granulocyte and mono-histiocytes 2001. 백혈구의 종류는 ? phagocyte : granulocyte : neutrophil...
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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