HEMATOLOGY REVIEW

Where are blood cells produced?

 Where are blood cells produced?

How are blood cells produced?

All the different forms of blood cells have
developed from a primitive cell call STEM
CELLS. These cells are located in the bone
marrow and they reproduce themselves and
evolve into either the mature rbc, wbc or plt.
All blood cells undergo several stages of
development before reaching maturity in the
bone marrow.
Once the cells are mature they are released
from the bone marrow into the circulation.
 What stimulates production?

White Blood Cells - Infection

Red Blood Cells - Low Oxygen in the Tissues

Platelets - Blood Loss

 What are the three main types of blood cells?

White Blood Cells - WBC

Red Blood Cells - RBC

Platelets - PLT
What is the function of each blood cell type?

WBCs - part of the immune system, protection

against microorganisms and foreign matter

RBCs - transport oxygen from lungs to cells and CO 2

from cells to lungs

Platelets - essential in preventing blood loss -

bleeding
 What other names are cells known by?

WBCs - Leukocytes

RBCs - Erythrocytes

Platelets - Thrombocytes
 What are the normal ranges (generic)?

WBCs 4 - 11 thousand/L

RBCs 4 - 6 million/L

Platelets150 - 450 thousand/L

 Routine Hematology Tests

Purpose: to facilitate the diagnosis

and treatment of many blood
disorders such as leukemias and
anemias. It also facilitates the
diagnosis and management of
diseases that originate in other body
systems.
 Routine Hematology Tests

Complete Blood Count - CBC

a combination of test that include WBC, RBC,
Hemoglobin, Hematocrit, MCV, MCH, MCHC,
CHCM, RDW and Platelet Count

CBC and Differential

all of the above mentioned tests plus the
differential of the white blood cells - a
breakdown of the major types of cells expressed
as a percentage of the total WBC
 Routine Hematology Tests

WBC- White Blood Cell Count

Determines the number (#) of leukocytes (white blood
cells) in a microliter (L)of blood

WBC count = leukocytosis - infection, leukemia,

parasites

WBC count = leukopenia - autoimmune disease,

bone marrow depression
 Routine Hematology Tests

WBC- Differential

is performed to obtain the % and/or # of each of the

leukocyte types present

manual diff - counting either 100 or 200 white blood

cells from a stained blood smear and recording the
number of each type observed

automated diff - electronically performed

 Routine Hematology Tests

RBC- Red Blood Cell Count

Determines the number (#) of erythrocytes (red blood
cells) in a microliter (L)of blood

RBC count = erythrocytosis - dehydration,

polycythemia

RBC count = anemia - blood loss, decreased

production, nutritional deficiencies, genetic
disorders
 Routine Hematology Tests

Red Cell Indicies

MCV (mean cell volume)
average volume of RBCs
normal range (80 - 96 fL)
MCV = pernicious anemia
MCV = iron deficiency anemia

MCH (mean cell hemoglobin)

a ratio of hemoglobin to the RBC count
normal range (27.5 - 33.2 pg)
 Routine Hematology Tests

Red Cell Indicies (cont)

MCHC = Mean Cell Hemoglobin Concentration. A

calculated parameter. MCHC is an expression of the
average concentration of hemoglobin in the RBCs.
Normal range is 32 - 36 %

%MCHC = HGB x 100

MCV x RBC

CHCM = Cellular Hemoglobin Concentration Mean A

directly measured parameter.
Cell by cell measurement from the RBC channel
 Routine Hematology Tests

Platelet Count - PLT

Determines the number (#) of platelets
(thrombocytes) in a microliter (L)of blood

PLT count = thrombocytosis - increased production,

iron deficiency anemia

PLT count = thrombocytopenia - bone marrow

suppression, chemotherapy, decreased production,
destruction,
 Routine Hematology Tests
Platelet Count - PLT
Importance of Accurate Platelet Counts
Low Counts:
Determine need for transfusion
Oncology 10 x 103/ mL
General 50 x 103/mL
Adjust / monitor platelet (PLT) therapy
Monitor bone marrow recovery post transplant
Monitor impact on chemotherapy and radiation therapy
High Counts:
Monitor therapy to lower platelet counts
 Routine Hematology Tests

Reticulocyte count - retic count

Why do we count retics?
Asses red blood cell production
Distinguish between those anemias caused by blood
loss and those caused by bone marrow failures
Evaluate patient response to chemotherapy and
radiation
Assess the return of bone marrow function after
autologous bone marrow transplant
Monitoring the response of r-HuEPO
 Routine Hematology Tests

