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