Granulocyte and Mono-histiocytes

2001

백혈구의 종류는 ?

• Phagocyte :

Granulocyte : Neutrophil

Eosinoiphil

Basophil

Monocyte• Immunocyte : Lymphocyte

Plasma cell

Stem cell (PSC) 부터 Seg. Neutrophil 까지 분화단계별 혈구 이름 ?

• PSC→ CFU-GEMM → CFU-GM → CFU-G →

• Myeloblast → promyelocyte → myelocyte → metamyelocyte → band → segmented (neutrophil, eosinophil, basophil)

Pools

• Bone marrow : Stem cell pool: PSC - CFUG Mitotic pool (5 ds ): myeloblast-myelocyte Post mitotic (reserve) pool (6.6 ds): metamyelocyte - seg.N

• Peripheral blood (9.5 hrs) : Circulating pool Marginating pool • Tissue

CBC 에서 측정되는 Neutrophil 은 어느 Pool 의 것인가 ?

• BM reserve cell > PB : 10-15 배• Glucocorticoid: BM CP →⇒ ＼ MP

• Endotoxin: BM CP MP⇒ ⇒ ≫• Epinephrine: CP ← MP

백혈구 수 (/L) 의 변화

• Neutrophilia : 7500 이상 • Neutropenia : 2500 미만 ( 중등도 위험 : 500-1000, 고위험 : 500 미만 )• Eosinophilia : 직접계산 ; 350 이상 , 백혈구 백분율로 환산 ; 500 이상 • Eosinopenia : <40 미만 • Basophilia : 200 이상 • Monocytosis : 1000, 이상 • Monocytopenia : 200 미만• Lymphocytosis : 성인 ; 4000 이상 , 소아 ; 8800 이상

• Lymphocytopenia : 성인 ;.500 미만 소아 ; 3000 미만

과립구 구조• Primary granules: myeloperoxidase, lactoferri

n ,leukocyte adhesion receptors, ALP, defensin, azurophil-derived bactericidal factor(ADBF)

• Secondary granules: lysozyme, collagenase, plasmin

• Surface : adhesion molecules(CD11/CD18 )• Membrane: receptors for opsonin, chemotaxi

n, GM-CSF, G-CSF, phospholipid(PGE2, leukotriene 등 생성 )

• Cytoplasm: actin, myosin, tubulin

Adhesion Cascade

과립구 염증부위로 이동 기전

과립구 이동에 관여하는 물질

• Selectins: tethering, rolling, sticking• Integrins and IgSF: rolling, sticking, diapede

s, chemotaxis• Activation of endothelial cell by histamin, thrombin, TNF, IL-1,-4, LPS• Activation of leukocyte by IL-8, C5a • Leukocyte adhesion deficiency syndromes : L

AD I(CD11/CD18 def.), LAD II(SLeX def.)

과립구와 단구의 기능

• Chemotaxis : IL-8(neutrophil specific), C5a , protein 1(monocyte specific)

• Phagocytosis : Fc and C3b receptors recognize opsonized (by Ig and complements) particles.

• Killing and Digestion : superoxide, hydrogen peroxide, low pH

단구 (Monocyte) 의 기능

• Phagocytosis• Antigen presentation• Growth factors 생산 : IL-3, IL-6,

GM-CSF, G-CSF, M-CSF

Phagocytosis and Killing

과립구 기능 이상

• Defects of chemotaxis : aspirin, alcohol, corticosteroids, leukemias, lazy leucocyte syndrome

• Defects of phagocytosis: lack of opsonization(hypogammaglobulinemia)

• Defects of killing: chronic granulomatous disease(cytochrome b558 def), myeloperoxidase def.

• Leukemoid reaction WBC>50,000, or immature cells in PB Granulocyte, Lymphocyte Infection

• Leukoerythroblastic reaction Immature granulocyte and normoblast in PB myelofibrosis, cancer BM metastasis, massive bleeding or hemolysis, MDS, leukemia

과립구의 유전성질환

• Pelger-Huet • May-Hegglin • Chediak Higashi • CGD • Myeloperoxidase deficiency

Neutropenia

• Drug induced • Cyclic • Immune (neonatal neutropenia)• Idiopathic

과립구의 악성질환

• Myelodysplastic syndrome (MDS) • Chronic myeloproliferative disorders (CMPD)• CML • AML