Blood And Bone Marrow

Front 1

Blood Consists of what?

Back 1

Cells and plasma

Front 2

What type of cells are in blood?

Back 2

Erythrocytes (Red Blood Cells)
Leukocytes (White Blood Cells)
Platelets

Front 3

What is packed cell volume?

Back 3

(“Hematocrit”) = R/T x 100 [%]
R= % of Erythrocytes (40-50%)
T= Total volume (Plasma 50-60%, buffy coat of WBC and Platelets, Erythrocytes 40-50%)

Front 4

What is plasma and what does it contain?

Back 4

- Liquid phase of blood (anticoagulated)
~90% Water
- Proteins
- Ions, glucose, amino acids, waste products

Front 5

What kinds of proteins are present in plasma?

Back 5

Albumin
Coagulation factors
Immunoglobulins, lipoproteins, others

Front 6

What is Serum?

Back 6

Fluid remaining after blood clotted

Front 7

What are erythrocytes?
How long do they live?
How are they destroyed?

Back 7

- Red Blood Cells
- Anucleate
- Life span ≈ 120 days
- Phagocytized & destroyed in spleen

Front 8

What is the primary function of RBC's?

Back 8

Oxygen transport
Hemoglobin = Oxygen carrying molecule
Oxygen bound to iron in heme ring

Front 9

What is the secondary function of RBC's

Back 9

Acid-base balance

Front 10

What does Hemoglobin consist of?

Back 10

- Heme = iron atom in protoporphyrin ring
- Globin = protein portion
- Hemoglobin = tetramer: 2 a-chains, 2 b-type chains

Front 11

What is the color, shape and size of RBC's?

Back 11

- Reddish-orange color on blood smear
- Biconcave disk shape
- Central pallor: ~ 1/3rd diameter of RBC
- Diameter: ~ 7-8 microns
~ Same size as nucleus of small, resting lymphocyte

Front 12

What is a reticulocyte?
About how many of them are there?

Back 12

- Immature RBC containing RNA
- Normal reticulocyte count ~ 1% of RBCs (~1% of RBCs replaced daily)

Front 13

How can you identify a reticulocyte on a slide?

Back 13

- Basophilic (bluish) on routine blood smear stains
- Definitive identification requires special stain (“reticulocyte stain”)

Front 14

What is the range of Hemoglobin (grams/DL) for males and females?

Back 14

Man: 14-18
Woman: 12-16

Front 15

What is the Hematocrit (%) range for both Men and Women?

Back 15

Man: 42-52
Woman: 37-47

Front 16

What is the Mean Corpuscular Volume or MCV (Femtoliters [10-15 L])
for both men and women?

Back 16

Man: 80-94
Woman: 81-99

Front 17

What are also known as White Blood Cells and what two categories do they contain?

Back 17

Leukocytes are either:
- Granulocytes: Contain specific granules
- Agranulocytes: May contain lysosomes (nonspecific granules):

Front 18

What are the types of Granulocytes?

Back 18

Neutrophils (polymorphonuclear leukocytes or “Segs”)
Eosinophils (red granules)
Basophils (dark blue granules)

Front 19

What are the types of Agranulocytes?

Back 19

Lymphocytes
Monocytes

Front 20

What is the most common Leukocyte?

Back 20

Neutrophils

Front 21

What is the function of the Neutrophil?

Back 21

Phagocytosis, predominantly bacteria

Front 22

What is the appearance of the Neutrophil?

Back 22

- Nucleus segmented (“Seg”) or horseshoe-shaped (“Band”)
- Granules small, weakly stained (“neutrophilic”)

Front 23

How can you determine a Neutrophil on a slide?

Back 23

- Nucleus with distinct lobes separated by thin strands of chromatin
- Finely granular cytoplasm
- Weakly staining granules

Front 24

What characterizes a "Band" Neutrophil?

Back 24

- Non-segmented, horseshoe-shaped nucleus
- Less mature than segmented neutrophil
- Fully functional

Front 25

What is the lifespan of a Neutrophil?

Back 25

~10 hours in circulation, 1-4 days in tissue

Front 26

What causes an increase in Neutrophils?

Back 26

- Increase in acute infection, inflammation or other stress:
- Increase in “band” forms particularly suggests acute infection or inflammation

Front 27

How would you describe an Eosinophil?

Back 27

Large, intensely red (“eosinophilic”) granules

Front 28

What is the function of the Eosinophil?
How long do they live and how many of them are there?

Back 28

- Phagocytosis of antigen-antibody complexes; kill parasites
- Normally ~ 2-4% of WBCs:
- Lifespan in blood ~ 8 hours

Front 29

What causes an increase in Eosinophils?

Back 29

Increase in allergic reactions, parasitic infections

Front 30

How would you identify an Eosinophil on a slide?

Back 30

- Segmented nucleus- usually bilobed
- Large, uniform, reddish cytoplasmic granules

Front 31

What is the size and color of Basophils?
What are they most closely related to?

