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SERIE BLANCA

NORMAL YPATOLGICABqco. Gonzalo Ojeda

Hematologa ClnicaFa.C.E.N.A U.N.N.E2011

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LEUCOPOYESIS

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Neutrfilos( 50-70%) Basfilos(0-2%) Eosinfilos (0-5%)

Monocitos (1-9%) Linfocitos(20-40%)

Leucocitos granulares

Leucocitos agranulares

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80 a 8002 a 8MONOCITOS

1500 a 400020 a 40LINFOCITOS

0 a 1000 a 1BASOFILOS

40 a 4001 a 4EOSINOFILOS

3000 a 600050 a 70SEGMENTADOS

0 a 3000 a 3CAYADOS

ABSOLUTA

(mm3)

RELATIVA %

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FUNCIONES DESTACADAS GRANULOCITOS : inmunidad innata

MONOCITOS: inmunidadinnata/adaptativa

LINFOCITOS: inmunidad adaptativa

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GRANULOCITOS

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GRANULOPOYESISNEUTRFILO

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GRANULOPOYESIS

EOSINFILO y BASFILOS

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Histamina, mediadores lipdicos,citoquinas.IL-8, MCP-1.

Mastocitos,basfilos.

Protenas catinicas, radicaleslibres de oxgeno, fosfolpidos,citoquinas

IL-5,C5a, MIP-1Eosinfilos

Mediadores lipdicos, citoquinas.MCP-1, MIP 1.Monocitos

IL-8, TNF-, IL-1

Factoresquimiotcticosy activadores

Radicales libres de oxgeno, NO,

prostaglandinas, leucotrienos, PAF,citoquinasNeutrfilo

MediadoresClula

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NEUTRFILO

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NEUTRFILO

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GRANULOCITO NEUTRFILOSP:3000 A 6000 cel/mm3Tamao: 12-20 mGRANULOS 1- AZUROFILOS

INESPECIFICOSLisosomas 1,10 a 20% del contenido granularMieloperoxidasa (MPO)Fosfatasa acida (FAC)

EsterasasBeta glucuronidasa y beta galactosidasaLisozimaOtras proteinas bsicas catinicas

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*VESICULAS SECRETORIAS:Contienen FAL

*GRANULOS GELATINOSOS

Gelatinasa, lisozima

*Contienen alto contenido de glucgeno

citoplasmtico

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*GRANULOS SECUNDARIOS O

ESPECIFICOSConstituyen 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

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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

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MECANISMOS DE LA FUNCION

FAGOCITARIA ADHERENCIA AL ENDOTELIO QUIMIOTAXIS OPSONIZACION Y RECONOCIMIENTO ENDOCITOSIS O INGESTION DEGRANULACION

ACTIVACION DEL METABOLISMOOXIDATIVO SISTEMAS BACTERICIDAS

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ALTERACIONES FUNCIONALESADHERENCIA ACTIVIDAD

OXIDATIVAQUIMIOTAXIS GRNULOS

CD11/CD18CITOESQUELETO

Rc DE MEMBCHEDIAK H

DEFICIT DE MPOEGC

DEFICT DEG6PDH

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MIELOBLASTOS

1. myeloblast 2. neutrophil myelocyte 3. band neutrophil

Magnification: x 1000

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

Occurrence:blood: not presentmarrow: < 5%

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

Nuclear/cytoplasmic ratio: high

Type of chromatin: fin e, with reticul arappearance

Nucleus' shape: usually oval,sometimes irregular, rarely round

Granularity: nongranular cytoplasm or afew thick azurophilic granules

Colour of cytoplasm: blue, withoutdistinct perinuclear halo or withextended perinuclear halo

Shape of the cell: oval, sometimes

round

Size of the cell: 15 - 25 m

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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


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

Occurrence:blood: not presentmarrow: < 5%

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

Nuclear/cytoplasmic ratio: high orrelatively high

Type of chromatin: fin e, withreticular appearance

Nucleus' shape: usually oval,

sometimes irregular, rarely round

Granularity: nongranular cytoplasmor a few thick azurophilic granules

Colour of cytoplasm: blue, withoutdistinct perinuclear halo or withextended perinuclear halo

Shape of the cell: oval, sometimesround


MIELOBLASTOS

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PROMIELOCITOS

1. neutrophil myelocyte 2. neutrophil metamyelocyte 3. band neutrophil 4. segmented neutrophil 5. plasmocyte 6. eosinophil7. megakaryoblast


Staining: MGGComment: The arrow indicates one promyelocyte, which is the only promyelocyte in the field. The nearby largecell of the granulopoiesis series is not a completely differentiated promyelocyte (lack of perinuclear zone, and not

abundant granules).