Reticulocyte count - retic count

determines # of young RBCs in the peripheral blood

Manual Retic Count - a few drops of blood are smeared

on a slide, stained with methylene blue and are
examined under a microscope. At least 1,000 RBCs are
counted and the number of young RBCs having a blue
stained dot are expressed as a % of the total RBC
count.
Automated Retic Count - retics are stained and counted
electronically and at least 20,000 cells are counted
 Routine Hematology Tests

Retic count = bone marrow in response to the

following

blood loss high altitudes

therapy for anemia hemolytic anemia
successful bone marrow transplant

Retics count = in anemic patients indicate:

bone marrow failure due to infection

aplastic anemia iron deficiency anemia
 Routine Hematology Tests

Hematocrit - Hct
measures the % of RBCs in a whole blood
sample
also called packed cell volume (PCV)
helps diagnose anemia ( Hct) and
dehydration ( Hct)
 Routine Hematology Tests

Hemoglobin - Hb
a protein of the red blood cell whose main
function is to transport oxygen to the cells and
to return carbon dioxide to the lungs
Hb= heme + globin

heme requires iron for its synthesis, when patient

iron deficient, low hemoglobin results in low
oxygen carrying capacity of the RBCs which will
lead to anemia
 Routine Hematology Tests

Review Rate = the % of automated samples that

require subsequent testing i.e.. manual check or manual
differential

Rerun (Repeat) Rate = the % of automated

samples that must be repeated to obtain a valid result
 WBCs

Leukocytes
 Where are white blood cells produced?
What are the 3 characteristics (morphology)
used to describe white blood cells?

cell size

nuclear size, shape and density

Nucleus

cytoplasm appearance

Cytoplasm
 What are the two main categories of white
blood cells (Leukocytes)?

Granulocytic - cytoplasm contains

granules

Agranular - no specific granules

present in cytoplasm,
also mononuclear
 What are the three Granulocytic cell
subclassifications?

Neutrophils

Eosinophils

Basophils
What cell lines belong to the agranulocytic
category?

Lymphocytes

Monocytes
How many morphological types of WBCs are
found in normal peripheral blood?

5 - Five Part Differential

Neutrophil - Granulocyte - PMN

Lymphocyte - Mononuclear - MN

Monocyte - Mononuclear - MN

Eosinophil - Granulocyte - PMN

Basophil - Granulocyte - PMN

 Granulocyte - Maturation

Granulocyte maturation occurs on a continuum that

has been divided into six stages for morphologic
identification

Cytoplasmic granules develop during granulocyte

maturation and are important for granulocyte function

Granulocytes are divided into three distinct lineages

based on the staining characteristics of their granules
- neutrophilic, eosinophilic and basophilic
 Granulocyte - Maturation

Blast

IG - Immature Granulocyte

Promyelocyte Myelocyte Metamyelocyte

 Granulocyte - Maturation

Band (Stab)
Left Shift

Neutrophil - Seg (Poly)

 Neutrophil
Key features
Size: 10 - 15 microns in
Nucleus - lobed diameter
Nucleus:
2 - 5 lobes joined by thin
filaments
very coarse chromatin
nucleoli absent
Cytoplasm
pale pink
fine, pink-purple granules
strongly Peroxidase
positive

Cytoplasm with granules

 Neutrophil

develop in bone marrow

life span of a few hours

make up 70 - 74 % of circulating WBCs

primary function is phagocytosis

surface receptors help bind them to antigens

attracted by chemicals, phagocytize, die and are

cleaned up by macrophages

first to enter an infected area

 Basophil

develop in bone marrow

make up less than 0.5% of circulating WBCs

primary function is to release anticoagulant,

heparin, in areas of foreign invasion to keep blood
flowing at site, keeps clots from impeding delivery
of WBCs to site of damage/invasion

release histamine - vasodilator to enlarge pores

and let the cells out
Lymphocyte Maturation
 Lymphocyte Maturation

Lymphoblast Prolymphocyte Lymphocyte

Lymphocyte maturation progresses from the

Lymphoblast to the
Prolymphocyte to the
Mature Lymphocyte
Lymphocyte
Key features
Size: 7 - 15 microns in
diameter
Nucleus:
round
very coarse chromatin
nucleoli absent
Cytoplasm
variable amount
light blue
few granules may be
present
Peroxidase negative
 Lymphocyte
produced in the bone marrow and matures either in the
marrow or in the thymus

make up about 25% of circulating WBCs

reside in circulation, lymph nodes, spleen and other extra

vascular sites

function - to generate a response to foreign invasion (including

transplant rejection)

two major types:

