كتاب الدم - علم الأنسجة العام PDF

‫اﻟﺪم‬ ‫اﻟﺒﻼزﻣﺎ واﻟﻤﺼﻞ‬ ‫‪2‬‬ ‫ﻣﻜﻮﻧﺎت اﻟﺒﻼزﻣﺎ‬ ‫‪3‬‬ ‫ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء‬ ‫‪4‬‬ ‫ﻛﺮﻳﺎت اﻟﺪم اﻟﺒﻴﻀﺎء‬ ‫‪6‬‬ ‫اﻟﺼﻔﻴﺤﺎت اﻟﺪﻣﻮﻳﺔ‬ ‫‪13‬‬ ‫اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ‬ ‫‪14‬‬ ‫ﻧﻘﻲ اﻟﻌﻈﻢ‬ ‫‪19‬‬ ‫ﺗﻜ...

‫اﻟﺪم‬ ‫اﻟﺒﻼزﻣﺎ واﻟﻤﺼﻞ‬ ‫‪2‬‬ ‫ﻣﻜﻮﻧﺎت اﻟﺒﻼزﻣﺎ‬ ‫‪3‬‬ ‫ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء‬ ‫‪4‬‬ ‫ﻛﺮﻳﺎت اﻟﺪم اﻟﺒﻴﻀﺎء‬ ‫‪6‬‬ ‫اﻟﺼﻔﻴﺤﺎت اﻟﺪﻣﻮﻳﺔ‬ ‫‪13‬‬ ‫اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ‬ ‫‪14‬‬ ‫ﻧﻘﻲ اﻟﻌﻈﻢ‬ ‫‪19‬‬ ‫ﺗﻜﻮن اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮاء‬ ‫‪22‬‬ ‫ﻧﻀﺞ اﻟﻠﻤﻔﺎوﻳﺎت واﻟﻮﺣﻴﺪات‬ ‫‪29‬‬ ‫ﻣﻨﺸﺄ اﻟﺼﻔﻴﺤﺎت‬ ‫‪32‬‬ ‫‪39‬‬ ‫‪6‬‬  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫اﻟﻤﻘﺪﻣﺔ‬ ‫‪ ‬اﻟﺪم‪ :‬ﻫﻮ ﻧﺴﻴﺞ ﺿﺎم ﺗﺨﺼﺼﻲ ﺣﻴﺚ اﻟﺨﻼﻳﺎ ﻣﻌﻠﻘﺔ ﺿﻤﻦ ﺳﺎﺋﻞ‬ ‫ﺧﺎرج ﺧﻠﻮي ﻳﺴﻤﻰ اﻟﺒﻼزﻣﺎ‪.‬‬ ‫‪ ‬اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ ﻫﻲ ﺧﻼﻳﺎ ﻓﺎﻗﺪة ﻟﻠﻨﻮاة‬ ‫‪ ‬اﻟﺼﻔﻴﺤﺎت اﻟﺪﻣﻮﻳﺔ ﻫﻲ أﺟﺰاء ﺧﻠﻮﻳﺔ )ﻟﻴﺴﺖ ﺑﺨﻠﻴﺔ(‬ ‫‪ ‬ﺣﺠﻢ اﻟﺪم ﻟﺪى اﻟﺮﺟﻞ اﻟﺒﺎﻟﻎ ‪ 5.5‬ﻟﻴﺘﺮ‬ ‫اﻟﺪم‬ ‫ﻋﻨﺎﺻﺮ اﻟﺪم اﻟﻤﺘﺸﻜﻠﺔ‬ ‫اﻟﺒﻼﺳﻤﺎ‬ ‫‪Formed elements (are‬‬ ‫‪Plasma‬‬ ‫) ‪blood cells‬‬ ‫اﻟﺼﻔﻴﺤﺎت‬ ‫اﻟﻜﺮﻳﺎت اﻟﺒﻴﺾ‬ ‫اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ‬ ‫اﻟﺴﺎﺋﻞ اﻟﺬي ﺗﻜﻮن ﻓﻴﻪ‬ ‫اﻟﺨﻼﻳﺎ اﻟﺪﻣﻮﻳﺔ ﻣﻌﻠﻘﺔ‬ ‫ﺿﻤﻨﻪ داﺧﻞ اﻟﻮﻋﺎء‬ ‫اﻟﺪﻣﻮي‬ ‫ﺗﻮﺿﻴﺢ‪:‬‬ ‫‪ ‬اﻟﻨﺴﻴﺞ اﻟﻀﺎم ﻣﺘﺨﺼﺺ‪:‬‬ ‫ﻣﺎء‪+‬ﺑﺮوﺗﻴﻨﺎت‪+‬ﻣﻮاد ﻋﻀﻮﻳﺔ‪+‬ﻏﺎزات ﻣﺬاﺑﺔ ‪....‬‬ ‫‪ (3‬اﻟﺪم‬ ‫‪ (2‬ﻏﻀﺎرﻳﻒ‬ ‫‪ (1 ‬ﻋﻈﺎم‬ ‫‪1‬‬ ‫‪1‬‬  ‫ ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬.‫د‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ Plasma and Serum ‫اﻟﺒﻼزﻣﺎ واﻟﻤﺼﻞ‬ ‫ ﻣﺎ اﻟﻔﺮق ﺑﻴﻦ اﻟﺒﻼزﻣﺎ واﻟﻤﺼﻞ؟‬  If blood is removed from the cir- ‫ اﻟﺪم ﺧﺎرج اﻷوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ﻳﺸﻜﻞ ﻋﻠﻘﺔ‬ culatory system, it will clot. clot  This clot contains formed ele- ‫ اﻟﻌﻠﻘﺔ ﺗﺘﺄﻟﻒ ﻣﻦ ﻋﻨﺎﺻﺮ اﻟﺪم اﻟﻤﺘﺸﻜﻠﺔ‬ ‫ﹰ‬ ments and a clear yellow liquid ‫إﺿﺎﻓﺔ إﻟﻰ ﺳﺎﺋﻞ أﺻﻔﺮ ﻣﻔﺼﻮل ﻋﻦ اﻟﻌﻠﻘﺔ‬ called serum, which separates.serum ‫ﻫﻮ اﻟﻤﺼﻞ‬ from the coagulum.  Serum contains growth factors :‫ اﻟﻤﺼﻞ‬ and other proteins released from ‫ ﻳﺤﺘﻮي ﻋﻠﻰ ﻋﻮاﻣﻞ ﻧﻤﻮ وﺑﺮوﺗﻴﻨﺎت‬ platelets during clot formation, ‫ﺗﺤﺮرت ﻣﻦ اﻟﺼﻔﻴﺤﺎت أﺛﻨﺎء ﺗﺸﻜﻴﻞ‬ which confer biological properties ‫اﻟﺨﺜﺮة )وﺑﺬﻟﻚ ﻳﻜﻮن ﺗﺮﻛﻴﺐ اﻟﻤﺼﻞ‬ very different from those of ‫وﺧﻮاﺻﻪ اﻟﺤﻴﻮﻳﺔ ﻣﺨﺘﻠﻔﺔ ﻋﻦ‬ plasma..(‫اﻟﺒﻼﺳﻤﺎ‬  Collected blood in which clotting is.‫ ﻫﻮ ﻋﺒﺎرة ﻋﻦ ﺑﻼزﻣﺎ – ﻋﻮاﻣﻞ ﺗﺨﺜﺮ‬ prevented by the addition of anti-.‫ ﻧﺤﺼﻞ ﻋﻠﻴﻪ ﺧﺎرج اﻟﻮﻋﺎء اﻟﺪﻣﻮي‬ coagulants (eg, heparin or citrate) can be separated by centrifugation ‫ اﻟﺪم اﻟﻤﺴﺤﻮب ﻣﻦ اﻷوﻋﻴﺔ واﻟﻤﻀﺎف إﻟﻴﻪ‬ into layers that reflect its hetero- ‫ﻣﺎﻧﻌﺎت اﻟﺘﺨﺜﺮ )ﻣﺜﻞ اﻟﻬﻴﺒﺎرﻳﻦ( ﻳﻨﻔﺼﻞ ﻓﻲ‬ ‫ﹼ‬ geneity. Erythrocytes comprise ‫اﻟﻤﺜﻔﻠﺔ إﻟﻰ ﻃﺒﻘﺎت ﺣﻴﺚ ﺗﺘﺮﺳﺐ اﻟﻜﺮﻳﺎت‬ the sedimented material. At the.‫اﻟﺤﻤﺮ إﻟﻰ أﺳﻔﻞ وﺗﻌﻠﻮﻫﺎ اﻟﺒﻼﺳﻤﺎ‬ top half of the centrifugation tube is the plasma. ‫ﺑﻴﻦ اﻟﻄﺒﻘﺘﻴﻦ اﻟﺴﺎﺑﻘﺘﻴﻦ ﻃﺒﻘﺔ رﻓﻴﻌﺔ ﺗﻤﺜﻞ‬ A thin gray-white layer called the buffy coat between the plasma ‫ وﻓﻮﻗﻬﺎ‬buffy coat ‫اﻟﻜﺮﻳﺎت اﻟﺒﻴﺾ‬ and the hematocrit, consists of.‫اﻟﺼﻔﻴﺤﺎت اﻟﺘﻲ ﻻ ﺗﻈﻬﺮ ﺑﺎﻟﻌﻴﻦ اﻟﻤﺠﺮدة‬ leukocytes and platelets. ‫ﻫﻮ ﺗﻌﺒﻴﺮ أﻃﻠﻖ‬hematocrit ‫ اﻟﻬﻴﻤﺎﺗﻮﻛﺮﻳﺖ‬ The hematocrit is an estimate of ‫ﱠ‬ the volume of packed erythrocytes ‫ﻋﻠﻰ اﻟﺤﺠﻢ اﻟﻤﻘﺪر ﻟﻠﻜﺮﻳﺎت اﻟﺤﻤﺮ‬ ‫ﹰ‬ per unit volume of blood..‫اﻟﻤﺘﻜﺪﺳﺔ )أﺛﻨﺎء اﻟﺘﺜﻔﻴﻞ( ﻧﺴﺒﺔ ﻟﺤﺠﻢ اﻟﺪم‬ ‫ﹰ‬ The normal value is 40–50% in men ‫ ﺗﻘﺮﻳﺒﺎ )ﻋﻨﺪ‬%44 ‫اﻟﻘﻴﻤﺔ اﻟﻄﺒﻴﻌﻴﺔ ﻫﻲ‬ and 35–45% in women..(%45-35 ‫ وﻋﻨﺪ اﻟﻨﺴﺎء‬%50-40 ‫اﻟﺮﺟﺎل‬ 2  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪COMPOSITION OF PLASMA‬‬ ‫‪ ‬ﻣﻜﻮﻧﺎت اﻟﺒﻼزﻣﺎ‬ ‫اﻟﺒﻼﺳﻤﺎ ﻫﻲ ﺳﺎﺋﻞ ذو ‪ pH 7.4‬وﻳﺤﺘﻮي ﻋﻠﻰ ﻣﻮاد ﻣﻨﺤﻠﺔ ﻋﺎﻟﻴﺔ أو ﻣﻨﺨﻔﻀﺔ اﻟﻮزن اﻟﺠﺰﻳﺌﻲ‬ ‫‪‬‬ ‫ﺗﺸﻜﻞ ‪ 10%‬ﻣﻦ ﺣﺠﻤﻬﺎ واﻟﺒﺎﻗﻲ ﻫﻮ اﻟﻤﺎء‪.‬‬ ‫ﹰ‬ ‫اﻟﻤﻜﻮﻧﺎت اﻟﻤﻨﺤﻠﺔ اﻟﻤﺬﻛﻮرة ﻣﻌﻈﻤﻬﺎ ﺑﺮوﺗﻴﻨﺎت ‪ 7%‬إﺿﺎﻓﺔ إﻟﻰ ﻣﻮاد أﺧﺮى ‪ 1%‬ﻏﺬاﺋﻴﺔ‬ ‫‪‬‬ ‫وﻏﺎزات ﺗﻨﻔﺴﻴﺔ وﻫﺮﻣﻮﻧﺎت وﺷﻮارد ﻏﻴﺮ ﻋﻀﻮﻳﺔ ‪ electrolytes‬وﻣﺨﻠﻔﺎت ﻧﻴﺘﺮوﺟﻴﻨﻴﺔ‪.‬‬ ‫ﻋﺒﺮ ﺟﺪران اﻟﺸﻌﻴﺮات ﺗﻜﻮن اﻟﻤﻜﻮﻧﺎت ذات اﻟﻮزن اﻟﺠﺰﻳﺌﻲ اﻟﻤﻨﺨﻔﺾ ﻓﻲ اﻟﺒﻼزﻣﺎ ﻓﻲ ﺣﺎﻟﺔ‬ ‫‪‬‬ ‫ﺗﻮازن ﺣﻠﻮﻟﻲ ﻣﻊ اﻟﺴﺎﺋﻞ اﻟﺨﻼﻟﻲ ﻟﻠﻨﺴﺞ‪.‬‬ ‫ﻳﻜﻮن ﻣﺤﺘﻮى اﻟﺒﻼزﻣﺎ ﻣﺆﺷﺮ ﻟﻤﺤﺘﻮى اﻟﺴﻮاﺋﻞ ﺧﺎرج اﻟﺨﻠﻮﻳﺔ ﻓﻲ اﻷﻧﺴﺠﺔ‪.‬‬ ‫‪‬‬ ‫‪Protein types in the plasma‬‬ ‫‪ ‬أﻧﻮاع اﻟﺒﺮوﺗﻴﻨﺎت ﻓﻲ اﻟﺒﻼزﻣﺎ‬ ‫‪ The major plasma proteins include the folowing:‬‬ ‫‪ ‬ﺗﺘﻀﻤﻦ ﺑﺮوﺗﻴﻨﺎت اﻟﺒﻼزﻣﺎ اﻟﺮﺋﻴﺴﻴﺔ ﻣﺎ ﻳﻠﻲ‪:‬‬ ‫ﹰ‬ ‫‪ Albumin, the most abundant plasma‬‬ ‫‪ ‬اﻷﻟﺒﻮﻣﻴﻦ‪ :‬أﻛﺜﺮ اﻟﺒﺮوﺗﻴﻨﺎت ﺗﻮاﺟﺪا‬ ‫‪protein, is made in the liver and‬‬ ‫ﻳﻨﺘﺞ ﻣﻦ اﻟﻜﺒﺪ‪ ،‬ﻣﻬﻤﺘﻪ اﻟﺤﻔﺎظ ﻋﻠﻰ‬ ‫‪serves primarily to maintain the os-‬‬ ‫اﻟﻀﻐﻂ اﻷوزﻣﻮزي‪.‬‬ ‫‪motic pressure of the blood.‬‬ ‫‪ α-Globulins and β -globulins, made‬‬ ‫‪ ‬أﻟﻔﺎ ﻏﻠﻮﺑﻴﻮﻟﻴﻦ وﺑﻴﺘﺎ ﻏﻠﻮﺑﻴﻮﻟﻴﻦ‪:‬‬ ‫‪by liver and other cells, include‬‬ ‫ﺗﺼﻨﻊ ﻓﻲ اﻟﻜﺒﺪ واﻟﺨﻼﻳﺎ اﻷﺧﺮى‬ ‫‪transferrin and other transport fac-‬‬ ‫وﺗﺘﻀﻤﻦ‪ :‬اﻟﺘﺮاﻧﺴﻔﻴﺮﻳﻦ‪ ،‬اﻟﻔﻴﺮوﻧﻴﻜﺘﻴﻦ‪,‬‬ ‫‪tors; fibronectin; prothrombin and‬‬ ‫اﻟﺒﺮوﺗﺮوﻣﺒﻴﻦ و ﻋﻮاﻣﻞ اﻟﺘﺨﺜﺮ اﻷﺧﺮى‪,‬‬ ‫‪other coagulation factors; lipopro-‬‬ ‫اﻟﺒﺮوﺗﻴﻨﺎت اﻟﺸﺤﻤﻴﺔ واﻟﺒﺮوﺗﻴﻨﺎت‬ ‫‪teins and other proteins entering‬‬ ‫اﻷﺧﺮى اﻟﺘﻲ ﺗﺪﺧﻞ اﻟﺪم ﻣﻦ‬ ‫‪blood from tissues.