about 45%

red blood cells (erythrocytes)

white blood cells (leukocytes)

platelets (thrombocytes)

most numerous cells in the blood

also known as erythrocytes

composed mainly of hemoglobin

molecules which bind oxygen for transport to tissues of the body

gives rbcs there red color

main functions:

carry oxygen from the lungs to the tissues

carry carbon dioxide from the tissues back to the lungs

other functions:

transporting electrolytes througout the body

buffering pH of the blood

also called leukocytes

5 different types:

neutrophils (most numerous)

eosinophils

basophils

monocytes (largest wbc)

lymphocytes (2nd most numerous)

neutrophils

basophils

eosinophils

monocytes

lymphocytes (B and T lymphocytes)

main function is to fight infections within the body

accomplish their function by either neutralizing or destroying pathogens either by:

surrounding, engulfing, and destroying pathogens or foreign matter

producing antibodies that destroy pathogens indirectly

releasing substances that attack foreign matter

perform their specialized functions inside the bodys tissues

neutrophils - seek, ingest, and kill bacteria

eosinophils- release histaminase and heparin to help the body's inflammatory process

basophils- release histamine and heparin to help the body's inflammatory process

lymphocytes- play key role in immunity by producing antibodies (b-lymphocytes)

monocytes- phagocytic cells that engulf and kill bacteria and play a role in killing tumor cells

also called thrombocytes

smallest of the 3 types of formed elements

part of a larger cell called a megakaryocyte, which is found in the bone marrow

function: promote blood clotting at the site of injury to a blood vessel

the most commonly ordered hematology test

test measures:

the no. of rbcs, wbcs, and plts

total amount of Hgb in the blood

mean corpuscular hemoglobin (mch)/ mean corpuscular hemoglobin concentration( mchc)- provides information on the size and Hgb content of individual rbcs

erythrocyte sedimentation rate (esr)- detects and monitors inflammation of the body

reticulocyte counts- evaluates bone marrow production of rbcs

coagulation tests- screens for coagulation problems

the production, differentiation, and maturation of blood cells

maintains and regulates the cellular population of the body's blood cells

a spongy, fatty substance inside your bones

most blood cells are produced inside the bone marrow

all of the rbcs

 60-70% of wbcs

all of the plts

liver

spleen

lymph nodes

thymus

cells that can become any type of cell as they mature

as cells mature, they differentiate into specialized blood cells

fetal development

childhood

adulthood

yolk sac

liver

spleen

bone marrow

other structures:

thymus

lymph nodes

first 2 months: embroyonic yolk sac

2-7 months: liver and spleen take over hemotopoietic role.

after 7 months: bone marrow assumes primary role

at birth bone marrow is red.

blood production is confined to:

sternum

skill

scapulae

vertebrae and ribs

pelvic bones

long bones/arms

red marrow: highly cellular and active in blood cells production

red marrow is transformed into fat cells and becomes yellow

yellow marrow: not active in cell production

is confined to flat bones only:

same sites as in a child excluding the long bones

also the proximal ends of the long bones

unspecialized cells waiting to be assigned a duty

differentiate in multiple types of cells

myeloid stem cells

lymphoid

erythryocytes (rbcs)

thrombocytes (plts)

granulocytes (neutrophils,basophils, eosinophils)

monocytes

b- lymphocytes

t- lymphocytes

amount of cytoplasm in relation to its size increases

cytoplasm color fades from a deep blue color to a paler, less intense blue

round biconcave disc

high surface to volume ratio:

allows for change of shape as it passes through capillaries

allow for swelling hypotonic solution

pink to reddish-orange in color when stained with wright's stain

have normal size central pallor

central pallor is the central light staining area of the RBC

normal size central pallor is bout 2-3 um in diameter

no inclusion bodies

content is 90% hemoglobin

hypochromic cells

polychromic cells

pale cell with increased central pallor

result of decreased hemoglobin and iron production

RBCs with a faint blue color due to RNA

larger than normal RBCs are actually reticulocytes

RBCs arranged in stacks like coins evenly dispersed

increased plasma protein

multiple myeloma

macroglobulinemia

in blood bank: antibody/ antigen reactions

in patients: warm blood in 37. C heating before making smear

autoimmune hemolytic anemia

lacks the biconcave shape

no central pallor

increased hemoglobin content

hereditary spherocytosis

hemolytic anemia

post transfusion

oval or egg shaped displaying a degree of elliptical or cylindrical form

ovalocytes: more egg shaped

elliptocytes: more pencil shaped

ovalocytes:

