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A basic and worth information for diagnostic is urine microscopy. ideally it should be by the physician at his clinic to add and correlate diagnosis promptly. this will make physician confident in dealing with patients. it also help in follow up the consequences in some important glomerulopathies.
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For Health benefits and medicine videos Subscribe youtube channel - https://www.youtube.com/playlist?list=PLKg-H-sMh9G01zEg4YpndngXODW2bq92w
A basic and worth information for diagnostic is urine microscopy. ideally it should be by the physician at his clinic to add and correlate diagnosis promptly. this will make physician confident in dealing with patients. it also help in follow up the consequences in some important glomerulopathies.
This PPT is Second part of Hematology and covers the different concepts in Hematology. This includes functions of blood, components of blood, formation of blood cells, functions of RBC, WBC and Platelets, Eryhropoiesis, leucopoiesis and Synthesis of hemoglobin
Morphological abnormality of white blood cellNAZAR ABU-DULLA
This presentation describe the normal WBC normal and abnormal shape.
it can also describe the maturation of different WBC and reactivity of the WBC different infection
Physicians working in the field of hematology are called hematologists. Initially, hematologists complete a four-year medical degree and this is followed by three or four years in an internship or residency program. Thereafter, they spend two or three more years learning how to diagnose and treat blood disorders.
Hematopoiesis: Formation of Blood Cells - An OverviewStudyFriend
Hematopoiesis or haemopoiesis is a process of formation of blood cellular components, i.e. formation, development, and differentiation of blood cells, which are derived from haematopoietic stem cells (HSC).
Hematology is the branch of medicine, that is concerned with the study of blood, blood forming organs and blood diseases. It includes study of etiology, diagnosis, treatment, prognosis and prevention of blood diseases .
After the completion of this presentation we will know about:
What is hematology and its purpose.
hematology laboratory.
Blood and its compositions and collections
Hematology lab equipment's
Some hematological tests , disease and hazards too.
Blood its functions composition and Haemopoiesis.pptxBYeshwantRao
Blood is a vital fluid connective tissue in the body.
It delivers oxygen and nutrients to the organs and tissues while removing waste products.
Study of blood is called HAEMATOLOGY.
Blood makes up about 7% of the total body weight of an adult, with an average volume of about 5 liters in males and 4.5 liters in females.
Blood is constantly replenished through a process called Haematopoiesis, which occurs in the bone marrow.
This PPT is Second part of Hematology and covers the different concepts in Hematology. This includes functions of blood, components of blood, formation of blood cells, functions of RBC, WBC and Platelets, Eryhropoiesis, leucopoiesis and Synthesis of hemoglobin
Morphological abnormality of white blood cellNAZAR ABU-DULLA
This presentation describe the normal WBC normal and abnormal shape.
it can also describe the maturation of different WBC and reactivity of the WBC different infection
Physicians working in the field of hematology are called hematologists. Initially, hematologists complete a four-year medical degree and this is followed by three or four years in an internship or residency program. Thereafter, they spend two or three more years learning how to diagnose and treat blood disorders.
Hematopoiesis: Formation of Blood Cells - An OverviewStudyFriend
Hematopoiesis or haemopoiesis is a process of formation of blood cellular components, i.e. formation, development, and differentiation of blood cells, which are derived from haematopoietic stem cells (HSC).
Hematology is the branch of medicine, that is concerned with the study of blood, blood forming organs and blood diseases. It includes study of etiology, diagnosis, treatment, prognosis and prevention of blood diseases .
After the completion of this presentation we will know about:
What is hematology and its purpose.
hematology laboratory.
Blood and its compositions and collections
Hematology lab equipment's
Some hematological tests , disease and hazards too.
Blood its functions composition and Haemopoiesis.pptxBYeshwantRao
Blood is a vital fluid connective tissue in the body.
It delivers oxygen and nutrients to the organs and tissues while removing waste products.