‬‬ ‫اﻷﻧﺴﺠﺔ‪.‬‬ ‫‪ Ƴ-Globulins, which are immunoglobu-‬‬ ‫‪ ‬ﻏﺎﻣﺎ ﻏﻠﻮﺑﻴﻮﻟﻴﻦ‪ :‬ﻏﻠﻮﺑﻴﻮﻟﻴﻦ ﻣﻨﺎﻋﻲ‬ ‫‪lins (antibodies) secreted by plasma‬‬ ‫ﺗﻔﺮزه اﻟﺨﻼﻳﺎ اﻟﺒﻼﺳﻤﻴﺔ‪.‬‬ ‫‪cells in many locations.‬‬ ‫‪Fibrinogen, the largest plasma protein‬‬ ‫‪ ‬اﻟﻔﻴﺒﺮﻳﻨﻮﺟﻴﻦ‪ :‬أﻛﺒﺮﻫﺎ‪ ،‬ﻳﺼﻨﻊ ﻓﻲ‬ ‫‪(340 kD), also made in the liver, which,‬‬ ‫اﻟﻜﺒﺪ‪ ،‬ﻳﺘﺒﻠﻤﺮ ﺧﻼل اﻟﺘﺨﺜﺮ اﻟﻰ أﻟﻴﺎف‬ ‫‪during clotting, polymerizes as insoluble,‬‬ ‫اﻟﻔﻴﺒﺮﻳﻦ اﻟﺘﻲ ﺗﻤﻨﻊ ﻓﻘﺪان اﻟﺪم‪.‬‬ ‫‪cross-linked fibers of fibrin that block‬‬ ‫‪blood loss from small vessels.‬‬ ‫‪ Complement proteins, a system of‬‬ ‫‪ ‬ﺑﺮوﺗﻴﻨﺎت ﺟﻤﻠﺔ اﻟﻤﺘﻤﻤﺔ‪ :‬ﻋﻮاﻣﻞ‬ ‫‪factors important in inflammation‬‬ ‫ﻣﻬﻤﺔ ﻓﻲ اﻻﻟﺘﻬﺎب واﻟﻘﻀﺎء ﻋﻠﻰ‬ ‫‪and destruction of microorganisms.‬‬ ‫اﻷﺣﻴﺎء اﻟﺪﻗﻴﻘﺔ‪.‬‬ ‫‪3‬‬ ‫‪3‬‬  ‫د‪.‬ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪Blood Cells‬‬ ‫ﺧﻼﻳﺎ اﻟﺪم‬ ‫‪Erythrocytes‬‬ ‫ﻛﺮﻳﺎت اﻟﺪم اﻟﺤﻤﺮاء‬ ‫ﹰ‬ ‫ﹰ‬ ‫ﻫﻲ ﺑﻨﻰ ﻣﺘﻤﺎﻳﺰة ﺗﻤﺎﻳﺰا ﻧﻬﺎﺋﻴﺎ ﻻ ﺗﺤﺘﻮي ﻋﻠﻰ ﻧﻮاة‪.‬‬ ‫‪‬‬ ‫ﻻ ﺗﻐﺎدر اﻟﺪوران ﻓﻲ اﻟﺤﺎﻻت اﻟﻄﺒﻴﻌﻴﺔ‪.‬‬ ‫‪‬‬ ‫ﻣﻤﻠﻮءة ﺑﺎﻟﻜﺎﻣﻞ ﺑﺎﻟﺒﺮوﺗﻴﻦ اﻟﺤﺎﻣﻞ ﻟﻸوﻛﺴﻴﺠﻴﻦ أو‬ ‫‪‬‬ ‫اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ ‪.Hemoglobin‬‬ ‫أﻗﺮاص ﻣﺮﻧﺔ ﻣﻘﻌﺮة اﻟﻮﺟﻬﻴﻦ ﻣﺎ ﻳﺆﻣﻦ ﺳﻄﺢ واﺳﻊ‬ ‫‪‬‬ ‫ﻳﺴﻬﻞ اﻟﺘﺒﺎدل اﻟﻐﺎزي‪.‬‬ ‫ﻗﻄﺮﻫﺎ ‪7.5‬ﻣﻴﻜﺮوﻣﺘﺮ ﺛﺨﺎﻧﺘﻬﺎ ﻋﻨﺪ اﻟﺤﺎﻓﺔ ‪ 2.6‬ﻣﻴﻜﺮوﻣﺘﺮ‬ ‫‪‬‬ ‫وﻓﻲ اﻟﻤﺮﻛﺰ ‪ 0.75‬ﻣﻴﻜﺮوﻣﺘﺮ‪.‬‬ ‫ﺑﺴﺒﺐ اﻷﺑﻌﺎد اﻟﻤﺘﻨﺎﺳﻘﺔ ووﺟﻮدﻫﺎ ﻓﻲ ﻣﻌﻈﻢ أﻧﺴﺠﺔ‬ ‫‪‬‬ ‫اﻟﺠﺴﻢ‪ ،‬ﻓﺈﻧﻪ ﻳﻤﻜﻦ اﺳﺘﺨﺪام اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ ﻛﻤﻌﻴﺎر ﻟﺘﻘﺪﻳﺮ‬ ‫ﺣﺠﻢ اﻟﺨﻼﻳﺎ‪.‬‬ ‫ﺗﺮﻛﻴﺰﻫﺎ اﻟﻄﺒﻴﻌﻲ ‪ 5.5-3.9‬ﻣﻠﻴﻮن ﻓﻲ ﻛﻞ ﻣﻴﻜﺮوﻟﻴﺘﺮ ﻋﻨﺪ‬ ‫‪‬‬ ‫ﻣﻦ اﻟﻤﻤﻜﻦ دراﺳﺔ اﻟﺨﻼﻳﺎ‬ ‫اﻟﻨﺴﺎء‪ ،‬أﻣﺎ ﻋﻨﺪ اﻟﺮﺟﺎل ‪ 4.1-6‬ﻣﻠﻴﻮن ﻓﻲ اﻟﻤﻴﻜﺮوﻟﻴﺘﺮ‪).‬ﻫﺎم(‬ ‫ﹰ‬ ‫اﻟﺪﻣﻮﻳﺔ ﻋﻦ ﻃﺮﻳﻖ ﻣﺎ ﻳﺴﻤﻰ‬ ‫اﻷﻗﻄﺎر‬ ‫ﻣﻊ‬ ‫اﻟﺘﻜﻴﻒ‬ ‫و‬ ‫ﺑﺎﻻﻧﺜﻨﺎء‬ ‫ﻟﻬﺎ‬ ‫ﻳﺴﻤﺢ‬ ‫ﻣﻤﺎ‬ ‫ﻧﺴﺒﻴﺎ‬ ‫ﻣﺮﻧﺔ‬ ‫‪‬‬ ‫ﺑﺎﻟﻠﻄﺎﺧﺔ اﻟﺪﻣﻮﻳﺔ ‪blood‬‬ ‫اﻟﺼﻐﻴﺮة ﻟﻠﺸﻌﻴﺮات اﻟﺪﻣﻮﻳﺔ‪.‬‬ ‫ﹸ‬ ‫ﹰ‬ ‫ﹰ‬ ‫‪ Smear‬ﺣﻴﺚ ﺗﻤﺪ ﻗﻄﺮة دم‬ ‫ﻓﻲ زواﻳﺎ ﺗﻔﺮع اﻟﺸﻌﻴﺮات ﺗﺄﺧﺬ ﺷﻜﻼ ﻓﻨﺠﺎﻧﻴﺎ‪.‬‬ ‫‪‬‬ ‫ﻋﻠﻰ ﺷﺮﻳﺤﺔ زﺟﺎﺟﻴﺔ وﺗﺘﻢ‬ ‫ﻓﻲ اﻷوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ اﻟﺼﻐﻴﺮة ﺗﻠﺘﺼﻖ إﻟﻰ ﺑﻌﻀﻬﺎ وﺗﺄﺧﺬ‬ ‫‪‬‬ ‫ﺻﺒﺎﻏﺘﻬﺎ ﺛﻢ ﺗﺪرس ﺑﺎﻟﻤﺠﻬﺮ‪.‬‬ ‫ﺷﻜﻞ أﻋﻤﺪة اﻟﻨﻘﻮد ‪.Rouleaux‬‬ ‫ﺗﺤﺎط اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ ﺑﻐﺸﺎء ﺗﺆﻟﻒ اﻟﺒﺮوﺗﻴﻨﺎت ﻧﺼﻒ ﻣﻜﻮﻧﺎﺗﻪ‪.‬‬ ‫‪‬‬ ‫ﺗﻜﻮن ﻫﺬه اﻟﺒﺮوﺗﻴﻨﺎت اﻟﻤﺤﻴﻄﻴﺔ ﺑﻤﺜﺎﺑﺔ ﻫﻴﻜﻞ ﻏﺸﺎﺋﻲ ﻳﺤﺪد ﺷﻜﻞ اﻟﻜﺮﻳﺔ وﻳﺴﻤﺢ ﺑﻤﺮوﻧﺘﻬﺎ‬ ‫‪‬‬ ‫اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ ﻏﻴﺮ ﻗﺎدرة ﻋﻠﻰ اﺳﺘﺒﺪال ﺑﺮوﺗﻴﻨﺎﺗﻬﺎ اﻟﻤﺼﺎﺑﺔ ﺑﺎﻟﺨﻠﻞ ﻟﻌﺪم اﺣﺘﻮاﺋﻬﺎ ﻋﻠﻰ اﻟﻨﻮاة‪.‬‬ ‫‪‬‬ ‫ﺗﻌﺘﻤﺪ ﻋﻠﻰ ﺗﺤﻠﻞ اﻟﺴﻜﺮ اﻟﻼﻫﻮاﺋﻲ ﻟﺘﺄﻣﻴﻦ اﺣﺘﻴﺎﺟﺎﺗﻬﺎ ﻣﻦ اﻟﻄﺎﻗﺔ‪.‬‬ ‫‪‬‬ ‫اﻟﻬﻴﻮﻟﻰ ﺗﻔﺘﻘﺮ إﻟﻰ اﻟﺒﻨﻰ اﻟﺪﻗﻴﻘﺔ‪ ،‬وﺗﻜﻮن ﻣﻤﻠﻮءة ﺑﻜﺜﺎﻓﺔ ﺑﺎﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ‪.‬‬ ‫‪‬‬ ‫ﹰ‬ ‫ﻓﺘﺮة ﺣﻴﺎة اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮاء ‪120‬ﻳﻮﻣﺎ‪.‬‬ ‫‪‬‬ ‫ﹸ‬ ‫ﹸ‬ ‫ﺗﺰال اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮاء اﻟﺘﻲ ﺗﻈﻬﺮ ﺗﻐﻴﺮات ﻣﻦ ﻣﺠﺮى اﻟﺪم ﺑﺎﻟﺒﻼﻋﻢ ﻓﻲ اﻟﻜﺒﺪ وﻧﻘﻲ اﻟﻌﻈﻢ‬ ‫‪‬‬ ‫واﻟﻄﺤﺎل‪.‬‬ ‫ﹼ‬ ‫ﻳﺘﻜﻮن اﻟﻐﺸﺎء اﻟﺨﻠﻮي ﻟﻠﻜﺮﻳﺎت اﻟﺤﻤﺮاء ﻣﻦ‪ %40 :‬ﺷﺤﻮم‪ %10 ،‬ﻛﺮﺑﻮﻫﻴﺪرات‪%50 ،‬‬ ‫‪‬‬ ‫ﺑﺮوﺗﻴﻨﺎت‪.‬‬ ‫‪4‬‬  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪ ‬ﺣﻮاﻟﻲ ﻧﺼﻒ اﻟﺒﺮوﺗﻴﻨﺎت ﺗﺨﺘﺮق ﻃﺒﻘﺘﻲ اﻟﺸﺤﻮم وﺗﻌﺮف ﺑﺒﺮوﺗﻴﻨﺎت اﻟﻐﺸﺎء اﻟﻤﺪﻣﺠﺔ أو‬ ‫اﻟﻀﻤﻨﻴﺔ ﻣﺜﻞ‪:‬‬ ‫اﻟﻐﻠﻴﻜﻮﻓﻮرﻳﻦ )ﺑﺮوﺗﻴﻦ ﻏﺸﺎﺋﻲ ﻳﺤﻤﻞ ﻋﻠﻰ ﺳﻄﺤﻪ ﺳﻜﺮ وﻳﻜﻮن ﻣﺴﺆول ﻋﻦ ﺗﻨﻤﻴﻂ اﻟﺪم(‬ ‫ﹰ‬ ‫ﻳﻮﺟﺪ أﻳﻀﺎ ﺑﺮوﺗﻴﻨﺎت ﻏﺸﺎﺋﻴﺔ ﻣﺤﻴﻄﻴﺔ )ﺧﺎرج اﻟﻐﺸﺎء( ﻣﻨﻬﺎ ﻣﺎ ﻳﻜﻮن ﻣﺮﺗﺒﻂ ﻣﻊ اﻟﺴﻄﺢ اﻟﺪاﺧﻠﻲ‬ ‫ﻟﻠﻜﺮﻳﺔ اﻟﺤﻤﺮاء ﻣﺜﻞ‪:‬‬ ‫اﻟﺴﺒﻜﺘﺮﻳﻦ )ﺗﺸﻜﻴﻞ ﺷﺒﻴﻜﺔ ﻟﺘﻌﺰﻳﺰ ﻗﻮة اﻟﻐﺸﺎء وﻣﺮوﻧﺘﻪ(‪.‬‬ ‫‪ ‬ﺗﻜﻮن ﻫﺬه اﻟﺒﺮوﺗﻴﻨﺎت اﻟﻤﺤﻴﻄﻴﺔ ﺑﻤﺜﺎﺑﺔ ﻫﻴﻜﻞ ﻏﺸﺎﺋﻲ ﻳﺤﺪد ﺷﻜﻞ اﻟﻜﺮﻳﺔ وﻳﺴﻤﺢ ﺑﻤﺮوﻧﺘﻬﺎ‪.‬‬ ‫‪Haemoglobin's reactions‬‬ ‫‪ ‬ﺗﻔﺎﻋﻼت اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ‬ ‫)‪ Anemia & erythrocytosis (polycythemia‬‬ ‫ﻓﻘﺮ اﻟﺪم واﺣﻤﺮار اﻟﺪم‬ ‫‪ ‬ﻓﻘﺮ اﻟﺪم‪:‬‬ ‫‪ ‬ﻫﻮ اﻟﺤﺎﻟﺔ اﻟﺘﻲ ﺗﺘﺮاﻓﻖ ﺑﻨﻘﺺ ﺗﺮﻛﻴﺰ اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ وﺗﻌﺪادﻫﺎ ﻓﻲ اﻟﺪم وﺑﺬﻟﻚ ﻳﺘﻨﺎﻗﺺ‬ ‫ﺗﺰوﻳﺪ اﻷﻧﺴﺠﺔ ﺑﺎﻷوﻛﺴﻴﺠﻴﻦ‪.‬‬ ‫‪ ‬اﻷﻋﺮاض‪ :‬ﻛﺴﻞ‪ ،‬ﻗﺼﺮ ﺗﻨﻔﺲ‪ ،‬ﺗﻌﺐ‪ ،‬ﺷﺤﻮب اﻟﺠﻠﺪ‪ ،‬ﺧﻔﻘﺎن اﻟﻘﻠﺐ‪.‬‬ ‫‪ ‬اﻷﺳﺒﺎب‪ :‬ﺗﺼﻨﻴﻊ ﻏﻴﺮ ﻛﺎف ﻟﻠﻜﺮﻳﺎت اﻟﺤﻤﺮ ﻣﺜﻼ ﺑﺴﺒﺐ ﻧﻘﺺ اﻟﺤﺪﻳﺪ أو ﻓﻘﺪان اﻟﺪم‬ ‫ﺑﺴﺒﺐ اﻟﻘﺮﺣﺔ اﻟﻤﻌﺪﻳﺔ أو ﻃﻤﺚ زاﺋﺪ‪.‬‬ ‫‪5‬‬ ‫‪5‬‬  ‫د‪.‬ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪ ‬اﺣﻤﺮار اﻟﺪم‪:‬‬ ‫‪ ‬ﻓﻲ ﻫﺬه اﻟﺤﺎﻟﺔ ﻫﻨﺎك زﻳﺎدة ﻓﻲ ﺗﺮﻛﻴﺰ اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ وﺗﻌﺪادﻫﺎ ﻓﻲ اﻟﺪم‪ ،‬اﻷﺳﺒﺎب‪:‬‬ ‫ﺣﺎﻟﺔ ﺗﻼؤﻣﻴﺔ ﻓﻲ ﻇﺮوف ﻧﻘﺺ اﻷوﻛﺴﻴﺠﻴﻦ ﻓﻲ اﻟﻬﻮاء ﻛﻤﺎ ﻟﺪى اﻟﻨﺎس اﻟﺬﻳﻦ‬ ‫ﻳﻌﻴﺸﻮن ﻓﻲ اﻟﻤﺮﺗﻔﻌﺎت أو ﻷﺳﺒﺎب ﻣﺮﺿﻴﺔ )وراﺛﻴﺔ(‪.‬‬ ‫‪ ‬اﺣﻤﺮار اﻟﺪم ﻗﺪ ﻳﺆدي إﻟﻰ زﻳﺎدة ﻟﺰوﺟﺔ اﻟﺪم وإﻋﺎﻗﺔ ﺟﺮﻳﺎﻧﻪ ﻓﻲ اﻷوﻋﻴﺔ اﻟﺼﻐﻴﺮة‪.‬‬ ‫‪ ‬ارﺗﻔﺎع اﻟﻬﻴﻤﺎﺗﻮﻛﺮﻳﺖ ﻳﺰﻳﺪ ﻣﻦ ﻟﺰوﺟﺔ اﻟﺪم ﻣﻤﺎ ﻳﺆدي اﻟﻰ اﺟﻬﺎد اﻟﻘﻠﺐ وﻳﻤﻜﻦ أن‬ ‫ﻳﻀﻌﻒ اﻟﺪوران ﻋﺒﺮ اﻟﺸﻌﻴﺮات إذا ﻛﺎن ﺷﺪﻳﺪ‪.‬‬ ‫‪ Sickle Cell anemia‬‬ ‫ﻓﻘﺮ اﻟﺪم اﻟﻤﻨﺠﻠﻲ‬ ‫ﺗﻐﻴﺮات وراﺛﻴﺔ ﻓﻲ ﺟﺰﻳﺌﺎت اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ ﻧﺘﻴﺠﺔ ﻃﻔﺮة ﻧﻘﻄﻴﺔ ﻓﻲ ﺟﻴﻦ ﺳﻠﺴﻠﺔ ﺑﻴﺘﺎ‬ ‫‪‬‬ ‫ﻟﻠﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ‪.‬‬ ‫ﻧﺘﻴﺠﺔ ﻧﺰع اﻷﻛﺴﺠﻴﻦ ﻣﻦ اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ اﻟﻤﺘﺒﺪل ﻓﻲ اﻟﺸﻌﻴﺮات اﻟﻮرﻳﺪﻳﺔ ﻓﺈﻧﻪ ﻳﺘﺒﻠﻤﺮ وﻳﺸﻜﻞ‬ ‫‪‬‬ ‫ﹰ‬ ‫ﹰ‬ ‫ﺗﺠﻤﻌﺎت ﻗﺎﺳﻴﺔ ﺗﻌﻄﻲ اﻟﻜﺮﻳﺔ اﻟﺤﻤﺮاء ﺷﻜﻼ ﻣﻨﺠﻠﻴﺎ‪.