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    Introduction To Hematology 2

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    irishgopez24

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    Introduction To Hematology 2

    Uploaded by

    irishgopez24
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    Introduction to Hematology 2

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    9 views39 pages

    Introduction To Hematology 2

    Uploaded by

    irishgopez24

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    © All Rights Reserved
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    of 39

    INTRODUCTION TO

    HEMATOLOGY 2
    Wilson R. Delos Reyes Jr. RMT, MLS (ASCPi), MSMT, MD
    Vascular Structure and Function
    ENDOTHELIUM
    - Vascular permeability and blood flow rate are controlled by a single
    layer of endothelial cells that line the vessel wall.
    - Vascular lining is nonreactive to platelets and plasma proteins until
    damaged.
    - Upon injury, increased vascular permeability occurs, allowing leakage
    of plasma proteins and blood cell migration to site of injury.
    - Damage causes vasoconstriction to minimize blood loss; allows
    interaction among vessels, platelet and plasma proteins.
    Vascular Structure and Function
    SUBENDOTHELIUM
    - Composed of smooth muscle cells and connective tissue with
    collagen fibers
    - Exposure of collagen causes platelet activation; activates the intrinsic
    pathway of secondary hemostasis.
    Vascular Structure and Function
    Vascular endothelium produces and releases:
    A. von Willebrand factor (vWF)
    B. Tissue Factor
    C. Tissue plasminogen
    D. Prostacyclin
    E. Thrombomodulin (endothelial surface receptor)
    Disease and Condition Associated with the
    Vascular System
    Hereditary Vascular Defects
    A. Hemorrhagic telaniectasia
    – Thin vessel walls cause mucous membrane bleeding
    B. Ehlers-Danlos syndrome
    – A abnormal collagen production causes hyperelastic skin and
    joint abnormalities.
    Disease and Condition Associated with the
    Vascular System
    Acquired Vascular Defects
    A. Vitamin C deficiency
    – Vitamin C is needed for proper collagen synthesis and vessel
    integrity.
    - Deficiency will cause scurvy
    B. Drug – induced (steroids) or Age – induced (senile purpura)
    C. Inadequate platelet support because of quantitative or qualitative
    platelet defect
    Introduction to Thrombocytes
    MEGAKARYOBLAST
    - Committed myeloid progenitor cell, in response to growth factor
    thrombopoietin, give rise to megakaryocytes.
    - Earliest thrombocytes stage where the nucleus divides without
    cytoplasmic division; process known as endomitisos.
    - Formation of giant cells, with size range of 20 – 50 um
    - Round nucleus contains 2-6 nucleoli and fine chromatin
    - Scant basophilic cytoplasm contains no granules; irregularly shaped
    with cytoplasmic tags (blunt extensions of cytoplasm)
    Introduction to Thrombocytes
    PROMEGAKARYOCYTE
    - Increases size with a range of 20 – 80 um
    - Intended or lobulated nucleus contains variable number of nucleoli
    with coarsening chromatin.
    - Basophilic cytoplasm with granules beginning to appear; cytoplasmic
    tags present
    - Demarcating membrane system (DMS) begins to form.
    - DMS is an invagination of the plasma membrane that becomes the
    future site of platelet fragmentation.
    Introduction to Thrombocytes
    MEGAKARYOCYTE
    - Increases in size up to 100 um; largest cell in the body.
    - It contains a multilobulated nucleus with very coarse chromatin and
    variable number of nucleoli.
    - Cytoplasm has many small granules that stain purple with Wright’s
    stain.
    - Represents 1% of nucleated bone marrrow cells
    - Approximately 2000 – 4000 platelets per megakaryocyte are shed
    into marrow sinus and enter circulation as cytoplasmic fragments.
    Introduction to Thrombocytes
    MATURE PLATELETS (Thrombocytes)
    - 2-4 um in size, appearing as pale blue cells with azurophilic granules
    - Mature platelets have no nucleus
    Platelet zones:
    - A. PERIPHERAL ZONE
    - B. SOL-GEL ZONE
    - C. ORGANELLE ZONE
    MEMBRANE SYSTEM:
    - Dense tubular system
    - Open canalicular system
    Peripheral zone
    A. Glycocalyx – exterior coat and contains glycoprotein receptor sites.

    A. Submembrane area – contains the phospholipid membrane (PF3),


    which serves as a surface for interaction of coagulation factors in
    secondary hemostasis.
    Open Canalicular System

    Channels of the surface-connected,


    open canalicular system (OCS) of
    human platelets serve as the
    pathway for transport of
    substances into the cells and as
    conduits for the discharge of alpha
    granule products secreted during the
    platelet release reaction.
    Sol-gel zone
    • contains microtubules, cytoskeleton, actin and myosin.
    Organelle zone
    - Contain the granules, lysosomes, mitochondria, peroxisomes and
    glycogen. It controls platelet function in response to coagulation.
    A. Alpha granules – predominate and contain a number of different
    proteins, with some of the most prominent being fibrinogen, von
    Willebrand factor, beta thromboglobulin, platelet-derived growth
    factor (PDGF), and PF4 (platelet factor 4)
    B. Dense bodies (delta granules) – contain ADP, ATP, serotonin and
    calcium
    C. Lysosomes (third type of granules) – contain hydrolase enzymes
    Platelet Characteristics
    • Reference range for healthy individual 150 – 450 x 109/L or
    approximately 7 – 21 per high power field.
    • 2/3 of available platelet are in thecirculation; 1/3 stored in the spleen
    • Life span of 8-12 days; shorter in certain disease states
    • Wright stain: platelets stain gray-blue with purple granules
    • Originate from same progenitor cells as the erythroid and myeloid
    series.
    Thrombocyte Function
    • Platelet function is dependent on platelet secreted proteins, ATP,
    ADP, calcium and platelet factors
    • Platelet-secreted proteins
    - Serotonin
    - Thromboxane A2
    - Actomyosin
    • Platelet Factors
    - PF 4
    - PF 3
    Thrombocyte Function
    • Involves adhesion, release of granule contents, aggregation and clot
    retraction.
    ADHESION
    - Platelet undergo a shape change and adhere to vascular surfaces
    - Response to collagen exposure in subendothelium caused by vascular
    injury
    - Dependent on binding of von Willebrand factor at GPIb receptor site
    - Can be activated by thrombin
    Thrombocyte Function
    AGGREGATION
    - Fibrinogen attaches at the GP llb/llla receptor of adjoining platelets,
    forming the initial platelet plug.
    - Platelets releases non metabolic ADP (platelet agonist), serotonin,
    and PF 4.
    - During aggregation, PF 3 is released yo provide the phospholipid
    surface needed for binding of clotting factors in secondary
    hemostasis
    Thrombocyte Function
    SECRETION
    - platelet secretes granules during adhesion and aggregation
    - most secretion occurring late in the platelet activation process
    Thrombocyte Function
    CLOT RETRACTION
    - Follows clot formation
    - Dependent on thrombasthenin and GP llb/llla
    - Restores normal blood flow to the vessels
    Laboratory Analysis
    QUANTITATIVE
    - Platelet numbers: automated instrumentation, hemocytometer
    counts and blood smear estimates.

    QUALITATIVE
    - Bleeding time
    - Platelet aggrgation studies
    - vWF:Ag (antigenic) and vWF:Rco (Acrivity) assays

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