introduction to White blood cells disorders

2. Presented By
EBTIHAL AHMED BABEKIR
Hematology department

3.  Definition:
 The process by which WBCs are formed and
developed. This process usually takes between
5-6 days.
 The blood granulocytes and monocytes are
formed in the bone marrow from a common
precursor cell.

5. Granulopoiesis
It occurs primarily within bone marrow and involves the following
stages:
Pluripotential hemopoietic stem cell
Myloid progenator (multipotent stem cell)
Myeloblast(First recognizable stage)
Promyelocyte
Eosino/neutro/basophilic myelocyte
Metamyelocyte
Band cell (Stab cell)
Granulocytes (Eosino/neutro/basophil)

6. Control of Myelopoieisis:
Many growth factors are involved in this
process including:
interleukin-1 (IL-1),
IL-3, IL-5 IL-6, IL-ll, granulocyte
macrophage colony-stimulating factor (GM-
CSF),
granulocyte CSF (G-CSF) and monocyte CSF
(MCSF)

7. The growth factors stimulate
proliferation and differentiation and
also affect the function of the mature
cells.
This growth factors are produced by
stromal cells.

8. G-CSF
 Granulocyte colony-stimulating
factor (G-CSF or CSF3) is a colony-
stimulating factor hormone, which
stimulates the bone marrow to release
granulocyte into the blood. It also
stimulates the survival, proliferation,
differentiation, and function
of neutrophil precursors and mature
neutrophils.

9. 9 9
HEMOPOIESISMYELOID/ LYMPHOID
STEM CELLS
(CD34)
LYMPHOID
STEM CELLS
MYELOID
STEM CELLS
LYMPHOCYTES RBC WBC PLATELET

10. 10
www.drsarma.in
10
HEMOPOIESIS
MYELOID/ LYMPHOI
STEM CELLS
(CD34)
MYELOID
STEM CELLSPRO-
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

11. 11
 Myeloblast
 Promyelocyte
 Myelocyte
 Metamyelocyte
 Band Neutrophil
 Segmented Neutrophil

12. www.drsarma.in
1212MYELOBLAT PROMYELOCE MYELOCYTE
META-
MYELOCYTE
STAB or BAND
FORM
Mature
Granulocytes
2)post mitotic pool: also called maturation pool, no mitosis in this pool
1) mitotic pool: mitosis takes place in this pool

13. 13
Myelopoiesis

14.  1: Myeloblast;
 This is the first cell in the
granulocytic series.
 - Round, 15-20 um in diameter(
two to three times of mature
RBCs).
 - Scanty, deep blue cytoplasm. No
Granules
 -Nucleus is centrally placed,
round in shape, fine chromatin,
2-5 nucleoli.
 N/C ratio 6/1
 ~ 2% of normal marrow

MYELOBLAST

15. 15One myeloblast with 3 prominent nucleoli, 3
polychromatic NRBCs, normal marrow - 100X

16. 16
 Type I myeloblasts: have no azuriphilic primary granules
nor Auer rods.
 Type II myeloblasts: have a few ( ²20) azuriphilic primary
granules. Auer rods may be seen.
 Type III myeloblasts: have ³20 azuriphilic primary
granules have a lower N/C ratio with denser chromatin, and
usually have Auer rods (may be seen).
No azuriphilic primary
granules.
No Auer rods.
Few (<20) azuriphilic primary
granules.
Auer rods may be seen.
>20 azuriphilic primary
granules without a Golgi
zone.
Auer rods may be seen.

17. 17Lymphoblast Myeloblasts
Similarities round-oval nuclei round-oval nuclei
Differences
Nuclear coarse chromatin which tends
to aggregate into masses
fine delicate chromatin
Cytoplasmic more basophilic no azurophilic
granules no Auer rods may
have non-specific cytoplasmic
granules
less basophilic has primary
azurophilic granules may have
Auer rods

18. 18
• Usually larger than MB!
Cytoplasm stains less
basophilic than myeloblast
Cytoplasm contains primary
granules( azurophilic
granules)( large prominent,
reddish purple granules)
Nucleus:
shape :oval or round
Location: central or eccentric
• N/C ratio is 4/1
PROMYELOCYTE
Nucleoli: +
Granules: +++

19. 19
Size: 18-25 um
Nucleus:
Color :purple
chromatin : relatively fine, becoming coarser.
Nucleoli : 2-3,varing from invisible to distinct.
Cytoplasm:
color: blue, lighter staining
content: few to many dark blue to reddish-blue primary
azurophilic granules
Clinical condition:
M2,M3,CML,sever infections,M4,M6 AML.

