Hematology Exam 2

These mature in the tissues into macrophages primarily for phagocytosis but are also capable of compounds __________________involved in various immunity processes ________________

(monocytes) complement, interferon killer role, tumor destruction

The average time that a neutrophil spends in the peripheral blood

10 hours

monocytes spend how long in the blood in route to the tissues

12 hours

Although the monocyte is LARGE _______________in size the macrophage (histocyte) ranges ________________ in size

12-20; 15-80

platelets that are in the systemic circulating pool______________ and in the spleen_____________

2/3; 1/3

Eosinohils have _________________ in the tissues for each one that is in the blood

300-500

Not counted in the white count

50% that adhere to the walls of the blood vessels (marginal pool)

When circulating _____________of the neutrophils circulate freely _____________and ______________adhere to the walls of the blood vessels__________________

50%; circulating pool; 50%; marginal pool

Hypersegmantation

6 or more lobes seen in SEGMENTED NEUTROPHILS May be acquired (B12 and folic acid deficiencies), chronic infections or rarely inherited representing abnormal cellular maturation

Chediak-Higashi syndrome

A rare fatal hereditary disorder found in children making them prone to infections PRIMARLY DUE TO THE NEUTROPHILS impaired function NEUTROPHILS MONOCYTES AND LYMPHOCYTES ARE EFFECTED with large granules with are bluish-purple in neutrophils and reddish purple in monocytes and lymphocytes

Auer rods

Rod like bodies that stain reddish purple and found in the cytoplasm of blast cells in acute myelogenous, monocytic and erythroblstic leukemias

Toxic granulation

Seen primarily in neutrophils (rarely monocytes) seen in acute infections, drug poisoning and burns

Degenerated neutrophil with pyknotic nucleus

NEUTROPHIL have very round small segments representing nuclear degeneration. May be seen on slides made with old blood (cell death) NOT COUNTED IN DIFF

Monocyte

Nuclei take different shapes from brainy convolutions to lobulated and s shaped chromatin is open lose weaved lacy open and thin the cytoplasm is abundant grey blue with moderate nonspecific granules may show and area of protrusion may have numerous vacuoles DISTINGUISHING CHARACTERISTIC: nuclear chromatin lacks density; open weaved, soft, and velvetlike

Pomyelocyte

Prominent nuclei, prominent nonspecific granules, and slightly coarse nuclear chromatin. azurophilic granules (primary or non specific)

Pelger-Huet anomaly (Pseudoanomaly)

a genetic failure of the NEUTROPHILS NUCLEUS to segment properly. ALL OF THE NEUTROPHILS fail to segment properly benign anomaly with normal immunity homozygous (single lobed- peanut shaped) heterozygous (2 lobes or rarely 3)

Myeloblast

a granular

May-Hegglin Anomaly

an inherited condition that causes large Dohle like inclusion bodies PRIMARILY IN NEUTROPHILS PLATELETS ARE EFFECTED! 1/2 of pts will be asymptomatic while those with decreased platelet counts may experience bleeding.

T lymphocytes have __________ memory which is _____________

antigenic; immunity

Opsonization

antigens coated with antibodies which usually leads to phagocytosis by other cells

Necrotaxis

attraction to dead or dying cells

Promyelocyte

azurophilic (primary or non specific granules first appear) ^continue to band stage (prominence decreasing) RARELY SEEN IN MATURE SEGMENTED NEUTROPHIL

Band

band shaped nucleus

Released into peripheral circulation (few) (many) depending on infection

bands

Mature much like neutrohpils with the exception of larger dark/ purple - black granules appearing at the myelocyte stage

basophils

Play a role in acute systemic allergic reactions (heparin and histamine)

basophils

primarily a tissue cell and are normally called mast cells when fully mature in their tissue invironment

basophils

Metamyelocyte

bean shaped nucleus patches of coarse chromatin in spots the cytoplasm is a pale blue to pinkish tan with moderate specific granules DIFFERENTIATING CHARACTERISTICS: nucleus's indentation is less that half the diameter of the nucleus and condensed chromatin with no nuclei SAME FOR THE MYELOCYTE