‬‬ ‫ﻳﻨﺘﺞ ﻋﻦ ﺗﺸﻜﻞ اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮاء اﻟﻤﻨﺠﻠﻴﺔ ﺣﺪوث ﻓﻘﺮ دم وزﻳﺎدة ﻟﺰوﺟﺔ اﻟﺪم وﺗﺨﺮب ﻟﺠﺪران‬ ‫‪‬‬ ‫اﻷوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ وﻳﻤﻜﻦ أن ﻳﺤﺼﻞ اﻧﺴﺪاد ﻟﻠﺸﻌﻴﺮات اﻟﺪﻣﻮﻳﺔ‪.‬‬ ‫ﻳﺆدي إﻋﺎﻗﺔ ﺟﺮﻳﺎن اﻟﺪم ﻓﻲ اﻟﺸﻌﻴﺮات اﻟﺪﻣﻮﻳﺔ إﻟﻰ ﻧﻘﺺ ﺣﺎد ﻓﻲ أﻛﺴﺠﺔ اﻷﻧﺴﺠﺔ‬ ‫‪‬‬ ‫وﺗﺨﺮﺑﻬﺎ أو ﺣﺪوث اﺣﺘﺸﺎءات‪.‬‬ ‫‪Leukocytes‬‬ ‫ﻛﺮﻳﺎت اﻟﺪم اﻟﺒﻴﻀﺎء‬ ‫‪ ‬ﺗﻘﻮم ﺑﺘﺄدﻳﺔ وﻇﺎﺋﻒ ﻣﻨﺎﻋﻴﺔ ﺣﻴﺚ ﺗﺘﺮك ﻣﺠﺮى اﻟﺪم وﺗﻬﺎﺟﺮ إﻟﻰ اﻷﻧﺴﺠﺔ‬ ‫ﹰ‬ ‫‪ ‬وﻓﻘﺎ ﻷﻧﻮاع اﻟﺤﺒﻴﺒﺎت اﻟﻤﻮﺟﻮدة ﻓﻲ اﻟﺴﻴﺘﻮﺑﻼﺳﻤﺎ وﻟﺸﻜﻞ اﻟﻨﻮاة ﻳﻤﻜﻦ ﺗﻘﺴﻴﻢ اﻟﺨﻼﻳﺎ‬ ‫اﻟﺒﻴﻀﺎء إﻟﻰ ﻣﺠﻤﻮﻋﺘﻴﻦ‪:‬‬ ‫‪ ‬اﻟﻤﺤﺒﺒﺎت ‪ :granulocytes‬اﻟﺨﻼﻳﺎ اﻟﺒﻴﻀﺎء‬ ‫ﻣﻔﺼﺼﺔ اﻟﻨﻮاة‬ ‫‪ ‬اﻟﻼﻣﺤﺒﺒﺎت ‪ :agranulocytes‬اﻟﺨﻼﻳﺎ‬ ‫ذات ﻧﻮاة ﻏﻴﺮ ﻣﻔﺼﺼﺔ‬ ‫‪ ‬ﻛﻼ اﻟﻨﻮﻋﻴﻦ ﻟﻪ ﺷﻜﻞ ﻛﺮوي ﻓﻲ اﻟﺪم ﻟﻜﻦ‬ ‫ﻋﻨﺪﻣﺎ ﺗﺨﺮج ﻣﻦ اﻷوﻋﻴﺔ وﺗﻐﺰو اﻷﻧﺴﺠﺔ ﺗﺼﺒﺢ‬ ‫ﺗﺬﻛﺮ‪:‬‬ ‫أﻣﻴﺒﻴﺔ وﻣﺘﺤﺮﻛﺔ‪.‬‬ ‫‪1cm ‬ﻣﻜﻌﺐ ﻳﺴﺎوي ‪1‬ﻣﻴﻠﻲ ﻟﺘﺮ‬ ‫‪ ‬اﻟﺸﺨﺺ اﻟﺒﺎﻟﻎ اﻟﺴﻠﻴﻢ ﻳﻤﻠﻚ ﻣﺎ ﻳﻘﺎرب ‪10000-‬‬ ‫‪1 ‬ﻣﻴﻠﻲ ﻟﺘﺮ ﻳﺴﺎوي ‪ 1000‬ﻣﻴﻜﺮوﻟﺘﺮ‬ ‫‪6000‬ﺧﻠﻴﺔ ﺑﻴﻀﺎء ﻓﻲ اﻟﻤﻴﻜﺮوﻟﻴﺘﺮ دم‪.‬‬ ‫‪6‬‬  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫اﻟﻜﺮﻳﺎت اﻟﺒﻴﺾ‬ ‫‪Leukocytes‬‬ ‫ﻻﻣﺤﺒﺒﺎت ‪agranulocytes‬‬ ‫ﻣﺤﺒﺒﺎت ‪granulocytes‬‬ ‫اﻟﻮﺣﻴﺪات‬ ‫اﻟﻠﻤﻔﺎوﻳﺎت‬ ‫اﻟﻘﻌﺪات‬ ‫اﻟﻌﺪﻻت‬ ‫اﻟﺤﻤﻀﺎت‬ ‫‪Monocytes‬‬ ‫‪Lymphocytes‬‬ ‫‪Basophils‬‬ ‫‪Neutrophils‬‬ ‫‪eosinophils‬‬ ‫ﹼ‬ ‫ﹼ‬ ‫اﻟﻼﻣﺤﺒﺒﺎت‬ ‫اﻟﻤﺤﺒﺒﺎت‬ ‫ﻻ ﺗﺤﺘﻮي ﺣﺒﻴﺒﺎت ﻧﻮﻋﻴﺔ ﻟﻜﻨﻬﺎ ﺗﺤﺘﻮي اﻟﺤﺒﻴﺒﺎت‬ ‫ﺗﺤﺘﻮي ﻋﻠﻰ ﻧﻮﻋﻴﻦ ﻣﻦ اﻟﺤﺒﻴﺒﺎت‪:‬‬ ‫‪ ‬ﺣﺒﻴﺒﺎت ﻣﺤﺒﺔ ﻟﻶزور‪ :‬ﻋﺒﺎرة اﻟﻤﺤﺒﺔ ﻟﻶزور )اﻷﺟﺴﺎم اﻟﺤﺎﻟﺔ( واﻟﺘﻲ ﻟﻬﺎ إﻟﻔﺔ‬ ‫ﻟﻠﺼﺒﺎغ اﻷﺳﺎﺳﻲ اﻟﻼزورد ‪A‬‬ ‫ﻋﻦ اﻟﺠﺴﻴﻤﺎت اﻟﺤﺎﻟﺔ‪.‬‬ ‫اﻟﺤﺒﻴﺒﺎت اﻟﺘﻲ‬ ‫‪ ‬ﺣﺒﻴﺒﺎت ﻧﻮﻋﻴﺔ‪ :‬ﺗﺮﺗﺒﻂ ﻣﻊ‬ ‫ﺗﺤﺘﻮﻳﻬﺎ‪:‬‬ ‫ﺻﺒﻐﺎت ﻣﻌﻴﻨﺔ وﺗﺆدي‬ ‫وﻇﺎﺋﻒ ﻣﺤﺪدة‪.‬‬ ‫اﻟﻨﻮاة ﻣﺘﻌﺪدة اﻷﺷﻜﺎل‪ ،‬ذات ﻓﺼﻴﻦ اﻟﻨﻮاة ﻏﻴﺮ ﻣﻔﺼﺼﺔ‪.‬‬ ‫ﺷﻜﻞ اﻟﻨﻮاة‪:‬‬ ‫أو أﻛﺜﺮ‪.‬‬ ‫‪ ‬اﻟﻠﻤﻔﺎوﻳﺎت ‪Lymphocytes‬‬ ‫أﻧﻮاع اﻟﺨﻼﻳﺎ ‪ ‬اﻟﻌﺪﻻت ‪Neutrophils‬‬ ‫ﹸ ﹶ‬ ‫‪ ‬اﻟﻮﺣﻴﺪات ‪Monocytes‬‬ ‫‪ ‬اﻟﺤﻤﺾ ‪Eosinophils‬‬ ‫اﻟﺘﻲ‬ ‫‪ ‬اﻟﻘﻌﺪات ‪Basophils‬‬ ‫ﺗﺘﻀﻤﻨﻬﺎ‪:‬‬ ‫ﹰ‬ ‫‪ ‬ﻳﺨﺘﻠﻒ ﻋﺪد اﻟﺨﻼﻳﺎ اﻟﺒﻴﻀﺎء ﻓﻲ اﻟﺪم ﺗﺒﻌﺎ ﻟﻠﻌﻤﺮ‬ ‫ﺟﻤﻴﻊ اﻟﻤﺤﺒﺒﺎت ﺧﻼﻳﺎ اﻧﺘﻬﺎﺋﻴﺔ اﻟﺘﻤﺎﻳﺰ‬ ‫واﻟﺠﻨﺲ واﻟﺤﺎﻟﺔ اﻟﻔﻴﺰﻳﻮﻟﻮﺟﻴﺔ‪.‬‬ ‫ودورة ﺣﻴﺎﺗﻬﺎ ﻋﺪة أﻳﺎم‪.‬‬ ‫اﻟﻌﻤﺮ‬ ‫ﺗﻤﻮت ﺑﻄﺮﻳﻘﺔ اﻟﻤﻮت اﻟﺨﻠﻮي‬ ‫واﻟﻤﻮت‬ ‫اﻟﻤﺒﺮﻣﺞ ‪ apoptosis‬ﻓﻲ اﻟﻨﺴﻴﺞ‬ ‫واﻟﻌﺪد‪:‬‬ ‫اﻟﻀﺎم‪.‬‬ ‫ﺗﻌﺘﻤﺪ ﻋﻠﻰ ﺗﺤﻠﻞ اﻟﻐﻠﻮﻛﻮز ﻟﺴﺪ‬ ‫اﺣﺘﻴﺎﺟﺎﺗﻬﺎ ﻣﻦ اﻟﻄﺎﻗﺔ‪.‬‬ ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ﺗﺤﺘﻮي ﻋﻠﻰ اﻟﻐﻠﻴﻜﻮﺟﻴﻦ اﻟﺬي‬ ‫ﻣﻌﻠﻮﻣﺎت‬ ‫ﻳﺴﻤﺢ ﻟﻬﺎ ﺑﺎﻟﻌﻤﻞ ﻓﻲ اﻟﻤﻨﺎﻃﻖ‬ ‫أﺧﺮى‪:‬‬ ‫اﻻﻟﺘﻬﺎﺑﻴﺔ ﺣﻴﺚ اﻷوﻛﺴﺠﻴﻦ ﻳﻜﻮن‬ ‫ﹰ‬ ‫ﻗﻠﻴﻼ‪.‬‬ ‫‪7‬‬ ‫‪7‬‬  ‫د‪.‬ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪Neutrophils‬‬ ‫‪ ‬اﻟﻌﺪﻻت‬ ‫ﹰ‬ ‫ﺗﺸﻜﻞ ‪ 60-70%‬ﺗﻘﺮﻳﺒﺎ ﻣﻦ اﻟﻜﺮﻳﺎت اﻟﺒﻴﺾ اﻟﺠﻮاﻟﺔ ﻓﻲ اﻟﺪم ﻗﻄﺮﻫﺎ ﻣﻦ ‪ 12-15‬ﻣﻴﻜﺮون‪.‬‬ ‫‪‬‬ ‫اﻟﻨﻮاة ﻣﻔﺼﺼﺔ إﻟﻰ ‪ 2-5‬ﻓﺼﻮص ﺗﺮﺗﺒﻂ ﺑﺎﺳﺘﻄﺎﻻت ﻧﻮوﻳﺔ رﻓﻴﻌﺔ‪.‬‬ ‫‪‬‬ ‫اﻟﻌﺪﻻت ﻛﺮوﻳﺔ اﻟﺸﻜﻞ ﻏﻴﺮ ﻧﺸﻴﻄﺔ ﻟﻜﻨﻬﺎ ﺗﺼﺒﺢ أﻣﻴﺒﻴﺔ اﻟﺸﻜﻞ وﻧﺸﻴﻄﺔ ﻋﻨﺪ اﻻﻧﺴﻼل‬ ‫‪‬‬ ‫وﻓﻲ أﺛﻨﺎء اﻟﺘﺼﺎﻗﻬﺎ ﺑﻤﻮاد ﺻﻠﺒﺔ ﻛﺎﻟﻜﻮﻻﺟﻴﻦ ﻓﻲ اﻟﻤﻄﺮق ﺧﺎرج اﻟﺨﻠﻮي‪.‬‬ ‫ﹰ‬ ‫ﺗﻘﻮم ﺑﺒﻠﻌﻤﺔ اﻟﺒﻜﺘﻴﺮﻳﺎ واﻟﺠﺰﻳﺌﺎت اﻟﺼﻐﻴﺮة وﻫﻲ أول اﻟﻜﺮﻳﺎت اﻟﺒﻴﻀﺎء وﺻﻮﻻ إﻟﻰ ﻣﻮﻗﻊ‬ ‫‪‬‬ ‫اﻻﻟﺘﻬﺎب ﺣﻴﺚ ﺗﻘﻮم ﺑﺘﻌﻘﺐ اﻟﺒﻜﺘﻴﺮﻳﺎ ﺑﻮاﺳﻄﺔ اﻻﻧﺠﺬاب اﻟﻜﻴﻤﻴﺎﺋﻲ‪.‬‬ ‫ﺗﺤﺘﻮي اﻟﻌﺪﻻت ﻋﻠﻰ اﻟﻐﻠﻴﻜﻮﺟﻴﻦ اﻟﺬي ﻳﺘﻔﻜﻚ إﻟﻰ ﻏﻠﻮﻛﻮز وﺗﺴﺘﺨﺪﻣﻪ ﻹﻧﺘﺎج اﻟﻄﺎﻗﺔ‪.‬‬ ‫‪‬‬ ‫ﺗﺴﺘﻄﻴﻊ اﻟﻌﺪﻻت اﻟﻌﻴﺶ ﻓﻲ أوﺳﺎط ﻻ ﻫﻮاﺋﻴﺔ وﻟﻬﺬا أﻫﻤﻴﺔ ﺑﺎﻟﻐﺔ ﻓﻲ ﻗﺘﻞ اﻟﺠﺮاﺛﻴﻢ وإزاﻟﺔ‬ ‫‪‬‬ ‫اﻟﻔﻀﻼت ﻓﻲ اﻟﻤﻨﺎﻃﻖ اﻟﻔﻘﻴﺮة ﺑﺎﻷوﻛﺴﺠﻴﻦ ﻛﻤﻨﺎﻃﻖ اﻻﻟﺘﻬﺎب وﻣﻨﺎﻃﻖ اﻟﻨﺨﺮ اﻟﻨﺴﻴﺠﻲ‪.‬‬ ‫ذات ﻓﺘﺮة ﺣﻴﺎة ﻗﺼﻴﺮة‪ ،‬ﻋﻤﺮ اﻟﻨﺼﻒ ‪ half-life‬ﻟﻬﺎ ﻳﺒﻠﻎ ‪ 6 -7‬ﺳﺎﻋﺎت ﻓﻲ اﻟﺪم‪ ،‬و‪ 1-4‬ﻳﻮم‬ ‫‪‬‬ ‫ﻓﻲ اﻷﻧﺴﺠﺔ اﻟﻀﺎﻣﺔ ﻗﺒﻞ أن ﺗﻤﻮت ﺑﺎﻟﻤﻮت اﻟﺨﻠﻮي اﻟﻤﺒﺮﻣﺞ‪.‬‬ ‫‪ %3‬ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﺒﻴﻀﺎء اﻟﻤﻌﺘﺪﻟﺔ ﻟﻬﺎ اﻣﺘﺪاد ﻣﻦ اﻟﺠﺎﻧﺐ )ﻫﻮ ﻋﺒﺎرة ﻋﻦ ﺻﺒﻐﻲ ‪ x‬ﺧﺎﻣﻞ( ﻳﻮﺟﺪ‬ ‫‪‬‬ ‫ﻟﺪى اﻻﻧﺎث ﻓﻘﻂ وﻟﻬﺎ اﺳﺘﺪﻻت ﻓﻲ اﻟﻄﺐ اﻟﺸﺮﻋﻲ‪..‬‬ ‫ﻟﻠﻌﺪﻻت اﻟﻔﻌﺎﻟﺔ دور ﻣﻬﻢ ﻓﻲ اﻻﺳﺘﺠﺎﺑﺔ اﻻﻟﺘﻬﺎﺑﻴﺔ ﺿﻤﻦ اﻟﻤﻨﺎﻃﻖ اﻟﻤﺼﺎﺑﺔ او اﻟﻤﺘﻀﺮرة‬ ‫‪‬‬ ‫ﺣﻴﺚ ﺗﻘﻮم ﺑﺒﺪء ﻋﻤﻠﻴﺔ اﺳﺘﻌﺎدة اﻟﺒﻴﺌﺔ اﻟﻄﺒﻴﻌﻴﺔ ﻟﻠﻨﺴﻴﺞ‪.‬‬ ‫ﻋﻤﺮ اﻟﻨﺼﻒ ﻟﻤﺎدة‪ :‬اﻟﺰﻣﻦ اﻟﻼزم ﻟﻤﻮت ﻧﺼﻒ ﻋﺪد اﻟﺨﻼﻳﺎ ﻣﻦ ﻫﺬه اﻟﻤﺎدة‪.‬‬ ‫‪8‬‬  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪ ‬اﻟﺤﺒﻴﺒﺎت اﻟﻤﻮﺟﻮدة ﻓﻲ ﺳﻴﺘﻮﺑﻼﺳﻤﺎ اﻟﻌﺪﻻت ﻧﻮﻋﻴﻦ‪:‬‬ ‫‪.1‬ﺣﺒﻴﺒﺎت ﻣﺤﺒﺔ ﻟﻶزور‪:‬‬ ‫‪ ‬ﺟﺴﻴﻤﺎت ﺣﺎﻟﺔ ﻣﺘﺨﺼﺼﺔ ﻓﻴﻬﺎ ﻣﻜﻮﻧﺎت ﻗﺎدرة ﻋﻠﻰ ﻗﺘﻞ اﻟﺠﺮاﺛﻴﻢ اﻟﻤﺒﺘﻠﻌﺔ‬ ‫‪ ‬ﺗﺤﺘﻮي أﻧﺰﻳﻤﺎت ﺑﺮوﺗﻴﻨﻴﺔ وﺑﺮوﺗﻴﻨﺎت ﻣﻀﺎدة ﻟﻠﺠﺮاﺛﻴﻢ ﺗﺘﻀﻤﻦ ﻣﺎ ﻳﻠﻲ‪:‬‬ ‫أﻧﺰﻳﻢ ﻣﻴﻠﻮﺑﻴﺮوﻛﺴﻴﺪاز اﻟﺬي ﻳﻮﻟﺪ ﻋﻮاﻣﻞ ﺳﺎﻣﺔ ﻟﻠﺒﻜﺘﻴﺮﻳﺎ‬ ‫‪‬‬ ‫أﻧﺰﻳﻢ اﻟﻠﻴﺰوزﻳﻢ اﻟﺬي ﻳﺨﺮب ﺟﺪار اﻟﺒﻜﺘﻴﺮﻳﺎ اﻟﺨﻠﻮي‪.‬‬ ‫‪‬‬ ‫‪ ‬ﻋﻮاﻣﻞ دﻓﺎﻋﻴﺔ ﺗﺘﺄﻟﻒ ﻣﻦ ﺑﺮوﺗﻴﻨﺎت ﺻﻐﻴﺮة ﻏﻨﻴﺔ ﺑﺎﻟﺴﻴﺴﺘﺌﻴﻦ ﺗﺮﺗﺒﻂ ﺑﻐﺸﺎء اﻟﺨﻠﻴﺔ‬ ‫اﻟﺒﻜﺘﻴﺮﻳﺔ وﺗﻤﺰﻗﻪ‪.‬‬ ‫‪.2‬ﺣﺒﻴﺒﺎت ﻧﻮﻋﻴﺔ‪:‬‬ ‫ﹰ‬ ‫‪ ‬أﺻﻐﺮ وأﻗﻞ ﻛﺜﺎﻓﺔ ﺗﺼﻄﺒﻎ ﻗﻠﻴﻼ ﺑﺎﻟﻮردي‪ ،‬ﻟﻬﺎ وﻇﺎﺋﻒ ﻋﺪة ﻣﺜﻞ إﻓﺮاز أﻧﺰﻳﻤﺎت ﻫﺎﺿﻤﺔ‬ ‫ﻟﻤﻜﻮﻧﺎت اﻟﻤﻄﺮق ﺧﺎرج اﻟﺨﻠﻮي )اﻟﻜﻮﻻﺟﻴﻨﺎز(‪ ،‬إﻳﺼﺎل اﻟﺒﺮوﺗﻴﻨﺎت اﻟﻘﺎﺗﻠﺔ ﻟﻠﺠﺮاﺛﻴﻢ إﻟﻰ‬ ‫اﻟﺠﺴﻴﻤﺎت اﻟﺤﺎﻟﺔ اﻟﺒﺎﻟﻌﺔ‪ ،‬وإﻓﺮاز ﻣﻜﻮﻧﺎت اﻟﻐﺸﺎء اﻟﺨﻠﻮي اﻟﺠﺪﻳﺪ‪.‬‬ ‫‪Eosinophils‬‬ ‫‪ ‬اﻟﺤﻤﻀﺎت‬ ‫ﹰ‬ ‫‪ Eosinophils are far less numerous‬‬ ‫‪ ‬أﻗﻞ ﻋﺪدا ﻣﻦ اﻟﻌﺪﻻت وﺗﺸﻜﻞ ‪-2%‬‬ ‫‪than neutrophils, constituting only‬‬ ‫‪4‬ﻓﻘﻂ ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﺒﻴﻀﺎء‪.‬‬ ‫‪2% to 4% of leukocytes.‬‬ ‫‪ In blood smears, this cell is about‬‬ ‫‪ ‬ﺗﺒﺪو ﺑﺤﺠﻢ اﻟﻌﺪﻻت )ﻗﻄﺮﻫﺎ ‪15-12‬‬ ‫‪the same size as a neutrophil or‬‬ ‫ﻣﻴﻜﺮون( وﺗﺘﻤﻴﺰ ﺑﻨﻮاة ذات ﻓﺼﻴﻦ ‪.‬‬ ‫‪slightly larger, but with a character-‬‬ ‫‪istic bilobed nucleus.