 Ay ba't hindi nag-record? Ayyan, it's recording. Okay, so we discussed last time that your hematopoasis actively happened within your red bone marrow. So can somebody enumerate what are the sites of red bone marrow or the site of active hematopoasis? Miss Obreking, give me one. Sir Lim's book. Miss Manalo, give me one. Skull, sir. Skull, aside from Skull, it's completely menang yung tatlong S. Scapula and sternum. Scapula and sternum. What about Miss Lappie? What is the V? Isalang naman ata yung V. Ay, ay, ay, may vote. May iba pa lang. What is letter V, Miss Lappie? Two. One. Okay, let's go to Miss Lapore. Lapore, what is letter V? The vertebrae po, sir. The vertebrae. Wait lang. Parang may nakikita kong bagong picture. Ready ng ready na po si Mr. CMT. What is the other P, Mr. Montero? What are the other sources? The letter P in RSVP. Approximal long bones po, sir. And? And? Okay, nasa bintika papatakas. Ano yung nasa? Pelvis. Pelvis. Or your pelvis. So, try to practice it. You know how to start? Parang nagganga, minamasaj mo yung parang nagihilod ka. First, yung ribs papunta sa sternum, papunta sa Skull, pababa sa Scapula, pabunta ka sa Pelvis, sas nandun ka na sa proximal long bones. So, gawin nyo yun. Para siyang pataas ng isa. Isang hagod pataas. So, those are the different sites. We have your ribs, your RSVP. Your RSVP. But aside from that, there is also what we call extra medulari hematopovesis. So, medulari hematopovesis, we are talking about the bone marrow. But there are also extra medulari hematopovesis that is happening. And that is your liver, your spleen, and your lymph nodes. Okay? So, let us try to differentiate one from the other. Mr. Montero, please message me by this afternoon. Remind me to send you the notes for blood collection. Douted, sir. Okay. And aside from that, I will also be sending, unfair because if I will not be sending you the power point of this. So, since pinapamigay ang power point nito, papamigay ko din, kasi di naman aking. So, si-share ko sa. So, kumalmakayo at makinig ng mabutay. So, medulari versus extra medulari. Here's the thing, when you get a copy of the power point, check the notes. Hello. Okay. Niyong mga side notes niya kasi dun maraming pan-notes. And aside from that, I would highly appreciate if you don't print it as is. Parang, bag-lagin, bag-lagin, bag-lagin, bag-lagin, bag-lagin naman natin ng kontin effort. Itryin nyo siya, itransfer sa word. Okay. I can no longer do that for you guys kasi ang dami-kong prep na kailangan gawin for the prelims. And the prelims move Wednesday, Thursday, and Friday. Meaning to say, on why we will be meeting, on Tuesday, we will be meeting. And I want to be ready to, on why we will be having our luck with as we, about as time, we will be having our quiz in Kim and we will be having our quiz at the basis on Tuesday. Am I clear? Not at all. And then afterwards, okay, afterwards, will utilize the entire time. I'll let you choose. It's either we can take, for example, the quiz is 40 minutes or 30 minutes lang. And then we still have one hour left. So I'll give you the discretion, talk among yourselves. If we will be using that one hour for review, and when I say review, prepare your questions. I will be answering them. Prepare your questions of if there are any clarifications that you want to ask or that you need to be made during the discussion, we will allot that. Both for Hima and for Clinton. It's up to you if you would take that or you will just take it as a risk for if ever na merendin for that particular day. Okay. So moving forward now, okay, let me first differentiate medulari and extra medulari hematopoasis. So when we say medulari hematopoasis, the blood production, we are talking about the hematopoasis, the blood production happens within the bone marrow. Okay. Within the bone marrow. So it usually begins in the fifth month of the station all throughout your life. It is medulari hematopoasis. So sir, what are you trying to say? Extra medulari hematopoasis only happen if your bone marrow can no longer meet the body's requirement. Okay. Take for example, your liver, your spleen, your lymph nodes are performing different function as we are speaking right now. But in the event knock on wood, I don't believe on that, but you can knock on your wood. Okay. But in the event, take for example, that your bone marrow failed. Okay, your bone marrow failed. Your body would try to compensate. Okay. Using this particular organs, your liver, your spleen and your lymph nodes. And in this case, extra medulari hematopoasis means that the blood production now happens outside the bone marrow and occurs mainly on your liver and on your spleen. And usually, okay, in these cases, there are cases of hepatomegaly and splenomegaly. Sir, why hepatomegaly and splenomegaly? I