Occurrence:

blood: not presentmarrow: < 5 %

Nucleoli: visible, medium or largesize, brighter than chromatin, 1-2.Sometimes not visible.

Nuclear/cytoplasmic ratio: moderate,

low or very low

Type of chromatin: start ofcondensation

Nucleus' shape: oval

Granularity: thick, azurophi licabundant or very abundant

Colour of cytoplasm: light-blue, withdistinct halo

Shape of the cell: oval or round


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Magnification: 1000

Staining: MGGComment: 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.

Occurrence:blood: not presentmarrow: < 5 %

Nucleoli: visible, medium or largesize, brighter than ch romatin, 1-2.Sometimes not visible.

Nuclear/cytoplasmic ratio: moderate,low or very low




Colour of cytoplasm: light-blue, withdistinct halo

Shape of t he cell: oval or round

Size of the cell: 15 - 30 mPROMIELOCITOS

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Staining: MGGComment: The promyelocyte contains abundant primary granules and a distinct zone of perinuclear halo. Alsodistinct anisocytosis of the erythrocytes.

Occurrence:

blood: not presentmarrow: < 5 %

Nucleoli: visible, medium or largesize, brighter than chromatin, 1-2.Sometimes not visible.

Nuclear/cytoplasmic ratio:moderate, low or very low




Colour of cytoplasm: light-blue,with distinct h alo


Size of the cell: 15 - 30 mPROMIELOCITOS

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1. neutrophil myelocyte 2. neutrophil metamyelocyte 3. band neutrophil 4. segmented neutrophil 5. lymphocyte 6. plasmocyte

7. proerythroblast 8. polychromatic normoblast 9. pycnotic normoblast


Staining: MGGComment: The arrow indicates neutrophil myelocyte with pink cytoplasm and disappearing primarygranules. In the field there are also four ot her cells at a similar stage of maturation and numerous othermaturating neutrophil cells.

Occurrence:

blood: not presentmarrow: 5 - 20 %

Nucleoli: not visible

Nuclear/cytoplasmic ratio: low or verylow

Type of chromatin: partially

condensed

Nucleus' shape: oval or kidneyshaped

Granularity: abundant, thickazurophilic and neutrophilicgranulation

Colour of cytoplasm: light-blue or ofpale pink colour undiscernible halo



MIELOCITOS NEUTRFILOS

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Staining: MGGComment: Early neutrophil myelocyte in the blood. Also two matured neutrophilic leucocytes, a lymphocyte andplatelets.

Occurrence:



Nuclear/cytoplasmic ratio: lowor very low

Type of chromatin: partiallycondensed

Nucleus' shape: oval or kidneyshaped

Granularity: abundant, thickazurophilic and neutrophilicgranulation

Colour of cytoplasm: light-blueor of pale pink colourundiscernible halo


Size of the cell: 15 - 25m

MIELOCITOS NEUTRFILOS

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METAMIELOCITOS NEUTRFILOS

1. neutrophil metamyelocyte 2. neutrophil myelocyte 3. promonocyte 4. promyelocyte 5. plasmocyte 6. basophilic normoblast

7. polychromatic normoblast 8. pycnotic normoblast


Staining: MGGComment: The arrow ind icates a neutrophil metamyelocyte, one of seven present in the picture. Also otherforms of maturating granulopoiesis are seen.

Occurrence:



Nuclear/cytoplasmic ratio: low orvery low

Type of chromatin: cond ensed

Nucleus' shape: elongated,semicircular

Granularity: a few azurophilic andneutrophilic, different in number

Colour of cytoplasm: pink



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Staining: MGGComment: Neutroph il metamyelocyte indicated by the arrow is present in blood. Besides, neutrophilsegmented and band-forms leucocytes are seen. Platelets not rich in granules.

Occurrence:blood: not presentmarrow: 10 - 25 %


Nuclear/cytoplasmic ratio: low orvery low

Type of chromatin: cond ensed

Nucleus' shape: elongated,semicircular




Size of the cell: 14 - 20 mMETAMIELOCITOS NEUTRFILOS

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Staining: MGGComment: Two band forms and one segmented neutrophil leucocytes in the blood. Also crenated blood cells and

platelets without granules are seen.

