1. Blood, hemopoesis Dr. Ádám Ágota → Blood cells + plasma
Hematocrit: percentage of cellular elements
Dr. Ádám Ágota

2. Blood cells: Erythrocytes (RBC)
Leukocytes(WBC) – blood as transporting medium
- granulocytes: lobulated nuclei, many cytoplasmic granules
- neutrophils
- eosinphils
- basophils
- agranulocytes: single, non-lobulated nucleus, few cytoplazmic granules
- lymphocytes
- monocytes
- Thrombocytes (platelets)

3. Blood smear
Staining: May-Grünwald-Giemsa

4. Main categories describing blood cells:
Quantity/percentage in blood
Shape
Size
Microscopic appearance (what does it look like?) – GIEMSA staining
Electronmicroscopic picture, subcellular organelles
Movement?
Function
Life span
Site (organ) of origin?
Site of destruction?
Main pathological alterations

5. The red blood cell: 4-5 million/mm3 ; lab code: RBC: 4-5 T/l (T=tera)
Doughnut (thinner centre, thicker rim)
7 µm diameter
Periphery: intense acidophilia, lightly stained central part
No subcellular organelles! Characteristic membrane components, e.g.: cholesterol: decreased amounts lead to loss of membrane elasticity .
No self-mobility; drifted by blood stream
Transport of oxygen and carbon dioxide
120 days (with aging cholesterol ↓)
Red bone marrow
Red bone marrow, spleen

6. The red blood cell, cont.:
11. Sensitive to ionic concentration
lower than isotonic ⇒ ‘Spherocyte’ (ball shape)
higher than isotonic ⇒ ‘Echinocyte’ (thorny)
Pathological increase of RBC: ERYTHROCYTOSIS
Pathological decrease of RBC: ANAEMIA
ANISOCYTOSIS: RBCs are of different shape

7. Sickle cell anaemia

8. The neutrophilic granulocyte (Neutrophil):
a.k.a. Polymorphonuclear WBC („Poly”)
Abundant; 60-70% of total WBC
Regular, spherical → appears round in blood smear
10-15 µm diameter
Segmented nucleus (usually 3 lobules); neutrophilic granules
Featureless cytoplasm, fair amount of glycogen particles; primary (20%) and secondary (80%) granules with enzymes: peroxidase, acidic phosphatase, collagenase, alkaline phosphatase, ribonuclease, lysozime, etc…
Motility; the fastest moving type of WBC (40 µm/min); amoeboid movement (with pseudopodia)
Devouring of foreign bodies („microphage”), small particles, bacteria, followed by decomposition with the help of specific particles
Very short-lived, ca. 1 day!
Red bone marrow
At the site of phagocytosis ⇒ pus („pus cells”) or the connective tissue
Enhanced percentage: NEUTROPHILIA (bacterial infection or leukaemia)
Decreased percentage: NEUTROPENIA (disfunction of red bone marrow); „RIGHT SHIFT” – hypersegmentation – alcoholism

9. Neutrophils
Barr body: Only in females – inactive X chromosome

10. The eosinophilic granulocyte (Eosinophil):
crystalloid
The eosinophilic granulocyte (Eosinophil):
2-4 % of total WBC
Regular, spherical → round in smear
10-15 µm diameter
Bilobular nucleus; eosinophilic granules in cytoplasm
Featureless cytoplasm, many granules: specific granules (peroxidase, ribonuklease, acidic phosphatase, histaminase)
Motility (chemotactic signal: allergic reactions – histamine release; metabolic products of parasites)
Endocytosis, attenuation of allergic responses, anti-parasitic
2-3 days
Red bone marrow
Site of discharge or anywhere in the connective tissue
Enhanced percentage: EOSINOPHILIA (allergic reactions of parasitic infections)
Decreased percentage: EOSINOPENIA (disfunction of red bone marrow)

11. Eosinophils

12. The basophilic granulocyte (Basophil):
Scarce (less than 1 %) – invisible in smears
Regular, spherical → round in smear
10 µm diameter
Horseshoe-shaped, non-segmented nucleus; large cytoplasm full of basophilic granules (metachromasic with toluidine blue)
Lysosomes do not occur; heterogeneous granules, containing histamine, serotonin, hyaluronidase, etc.
Motility
Transforms to mastocytes – allergic and inflammatory reactions
5-6 days
Red bone marrow
Anywhere in connective tissues
Enhanced percentage: BASOPHILIA (initial symptom of allergic reactions)