Study of blood is called HAEMATOLOGY.
Blood makes up about 7% of the total body weight of an adult, with an average volume of about 5 liters in males and 4.5 liters in females.
Blood is constantly replenished through a process called Haematopoiesis, which occurs in the bone marrow.
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Hematopoiesis is the process of blood cells being differentiated from hematopoietic stem cells. This process must be repeated on a regular basis in order to keep the body's circulating blood cell numbers stable. Blood cells are divided into three main linages:
Reticulocytes and erythrocytes make up the Erythroid Lineage (red blood cells).
Lymphocytes (B and T cells) and natural killer cells make up the lymphoid lineage.
Macrophages, dendritic cells, granulocytes, and megakaryocytes are all members of the myeloid lineage.
## Site Of Hematopoiesis
Yolk sac
Liver and spleen
Bone marrow
Gradual replacement of active (red) marrow by tissue inactive (fatty)
Expansion can occur during increased need for cell production
Description about origin of blood cells from bone marrow i.e. hematopisis and process of eryhtropoisis and its regulation,Leukopoisis includingformation of all type of WBC's,
Useful for medical science,Post graduate ,and Undergraduate life science students.
Hematopoiesis is the process through which the body manufactures blood cells. It begins early in the development of an embryo, well before birth, and continues for the life of an individual. Hematopoiesis begins during the first weeks of embryonic development. All blood cells and plasma develop from a stem cell that can develop into any other cell.
Hematophoisis is the synthesis of all blood cells within the bone marrow under the influence of certain hormones and growth factors, what are the different step, stages, and factors are given in this presentation
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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NYSORA Guideline
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Josiah Bimabam
BMLS (Buea) MMLSc (Calabar)
St Louis Higher Institute of Medical
Studies Douala
Hemopoiesis
2. Hemopoiesis
Hemopoiesis (or hematopoiesis) is the
process of blood cell formation aiming at
continual replacement of short-lived mature
blood cells
It first occurs in a mesodermal cell population
of the embryonic yolk sac, and shifts during
the second trimester mainly to the developing
liver, before becoming concentrated in newly
formed bones during the last 2 months of
gestation.
Hemopoietic bone marrow occurs in many
locations through puberty, but then becomes
2
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
4. Stem Cells, Growth Factors,
& Differentiation
4
Stem cells are pluripotent cells capable of
asymmetric division and self-renewal.
Some of their daughter cells form specific,
irreversibly differentiated cell types, and other
daughter cells remain as a small pool of
slowly dividing stem cells.
All blood cells arise from a single major type
of pluripotent stem cell in the bone marrow
that can give rise to all the blood cell types.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
5. Hemopoietic Stem Cells
5
Hemopoietic pluripotent stem cells are rare, but they
proliferate and form two major lineages of progenitor
cells with restricted potentials (committed to produce
specific blood cells):
1. One for lymphoid cells (lymphocytes).
2. Another for myeloid cells (Gr. myelos, marrow) that
develop in bone marrow.
Myeloid cells include granulocytes, monocytes,
erythrocytes, and megakaryocytes.
The lymphoid progenitor cells migrate from the
bone marrow to the thymus or the lymph nodes,
spleen, and other lymphoid structures, where they
proliferate and differentiate.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
7. Progenitor & Precursor Cells
7
The progenitor cells for blood cells are commonly
called colony-forming units (CFUs), because
they give rise to colonies of only one cell type
when cultured or injected into a spleen.
There are four major types of progenitor
cells/CFUs:
1. Erythroid lineage of CFU-erythrocytes (CFU-E).
2. Thombocytic lineage of CFU-megakaryocytes
(CFU-Meg).
3. Granulocyte-monocyte lineage of CFU-
granulocytes-monocytes (CFU-GM).
4. Lymphoid lineage of CFU-lymphocytes of all
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
8. Progenitor & Precursor Cells
8
Each progenitor cell produces precursor cells
(or blasts) that gradually assume the
morphologic characteristics of the mature,
functional cell types they will become.