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



Type of chromatin: condensed

Nucleus' shape: semicircular





CAYADOS

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CRITERIOS PARA CLASIFICAR UN NEUTRFILO COMOEN CAYADO

-CUANDO NO SE OBSERVA LOBULACIN EVIDENTE

-CUANDO EL NCLEO TIENE DIMETRO UNIFORMESIN ESTRANGULACIN EVIDENTE

-SI EL NCLEO PRESENTA UNA PARTE MS DELGADA,ESTA NO DEBE SER MENOR A 1/3 DE LA PARTE DE

MAYOR GROSOR

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Staining: MGGComment: Three-lobulated segmented neutrophil leucocyte with fine neutrophil granularity.

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



Type of chromatin: condensed

Nucleus' shape: lobulated (normally lessthan 5 lobes)

Granularity: a few azurophi lic andneutrophilic, different in numbergranulation




NEUTRFILO SEGMENTADO

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ALTERACIONES

LEUCOCITARIAS

NUCLEARES CITOPLASMTICAS

CUALITATIVAS

LEUCOCITOSISLEUCOPENIAS

CUANTITATIVAS

F(X)

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ADQUIRIDA

HIPERSEG

CONGNITA ADQUIRIDACONGENITA

HIPOSEG

NUCLEARES

PELGER HETDFICIT DE B12

SMD

UNDRITZPSEUDO PELGERO

PELGUEROIDESMD

EMBARAZADASFARMACOS

SEPSIS DE MALA EVLMA-LMC

OTROS

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CITOPLASMTICAS

ADQUIRIDASCONGNITAS

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

-A. DE ALDER-DEGRANULADOS

-GRAN. TXICAS-VACUOLAS

-CUERPOS DE DHLE

-DEGRANULADOS

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HIPOSEGMENTACIN

NUCLEAR NO CONFUNDIR PELGER CON CAYADOS

CROMATINA MEDIANAMENTE CONDENSADACROMATINA HIPERCON-

DENSADALLEGA A MADURO SIN

SEGMENTAR

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PELGER HET AUTOSMICO DOMINATE PUEDE SER HOMO O HETEROCIGOTA

PUEDE AFECTAR TB A EOS Y BASOFILOS

HOMOCIGOTA

HETEROCIGOTA

STODSMEYSTER

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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 FRECUENTE-

SMD-ANEMIAS MEGALOBLSTICAS -ALCOHOLISMO

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HIPERSEGMENTANCIN

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HIPERSEGMENTANCIN

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ALTERACIONES

CITOPLASMTICAS CHEDIAK HIGASHI

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ALBINISMO PARCIAL

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MAY HEGGLIN

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ALDER REILLY

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Staining: MGGComment: Granulesless segmented neutrophil.

Occurrence in blood:normally not present

NEUTROFILO AGRANULAR

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Staining: MGGComment: Band neutrophil leucocytewith dark, very abundant toxic granulation. Also anisocytosis oferythrocytes. Numerous o valocytes. Normal pl atelets.

Occurrence in blood:normally not present

Granularity: thick granules,more eosinophilic stained thantypical neutrophilicgranularity. Single granuleswith a tendency to aggregate.

GRANULACIONES TOXICAS

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

Occurrence in blood:

normally not present.

Definition: Dotted inclusions ofblue, non-granular cytoplasm inpink cytoplasm of matureneutrophil leucocyte.

CUERPOS DE DHLE

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

Occurrence in blood:

normally not present.

Definition: Dottedinclusions of blue, non-granular cytoplasm in pinkcytoplasm of matureneutrophil leucocyte.

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Staining: MGGComment: Distinct vacuoles changes in the neutrophilic leucocytes. Two target cells and one ovalocyte arepresent.

Occurrence: normal matureneutrophil leucocytes may containsingle small vacuoles in cytoplasm

VACUOLAS

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Staining: MGGComment: Small vacuoles in a neutrophil leucocyte with fine neutrophilic granulation. Also anizocytosis oferythrocytes. A single spherocyte and a polychro matophilic cell are seen.

Occurrence: normal mature

neutrophil leucocytes may containsingle small vacuoles in cytoplasm

VACUOLAS

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NEUTRFILO

APOPTTICO/MUESTRAVIEJA

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