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SERIE BLANCA NORMAL Y PATOLÓGICABqco. Gonzalo OjedaHematología ClínicaFa.C.E.N.A – U.N.N.E2011

LEUCOPOYESIS

Neutrófilos( 50-70%) Basófilos(0-2%) Eosinófilos (0-5%)

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

Leucocitos granulares

Leucocitos agranulares

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 %

FUNCIONES DESTACADAS

GRANULOCITOS : inmunidad innata

MONOCITOS: inmunidad innata/adaptativa

LINFOCITOS: inmunidad adaptativa

GRANULOCITOS

GRANULOPOYESIS NEUTRÓFILO

GRANULOPOYESIS EOSINÓFILO y BASÓFILOS

Histamina, mediadores lipídicos, citoquinas.IL-8, MCP-1.Mastocitos,

basófilos.

Proteínas catiónicas, radicales libres de oxígeno, fosfolípidos, citoquinas

IL-5,C5a, MIP-1Eosinófilos

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

IL-8, TNF-α, IL-1

Factores quimiotácticosy activadores

Radicales libres de oxígeno, NO, prostaglandinas, leucotrienos, PAF, citoquinas

Neutrófilo

MediadoresCélula

NEUTRÓFILO

GRANULOCITO NEUTRÓFILOSP:3000 A 6000 cel/mm3Tamaño: 12-20 µmGRANULOS 1°- AZUROFILOS

INESPECIFICOSLisosomas 1°,10 a 20% del contenido granularMieloperoxidasa (MPO)Fosfatasa acida (FAC)EsterasasBeta glucuronidasa y beta galactosidasaLisozimaOtras proteinas básicas catiónicas

*VESICULAS SECRETORIAS:Contienen FAL

*GRANULOS GELATINOSOSGelatinasa, lisozima

*Contienen alto contenido de glucógeno citoplasmático

*GRANULOS SECUNDARIOS O ESPECIFICOS

Constituyen el 80-90% de los gránulos, son anfóteros se tiñen lila o rojizo

*Fosfatasa acida (FAC)*Lactoferrina*Fagocitina*Proteínas catiónicas leucocitaria (pirógenos)* Lisozima*NADPH oxidasa*Proteína de unión de la B12

FUNCIONES DEL GN

1-Defensa antimicrobiana: fagocitosis, bactericidia

2-Síntesis de la Proteína transportadora de B12

3- Síntesis de pirógeno leucocitario

4-Biosíntesis de nucleótidos

MECANISMOS DE LA FUNCION FAGOCITARIA

ADHERENCIA AL ENDOTELIO QUIMIOTAXIS OPSONIZACION Y RECONOCIMIENTO ENDOCITOSIS O INGESTION DEGRANULACION ACTIVACION DEL METABOLISMO

OXIDATIVO SISTEMAS BACTERICIDAS

ALTERACIONES FUNCIONALES

ADHERENCIA ACTIVIDAD OXIDATIVA

QUIMIOTAXIS GRÁNULOS

CD11/CD18CITOESQUELETO

Rc DE MEMBCHEDIAK H

DEFICIT DE MPOEGC

DEFICT DE G6PDH

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: visible, medium or large size 1 to 4; brighter than chromatin

Nuclear/cytoplasmic ratio: high

Type of chromatin: fine, with reticular appearance

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

Granularity: nongranular cytoplasm or a few thick azurophilic granules

Colour of cytoplasm: blue, without distinct perinuclear halo or with extended perinuclear halo

Shape of the cell: oval, sometimes round

Size of the cell: 15 - 25 m

1. myeloblast 2. promyelocyte 3. neutrophil myelocyte 4. neutrophil metamyelocyte 5. band neutrophil 6. segmented neutrophil7. 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 there are numerous other cells representing next stages of maturation of the series of granulopoiesis.

Occurrence:blood: not presentmarrow: < 5%

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

Nuclear/cytoplasmic ratio: high or relatively high

Type of chromatin: fine, with reticular appearance

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

Granularity: nongranular cytoplasm or a few thick azurophilic granules

Colour of cytoplasm: blue, without distinct perinuclear halo or with extended perinuclear halo

Shape of the cell: oval, sometimes round


MIELOBLASTOS

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 large cell 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 large size, brighter than chromatin, 1-2. Sometimes not visible.

Nuclear/cytoplasmic ratio: moderate, low or very low

Type of chromatin: start of condensation

Nucleus' shape: oval

Granularity: thick, azurophilicabundant or very abundant

Colour of cytoplasm: light-blue, with distinct halo

Shape of the cell: oval or round


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.










PROMIELOCITOS


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









Size of the cell: 15 - 30 mPROMIELOCITOS

1. neutrophil myelocyte 2. neutrophil metamyelocyte 3. band neutrophil 4. segmented neutrophil 5. lymphocyte 6. plasmocyte7. proerythroblast 8. polychromatic normoblast 9. pycnotic normoblast


Staining: MGGComment: The arrow indicates neutrophil myelocyte with pink cytoplasm and disappearing primary granules. In the field there are also four other cells at a similar stage of maturation and numerous other maturating neutrophil cells.