13. Basophils

14. The lymphocyte: 20-30 % Regular, spherical → round in smear
Heterogeny in size: small lymphocyte: 7-8 µm, medium sized: µm, large: µm
Round nucleus; small lymphocyte (resting form) – rich in heterochromatin; large lymphocyte (active, lymphoblast) – rich in euchromatin; reduced and pale stained cytoplasm
Abundant free ribosomes, little cytoplasm
Fast and active movements; Ly’s tend to leave the circulatory system when stimulated by any foreign substance
Generation of immune response
Different life spans: few days – years (memory cells)
Red bone marrow, followed by migration into primary lymphatic organs (thymus)
Usually in lymphatic organs
Enhanced percentage: LYMPHOCYTOSIS (foreign proteins) Decreased percentage: LYMPHOPENIA (destruction of lymphatic organs)

15. Lymphocytes (large, medium, small)

16. The monocyte:
2-8 %
Regular, spherical→ round in smear; in tissue: irregular, with processes
The largest WBC, µm
Bean shaped and eccentric nucleus; cytoplasm „greyish-blue” – discrete azurophilic granules (tiny)
Abundant lysosomes, well developed microtubular system
Active motility
Large, phagocytic cells (MACROPHAGE); transient form in blood – migrating from bone marrow to tissues, transforming into macrophage
Variable life span; 2-3 month
Red bone marrow
At the site of definitive formation
Enhanced percentage: MONOCYTOSIS (protracted bacterial infections, mononucleosis); Decreased percentage: MONOCYTOPENIA (diseases of bone marrow)

17. Monocytes

18. The thrombocyte (platelet):
– /mm3
Ovoidal or elongated; multiple occurrence in smear (tends to aggregate)
The smallest blood cell; 2-5 µm
Only part of it is visible in smears (granulomer: central part, hyalomer: peripheral part – glassy, not stained)
Specific components (α-granule, dense-core granule – blood clotting factors)
No self-mobility; drifted by circulation
Blood clotting (hemostasis) (degranulation – hemostatic factors released)
5-10 days
Red bone marrow
Spleen
Enhanced percentage: THROMBOCYTOSIS (hypertrophy of bone marrow); Decreased percentage: THROMBOCYTOPENIA (may be related to side effects of certain medicines)

19. Thrombocytes
Origin:
Megakaryocyte (red bone marrow)

20. Haematopoesis Red bone marrow CFU cells (Colony forming unit) –
pluripotent precursors of blood cells;
all blood cells are differentiated from these

21. Erythropoiesis CFU-E cell Proerythroblast: - Large (20-25µm)
- Euchromatic
- Basophilic cytoplasm
- Many ribosomes
Basophilic
erythroblast: µm
Heterochromat.
- Basophilic cytoplasm
Polychromatophilic erythroblast: µm
-hemoglobin prod.
- Mixed eosinophilic and basophilic cytoplasm: „greyish”
Acidophilic erythroblast: µm
-nucleus pressed onto periphery
Reticulocyte
Nucleus is being ejected
Erythrocyte
Normally, only this form is present in circulation
In summary: cell size decreases, haemoglobin synthesis, ejection of nucleus.

22. Granulopoiesis (myelopoiesis)
myelocyte
metamyelocyte
STAB form!
Myeloblast
(euchromatic nucl.; basophilic citopl., multiple ribosomes)
Promyelocyte
(large granules)

23. Thrombopoiesis Megakaryoblast (euchromatic nucleus; free ribosomes)
Promegakaryocyte (2 nuclei)
Basophilic megakaryocyte (4 nuclei)
Acidophilic megakaryocyte
6 osztódás
Thrombogenic megakaryocyte (64 nuclei!; gigantic cell)
Cytoplasmic fragmentation
Thrombocyte (remaining nuclei get phagocytosed by macrophages)

24. Normal blood smear

25. Acute myeloid leukemia
Acute proliferation of abnormal myeloid precursors

26. Chronic myeloid leukemia

27. Acute lymphoid leukemia
Acute proliferation of immature lymphoblasts

28. Thank you for your attention!