hope it was already discussed in your histopath, the megaly, the atrophy, manganyan. Megaly is the enlargement of your enlargement of your organ. In this case, hepatomegaly, enlargement of your liver has splenomegaly, the enlargement of your spleen, trying to compensate the failing bone marrow. So this is usually due to bone marrow dysfunction or bone marrow is unable to meet the demands. Okay. In abnormal circumstances, take for example, the spleen, the liver and the lymph node can revert back to producing immature blood cells. And that is the case now of your extra medullary hematopoiesis. So I'll just copy this one. Okay. For those who are taking notes right now, which I would definitely appreciate, is this. Your bone marrow dysfunction and your bone marrow will be your hematolitic anemia and your aplastic anemia. Yan yung mga causes, examples. I hope, guys, you still read your rodac. Bumili kayo ng rodac. Mahali yan. Okay. You use it. Okay. You use it. Like what I was teaching some of the students. Okay. I talked to a couple of students already. What I always tell them is that even if you have the PowerPoint, okay. Even if the page number, Miss Lawrence, I cannot give you the page number. Just look for the chapter. Chapter four yan. Hematopoiesis. Okay. Chapter four is hematopoiesis. What do you mean na unavailable? Unavailable yung book. You can have the PDF. It's already been circulating in your batch. So you should have a copy of that. So resourcefulness. Okay. Resourcefulness. So the egg ng matal, the egg ng magdiscarate ang matalingo. Okay. So resourcefulness. So aside from that, aside from what I was saying, even if you, even if in the case, eventually you already have this ano na. You already have this PowerPoint. I want you guys to study it side by side with the topic on the book. For example, yung topic is yogsak. You are also going to read everything on the yogsak. Just to make sure that your nose are really enriched. Okay. So moving forward, okay. Naguhomili na naman. Bo ang gagigigil kasi ako pag, I mean, I want to help you, but I don't want you to get too comfortable na hindi niyo aaralin yung book. Parang nandun ako sa ganung dilemma. Na I want you to do well, but I don't want you to be tamad. Okay. So moving forward, okay. Bigin at the end of the day, deba. Mas worth it yung mga pinagihirapan nating bagay compared to those na dumadating na lang. Okay. So moving forward, let's go to the hematopoetic microenvironment. So the hematopoetic microenvironment, we're going now into the bone marrow. So in the bone marrow, we have your supply, semi-fluid matrix, which is the anchor for the development of your hematopoetic stem cell. HSC puyan ha. And the hematopoetic microenvironment is like an ecology. It's like a microenvironment na within your bone marrow. And they maintain, and they maintain the proliferation, the multiplication, and the differentiation of your, and the differentiation of your, and the differentiation of your stem cell. Okay. So what do we mean by that? The stromal cells that we will be talking about and the extra cellular matrix, they actually influence the stem cell if it will be multiplying, if it needs to become a red blood cell, if it needs to become a white blood cell, or omega carioside. Okay. If it needs to become omega carioside. Am I talking too fast? No po, sir. Anong nangyari sa, anon nyo, ang exam nyo. But parang ang lungkot ng mga bosses ninyo. Hindi naman kaya nagkape, children. Takatapos ng exam, pala naman po, lecture lang po. Okay. So let's talk about the microenvironment. Okay. Let's talk about the microenvironment. Each of this, the endothelial cell, the adipocytes. Okay. The endothelial cell, the adipocytes, they also have their own function. Like for example, let's go to the stromal cell. Okay. Your stromal cell includes your, the list goes on. Okay. The endothelial cell, okay, they perform, the endothelial cell are broad, ang dun yan sa book. Anong page ko to? Page 46. Okay. The endothelial cell are broad flat cells that form a single continuous layer in the inner surface of your arteries and vein. So, the endothelial cell, what do they do? They regulate the particle that enters and leaves the hematopoietic stem, the hematopoietic, yan. So, take for example, this is the sinus, this is the, this is the sinus. This is, this are your endothelial cell. Can you see it? Naki kita niya ba? Okay. This is your endothelial cell. Your endothelial cell is serving as a membrane. Okay. It is serving as a membrane. Membrane for what? Membrane for anything that will come in and will come out of your, my goal is at least to finish this until, ayan. Umpisan ko nang eritropoies if ever later, ha? So, again, the endothelial cell, makikisulat po tayo, it serves as a regulator of particles coming in and out