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SERIE BLANCA
NORMAL YPATOLGICABqco. Gonzalo Ojeda
Hematologa ClnicaFa.C.E.N.A U.N.N.E2011
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LEUCOPOYESIS
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Neutrfilos( 50-70%) Basfilos(0-2%) Eosinfilos (0-5%)
Monocitos (1-9%) Linfocitos(20-40%)
Leucocitos granulares
Leucocitos agranulares
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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 %
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FUNCIONES DESTACADAS GRANULOCITOS : inmunidad innata
MONOCITOS: inmunidadinnata/adaptativa
LINFOCITOS: inmunidad adaptativa
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GRANULOCITOS
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GRANULOPOYESISNEUTRFILO
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GRANULOPOYESIS
EOSINFILO y BASFILOS
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Histamina, mediadores lipdicos,citoquinas.IL-8, MCP-1.
Mastocitos,basfilos.
Protenas catinicas, radicaleslibres de oxgeno, fosfolpidos,citoquinas
IL-5,C5a, MIP-1Eosinfilos
Mediadores lipdicos, citoquinas.MCP-1, MIP 1.Monocitos
IL-8, TNF-, IL-1
Factoresquimiotcticosy activadores
Radicales libres de oxgeno, NO,
prostaglandinas, leucotrienos, PAF,citoquinasNeutrfilo
MediadoresClula
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NEUTRFILO
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NEUTRFILO
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GRANULOCITO NEUTRFILOSP:3000 A 6000 cel/mm3Tamao: 12-20 mGRANULOS 1- AZUROFILOS
INESPECIFICOSLisosomas 1,10 a 20% del contenido granularMieloperoxidasa (MPO)Fosfatasa acida (FAC)
EsterasasBeta glucuronidasa y beta galactosidasaLisozimaOtras proteinas bsicas catinicas
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*VESICULAS SECRETORIAS:Contienen FAL
*GRANULOS GELATINOSOS
Gelatinasa, lisozima
*Contienen alto contenido de glucgeno
citoplasmtico
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*GRANULOS SECUNDARIOS O
ESPECIFICOSConstituyen el 80-90% de los grnulos, son
anfteros se tien lila o rojizo
*Fosfatasa acida (FAC)
*Lactoferrina
*Fagocitina
*Protenas catinicas leucocitaria (pirgenos)
* Lisozima*NADPH oxidasa
*Protena de unin de la B12
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FUNCIONES DEL GN
1-Defensa antimicrobiana: fagocitosis,bactericidia
2-Sntesis de la Protena transportadora de B12
3- Sntesis de pirgeno leucocitario
4-Biosntesis de nucletidos
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MECANISMOS DE LA FUNCION
FAGOCITARIA ADHERENCIA AL ENDOTELIO QUIMIOTAXIS OPSONIZACION Y RECONOCIMIENTO ENDOCITOSIS O INGESTION DEGRANULACION
ACTIVACION DEL METABOLISMOOXIDATIVO SISTEMAS BACTERICIDAS
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ALTERACIONES FUNCIONALESADHERENCIA ACTIVIDAD
OXIDATIVAQUIMIOTAXIS GRNULOS
CD11/CD18CITOESQUELETO
Rc DE MEMBCHEDIAK H
DEFICIT DE MPOEGC
DEFICT DEG6PDH
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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: visibl e, medium or large size 1to 4; brighter than chromatin
Nuclear/cytoplasmic ratio: high
Type of chromatin: fin e, with reticul arappearance
Nucleus' shape: usually oval,sometimes irregular, rarely round
Granularity: nongranular cytoplasm or afew thick azurophilic granules
Colour of cytoplasm: blue, withoutdistinct perinuclear halo or withextended perinuclear halo
Shape of the cell: oval, sometimes
round
Size of the cell: 15 - 25 m
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1. myeloblast 2. promyelocyte 3. neutrophil myelocyte 4. neutrophil metamyelocyte 5. band neutrophil 6. segmented neutrophil
7. pycnotic normoblast 8. polychromatic normoblast 9. basophilic normoblast 10. proerythroblast
Magnification: x 1000
Staining: MGGComment: Early myeloblast with very high cytoplasm - nucleus ratio, without granules. In the picture thereare numerous other cells representing next stages of maturation of the series of granulopoiesis.