‬‬ ‫‪ The main identifying characteristic‬‬ ‫‪ ‬اﻟﺴﻤﺔ اﻟﺮﺋﻴﺴﻴﺔ اﻟﺘﻲ ﺗﻤﻴﺰ اﻟﺤﻤﻀﺎت ﻫﻲ‬ ‫‪is the abundance of large, acidophilic‬‬ ‫ﻛﺜﺮة اﻟﺤﺒﻴﺒﺎت اﻟﻨﻮﻋﻴﺔ اﻟﻜﺒﻴﺮة اﻟﺘﻲ ﺗﺼﻄﺒﻎ‬ ‫‪specific granules typically staining‬‬ ‫ﺑﺎﻟﻠﻮن اﻷﺣﻤﺮ‪.‬‬ ‫‪pink or red.‬‬ ‫‪ ‬ﺗﺒﺪو اﻟﺤﺒﻴﺒﺎت اﻟﻨﻮﻋﻴﺔ ﺑﺎﻟﻤﺠﻬﺮ اﻻﻟﻜﺘﺮوﻧﻲ ﺑﻴﻀﻮﻳﺔ اﻟﺸﻜﻞ‬ ‫ﺗﻤﺘﻠﻚ ﺟﺴﻢ ﺑﻠﻮري ﻣﺴﻄﺢ ﻳﺤﻮي اﻟﺒﺮوﺗﻴﻦ اﻟﻘﺎﻋﺪي‬ ‫اﻟﻜﺒﻲ )ﻋﺎﻣﻞ ﻏﻨﻲ ﺑﺎﻷرﺟﻨﻴﻦ وﻣﺴﺆول ﻋﻦ ﺷﺮه اﻟﺤﺒﻴﺒﺎت‬ ‫ﻟﻠﻤﻠﻮﻧﺎت اﻟﺤﻤﻀﻴﺔ( ﻳﺸﻜﻞ ﻫﺬا اﻟﺒﺮوﺗﻴﻦ ‪%50‬ﻣﻦ إﺟﻤﺎﻟﻲ‬ ‫ﺑﺮوﺗﻴﻦ اﻟﺤﺒﻴﺒﺔ‪.‬‬ ‫‪9‬‬ ‫‪9‬‬  ‫د‪.‬ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫ﹰ‬ ‫ﹰ‬ ‫‪ ‬إن ﻟﻠﺒﺮوﺗﻴﻦ اﻟﻘﺎﻋﺪي اﻟﻜﺒﻴﺮ ﻣﻊ أﻧﺰﻳﻢ اﻟﺒﻴﺮوﻛﺴﻴﺪاز ﺗﺄﺛﻴﺮا ﺳﺎﻣﺎ ﻋﻠﻰ‬ ‫اﻟﻄﻔﻴﻠﻴﺎت ﻛﺎﻟﺪﻳﺪان‪.‬‬ ‫‪ ‬ﻟﻬﺎ دور ﻫﺎم ﻓﻲ ﺗﻔﺎﻋﻼت اﻟﺤﺴﺎﺳﻴﺔ ﻛﻤﺎ ﺗﻘﻮم ﺑﺒﻠﻌﻤﺔ‬ ‫ﻣﻌﻘﺪات ﺿﺪ‪-‬ﻣﺴﺘﻀﺪ‪.‬‬ ‫‪ ‬ﺗﻘﻮم ﺑﺘﻨﻈﻴﻢ اﻻﺳﺘﺠﺎﺑﺔ اﻻﻟﺘﻬﺎﺑﻴﺔ ﻋﺒﺮ ﺗﺤﺮﻳﺮ اﻟﻜﻤﺒﻮﻛﻴﻨﺎت‬ ‫واﻟﺴﻴﺘﻮﻛﻴﻨﺎت واﻟﻮﺳﺎﺋﻂ اﻟﺸﺤﻤﻴﺔ‪.‬‬ ‫‪MEDICAL APPLICATION‬‬ ‫ﺗﻄﺒﻴﻖ ﻃﺒﻲ‬ ‫ﺗﺘﺮاﻓﻖ اﻟﺰﻳﺎدة ﻓﻲ ﻋﺪد اﻟﺤﻤﻀﺎت )‪ (eosinophilia‬ﻣﻊ اﻟﺘﻔﺎﻋﻼت اﻟﺘﺤﺴﺴﻴﺔ واﻹﺻﺎﺑﺔ‬ ‫‪‬‬ ‫اﻟﺪودﻳﺔ اﻟﻄﻔﻴﻠﻴﺔ‪.‬‬ ‫ﺗﻮﺟﺪ اﻟﺤﻤﻀﺎت ﻓﻲ اﻷﻧﺴﺠﺔ اﻟﻀﺎﻣﺔ ﺗﺤﺖ اﻟﻈﻬﺎرﻳﺔ ﻟﻠﻘﺼﺒﺎت واﻷﻧﺒﻮب اﻟﻤﻌﺪي اﻟﻤﻌﻮي‬ ‫‪‬‬ ‫واﻟﺮﺣﻢ واﻟﻤﻬﺒﻞ وﺗﺤﻴﻂ ﺑﺎﻟﺪﻳﺪان اﻟﻄﻔﻴﻠﻴﺔ ﻓﻲ اﻷﻧﺴﺠﺔ‪.‬‬ ‫ﺗﻔﺮز اﻟﺤﻤﻀﺎت ﻣﻮاد ﺗﺘﻮﺳﻂ ﻋﻤﻠﻴﺔ اﻻﻟﺘﻬﺎب ﻋﻦ ﻃﺮﻳﻖ ﺗﺜﺒﻴﻂ اﻟﻠﻴﻜﻮﺗﺮﻳﻨﺎت واﻟﻬﻴﺴﺘﺎﻣﻴﻦ‬ ‫‪‬‬ ‫اﻟﻤﻔﺮز ﻣﻦ ﺧﻼﻳﺎ أﺧﺮى‪.‬‬ ‫ﺗﺴﺒﺐ ﻫﺮﻣﻮﻧﺎت ﻗﺸﺮ اﻟﻜﻈﺮ – اﻟﻜﻮرﺗﻴﻜﻮﺳﺘﻴﺮوﺋﻴﺪات ‪ -‬اﻧﺨﻔﺎض ﺳﺮﻳﻊ ﻓﻲ أﻋﺪاد اﻟﺤﻤﻀﺎت‬ ‫‪‬‬ ‫ﻋﻦ ﻃﺮﻳﻖ ﺗﺪﺧﻠﻬﺎ ﻓﻲ ﺗﺤﺮر اﻟﺤﻤﻀﺎت ﻣﻦ ﻧﻘﻲ اﻟﻌﻈﻢ إﻟﻰ ﻣﺠﺮى اﻟﺪم‪.‬‬ ‫‪Basophils‬‬ ‫‪ ‬اﻟﻘﻌﺪات‬ ‫‪ Basophils are also 12 to 15 μm in di-‬‬ ‫‪ ‬ﻳﺘﺮاوح ﻗﻄﺮﻫﺎ ﻣﻦ ‪ 12-15‬ﻣﻴﻜﺮون وﺗﺸﻜﻞ‬ ‫‪ameter but make up less than 1% of‬‬ ‫‪ 1%‬ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﺒﻴﻀﺎء وﻣﻦ اﻟﺼﻌﺐ إﻳﺠﺎدﻫﺎ‬ ‫‪blood leukocytes and are therefore‬‬ ‫ﻓﻲ ﻟﻄﺎﺧﺔ اﻟﺪم اﻟﻄﺒﻴﻌﻴﺔ‪.‬‬ ‫‪difficult to find in normal blood‬‬ ‫‪smears.‬‬ ‫‪ The nucleus is divided into two irreg-‬‬ ‫‪ ‬اﻟﻨﻮاة ﻣﻘﺴﻮﻣﺔ ﻟﻔﺼﻴﻦ ﻏﻴﺮ ﻣﻨﺘﻈﻤﻴﻦ ﻟﻜﻦ‬ ‫‪ular lobes, but the large specific‬‬ ‫ﺗﻮﺿﻊ اﻟﺤﺒﻴﺒﺎت اﻟﻨﻮﻋﻴﺔ اﻟﻜﺒﻴﺮة ﻳﺤﺠﺐ‬ ‫‪granules overlying the nucleus usually‬‬ ‫ﺗﻔﺼﺺ اﻟﻨﻮاة‪.‬‬ ‫‪obscure its shape.‬‬ ‫‪ ‬ﺗﺘﺸﺎﺑﻪ اﻟﻘﻌﺪات ﻓﻲ اﻟﻮﻇﻴﻔﺔ ﻣﻊ اﻟﺨﻼﻳﺎ اﻟﺒﺪﻳﻨﺔ ‪mast cells‬‬ ‫ﹰ‬ ‫ﺣﻴﺚ ﺗﻤﺘﻠﻚ ﻛﻼ ﻣﻨﻬﺎ ﺣﺒﻴﺒﺎت ﺗﺤﻮي اﻟﻬﻴﺒﺎرﻳﻦ واﻟﻬﻴﺴﺘﺎﻣﻴﻦ‬ ‫وﻣﺴﺘﻘﺒﻼت ﺳﻄﺤﻴﺔ ﻟـ)‪ (IgE‬وﺗﻔﺮز ﻫﺬه اﻟﺤﺒﻴﺒﺎت ﻣﺤﺘﻮﻳﺎﺗﻬﺎ‬ ‫اﺳﺘﺠﺎﺑﺔ ﻟﻤﺴﺘﻀﺪات ﻣﻌﻴﻨﺔ‪.‬‬ ‫‪10‬‬  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪ ‬اﻟﺤﺒﻴﺒﺎت اﻟﻨﻮﻋﻴﺔ ذات ﻗﻄﺮ ‪ 0.5‬ﻣﻴﻜﺮون وﺗﺼﻄﺒﻎ ﺑﺎﻟﻠﻮن اﻷزرق اﻟﻘﺎﺗﻢ وﺗﻈﻬﺮ ﺑﻌﺪد‬ ‫واﻧﺘﻈﺎم أﻗﻞ ﺑﺎﻟﻤﻘﺎرﻧﺔ ﻣﻊ ﺣﺒﻴﺒﺎت اﻟﺨﻼﻳﺎ اﻟﺒﻴﺾ اﻷﺧﺮى‪.‬‬ ‫‪ ‬ﻳﻌﻮد اﻟﻠﻮن اﻟﻘﺎﻋﺪي ﻟﻬﺎ ﻟﻮﺟﻮد اﻟﻬﻴﺒﺎرﻳﻦ ﻓﻲ اﻟﺤﺒﻴﺒﺎت‪.‬‬ ‫ﹰ‬ ‫‪ ‬ﺗﺤﺘﻮي ﺣﺒﻴﺒﺎت اﻟﻘﻌﺪات أﻳﻀﺎ ﻋﻠﻰ اﻟﻬﻴﺴﺘﺎﻣﻴﻦ واﻟﻌﺪﻳﺪ ﻣﻦ‬ ‫اﻟﻮﺳﺎﺋﻂ اﻻﻟﺘﻬﺎﺑﻴﺔ ﻣﺜﻞ اﻟﻌﺎﻣﻞ اﻟﻤﻨﺸﻂ ﻟﻠﺼﻔﻴﺤﺎت وﻋﺎﻣﻞ‬ ‫اﻻﻧﺠﺬاب اﻟﻜﻴﻤﻴﺎﺋﻲ وأﻧﺰﻳﻢ اﻟﻔﻮﺳﻔﻮﻟﻴﺒﺎز ‪.A‬‬ ‫‪MEDICAL APPLICATION‬‬ ‫ﺗﻄﺒﻴﻖ ﻃﺒﻲ‬ ‫‪ ‬ﻳﺆدي اﻟﺘﻌﺮض اﻟﺜﺎﻧﻲ ﻟﻤﺴﺘﻀﺪ ﻣﻌﻴﻦ )اﻟﻤﻮﺟﻮد‬ ‫ﹰ‬ ‫ﻓﻲ ﻟﺴﻌﺔ اﻟﻨﺤﻞ ﻣﺜﻼ( ﻋﻨﺪ ﺑﻌﺾ اﻷﺷﺨﺎص إﻟﻰ‬ ‫اﺳﺘﺠﺎﺑﺔ ﺟﻬﺎزﻳﺔ ﺳﺮﻳﻌﺔ وﺷﺪﻳﺪة‪.‬ﺣﻴﺚ ﻳﺘﺴﺒﺐ‬ ‫اﻹﻃﻼق اﻟﺴﺮﻳﻊ ﻟﻤﺤﺘﻮى ﺣﺒﻴﺒﺎت اﻟﻘﻌﺪات واﻟﺨﻼﻳﺎ‬ ‫اﻟﺒﺪﻳﻨﺔ إﻟﻰ ﺗﻮﺳﻊ اﻷوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ واﻧﺨﻔﺎض‬ ‫ﻣﻔﺎﺟﺊ ﻓﻲ ﺿﻐﻂ اﻟﺪم وﺗﺄﺛﻴﺮات أﺧﺮى ﺧﻄﺮة‬ ‫اﻟﺸﺮي‬ ‫ﺗﺪﻋﻰ اﻟﺼﺪﻣﺔ اﻟﺘﺄﻗﻴﺔ ‪.Anaphylactic shock‬‬ ‫ﺗﺘﻢ ﻣﻌﺎﻟﺠﺘﻬﺎ ﺑﻮاﺳﻄﺔ اﻟﺴﺘﻴﺮوﺋﻴﺪات اﻟﻘﺸﺮﻳﺔ‪.‬‬ ‫‪Lymphocytes‬‬ ‫‪ ‬اﻟﻠﻤﻔﺎوﻳﺎت‬ ‫‪ By far the most numerous types of‬‬ ‫‪ ‬أﻛﺜﺮ أﻧﻮاع اﻟﺨﻼﻳﺎ ﻏﻴﺮ اﻟﻤﺤﺒﺒﺔ اﻟﻤﻮﺟﻮدة ﻓﻲ‬ ‫‪agranulocyte in normal blood smears‬‬ ‫اﻟﻤﺴﺤﺎت اﻟﺪﻣﻮﻳﺔ اﻟﻄﺒﻴﻌﻴﺔ‪.‬‬ ‫‪or CBCs, lymphocytes constitute a‬‬ ‫‪ ‬أﺻﻐﺮ اﻟﺨﻼﻳﺎ اﻟﺒﻴﺾ ﺣﻴﺚ ﺗﺸﻜﻞ ﺛﻠﺚ اﻟﺨﻼﻳﺎ‬ ‫‪family of leukocytes with spherical‬‬ ‫اﻟﺒﻴﺾ‪.‬‬ ‫‪nuclei.‬‬ ‫ﹰ‬ ‫‪ ‬ﺗﺘﺸﺎﺑﻪ اﻟﻠﻤﻔﺎوﻳﺎت ﺷﻜﻠﻴﺎ ﻟﻜﻦ ﻳﻤﻜﻦ ﺗﺼﻨﻴﻔﻬﺎ‬ ‫‪ Lymphocytes are typically the‬‬ ‫إﻟﻰ ﻣﺠﻤﻮﻋﺎت وﻇﻴﻔﻴﺔ ﺣﺴﺐ اﻟﺠﺰﻳﺌﺎت‬ ‫‪smallest leukocytes and are‬‬ ‫اﻟﺴﻄﺤﻴﺔ اﻟﻤﻤﻴﺰة )اﻟﻮاﺳﻤﺎت( وﻳﻤﻜﻦ ﺗﻔﺮﻳﻘﻬﺎ‬ ‫‪abundant, constituting up to a‬‬ ‫ﹰ‬ ‫اﻋﺘﻤﺎدا ﻋﻠﻰ ﺗﻘﻨﻴﺎت اﻟﻤﻨﺎﻋﺔ اﻟﻜﻴﻤﻴﺎﺋﻴﺔ‬ ‫‪third of these cells, B Lympho-‬‬ ‫اﻟﻨﺴﻴﺠﻴﺔ‪ ،‬ﺣﻴﺚ ﻧﻤﻴﺰ ﺧﻼﻳﺎ‪ :‬ﺑﺎﺋﻴﺔ ‪ ،B‬ﺗﺎﺋﻴﺔ ‪،T‬‬ ‫‪cytes, T Lymphocytes and natural‬‬ ‫ﻗﺎﺗﻠﺔ ﻃﺒﻴﻌﻴﺔ‪.NK‬‬ ‫‪killer cells (NK).‬‬ ‫ﹰ‬ ‫)وﻳﻜﻮن ﻟﻬﺎ أدوارا ﻣﺨﺘﻠﻔﺔ ﻓﻲ ﻋﻤﻠﻴﺔ اﻟﺪﻓﺎع اﻟﻤﻨﺎﻋﻴﺔ( ‪.‬‬ ‫‪ ‬ﻧﻤﻴﺰ ﻓﻲ اﻟﺪم اﻟﻤﺤﻴﻄﻲ ﺛﻼﺛﺔ أﻧﻮاع ﻣﻦ اﻟﻠﻤﻔﺎوﻳﺎت ﺗﺼﻨﻒ ﺣﺴﺐ ﺣﺠﻤﻬﺎ إﻟﻰ‪ :‬ﻟﻤﻔﺎوﻳﺎت‬ ‫ﹰ‬ ‫ﺻﻐﻴﺮة وﻣﺘﻮﺳﻄﺔ وﻛﺒﻴﺮة ﺗﻜﻮن اﻟﻠﻤﻔﺎوﻳﺎت اﻟﺼﻐﻴﺮة أﻛﺜﺮ ﺗﻮاﺟﺪا‪.‬‬ ‫‪11‬‬ ‫‪11‬‬  ‫د‪.‬ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫ﺗﺘﻤﻴﺰ اﻟﻠﻤﻔﺎوﻳﺎت اﻟﺼﻐﻴﺮة ﺑﻨﻮاة ﻣﺤﻴﻄﻴﺔ ذات ﻛﺮوﻣﺎﺗﻴﻦ ﻛﺜﻴﻒ ﺗﺸﻐﻞ ﻣﻌﻈﻢ اﻟﺨﻠﻴﺔ ﺑﺤﻴﺚ‬ ‫‪‬‬ ‫ﻳﺤﻴﻂ ﺑﻬﺎ إﻃﺎر رﻗﻴﻖ ﻣﻦ اﻟﺴﻴﺘﻮﺑﻼﺳﻤﺎ ﺗﺤﺘﻮي ﻋﻠﻰ اﻟﻘﻠﻴﻞ ﻣﻦ اﻟﺤﺒﻴﺒﺎت اﻟﻤﺤﺒﺔ ﻟﻶزور‬ ‫واﻟﻘﻠﻴﻞ ﻣﻦ اﻟﻤﺘﻘﺪرات‪ ،‬ﺗﻠﻮﻧﻬﺎ أﺳﺎﺳﻲ ﺧﻔﻴﻒ‪.‬‬ ‫اﻟﻠﻤﻔﺎوﻳﺎت اﻟﻜﺒﻴﺮة ﻧﻮاﺗﻬﺎ ﻣﺴﻨﻨﺔ ﻛﺜﻴﻔﺔ وأﻛﺒﺮ وﻛﻤﻴﺔ اﻟﺴﻴﺘﻮﺑﻼﺳﻤﺎ أﻛﺒﺮ‪ ،‬ﺗﻠﻮﻧﻬﺎ أﺳﺎﺳﻲ‬ ‫‪‬‬ ‫ﺷﺪﻳﺪ‪.‬‬ ‫ﹰ‬ ‫ﺗﺨﺘﻠﻒ دورة ﺣﻴﺎة اﻟﻠﻤﻔﺎوﻳﺎت ﺗﺒﻌﺎ ﻟﻮﻇﻴﻔﺘﻬﺎ ﻓﺒﻌﻀﻬﺎ ﻳﻌﻴﺶ ﻟﺒﻀﻌﺔ أﻳﺎم وﺑﻌﻀﻬﺎ اﻵﺧﺮ ﻟﻌﺪة‬ ‫‪‬‬ ‫ﺳﻨﻮات )ﻣﺜﻞ ﺧﻼﻳﺎ اﻟﺬاﻛﺮة( ﻓﻲ ﻣﺠﺮى اﻟﺪم أو اﻷﻧﺴﺠﺔ‪.‬‬ ‫ﺗﻌﺪ اﻟﻠﻤﻔﺎوﻳﺎت اﻟﻨﻮع اﻟﻮﺣﻴﺪ ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﺒﻴﻀﺎء اﻟﺘﻲ ﺗﺴﺘﻄﻴﻊ اﻻﻧﺴﻼل ﻣﻦ اﻷﻧﺴﺠﺔ‬ ‫‪‬‬ ‫واﻟﻌﻮدة ﻟﻠﺪم‪.‬‬ ‫ﺻﻐﻴﺮة‬ ‫ﻣﺘﻮﺳﻄﺔ‬ ‫ﻛﺒﻴﺮة‬ ‫‪Lymphomas‬‬ ‫ﺳﺮﻃﺎن اﻟﻐﺪد اﻟﻠﻤﻔﺎوﻳﺔ‬ ‫ﺗﻘﻮم اﻟﻠﻤﻔﻴﺎت ﺑﺄدوار ﻣﻬﻤﺔ ﺟﺪا ﻓﻲ اﻟﻌﺪﻳﺪ ﻣﻦ اﻻﻣﺮاض وذﻟﻚ ﺗﺒﻌﺎ ﻟﻮﻇﻴﻔﺘﻬﺎ اﻟﻤﻨﺎﻋﻴﺔ‪.‬‬ ‫‪‬‬ ‫اﻟﻠﻴﻤﻔﻮﻣﺎ ﻫﻮ ورم ﺧﺒﻴﺚ ﻳﻨﺸﺄ ﻋﻠﻰ ﺣﺴﺎب اﻟﺨﻼﻳﺎ اﻟﻠﻤﻔﺎوﻳﺔ‪.