HCM

University of Science Short Course

Basic Principles for Clinical Lab Medicine

Avy An Bui
Dept. of Pathology & Lab Medicine College of Medicine University of Saskatchewan avy.an.bui@gmail.com
Dept. of Pathology, College of Medicine, University of Saskatchewan

Hematopathology:

HCMUS Course, July 2012

Basic Principles for Clinical Lab Medicine

Hematopathology:

Pathology: study & diagnosis of diseases Hemato-: relaHng to blood Hematopathology: study & diagnosis of blood diseases

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

What Types of Formed Elements Found in Blood?

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

Formed Elements of Blood

Withdraw blood

Erythrocytes (RBCs):
Around 45% total volume

Buffy coat:
Centrifuge Plasma (55% of whole blood)

White blood cells (WBCs) Platelets

Buffy coat: leukocytes and platelets (<1% of whole blood) Erythrocytes (45% of whole blood) Formed elements

v Less than 1% total volume Plasma:

The remainder of volume Around 55% of total volume

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

Components & General ProperKes of Blood

1) Erythrocytes: Red Blood Cells
(RBCs) 2) Platelets: cell fragments from special cell in the bone marrow

3) Leukocytes: White Blood Cells (WBCs)

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

Formed Elements of Blood

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

The Shape of an Erythrocyte

Biconcave or disc-shaped cell with thick rim Cytoskeletal proteins (spectrin & actin) give the membrane durability & resilience Stretch & bend: to be squeezed through the small capillaries

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

The Shape of an Erythrocyte

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

FuncKons of the Red Blood Cells (RBCs)

Two Main functions:
Carry O2 from lungs to the cell tissues Pick up CO2 from tissues & bring to lungs

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

Erythrocyte ProducKon
Pluripotent stem cell Colony-forming unit (CFU) Precursor cells Mature cell

Erythrocyte CFU

Erythroblast

ReKculocyte

Erythrocyte

Average lifespan of about 120 days Development takes from 3 to 5 days

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

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Dierent Stages of an Erythrocyte

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Dept. of Pathology, College of Medicine, University of Saskatchewan

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RBC Morphology Diagrams

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

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RBC Morphology Diagrams

A Normal RBCs B Acanthocytes C Blister cells D Burr cells F Poikilocytes E Crenated RBCs G Elliptocytes H Helmet cells I Leptocytes J Oval macrocytes K Schistocytes L Sickle cells M Spherocytes N Stomatocytes O Target cells (Codocytes) P Teardrop cells (Dacryocytes)
HCMUS Course, July 2012 Dept. of Pathology, College of Medicine, University of Saskatchewan 13

Teardrop Cells (Dacryocytes)

Red blood cells (RBCs) with one pointed extremity & resemble a teardrop or a pear MegaloblasHc anemia Thalassemia IneecHve erythropoiesis
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Target Cells (Codocytes)

Abnormal red cells that have a bullseye appearance; thin cells Obstructive liver disease Severe iron deficiency Thalassaemia

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

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Sickle Red Cells

The RBCs become rigid, sticky, & pointed at the ends Sickle Cell Disease: a hemoglobin defect occurs mostly among people of African descent

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

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Leukocytes White Blood Cells (WBCs)

Protect against infectious microorganisms & other pathogens

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

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Types of Leukocytes (WBCs)

Granulocytes (with granules)
Neutrophils (60% to 70%) Eosinophils (2% to 4%) Basophils (less than 1%)

Agranulocytes (without granules)

Lymphocytes (25% to 33%) Monocytes (3% to 8%)

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

18

WBCs Granulocytes
Neutrophils: increased numbers in bacterial infections Eosinophils: increased numbers in parasitic infections, collagen diseases, allergies, & diseases of spleen Basophils: increased numbers in chickenpox, sinusitis, & diabetes

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

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WBCs Granulocytes

Neutrophils

10 m

Eosinophil

10 m

Basophil

10 m

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Dept. of Pathology, College of Medicine, University of Saskatchewan

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WBC Neutrophils

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Dept. of Pathology, College of Medicine, University of Saskatchewan

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WBC Eosinophil

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Dept. of Pathology, College of Medicine, University of Saskatchewan

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WBC Basophils

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Dept. of Pathology, College of Medicine, University of Saskatchewan

23

WBCs Agranulocytes
Lymphocytes: increased numbers in diverse bacterial infections & immune responses Monocytes: increased numbers in viral infections & inflammation

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

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WBCs Agranulocytes

Lymphocyte

10 m

Monocyte

10 m

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Dept. of Pathology, College of Medicine, University of Saskatchewan

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Pluripotent stem cell

Colony-forming units (CFUs)

Precursor cells

Mature cells

Leukopoiesis

Leukocytes develop from the Pluripotential Hematopoietic Stem Cell (HSC) Stem cell proliferates & differentiates into various types of leukocytes: v Granulocytes Neutrophils Eosinophils Basophils v Agranulocyes Monocytes Lymphocytes
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Eosinophilic CFU

Eosinophilic Eosinophilic myeloblast promyelocyte

Eosinophilic myelocyte

Eosinophil

leaves

Basophilic CFU

Basophilic myeloblast

Basophilic promyelocyte

Basophilic myelocyte

Basophil

Neutrophilic CFU

Neutrophilic myeloblast

Neutrophilic promyelocyte

Neutrophilic myelocyte

Neutrophil

Monocytic CFU

Monoblast

Promonocyte

Monocyte

B prolymphocyte

B lymphocyte

Lymphocytic CFU

Lymphoblast

T prolymphocyte

T lymphocyte

NK prolymphocyte

NK cell

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

Leukocyte Disorders
Leukopenia:
Low WBC count (less than 5,000 WBCs/L)

Causes: radiation, poisons, or infectious disease

Leukocytosis:
High WBC count (above 10,000 WBCs/L)

Causes: infection or allergy

HCMUS Course, July 2012 Dept. of Pathology, College of Medicine, University of Saskatchewan 27

Leukocyte Disorders
Leukemia: a cancer of hematopoietic tissue that produces high number of circulating leukocytes & their precursors
Myeloid leukemia: uncontrolled granulocyte production Lymphoid leukemia: uncontrolled lymphocyte or monocyte production
HCMUS Course, July 2012 Dept. of Pathology, College of Medicine, University of Saskatchewan 28

Normal & Leukemic Blood Smears

Platelets Monocyte Neutrophils

Lymphocyte Erythrocytes (a)

(b)

HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

75 m

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HCMUS Course, July 2012

Dept. of Pathology, College of Medicine, University of Saskatchewan

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References
Anatomy & Physiology: The Unity of Form and FuncHon, 5th Ed., by Kenneth Saladin, 2010. Color Atlas of Hematology, by Harald Theml, 2004. Clinical Laboratory Hematology, 2nd Ed., by Shirlyn B. McKenzie, 2009. Clinical Hematology: Theory and Procedures, 5th Ed., by Mary L. Turgeon, 2011. Hematology: Clinical Principles and ApplicaHons, 3rd Ed., by Bernadebe F. Rodak, 2007. Wintrobe's Clinical Hematology, 2nd Vol., by John P. Greer, 2008.
HCMUS Course, July 2012 Dept. of Pathology, College of Medicine, University of Saskatchewan 31