1. Granulocyte and Mono-histiocytes 2001

2. 백혈구의 종류는 ? Phagocyte : Granulocyte : Neutrophil Eosinoiphil Basophil Monocyte Immunocyte : Lymphocyte Plasma cell

9. Stem cell (PSC) 부터 Seg. Neutrophil 까지 분화단계별 혈구 이름 ? PSC→ CFU-GEMM → CFU-GM → CFU-G → Myeloblast → promyelocyte → myelocyte → metamyelocyte → band → segmented (neutrophil, eosinophil, basophil)

11. Pools Bone marrow : Stem cell pool: PSC - CFU G Mitotic pool (5 ds ): myeloblast-myelocyte Post mitotic (reserve) pool (6.6 ds): metamyelocyte - seg.N Peripheral blood (9.5 hrs) : Circulating pool Marginating pool Tissue

13. CBC 에서 측정되는 Neutrophil 은 어느 Pool 의 것인가 ? BM reserve cell > PB : 10-15 배 Glucocorticoid: BM ⇒ CP → ＼ MP Endotoxin: BM ⇒ CP ⇒ ≫ MP Epinephrine: CP ← MP

14. 백혈구 수 (/L) 의 변화 Neutrophilia : 7500 이상 Neutropenia : 2500 미만 ( 중등도 위험 : 500-1000, 고위험 : 500 미만 ) Eosinophilia : 직접계산 ; 350 이상, 백혈구 백분율로 환산 ; 500 이상 Eosinopenia : <40 미만 Basophilia : 200 이상 Monocytosis : 1000, 이상 Monocytopenia : 200 미만 Lymphocytosis : 성인 ; 4000 이상, 소아 ; 8800 이상 Lymphocytopenia : 성인 ;.500 미만 소아 ; 3000 미만

16. 과립구 구조 Primary granules: myeloperoxidase, lactoferrin,leukocyte adhesion receptors, ALP, defensin, azurophil-derived bactericidal factor(ADBF) Secondary granules: lysozyme, collagenase, plasmin Surface : adhesion molecules(CD11/CD18 ) Membrane: receptors for opsonin, chemotaxin, GM-CSF, G-CSF, phospholipid(PGE2, leukotriene 등 생성 ) Cytoplasm: actin, myosin, tubulin

17. Adhesion Cascade 과립구 염증부위로 이동 기전

18. 과립구 이동에 관여하는 물질 Selectins: tethering, rolling, sticking Integrins and IgSF: rolling, sticking, diapedes, chemotaxis Activation of endothelial cell by histamin, thrombin, TNF, IL-1,-4, LPS Activation of leukocyte by IL-8, C5a Leukocyte adhesion deficiency syndromes : LAD I(CD11/CD18 def.), LAD II(SLeX def.)

19. 과립구와 단구의 기능 Chemotaxis : IL-8(neutrophil specific), C5a, protein 1(monocyte specific) Phagocytosis : Fc and C3b receptors recognize opsonized (by Ig and complements) particles. Killing and Digestion : superoxide, hydrogen peroxide, low pH

20. 단구 (Monocyte) 의 기능 Phagocytosis Antigen presentation Growth factors 생산 : IL-3, IL-6, GM-CSF, G-CSF, M-CSF

21. Phagocytosis and Killing

22. 과립구 기능 이상 Defects of chemotaxis : aspirin, alcohol, corticosteroids, leukemias, lazy leucocyte syndrome Defects of phagocytosis: lack of opsonization(hypogammaglobulinemia) Defects of killing: chronic granulomatous disease(cytochrome b558 def), myeloperoxidase def.

23. Leukemoid reaction WBC>50,000, or immature cells in PB Granulocyte, Lymphocyte Infection Leukoerythroblastic reaction I mmature granulocyte and normoblast in PB myelofibrosis, cancer BM metastasis, massive bleeding or hemolysis, MDS, leukemia

24. 과립구의 유전성질환 Pelger-Huet May-Hegglin Chediak Higashi CGD Myeloperoxidase deficiency

25. Neutropenia Drug induced Cyclic Immune (neonatal neutropenia) Idiopathic

26. 과립구의 악성질환 Myelodysplastic syndrome (MDS) Chronic myeloproliferative disorders (CMPD) CML AML