Haemopoiesis Clinical application
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Transcript Haemopoiesis Clinical application
Haemopoiesis
Clinical application
Dr. Tariq M. Roshan
Department of Hematology
PPSP
Introduction
Life span
Granulocytes
Erythrocytes
Platelets
Lymphocytes
Introduction
Stem cells
Self renewal
Plasticity
Progenitor cells
Developmentally-restricted cells
Mature cells
Mature cell production takes place from the more
developmentally-restricted progenitors
Cell hierarchy (Haemopoiesis
schematic representation)
Sites of Haemopoiesis
Yolk sac
Liver and spleen
Bone marrow
Gradual replacement
of active (red) marrow
by inactive (fatty)
tissue
Expansion can occur
during increased need
for cell production
Stem cells
Self-renewal
Normally in G0 phase of cell cycle
The capacity for self-reproduction is vastly in
excess of that required to maintain cell production
for normal lifetime
As cells increase in number they differentiate as
well
Multipotentiality
Capacity to generate cells of all the
lymphohaemopoietic lineages
Progenitor cells
Encompasses from immediate progeny of
stem cells to cells committed to one
differentiation lineage
Progenitor cells become progressively more
restricted in their differentiation and
proliferation capacity
Late progenitor cells eventually restricted to one
lineage
Regulation of Haemopoiesis
Controlled cell
death
Controlled cell
production
There should be a balance between cell production and
cell death except at the times of requirement
Regulation of Haemopoiesis
Local environmental control
Stromal cell mediated Haemopoiesis
Apoptosis
Haemopoietic
growth factors (Humoral regulation)
Interaction of stromal cells, growth
factors and haemopoietic cells
Local and Humoral regulation of
Haemopoiesis
Haemopoietic growth factors
GM-CSF
Granulocyte-Macrophage colony stimulating factor
M-CSF
Macrophage colony stimulating factor
Erythropoietin
Erythropoiesis stimulating hormone
(These factors have the capacity to stimulate the proliferation of their target
progenitor cells when used as a sole source of stimulation)
Thrombopoietin
Stimulates megakaryopoiesis
Haemopoietic growth factors
Cytokines
IL 1 (Interleukin 1)
IL 3
IL 4
IL 5
IL 6
IL 9
IL 11
TGF-β
SCF (Stem cell factor, also known as kit-ligand)
Cytokines have no (e.g IL-1) or little (SCF) capacity to stimulate cell
proliferation on their own, but are able to synergise with other cytokines to
recruit nine cells into proliferation
Erythropoiesis and erythrocytes
Lifespan – 120 days
Non nucleated
Biconcave disc
Production regulated by
Epo
Needs Fe, B12, folate &
other elements for
development
Functions of erythrocytes
Transport of respiratory gases
Large surface area : volume ratio
Flexible biconcave disc
Haemoglobin for exchange of gases
Capable of glycolysis for the source of energy for
cell survival
Erythrocyte disorders
Qualitative
Haemoglobin defect
(Anemia, Thalassaemia, sickle cell anemia etc)
Membrane & enzyme abnormalities
(G6PD, eliptocytosis, stomato-ovalocytosis)
Quantitative
Increased (polycythemia) inherited / acquired
Decrease (inherited / acquired hypoplasia)
Bleeding
Anaemia
Reduction in circulation
haemoglobin
Nutritional deficiency
anaemias
Iron deficiency
anaemia
Iron deficiency
B12 & folate deficiency
anaemia
Protein deficiency
anaemia
Scurvy & other
element deficiency
B12 & folate deficiency
Nutritional deficiency anaemia
clinical application
Angular
Cheilosis
Glossitis
Koilonychia
Marrow iron stores
Plummer-Vinson
syndrome
Anaemia; Globin chain defects