Primary lymphoid tissues

bone marrow and thymus

The B lymphocyte comes from ___________ and migrates to the _________ where it interacts with _________ and differentiates into a _______________

bone marrow; peripheral lymphatic tissues; antigens; plasma cell

Eosinophils

can appear at the myelocytic stage and move through the maturation sequence eccentric nucleus usually bilobed (two lobes conected by a filament) the cytoplasm is a large distinctive red-orange specific granules are orange-pink DISTINGUISHING CHARACTERISTICS: granules are uniformly round, large and individualized; if stain is inadequate, observe granules carefully for their crystalloid nature

Basophil

can appear in the myelocytic stage and move through the maturation process chromatin is coarse clumped and there is a bilobed nuceus; its is often obscured by large dark granules present in the cytoplasm there are many large, specific secondary purple black granules that obscure the large clover leaf form nucleus DISTINGUISHING CHARACTERISTICS: size and color of granules obscure the nucleus

Myeloblast

can be neutrophilic, eosinophilic, or basophilic round, oval, slightly indented central nucleus chromatin is a light red-purple with a fine meshlike appearance small amount of cytoplasm moderate blue color usually without granules DIFFERENTIATING CHARACTERISTIC: nucleus has thin chromatin strands that are distributed throughout the nucleus uniformly chromatin appears smooth and velvety

Where can lymphocyte stem cells go for maturation

can remain in the bone marrow or migrate to the thymus lymph-nodes, spleen, or peyers patches in the intestine

hematopoietic growth factors _________stimulate lymphocytic stem cells in becoming various types of ____________ or ____________

cytokines; t lymphocytes; b lymphocytes

Neutropenia

decrease in neutrophils in the peripheral blood

Many Neutrophils __________in the tissues and end up_____________________ by _________________

die; phagocytized; macrophages

Alder-Reilly Anomaly

difficult to tell apart from toxic granulation NEUTROPHILS EOSINOPHILS BASOPHILS MONOCYTES LYMPHOCYTES caused by mucopolysaccharide disorder seen in pts with Hurler and Hunter Syndromes

what is primarily a tissue cell

eosinophil

Mature much like meutrophils (larger red/ orange) granules appearing at the myelocyte stage instead of the fine lt. purple granules of the neutrophil

eosinophils

These travel to sites of inflammatory reactions and parasitic infection

eosinophils

immature eosiniophils and basophils are identified as....... (generally)

eosinophils and basophils NOT eosinophilic/ basophilic myelocytes, metamyeloctes, or band (stabs)

They respectively reduce inflammation and release substances to help destroy parasties increase of about ____________in these situations

eosinophils; 15%

B Lymphocytes live _______________________

few days

Mott cell

plasma cell with vacuoles

B lymphs may differentiate into what?

plasma cells

___________________secrete immunoglobulins (antibodies) for defense against various foreign antigens (possible infections) referred to as ________________

plasma cells (mature B lymphocytes) humoral immunity

fragments of the cytoplasm

platelets, live about 9 days; maintain hemeostasis (stoppage of bleeding and capillary integrity)

shift to the left refers too.....

predominance of immature cells

time that neutrophils spend in the tissues

several days

T lymphocytes live ________________

several months or 4-10 years

Hypersegmentation

six or more lobes seen in segmented neutrophils

Dohle bodies

small lt. blue staining inclusions seen in the cytoplasm of NEUTROPHILS seen in infections, poisoning (CHEMO), burns, and Dohle-like inclusions in May-Hegglin anomaly

Myelocyte

specific secondary granules being and become more prominent with maturity

______mature in the thymus and travel to the peripheral tissues where they interact in conjunction with _____________and_______________to form specific effector cells

t lymphocytes macrophages antigens

lymphocytic stem cells are produced by

the bone marrow only

blast cells are identified by .....

the company they keep ex.great number of immature myelocytic stages + no other immature stages = myeloblast "copy cat rule"

where neutrophils carry out their major functions

tissues

vacuolated neutrophil

vacuoles in cytoplasm due to active phagocytosis caused by bacterial/ fungal infection

band

"band" shaped c or s shaped leopard spot coarseness the cytoplasm is a brown pink with many fine specific granules or secondary granules DIFFERENTIATING CHARACTERISTICS: indentation is more than half of the nuclear margin and chromatin is more clumped

humoral immunity

ANIBODIES

cellular immunity

Also called cell-mediated immunity. T lymphocytes interact with macrophages and antigens to form specific effector cells involved in hypersensitivity reactions, suppression of tumors, graft rejection, and some intra cellular orgranisms.

