SERIE BLANCA NORMAL Y PATOLGICA

Bqco. Gonzalo Ojeda Hematologa Clnica Fa.C.E.N.A U.N.N.E 2011

LEUCOPOYESIS

Leucocitos granulares

Neutrfilos( 50-70%)

Basfilos(0-2%)

Eosinfilos (0-5%)

Leucocitos agranulares

Monocitos (1-9%)

Linfocitos(20-40%)

RELATIVA %

ABSOLUTA (mm3) 0 a 300 3000 a 6000 40 a 400 0 a 100 1500 a 4000 80 a 800

CAYADOS SEGMENTADOS EOSINOFILOS BASOFILOS LINFOCITOS MONOCITOS

0a 3 50 a 70 1a 4 0a 1 20 a 40 2a 8

FUNCIONES DESTACADAS

GRANULOCITOS : inmunidad innata MONOCITOS: inmunidad innata/adaptativa LINFOCITOS: inmunidad adaptativa

GRANULOCITOS

GRANULOPOYESIS NEUTRFILO

GRANULOPOYESIS EOSINFILO y BASFILOS

Clula

Factores quimiotcticos y activadores

Mediadores

Neutrfilo

IL-8, TNF-, IL-1

Radicales libres de oxgeno, NO, prostaglandinas, leucotrienos, PAF, citoquinas Protenas catinicas, radicales libres de oxgeno, fosfolpidos, citoquinas Mediadores lipdicos, citoquinas. Histamina, mediadores lipdicos, citoquinas.

Eosinfilos Monocitos Mastocitos, basfilos.

IL-5,C5a, MIP-1

MCP-1, MIP 1.

IL-8, MCP-1.

NEUTRFILO

NEUTRFILO

GRANULOCITO NEUTRFILO
SP:3000 A 6000 cel/mm3 Tamao: 12-20 m GRANULOS 1- AZUROFILOS INESPECIFICOS Lisosomas 1,10 a 20% del contenido granular Mieloperoxidasa (MPO) Fosfatasa acida (FAC) Esterasas Beta glucuronidasa y beta galactosidasa Lisozima Otras proteinas bsicas catinicas

*VESICULAS SECRETORIAS: Contienen FAL *GRANULOS GELATINOSOS Gelatinasa, lisozima *Contienen alto contenido de glucgeno citoplasmtico

*GRANULOS SECUNDARIOS O ESPECIFICOS Constituyen el 80-90% de los grnulos, son anfteros se tien lila o rojizo *Fosfatasa acida (FAC) *Lactoferrina *Fagocitina *Protenas catinicas leucocitaria (pirgenos) * Lisozima *NADPH oxidasa *Protena de unin de la B12

FUNCIONES DEL GN
1-Defensa antimicrobiana: fagocitosis, bactericidia 2-Sntesis de la Protena transportadora de B12 3- Sntesis de pirgeno leucocitario 4-Biosntesis de nucletidos

MECANISMOS DE LA FUNCION FAGOCITARIA

ADHERENCIA AL ENDOTELIO QUIMIOTAXIS OPSONIZACION Y RECONOCIMIENTO ENDOCITOSIS O INGESTION DEGRANULACION ACTIVACION DEL METABOLISMO OXIDATIVO SISTEMAS BACTERICIDAS

ALTERACIONES FUNCIONALES
ADHERENCIA QUIMIOTAXIS GRNULOS ACTIVIDAD OXIDATIVA

CD11/CD18 CITOESQUELETO Rc DE MEMB CHEDIAK H DEFICIT DE MPO EGC DEFICT DE G6PDH

MIELOBLASTOS
Size of the cell: 15 - 25 m Shape of the cell: oval, sometimes round Colour of cytoplasm: blue, without distinct perinuclear halo or with extended perinuclear halo Granularity: nongranular cytoplasm or a few thick azurophilic granules Nucleus' shape: usually oval, sometimes irregular, rarely round Type of chromatin: fine, with reticular appearance Nuclear/cytoplasmic ratio: high

Nucleoli: visible, medium or large size 1 to 4; brighter than chromatin

Occurrence: blood: not present marrow: < 5%

Comment: One myeloblast and two more mature neutrophilic cells (myelocyte and band neutrophil leucocyte) are seen. Platelets with small number of granules.