‬‬ ‫‪‬‬ ‫اﻟـ)‪ (LYMPHOMAS‬ﻫﻮ ﻣﺠﻤﻮﻋﺔ اﻻﺿﻄﺮاﺑﺎت اﻟﺘﻲ ﺗﺘﻀﻤﻦ ﺗﻜﺎﺛﺮ ورﻣﻲ ﻟﻠﻤﻔﺎوﻳﺎت أو ﻓﺸﻞ‬ ‫‪‬‬ ‫ﻫﺬه اﻟﺨﻼﻳﺎ ﻓﻲ اﻟﺨﻀﻮع ﻟﻠﻤﻮت اﻟﺨﻠﻮي اﻟﻤﺒﺮﻣﺞ‪.‬‬ ‫ﹰ‬ ‫ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن ﻧﻤﻮ اﻟﺨﻼﻳﺎ ﺑﻄﻲء ﻟﻜﻨﻬﺎ ﺗﻌﺘﺒﺮ أوراﻣﺎ ﺧﺒﻴﺜﺔ‪.‬‬ ‫‪‬‬ ‫ﻳﺠﺐ ﻣﺮاﻗﺒﺘﻬﺎ ﺑﺸﻜﻞ داﺋﻢ ﺑﺴﺒﺐ ﻗﺪرﺗﻬﺎ ﻋﻠﻰ اﻻﻧﺘﺸﺎر ﺑﺴﻬﻮﻟﺔ ﻓﻲ اﻟﺠﺴﻢ وﻗﺘﻞ اﻟﻤﺮﻳﺾ‬ ‫‪‬‬ ‫إذا ﻟﻢ ﺗﻌﺎﻟﺞ‪.‬‬ ‫ﹰ‬ ‫ﹼ‬ ‫اﻟﻌﻼج اﻟﻜﻴﻤﻴﺎﺋﻲ ﺣﺴﻦ ﻛﺜﻴﺮا إﻧﺬار ﻫﺬه اﻷورام‪.‬‬ ‫‪‬‬ ‫ﹸ ﹶ‬ ‫‪Monocytes‬‬ ‫‪ ‬وﺣﻴﺪات اﻟﻨﻮى‬ ‫‪ ‬ﺧﻼﻳﺎ ﻏﻴﺮ ﻣﺤﺒﺒﺔ ﺗﺘﻤﺎﻳﺰ ﺑﻌﺪ ﻋﺒﻮرﻫﺎ اﻟﻮرﻳﺪات )أي ﺑﻌﺪ ﻋﺒﻮرﻫﺎ‬ ‫اﻷوﻋﻴﺔ إﻟﻰ اﻟﻨﺴﻴﺞ اﻟﺨﻼﻟﻲ( إﻟﻰ‪:‬‬ ‫‪ (1‬اﻟﺨﻼﻳﺎ اﻟﺒﺎﻟﻌﺔ ﻓﻲ اﻟﻨﺴﻴﺞ اﻟﻀﺎم‬ ‫‪12‬‬  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪ (2‬وﻟﻜﺎﺳﺮات اﻟﻌﻈﻢ ﻓﻲ اﻟﻌﻈﺎم‬ ‫ﻣﻼﺣﻈﺔ‪:‬‬ ‫‪ (3‬وﻟﺨﻼﻳﺎ دﺑﻘﻴﺔ ﻓﻲ اﻟﺠﻬﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي‪.‬‬ ‫أﺳﻼف اﻟﺒﺎﻟﻌﺎت ﻫﻲ اﻟﻮﺣﻴﺪات‪.‬‬ ‫ﻛﻞ اﻟﺨﻼﻳﺎ اﻟﻤﺸﺘﻘﺔ ﻣﻦ اﻟﻮﺣﻴﺪات ﻫﻲ ﺧﻼﻳﺎ ﻟﻬﺎ دور‬ ‫‪‬‬ ‫ﻫﺎم ﻓﻲ اﻟﺪﻓﺎع اﻟﻤﻨﺎﻋﻲ‪.‬‬ ‫ﻳﺘﺮاوح ﻗﻄﺮﻫﺎ ﻓﻲ اﻟﺪوران ﺑﻴﻦ ‪ 12-20‬ﻣﻴﻜﺮون‪.‬‬ ‫‪‬‬ ‫ﹰ‬ ‫ﻧﻮى اﻟﻮﺣﻴﺪات ﻛﺒﻴﺮة وﻏﺎﻟﺒﺎ ﻣﺎ ﺗﻜﻮن ﻣﺴﻨﻨﺔ ﺑﻮﺿﻮح أو‬ ‫‪‬‬ ‫ﺑﺸﻜﻞ ﺣﺮف ‪.C‬‬ ‫اﻟﻜﺮوﻣﺎﺗﻴﻦ أﻗﻞ ﻛﺜﺎﻓﺔ ﻣﻦ اﻟﻠﻤﻔﺎوﻳﺎت‪.‬‬ ‫‪‬‬ ‫اﻟﻬﻴﻮﻟﻰ أﻟﻴﻔﺔ ﻟﻸﺳﺎس وﺗﺤﺘﻮي ﻋﺪد ﻗﻠﻴﻞ ﻣﻦ اﻟﺤﺒﻴﺒﺎت‬ ‫‪‬‬ ‫اﻟﻮﺣﻴﺪات‬ ‫اﻟﻤﺤﺒﺔ ﻟﻶزور‪.‬‬ ‫‪Platelets‬‬ ‫اﻟﺼﻔﻴﺤﺎت اﻟﺪﻣﻮﻳﺔ‬ ‫‪ ‬ﺗﻨﺸﺄ ﻣﻦ ﺗﺸﺪف ﻧﻬﺎﻳﺎت اﻻﺳﺘﻄﺎﻻت اﻟﻬﻴﻮﻟﻴﺔ اﻟﻤﻤﺘﺪة ﻣﻦ ﺧﻼﻳﺎ ﻋﻤﻼﻗﺔ اﻟﻨﻮاة اﻟﻤﻮﺟﻮدة‬ ‫ﻓﻲ ﻧﻘﻲ اﻟﻌﻈﻢ‪.‬‬ ‫‪ ‬أﺟﺰاء ﺧﻠﻮﻳﺔ ﺧﺎﻟﻴﺔ ﻣﻦ اﻟﻨﻮاة ذات ﺷﻜﻞ ﻗﺮﺻﻲ ﺑﻘﻄﺮ ‪ 2-4‬ﻣﻴﻜﺮون‪.‬‬ ‫‪ ‬ﺗﺴﺎﻋﺪ اﻟﺼﻔﻴﺤﺎت ﻓﻲ ﺗﺠﻠﻂ اﻟﺪم وﺗﺮﻣﻴﻢ اﻟﺸﻘﻮق ﻓﻲ ﺟﺪران اﻷوﻋﻴﺔ اﻟﺪﻣﻮﻳﺔ ﻣﻤﺎ ﻳﻤﻨﻊ‬ ‫ﻓﻘﺪان اﻟﺪم‪.‬‬ ‫ﻳﺘﺮاوح ﻋﺪد اﻟﺼﻔﻴﺤﺎت ﻣﻦ ‪ 400,000 - 200,000‬ﺻﻔﻴﺤﺔ‪/‬ﻣﻴﻜﺮوﻟﻴﺘﺮ‬ ‫وﺗﺘﻤﻴﺰ ﺑﻔﺘﺮة ﺣﻴﺎة ﺗﺒﻠﻎ ‪ 10‬أﻳﺎم‪.‬‬ ‫‪ ‬ﺗﻈﻬﺮ ﻓﻲ اﻟﻤﺴﺤﺎت اﻟﺪﻣﻮﻳﺔ اﻟﻤﺼﺒﻮﻏﺔ ﻋﻠﻰ ﺷﻜﻞ ﻛﺘﻞ‪.‬‬ ‫‪ ‬ﻛﻞ ﺻﻔﻴﺤﺔ ﻟﻬﺎ‪:‬‬ ‫‪ ‬ﻧﻄﺎق ﻣﺤﻴﻄﻲ ﺷﻔﺎف ذو ﻟﻮن أزرق ﺷﻔﺎف ﻳﻌﺮف ﺑﺎﻟﻘﺴﻴﻢ‬ ‫اﻟﺸﻔﺎف‪. hyalomere‬‬ ‫‪ ‬ﺟﺰء ﻣﺮﻛﺰي ﻳﺤﺘﻮي ﺣﺒﻴﺒﺎت داﻛﻨﺔ اﻟﻠﻮن ﻳﻌﺮف ﺑﺎﻟﻘﺴﻴﻢ اﻟﺤﺒﻴﺒﻲ ‪.granulomere‬‬ ‫ﺗﻜﻮن اﻟﺪم‬ ‫‪ Mature blood cells have a relatively‬‬ ‫‪ ‬اﻟﺨﻼﻳﺎ اﻟﺪﻣﻮﻳﺔ اﻟﻨﺎﺿﺠﺔ ﺗﻤﺘﻠﻚ ﻣﺪة ﺣﻴﺎة‬ ‫‪short life span and must be contin-‬‬ ‫ﻗﺼﻴﺮة وﻳﺠﺐ أن ﺗﻨﺘﺞ ﺑﺎﺳﺘﻤﺮار ﻟﺘﻌﻮﻳﺾ‬ ‫‪uousl replaced with new cells from‬‬ ‫اﻟﺨﻼﻳﺎ اﻟﻤﻴﺘﺔ‪.‬‬ ‫‪13‬‬ ‫‪13‬‬  ‫ ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬.‫د‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ precursors developing during he- ‫ ﻫﺬه اﻟﻌﻤﻠﻴﺔ ﺗﺤﺪث ﻓﻲ ﻧﻘﻲ اﻟﻌﻈﻢ‬ mopoiesis (Gr. haima, blood + poie-.Hemopoiesis ‫وﺗﺴﻤﻰ ﺗﻜﻮن اﻟﺪم‬ sis, a making) ‫ أﺛﻨﺎء اﻟﺤﻴﺎة ﺗﺴﺘﻤﺮ اﻟﺨﻼﻳﺎ اﻟﺪﻣﻮﻳﺔ ﺑﺎﻟﺘﻜﻮن‬  Throughout childhood and adult ‫ﻣﻦ ﺧﻼﻳﺎ ﺟﺬﻋﻴﺔ ﻣﻮﺟﻮدة ﻓﻲ ﻧﻘﻲ‬ life, erythrocytes, granulocytes,.‫اﻟﻌﻈﻢ‬ monocytes and platelets continue to form from stem cells located in bone marrow. ‫ ﻳﺤﺪث ﺗﻜﻮن اﻟﻠﻤﻔﺎوﻳﺎت ﻓﻲ ﻧﻘﻲ‬  Lymphopoiesis or lymphocytes develop- ‫اﻟﻌﻈﻢ واﻷﻋﻀﺎء اﻟﻠﻤﻔﺎوﻳﺔ اﻟﺘﻲ ﺗﻬﺎﺟﺮ‬ ment occurs in the marrow and in lym-.‫إﻟﻴﻬﺎ اﻟﺨﻼﻳﺎ اﻟﺴﻠﻴﻔﺔ ﻣﻦ ﻧﻘﻲ اﻟﻌﻈﻢ‬ phoid organs to which precursor cells mi- grate from marrow. :‫ﻧﻌﺒﺮ ﻋﻦ ﺗﻜﻮن ﻛﻞ ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﺪﻣﻮﻳﺔ ﻛﻤﺎ ﻳﻠﻲ‬ erythropoiesis (Gr. Erythros,red + ‫ﺗﻜﻮن اﻟﺤﻤﺮ‬ poiesis , making) granulopoiesis ‫ﺗﻜﻮن اﻟﺒﻴﺾ اﻟﻤﺤﺒﺒﺔ‬ monocytopoiesis ‫ﺗﻜﻮن اﻟﻮﺣﻴﺪات‬ thrombocytopoiesis ‫ﺗﻜﻮن اﻟﺼﻔﻴﺤﺎت اﻟﺪﻣﻮﻳﺔ‬ lymphopoiesis ‫ﺗﻜﻮن اﻟﻠﻤﻔﺎوﻳﺎت‬ Stem Cells ‫اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ‬  stem cells are pluripotent cells ca- ‫ اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ ﻫﻲ ﺧﻼﻳﺎ ﻣﺘﻌﺪدة‬ pable of asymmetric division and ‫اﻹﻣﻜﺎﻧﺎت ﺗﺘﻤﻴﺰ ﺑﺼﻔﺘﻴﻦ ﻫﻤﺎ اﻻﻧﻘﺴﺎم ﻏﻴﺮ‬ self-renewal..‫اﻟﻤﺘﻨﺎﻇﺮ واﻟﺘﺠﺪد اﻟﺬاﺗﻲ‬  Some of their daughter cells form ‫ ﺑﻌﺾ اﻟﺨﻼﻳﺎ اﻟﺒﻨﺎت ﺗﺘﻤﺎﻳﺰ ﻟﺘﺸﻜﻞ ﺧﻼﻳﺎ‬ specific, irreversibly differenti- ‫ﻣﺘﻤﺎﻳﺰة ﺑﺸﻜﻞ ﻏﻴﺮ ﻋﻜﻮس وﻫﺬا ﻣﺎ ﻳﺪﻋﻰ‬ ated cell types..‫ﺑﺎﻻﻧﻘﺴﺎم ﻏﻴﺮ اﻟﻤﺘﻨﺎﻇﺮ‬  and other daughter cells remain as ‫ اﻟﺨﻼﻳﺎ اﻟﺒﻨﺎت اﻷﺧﺮى ﺗﺒﻘﻰ ﺑﻨﻔﺲ ﺻﻔﺎت‬ a small pool of slowly dividing stem ‫ودرﺟﺔ ﺗﻤﺎﻳﺰ اﻟﺨﻼﻳﺎ اﻷم وﺗﺸﻜﻞ اﺣﺘﻴﺎﻃﻲ‬ cells. ‫ﺧﻼﻳﺎ ﺟﺬﻋﻴﺔ وﻫﺬا ﻣﺎ ﻳﺪﻋﻰ ﺑﺎﻟﺘﺠﺪد‬.‫اﻟﺬاﺗﻲ‬ 14  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ Hemopoietic Stem Cells ‫اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ اﻟﻤﻜﻮﻧﺔ ﻟﻠﺪم‬ ‫ﹶ‬ ‫إﻻم ﺗﺘﻤﺎﻳﺰ ﻛﻞ ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ اﻟﻠﻤﻔﺎوﻳﺔ واﻟﻨﻘﻮﻳﺔ؟‬  All blood cells arise from a single ‫ ﺗﻨﺸﺄ ﻛﻞ اﻟﺨﻼﻳﺎ اﻟﺪﻣﻮﻳﺔ ﻣﻦ ﻧﻤﻂ واﺣﺪ‬ major type of pluripotent stem ‫ﻣﻦ اﻟﺨﻼﻳﺎ ﻫﻲ اﻟﺨﻠﻴﺔ اﻟﺠﺬﻋﻴﺔ ﻣﺘﻌﺪدة‬ cell in the bone marrow that can pluripotent stem cell ‫اﻹﻣﻜﺎﻧﺎت‬.‫اﻟﺘﻲ ﺗﻌﻄﻲ ﻛﻞ أﻧﻮاع اﻟﺨﻼﻳﺎ اﻟﺪﻣﻮﻳﺔ‬ give rise to all the blood cell types.  These pluripotent stem cells are ‫ ﻫﺬه اﻟﺨﻼﻳﺎ ﻋﺪدﻫﺎ ﻗﻠﻴﻞ وﻟﻜﻨﻬﺎ ﺗﻨﺘﺞ‬ rare, but they proliferate and form ‫ﻧﻮﻋﻴﻦ ﻣﻦ ﺧﻄﻮط اﻹﻧﺘﺎج أو ﻣﻦ اﻟﺨﻼﻳﺎ‬ two major lineages of progenitor ‫ذات إﻣﻜﺎﻧﺎت اﻟﺘﻤﺎﻳﺰ اﻟﻤﺤﺪودة واﻟﻤﺒﺮﻣﺠﺔ‬ cells with restricted potentials :‫ﻹﻧﺘﺎج ﺧﻼﻳﺎ ﻣﻌﻴﻨﺔ‬ (committed to produce specific ‫ اﻟﻨﻮع اﻷول )ﺧﻼﻳﺎ ﺟﺬﻋﻴﺔ ﻟﻤﻔﺎوﻳﺔ‬ blood cells). ‫( ﻳﻌﻄﻲ‬Lymphoid stem cells one for lymphoid cells (lym- ‫ﺳﻠﺴﻠﺔ اﻟﺨﻼﻳﺎ اﻟﻠﻤﻔﺎوﻳﺔ‬ phocytes) ‫ واﻟﺘﻲ ﺗﻨﺘﻬﻲ‬lymphocyte and another for myeloid cells.