MRCEM Notes

White blood cells

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White blood cells (leucocytes) play a key role in immunity. There are three main types:
  • Granulocytes
  • Monocytes
  • Lymphocytes

The process of forming these cellular components of the blood is termed haematopoiesis or haemopoiesis and as can be seen from the diagram below these cells start as multi potential stem cells before differentiating into the different classes of blood cell.

Haemopoiesis. click on image to enlarge

Granulocytes
Granulocytes encompass the following cell types:
  • Neutrophils (neutral staining granules)
  • Eosinophils (acid staining granules)
  • Basophils (basic staining granules)
All of the above contribute to inflammation via the release of mediators.

Neutrophils migrate to sites of infection via chemotaxis and destroy bacterial by engulfing them in a process called phagocytosis. The chemotaxis response is typically very fast with neutrophils arriving at infection sites within minutes. Neutrophils live for around 6 hours in blood but survive longer in tissues.

Neutrophils are a major component of pus.

Eosinophils have a number of functions. They are involved in phagocytosis of some parasite infections such as helminth (worms) and protozoa. They play a role in allergic response via release of inflammatory mediators. Eosinophils are longer lived than neutrophils.

Basophils play a role in inflammation via the release of histamine and heparin. They play a similar role to mast cells.

Lymphocytes

There are 3 main types of lymphocyte:
  • B-cell (produce antibodies)
  • T-cell (Directly kill infected cells via cytotoxic CD8 T-cells or mediate immune response against infected cells via CD4 T-cells)
  • Natural killer cells (kill cancerous or infected cells via secretory cytotoxic lysosomes)
Lymphocytes are produced in the bone marrow but mature in organs of the lymphatic system (spleen, thymus and lymph nodes).

Monocytes

Monocytes circulate in the blood for around 72 hours before arriving in the tissues and maturing into macrophages. Macrophages are phagocytes but are larger and longer lived than granulocytes. They can phagocytose dead cell debris and make up the reticuloendothelial system (RES) i.e. macrophages which are able to perform phagocytosis of foreign materials and particles. 90% of the RES are located in the liver, the remaining 10% are located mainly in the spleen and lymph nodes.
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