Back 31

- Large, dark blue (“basophilic”) granules
- Possibly related to tissue mast cells

Front 32

How common are Basophils?

Back 32

Least common leukocytes (≤1%):
Increase in chronic infections; some neoplasms

Front 33

What is the Function of Basophils?

Back 33

Function not entirely clear; may control immune reactions

Front 34

How would you identify a Basophil on a slide?

Back 34

- Large, purple granules
- Segmented nucleus

Front 35

What is the size, shape and color of a Lymphocyte?

Back 35

- Nucleus round; ~size of normal RBC
- Usually scanty, pale blue cytoplasm

Front 36

What is the general amount of Lymphocytes?

Back 36

Normally ~20-40% of WBC (higher in children)

Front 37

What causes an increase in Lymphocytes?

Back 37

Increase in viral infections, Toxoplasmosis, other conditions

Front 38

Reactive or “atypical” lymphocytes are known as...?

Back 38

Infectious mononucleosis

Front 39

How would you identify a Lymphocyte on a slide?

Back 39

- Small, round, condensed nucleus
- Scant pale blue cytoplasm
- Nucleus ~ same size as erythrocyte

Front 40

_____ may recirculate between blood and tissue

Back 40

Lymphocytes

Front 41

What are the two main types of Lymphocytes and what do they do?

Back 41

B-Cells: Humoral immune system
T-Cells: Cell-mediated immunity; Control of immune system

Front 42

What is the third type of Lymphocyte?

Back 42

Natural killer cells

Front 43

How do Lymphocyte B cells mature?

Back 43

- Early maturation & differentiation in bone marrow
- Final maturation after stimulation by antigen in tissues
- Differentiate into plasma cells: Antibody synthesizing cells

Front 44

Where are the T cell Lymphocytes located? Where did they start and why did they migrate?

Back 44

T-Cell = Thymus
Originate in bone marrow
Migrate to thymus for differentiation and maturation

Front 45

What is the responsibility of the T Cell Lymphocyte?

Back 45

Key regulation & control of immune system
Effector cells of cell-mediated immunity

Front 46

What are the two main types of T Cell Lymphocyte?

Back 46

- T-Helper: Express CD4 antigen; Master control cells of immune system
- T-Suppressor: Express CD8 antigen

Front 47

The _____ virus preferentially infects _____ lymphocytes by recognition of _____ molecule on surface of T-cell.

Back 47

HIV, CD4+, CD4

Front 48

What are reactive (“Atypical”) Lymphocytes?

Back 48

- Characteristic of infectious mononucleosis
- May occur in cytomegalovirus (CMV) and other infections

Front 49

How would you identify a reactive (Atypical) Lymphocyte on a slide?

Back 49

- Abundant, pale-blue cytoplasm
- Larger, less condensed nucleus; may have nucleolus
- Characteristically “hug” or “skirt around” erythrocytes

Front 50

Aspergillus fumigatus

Back 50

mold with septate hyphae, 45 deg acute angle
not dimorphic
lung cavity, "fungus ball"
allergic bronchopulmonary aspergillosis
invasive aspergillosis (esp. in immunocompromised and those with chronic granulomatous disease)

A in Aspergillus fumigatus for Acute Angles

Front 51

About how many Monocytes are there?

Back 51

~3-8% of WBCs

Front 52

How would you identify a monocyte on a slide?

Back 52

Folded nucleus
Abundant, light grey cytoplasm
Cytoplasmic vacuoles common
Few, small cytoplasmic granules

Front 53

What can monocytes differentiate into?

Back 53

Tissue macrophages or histiocytes

Front 54

What are the two main function of Monocytes?

Back 54

- Phagocytosis: Organisms (fungi, mycobacteria), debris, foreign material
- Antigen processing and presentation to lymphocytes

Front 55

What is the Leukocyte differential?

Back 55

Never Let Monkeys Eat Bananas
Neutrophils 52-76%
Lymphocytes 20-40%
Monocytes 2-9%
Eosinophils 2-4%
Basophils < 1%

Front 56

What is another name for Platelets?
What is their size, and color?

Back 56

Thrombocytes
Smallest cellular elements: ~1-4 m diameter
Anucleate; light blue with reddish-purple granules

Front 57

Why are Platelets important?
What do they do?

Back 57

Important in hemostasis:
- Adhere to injured blood vessel wall
- Form immediate hemostatic plug
- Form surface for coagulation cascade

Front 58

What is a normal number for a platelet count?

Back 58

~140,000-440,000 per mL (140-440 x 109/Liter

Front 59

What is considered adequate hemostasis for normal conditions of platelets?

Back 59

>20,000/mL

Front 60

What is an adequate platelet count for most surgery?

Back 60

>50,000-100,000/mL

Front 61

What is a platelet count that is considered a risk for spontaneous hemorrage?

Back 61

<10,000/mL

Front 62

What is the complete blood count (CBC)

Back 62

Reb Cells + White Cells + Platelets or Platelet count

Front 63

What comprises the Red Cells in a Complete Blood Count?

