BLOOD

CELL
MORPHOLOGY
BLOOD
45%
55%
BLOOD
RESPIRATION
INFECTION BLEEDING
NUTRITION
JAWHAR AL HAYAT
ERYTHROPOIESIS
ERYTHROPOIESIS
Blood Cells

RBC Red Blood Cells
WBC White Blood Cells
Platelets
Blood Cells

RBC
WBC
Platelets


BLOOD
8% OF TOTAL BODY WEIGHT

HEMOPOIESIS:

*ERYTHROPOIESIS
**MYELOPOIESIS
***PLATELET PRODUCTION
45%
55%
HEMOPOIESIS
MYELOID/ LYMPHOID
STEM CELLS
(CD34)
LYMPHOID
STEM CELLS
MYELOID
STEM CELLS
LYMPHOCYTES
RBC WBC PLATELET
HEMOPOIESIS

MYELOID/ LYMPHOID
STEM CELLS
(CD34)
LYMPHOID
STEM CELLS
Pre-T
Thymocyte
Peripheral T Cells
T-
Helper
T-
Supp.
Pro-B
Pre-B
B- Virgin
B- Mature
LPC
PLASMA
CELL
HEMOPOIESIS

MYELOID/ LYMPHOID
STEM CELLS
(CD34)
MYELOID
STEM CELLS
PRO-
NORMOBLAST
EARLY
NORMOBLAST
INTERMEDIATE
NORMOBLAST
LATE
NORMOBLAST
RETICULOCYTE
RBC
MONO-
BLAST
PRO
MONO-
CYTE
MONO-
CYTE
MYELOBLAST
PRO-MYELOCYTE
MYELOCYTE
META-MYELOCYTE
BAND or STAB
GRANULOCYTES
MEGA-
KARYO-
CYTE
MEGA-
KARYO-
BLAST
PLATELET
ERYTHROPOIESIS
ERYTHROPOIESIS
Pro
NB
Early
NB
Inter.
NB
Late
NB
Retic. RBC
PRO-
NORMO-
BLAST
The earliest recognizable
erythroid cell
Around 16 um in diameter
Deep blue basophilic
cytoplasm surrounding a
large ROUND nucleus
The nucleus consists of a
network of finely
reticulated chromatin
strands having a spongy
or stippled reddish
purple appearance
Several nucleoli seen

Resembles Pronormoblast
although it is smaller
(10 to 16 um) and does
not have nucleoli

The nuclear chromatin
is condensed to form
coalescent clumps
EARLY
or
BASOPHILIC

NORMOBLAST
Hemoglobin synthesis
starts at this stage &
the cytoplasm takes
both acidic and basic
stains giving it a
polychromatic color
The average diameter
is 10 um
The nucleus becomes
progressively smaller
and stains deeply as
the chromatin becomes
more clumpy
INETRMEDIATE
or
POLYCHROMATI
C

NORMOBLAST
The cell is round & small

It measures 8 to 10 um

The nucleus becomes
smaller, darker and
structureless. It moves to
the periphery (eccentric)
prior to expulsion

The cytoplasm becomes
increasingly hemoglobinized
LATE
or
ORTHOCHROMIC

NORMOBLAST
This poor young graduate of marrow school of
medicine has to join the army and do some
training in the spleen.

Spleen is red cells tough battle-field. Unfit
soldiers hardly make it out of the training camp

Fit Reticulocytes enter circulation as young
RBCs but still contain fine basophilic reticulum
which stains bluish with Romanowsky stain and
reticulated with supravital stain. After losing
this basophilic reticulum , they will develop to
RBCs
RETICULOCYTE
0.2 to 2.0% of RBCs
in Adult & Children
(10,000 to 100,000/uL)

2.0 to 6.0% in
infants & cord blood

Remain in circulation
as Reticulocytes for
2 days

RETICULOCYTE
Fully-hemoglobinized,
biconcave, flexible &
squeezable hard-working
mature cells

Life-span ~120 days
Diameter ~8 um
Volume (MCV) 76-96 fL
Hb (MCH) 27-32 pg

Stains deep at periphery
and pale in the center.
This area of central
pallor is < one third of
diameter.
RBC
Myelo-
poiesis
16 um

2 to 6 Nucleoli
No Granules

N/C ratio 6/1
Nucleus has finely-
reticulated, evenly-
distributed chromatin
strands
Pale blue cytoplasm
~ 2% of normal marrow

MYELOBLAST
Nucleoli: ++
Granules: _

Usually larger than MB!

Large ovoid purple
nucleus with denser
chromatin than MB and
fewer nucleoli

Granules are large &
azurophilic

N/C ratio is 4/1
PROMYELOCYTE
Nucleoli: +
Granules: +++
Round or Oval cell
with a round nucleus
Thick strands of
nuclear chromatin

Granules are either
primary azurophilic
or secondary
specific according
to WBC type:
(Neutrophil,
Eosinophil or
Basophil)

MYELOCYTE
Nucleoli: -
Granules: +
Kidney-shaped
nucleus

Chromatin is
more
condensed
META-
MYELOCYTE
Smaller cells
with a U-shaped
nucleus

Chromatin is
coarse and
clumped
STAB or BAND
FORM
Neutrophils have
pink cytoplasm
with fine evenly-
distributed
neutrophilic
granules
2 to 5 nuclear
segments

Eosinophils &
Basophils have bi-
lobed nuclei &
orange or deep
blue granules
SEGMENTED
GRANULOCYTES
Differs from MB by:

