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Medicine Haematology Summary

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3rd year haematology summary of lecture notes

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Haematology Block
Section 3 Summary
Chaandanee Bhayroo
1420214
GEMP 1

,Leucocytes
● Function = defence against infections

Innate Immune System:

● Granulocytes
o Neutrophils
o Eosinophils
o Basophils
● Monocytes
● Natural Killer Cells

Adaptive Immune System:

● B lymphocytes
● T lymphocytes



Neutrophils

● Seek and destroy

Life Cycle

1. Produced in the bone marrow and only once
matured will the leave and enter the peripheral
blood system
2. Some travel in the blood stream
3. Others surveillance the endothelium =
inflammation and cytokines attract them
4. Enter the tissues and kills BACTERIA by either
phagocytosis / NETosis
5. Also secrete chemokines to recruit other cells to
the site of inflammation

Controls of neutrophil activity

Extensive network of receptors for:

● Opsonins – immunoglobulins, complement
● Chemotaxins – recruitment
● Growth factors – enhance stimulation
● Other inflammatory mediators – recognise damage

Moving from the blood to the tissues

1. Rolling of neutrophil by selectins on both
neutrophil and quiescent endothelium
2. Activated endothelium allows ICAMs to
bind to integrins on neutrophil =
activating neutrophil (nucleus elongates)
3. Transmigration and follows chemotactic
gradient

,Neutrophil form and function

● If proteins and pathways are activated all the time, the cell would not survive for very long
(self-digestion)
● Thus, it is packaged in granules

Granules

● Primary: formed in the promyelocyte
● Secondary/specific and tertiary: formed in the myelocyte and metamyelocyte


Antimicrobial Mechanisms:

● Can generate oxygen and nitrogen dependent molecules = oxidises infectious material (kills)
● Very complex cells

Neutrophil Extracellular Traps (NETs)

● Neutrophils extrude sticky fibres
(chromatin) onto the bacteria and
granules rupture causing bacteria
to die
● Strands of chromatin physically
trapping the bacteria
● Pus = sticky and viscous = due to
chromatin fibres
● May be of different colours = due to
bacteria or breakdown of RBCs or
enzymes of primary granules

Intracellular Killing

● Some of the enzymes required to phagocytize come
from the membrane, produced in granules,
proteases, lysosomes & are only brought together
when neutrophil phagocytoses a bacterium

, Side Effect of Neutrophil Function:

= Tissue Destruction if excessive and not kept in check



Neutrophil Pools

1. Mature neutrophils in the marrow (reserve pool)
2. Circulating neutrophils (24hrs):
- marginating
- free flowing (FBC)
3. Sequestered in the spleen (can contract and release at time of need)
4. In the tissues



Neutrophil Disorders

Qualitative:

● Inherited
● Acquired

Quantitative:

● Increased
● Decreased

Neutrophilia

● Increased synthesis
● Mobilisation of unmeasured pools (does not mean increased production)

Neutropenia

● Decreased synthesis
● Increased destruction/ sequestration



Eosinophils

● Very complex cells
● Part of the Th2 response
● Production is Il-5 dependent
● Homing to the tissues, principally the gut/ lungs, is mediated by eotaxin (chemotaxin)
● Many are lost by moving into the lumen of the gut

Life Cycle

1. Circulate for about 18 hours
2. Most go to the gut. Emigration into the tissues is initiated by selectin/ligand pairing on the
endothelium (very specific interaction)
3. Thought to be quite long-lived in the tissues with most loss occurring by migration into the
gut or alveolar lumen.

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