组织学与胚胎学-血液-双语教学

LearningObjectives

Thecompositionofblood(血液).

Thestructure,functionandnormalvalues(正常值)oftheformedelementsofblood(血液有形成(xíngchéng)分).Hematopoiesis(血细胞的发生).

Thehematopoietictissue(造血组织)andthehematopoieticstemcells(造血干细胞).Theproductionandsignificanceoflymph(淋巴).第二页，共五十六页。*aspecializedformofC.T.*acirculatingtissue*asatransportingmedium*atotalvolumeabout5litersin healthadultINTRODUCTION第三页，共五十六页。Componentsofblood血液(xuèyè)的组成成分

*Formedelements------bloodcells(45%)

*Intercellularsubstance------plasma(55%)

Erythrocytes红细胞 Leukocytes白细胞 Platelets血小板H2O(90%)Plasmaproteins:albumin白蛋白,globulin球蛋白,fibrinogen纤维蛋白(xiānwéidànbái)原,etc.Others:第四页，共五十六页。血液(xuèyè)的组成centrifugation(离心(líxīn))-------

plasmaLeukocytes+Platelets

--------Erythrocyte(Redbloodcell)anticoagulant(heparin)

抗凝剂（肝素(ɡānsù)）

第五页，共五十六页。血块(xuèkuài)、血清—Serum血清(xuèqīng)

—withoutanticoagulant

Clotting无纤维蛋白(xiānwéidànbái)原第六页，共五十六页。血液(xuèyè)有形成分红细胞：男（4.0—5.5）×1012/L

；女（3.5—5.0）×1012/L（350-500万个/ul)白细胞(4.0—10)×109

/L或4千-1万个/ul血小板（100—300）×109

/L

（或10-30万个/ul）

有粒白细胞

无粒白细胞中性(zhōngxìng)粒细胞50-70%嗜酸性粒细胞0.5-3%嗜碱性粒细胞0-1%淋巴细胞25-30%单核细胞3-8%血液(xuèyè)有形成分正常值血象(hemogram)：血细胞的形态、数量、百分比及血红蛋白的含量.血象是临床疾病诊断、治疗的重要指标。第七页，共五十六页。Wright染色法（瑞特染色法）:染料是由酸性(suānxìnɡ)染料伊红和碱性染料亚甲蓝组成。与酸性染料伊红结合，染粉红色；与碱性染料亚甲蓝结合，染紫蓝色。

Giemsa染色法（吉姆萨染色法）:吉姆萨染液由伊红，天青组成。

血涂片bloodsmear:观察血细胞形态(xíngtài)染色方法:Wright或Giemsa染色第八页，共五十六页。一、红细胞（erythrocyte,redbloodcell,RBC）

1.结构(jiégòu)特点2.血型3.功能4.寿命5.网织红细胞第九页，共五十六页。MatureErythrocyte

*biconcavediscshape,

providing

greatersurfacearea;

*nonucleusandorganelles;

*

Hemoglobin(Hb

);

*deformability.SEMSize:

7.5~8.5µm(diameter)Number:

Male:4.2~5.5×1012/L(Hb:120~150g/L) Female:3.5~5.0×1012/L(Hb:110~140g/L)第十页，共五十六页。第十一页，共五十六页。2．ABO血型抗原(kàngyuán)系统：红细胞膜含血型抗原

A型：有A型抗原

B型：有B型抗原

O型：无A型、B型抗原

AB型：有A型、B型抗原3．功能:

红细胞具有携带O２和CO２的功能，由血红蛋白执行。4．寿命(shòumìng):红细胞的平均寿命约为120天。溶血(rónɡxuè)(hemolysis)血影（erythrocyteghost）:溶血后残留的红细胞膜囊。第十二页，共五十六页。

*notfullymatureRBC*0.51%ofatotalnumberofRBC*nonucleus*ribosomalRNAremnants(netlikestructure)*remainingHbsynthesis*ClinicsignificanceReticulocyte网织红细胞

第十三页，共五十六页。

PathologicalconditionsNumberSizeShapeHbAnemia贫血(pínxuè)

Erythrocytosis红细胞增多(zēnɡduō)症

Spherocytosis;SicklecellanemiaThalassemia（地中海贫血(pínxuè)）Large/smallcellanemia第十四页，共五十六页。

Sickle-cellanemiaisapainfuldiseaseinwhichRBCsbecomecrescentshapedduetoinheritanceofanabnormaltypeofhemoglobin.SickledRBCsbreakdown,releasinghemoglobinintothecirculation.第十五页，共五十六页。NormalRBCSickledRBC镰状第十六页，共五十六页。第十七页，共五十六页。Typically,theaffectedRBCsaresmall,sphericallyshaped,andlackthelightcentersseeninnormalRBCs.