In contrast, stem and progenitor cells cannot be
morphologically distinguished and simply
resemble large lymphocytes.
While stem cells divide at a rate only sufficient to
maintain their relatively small population,
progenitor and precursor cells divide more rapidly,
producing large numbers of differentiated, mature
cells.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
10. Progenitor & Precursor Cells
10
Progenitor cells, committed to forming each type
of mature blood cell, proliferate and differentiate
within microenvironmental niches of stromal cells,
other cells, and ECM with specific growth factors.
Hemopoietic growth factors, often called colony-
stimulating factors (CSF) or cytokines, are
glycoproteins that stimulate proliferation of
progenitor and precursor cells and promote cell
differentiation and maturation within specific
lineages.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
12. Bone Marrow
12
Bone marrow is found in the medullary canals of long
bones and in the small cavities of cancellous bone,
with two types based on their appearance at gross
examination:
1. Blood-forming red bone marrow, whose color is
produced by an abundance of blood and
hemopoietic cells.
2. Yellow bone marrow, which is filled with adipocytes
that exclude most hemopoietic cells.
In the newborn all bone marrow is red and active in
blood cell production, but as the child grows, most of
the marrow changes gradually to the yellow variety.
Under certain conditions, such as severe bleeding or
hypoxia, yellow marrow reverts to red.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
13. Bone Marrow
13
Red bone marrow contains a reticular connective
tissue stroma, hemopoietic cords or islands of cells,
and sinusoidal capillaries.
The stroma is a meshwork of specialized fibroblastic
cells called stromal cells (also called reticular or
adventitial cells) and a delicate web of reticular fibers
supporting the hemopoietic cells and macrophages.
The matrix of bone marrow also contains collagen
type I, proteoglycans, fibronectin, and laminin, the
latter glycoproteins
interacting with integrins to bind cells to the matrix.
Red marrow is also a site where older, defective
erythrocytes undergo phagocytosis by macrophages,
which then reprocess heme-bound iron for delivery to
the differentiating erythrocytes.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
14. Bone Marrow
14
The hematopoietic niche in marrow includes the
stroma,
osteoblasts, and megakaryocytes.
Between the hematopoietic cords run the
sinusoids, which have discontinuous
endothelium, through which newly differentiated
blood cells and platelets enter the circulation.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
17. Medical Application
17
Red bone marrow also contains stem cells that can
produce other tissues in addition to blood cells.
These pluripotent cells may make it possible to
generate specialized cells that are not rejected by the
body because they are
produced from stem cells from the marrow of the
same patient.
The procedure is to collect bone marrow stem cells,
cultivate them in appropriate medium for their
differentiation to the cell type needed for transplant,
and then use the resulting cells to replace defective
cells.
These studies in regenerative medicine are at early
stages, but
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
18. Maturation of Erythrocytes
18
Several major changes take place during
erythropoiesis:
1. Cell and nuclear volumes decrease.
2. The nucleoli diminish in size and disappear.
3. Chromatin density increases until the nucleus
presents a pyknotic appearance and is finally
extruded from the cell.
4. There is a gradual decrease in the number of
polyribosomes (basophilia), with a simultaneous
increase in the amount of hemoglobin (a highly
eosinophilic protein).
5. Mitochondria and other organelles gradually
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
19. Maturation of Erythrocytes
19
There are three to five intervening cell divisions
between the proerythroblast and the mature
erythrocyte.
The development of an erythrocyte from
proerythroblast to the release of reticulocytes into the
blood takes approximately 1 week.
The glycoprotein erythropoietin, a growth factor
produced by cells in the kidneys, stimulates
production of mRNA for globins, the protein
components of hemoglobin, and is essential for the
production of erythrocytes.
