dr.

Indriati Dwi Rahayu

PENDAHULUAN

SEL-SEL

HEMATOPOIESIS
Umum
- Special connective tissue
• Total volume: + 5 L, + 8 % body weight
• Composition :
√ plasma : tersebar unsur padat,
protein, hormon
√ unsur padat : blood cells

STAINING : Wright, Giemsa, Romanowsky,

~ Hematocrite
Leishman
 Composition of PLASMA

Formed
elements :
blood cells

Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

Fig 20.1
PLASMA
 +55 % blood, homogen
 Komposisi:
• +90 % water
• +10 % zat terlarut :
 Garam anorganik : 0.9 %. Ex : Na, K, Ca
 Zat organik : 2,1 %. Ex : As.amino, glukosa,
peptida, hormon, lipid
 Protein plasma : 7 %. Ex; Albumin, Globulin
(α,β,γ) Fibrinogen, prothrombin
• The composition of plasma is usually an indicator of
the mean composition of the extracellular fluids in
general
KOMPONEN PADAT  + 45 % : sel2 DARAH
PENDAHULUAN

SEL-SEL DARAH

HEMATOPOIESIS
sel2 DARAH
RBC

L EOSINOPHYL
E
U BASOPHYL HARGA NORMAL

!
C
FUNGSI
O
C
NETROPHYL STRUKTUR
Y KORELASI
T LYMPHOCYTE KLINIS
E
S MONOCYTE

THROMBOCYTE
KOMPONEN PADAT  45 %

1. Red Blood Cell = Erythrocyte

- Normal value: 4 - 6 X 106 /μL

- Life span : 120 hr  lien dan sum2 tulang

- hematocrit : perkiraan volume eritrosit per unit volume
darah. Harga normal : laki2 :40–50% ; wanita : 35–45%
- FUNGSI :
* untuk transpor O2 (oleh Hemoglobin)
* buffer asam-basa (oleh Hemoglobin)
* katalisator reaksi ( dg enzym karbonik anhidrase)

HEMOGLOBIN
* Tdd 4 polipeptida, @ memiliki 1 Heme
* Type (berdasar asam amino)
1. Hb A1 : 97 %
2. Hb A2 : 2 %
3. Hb F : 1 %. (pada neonatus 80%)
4. Hb S : abnormal dr Hb A  Sickle cell
anemia
- STRUKTUR :
* Ф : 7 – 8 μm, (sediaan segar lebih besar; warna kuning
kehijauan)
* bikonkaf ; bag tengah: central pallor
* (matur) : inti dan organella (-)
* Sitoplasma Isotonis; mengandung Hb
* Plasmalemma : tdd membran protein integral:
Dalam  Spectrin
Luar  Mengandung antigen
* Bersifat fleksibel
* Cenderung saling melekat  Rouleaux formation
(hanya sementara)
- abnormalitas struktur:
* Anisositosis : RBC dalam ukuran bervariasi
* Makrositer : Ø > 9 µm
* Mikrositer : Ø < 6 µm
* Cabot ring = Howell Jolly body : fragmen inti. (> 1 %)
Pengecatan : Brilliant Cresyl Blue utk melihat sisa
RER & ribosom pada retikulosit
* Shadow/Ghost blood : pucat, bulat. Karena hemolisis.
* Crenated : mengkerut. Karena suasana hipertonis
* Spherocytosis : Spheroidal erythrocyte
KLINIS
Anemia : Hb ↓
may be caused by :
– loss of blood (hemorrhage);
– insufficient production of erythrocytes by the bone marrow;
– production of erythrocytes with insufficient hemoglobin, usually
related to iron deficiency in the diet; or
– accelerated destruction of blood cells.
Ex : Sickle cell anemia : The sickled erythrocyte is inflexible and
fragile and has a shortened life span that leads to anemia.
It increases the blood viscosity and can damage the walls of
blood vessels, promoting blood coagulation. Blood flow through
the capillaries is retarded or even stopped, leading to severe O2
shortage (anoxia) in tissues.
sel2 DARAH
RBC