of your, coming in and out of your, coming in and out of your hematopoietic spaces. Aside from that, okay, we also have your adipocytes. Adipocytes or your adipose tissue. Okay? Your adipose cell, your, fat cell or adipocytes. So, your adipose tissue on the other hand, maintains the volume of your bone marrow. Remember that, okay, what do you call the process whereby your red bone marrow becomes your yellow bone marrow, mislapus? What is the process that occurs when your bone marrow becomes now your, your yellow bone marrow, your red pala, your red bone marrow becomes your yellow bone marrow? Hello. What do you call that? Anong air know me po? And nico gets, my gosh. Sir, know me. Anong know me? Not me ba yan? Anong may? Okay. So, let's go to, miss Homan Tok. What do you call that process? Miss Jayzer. Jayzer me. Okay, what is the process? Anyone? Sir, try po. Let's meet later on. Retrogression. Correct. It is your retrogression. Okay? We call it retrogression. And by the way, naalala ko pala. Did you receive the, na na na? Did you receive the results of your clean chemlong quiz? Not yet po, sir. Nag, hindi nyo patyine-check TLC nyo. That's the reason why. I message you, ano oras ba ako nag-message? Around 3 a.m. ata for mga ganang, 3 a.m. Di ako makatulog eh. So, nag-manual check ako. Ya. Manual check na po yun. Again, bago nyo ako ulanin ng email, i-check nyo muna kung may mark na. Okay. At nakacross out, wala po yung mark. Please check it. Kapag hindi ko, kapag hindi ko, kapag hindi ko, hindi ko, pag hindi nalagyan, meaning today, I did not consider your answer. Okay. So, moving forward, actually the top is, the top scorers for that particular quiz was Martin and Montero, The Highest, and then followed by Navarrete, Top 2. The Top 3, we have a couple of students. We have Mungi. We also have Jose and Leibang. So, that was the results. So, you can check that later. Okay, later. So, moving forward, okay, so that, you call it retrogression. Okay. We call it retrogression. So, we also have here your, we also have here your, aside from adipose, regulating the ratio of your red bone marrow to your yellow bone marrow. It also secretes substances like your cytokines and growth factor. Okay, growth factor that will initiate or that will promote the proliferation of your hematopoietic stem cell. Hematopoietic stem cell. Okay. So, aside from that, we also have your macrophages. Of course, we already know what is the function of your your macrophages. Your macrophage is the phagocyte within your hematopoietic environment. And at the same time, we also have there your osteoblast and your osteoblast. Okay. Osteoblast born forming. Okay. Sabi na natin bone. Magbo-born ng bagong bone. Bone forming. And you also have your osteoblast. Okay. Nag-crash. So, nag-dysintegrate sa resorption. Okay. Bone resorption. Or, ya, bone destruction for the osteoblast. So, we also have here your extracellular matrix. So, we also have here your extracellular matrix. So, what I'm just trying to say here is that it's one of this. Okay. And dutilial, adiposite, meron silang function that they perform. Okay. In the extracellular matrix. Okay. In the extracellular matrix, their major role okay. Their major role is to provide is to provide your substances like fibronectin, your collagen, thrombospondin, your tinesin, your proctoglycans, which in turn helps in the differentiation of your, helps in the differentiation of your differentiation and proliferation of your hematopoietic stem cell. Okay. So, guys, your stromal cells and your extra cellular matrix are key for the proliferation and differentiation. So, kung mapapansin nyo pagsinabi natin stromal cell, lahat yan are different cell. When we say extracellular matrix, these are already substances that are in the extracellular portion of your hematopoietic, hematopoietic what is that term? Hematopoietic outside your hematopoietic hematopoietic spaces. So, we have your stromal cell and your extracellular matrix. So, moving forward, ayan, we have your adult lymphoid tissue. Your lymphoid tissue are part of what organ system. Sige na, try ko lang kung tanda. Your lymphoid tissues are part of what ano. Your lymphoid tissue are part of your part of your your your lymphatic system. Lymphatic system. I can smell ulam already. My gosh. Okay, it's part of your it's actually part of your lymphatic system. So, we have primary lymphoid tissue and we have secondary lymphoid tissue. So, primary lymphoid tissue. Guys, please remember this because you will be encountering this in immunology eventually. So, your primary lymphoid tissue are two. It's your bone marrow and your thymus. Two things that I want you to remember, guys. Okay? Number one, in the primary lymphoid tissue, two different things that I want to emphasize first is that in the