thalassemia

megaloblastic anemia

elliptocyte:

hereditary elliptocytosis

iron deficiency anemia

also called crenated RBC or burr cells

rounded spicules evenlu distributed over entire surface of RBC

often formed due to increased hypertonic solutions of saline

generally seen due to technical (slide manufacturing) error

a protein and the main cytoplasmic component of erythrocytes

oxygen carrying component of the rbc

maintains the homeostatic balance of facilitating cellular respiration

delivers oxygen from the lungs to the bodys tissue

pulls carbon dioxide away from the tissues

keeps blood in a balanced pH

oxygen delivery from the lungs to the body's tissues

this is the primary purpose of the hemoglobin

done easily through reverisible bonding with oxygen 

4 heme groups

2 pairs of unlike polypeptide chains

protoporhyrin rings ( made of carbon, hydrogen, and nitrogen atoms)

plus an atom of ferrous iron attached

composed of 2 pairs of unlike polypeptide chains

polypetide chains are bracelets of amino acid liked together

begins in the poluchromatic normoblast stage

ends in the reticulocyte stage

synthesis occurs in the mitchondria and cytoplasm of the rbc precursor

iron is transported into the primitive RBC and proceeds to the mitochondria

inside mitochondria, iron combines with protoporphyrin IX

newly formed heme leaves the mitochondria to join the globin chains in the RBC cytoplasm

occurs in ribosomes via transcription of the genetic code

using mRNA they are then translated into globin polypeptide chains

once released from the ribosome each globin chain pairs off with a heme molecule

an a globin and a non-a globin chain then binds forming a heterodimer

two heterodimers then combine to form a tetramer hemoglobin molecule ( 4 chains)

hemoglobin A

hemoglobin A2

hemoglobin F

hemoglobin type is determined by contamination of globin chains

most common type in adults: hemoglobin A (adult hemoglobin)

most common type in infants: hemoglobin F

A: 2 alpha 2 beta: newborns- 20% adults:95-97%

A2: 2 alpha 2 delta:newborns- 0.5% adults: 2-3%

F: 2 alpha 2 gamma: newborns-80% adults-2%

molecule fully saturated with oxygen

carries oxygen from the lungs to the tissues of the body

hemoglobin returning to the lungs with CO2 from the tissue

oxygen transport is based on the affinity for hemoglobin to bind oxygen

an increase in blood CO2 levels

decreased pH

an increase in 2,3-dpg

and or increased temperature

when pH falls low the hgb loses its affinity for oxygen

when ph rises, hgb gains affinity for oxygen

increased 2,3-dpg makes oxygen binding to hgb harder

increase in oxygen expells 2,3- dpg

carboxyhemoglobin

methemoglobin

sulfhemglobin

a compound formed by the binding of carbon monoxide to the heme iron

hgb has 200 times more affinity for carbon monoxide than oxygen

a form of hgb in which the iron converts

oxidized iron is incapable of combining reversibly

a chemically modified hgb formed by the irreversible oxidation of hgb by certain drugs and chemicals

formation is irreversible and conversion persists throughout the life of the erythocyte

has 100x less affinity for oxygen than unmodified hgb

amount: rarely exceeds 10% of total hgb

after 120 days rbcs are phagocytized by macrophages; this is the main way rbcs die

when they die the contents are returned to various parts of the circulation to be recycled for red cell regeneration

during normal cell death rate :

hgb is kept at normal levels

 bone marrow maintains steady reproduction

the destruction of rbcs cuaing the release of hgb into the plasma

leades to a reduced number of rbcs resulting in:

reduced tissue oxygenation

increased rbc production

possible anemia

accounts for 90% of hemolysis

destruction of an erythrocyte outside of a blood vessel, typically by macrophage ingestion