Back 63

RBC count
Hemoglobin
Hematocrit:
- Red cell indices: MCV

Front 64

What comprises the White Cells in a Complete Blood Count?

Back 64

Total WBC count:
- Differential: % and absolute number
- Absolute neutrophil count most important in WBCs

Front 65

Where does the term Hematopoiesis come from?

Back 65

Derived from the Greek:
Haima-blood
Poiein-to make

Front 66

How much RBC's does bone marrow produce daily?

Back 66

Marrow produces ~5 x 1011 cells/day

Front 67

What characterizes hematopoiesis?

Back 67

- Extremely complex process
- Tightly regulated:
-->Mature cells maintained at constant levels
- Able to increase production several-fold in response to increased need

Front 68

- Give rise to all lines of mature blood cells
- Self-renewing
- Cannot be specifically identified

Back 68

Pluripotent (Totipotent) Stem Cells

Front 69

What do stem cells give rise to?
What is the result of this?

Back 69

- Committed progenitor cells
- Progressive commitment to single lineage
- Progressively more differentiated
- More mitotically active than stem cells
- Less capacity for self renewal

Front 70

What is the initial differentiation of Hematopoietic Stem Cells?

Back 70

Differentiation into CFU-GEMM (CMP) or CFU-L (CLP)

Front 71

What does CFU stand for?

Back 71

Colony Forming Unit

Front 72

What does CFU-GEMM consist of?

Back 72

Granulocytes, Erythrocytes, Monocytes, Megakaryocytes

Front 73

What does CFU-L consist of?

Back 73

Lymphocytes (both B-cells & T-cells)

Front 74

Where does Hematopoiesis take place in the first trimester?

Back 74

Yolk sac and aorta-gonadal-mesoderm (AGM) area

Front 75

Where does Hematopoiesis take place in the second trimester?

Back 75

Predominantly liver; less so spleen

Front 76

Where does Hematopoiesis take place in the third trimester?

Back 76

Bone marrow hematopoiesis becomes predominant

Front 77

Where does Hematopoiesis take place in the post-natally?

Back 77

Bone marrow is only normal site of hematopoiesis

Front 78

What are the types of Bone Marrow?

Back 78

Red and Yellow Marrow

Front 79

Red Marrow is characterized as what?
Where is it primarily found?

Back 79

- Active hematopoiesis:
- Primarily axial skeleton in adults (vertebrae, ribs, pelvis, skull, sternum)

Front 80

Yellow marrow is characterized as what?
Where is it primarily found?

Back 80

- No active hematopoiesis:
- Primarily adipose
- May resume hematopoiesis under stress conditions

Front 81

What are Hematopoietic Growth Factors?

Back 81

- Proteins or glycoproteins that regulate hematopoiesis
- Act on specific transmembrane growth factor receptors
- Activate intracellular signaling pathways
- Result in DNA transcription

Front 82

What are Hematopoietic Growth Factor Receptors?

Back 82

- Specific transmembrane proteins
- Many are, or activate, protein tyrosine kinases - or both
- Multiple signaling pathways involved

Front 83

Where are Hematopoietic Growth Factors produced and by what?

Back 83

Mostly produced in bone marrow by macrophages, T-cells, adventitial cells

Front 84

What are the few Hematopoietic Growth Factors produced outside marrow
How do they reach the bone marrow

Back 84

Erythropoietin: Produced in kidneys & liver
Thrombopoietin: Produced in liver & spleen

Reach marrow through bloodstream

Front 85

What are some clinically relevant Hematopoietic Growth Factors?

Back 85

- G-CSF (Neupogen®)
- Erythropoietin (EPO; Procrit®)
- Thrombopoietin (Promacta®; Nplate®)

Front 86

Where is G-CSF produced and by what?

Back 86

Produced in bone marrow by macrophages, T-cells, fibroblasts and/or endothelial cells

Front 87

What is the function of G-CSF?

Back 87

Stimulates production of granulocytes
Also stimulates function of mature cells

Front 88

What are the therapeutic uses of G-CSF?

Back 88

Granulocytopenia due to chemotherapy & other causes
Bone marrow transplantation

Front 89

Where is the main site and secondary site of production of Erythropoietin (EPO)?
What stimulates production?

Back 89

- Kidneys = main site of production:
- Liver = small amount (secondary)
- Production stimulated by renal ischemia or hypoxia

Front 90

What are some clinical uses of Erythropoietin (EPO)?

Back 90

- Anemia of renal failure
- Anemia of chronic disease
- Anemia of AIDS
- Anemia of cancer chemotherapy

Front 91

Where is the main site and secondary sites of Thrombopoietin?
What does this stimulate?

Back 91

- Primarily produced in liver
- Secondary sites: Spleen, kidneys, bone marrow
- Stimulates megakaryocyte differentiation & platelet production

Front 92

What are the possible uses of Thrombopoietin?

Back 92

Thrombocytopenia; Cancer chemotherapy; Bone marrow transplantation