Being slightly
smaller

Nucleus fills the
cell

Fewer and less
distinct
nucleoli

Lymphoblast
Small LC have a dark,
dense, central, round,
mature nucleus that
fills the cell & have
size of RBC
Large LC is double the
size with ample
cytoplasm & may be even
granules.
Lymphocytes
Children: Up to 9,000/uL
Adult: 1,500 to 4,000/uL
Elliptical fried-egg
like cells with
eccentric nuclei
The chromatin is very
dense & clumped
Cytoplasm is deeply
basophilic with a pale
perinuclear halo
Produces immunoglobulins
<5% of marrow cells
Not seen in blood

Plasma
Cells

Differs from MB
by:
Being bigger
Lighter cytoplasm
Lacey nuclear
chromatin

Nucleoli seen
Monoblast
s
Largest blood cells

Usually kidney-
shaped nuclei with
delicate chromatin

Sky-blue cytoplasm
with occasional
vacuoles
Monocytes
Largest hemopoietic
marrow cells (~100
um)
Multi-lobulated
nuclei; no mitosis
but nuclear
duplication
Abundant cytoplasm
with azurophilic
granules
Each Produces 3000
platelets

Megakaryocytes
Megakaryocytes
The committed platelet
progenitor cells
do not undergo
classical mitosis;
instead they will develop
nuclear duplications &
cytoplasmic expansion. The
rapid increase in cytoplasm is
accommodated by progressive
folding, or invaginations, of
megakaryocytic membrane. These
demarcation membranes will
eventually produce individual
platelet membranes.

MK pseudopodia penetrates marrow
sinusoids. Blood flow breaks
off large platelets that are
finally fragmented to
individual platelets in the
pulmonary microcirculation.
Megakaryocytes
In stressed
thrombopoiesis,
cytoplasm matures
quicker than
nucleus so that low
ploidy MK start to
produce platelets
that are larger,
denser and
metabolically more
active
EACH MK CAN
PRODUCE 3000
PALETLETS
Tiny disc-shaped
important cells
150,000 to 400,000/uL
Life span: ~ 10 days
MPV: 5 to 8 fL
Pct: 0.1 to 0.4%


Platelets
DIAGNOSTIC
TOOLS
IN
HEMATOLOGY
DIAGNOSTIC TOOLS
IN
HEMATOLOGY

BLOOD SMEAR
MARROW
TREPHINE BIOPSY
MARROW
ASPIRATION
Blood Smear
SHEIKHA
Bone
Marrow
Aspiration
Bone Marrow
Trephine Biopsy
BLOOD SMEAR
TERMS
USED
TO
DESCRIBE
PATHOLOGICAL
RBC
CHANGES
Normal Smear


NORMOCYTIC
NORMOCHROMIC
RED CELLS
PATHOLOGICAL RBC ABNORMALITIES

AN
ISO
CYT
OSIS
Variation in size
High RDW

Normal RDW 11.5 to 14.5%

ANISOCYTOSIS

PATHOLOGICAL RBC ABNORMALITIES
POIKILO-
CTOSIS

Variation in Shape
Poikilocytosis
APK
APK
SC
SS CC
TTP
Normal Red Cells
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES


SPHEROCYTOSIS
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES



ELLIPTOCYTOSIS
or
OVALOCYTOSIS
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES



STOMATOCYTOSIS
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES

Sickle
Cells
PATHOLOGICAL RBC ABNORMALITIES

PATHOLOGICAL RBC ABNORMALITIES



Target
Cells

PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES

Teardrop
Red cells
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES

Blister
or
Bite
Red Cells
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES

Burr
Cells
PATHOLOGICAL RBC ABNORMALITIES

Red cells
On
FIRE
PATHOLOGICAL RBC ABNORMALITIES



Acanthocytosis
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES



HYPOCHROMIC
RED CELLS
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES


Dimorphic
red cells
PATHOLOGICAL RBC ABNORMALITIES


Burr
Spur
&
Acanthocytes
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES

HOWELL
JOLLY BODY
WHAT IS HJB?
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES


BASOPHILIC
STIPPLING
PATHOLOGICAL RBC ABNORMALITIES
PATHOLOGICAL RBC ABNORMALITIES


RING
SIDEROBLASTS
PATHOLOGICAL RBC ABNORMALITIES

PATHOLOGICAL RBC ABNORMALITIES



SCHISTOCYTOSIS

MAHA
Acanthocytosis
Punctate Basophilia
Blister Cells
Lead Poisoning
Teardrop RBC &
Punctate Basophilia
Ring Sideroblasts
Reticulocytosis
Sickle cells
Burr Cells
Dimorphic Blood Smear
Elliptocytosis
Burr Spur & Acanthocytes
Burr Spur & Acanthocytes
Blister Red cells
Red Cells on Fire
Stomatocytes

Target cells

SHEIKHA
Hypochromic Cells
HE
Heinz Bodies
HbH
Howell Jolly Body
Spherocytosis &
a Lymphocyte
Hypersegmentation
Hypochromic
Microcytic RBCs
Fe
Megaloblastic Marrow
Megaloblastic Marrow
Intermediate Megaloblast
Polychromatic Megaloblasts
HJB in Megaloblastic Anemia
What is HJB?
Neutrophil & Lymphocyte

MYELOPOIESIS
Myelopoiesis
Myeloblast
Nucleoli
in Myeloblasts
Myeloblasts
Myeloblasts
Promyelocytes
Promyelocytes
Faggot
Cell
Myelocyte