occurs in the spleen, liver, bone marrow, lymph nodes, and circulating monocytes

accounts for 10% of hemolysis

destruction of rbc within a blood vessel

controlled by the hormone erythropoietin

occurs inside the bone marrow

maturation process takes approximately 3-5 days

myeloid stem cells give rise to erythroblasts

erythroblasts undergo morphological changes and mature into rbcs

in the blood

approximately 20-30 trillion in average adult

lives appx 120 days inside the bloodstream

typically die in the spleen and are ingested by macrophages

cell size decreases

cytoplasm- color changes from blue to pink

amount increases compared to cel size

nucleus- decreases in size more significantly than cell's size

disappears, color changes from purplish-red to dark blue

nuceoli disappear

chromatin becomes coarse, clumped, and condensed

N/C ratio- nucleus shrinks more significantly than cell size

causes nucleus to cytoplasm ratio to decrease

named for cytoplasm's deep rich blue color

cell size: 10-15um

N/C ration- 6:1

located in bone marrow

cytoplasm- deeper richer blue; scanty amount and non-granular

nucleus- nucleol; some chromatin climping; round slightly oval; stains less red; exhibits perinuclear HALO around nucleus

cell size: 10-15um

N/C ratio- 6:1

cytoplasm- stains more deeplu basophilic than pronoblast(rubriblast); scanty amount and non-granular

nucleus- nucleoli; some chromatin clumping; round or slightly oval; stains less red; exhibits perinuclear HALO around nucleus

located in the bone marrow

marked by the first true appearance of hemoglobin; last stage of cell division

cell size: 10-12 um

N/C ratio: 4:1

cytoplasm- murky gray-blue due to pink hemoglobin pigmentation; moderate amount

nucleus- no nucleoli condensed and clumped chromatin pattern; has a wagon wheel appearance; deeper blue in color

located in the bone marrow

last stage where nucleus is present

known as nucleated rbc

cell size: 8-10 um

N/C ratio: 1:2

cytoplasm: pink-orange color due to hemoglobin production; moderate amount

nucleus: small and pyknotic ( a homogenous blue-black mass with no structure); coarse and clumped chromatin pattern; blue purple

location- mostly found in bone marrow; may migrate to peripheral blood during times of increased production

cell size: 8-8.5 um

N/C Ratio: N/A

cytoplasm- cell is all cytoplasm; pink to slightly pinkish-gray(same as mature RBC);small amounts of RNA remain in cell appears as small blue granule-like material

irregular shape, not biconcave as in mature RBC

location- mostly found in the bone marrow; may migrate to peripheral blood in times of increased production

cell size: 6-8cm

N/C ratio- n/a

cytoplasm- round biconcave disk with distinct and smooth margins (allows for movement through the vessels); stains salmon pink with a central pale area

nucleus: n/a

location: peripheral blood

pronormoblast- rubriblast

basophilic normoblast- prorubricyte

polychromatophilic normoblast- rubricyte

orthochromic normoblast- metarubricyte

reticulocyte- reticulocyte

erythrocyte-erythrocyte

size

color

shape

inclusion bodies

6-8 microns in diameter

about the same size as the nucleus of a

small lymphocyts

very similar to echinocytes

have irregularly spaced spicules, not uniformed spaced

uneven projections are blunt rather than pointed

liver diseases

alcoholism

post-splenectomy

vitamin e dificency

extremely fragmented cells

fragments are usually bizarre looking

their prescence should alert medical evaluation

disseminated intravascular coagulation (DIC)

hemolytic anemia

artificial heart valves (fragmentation due to artificial structure exposure)

crescent shaped cells

resembles a sicke with two pointed ends

cells are rigid and inflexible

hypochromic target shaped cells

resemble targets due to the increased central pallor and outlining of the hemoglobin around it

have excess cell memebrane in relation to the amount of hemoglobin present

appear when Hgb is affected

hallmark cell of liver disease

Hgb C disease

post splenectomy

pear or teardrop shaped

have an elongated tail at one end

seen when cells pass through speen

half moon shaped cells with two or more spicules

deformed but typically have normal cell volume

G6PD deficiency

pulmonary embolism

disseminated intravascular coagulation (DIC)