‫ﺑﺎﻟﻠﻤﻔﺎوﻳﺎت‬ (Gr. myelos, marrow) that de- ‫ اﻟﻨﻮع اﻟﺜﺎﻧﻲ )ﺧﻼﻳﺎ ﺟﺬﻋﻴﺔ ﻧﻘﻮﻳﺔ‬ velop in bone marrow. Myeloid ‫( ﻳﻌﻄﻲ‬myeloid stem cells cells include granulocytes, (myelocytes ) ‫ﺳﻠﺴﻠﺔ اﻟﺨﻼﻳﺎ اﻟﻨﻘﻮﻳﺔ‬ monocytes, erythrocytes, and ‫اﻟﺘﻲ ﺗﺘﻄﻮر ﻟﺘﻌﻄﻲ اﻟﻤﺤﺒﺒﺎت‬ megakaryocytes. ‫ووﺣﻴﺪات اﻟﻨﻮى واﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ‬.‫واﻟﻨﻮاءات‬ 15 15  ‫ ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬.‫د‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫اﻟﺨﻼﻳﺎ اﻟﻨﺴﻴﻠﺔ واﻟﻮﺣﺪات اﻟﻤﺸﻜﻠﺔ ﻟﻠﻤﺴﺘﻌﻤﺮات‬ Colony forming Units&Progenitor cells  The progenitor cells for blood cells ‫ اﻟﻨﺎﺗﺠﺔ‬progenitor cells ‫ اﻟﺨﻼﻳﺎ اﻟﻨﺴﻴﻠﺔ‬ ‫ﹰ‬ are commonly called colony form- ‫ﻋﻦ ﺗﻜﺎﺛﺮ اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ اﻟﻤﺬﻛﻮرة ﺳﺎﺑﻘﺎ‬ ‫ﹰ‬ ing units (CFUs), because they ‫)اﻟﻠﻤﻔﺎوﻳﺔ واﻟﻨﻘﻮﻳﺔ( ﺗﺴﻤﻰ أﻳﻀﺎ‬ give rise to colonies of only one cell ‫اﻟﻮﺣﺪات اﻟﻤﺸﻜﻠﺔ ﻟﻠﻤﺴﺘﻌﻤﺮات‬ type when cultured or injected into ‫( ﺑﺤﻴﺚ ﻳﺼﺒﺢ‬colonyforming unit) a spleen. there are four major :‫ﻟﺪﻳﻨﺎ‬ types of progenitor cells/CFUs: Erythroid lineage of CFU-erythrocytes ‫اﻟﻮﺣﺪة اﻟﻤﺸﻜﻠﺔ ﻟﻤﺴﺘﻌﻤﺮة اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮاء‬ (CFU-E) Thrombocytic lineage of CFU-megakar- ‫اﻟﻮﺣﺪة اﻟﻤﺸﻜﻠﺔ ﻟﻤﺴﺘﻌﻤﺮة اﻟﺼﻔﻴﺤﺎت‬ yocytes (CFU-Meg) Granulocyte-monocyte lineage of CFU- ‫اﻟﻮﺣﺪة اﻟﻤﺸﻜﻠﺔ ﻟﻤﺴﺘﻌﻤﺮة اﻟﻮﺣﻴﺪات‬ granulocytesmonocytes (CFU-GM) ‫واﻟﺨﻼﻳﺎ اﻟﻤﺤﺒﺒﺔ‬ Lymphoid lineage of CFU-lymphocytes of ‫اﻟﻮﺣﺪة اﻟﻤﺸﻜﻠﺔ ﻟﻤﺴﺘﻌﻤﺮة اﻟﻠﻤﻔﺎوﻳﺎت‬ all types (CFU-L) ‫اﻟﺨﻼﻳﺎ اﻟﻨﺴﻴﻠﺔ واﻟﺨﻼﻳﺎ اﻷروﻣﻴﺔ‬.‫ ﻣﺎﻫﻲ اﻟﺨﻼﻳﺎ اﻟﺘﻲ ﺗﻨﺘﺠﻬﺎ اﻟﺨﻼﻳﺎ اﻟﻨﺴﻴﻠﺔ؟ ﺗﻨﺘﺞ اﻷروﻣﺎت‬ :‫ﻣﻘﺎرﻧﺔ اﻟﺼﻔﺎت اﻟﺸﻜﻠﻴﺔ وﻣﻌﺪل اﻻﻧﻘﺴﺎم‬  Each progenitor cell/CFU lineage pro- ‫ ﺗﻨﺘﺞ‬progenitor cells ‫ اﻟﺨﻼﻳﺎ اﻟﻨﺴﻴﻠﺔ‬ duces precursor cells (or blasts) that (precurons or blast ‫ﺧﻼﻳﺎ أروﻣﻴﺔ‬ gradually assume the morphologic ‫ﹰ‬ ‫( واﻟﺘﻲ ﺗﻜﺘﺴﺐ ﺗﺪرﻳﺠﻴﺎ اﻟﺼﻔﺎت‬cells characteristics of the mature, func- ‫اﻟﺸﻜﻠﻴﺔ واﻟﻮﻇﻴﻔﻴﺔ ﻟﻠﺨﻼﻳﺎ اﻟﺘﻲ ﺳﺘﺼﺒﺢ‬ tional cell types they will become..‫ﻋﻠﻴﻬﺎ‬  In contrast, stem and progenitor cells ‫ ﺑﺎﻟﻤﻘﺎﺑﻞ اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ واﻟﺨﻼﻳﺎ اﻟﻨﺴﻴﻠﺔ ﻻ‬ cannot be morphologically distin- ‫ﻳﻤﻜﻦ ﺗﻤﻴﻴﺰﻫﺎ ﻋﻦ ﺑﻌﻀﻬﺎ ﺑﺎﻟﺸﻜﻞ وﻫﻲ‬ guished and simply resemble large ‫ﻛﻠﻬﺎ ﺗﺸﺒﻪ ﺑﺎﻟﻤﺠﻬﺮ اﻟﻀﻮﺋﻲ اﻟﻠﻤﻔﺎوﻳﺎت‬ lymphocytes..‫اﻟﻜﺒﻴﺮة‬ 16  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪ stem cells divide at a rate only suf-‬‬ ‫‪ ‬ﺗﻨﻘﺴﻢ اﻟﺨﻼﻳﺎ اﻟﺠﺬﻋﻴﺔ ﺑﻤﻌﺪل ﻳﻜﻔﻲ‬ ‫‪ficient to maintain their relatively‬‬ ‫ﻓﻘﻂ ﻟﻠﺤﻔﺎظ ﻋﻠﻰ ﻋﺪدﻫﺎ اﻟﻘﻠﻴﻞ‪.‬‬ ‫‪small population.‬‬ ‫‪ progenitor and precursor cells di-‬‬ ‫‪ ‬اﻟﺨﻼﻳﺎ اﻷروﻣﻴﺔ ﺗﻨﻘﺴﻢ ﺑﺴﺮﻋﺔ أﻛﺒﺮ‬ ‫ﹰ‬ ‫ﹰ‬ ‫‪vide more rapidly, producing large‬‬ ‫ﻣﻨﺘﺠﺔ أﻋﺪادا ﻛﺒﻴﺮة ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﻤﺘﻤﺎﻳﺰة‬ ‫‪numbers of differentiated, mature‬‬ ‫اﻟﻨﺎﺿﺠﺔ‪.‬‬ ‫‪cells.‬‬ ‫ﹶ‬ ‫‪ 3× 10⁹ erythrocytes and 0.85 × 10⁹‬‬ ‫‪ ‬ﻓﻤﺜﻼ ﻛﻞ ﻛﻴﻠﻮﻏﺮام ﻣﻦ اﻟﺠﺴﻢ‪ ،‬ﺗﻨﺘﺞ‬ ‫‪granulocytes/kg/d in human bone mar-‬‬ ‫‪0.85 x10⁹ ×3‬ﻛﺮﻳﺎت ﺣﻤﺮ ﻛﻞ ﻳﻮم‪.‬‬ ‫‪row).‬‬ ‫ﹰ‬ ‫ﹰ‬ ‫‪ ‬ﺗﺘﻨﺎﻗﺺ اﻟﻘﺪرة ﻋﻠﻰ اﻟﺘﻤﺎﻳﺰ ‪ potentiality‬واﻟﺘﺠﺪد اﻟﺬاﺗﻲ ‪self-renewing‬ﺗﺪرﻳﺠﻴﺎ ﺑﺪءا ﻣﻦ ﺗﺤﻮل‬ ‫اﻟﺨﻠﻴﺔ اﻟﺠﺬﻋﻴﺔ إﻟﻰ ﺧﻠﻴﺔ ﻧﺴﻴﻠﺔ ﻟﺘﻨﺘﻬﻲ ﻋﻨﺪﻫﺎ )اﻟﺨﻼﻳﺎ اﻷروﻣﻴﺔ ﻏﻴﺮ ﻗﺎدرة ﻋﻠﻰ اﻟﺘﻤﺎﻳﺰ أو اﻟﺘﺠﺪد اﻟﺬاﺗﻲ(‬ ‫ﹰ‬ ‫‪ ‬اﻟﻔﻌﺎﻟﻴﺔ اﻻﻧﻘﺴﺎﻣﻴﺔ ‪ mitotic activity‬ﺗﺰداد ﺗﺪرﻳﺠﻴﺎ ﻟﺘﺼﺒﺢ أﻋﻈﻤﻴﺔ ﻟﺪى اﻟﺨﻼﻳﺎ اﻷروﻣﻴﺔ وﺗﻨﺘﻬﻲ‬ ‫ﻋﻨﺪﻫﺎ )اﻟﺨﻼﻳﺎ اﻟﻨﺎﺿﺠﺔ ﻻ ﺗﻨﻘﺴﻢ(‬ ‫ﹰ‬ ‫‪ ‬ﺗﺘﺄﺛﺮ ﻛﻞ أﺟﻴﺎل ﺧﻼﻳﺎ اﻟﺪم ﺑﻌﻮاﻣﻞ اﻟﻨﻤﻮ وﻟﻜﻦ ﻳﻜﻮن ﺗﺄﺛﻴﺮﻫﺎ أﻋﻈﻤﻴﺎ ﻋﻨﺪ ﺗﺤﻮل اﻟﺨﻠﻴﺔ اﻟﻨﺴﻴﻠﺔ إﻟﻰ ﺧﻠﻴﺔ‬ ‫أروﻣﻴﺔ‪.‬‬ ‫‪ ‬اﻻﻛﺘﺴﺎب اﻟﺸﻜﻠﻲ اﻟﻨﻮﻋﻲ ﻳﺒﺪأ ﻟﺪى اﻟﺨﻠﻴﺔ اﻷروﻣﻴﺔ أﻣﺎ اﻟﻔﻌﺎﻟﻴﺔ اﻟﻮﻇﻴﻔﻴﺔ ﻓﺘﺒﺪأ ﻟﺪى اﻟﺨﻼﻳﺎ اﻟﻨﺎﺿﺠﺔ‪.‬‬ ‫‪17‬‬ ‫‪17‬‬  ‫ ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬.‫د‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ (‫ ﻋﻮاﻣﻞ ﻧﻤﻮ ﺗﻜﻮن اﻟﺪم ) ﻋﻮاﻣﻞ ﻧﻤﻮ اﻟﻤﺴﺘﻌﻤﺮات‬  Under normal conditions,the produc- ‫ ﻓﻲ اﻟﺤﺎﻻت اﻟﻄﺒﻴﻌﻴﺔ ﻳﺘﻢ ﺿﺒﻂ إﻧﺘﺎج‬ tion of blood cells by the bone mar- ‫ﻣﻜﻮﻧﺎت اﻟﺪم ﺣﺴﺐ ﺣﺎﺟﺎت اﻟﻌﻀﻮﻳﺔ‬ row is adjusted to the bod’s activity ‫وﻫﻨﺎك إﻣﻜﺎﻧﻴﺔ ﻟﻤﻀﺎﻋﻔﺔ اﻹﻧﺘﺎج ﻋﺪة‬ sereval-fold in a short time..‫ﻣﺮات ﻋﻨﺪ اﻟﺤﺎﺟﺔ‬  Hemopoietic growth factors, often called or cytokines, are glycopro- (CSF)‫ ﻋﻮاﻣﻞ ﺗﻜﻮن اﻟﺪم‬ teins that stimulate proliferation of progenitor and precursor cells and ‫ﻫﻲ ﺳﻴﺘﻮﻛﻴﻨﺎت ﺗﺘﺄﻟﻒ ﻣﻦ ﺑﺮوﺗﻴﻨﺎت‬ promote cell differentiation and ‫ﺳﻜﺮﻳﺔ ﺗﺤﺮض ﺗﻜﺎﺛﺮ اﻟﺨﻼﻳﺎ اﻟﻨﺴﻴﻠﺔ واﻟﺨﻼﻳﺎ‬ maturation within specific lineages. ‫اﻟﺴﻠﻴﻔﺔ وﺗﺴﺎﻋﺪ ﻋﻠﻰ ﺗﻤﺎﻳﺰ اﻟﺨﻼﻳﺎ ﺿﻤﻦ‬  Cloning of the genes for several.‫اﻟﺨﻄﻮط اﻟﻤﻄﻠﻮﺑﺔ‬ important hematopoietic growth fac- tors have significantly advanced ‫ إن ﺗﻨﺴﻴﻞ اﻟﺠﻴﻨﺎت اﻟﻤﺮﻣﺰة ﻟﺘﺮﻛﻴﺐ ﻋﻮاﻣﻞ‬ study of blood formation and permit- ‫اﻟﻨﻤﻮ ﻳﻔﻴﺪ ﻋﻠﻰ اﻟﻤﺴﺘﻮى اﻟﺴﺮﻳﺮي‬ ted the production of clinically use- ful factors for patients with hemo-.‫ﻟﻠﻤﺮﺿﻰ اﻟﻤﺼﺎﺑﻴﻦ ﺑﺈﺿﻄﺮاﺑﺎت دﻣﻮﻳﺔ‬ poietic disorders. 18  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪MEDICAL APPLICATION‬‬ ‫ﺗﻄﺒﻴﻖ ﻃﺒﻲ‬ ‫اﻻﺳﺘﻌﻤﺎﻻت اﻟﺴﺮﻳﺮﻳﺔ ﻟﻌﻮاﻣﻞ ﻧﻤﻮ اﻟﻤﺴﺘﻌﻤﺮات‬ ‫ﹰ‬ ‫‪ ‬ﻋﻮاﻣﻞ ﻧﻤﻮ ﺗﻜﻮن اﻟﺪم ﻫﻲ ﻣﻨﺘﺠﺎت ﻫﺎﻣﺔ ﻟﺸﺮﻛﺎت اﻟﺘﻘﺎﻧﺎت اﻟﺤﻴﻮﻳﺔ وﻫﻲ ﺗﺴﺘﻌﻤﻞ ﺳﺮﻳﺮﻳﺎ‬ ‫ﻟﺰﻳﺎدة ﺧﻠﻮﻳﺔ ﻧﻘﻲ اﻟﻌﻈﻢ وﺗﻌﺪاد اﻟﺪم ﻟﺪى ﻣﺮﺿﻰ ﻓﻘﺮ اﻟﺪم اﻟﺸﺪﻳﺪ واﻟﻤﻌﺮﺿﻴﻦ‬ ‫ﻟﻠﻤﻌﺎﻟﺠﺎت اﻟﻜﻴﻤﻴﺎﺋﻴﺔ واﻟﺸﻌﺎﻋﻴﺔ اﻟﺘﻲ ﺗﺨﻔﺾ ﻟﺪﻳﻬﻢ ﺗﻌﺪاد اﻟﻜﺮﻳﺎت اﻟﺒﻴﺾ‬ ‫)‪(Leukopenia‬‬ ‫ﹰ‬ ‫‪ ‬ﻫﺬه اﻟﻤﻮاد ﻫﻲ ﺳﻴﺘﻮﻛﻴﻨﺎت أﻳﻀﺎ ﺗﻔﻴﺪ ﻓﻲ ﺗﻌﺰﻳﺰ ﻓﻌﺎﻟﻴﺔ اﻟﻨﻘﻲ اﻟﻤﺰروع‪ ،‬وﻓﻲ ﺗﻌﺰﻳﺰ‬ ‫ﻣﻘﺎوﻣﺔ اﻟﻌﻀﻮﻳﺔ ﻟﺪى ﻣﺮﺿﻰ اﻹﻧﺘﺎﻧﺎت وﻧﻘﺺ اﻟﻤﻨﺎﻋﺔ‪ ،‬ﻛﻤﺎ ﺗﻌﺰز ﻋﻼج ﺑﻌﺾ اﻷﻣﺮاض‬ ‫اﻟﻄﻔﻴﻠﻴﺔ‪.