we are unable to specifically identify these without more advanced testing called ______________

B or T lymphocytes flow cytometry

where do hematopoietic growth factors stimulate lymphocytic stem cells?

peyer's patches in the intestine

Megakaryocytes

LARGE CELLS

YOUNG PLATELETS

LARGER and more effective at maintaining hemostasis

myelocyte

first stage where specific granules allow for differentiation between granulocytes the chromatin has an oval, indented nucleus, denser red-purple with slight granular appearance coarser, clumped appearance the cytoplasm has specific or secondary granules neutrophilic granules are dusty, fine and red-blue eosinophilic granules are large and red-orange. basophils granules are large deep blue and purple This is the last stage capable of dividing DIFFERENTIATING CHARACTERISTIC: small pink purple granules for neutrophilic myelocyte the nucleus stains a deep color; granular pattern to the chromatin ; eccentric nucleus; visible golgi apparatus seen in lighter area near nucleus

generally determine membrane surface characteristics

flow cytometry

segmented neutrophil

have two to five nuclear lobes connected by thin threadlike filaments cytoplasm is a pale lilac with blue shading and many fine secondary dustlike granules

Neutrophilia

increase in neutrophils in the peripheral blood

Metamyelocyte

indented nucleus

What are neutrophils major functions?

ingesting (phagocytosis) ; releasing lysozymes aiding in the destruction of invading microorganisms (bacteria, viruses, ect.)

Necrophagocytosis

ingestion of dying cells and cellular debris

small lymphs that attack only antibody coated cells

k-type

stages of lymphocytes

lymphoblast prolymphoblast lymphocyte

helps cells by recognizing foreign antigens (viruses, bacteria, ect.) and producing antibodies to combat them

lymphocytes

these change their appearance with various types of infections (generally viral)

lymphocytes

referred to as reactive (atypical, variant, downey) lymphocytes

lymphocytes that change their appearance with various types of infections

rarely seen in blood and are given various names depending on the specific tissue in which they are found

macrophages

once monocytes are in the tissues they mature into ________________ and spend _________________ carrying out their functions before they die

macrophages; several months

Stages of a megakaryocyte

megakaryoblast, promegakaryocyte, megakaryocyte, then platelets -which are fragments of cytoplasm

stages of monocyte

monoblast promonocyte monocyte

nucleus has a fine lacy chromatin/parachromatin pettern and is often horseshoe/ kidney shaped or clefted/ folded (noneucleoli) The cytoplasm is blue-grey with a fine granulation often reffered to as a ground glass appearance

monocytes

often pseudopods and vacuoles will be present

monocytes

produced in the bones marrow and still considered immature when released into the paripheral blood

monocytes

Atypical Platelets

most often seen in myleoproliferative disorders

Neutrophil stages of development

myeloblast promyelocyte myelocyte metamyelocyte band segmented neutrophil

Where do the 3 specific (secondary) granules first appear?

myelocyte stage

type of lymphocyte formerly called null cells and appear as large granular lymphs

natural killer (NK)

these are known to destroy targeted cells through a cytoxic mechanism that lyse cells rather than phagocytic route

natural killer (NK) K-type

These cells do not have the common cell surface markers of the B&T lymphocytes

natural killer (NK) and k-type

Produced in the bone marrow and mature there as well going through the various stages before they are released into the peripheral circulation

neutrophilic granulocytes (released into peripheral circulation) mature segmented neutrophils

what 3 cell types are distinguished by 3 types of specific (secondary) granules

neutrophils eosinophils and basophils

Barr Body

nuclear chromatin projection with a drumstick shape with no clinical significance

smudge cell

nucleus without cytoplasm LYMPHOCYTES MOSTLY OR VERY RARELY A NEUTROPHIL

Promyelocyte

oval, round, or eccentric flattened nucleus chromatin is a light red-purple of medium density may see one to three prominent nuclei moderate blue cytoplasm difficult to observe because of the blue-red azurophilic granules are scattered everywhere DIFFERENTIATING CHARACTERISTIC: Cell is usually larger than a blast with a large prominent nuclei nuclear chromatin is slightly coarse