Occurrence:blood: not presentmarrow: < 5%
Nucleoli: visible, medium or largesize 1 to 4; brighter than chromatin
Nuclear/cytoplasmic ratio: high orrelatively high
Type of chromatin: fin e, withreticular appearance
Nucleus' shape: usually oval,
sometimes irregular, rarely round
Granularity: nongranular cytoplasmor a few thick azurophilic granules
Colour of cytoplasm: blue, withoutdistinct perinuclear halo or withextended perinuclear halo
Shape of the cell: oval, sometimesround
Size of the cell: 15 - 25 m
MIELOBLASTOS
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PROMIELOCITOS
1. neutrophil myelocyte 2. neutrophil metamyelocyte 3. band neutrophil 4. segmented neutrophil 5. plasmocyte 6. eosinophil7. megakaryoblast
Magnification: x 1000
Staining: MGGComment: The arrow indicates one promyelocyte, which is the only promyelocyte in the field. The nearby largecell 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 largesize, brighter than chromatin, 1-2.Sometimes not visible.
Nuclear/cytoplasmic ratio: moderate,
low or very low
Type of chromatin: start ofcondensation
Nucleus' shape: oval
Granularity: thick, azurophi licabundant or very abundant
Colour of cytoplasm: light-blue, withdistinct halo
Shape of the cell: oval or round
Size of the cell: 15 - 30 m
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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.
Occurrence:blood: not presentmarrow: < 5 %
Nucleoli: visible, medium or largesize, brighter than ch romatin, 1-2.Sometimes not visible.
Nuclear/cytoplasmic ratio: moderate,low or very low
Type of chromatin: start ofcondensation
Nucleus' shape: oval
Granularity: thick, azurophi licabundant or very abundant
Colour of cytoplasm: light-blue, withdistinct halo
Shape of t he cell: oval or round
Size of the cell: 15 - 30 mPROMIELOCITOS
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Magnification: x 1000
Staining: MGGComment: The promyelocyte contains abundant primary granules and a distinct zone of perinuclear halo. Alsodistinct anisocytosis of the erythrocytes.
Occurrence:
blood: not presentmarrow: < 5 %
Nucleoli: visible, medium or largesize, brighter than chromatin, 1-2.Sometimes not visible.
Nuclear/cytoplasmic ratio:moderate, low or very low
Type of chromatin: start ofcondensation
Nucleus' shape: oval
Granularity: thick, azurophi licabundant or very abundant
Colour of cytoplasm: light-blue,with distinct h alo
Shape of the cell: oval or round
Size of the cell: 15 - 30 mPROMIELOCITOS
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1. neutrophil myelocyte 2. neutrophil metamyelocyte 3. band neutrophil 4. segmented neutrophil 5. lymphocyte 6. plasmocyte
7. proerythroblast 8. polychromatic normoblast 9. pycnotic normoblast
Magnification: x 1000
Staining: MGGComment: The arrow indicates neutrophil myelocyte with pink cytoplasm and disappearing primarygranules. In the field there are also four ot her cells at a similar stage of maturation and numerous othermaturating neutrophil cells.
Occurrence:
blood: not presentmarrow: 5 - 20 %
Nucleoli: not visible
Nuclear/cytoplasmic ratio: low or verylow
Type of chromatin: partially
condensed
Nucleus' shape: oval or kidneyshaped
Granularity: abundant, thickazurophilic and neutrophilicgranulation
Colour of cytoplasm: light-blue or ofpale pink colour undiscernible halo
Shape of the cell: oval or round
Size of the cell: 15 - 25 m
MIELOCITOS NEUTRFILOS
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Magnification: x 1000
Staining: MGGComment: Early neutrophil myelocyte in the blood. Also two matured neutrophilic leucocytes, a lymphocyte andplatelets.