‬‬ ‫‪ ‬ﻣﻦ اﻷﺳﻤﺎء اﻟﻤﺘﺪاوﻟﺔ ‪.Neupogen‬‬ ‫‪Bone Marrow‬‬ ‫ﻧﻘﻲ اﻟﻌﻈﻢ‬ ‫‪‬‬ ‫‪Bone marrow is found in the‬‬ ‫‪medullary‬‬ ‫‪ ‬ﻳﻮﺟﺪ ﻧﻘﻲ اﻟﻌﻈﻢ ﻓﻲ اﻟﻘﻨﻮات اﻟﻠﺒﻴﺔ‬ ‫‪canals of long bones and in the small‬‬ ‫ﻟﻠﻌﻈﺎم اﻟﻄﻮﻳﻠﺔ وﻓﻲ اﻟﻔﺮاﻏﺎت اﻟﺼﻐﻴﺮة‬ ‫‪cavities of cancellous bone, with two‬‬ ‫ﻟﻠﻌﻈﺎم اﻟﻘﺼﻴﺮة )اﻻﺳﻔﻨﺠﻴﺔ( وﻫﻨﺎك‬ ‫‪types based on their appearance at gross‬‬ ‫ﻧﻤﻄﺎن ﻣﻦ ﻧﻘﻲ اﻟﻌﻈﻢ‪:‬‬ ‫‪examination:‬‬ ‫‪ blood-forming red bone marrow,‬‬ ‫‪ ‬ﻧﻘﻲ اﻟﻌﻈﻢ اﻷﺣﻤﺮ )ﻣﻜﻮن ﻟﻠﺪم(‬ ‫‪whose color is produced by an abun-‬‬ ‫‪dance of blood and hemopoietic‬‬ ‫‪cells,‬‬ ‫‪ and yellow bone marrow, which‬‬ ‫‪ ‬ﻧﻘﻲ اﻟﻌﻈﻢ اﻷﺻﻔﺮ‪ :‬وﻫﻮ ﻏﻨﻲ‬ ‫‪is filled with adipocytes that ex-‬‬ ‫ﺑﺎﻟﻨﺴﻴﺞ اﻟﺸﺤﻤﻲ اﻟﺬي ﻳﺤﺘﻞ ﻣﻌﻈﻢ‬ ‫‪clude most hemopoietic cells.‬‬ ‫اﻟﻤﻨﻄﻘﺔ‪.‬‬ ‫‪ In the newborn all bone marrow is‬‬ ‫‪ ‬ﻟﺪى اﻟﻮﻟﺪان ﻳﻜﻮن ﻛﻞ ﻧﻘﻲ اﻟﻌﻈﻢ ﻣﻦ‬ ‫‪red and active in blood cell produc-‬‬ ‫ﹰ‬ ‫اﻟﻨﻮع اﻷﺣﻤﺮ وﻳﻜﻮن ﻧﺸﻴﻄﺎ ﻣﻦ ﺣﻴﺚ‬ ‫‪tion, but as the child grows, most‬‬ ‫ﺗﻮﻟﻴﺪ اﻟﺪم‪ ،‬ﻣﻊ ﻧﻤﻮ اﻟﻮﻟﻴﺪ ﻳﺘﺤﻮل ﻣﻌﻈﻢ‬ ‫‪of the marrow changes gradually to‬‬ ‫‪the yellow variety‬‬ ‫اﻟﻨﻘﻲ إﻟﻰ اﻟﻨﻮع اﻷﺻﻔﺮ ﺑﺸﻜﻞ ﺗﺪرﻳﺠﻲ‪.‬‬ ‫‪ Under certain conditions, such as‬‬ ‫‪ ‬ﻓﻲ ﺑﻌﺾ اﻟﺤﺎﻻت ﻣﺜﻞ اﻟﻨﺰف اﻟﺸﺪﻳﺪ أو‬ ‫‪severe bleeding or hypoxia, yellow‬‬ ‫ﻧﻘﺺ اﻷﻛﺴﺠﺔ ﻳﻌﻮد اﻟﻨﻘﻲ اﻷﺻﻔﺮ إﻟﻰ‬ ‫‪marrow reverts to red‬‬ ‫ﺗﻮﻟﻴﺪ اﻟﺪم )ﻳﺘﺤﻮل إﻟﻰ أﺣﻤﺮ(‪.‬‬ ‫‪19‬‬ ‫‪19‬‬  ‫د‪.‬ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫ﹰ‬ ‫‪ ‬ﻳﺤﺪث ﺗﻜﻮن اﻟﺪم أوﻻ ﻓﻲ ﻣﺠﻤﻮﻋﺔ ﺧﻼﻳﺎ‬ ‫اﻷدﻳﻢ اﻟﻤﺘﻮﺳﻂ اﻟﻤﺤﻴﻄﺔ ﺑﺎﻟﻜﻴﺲ اﻟﻤﺤﻲ‬ ‫اﻟﺠﻨﻴﻨﻲ‪ ،‬وﻳﺘﺤﻮل ﺧﻼل ﺗﻄﻮر اﻟﺠﻨﻴﻦ إﻟﻰ اﻟﻜﺒﺪ‬ ‫اﻟﻨﺎﻣﻲ )ﺑﺸﻜﻞ رﺋﻴﺴﻲ( واﻟﻄﺤﺎل‪ ،‬وذﻟﻚ ﻗﺒﻞ‬ ‫ﹰ‬ ‫أن ﻳﺘﺮﻛﺰ ﻓﻲ اﻟﻌﻈﺎم اﻟﻤﺘﺸﻜﻠﺔ ﺣﺪﻳﺜﺎ ﺧﻼل‬ ‫اﻟﺸﻬﺮﻳﻦ اﻷﺧﻴﺮﻳﻦ ﻣﻦ اﻟﺤﻤﻞ‪.‬‬ ‫‪ ‬ﻳﺘﺸﻜﻞ ﻧﻘﻲ اﻟﻌﻈﻢ اﻟﻤﻜﻮن ﻟﻠﺪم ﻓﻲ اﻟﻌﺪﻳﺪ‬ ‫ﻣﻦ اﻷﻣﺎﻛﻦ ﺧﻼل ﻓﺘﺮة اﻟﺒﻠﻮغ وﻟﻜﻦ ﺑﻌﺪ ذﻟﻚ‬ ‫ﹰ‬ ‫ﻳﺼﺒﺢ ﻣﻘﻴﺪا ﺑﺸﻜﻞ ﻣﺘﺰاﻳﺪ ﺑﻤﻜﻮﻧﺎت اﻟﻬﻴﻜﻞ‬ ‫اﻟﻌﻈﻤﻲ اﻟﻤﺤﻮري‪.‬‬ ‫‪Red Bone Marrow‬‬ ‫ﻧﻘﻲ اﻟﻌﻈﻢ اﻷﺣﻤﺮ‬ ‫‪ Red bone marrow contains a reticu-‬‬ ‫‪ ‬ﻳﺤﺘﻮي ﻧﻘﻲ اﻟﻌﻈﻢ اﻷﺣﻤﺮ ﻋﻠﻰ ﻟﺤﻤﺔ‬ ‫ﹰ‬ ‫‪lar connective tissue stroma (Gr.‬‬ ‫ﺟﺰر‬ ‫إﻟﻰ‬ ‫إﺿﺎﻓﺔ‬ ‫ﻣﻦ ﻧﺴﻴﺞ ﺿﺎم ﺷﺒﻜﻲ‬ ‫‪stroma, bed), hemopoietic cords‬‬ ‫ﻣﻦ اﻟﺨﻼﻳﺎ )ﺣﺒﺎل ﻣﻮﻟﺪة ﻟﻠﺪم( وﺷﻌﻴﺮات‬ ‫‪or islands of cells, and sinusoidal‬‬ ‫دﻣﻮﻳﺔ ﺟﻴﺒﻴﺔ ‪sinusoidal‬‬ ‫‪capillaries.‬‬ ‫‪.capillaries‬‬ ‫‪ ‬اﻟﻠﺤﻤﺔ ﻫﻲ ﺷﺒﻜﺔ ﻣﻦ ﺧﻼﻳﺎ ﻣﻮﻟﺪة ﻟﻠﻴﻒ ‪ The stroma is a meshwork of special-‬‬ ‫‪ized fibroblastic cells called stromal‬‬ ‫ﺗﺨﺼﺼﻴﺔ ﺗﺪﻋﻰ اﻟﺨﻼﻳﺎ اﻟﺸﺒﻜﻴﺔ‬ ‫‪cells (also called reticular or adventi-‬‬ ‫‪ reticular cells‬وﺷﺒﻜﺔ رﻓﻴﻌﺔ ﻣﻦ‬ ‫‪tial cells) and a delicate web of retic-‬‬ ‫أﻟﻴﺎف ﺷﺒﻜﻴﺔ ﺗﺪﻋﻢ اﻟﺨﻼﻳﺎ اﻟﻤﻮﻟﺪة ﻟﻠﺪم‬ ‫‪ular fibers supporting the hemopoietic‬‬ ‫واﻟﺒﺎﻟﻌﺎت‪.‬‬ ‫‪cells and macrophages.‬‬ ‫ﺗﺮاﺑﻴﻖ)‪T:(trabeculae‬‬ ‫ﺧﻼﻳﺎ ﺷﺤﻤﻴﺔ )‪A:(adipocytes‬‬ ‫ﺟﻴﻮب)‪S:(sinusoids‬‬ ‫ﺣﺒﺎل )‪C:(cords‬‬ ‫ﺧﻼﻳﺎ )‪E:(endothelial cells‬‬ ‫ﺑﻄﺎﻧﻴﺔ‬ ‫‪20‬‬  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫ﹰ‬ ‫‪ Red marrow is also a site where‬‬ ‫‪ ‬اﻟﻨﻘﻲ اﻷﺣﻤﺮ ﻫﻮ أﻳﻀﺎ ﻣﻜﺎن ﻟﺘﺤﻄﻢ‬ ‫‪older, defective erythrocytes un-‬‬ ‫وﺑﻠﻌﻤﺔ اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ اﻟﻬﺮﻣﺔ أو اﻟﻤﻌﻴﺒﺔ‬ ‫‪dergo phagocytosis by macro-‬‬ ‫ﻣﻦ ﻗﺒﻞ اﻟﺨﻼﻳﺎ اﻟﺒﺎﻟﻌﺔ اﻟﻜﺒﻴﺮة اﻟﺘﻲ‬ ‫‪phages, which then reprocess‬‬ ‫ﺗﺴﺘﺨﻠﺺ اﻟﺤﺪﻳﺪ ﻣﻨﻬﺎ ﻹﻋﺎدة اﺳﺘﻌﻤﺎﻟﻪ‬ ‫‪hemebound iron for delivery to the‬‬ ‫ﻓﻲ اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ اﻟﺠﺪﻳﺪة‪.‬‬ ‫‪differentiating erythrocytes.‬‬ ‫‪‬‬ ‫‪Between the hematopoietic cords run the‬‬ ‫‪ ‬ﺑﻴﻦ ﺣﺒﺎل ﺗﻮﻟﻴﺪ اﻟﺪم ﺗﺠﺮي اﻟﺠﻴﻮب‬ ‫‪sinusoids, which have discontinuous endo-‬‬ ‫‪ sinusoids‬اﻟﺘﻲ ﺗﻤﻠﻚ ﺧﻼﻳﺎ ﺑﻄﺎﻧﻴﺔ ﻏﻴﺮ‬ ‫‪thelium, through which newly differenti-‬‬ ‫ﻣﺴﺘﻤﺮة )ﺑﺸﻜﻞ ﻃﺒﻘﺔ ﻣﺘﻘﻄﻌﺔ( ﺑﺤﻴﺚ ﺗﺪﺧﻞ‬ ‫‪ated blood cells and platelets enter the‬‬ ‫ﻋﺒﺮﻫﺎ اﻟﺨﻼﻳﺎ اﻟﻤﺘﻤﺎﻳﺰة إﻟﻰ اﻟﺪوران‪.‬‬ ‫‪circulation.‬‬ ‫ﺗﺸﺎﻫﺪ ﺑﻴﻦ اﻟﻤﻜﻮﻧﺎت اﻟﺴﺎﺑﻘﺔ ﺧﻼﻳﺎ ﺷﺤﻤﻴﺔ‪.‬‬ ‫ﻣﻜﻮﻧﺎت ﻧﻘﻲ اﻟﻌﻈﻢ اﻻﺣﻤﺮ‬ ‫‪ ‬اﻟﻠﺤﻤﺔ )اﻟﺠﺰء اﻟﺪاﻋﻢ(‪ :‬ﻧﺴﻴﺞ ﺿﺎم‬ ‫ﺷﺒﻜﻲ‪.‬‬ ‫‪ ‬اﻟﺒﺮاﻧﺸﻴﻢ )اﻟﺠﺰء اﻟﻮﻇﻴﻔﻲ(‪:‬ﺣﺒﺎل أو ﺟﺰر‬ ‫ﻣﻜﻮﻧﺔ ﻟﻠﺪم‪.‬‬ ‫‪ ‬أﺷﺒﺎه ﺟﻴﻮب دﻣﻮﻳﺔ‪.‬‬ ‫‪21‬‬ ‫‪21‬‬  ‫د‪.‬ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫ﺧﺰﻋﺔ ﻧﻘﻲ اﻟﻌﻈﻢ‪:‬‬ ‫‪ ‬ﻃﻔﻞ ﻳﺸﻜﻮ آﻻم ﺑﻤﻨﻄﻘﺔ اﻟﻘﺺ ‪/‬ﺑﺎﻟﻤﻔﺎﺻﻞ‪/‬ﺑﺎﻟﺴﺎﻋﺪ ﺗﻢ إﺟﺮاء ﺗﺤﻠﻴﻞ دم وﺗﺒﻴﻦ أن ﻟﺪﻳﻪ‬ ‫ﹰ‬ ‫ﹰ‬ ‫ﹰ‬ ‫ﻋﺪدا ﻛﺒﻴﺮا ﺟﺪا ﻣﻦ اﻟﻜﺮﻳﺎت اﻟﺒﻴﺾ وﺑﺎﻟﺘﺎﻟﻲ ﺳﺮﻃﺎن دم )ﻟﻮﻛﻴﻤﻴﺎ(‪.‬‬ ‫‪ ‬ﻳﺘﻢ إﺟﺮاء ﺧﺰﻋﺔ ﻧﻘﻲ اﻟﻌﻈﻢ ﻟﻪ وذﻟﻚ ﻟﻠﻜﺸﻒ ﻋﻦ ﺗﻮزع ﺳﻼﺳﻞ اﻟﺨﻼﻳﺎ ﺿﻤﻦ اﻟﻨﻘﻲ إن‬ ‫ﹰ‬ ‫ﻛﺎن ﻣﺘﺠﺎﻧﺴﺎ أم ﻻ وﺑﺎﻟﺘﺎﻟﻲ ﻣﻌﺮﻓﺔ اﻟﺴﺒﺐ اﻷﺳﺎﺳﻲ ﻟﻬﺬا اﻟﻤﺮض‪.‬‬ ‫‪ ‬ﺑﺤﻴﺚ ﻳﺘﻢ إدﺧﺎل إﺑﺮة ﺗﺮﻳﻔﻴﻦ ﻓﻲ اﻟﻘﻤﺔ اﻟﺤﺮﻗﻔﻴﺔ اﻟﺨﻠﻔﻴﺔ ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﻗﻄﻌﺔ ﺻﻐﻴﺮة ﻣﻦ‬ ‫ﻧﺨﺎع اﻟﻌﻈﻢ‪ ،‬وﺑﺎﻟﺘﺎﻟﻲ اﻟﺤﻔﺎظ ﻋﻠﻰ ﺑﻨﻴﺔ اﻷﻧﺴﺠﺔ ﻟﻠﺘﻘﻴﻴﻢ اﻟﻤﺠﻬﺮي اﻟﻼﺣﻖ‪.‬‬ ‫‪ ‬ﺗﻮﺿﻊ اﻟﻤﺤﻀﺮات اﻟﻌﻈﻤﻴﺔ ﺿﻤﻦ أﻣﻼح اﻵزوت وذﻟﻚ ﻟﺘﺴﻬﻴﻞ ﺗﻘﻄﻴﻌﻬﺎ ﻋﻠﻰ اﻟﻤﻴﻜﺮوﺗﻮم‬ ‫ﹰ‬ ‫ﺛﻢ ﺗﺜﺒﺖ ﻓﻴﺰﻳﺎﺋﻴﺎ وﺗﺤﻀﺮ‪.‬‬ ‫‪ ‬ﻳﺘﻢ أﺧﺬ ﺧﺰﻋﺔ ﻣﻦ ﻧﻘﻲ اﻟﻌﻈﻢ ﻣﻦ اﻟﺤﺮﻗﻔﺔ أو اﻟﻘﺺ‪.