L EOSINOPHYL
E
U BASOPHYL
C
O
C
NETROPHYL
Y
T LYMPHOCYTE
HARGA NORMAL
E
FUNGSI MONOCYTE
S
STRUKTUR
KORELASI THROMBOCYTE
KLINIS
2. LEKOSIT
- jumlah normal: 6000 – 10.000 / μL
- dasar klasifikasi :
~ diameter
~ Bentuk inti
~ Ratio inti-sitoplasma
~ Pengecatan
• Karakteristik umum :
- sel sejati  inti & organella [+]
- gerak amuboid & diapedesis [+]
- berfungsi di jaringan ikat. Aliran darah hanya sebagai
sarana transportasi
- pada sediaan permanen ukuran lebih besar
- granul azurophilic, with lytic enzymes

• klasifikasi dengan pengecatan khusus  diff.count

(hitung jenis)
• tipe utama : granulosit & agranulosit
- Granulosit,
* = PMN (polymorpho nuclear)
* organella: [matur] Inti berlobus, Golgi,mitokondria,
free ribosom,RER
* specific granules dan azurophilic granules;
* TERDIRI DARI : Eosinofil, Basofil, da Netrofil

- Agranulosit
* mononuclear ; unsegmented
* granul azurophilic ONLY
* TERDIRI DARI : Limfosit, Monosit
Leukocytosis

• An increase in the number of circulating leukocytes occurs as

a normal protective reaction in a variety of pathological
conditions, especially in response to infections.

• Pathological leukocytosis : leukocyte count more than 11 x

109/1 (11. 000/mm3)

Leukopenia

the total blood leukocyte count : less than 4 x 109/1 (4000/mm3).

Granulocytopenia (neutropenia)
This is a general term used to indicate an abnormal
reduction in the numbers of circulating granulocytes
(polymorphonuclear leukocytes), commonly called
neutropenia because 40 to 75% of granulocytes are
neutrophils. A reduction in the number of circulating
granulocytes occurs when production does not keep
pace with the normal removal of cells or when the life
sel2 DARAH
RBC

L EOSINOPHYL
E
U BASOPHYL HARGA NORMAL
C FUNGSI
O
NETROPHYL STRUKTUR
C
Y KORELASI
T LYMPHOCYTE KLINIS
E
S MONOCYTE

THROMBOCYTE
• Eosinofil :
- % WBC : 1-4 %
- Karakteristik :
* >> di sirkulasi saat reaksi alergi & infeksi parasit
* gerak diapedesis [+]
* kemampuan fagositosis terbatas, t.u kompleks
Ag-Ab
* responsif dengan pemberian steroid
( = Thorn test)
STRUKTUR :
• Φ : (sirkulasi) : 9 µm
(jaringan) : 14 µm
- Sitoplasma :
* granul lebih besar, refraktil, uniform
* granul mengandung lisozym khusus (peroxidase, acid
fosfatase, cathepsin, ribonuclease, Eosinophilic
antiparasitic agent) + azurophilic
• Inti :
- chromatin padat
- p.u 2 lobus, sering tertutup granul
- Peran : * respon thd infeksi parasit
* modulasi proses inflamasi
* inaktivasi leukotrien & histamin
KLINIS :

Eosinophilia : associated with allergic reactions and

helminthic (parasitic) infections.

Corticosteroids can produce a rapid decrease in the

number of blood eosinophils, probably by interfering with
their release from the bone marrow into the bloodstream
sel2 DARAH
RBC

L EOSINOPHYL
E
U BASOPHYL HARGA NORMAL
C FUNGSI
O
NETROPHYL STRUKTUR
C
Y KORELASI
T LYMPHOCYTE KLINIS
E
S MONOCYTE

THROMBOCYTE
• Basofil :
- % WBC : 0-1 %
- karakteristik :
* mirip mast cell, kecuali ultrastrukturnya
* kemampuan gerak amuboid & fagositosis terbatas

- Peran :
 dalam reaksi immediate hipersensitivity;
 menghasilkan mediator radang
- Struktur :
* Φ :10-12 µm (lbh kecil dr netrofil)
* Sitoplasma :
- kurang padat
- ukuran granul bervariasi, granul spesifik gelap
- Granul mengandung heparin, histamin
* Inti :
chromatin padat, lebih pucat
p.u 3 lobus, bentuk S, sering tertutup granul
KLINIS