Occurrence:
blood: not presentmarrow: 5 - 20 %
Nucleoli: not visible
Nuclear/cytoplasmic ratio: lowor very low
Type of chromatin: partiallycondensed
Nucleus' shape: oval or kidneyshaped
Granularity: abundant, thickazurophilic and neutrophilicgranulation
Colour of cytoplasm: light-blueor of pale pink colourundiscernible halo
Shape of the cell: oval or round
Size of the cell: 15 - 25m
MIELOCITOS NEUTRFILOS
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METAMIELOCITOS NEUTRFILOS
1. neutrophil metamyelocyte 2. neutrophil myelocyte 3. promonocyte 4. promyelocyte 5. plasmocyte 6. basophilic normoblast
7. polychromatic normoblast 8. pycnotic normoblast
Magnification: x 1000
Staining: MGGComment: The arrow ind icates a neutrophil metamyelocyte, one of seven present in the picture. Also otherforms of maturating granulopoiesis are seen.
Occurrence:
blood: not presentmarrow: 10 - 25 %
Nucleoli: not visible
Nuclear/cytoplasmic ratio: low orvery low
Type of chromatin: cond ensed
Nucleus' shape: elongated,semicircular
Granularity: a few azurophilic andneutrophilic, different in number
Colour of cytoplasm: pink
Shape of t he cell: oval or round
Size of the cell: 14 - 20 m
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Magnification: x 1000
Staining: MGGComment: Neutroph il metamyelocyte indicated by the arrow is present in blood. Besides, neutrophilsegmented and band-forms leucocytes are seen. Platelets not rich in granules.
Occurrence:blood: not presentmarrow: 10 - 25 %
Nucleoli: not visible
Nuclear/cytoplasmic ratio: low orvery low
Type of chromatin: cond ensed
Nucleus' shape: elongated,semicircular
Granularity: a few azurophilic andneutrophilic, different in number
Colour of cytoplasm: pink
Shape of t he cell: oval or round
Size of the cell: 14 - 20 mMETAMIELOCITOS NEUTRFILOS
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Magnification: x 1000
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 %
Nucleoli: not visible
Nuclear/cytoplasmic ratio: low or verylow
Type of chromatin: condensed
Nucleus' shape: semicircular
Granularity: a few azurophilic andneutrophilic, different in number
Colour of cytoplasm: pink
Shape of the cell: oval or round
Size of the cell: 14 - 20 m
CAYADOS
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CRITERIOS PARA CLASIFICAR UN NEUTRFILO COMOEN CAYADO
-CUANDO NO SE OBSERVA LOBULACIN EVIDENTE
-CUANDO EL NCLEO TIENE DIMETRO UNIFORMESIN ESTRANGULACIN EVIDENTE
-SI EL NCLEO PRESENTA UNA PARTE MS DELGADA,ESTA NO DEBE SER MENOR A 1/3 DE LA PARTE DE
MAYOR GROSOR
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Magnification: x 1000
Staining: MGGComment: Three-lobulated segmented neutrophil leucocyte with fine neutrophil granularity.