Thalassaemias
Reduced globin chain
synthesis
Alpha and Beta
chain synthesis
defects
Thalassaemia
Haemoglobinopathies
Abnormal globin chain
synthesis
Sickle cell disease
Anaemia; Globin chain defects
Hemoglobin electrophoresis
for the diagnosis of
thalassaemia
X-ray appearance of
Thalassaemic patient
Anaemia; Membrane and enzyme
defects
Membrane defects
Elliptocytosis
Elliptocytosis
Hemolysis
Stomato-ovalocytosis
Without haemolysis
Red cell enzymopathies
G6PD
Hemolysis after
oxidant stress
Blood loss
G6PD deficiency
Anaemia; Reduced bone marrow
erythroid
Marrow failure
Marrow infiltration
Marrow infiltration
Trephine biopsy (Aplastic
Anemia)
Normal trephine
Leucocytes
Lymphocytes
Band
E
Monocytes /
P
Macrophages
Granulocytes
Neutrophils
Eosinophils
Basophils
N
L
M
B
Lymphocytes
Count varies with age
1.5 – 3.5 x109/l
The subset cells are
B-cells
Antibody mediated
immunity
T-cells
Cell mediated
immunity
NK cells
Disorders of lymphocytes
Benign disorders
Lymphocytosis
Viral infections
Bacterial infections
Protozoal infections
Lymphopenia
Marrow failure (drugs, irradiation)
Infections (viral infections)
Immune-deficiency syndromes
Antibody deficiency
Cell mediated immune defiency
Combined cell and antibody immune deficiency
Disorders of lymphocytes
Benign disorders
Infectious
mononucleosis
Epstein-Barr virus
infection
Autoimmune
lymphoproliferative
syndrome
Disorders of Lymphocytes
Malignant disorders
Acute lymphoblastic
ALL
leukemia (ALL)
Chronic lymphocytic
leukemia (CLL)
Lymphomas
Non Hodgkin’s
lymphoma
Hodgkin’s disease
CLL
Monocytes
Count is 0.2-0.8 x 109/l
Functions
Antigen presentation
Cytokine production
Phagocytosis
Disorders of Monocytes
Monocytosis
Benign
Chronic bacterial infection
Malignant
Chronic Myelomonocytic Leukaemia CMML
Neutrophils
Count 2.5 - 7.5 x 109/l
Granular cytoplasm
Transient stay in blood
Major phagocytic role
Bacterial killing
3-5 lobes of nucleus
Disorders of Neutrophil
Neutrophilia
Infection (Bacterial)
Inflammatory conditions
Neoplasia
Metabolic conditions
N
Uraemia
Haemorhage / haemolysis
Corticosteroids
Marrow infiltration
MM
Baso
CML
M
Disorders of Neutrophil
Neutropenia
Count < 1.5 x 109/l
Drugs
Chemotherapy
Viral infection
Inherited disorders
Morphological abnormalities
Pelger-Huet anomaly
May-Hegglin anomaly
Chediak-Higashi syndrome
Myeloid malignancies
Acute Myeloid
Leukaemia
Chronic Myeloid
Leukaemia
Acute Myeloid Leukaemia
(AML M-3)
Myeloproliferative
disorder
Chronic Myeloid Leukaemia
Eosinophils
Count 0.2 – 0.8 x 109/l
Bilobed nucleus
Phagocytic activity is low
Modulation of
hypersensitivity and
allergic reactions
Disorders of Eosinophil
Eosinophilia
>0.8 x 109/l
Allergic reactions
Parasitic infections
Malignancy
HD, NHL
Inflammatory conditions
Myeloproliferative disorders
Hypereosinophilic syndrome
Basophils
Count 0.1 – 0.2 x 109/l
Bilobed nucleus
Nucleus is hided behind
the granules
Inflammatory response
Basophilia is seen in
Myeloproliferative
disorders (CML)
Platelets
Platelets are fragments
of cytoplasm of bone
marrow
megakaryocytes
Count 150 – 400 x 109/l
Major role in
coagulation
Summary
As other rapidly regenerating tissues, the
haemopoietic system is organized in hierarchical
manner
Better understanding of the factors controlling
haemopoiesis is leading a way to better patient
care and reconstitution of different lineages, which
has been refractory to stimulation efforts previously
Understanding of stem cell physiology & pathology
will be essential in the coming years for a
hematopathologist
Thanks.