONOPHYLETIC THEORY

This stem cell theory suggests that ALL blood cells are derived from a SINGLE PROGENITOR STEM CELL

MULTIPOTENTIAL STEM CELLS

This type of stem cell may be found in adults

MULTIPOTENTIAL STEM CELLS

This type of stem cells are limited to SPECIFIC types of stem cells to form tissues

1. Totipotential Stem Cell 2. Pluripotential Stem Cell 3. Multipotential Stem Cell

Three types of HUMAN STEM CELL

• Direct aspirate smears • Anticoagulated aspirate smears • Crush smears • Imprints/Touch preparation • Concentrate/Buffy coat smear • Histology/Cell block

Types of BONE MARROW SPECIMEN

5TH TO 7TH WEEK OF GESTATION

WHEN does the HEPATIC PHASE of hematopoietic development occur?

PRIOR TO THE FIFTH MONTH of fetal development

WHEN does the MEDULLARY (MYELOID) PHASE of hematopoietic development occur?

LIVER

WHERE does the HEPATIC PHASE of hematopoietic development occur?

BONE MARROW CAVITY

WHERE does the MEDULLARY (MYELOID) PHASE of hematopoietic development occur?

RSVP • Ribs • Sternum, Shoulder blade, Skull (children) • Vertebrae • Pelvic bone, Proximal end of long bones (ex. radius ulna, humerus, femur, tibia and fibula)

What BONES in the body are capable of undergoing HEMATOPOIESIS in ADULT?

• Eythropoietin (EPO) • Granulocyte Colony Stimulating Factor (G-CSF) • Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) • Hemoglobin F • Hemoglobin A

What are present during the MEDULLARY (MYELOID) PHASE of hematopoietic development?

• Bone marrow • Spleen • Lymph nodes • Liver • Thymus

What are the ADULT HEMATOPOIETIC TISSUES?

• Gower I = 2 Epsilon + 2 Zeta • Gower II = 2 Alpha + 2 Epsilon • Portland = 2 Zeta + 2 Gamma

What are the GLOBIN CHAIN COMBINATIONS of embryogenic hemoglobin?

• Trephine (core) Biopsy = Trephine Biopsy needle/ Jamshidi needle/ Westerman-Jensen needle • Bone Marrow Aspirate = Aspiration needle/University of Illinois STERNAL NEEDLE

What are the instruments used for bone marrow collection?

STERNUM AND OTHER FLAT BONES

What are the principal sources of hematopoiesis in an adult?

• Lymph nodes • Spleen • Liver • Thymus

What are the sites for EXTRAMEDULLARY HEMATOPOIESIS?

1. Mesoblastic Stage/Yolk Sac 2. Hepatic Phase 3. Medullary (Myeloid Phase)

What are the stages of HEMATOPOIETIC DEVELOPMENT?

• RBC • WBC • Platelets

What blood components are present during the HEPATIC PHASE of hematopoietic development?

OSTEOCLAST

What cell in the bone marrow is mistaken as MEGAKARYOCYTES?

OSTEOBLAST

What cell in the bone marrow is mistaken as PLASMA CELL?

• Macrophages • Mast cells • Osteoblast • Osteoclast

What cells are normally found in the BONE MARROW?

It is the process of replacing the active marrow by the adipocytes (yellow marrow) RED MARROW --> YELLOW MARROW

What happens during RETROGRESSION?

PRIMITIVE ERYTHROBLAST in the central cavity of the yolk sac

What is formed during the MESOBLASTIC STAGE of hematopoietic development?

2 ALPHA + 2 GAMMA

What is the GLOBIN CHAIN COMBINATION of FETAL HEMOGLOBIN?

2 ALPHA + 2 DELTA

What is the GLOBIN CHAIN COMBINATION of HEMOGLOBIN A2?

2 ALPHA + 2 BETA

What is the GLOBIN CHAIN COMBINATION of Hemoglobin A?