Staining: MGG Magnification: x 1000

1. myeloblast 2. neutrophil myelocyte 3. band neutrophil

MIELOBLASTOS
Size of the cell: 15 - 25 m Shape of the cell: oval, sometimes round Colour of cytoplasm: blue, without distinct perinuclear halo or with extended perinuclear halo Granularity: nongranular cytoplasm or a few thick azurophilic granules Nucleus' shape: usually oval, sometimes irregular, rarely round Type of chromatin: fine, with reticular appearance Nuclear/cytoplasmic ratio: high or relatively high Nucleoli: visible, medium or large size 1 to 4; brighter than chromatin

Occurrence: blood: not present marrow: < 5%

Comment: Early myeloblast with very high cytoplasm - nucleus ratio, without granules. In the picture there are numerous other cells representing next stages of maturation of the series of granulopoiesis.

Staining: MGG Magnification: x 1000

1. myeloblast 2. promyelocyte 3. neutrophil myelocyte 4. neutrophil metamyelocyte 5. band neutrophil 6. segmented neutrophil 7. pycnotic normoblast 8. polychromatic normoblast 9. basophilic normoblast 10. proerythroblast

PROMIELOCITOS
Size of the cell: 15 - 30 m Shape of the cell: oval or round Colour of cytoplasm: light-blue, with distinct halo Granularity: thick, azurophilic abundant or very abundant Nucleus' shape: oval Type of chromatin: start of condensation Nuclear/cytoplasmic ratio: moderate, low or very low Nucleoli: visible, medium or large size, brighter than chromatin, 1-2. Sometimes not visible.

Occurrence: blood: not present marrow: < 5 %

Comment: The arrow indicates one promyelocyte, which is the only promyelocyte in the field. The nearby large cell of the granulopoiesis series is not a completely differentiated promyelocyte (lack of perinuclear zone, and not abundant granules).

Staining: MGG Magnification: x 1000

1. neutrophil myelocyte 2. neutrophil metamyelocyte 3. band neutrophil 4. segmented neutrophil 5. plasmocyte 6. eosinophil 7. megakaryoblast

Size of the cell: 15 - 30 m

PROMIELOCITOS

Shape of the cell: oval or round Colour of cytoplasm: light-blue, with distinct halo Granularity: thick, azurophilic abundant or very abundant Nucleus' shape: oval Type of chromatin: start of condensation Nuclear/cytoplasmic ratio: moderate, low or very low Nucleoli: visible, medium or large size, brighter than chromatin, 1-2. Sometimes not visible. Occurrence: blood: not present marrow: < 5 %

Comment: The promyelocyte contains very abundant primary granules and a distinct zone of perinuclear halo. Degranulated platelets and discrete anisocytosis of the erythrocytes are also seen.

Staining: MGG Magnification: 1000

PROMIELOCITOS

Size of the cell: 15 - 30 m Shape of the cell: oval or round Colour of cytoplasm: light-blue, with distinct halo Granularity: thick, azurophilic abundant or very abundant Nucleus' shape: oval Type of chromatin: start of condensation Nuclear/cytoplasmic ratio: moderate, low or very low Nucleoli: visible, medium or large size, brighter than chromatin, 1-2. Sometimes not visible.

Occurrence: blood: not present marrow: < 5 %

Comment: The promyelocyte contains abundant primary granules and a distinct zone of perinuclear halo. Also distinct anisocytosis of the erythrocytes.

Staining: MGG

Magnification: x 1000

Size of the cell: 15 - 25 m Shape of the cell: oval or round Colour of cytoplasm: light-blue or of pale pink colour undiscernible halo Granularity: abundant, thick azurophilic and neutrophilic granulation Nucleus' shape: oval or kidney shaped Type of chromatin: partially condensed Nuclear/cytoplasmic ratio: low or very low Nucleoli: not visible

MIELOCITOS NEUTRFILOS
Occurrence: blood: not present marrow: 5 - 20 %

Comment: The arrow indicates neutrophil myelocyte with pink cytoplasm and disappearing primary granules. In the field there are also four other cells at a similar stage of maturation and numerous other maturating neutrophil cells.