T cells - release chemicals to alert other WBCs
B cells - produce antibody
maintain memory - immunity for life
 Monocyte Maturation

Monoblast Promonocyte Monocyte

Monocyte maturation progresses from the

Monoblast the first identifiable cell type in the series to the

Promonocyte to the

Mature Monocyte the most mature cell type in the series

Monocyte
Key features
Size: 12 - 24 microns in
diameter
Nucleus:
indented or folded
sieve-like chromatin
nucleoli absent
Cytoplasm
abundant, gray-blue
vacuoles commonly present
few granules may be present
weakly Peroxidase positive
 Monocyte

produced in the bone marrow as a monocyte but

matures in tissues into a macrophage

make up about 5% of circulating WBCs

contain lysosomes (pockets of enzymes) to digest

whatever it phagocitizes

reside also in the lymphatic system to teach or

make aware the presence of an antigen to the T-
Lymphocyte
 RBCs

Erythrocytes
 Regulation of Red Cell Production

RBC production is regulated by the Feedback

Mechanism. Decreased level of Oxygen triggers
the kidneys to increase production of erythro-
poietin. This hormone stimulates the bone marrow
to produce stem cells which transform into Red
Blood Cells. Feedback signals to the marrow
maintain the normal production of RBCs.
 Regulation of Red Cell Production

Bone Marrow

Stem Cells Erythroid Tissue

Erythropoietin Red Cell Mass

Erythropoietin O2 Sensor
Producer

Kidney
Regulation of Red Cell Production

EPO

Bone
RBC Marrow
Production
Kidney Cycle
O2
Sensor

Reticulocyte

Mature
RBC

Normal Process
RBC - Erythrocyte Maturation

Bone Marrow Peripheral Blood

 RBC - Erythrocyte Maturation

Nucleated RBC Polychromatophilic RBC Erythrocyte

nRBC Reticulocyte RBC
Retic
Biconcave Disk
Mature RBCs lack a nucleus and

are shaped like biconcave disks

The biconcave shape is the

result of an increased amount

of membrane relative to cell

contents

A biconcave disk provides the

ideal ratio of surface area to

volume which aids oxygen

transport
RBC
Key features
Size: 6 - 8 microns in
diameter
biconcave disk -
maximum surface area for
exchange of gases
area of central pallor
Nucleus: absent
Cytoplasm: pink
Life span 120 days
flexible - pliable changes
shape as necessary to fit
into circulatory pathways
 RBC
RBCs contain hemoglobin
Hemoglobin content is referred to as Chromasia
Terms describing hemoglobin content in cells:
hypochromia: decreased amount of hemoglobin in
the cell - increased central pallor
hyperchromia: increased amount of hemoglobin -
little to no central pallor visible
normochromia: a normal amount of hemoglobin in
the cell - a normal central pallor
Inclusions - abnormal structures within the RBC
Howell Jolly Bodies
Malarial Parasites
 RBC
RBCs have specific sizes
Terms describing the size of cells:
microcytic: presence of cells that are smaller
than normal
macrocytic: presence of cells that are larger
than normal
normocytic: cells are normal in size
Variation in cell size - anisocytosis
Variation in cell shape - poikilocytosis
 Platelets

Thrombocytes
 Where are platelets produced?
 Platelet Maturation

Megakaryoblast
Megakaryocyte Platelets

Bone marrow is the primary site of platelet production

Platelets arise from a large precursor cell called a
megakaryocyte
Platelets are fragments of megakaryoctye cytoplasm
 Platelets

Key features
Round or oval
Size: 1.5 - 4 microns in
diameter
Nucleus: absent
Cytoplasm:
pale blue
purple granules
Life span 9 - 12 days
Platelets
Reticulocytes
RBC - Erythrocyte Maturation

Bone Marrow Peripheral Blood

 RBC - Erythrocyte Maturation

Nucleated RBC Polychromatophilic RBC Erythrocyte

nRBC Reticulocyte RBC
Retic
 Retics

Reticulocyte
larger than mature RBC requires special stains
life span 1 -2 days or procedures to count
no nucleus increased in hemolytic
anemias and treatment
slightly bluish in color
of nutritional
less than 2% of deficiencies
circulating RBCs
decreased in
earliest indicator of hypoplastic anemia,
bone marrow activity aplastic anemia