have a central pallor that is more of a slit rather than a round shape

lae biconcave shape of the cell

chronic liver disease

hereditary stomatocytosis

hereditary spherocytosis

remnants of dna that appear as round purple granules seen within the RBC

eccentrically located in the cytoplasm

see when rbc maturation is rushed

spleen removal

megaloblastic anemia

beaded blue- purple granules of free iron

located in rbc periphery

dark blue granules that appear as a result of rna and mitochondrial remnants

located t/o the cytoplasm and have either a dustlike or coarse appearance

may indicate lead poisoning

thalessemia

stained aggregates of denatured precipated hgb

 not seen though use of wrights stain

seen though use of crystal violet stain or brillant cresyl blue

usutally take out of rbc by the spleen

called pitting mechanism

leads to formation of bite cells or helmet cells

G6PD deficiency

alpha thalassemia

the globin portion of hemoglobin is metabolized further and broken down into amino acids

the amino acids are then released back into the peripheral blood

iron is released from the heme in the phagocyte and then returned to the plasma

once in the plasma, iron is bound to a protein and carried to the bone marrow where it is recycled into new developing erythrocytes

protoporphyrin into biliverdin and then into bilirubin by macrophages

bilirubin is release into the bloodstream where it binds with albumin for transport

bilirubin is picked up by the cells of the liver and secreted with bile into intestines where it is further metabolized into urobilinogen

urobiligen is excreted out in feces

Hgb is released into the peripheral blood

to prevent toxic build up of iron in the blood hgb is captured by a plasma protein called haptoglobin

smaller than normal rbcs

<6 microns in diameter

decreased mcv

iron deficiency

thalassemia

lead poisoning

anemia of chronic disorders

larger than normal rbcs

>8 microns in diameter

increased mcv

liver disease

hypothyroidism

megaloblastic anemia

chemotherapy patients

normal to find in new borns

myoblast

promyelocyte

myelocyte

metamyelocyte

band

cell size: becomes gradually smaller

cytoplasm: transforms from dark blue and becomes light pink

nuclear chromatin: becomes more clumped

nucleus: decreases in size and warps into lobes

staining color changes from reddish purple to bluish purple

nucleoli dissapear

develop first and are nonspecific

also called azurophilic granules

cparse and stain dark blue

replace primary granules as cell matures and are specific

stain different colors according to the type of granulocyte

cell ceases to produce primary granules

secondary granules are more fine

cells begins to produce secondary specific granules

cells can now be classified as a future neutrophils, basophils or eosinophils

size: 10-18 microns

N/C: 4:1

cytoplasm: smalll amount in relation to the rest of the cell; moderate blue, nongranular, and smooth

nucleus: round or slightly oval; occupies approximately 4/5 cell; reddish purple stain; nucleoli prominent; 2 or more; extremely fine chromatin pattern

location: bone marrow

marked by the appearance of primary azurophilic granules

size: 14-20 microns; varies- may be larger than the myeloblast

N/C: 3:1

cytoplasm: pale blue or basophilic; primary granules appear and eventually dominate

granules: larg, blue to reddish-purple

may obscure the nucleuS

nucleus: oval or round; occupies 1/2 or more of the cell; reddish purple stain; 2-3 nucleoli; chromatin may become a little coarser buut remains relatively fine

Location: bone marrow

cell ceases to produce primary granules

size: 12-18 microns

N/C: 2:1-1:1

cytoplasm: amount proportionately larger; may contain a few patches of blue; granules- small, specific; very fine and pinkish in color, usually bein near the nucleus

nucleus: round or slightly flattened on one side; centrally located; chromatin coarser and more condensed; no nucleoli

location: bone marrow

* stage marked by the domination of increasing secondary granules

*nucleus is kidney bean shaped

size: 10-18 microns

N/C: 1:1

cytoplasm: moderate to abundant in amount

secondary granules increase and are brighter

nucleus: indented or kidney shaped resembling a kidney bean; indention less than 1/2 the width of the nucleus; chromatin continues to become coarser and more condensed

size:10-16 microns

N/C: 1:1

cytoplasm: moderate to abundant amount; pink; specific bllue-pink granules

nucleus: takes on a band or rod like shape; deeply indented by more than 50% of the width of the nucleus; chromatin pattern is course and clumped

Location: bone marrow/peripheral blood