Reticulocytes pass to the circulation (where they may
constitute 1% of the red blood cells), quickly lose the
polyribosomes, and mature as erythrocytes.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
22. Maturation of Granulocytes
22
Granulopoiesis involves cytoplasmic changes
dominated by
synthesis of proteins for the azurophilic granules
and specific granules.
These proteins are produced in the rough ER and
Golgi apparatus in two successive stages:
1. Made initially are the azurophilic granules,
which contain lysosomal hydrolases, stain with
basic dyes, and are basically similar in all three
types of granulocytes.
2. Golgi activity then changes to produce proteins
for the specific granules, whose contents differ
in each of the three types of granulocytes.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
24. Medical Application
24
Before its complete maturation, the neutrophilic
granulocyte passes through an intermediate
stage, the band cell (or stab cell), in which the
nucleus is elongated but not yet polymorphic.
The appearance of large numbers of immature
neutrophils
(band cells) in the blood, sometimes called a
“shift to the
left,” is clinically significant, usually indicating a
bacterial
infection.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
25. Maturation of Granulocytes
25
The vast majority of granulocytes are neutrophils and the
total time required for a myeloblast to produce mature,
circulating neutrophils ranges from 10 to 14 days.
Developing and mature neutrophils exist in four
functionally and anatomically defined compartments:
1. The granulopoietic compartment in active marrow.
2. Storage as mature cells in marrow until release.
3. The circulating population.
4. A population undergoing margination, a process in which
neutrophils adhere loosely and accumulate transiently
along the endothelial surface in venules and small veins.
Margination can persist for several hours and is not
always followed by emigration from the vessels.
5. Inflamed connective tissue.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
27. Maturation of Granulocytes
27
Neutrophilia, an increase in the number of circulating
neutrophils, does not necessarily imply an increase in
granulopoiesis.
1. Transitory neutrophilia:
Intense muscular activity or the administration of epinephrine
can cause the marginating neutrophils to move into the
circulating compartment.
Glucocorticoids increase the mitotic activity of neutrophil
precursors.
Transitory neutrophilia is typically followed by a recovery
period during which no neutrophils are released.
2. Prolonged neutrophilia:
Bacterial infections is due to an increase in production of
neutrophils and a shorter duration of these cells in the
medullary storage compartment.
In such cases, immature forms such as band or stab cells,
neutrophilic metamyelocytes, and even myelocytes may
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
28. Maturation of Agranulocytes
28
The precursor cells of
monocytes & lymphocytes do
not show specific
cytoplasmic granules or
nuclear lobulation.
The monoblast is a
committed progenitor cell
that is virtually identical to the
myeloblast morphologically.
Promonocytes divide twice
as they develop into
monocytes.
Monocytes circulate in blood
for several hours and enter
tissues where they mature as
macrophages & function for
up to several months.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
29. Maturation of Agranulocytes
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
29
The first identifiable
progenitor of lymphoid
cells is the lymphoblast, a
large cell capable of
dividing two or three times
to form lymphocytes.
In the bone marrow and in
the thymus, these cells
synthesize the specific cell
surface proteins that
characterize B or T
lymphocytes,
respectively.
30. Medical Application
30
Abnormal proliferation of stem cells in bone marrow can
produce a range of myeloproliferative disorders.
Leukemias are malignant clones of leukocyte precursors.
They can occur in both lymphoid tissue (lymphoblastic
leukemias) and bone marrow (myelogenous leukemias).
In these diseases, there is usually a release of large
numbers of immature cells into the blood and an overall
shift in hemopoiesis, with a lack of some cell types and
excessive production of others.
The patient is usually anemic and prone to infection.
Diagnosis of leukemias and other bone marrow
disturbances involves bone marrow aspiration. A needle is
introduced through the compact bone, typically at the iliac
crest, and a sample of marrow is withdrawn.