Spherocytosis第十八页，共五十六页。Generalcharacteristicofleukocytes

*sphericalshape *possesnuclei *presenceoforganelles *atotalnumberlessthanthatoferythrocytes*exhibitingamoeboidmovement *involvinginbodydefensesandimmunity二、白细胞（leukocyte,whitebloodcell，WBC）第十九页，共五十六页。

第二十页，共五十六页。Classification *Granularleukocytes有粒白细胞 neutrophils5070%中性(zhōngxìng)粒细胞 eosinophils0.53%嗜酸性粒细胞 basophils01%嗜碱性粒细胞 *Agranularleukocytes无粒白细胞 lymphocytes2530%淋巴细胞 monocytes38%单核细胞第二十一页，共五十六页。

Neutrophil

Size:1012µm(diameter)

Morphology形态(xíngtài)

nucleus：highlymorphonuclear

rod-like

2-3lobulated 4-5lobulated young old

cytoplasm：

specificgranules:80%,small azurophilicgranules:20%,lysosome溶酶体

Neutrophils中性(zhōngxìng)粒细胞

(嗜天青(tiānqīng)颗粒)第二十二页，共五十六页。中性粒细胞模式图（示杆状核演变(yǎnbiàn)至5叶核,新生到衰老）第二十三页，共五十六页。中性(zhōngxìng)粒细胞（血涂片）NeutrophilsLobulatednuclei

Rod-likenucleusazurophilicgranules*fine,uniform细腻，均匀(jūnyún)

*evenlydistributed*pinkstainingCharateristicsofspecificgranules:第二十四页，共五十六页。Specificgranules(80%,samll)contain:alkalinephosphatase碱性(jiǎnxìnɡ)磷酸酶

*Phagocytin吞噬素*lysozyme

溶菌酶AzurophilicG.(large,less)containing:acidphosphatase酸性(suānxìnɡ)磷酸酶*

Peroxidase过氧化物酶Neutrophil(EM)第二十五页，共五十六页。FunctionChemotaxis(Mobility)趋化性:

Attractedbychemotacticfactor(releasedbymacrophages)Phagocytosis&destroybacteria:

吞噬(tūnshì)和杀灭细菌

thenumberofleukocytes↑

acute

the%ofneutrophils↑

bacteriainfection

第二十六页，共五十六页。Size:

1012µm(diameter)LM:nucleus:

lobulated;Sorirregular; obscuredoutlinecytoplasm:basophilicgranules

*variablesize*unevendistribution*strongbasophiliaCharacteristicBasophil嗜碱性(jiǎnxìnɡ)粒细胞第二十七页，共五十六页。

Basophil

E.M.:

Basophilicgranulescontain:*heparin*

histamineF.N.:

*

anticoagulate*

responsibletoallergicreactionnucleus第二十八页，共五十六页。Size:1015µm(diameter)LM: -usuallybilobednucleus-eosinophilicgranules

*strongeosinophilia(reddish) *coarseandrefractile

*uniformsizeandevenlydistributedEosinophils嗜酸性(suānxìnɡ)粒细胞Characteristic第二十九页，共五十六页。（电镜）

Eosinophilicgranules(primarylysosomes)whichcontainsubstances:

*acidphosphatase *arylsulphatase芳基硫酸酯酶 *Peroxidase *histaminase组胺(zǔàn)酶nucleusEosinophilicgranules

withcrystalloidinthecenter(EM)第三十页，共五十六页。FunctionChemotaxis（趋化性）

attractedbychemotacticfactorfromthemastcellsPhagocytize（吞噬(tūnshì)）

foreignbodies,Ag-AbcomplexAnti-allergy（抗过敏）

Releasehistaminase，inactivatehistamineforweakeningallergicreactionAnti-parasite

（抗寄生虫）

Itisincreasedinpatientsinfectedw/allergicreactionorparasite

第三十一页，共五十六页。Neutrophils:

*ruffledmembranemovement*chemetaxis*phagocytosis

Eosinophils:anti-parasite;anti-allergyBasophils:

*anticoagulation; *involvinginallergicresponseFunctionofgranularleukocytes第三十二页，共五十六页。Size:

1420µm(diameter)Nucleus:large,eccentric,lightstaining, deepindentation,horseshoe

cytoplasm：

abundant，gray-bluestaining, weakbasophilia, numerouspurplegranules(azurophilicG)Monocyte单核细胞第三十三页，共五十六页。第三十四页，共五十六页。

Smallpseudopodia,microvillus,mitochondrionRER,Lysosomes(azurophilicgranule)contain:*Peroxidase*Acidphoshpatase*Lysozyme

溶菌酶(EM模式图）nucleusMonocyteunderEM第三十五页，共五十六页。Functionof

monocyte

-differentiateintomacrophages.phagocytosisimmuneresponsegiverisetoosteoclasts破骨细胞,whichareabletodissolvebone.