Staining: MGG Magnification: x 1000

1. neutrophil myelocyte 2. neutrophil metamyelocyte 3. band neutrophil 4. segmented neutrophil 5. lymphocyte 6. plasmocyte 7. proerythroblast 8. polychromatic normoblast 9. pycnotic normoblast

Size of the cell: 15 - 25 m

MIELOCITOS NEUTRFILOS

Shape of the cell: oval or round Colour of cytoplasm: light-blue or of pale pink colour undiscernible halo Granularity: abundant, thick azurophilic and neutrophilic granulation Nucleus' shape: oval or kidney shaped Type of chromatin: partially condensed Nuclear/cytoplasmic ratio: low or very low

Nucleoli: not visible

Occurrence: blood: not present marrow: 5 - 20 %

Comment: Early neutrophil myelocyte in the blood. Also two matured neutrophilic leucocytes, a lymphocyte and platelets.

Staining: MGG Magnification: x 1000

METAMIELOCITOS NEUTRFILOS
Size of the cell: 14 - 20 m Shape of the cell: oval or round Colour of cytoplasm: pink Granularity: a few azurophilic and neutrophilic, different in number Nucleus' shape: elongated, semicircular Type of chromatin: condensed Nuclear/cytoplasmic ratio: low or very low

Nucleoli: not visible

Occurrence: blood: not present marrow: 10 - 25 %

Comment: The arrow indicates a neutrophil metamyelocyte, one of seven present in the picture. Also other forms of maturating granulopoiesis are seen.

Staining: MGG Magnification: x 1000

1. neutrophil metamyelocyte 2. neutrophil myelocyte 3. promonocyte 4. promyelocyte 5. plasmocyte 6. basophilic normoblast 7. polychromatic normoblast 8. pycnotic normoblast

Size of the cell: 14 - 20 m

METAMIELOCITOS NEUTRFILOS
Shape of the cell: oval or round Colour of cytoplasm: pink Granularity: a few azurophilic and neutrophilic, different in number Nucleus' shape: elongated, semicircular Type of chromatin: condensed Nuclear/cytoplasmic ratio: low or very low

Nucleoli: not visible

Occurrence: blood: not present marrow: 10 - 25 %

Comment: Neutrophil metamyelocyte indicated by the arrow is present in blood. Besides, neutrophil segmented and band-forms leucocytes are seen. Platelets not rich in granules.

Staining: MGG Magnification: x 1000

Size of the cell: 14 - 20 m

Shape of the cell: oval or round

CAYADOS

Colour of cytoplasm: pink Granularity: a few azurophilic and neutrophilic, different in number Nucleus' shape: semicircular Type of chromatin: condensed Nuclear/cytoplasmic ratio: low or very low

Nucleoli: not visible

Occurrence: blood: < 5% marrow: 5 - 20 %

Comment: Two band forms and one segmented neutrophil leucocytes in the blood. Also crenated blood cells and platelets without granules are seen.

Staining: MGG Magnification: x 1000

CRITERIOS PARA CLASIFICAR UN NEUTRFILO COMO EN CAYADO -CUANDO NO SE OBSERVA LOBULACIN EVIDENTE -CUANDO EL NCLEO TIENE DIMETRO UNIFORME SIN ESTRANGULACIN EVIDENTE -SI EL NCLEO PRESENTA UNA PARTE MS DELGADA, ESTA NO DEBE SER MENOR A 1/3 DE LA PARTE DE MAYOR GROSOR

Size of the cell: 14 - 20 m

Shape of the cell: oval or round Colour of cytoplasm: pink

NEUTRFILO SEGMENTADO

Granularity: a few azurophilic and neutrophilic, different in number granulation Nucleus' shape: lobulated (normally less than 5 lobes) Type of chromatin: condensed Nuclear/cytoplasmic ratio: low or very low

Nucleoli: not visible

Occurrence: blood: 40 - 75 % marrow: 5 - 20 %

Comment: Three-lobulated segmented neutrophil leucocyte with fine neutrophil granularity.