Immunocytochemistry with labeled monoclonal antibodies
specific to membrane proteins of precursor blood cells
contributes to a more precise diagnosis of the leukemia.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
31. Origin of Platelets
31
Platelets originate in the red bone marrow by
dissociating from mature megakaryocytes, which in
turn differentiate from megakaryoblasts in a process
driven by thrombopoietin.
The megakaryoblast is 25 to 50 μm in diameter and
has a large ovoid or kidney-shaped nucleus, often
with several small nucleoli.
Before differentiating, these cells undergo
endomitosis, with repeated rounds of DNA replication
not separated by cell divisions, resulting in a nucleus
that is highly polyploid (i.e, 64N or >30 times more
DNA than in a normal diploid cell).
The cytoplasm of this cell is homogeneous and highly
basophilic.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
33. Origin of Platelets
33
Megakaryocytes are giant cells, up to 150 μm in
diameter, with large, irregularly lobulated polyploid
nuclei, coarse chromatin, and no visible nucleoli.
Their cytoplasm contains numerous mitochondria, a
well-developed RER, and an extensive Golgi
apparatus from which arise the conspicuous specific
granules of platelets.
They are widely scattered in marrow, typically near
sinusoidal capillaries.
To form platelets, megakaryocytes extend several
long(>100 μm), wide (2-4 μm) branching processes
called proplatelets.
These cellular extensions penetrate the sinusoidal
endothelium and are exposed in the circulating blood
of the sinusoids
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
37. Origin of Platelets
37
Internally proplatelets have a framework of
actin filaments and microtubules along which
membrane vesicles and specific granules are
transported.
A loop of microtubules forms a teardrop-
shaped enlargement at the distal end of the
proplatelet, and cytoplasm within these loops
is pinched off to form platelets with their
characteristic marginal bundles of
microtubules, vesicles, and granules.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
38. Origin of Platelets
38
Mature megakaryocytes have numerous
invaginations of plasma membrane ramifying
throughout the cytoplasm, called demarcation
membranes, which were formerly considered
“fracture lines” or “perforations” for the release
of platelets but are now thought to represent a
membrane reservoir that facilitates the
continuous rapid proplatelet elongation.
Each megakaryocyte produces a few
thousand platelets, after which the remainder
of the cell shows apoptotic changes and is
removed by macrophages.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
40. Origin of Platelets
40
Mature megakaryocytes have numerous
invaginations of plasma membrane ramifying
throughout the cytoplasm, called demarcation
membranes, which were formerly considered
“fracture lines” or “perforations” for the release
of platelets but are now thought to represent a
membrane reservoir that facilitates the
continuous rapid proplatelet elongation.
Each megakaryocyte produces a few
thousand platelets, after which the remainder
of the cell shows apoptotic changes and is
removed by macrophages.
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
41. CASE STUDY
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
41
A 42-year-old premenopausal woman has
emphysema. This lung disease impairs the ability
to oxygenate the blood, so patients experience
significant fatigue and shortness of breath.
To alleviate these symptoms, oxygen is typically
prescribed, and this patient has a portable
oxygen tank she carries with her at all times,
breathing through nasal cannulae.
Before she began using oxygen, her red blood
cell (RBC) count was 5.8 x 1012/L. After oxygen
therapy for several months, her RBC count
dropped to 5.0 x 1012/L
42. Questions
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
42
1. What physiologic response
explains the elevation of the first
RBC count?
2. What hormone is responsible?
How is its production stimulated?
What is the major way in which it
acts?
3. What explains the decline in RBC
count with oxygen therapy for this
43. Answer to Question 1
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
43
When the blood is not well oxygenated, the bone
marrow responds by producing more red blood
cells to carry more oxygen.
44. Answer to Question 2
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
44
The hormone that stimulates RBC production is
erythropoietin (EPO). The peritubular cells of the
kidney detect hypoxia.
A hypoxia-sensitive transcription factor is
produced that moves to the peritubular cell
nucleus and upregulates transcription of the EPO
gene.