3:1 Myeloid = 30% Erythroid = 10% 30:10 --> 3:1 Di kasama ang Mono and Lympho sa M:E RATIO

What is the M:E Ratio? • Neutrophil = 20% • Eosinophil = 8% • Basophil = 2% • Monocyte = 10% • Lymphocyte = 5% • RBC Precursor = 10%

M:E RATIO = 1:20 INTERPRETATION = Decrease

What is the M:E ratio if there is ERYTHROID HYPERPLASIA?

M:E RATIO = 5:1 INTERPRETATION = Increase

What is the M:E ratio if there is ERYTHROID HYPOPLASIA?

M:E RATIO = 20:1 INTERPRETATION = Increase

What is the M:E ratio if there is MYELOID HYPERPLASIA?

M:E RATIO = 3:20 INTERPRETATION = Decrease

What is the M:E ratio if there is MYELOID HYPOPLASIA?

M:E RATIO = 6:1 INTERPRETATION = Increase

What is the M:E ratio when there is an INFECTION?

M:E RATIO = 25:1 INTERPRETATION = Increase

What is the M:E ration when there is LEUKEMIA?

POSTERIOR ILIAC CREST

What is the MOST COMMON SITE for BONE MARROW COLLECTION?

3:1 (OTHERS = 2:1 OR 4:!) Monocytes and Lymphocytes are excluded from the M:E RATIO

What is the NORMAL MYELOID to ERYTHROID RATIO?

FETAL HEMOGLOBIN (but detectable levels of adult hemoglobin may be present)

What is the PREDOMINANT HEMOGLOBIN in the HEPATIC PHASE of hematopoietic development?

BONE MARROW

What is the PRIMARY SITE of hematopoiesis by the end of the 24 weeks gestation?

WATERBUG or COMET appearance

What is the appearance of OSTEOBLAST?

Developing blood cells and their progenitors

What is the composition of the RED MARROW/ACTIVE MARROW?

• Adipocytes • Undifferentiated mesenchymal cells • Macrophages

What is the composition of the YELLOW/INACTIVE MARROW?

2 Epsilon + 2 Zeta

What is the globin chain combination of GOWER I?

2 Alpha + 2 Epsilon

What is the globin chain combination of GOWER II?

2 Zeta + 2 Gamma

What is the globin chain combination of Portland?

Aspiration needle/University of Illinois STERNAL NEEDLE

What is the instrument used for BONE MARROW ASPIRATE collection?

Trephine Biopsy needle/ Jamshidi needle/ Westerman-Jensen needle

What is the instrument used for TREPHINE (CORE) BIOPSY?

EMBRYOGENIC HEMOGLOBIN

What is the predominant HEMOGLOBIN in the MESOBLASTIC STAGE of hematopoietic development?

60% YELLOW MARROW 40% RED MARROW

What is the ratio of RED MARROW and YELLOW MARROW in ADULTS?

80-90% are RED/ACTIVE MARROW

What is the ratio of RED MARROW and YELLOW MARROW in NEWBORN and CHILDREN?

Upper end of tibial bone

What is the site of collection of BONE MARROW for NEWBORNS and INFANTS?

• Hemoglobin A • Hemoglobin A2 • Hemoglobin F

What is/are the HEMOGLOBIN present in the MEDULLARY (MYELOID) PHASE of hematopoietic development?

• Hemoglobin A

What is/are the MOST PREDOMINANT HEMOGLOBIN in the MEDULLARY (MYELOID) PHASE of hematopoietic development?

Provide PROTECTION and NOURISHMENT to the HSCS

What is/are the function of STROMAL CELLS?

• Cell renewal • Proliferation • Differentiation • Maturation

What occurs during HEMATOPOIESIS?

• Posterior Iliac Crest (MOST COMMON) • Sternum • Anterior iliac crest and spinal/vertebral bodies (RARELY USED) • Upper end of tibial bone (for NEWBORN and INFANTS)

What sites may be used for BONE MARROW COLLECTION?

RED/ACTIVE MARROW

What type of marrow is present during INFANCY and EARLY CHILDHOOD?

Around the 19TH DAY of embryonic development after fertlization

When does the MESOBLASTIC STAGE/YOLK SAC begin?

Central cavity of the yolk sac

Where does the MESOBLASTIC STAGE of hematopoietic development occur?

INACTIVE MARROW

YELLOW MARROW is also known as