第三十六页，共五十六页。Lymphocytes淋巴细胞3types:small6～8μm;medium-sized9～12μm;large13～20μmSmalllymphocyte(90%):LM:Roundorovoid;

Nu.:

sphericity,indentation,condensedchromatin,darkstaining.

Cytoplasm:

scanty,asathinriminlight-bluew/azurophilicgranules

第三十七页，共五十六页。*alargenumberoffreeribosomes,*afewmitochondria,andotherorganelles*exhibitingsmallcytoplasmicprojectionsinthesurfaceofcells.(EM模式图）nucleusLymphocyteunderEM

第三十八页，共五十六页。Classification*function#

T-Cell:75%cellularimmunityB-Cell:10-15%humoralimmunitylargegranulelymphocyte(K&NKcell)*basedonthesource,characteristicsoncellularmembrane,life&function#immunologicaldefence

Classification&Function第三十九页，共五十六页。三、血小板（bloodplatelet,thrombocyte）Megakaryocyte’sfragment,inclumpsLM:2～4μm，disc-likeorirregular,anucleated.

Tworegions:

①Granulomere:centrally-located,purple-bluegranules.②Hyalomere:peripherallylocated,inlight-blue.第四十页，共五十六页。①cellcoat:richinglycoproteinsassociatedtoplateletadhesion;②M.T.system:

a.openingtubulesystem开放(kāifàng)小管系统:toincreasethesurfaceareaforplateletadhesion.

b.densetubulesystem致密小管系统:sER,support,collectCa2+andsynthesizeprostaglandin前列腺素E.M.:第四十一页，共五十六页。③actin-likeM.F微丝:

mobile.④granules:

a.αgranules(specialgranules):containingplateletderivedgrowthfactor,PDGF;thrombospondin.

b.densegranules致密(zhìmì)颗粒:

serotonin(5-HT),ADP,ATP,Ca2+&adrenaline肾上腺素第四十二页，共五十六页。FunctionHemostasia止血(zhǐxuè):

2.

Coagulation凝血:3.

Protect

bloodvesselendothelium,repairingendothelium,preventatherosclerosis(动脉硬化)第四十三页，共五十六页。Slidesreview第四十四页，共五十六页。第四十五页，共五十六页。五、骨髓(ɡǔsuǐ)和血细胞的发生

（bonemarrowandhematopoiesis）

Hematopoieticorgan造血器官(qìguān)

yolksac卵黄囊（earlyembryo)→Liver肝/spleen脾(6w—5m)

→bonemarrow骨髓(4mandafter)Structureofbonemarrow

骨髓的结构

redbonemarrow:hematopoietictissue造血组织

+bloodsinusoid血窦

yellowbonemarrow:adiposetissue脂肪组织

+immaturehemocyte血细胞第四十六页，共五十六页。Redbonemarrow

hematopoietictissue:造血(zàoxuè)组织reticularc.t.+hemocytesinvariousstage,macrophages,adipocytes,mesenchymalcells

bloodsinusoid:血窦discontinuousendothelia,incompleteBM第四十七页，共五十六页。Hemopoieticstemcell(HSP)andHemopoieticprogenitorcell(HPC)Hemopoieticstemcell

self-replicationpowerfulproliferationpotencymulti-differentiationPotency

Hemopoieticprogenitorc.UnipotentialorbipotentialProducematruebloodc.Erythrocytesseriesgranulocyteseriesmonocyteseriesmegakaryocyte

series*Lymphocytesderivedfromlymphaticorgans&tissues第四十八页，共五十六页。第四十九页，共五十六页。Pb:原红Be:早幼红Pe:中幼红晚幼红Erythrocyteseries第五十页，共五十六页。Mb:原粒Pm:早幼粒MbM,Mb:中幼粒M1：晚幼粒Neutrophilicseries第五十一页，共五十六页。Morphologiccriteriaofhaemopoiesis

①Stages:

theoriginalstage原始(yuánshǐ)阶段

th