cutaneus basophil hypersensitivity : penumpukan

extravaskular karena inflamasi
sel2 DARAH
RBC

L EOSINOPHYL
E
U BASOPHYL HARGA NORMAL
C FUNGSI
O
NETROPHYL STRUKTUR
C
Y KORELASI
T LYMPHOCYTE KLINIS
E
S MONOCYTE

THROMBOCYTE
Netrofil :
- dominan, 60-70 %
- tidak dapat mitosis
- peran : first line pertahanan seluler : Fagositosis
- karakteristik :
> gerak amuboid  keluar pembuluh darah
 ~ makrofag aktif = microphage
> kemampuan mitosis [-]
> 2 macam granule ( specific & azurophilic)
> klasifikasi (menurut Schiling) :
~ Netrofil segmented (57 %)
Meningkat : shift to the right
- Netrofil nonsegmented (stab) (4%)
Meningkat : shift to the left
STRUKTUR
• Φ : (sirkulasi) : 12 µm
(jaringan) : 20 µm
• Sitoplasma :
- warna : salmon-pink
- Granul spesifik : Alkaline phosphatase, lysozym, Laktoferin
kolagenase, protein antibacterial non-
enzimatik (ex; Phagocytin)
- Granul Azurofilik : Acid phosphatase, myeloperoxidase,
protein antibakterial kationik, dll
- >> glikogen
Inti :
• chromatin padat
• multilobus
• macam :
* hipersegmented ( >5 )  tua
* segmented
* stab
• [wanita] drumstick=Barr body, mrpkn kromosom X
inaktif (menempel pada inti)
KLINIS :
An increased number of band neutrophils in the blood
indicates a higher production of neutrophils, probably in
response to a bacterial infection.
( Immature neutrophils that have recently entered the
blood circulation have a nonsegmented nucleus in the
shape of a horseshoe (band forms))
RBC

EOSINOFIL

BASOFIL
HARGA NORMAL
NETROFIL FUNGSI
STRUKTUR
LIMFOSIT KORELASI
KLINIS
MONOSIT

TROMBOSIT
Limfosit :
 % wbc :20 – 25 %
 di luar pembuluh darah : organ limfatik & jaringan
ikat
 Dapat berRESIRKULASI
 terbagi dalam 2 kelas : limfosit T (most) & B
 Peran : sesuai jenis sel.
sel T : berperan dalam immunitas seluler
sel B : berperan dalam immunitas humoral;
berdiferensiasi menjadi Sel Plasma; 
menghasilkan Imunoglobulin
 ! TIDAK DAPAT FAGOSITOSIS
 Struktur :
* Φ: Kecil 6 – 8 µm
Med-besar :8-18 µm
* Sitoplasma :
[kecil] :dekat inti tipis, basofil pucat, warna biru
kehijauan
>> ribosom; Organella lain << (tidak khas)
[med-besar] : lebih banyak, (lain sama)
 Inti :
[kecil] : - Bulat / pipih, dengan indentasi 1 sisi
- heterochromatis padat
- warna : biru s/d hitam- keunguan
[med-besar] : lebih besar
kurang heterocromatis
warna : ungu kemerahan
CLINICAL CORRELATION

AIDS
• HIV-infected adolescents and adults categorizes
persons on the basis of clinical conditions associated
with HIV infection and CD4+ T lymphocyte counts

SEVERE COMBINED IMMUNODEFICIENCY

• The SCID syndrome is characterized by gross functional
impairment of both humoral and cell-mediated immunity
and by susceptibility to devastating fungal, bacterial,
and viral infections
RBC

EOSINOFIL

BASOFIL
HARGA NORMAL
NETROFIL FUNGSI
STRUKTUR
LIMFOSIT KORELASI
KLINIS
MONOSIT

TROMBOSIT
Monosit (large mononuclear leucocyte) :
- % WBC : 3 – 8 %
- Karakteristik :
hanya di darah
Di luar sirkulasi  fagositosis
kemampuan resirkulasi [-]
gerak pseudopodia seperti octopus, dg inti di depan
- Peran :
• Generation of mononuclear-phagocyte system cells in
tissues;
• phagocytosis and digestion of protozoa and virus and
senescent cells
The monocyte-macrophage system consists of the
body's complement of monocytes and macrophages.
Some macrophages are mobile whereas others are
fixed. These include:
• histiocytes in connective tissues
• microglia in the brain
• Kupffer cells in the liver
• alveolar macrophages in the lungs
• sinus-lining macrophages (reticular cells) in the spleen,
lymph nodes and thymus gland
• mesangial cells in the glomerulus of nephrons in the
kidney
• osteoclasts in bone.
Struktur :
- Φ: (sirkulasi) : 12-15 µm (jaringan) : 20 µm
-Sitoplasma : * warna biru keabu-abuan
* >> granul azurofilik
* >> mitokondria & golgi & RER
* Ribosom bebas <<
- Inti : * p.u bentuk ginjal, eksentris
* lebih pucat (kromatin lebih halus)
* 2-3 nucleoli
* Warna : ungu kemerahan
CLINICAL CORRELATION
• Monocytopenia occurs with acute infections, with
stress, and after treatment with glucocorticoids.
Monocytopenia also occurs in aplastic anemia, hairy cell
leukemia, acute myeloid leukemia, and as a direct result
of myelotoxic drugs.