Occurrence:blood: 40 - 75 %marrow: 5 - 20 %
Nucleoli: not visible
Nuclear/cytoplasmic ratio: low or verylow
Type of chromatin: condensed
Nucleus' shape: lobulated (normally lessthan 5 lobes)
Granularity: a few azurophi lic andneutrophilic, different in numbergranulation
Colour of cytoplasm: pink
Shape of the cell: oval or round
Size of the cell: 14 - 20 m
NEUTRFILO SEGMENTADO
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ALTERACIONES
LEUCOCITARIAS
NUCLEARES CITOPLASMTICAS
CUALITATIVAS
LEUCOCITOSISLEUCOPENIAS
CUANTITATIVAS
F(X)
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ADQUIRIDA
HIPERSEG
CONGNITA ADQUIRIDACONGENITA
HIPOSEG
NUCLEARES
PELGER HETDFICIT DE B12
SMD
UNDRITZPSEUDO PELGERO
PELGUEROIDESMD
EMBARAZADASFARMACOS
SEPSIS DE MALA EVLMA-LMC
OTROS
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CITOPLASMTICAS
ADQUIRIDASCONGNITAS
-A. DE CHEDIAK-HIGASHI-A. DE MAY HEGGLIN
-A. DE ALDER-DEGRANULADOS
-GRAN. TXICAS-VACUOLAS
-CUERPOS DE DHLE
-DEGRANULADOS
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HIPOSEGMENTACIN
NUCLEAR NO CONFUNDIR PELGER CON CAYADOS
CROMATINA MEDIANAMENTE CONDENSADACROMATINA HIPERCON-
DENSADALLEGA A MADURO SIN
SEGMENTAR
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PELGER HET AUTOSMICO DOMINATE PUEDE SER HOMO O HETEROCIGOTA
PUEDE AFECTAR TB A EOS Y BASOFILOS
HOMOCIGOTA
HETEROCIGOTA
STODSMEYSTER
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HIPERSEGMENTACIN > A 5 LBULOS LIGERO AUMENTO DE TAMAO CELULAR CONGNITA (UNDRITZ) AUTOSMICA
DOMINANTE- MUY RARA-80 A 90 %NEUTRFILOS CON MS DE 5 LBULOS
PUEDE AFECTAR A EOSINFILOS ADQUIRIDA- BASTANTE FRECUENTE-
SMD-ANEMIAS MEGALOBLSTICAS -ALCOHOLISMO
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HIPERSEGMENTANCIN
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HIPERSEGMENTANCIN
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ALTERACIONES
CITOPLASMTICAS CHEDIAK HIGASHI
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ALBINISMO PARCIAL
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MAY HEGGLIN
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ALDER REILLY
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Magnification: x 1000
Staining: MGGComment: Granulesless segmented neutrophil.
Occurrence in blood:normally not present
NEUTROFILO AGRANULAR
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Magnification: x 1000
Staining: MGGComment: Band neutrophil leucocytewith dark, very abundant toxic granulation. Also anisocytosis oferythrocytes. Numerous o valocytes. Normal pl atelets.
Occurrence in blood:normally not present
Granularity: thick granules,more eosinophilic stained thantypical neutrophilicgranularity. Single granuleswith a tendency to aggregate.
GRANULACIONES TOXICAS
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Magnification: x 1000
Staining: MGGComment: The arrow points Dhles body in the granulocyte. Erythrocytes difficult to assess.
Occurrence in blood:
normally not present.
Definition: Dotted inclusions ofblue, non-granular cytoplasm inpink cytoplasm of matureneutrophil leucocyte.
CUERPOS DE DHLE
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Magnification: x 1000
Staining: MGGComment: Dhles body pointed by the arrow. Also anisocytosis of erythrocytes.
Occurrence in blood:
normally not present.
Definition: Dottedinclusions of blue, non-granular cytoplasm in pinkcytoplasm of matureneutrophil leucocyte.
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Magnification: x 1000
Staining: MGGComment: Distinct vacuoles changes in the neutrophilic leucocytes. Two target cells and one ovalocyte arepresent.
Occurrence: normal matureneutrophil leucocytes may containsingle small vacuoles in cytoplasm
VACUOLAS
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Magnification: x 1000
Staining: MGGComment: Small vacuoles in a neutrophil leucocyte with fine neutrophilic granulation. Also anizocytosis oferythrocytes. A single spherocyte and a polychro matophilic cell are seen.
Occurrence: normal mature
neutrophil leucocytes may containsingle small vacuoles in cytoplasm
VACUOLAS
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NEUTRFILO
APOPTTICO/MUESTRAVIEJA