Staining: MGG Magnification: x 1000

ALTERACIONES LEUCOCITARIAS
CUANTITATIVAS CUALITATIVAS LEUCOPENIAS F(X) LEUCOCITOSIS

NUCLEARES

CITOPLASMTICAS

NUCLEARES OTROS

HIPOSEG

HIPERSEG

CONGENITA

ADQUIRIDA

CONGNITA

ADQUIRIDA

PELGER HET

PSEUDO PELGER O PELGUEROIDE SMD EMBARAZADAS FARMACOS SEPSIS DE MALA EV LMA-LMC

UNDRITZ DFICIT DE B12 SMD

CITOPLASMTICAS ADQUIRIDAS

CONGNITAS

-A. DE CHEDIAK-HIGASHI -A. DE MAY HEGGLIN -A. DE ALDER -DEGRANULADOS

-GRAN. TXICAS -VACUOLAS -CUERPOS DE DHLE -DEGRANULADOS

HIPOSEGMENTACIN NUCLEAR

NO CONFUNDIR PELGER CON CAYADOS

CROMATINA MEDIANAMENTE CONDENSADA CROMATINA HIPERCONDENSADA LLEGA A MADURO SIN SEGMENTAR

PELGER HET

AUTOSMICO DOMINATE PUEDE SER HOMO O HETEROCIGOTA PUEDE AFECTAR TB A EOS Y BASOFILOS
HETEROCIGOTA HOMOCIGOTA

STODSMEYSTER

HIPERSEGMENTACIN

> A 5 LBULOS LIGERO AUMENTO DE TAMAO CELULAR CONGNITA (UNDRITZ) AUTOSMICA DOMINANTE- MUY RARA-80 A 90 % NEUTRFILOS CON MS DE 5 LBULOS PUEDE AFECTAR A EOSINFILOS ADQUIRIDA- BASTANTE FRECUENTESMD-ANEMIAS MEGALOBLSTICAS ALCOHOLISMO

HIPERSEGMENTANCIN

HIPERSEGMENTANCIN

ALTERACIONES CITOPLASMTICAS

CHEDIAK HIGASHI

ALBINISMO PARCIAL

MAY HEGGLIN

ALDER REILLY

NEUTROFILO AGRANULAR

Occurrence in blood: normally not present

Comment: Granulesless segmented neutrophil.

Staining: MGG Magnification: x 1000

GRANULACIONES TOXICAS

Granularity: thick granules, more eosinophilic stained than typical neutrophilic granularity. Single granules with a tendency to aggregate.

Occurrence in blood: normally not present

Comment: Band neutrophil leucocyte with dark, very abundant toxic granulation. Also anisocytosis of erythrocytes. Numerous ovalocytes. Normal platelets.

Staining: MGG Magnification: x 1000

CUERPOS DE DHLE

Definition: Dotted inclusions of blue, non-granular cytoplasm in pink cytoplasm of mature neutrophil leucocyte.

Occurrence in blood: normally not present.

Comment: The arrow points Dhles body in the granulocyte. Erythrocytes difficult to assess.

Staining: MGG Magnification: x 1000

Definition: Dotted inclusions of blue, nongranular cytoplasm in pink cytoplasm of mature neutrophil leucocyte.

Occurrence in blood: normally not present.

Comment: Dhles body pointed by the arrow. Also anisocytosis of erythrocytes.

Staining: MGG Magnification: x 1000

VACUOLAS

Occurrence: normal mature neutrophil leucocytes may contain single small vacuoles in cytoplasm

Comment: Distinct vacuoles changes in the neutrophilic leucocytes. Two target cells and one ovalocyte are present.

Staining: MGG Magnification: x 1000

VACUOLAS

Occurrence: normal mature neutrophil leucocytes may contain single small vacuoles in cytoplasm

Comment: Small vacuoles in a neutrophil leucocyte with fine neutrophilic granulation. Also anizocytosis of erythrocytes. A single spherocyte and a polychromatophilic cell are seen.

Staining: MGG Magnification: x 1000

NEUTRFILO APOPTTICO/MUESTRA VIEJA