20. 20Proerythroblast (1) next to a myeloblast (2) lower
a promyelocyte (3).Toward the upper left are
ametamyelocyte
(4) and a segmented neutrophilic granulocyte (5).

21. 21Neutrophilic myelocyte
Size: 12-18 um
Nucleus:
shape :oval or round or flattened on one side
Color :dark purple
chromatin : coarser chromatin pattern, invisible nucleoli
Cytoplasm:
color: pinkish-blue
content: variable granules ,small pinkish to reddish specific
granules first
appearing next to the nucleus
and then throughout the cytoplasm
Clinical condition:
M2,stress,CML,sever infections.
MYELOCYTE
Nucleoli: -
Granules: +

24. 24
Eosinophilic Myelocyte

25. 25
Post mitotic pool
: Metamyelocyte:
10-15 um in diameter,
round in shape,
cytoplasm is pink-blue
in color with numerous
secondary granules.
The primary granules
still present but not seen.
Nucleus: Kidney-shaped
nucleus. Nucleoli :
none
META-
MYELOCYTE

26. 26
Neutrophilic
Metamyelocyte

27. Nucleus becomes indented,
Chromatin highly condensed
Nucleoli are not present

29. 29
Neutrophilic Metamyelocyte

30. 30
Neutrophil Metamyelocyte

31. 31
Eosinophilic Metamyelocyte

32. 32Transitional form between a
metamyelocyte and a band cell

33.  Round in shape, about
12 um in diameter,
cytoplasm is pink-
blue color
 Primary granules are
not present but there
are few specific
granules.
 Nucleolus is band U-S
or crescent in shape
Chromatin is coarse
and clumped
STAB or BAND
FORM

34. 34
Neutrophilic Band
 A neutrophilic band, sometimes called a "stab"
cell, is an older or intermediate neutrophil. The
nucleus has started to elongate and has curved
itself into a horseshoe or S-shape. As the band
ages, it matures into a segmented neutrophil.

35. 35

36. 36
Segmented Neutrophil
Band
Metamyelocyte

37. 37
Neutrophil & Band cell

38. 38Blast, Promyelocyte, Myelocyte, Metamyelocyte, Band, and
Segmented Neutrophil, Bone marrow aspirate smear, Wright-
Giemsa stain, 1000x

39. 39

40. 40

41. 41
Basophil

44.  It is the first recognizable
stage in the development of
monocyte.
Size: 12-20 um in diameter
Cytoplasm is scanty, deep
blue-grey, no granules
 Nucleus:
Is large, chromatin fine, light bluish
purple Nucleoli : 1-5.
 Differs from MB by:
 Being bigger.
 Lighter cytoplasm.
 Lacey nuclear chromatin.
 *Clinical condition: M4,M5a and M5b
Monoblasts

45. 45

48. Size: Smaller(up to 18).
Nucleus:
shape : oval or indented.
chromatin: fine chromatin.
Nucleoli : is visible.
Cytoplasm:
color: pale blue-gray,
may contain few
azurophilic
granules(ground-glass)
appearance.

50. 50
Monocyte is the largest cell
in the peripheral blood(15-
20um in diameter).
Nucleus:
Usually,kidney-shaped
chromatin is fine but no
nucleoli,indented-nuclear,
folding may give the
appearance of brain-like,
also can be amoeboid or
irregular in shape.
Cytoplasm:
• Sky-blue with occasional
vacuoles. Moreover, the
edges of the cytoplasm are
not clearly seen.
Monocytes

52. brain-like

53. Amoeboid Nucleus

54. 54
folding Monocyte

56. lymphocyte
Morphology:
-The majority are small lymphocytes
- High nuclear: cytoplasmic ratio
- dense chromatin clumping (purplish
stained)
- Lymphocytes are divided into three
morphological categories,
depending on their size, the
amount of cytoplasm and the
presence or absence of cytoplasmic
granules.
- Differential:
25 – 35 % of circulating leukocytes.
 Function:
 1.T lymphocytes:
 - Recognition of foreign Ag’s on the
context of MHC molecules on surfaces of
APC
 - Cytotoxic T cells (CD8+) : mediate the
destruction of their targets
 -T-helper cells (CD4+) : influence the
innate and adaptive response
 - Natural killer (NK) cells:CD8+T cells
express HLA receptor that are required to
mediate the killing of their targets.
 2. B-lymphocytes:
 maturate in BM
 Differentiate into antibody-producing
cells (Plasma cells)

57. lymphoblast

58. prolymphocyte

59. lymphocyte

60. Reactive lymphocyte
 Size:10-22.
 Nucleus: pale dense with clumped chromatin
round , indented, may contains nucleoli.
 Cytoplasm: deeply basophilic to pale blue
abundant often with vacuole.
 (0-7.5)% in peripheral blood.