EPO acts by preventing apoptosis of the erythroid
colony-forming unit. In RBC precursors, it also
shortens the cell cycle time between mitoses and
reduces the number of mitotic divisions; and it
promotes early release of reticulocytes from the
bone marrow
45. Answer to Question 3
Hemopoiesis, Josiah Bimabam, St Louis
University Institute/IUC
45
Once the patient was receiving oxygen
therapy, hypoxia diminished and EPO
production also declined.
Thus, production of new RBCs slowed.
At the same time, RBCs reaching 120
days of age were removed from the
circulation. Thus the total number of
circulating RBCs decreased.
Figure 13–1 Shifting locations of hemopoiesis during development and aging.
Hemopoiesis, or blood cell formation, first occurs in a mesodermal cell population of the embryonic yolk sac, and shifts during the second trimester mainly to the developing liver, before becoming concentrated in newly formed bones during the last 2 months of gestation. Hemopoietic bone marrow occurs in many locations through puberty, but then becomes increasingly restricted to components of the axial skeleton.
Figure 13–2 Origin and differentiative stages of blood cells.
Rare pluripotent stem cells divide slowly, maintain their own population, and give rise to two major cell lineages of progenitor cells: the myeloid and lymphoid stem cells. The myeloid lineage includes precursor cells (blasts) for erythropoiesis, thrombopoiesis, granulopoiesis, and monocytopoiesis, all in the bone marrow. The lymphoid lineage forms lymphopoietic cells, partly in the bone marrow and partly in lymphoid organs.
Figure 13–3 Major changes in developing hemopoietic cells.
Figure 13–4 Red bone marrow (active in hemopoiesis).
Red bone marrow contains adipocytes but is primarily active in hemopoiesis, with several cell lineages usually present. It can be examined histologically in sections of bones or in biopsies, but its cells can also be studied in smears. Marrow consists of capillary sinusoids running through a stroma of specialized, fibroblastic stromal cells and an ECM meshwork with reticular fibers. Stromal cells produce the ECM; both stromal and bone cells secrete various CSFs, creating the microenvironment for hemopoietic stem cell maintenance, proliferation, and differentiation.
(a) Sections of red bone marrow include trabeculae (T) of cancellous bone, adipocytes (A), and blood-filled sinusoids (S) between hemopoietic cords (C) or islands of developing blood cells. X140. H&E. (b) At higher magnification the flattened nuclei of sinusoidal endothelial cells (E) can be distinguished, as well as the variety of densely packed hemopoietic cells in the cords (C) between the sinusoids (S) and adipocytes (A). Most stromal cells and specific cells of the hemopoietic lineages are difficult to identify with certainty in routinely stained sections of marrow. X400. H&E.
Figure 13–5 Sinusoidal endothelium in active marrow.
The diagram shows that mature, newly formed erythrocytes, leukocytes, and platelets in marrow enter the circulation by passing through the discontinuous sinusoidal endothelium. All leukocytes cross the wall of the sinusoid by their own activity, but the non-motile erythrocytes cannot migrate through the wall actively and enter the circulation pushed by a pressure gradient across the wall. Megakaryocytes form thin processes (proplatelets) that also pass through such apertures and liberate platelets at their tips.
Figure 13–6 Summary of erythrocyte maturation.
The color change in the cytoplasm shows the continuous decrease in basophilia and the increase in hemoglobin concentration from proerythroblast to erythrocyte. There is also a gradual decrease in nuclear volume and an increase in chromatin condensation, followed by extrusion of a pyknotic nucleus. The times indicate the average duration of each cell type. In the graph, 100% represents the highest recorded concentrations of hemoglobin and RNA.
Figure 13–7 Erythropoiesis: Major erythrocyte precursors.