‬‬ ‫ﻣﻼﺣﻈﺔ‪ :‬ﻳﺘﻢ ارﺗﺸﺎف ﻧﺴﻴﺞ وﻟﻴﺲ ﺳﺎﺋﻞ‬ ‫‪Erythropoiesis‬‬ ‫ﺗﻜﻮن اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮاء‬ ‫اﻟﺘﻐﻴﺮات اﻟﻤﻮرﻓﻮﻟﻮﺟﻴﺔ أﺛﻨﺎء ﺗﻜﻮن اﻟﺤﻤﺮ‪:‬‬ ‫‪ Several major changes take place‬‬ ‫‪ ‬أﺛﻨﺎء ﺗﻜﻮن اﻟﻜﺮﻳﺎت اﻟﺤﻤﺮ ﺗﻤﺮ اﻟﺨﻼﻳﺎ‬ ‫‪during erythropoiesis. Cell and nu-‬‬ ‫ﺑﻤﺮاﺣﻞ ﻣﺨﺘﻠﻔﺔ ﻣﻦ اﻟﺘﻐﻴﺮات‬ ‫‪clear volumes decrease, while the nu-‬‬ ‫اﻟﻤﻮرﻓﻮﻟﻮﺟﻴﺔ‪.‬ﻳﺤﺪث ﺗﻨﺎﻗﺺ ﻣﻄﺮد‬ ‫‪cleoli diminish in size and disappear.‬‬ ‫ﻟﺤﺠﻢ اﻟﺨﻠﻴﺔ واﻟﻨﻮاة‪ ،‬اﻟﻨﻮﻳﺎت ﻳﺘﻨﺎﻗﺺ‬ ‫‪Chromatin density increases until‬‬ ‫ﺣﺠﻤﻬﺎ وﺗﺨﺘﻔﻲ‪.‬ﻛﺜﺎﻓﺔ اﻟﻜﺮوﻣﺎﺗﻴﻦ ﺗﺰداد‬ ‫‪the nucleus presents a pyknotic ap-‬‬ ‫‪pearance and is finally extruded‬‬ ‫إﻟﻰ أن ﺗﺼﺒﺢ اﻟﻨﻮاة ﻧﻘﻄﻴﺔ وﺗﺨﺮج ﻓﻲ‬ ‫‪from the cell.‬‬ ‫اﻟﻨﻬﺎﻳﺔ إﻟﻰ ﺧﺎرج اﻟﺨﻠﻴﺔ‪.‬‬ ‫‪22‬‬  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬  There is a gradual decrease in the ‫ ﻫﻨﺎك ﺗﻨﺎﻗﺺ ﺗﺪرﻳﺠﻲ ﻓﻲ ﻋﺪد‬ number of polyribosomes (baso- ‫اﻟﺠﺴﻴﻤﺎت اﻟﺮﻳﺒﻴﺔ اﻟﻤﺘﻌﺪدة )ذات اﻟﺘﻠﻮن‬ philia), with a simultaneous increase in the amount of hemoglobin (a highly ‫ وﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ ﻫﻨﺎك‬،(‫اﻷﺳﺎﺳﻲ‬ eosinophilic protein). Mitochondria ‫زﻳﺎدة ﻓﻲ ﻛﻤﻴﺔ اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ )ﺑﺮوﺗﻴﻦ‬ and other organelles gradually disap- (‫ﺣﺎﻣﻀﻲ اﻟﺘﻔﺎﻋﻞ ﺑﺸﻜﻞ ﺷﺪﻳﺪ‬ pear ‫اﻟﻤﺘﻘﺪرات واﻟﻌﻀﻴﺎت اﻷﺧﺮى ﺗﺰول‬.‫ﺑﺎﻟﺘﺪرﻳﺞ‬ ‫ﹰ‬ (‫)ﻓﻘﺮة ﻫﺎﻣﺔ ﺟﺪا‬:‫ ﻳﺠﺐ ﺣﻔﻆ ﺗﺴﻤﻴﺎت اﻟﺨﻼﻳﺎ ﻓﻲ ﻋﻤﻠﻴﺔ ﺗﻜﻮن اﻟﺤﻤﺮ وﺗﺴﻠﺴﻠﻬﺎ اﻟﺰﻣﻨﻲ‬  The distinct progenitor cell of the ‫ اﻟﺨﻠﻴﺔ اﻷوﻟﻰ ﻓﻲ ﺗﻜﻮن اﻟﺤﻤﺮ ﻫﻲ‬ erythroid series is the proerythro- ‫( ﻃﻠﻴﻌﺔ أروﻣﺔ ﻛﺮﻳﺔ ﺣﻤﺮاء‬1) blast, a large cell with loose, lacy ‫ وﻫﻲ ﺧﻠﻴﺔ ﻛﺒﻴﺮة ذات‬proerythroblast chromatin, nucleoli, and basophilic ‫ﻛﺮوﻣﺎﺗﻴﻦ ﻣﺨﻠﺨﻞ وﻧﻮﻳﺎت وﺳﻴﺘﻮﺑﻼﺳﻤﺎ أﺳﺎﺳﻴﺔ‬ cytoplasm..‫اﻟﺘﻔﺎﻋﻞ‬  The next stage is represented by ‫( أروﻣﺔ ﻛﺮﻳﺔ ﺣﻤﺮاء‬2) ‫ اﻟﺨﻠﻴﺔ اﻟﺜﺎﻧﻴﺔ ﻫﻲ‬ the basophilic erythroblast, with basophilic erythroblast ‫أﺳﺎﺳﻴﺔ‬ more strongly basophilic cytoplasm ‫ﺣﻴﺚ ﺗﻜﻮن اﻟﺴﻴﺘﻮﺑﻼﺳﻢ أﺳﺎﺳﻴﺔ ﺑﺸﻜﻞ‬ and a condensed nucleus with no visi- ‫ اﻟﺘﻠﻮن‬.‫أﻗﻮى واﻟﻨﻮاة ﻛﺜﻴﻔﺔ واﻟﻨﻮﻳﺔ ﻏﻴﺮ ﻣﺮﺋﻴﺔ‬ ble nucleolus. The basophilia of ‫اﻷﺳﺎﺳﻲ ﻟﻠﺨﻠﻴﺘﻴﻦ اﻟﺴﺎﺑﻘﺘﻴﻦ ﺳﺒﺒﻪ اﻟﻌﺪد اﻟﻜﺒﻴﺮ‬ these two cell types is caused by the ‫ﻣﻦ اﻟﺠﺴﻴﻤﺎت اﻟﺮﻳﺒﻴﺔ اﻟﻤﺘﻌﺪدة اﻟﺘﻲ ﺗﺒﺪأ‬ large number of polysomes synthe-.‫ﺑﺘﺼﻨﻴﻊ اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ ﺑﻨﺸﺎط‬ sizing hemoglobin. ‫ ﻓﻲ اﻟﻤﺮﺣﻠﺔ اﻟﺘﺎﻟﻴﺔ ﻳﺘﻨﺎﻗﺺ ﺣﺠﻢ اﻟﺨﻠﻴﺔ وﻋﺪد‬  During the next stage cell volume is ‫اﻟﺠﺴﻴﻤﺎت اﻟﺮﻳﺒﻴﺔ وﺗﺒﺪأ ﺑﻌﺾ ﻣﻨﺎﻃﻖ ﻣﻦ‬ reduced, polysomes decrease,and (‫اﻟﺴﻴﺘﻮﺑﻼﺳﻢ ﺑﺎﻛﺘﺴﺎب ﺗﻠﻮن أﺣﻤﺮ )ﺣﺎﻣﻀﻲ‬ some cytoplasmic areas begin to be- ‫ﺑﺴﺒﺐ ﺗﺮاﻛﻢ اﻟﻬﻴﻤﻮﻏﻠﻮﺑﻴﻦ ﻓﻴﻬﺎ وﺑﺬﻟﻚ ﺗﺤﺘﻮي‬ filled with hemoglobin, producing re- ‫ﻫﺬه اﻟﺨﻠﻴﺔ ﻋﻠﻰ ﻣﻨﺎﻃﻖ أﺳﺎﺳﻴﺔ اﻟﺘﻠﻮن وأﺧﺮى‬ gions of both basophilia and acido- ‫( أروﻣﺔ ﻛﺮﻳﺔ‬3) ‫ﺣﺎﻣﻀﻴﺔ اﻟﺘﻠﻮن وﻫﻲ ﺗﺴﻤﻰ‬ philia in the cell, now called a poly- Polychromato ‫ﺣﻤﺮاء ﻣﺘﻌﺪدة اﻟﺘﻠﻮن‬ chromatophilic erythroblast..philic erythroblast  In the next stage, the cell and nuclear ‫ﹰ‬ ‫ اﻟﻤﺮﺣﻠﺔ اﻟﺘﺎﻟﻴﺔ ﻳﺰول اﻟﺘﻠﻮن اﻷﺳﺎﺳﻲ ﺗﻤﺎﻣﺎ‬ volumes continue to condense and no ،‫وﻳﺒﻘﻰ اﻟﺘﻠﻮن اﻟﺤﺎﻣﻀﻲ ﻓﻲ اﻟﺴﻴﺘﻮﺑﻼﺳﻢ‬ basophilia is evident, resulting in a uni- formly acidophilic cytoplasm—the or- ‫( أروﻣﺔ اﻟﻜﺮﻳﺔ اﻟﺤﻤﺮاء‬4) ‫ﻫﺬه اﻟﺨﻠﻴﺔ ﺗﺴﻤﻰ‬ thochromatophilic erythroblast (also orthochromatophilic ‫ﻋﺎدﻳﺔ اﻟﺘﻠﻮن‬ called a normoblast.erythroblast (normoblast) 23.‫ ﻳﺘﻢ ﻟﻔﻆ اﻟﻨﻮاة ﻋﻠﻰ ﻣﺴﺘﻮى أروﻣﺔ اﻟﻜﺮﻳﺔ اﻟﺤﻤﺮاء ﻋﺎدﻳﺔ اﻟﺘﻠﻮن‬:‫ﻣﻼﺣﻈﺔ‬ 23  ‫ ﺑﻴﺎن ﻣﻜﺎﻧﺴﻲ‬.‫د‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬  Late in this stage, this cell ejects its ‫ ﺑﻌﺪ ذﻟﻚ ﺑﻔﺘﺮة ﺗﻘﻮم اﻟﺨﻠﻴﺔ ﺑﻠﻔﻆ ﻧﻮاﺗﻬﺎ )اﻟﺘﻲ‬ nucleus which is then phagocytosed by ‫ﺗﺰﻳﻠﻬﺎ اﻟﺒﺎﻟﻌﺎت( وﺗﺒﻘﻰ اﻟﺨﻠﻴﺔ اﻟﺘﻲ ﺗﺤﺘﻮي ﻋﻠﻰ‬ macrophages. The cell still has a small ‫ﺑﻘﺎﻳﺎ ﻣﻦ اﻟﺠﺴﻴﻤﺎت اﻟﺮﻳﺒﻴﺔ اﻟﻤﺘﻌﺪدة وﻫﺬه‬ number of polyribosomes that, when ‫اﻷﺧﻴﺮة ﻟﺪى اﺳﺘﻌﻤﺎل ﺻﺒﻐﺔ أزرق اﻟﻜﺮﻳﺰﻳﻞ اﻟﻠﻤﺎع‬ treated with the dye brilliant cresyl ‫ﺗﺒﺪو ﺑﺸﻜﻞ ﺷﺒﻜﺔ وﻟﺬﻟﻚ ﻫﺬه اﻟﺨﻠﻴﺔ ﺗﺴﻤﻰ اﻟﺨﻠﻴﺔ‬ blue, form a faintly stained network Reticulocyte ‫اﻟﺸﺒﻜﻴﺔ‬ and the cell is called the reticulocyte. ‫ وﻫﻲ‬reticulocyte ‫( اﻟﺨﻠﻴﺔ اﻟﺸﺒﻜﻴﺔ‬5)   Reticulocytes pass to the circulation ‫ ﻣﻦ اﻟﻜﺮﻳﺎت‬٪١ ‫ﺗﻌﺒﺮ إﻟﻰ اﻟﺪوران وﺗﺸﻜﻞ ﻫﻨﺎك‬ (where they may constitute 1% of ‫اﻟﺤﻤﺮاء‬ the red blood cells) (6) ‫ ﺳﺮﻋﺎن ﻣﺎﺗﺰول ﻣﻨﻬﺎ اﻟﺸﺒﻜﺔ وﺗﺘﺤﻮل إﻟﻰ‬  quickly lose the polyribosomes,and.erythrocytes ‫ﻛﺮﻳﺎت ﺣﻤﺮاء ﻧﺎﺿﺠﺔ‬ mature as erythrocytes. ‫ ﻛﻢ ﻳﺴﺘﻐﺮق ﺗﻜﻮن اﻟﻜﺮﻳﺔ اﻟﺤﻤﺮاء ﺣﺘﻰ إﻃﻼﻗﻬﺎ إﻟﻰ اﻟﺪوران؟‬  There are three to five intervening ‫ ﺗﺤـﺪث ﺛﻼﺛـﺔ إﻟﻰ ﺧﻤﺲ اﻧﻘﺴـــــــﺎﻣـﺎت ﺑﻴﻦ‬ cell divisions between the pro- ‫اﻟﺨﻠﻴـﺔ اﻷوﻟﻰ ﻓﻲ اﻟﺴـــــــﻠﺴـــــ ـﻠـﺔ )ﻃﻠﻴﻌـﺔ‬ erythroblast and the mature eryth- ‫أروﻣــــﺔ ﻛــﺮﻳــــﺔ ﺣــﻤـﺮاء( واﻟــﻜــﺮﻳــــﻪ اﻟــﺤــﻤـﺮاء‬ rocyte. The development of an erythrocyte from its first recog- ‫ ﻳﺤﺘﺎج ﺗﻄﻮر اﻟﻜﺮﻳﺔ ﺣﺘﻰ إﻃﻼق‬.‫اﻟﻨﺎﺿــــــﺠﺔ‬ nizable progenitor cell to the re- ‫اﻟﺨﻠﻴﺔ اﻟﺸــــﺒﻜﻴﺔ إﻟﻰ اﻟﺪوران إﻟﻰ أﺳـــﺒﻮع‬ lease of reticulocytes into the ‫ﹰ‬.‫واﺣﺪ ﺗﻘﺮﻳﺒﺎ‬ blood takes approximately 1 week. 24  ‫اﻟﺪم‬ ‫ﻋﻠﻢ اﻟﻨﺴﺞ اﻟﻌﺎم‬ ‫‪ The glycoprotein erythropoietin, a‬‬ ‫‪ ‬اﻟـــﻐـــﻠـــﻴـــﻜـــﻮﺑـــﺮوﺗـــﻴـــﻦ اﻻﻳـــﺮﻳـــﺜـــﺮوﺑـــﻴـــﻮﺗـــﻴـــﻦ‬ ‫‪growth factor produced b