Occurrence:blood: not presentmarrow: 5 - 20 %

Nucleoli: not visible

Nuclear/cytoplasmic ratio: low or very low

Type of chromatin: partially condensed

Nucleus' shape: oval or kidney shaped

Granularity: abundant, thick azurophilic and neutrophilicgranulation

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



MIELOCITOS NEUTRÓFILOS


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




Type of chromatin: partially condensed

Nucleus' shape: oval or kidney shaped

Granularity: abundant, thick azurophilic and neutrophilicgranulation

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



MIELOCITOS NEUTRÓFILOS

METAMIELOCITOS NEUTRÓFILOS

1. neutrophil metamyelocyte 2. neutrophil myelocyte 3. promonocyte 4. promyelocyte 5. plasmocyte 6. basophilic normoblast7. polychromatic normoblast 8. pycnotic normoblast


Staining: MGGComment: The arrow indicates a neutrophil metamyelocyte, one of seven present in the picture. Also other forms of maturating granulopoiesis are seen.




Type of chromatin: condensed

Nucleus' shape: elongated, semicircular

Granularity: a few azurophilic and neutrophilic, different in number

Colour of cytoplasm: pink




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





Nucleus' shape: elongated, semicircular





METAMIELOCITOS NEUTRÓFILOS


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 %




Nucleus' shape: semicircular





CAYADOS

CRITERIOS PARA CLASIFICAR UN NEUTRÓFILO COMO “EN CAYADO”

-CUANDO NO SE OBSERVA LOBULACIÓN EVIDENTE

-CUANDO EL NÚCLEO TIENE DIÁMETRO UNIFORME SIN ESTRANGULACIÓN EVIDENTE

-SI EL NÚCLEO PRESENTA UNA PARTE MÁS DELGADA, ESTA NO DEBE SER MENOR A 1/3 DE LA PARTE DE MAYOR GROSOR


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

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




Nucleus' shape: lobulated (normally less than 5 lobes)

Granularity: a few azurophilic and neutrophilic, different in number granulation




NEUTRÓFILO SEGMENTADO

ALTERACIONES LEUCOCITARIAS

NUCLEARES CITOPLASMÁTICAS

CUALITATIVAS

LEUCOCITOSISLEUCOPENIAS

CUANTITATIVAS

F(X)

ADQUIRIDA

HIPERSEG

CONGÉNITA ADQUIRIDACONGENITA

HIPOSEG

NUCLEARES

PELGER HÜETDÉFICIT DE B12

SMD

UNDRITZPSEUDO PELGERO

PELGUEROIDE

SMDEMBARAZADAS

FARMACOSSEPSIS DE MALA EV

LMA-LMC

OTROS

CITOPLASMÁTICAS

ADQUIRIDASCONGÉNITAS

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

-A. DE ALDER-DEGRANULADOS

-GRAN. TÓXICAS-VACUOLAS

-CUERPOS DE DöHLE-DEGRANULADOS

HIPOSEGMENTACIÓN NUCLEAR NO CONFUNDIR PELGER CON CAYADOS

CROMATINA MEDIANAMENTE CONDENSADACROMATINA HIPERCON-

DENSADALLEGA A MADURO SIN

SEGMENTAR

PELGER HÜET AUTOSÓMICO DOMINATE PUEDE SER HOMO O HETEROCIGOTA PUEDE AFECTAR TB A EOS Y BASOFILOS

HOMOCIGOTA

HETEROCIGOTA

STODSMEYSTER

HIPERSEGMENTACIÓN

> A 5 LÓBULOS LIGERO AUMENTO DE TAMAÑO CELULAR CONGÉNITA (UNDRITZ) – AUTOSÓMICA

DOMINANTE- MUY RARA-80 A 90 % NEUTRÓFILOS CON MÁS DE 5 LÓBULOS

PUEDE AFECTAR A EOSINÓFILOS ADQUIRIDA- BASTANTE FRECUENTE-

SMD-ANEMIAS MEGALOBLÁSTICAS -ALCOHOLISMO

HIPERSEGMENTANCIÓN

ALTERACIONES CITOPLASMÁTICAS CHEDIAK HIGASHI

ALBINISMO PARCIAL

MAY HEGGLIN

ALDER REILLY


Staining: MGGComment: Granulesless segmented neutrophil.

Occurrence in blood: normally not present

NEUTROFILO AGRANULAR


Staining: MGGComment: Band neutrophil leucocyte with dark, very abundant toxic granulation. Also anisocytosis of erythrocytes. Numerous ovalocytes. Normal platelets.

Occurrence in blood: normally not present

Granularity: thick granules, more eosinophilic stained than typical neutrophilicgranularity. Single granules with a tendency to aggregate.

GRANULACIONES TOXICAS


Staining: MGGComment: The arrow points Döhle’s body in the granulocyte. Erythrocytes difficult to assess.

Occurrence in blood: normally not present.

Definition: Dotted inclusions of blue, non-granular cytoplasm in pink cytoplasm of mature neutrophil leucocyte.

CUERPOS DE DÖHLE


Staining: MGGComment: Döhle’s body pointed by the arrow. Also anisocytosis of erythrocytes.

Occurrence in blood: normally not present.

Definition: Dotted inclusions of blue, non-granular cytoplasm in pink cytoplasm of mature neutrophil leucocyte.


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

Occurrence: normal mature neutrophil leucocytes may contain single small vacuoles in cytoplasm

VACUOLAS


Staining: MGGComment: Small vacuoles in a neutrophil leucocyte with fine neutrophilic granulation. Also anizocytosis of erythrocytes. A single spherocyte and a polychromatophilic cell are seen.

Occurrence: normal mature neutrophil leucocytes may contain single small vacuoles in cytoplasm

VACUOLAS

NEUTRÓFILO APOPTÓTICO/MUESTRA VIEJA

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