(a) Micrographs showing a very large and scarce proerythroblast (P), a slightly smaller basophilic erythroblast (B) with very basophilic cytoplasm, typical and late polychromatophilic erythroblasts (Pe and LPe) with both basophilic and acidophilic cytoplasmic regions, and a small orthochromatophilic erythroblast (Oe) with cytoplasm nearly like that of the mature erythrocytes in the field. All X1400. Wright.
(b) Micrograph containing reticulocytes (arrows) that have not yet completely lost the polyribosomes used to synthesize globin, as demonstrated by a stain for RNA. X1400. Brilliant cresyl blue.
Figure 13–8 Granulopoiesis: Formation of granules.
Illustrated is the sequence of cytoplasmic events in the maturation of granulocytes from myeloblasts. Modified lysosomes or azurophilic granules form first at the promyelocyte stage and are shown in blue; the specific granules of the particular cell type form at the myelocyte stage and are shown in pink. All granules are fully dispersed at the metamyelocyte stage, when indentation of the nucleus begins.
Figure 13–12 Compartments of neutrophils in the body.
Neutrophils exist in at least four anatomically and functionally distinct compartments, whose sizes reflect the number of cells:
(1) A granulopoietic compartment in bone marrow with developing progenitor cells.
(2) A storage (reserve) compartment, also in red marrow, acts as a buffer system, capable of releasing large numbers of mature neutrophils as needed. Trillions of neutrophils typically move from marrow to the bloodstream every day.
(3) A circulating compartment throughout the blood.
(4) A marginating compartment, in which cells temporarily do not circulate but rather accumulate temporarily at the surface of the endothelium in venules and small veins.
The marginating and circulating compartments are actually of about equal size, and there is a constant interchange of cells between them, with the half-life of cells in these two compartments less than 10 hours. The granulopoietic and storage compartments together include cells in approximately the first 14 days of their existence and are about 10 times larger than the circulating and marginating compartments.
Figure 13–13 Megakaryoblast and megakaryocytes.
(a) Megakaryoblasts (Mb) are very large, fairly rare cells in bone marrow, with very basophilic cytoplasm. X1400. Wright.
Figure 13–13 Megakaryoblast and megakaryocytes.
(b) Megakaryoblasts undergo endomitosis (DNA replication without intervening cell divisions), becoming polyploid as they differentiate into megakaryocytes (M). These cells are even larger but with cytoplasm that is less intensely basophilic. X1400. Wright.
Figure 13–13 Megakaryoblast and megakaryocytes.
(c) Micrograph of sectioned bone marrow in which a megakaryocyte (M) is shown near sinusoids (S). X400. Giemsa. Megakaryocytes produce all the characteristic components of platelets (membrane vesicles, specific granules, marginal microtubule bundles, etc) and in a complex process extend many long, branching pseudopodia-like projections called proplatelets, from the ends of which platelets are pinched off almost fully formed.
Figure 13–5 Sinusoidal endothelium in active marrow.
The diagram shows that mature, newly formed erythrocytes, leukocytes, and platelets in marrow enter the circulation by passing through the discontinuous sinusoidal endothelium. All leukocytes cross the wall of the sinusoid by their own activity, but the non-motile erythrocytes cannot migrate through the wall actively and enter the circulation pushed by a pressure gradient across the wall. Megakaryocytes form thin processes (proplatelets) that also pass through such apertures and liberate platelets at their tips.
Figure 13–14 Megakaryocyte ultrastructure.
This TEM of a megakaryocyte shows the lobulated nucleus (N), numerous cytoplasmic granules (G), and an extensive system of demarcation membranes (D) through the cytoplasm. The system of demarcation membranes is considered to serve as a reservoir to facilitate rapid elongation of the numerous proplatelets extending from the megakaryocyte surface. X10,000.
René-Théophile-Hyacinthe Laennec (French: [laɛnɛk]; 17 February 1781 – 13 August 1826) was a French physician. He invented the stethoscope in 1816, while working at the Hôpital Necker and pioneered its use in diagnosing various chest conditions.