Granulopoiesis constitutes 40-80% of the haemopoietic cells in
the normal bone marrow. The myeloblast is the first recognizable
cell of the granulopoiesis. The myeloblast enlarges and
differientiates to the promyelocyte. At this stage specific
granules begin to appear (eosinophilic granules in the
eosinophilic leucocytes, basophilic granules in the basophilic
granulocytes and neutrophilic granules in the neutrophilic
leucocytes). The promyelocytes mature and become the myelocytes
and then metamyelocytes. In the end of the maturation process
metamyelocytes become band neutrophil and then segmented
neutrophil. These cells move from the marrow to the blood. The
majority of granulopoiesis in the normal marrow consists of
neutrophilic leucocytes.The percentage of eosinophilic
leucocytes and basophilic leucocytes should not exceed 5% and 1%
respectively.
Myeloblasts
in bone marrow
Myeloblasts
in peripheral blood
Promyelocytes
in bone marrow
Promyelocytes
in peripheral blood
Neutrophil myelocytes
in bone marrow
Neutrophil myelocytes
in peripheral blood
Neutrophil metamyelocytes
in bone marrow
Neutrophil metamyelocytes
in peripheral blood
Band neutrophils
in bone marrow
Band neutrophils
in peripheral blood
Segmented neutrophils
in bone marrow
Segmented neutrophils
in peripheral blood
Toxic granulation in neutrophils
Agranular neutrophils
Pelger-Huet anomaly
Doehle`s bodies
Left-shift of granulocytic cells
in peripheral blood
Neutrophil vacuolisation
Hypersegmentation
Granulation heterogeneity
Eosinophilic promyelocytes
in bone marrow
Early eosinophilic precursors
in bone marrow
Mature eosinophils
in bone marrow
Mature eosinophils
in peripheral blood
Basophils
in bone marrow
Basophils
in peripheral blood
Mastocyte
LYMPHOPOIESIS
Lymphopoiesis constitute 5-20% of the bone marrow cells. The
lymphocytes - as all hemopoietic cells are derived for the stem
cell, which differentiates into cells common for the two
lymphocytic series (B and T-cells). The cell divides into
precursors pro-B and pre-T cells, which develop into the stage
of the mature B- and T-lymphocyte. After antigen exposition the
mature lymphocytes differantiate into intensive proliferative
lymphocytes. They are capable of synthesis immunoglobulins and
immunological memory cells.
Lymphoblasts in bone marrow
Lymphocytes in bone marrow
Lymphocytes in peripheral blood
Lymphocytes in peripheral blood
Large granular lymphocytes
Lymphoplasmocytes
Plasma cells in bone marrow
Plasma cell in peripheral blood
ERYTHROPOIESIS
Erythropoiesis constitute 10-30% of hemopoietic cells in the bone
marrow. The mature erythrocyte is derived from the stem cell, which
differentiate to erythroid colony forming cells (BFU-E, CFU-E), and
next to the proerythroblast, the first morphologically recognizable
cell of the series. The proerythroblast matures to the basophilic
normoblast, then the polichromatic normoblast, where synthesis of
hemoglobin is started. At the end, the polychromatophilic normoblast
matures to the orthochromatic normoblast. The orthochromatic
normoblast loses its nucleus and developes into reticulocyte, which
after 2-4 days develops into mature erythrocyte. The mature
erythrocyte stays for ca. 4 months in the blood.
Proerythroblasts
Basophilic (early) normoblast
Polychromatic (intermediate) normoblas
Pycnotic (late) normoblast
Reticulocytes
Normocytes
Microcytes
Macrocytes
Megalocytes
Anisocytosis
Hypochromia
Polychromasia
Eliptocytes
Lacrymocytes
Target cells
Acanthocytes
Echinocytes
Crenated red blood cells
Schistocytes
Stomatocytes
Spherocytes
Leptocytes
Anulocytes
Sickle cells
Poikilocytosis
Howell-Jolly bodies
Cabot rings
Basophilic stippling
Pappenheimer bodies
Normoblasts in blood
Case 1
History:
Physical examination:
A 39- year old lady was admitted to the local
hospital because of short of breath on exertion and malaise. The symptoms
started about 3-4 months ago and progressed systematically. The patient
was afebrile, did not complain of pain. Her weight was stable.
pale, physical examination unremarkable
Laboratory findings:
Peripheral blood
morphology:
Hemoglobin - 9.3 g/dl
Erythrocytes - 3.05 T/l
MCV - 90 fl
Leukocytes - 11.80 G/l
Neutrocytes - 0.89 G/l
Lymphocytes - 10.10 G/l
Monocytes - 0.70 G/l
Eosinohils - 0.01 G/l
LDH - 1024 IU/l
gammaglobulins - 23 %
Direct antiglobulin test - negative
Liver and kidney function tests within normal limits
Pictures of peripheral blood smears
Bone marrow morphology:
Immunophenotypisation:
Bone marrow aspiration: hypocellular; Erythropoiesis -
2.5%; Granulopoiesis - 12.5% without displasia; Lymphocytes - increased to
82%, about 54% of lymphocytes contained large azurophilic granules.
Megakaryocytes decreased but of normal appearance.
The subpopulation of lymphocytes has the
following surface antigens: CD2+, CD3+, CD7+, CD8+, TCR gamma/delta+,
CD16&56+, CD5(-)B-cell antigens were absent.