• Monocytosis is associated with tuberculosis,

brucellosis, subacute bacterial endocarditis, Rocky
Mountain spotted fever, malaria, and visceral
leishmaniasis (kala azar).
Monocytosis also occurs with malignancies, leukemias,
myeloproliferative syndromes, hemolytic anemias,
chronic idiopathic neutropenias, and granulomatous
diseases such as sarcoidosis, regional enteritis, and
some collagen vascular diseases.
RBC

EOSINOFIL

BASOFIL
HARGA NORMAL
NETROFIL FUNGSI
STRUKTUR
LIMFOSIT KORELASI
KLINIS
MONOSIT

TROMBOSIT
PLATELET (thrombocyte=thromboplastid)
- berasal dr “budding’ megakariosit di sumsum tulang
- Σ Normal : 200.000-400.000/Μl, lifespan : 8 hari
- Fungsi : CLOT FORMATION
• Primary aggregation—Discontinuities in the
endothelium,  platelet aggregation  platelet plug
• Secondary aggregation—Platelets in the plug
release an adhesive glycoprotein and ADP. 
increasing the size of the platelet plug.
• Blood coagulation -- cascade, giving rise to a
polymer, fibrin  thrombus.
- Struktur :
 Ø : 2-5 μm; dalam sediaan nampak berkelompok
 Bentuk seperti cakram, biconvex
 pd sediaan segar : tidak berwarna
 permukaan membran : Glycocalyx untuk adhesi
 tepi : hyalomere,warna biru pucat. Terdapat
marginal bundle
 central : dense granulomere, Terdapat mitokhondria,
granul glikogen, dan granul2 warna ungu.
Jenis granul : δ, α, λ
CLINICAL CORRELATION

THROMBOCYTOPENIA
This is defined as a blood platelet count below 150 x 109/1
(150 000/mm3) but spontaneous capillary bleeding does
not usually occur unless the count falls below 30 x 109/1
(30 000/mm3).
Thrombocytopenia results from one or more of three
processes: (1) decreased bone marrow production; (2)
sequestration, usually in an enlarged spleen; and/or (3)
increased platelet destruction.
Disorders of production may be either inherited or acquired.
THROMBOCYTOSIS
Thrombocytosis is almost always due to (1) iron deficiency;
(2) inflammation, cancer, or infection (reactive
thrombocytosis); or (3) an underlying myeloproliferative
process [essential thrombocythemia or polycythemia vera
or, rarely, the 5q-myelodysplastic process
PENDAHULUAN

SEL-SEL

HEMATOPOIESIS

 HEMATOPOIESIS
= proses sintesa sel2 darah
Terdiri dari proliferasi dan differensiasi sel2 induk
hematopoiesis

Tahap :
Sel induk pluripotensial  Sel induk (stem cell) 
sel progenitor  sel prekursor (blast)  sel matur
Sel Induk Hematoipoiesis pluripotensial
• derivat mesoderm, undifferentiated
• Bersifat mitosis aktif
• Bersifat pluripotent
• dapat membelah berulang, & selanjutnya
differensiasi menjadi sel2 darah matur
• Berproliferasi, membentuk 2 jalur diferensiasi (2 stem
cell):
* Jalur Myeloid  RBC, granulosit, monosit, Platelet
~ erythropoiesis
~ granulopiesis
~ monopiesis
~ thrombopiesis
* Jalur lymphoid  limfosit dan sel plasma
Colony forming cell: (~ sel progenitor)
- = sel pembentuk koloni
- sebagai pembentuk koloni2 tipe2 sel darah tertentu
- differensiasi menjadi sel induk unipoten ( ex : ECFC
membentuk RBC, LCFC membentuk limfosit, dst)
Jalur Myeloid Jalur lymphoid
TERIMA KASIH