bone marrow, B, bone marrow letter B that is the site of maturation or differentiation for your B cells. Are we clear? Diba, we have two types of lymphocytes, your B cells and your T lymphocytes. Your B lymphocytes will differentiate in the B bone marrow. Your thymus, you're in your thymus on the other hand, your T lymphocytes will differentiate in the T thymus. Reason why they are also called B cell and T cell are because of their site of differentiation. Are we clear? Are we clear? Okay. So, I don't know if you're answering, but yeah. We also have here the antigen-independent lymphopoiesis. So when I say antigen, independent lymphopoiesis, so with regards to whether there is a presence of bacteria, virus or parasite or any invading antigen, the lymphopoiesis, when I say lymphopoiesis, the production now of your lymphocytes occur in your B cell, in your bone marrow and your thymus. Are we clear? So we also have your secondary lymphoid tissue. Actually, spleen and lymph nodes are just a few. We have a lot, but I will not be discussing that not to bombard you anymore, but I will be leaving that to your, I will be leaving that to your immunology, but that actually should be mentioned during your anaphy. We have yung mga payers patch, the tonsils. Those are also part of your secondary lymphoid tissue. Your secondary lymphoid tissue, okay, so ganito yan. Again, your B cell differentiate in the bone marrow. Your T cell differentiate in the thymus. What will happen next? I hope you're not reviewing other ano. I will try to check if you have quiz today. So tatan ko yung mga susunod yung professor. I hope you're not using my time reviewing other things. Okay, I'll make you regret it. So in the secondary lymphoid tissue, okay, in the secondary lymphoid tissue, your spleen and your lymph nodes are a few examples. This is what happened. In the primary lymphoid tissue, your B cell in your bone marrow, your T cell in your T lymphocyte, will enter the blood. They will enter the blood and will populate the secondary lymphoid tissue. Meaning to say, the secondary lymphoid tissue does not, there is no hematopo, which is happening there. There is no hematopo, which is happening there. In fact, what happened is that the B cell and the T cell goes to your spleen, to your lymph nodes, like your your payers patch, tonsils, like every single lymph node that you can imagine, their B cell and your T cell, go there. Why, sir? In there, okay, your antigen-dependent lymphopoasis happen. Okay. Your antigen-dependent lymphopoasis happen there. So what do we mean by antigen-dependent? Dito na yung part, yung function ng lymphocytes natin, is to ganito kasi yan, yung lymphocytes natin, they can mature but they can be naive. Parang sabihin na natin, I will say it straight na lang, okay, so part of my analogy but this is it. Para yung matang, para siyang mature na tao na, sabihin na natin, of course, I'm not saying that primarital sex is good, but what I'm trying to say is that naive pa siya, okay, yung 30 years old na yan, mature na yan, pero na naive pa siya sa maraming bagay. Ignore, sabihin na natin, not ignorantin but kung bagay, hindi niya pa nai-encounter yung mga bagay-bagay sa mundo, okay? And for them, okay, ganon din yung mga bisel. Pag mature nila sa bone marrow at siya ka sa til infocytes, they want to they want to fulfill their purpose and the only way for them to fulfill that purpose is to expose themselves into organs where there are high traffic of antigen. So saan yung? Dun sa mga bone marrow, dun yan sa mga spleen, yun yan sa lymph nodes. So kung saan dumadaan yung mga bacteria, saan dumadaan yung mga abnormalities natin, doon sila. Nagigets pa ba ako? Yes, sir. Yes, sir. So, your secondary lymphoid tissue, okay, those are your secondary lymphoid tissue, to take for example, a mature bisel, sabi natin kanina, a mature bisel, ang pinakagol niya is to become a plasmacel. A plasmacel will not happen in the bone marrow. A plasmacel will only happen if that mature bisel was exposed to take for example, a virus, a bacteria. So the moment na ma-expose yan, dun lang siya magiging plasmacel. Dun lang siya mag for further differentiate. Okay? So, moving forward now, okay. So, let's move forward. So, roles of different organ ten hematopoiesis, let's go now to your liver, okay. Your liver, what is the function of your liver? Your, okay, hindi si liver ha, yung liver, okay. What is the function of your liver? It is the site of hematopoiesis if the bone marrow shuts down. Aside from bone marrow, we have your spleen, okay. What is the function? It's your med-sik, okay. It's your med-sik. Number one is metabolism, eto function ng liver. Metabolism of carbohydrates and lipids, excretion of bilirubin, detoxification of drugs and toxin, and synthesis of protein, okay. Aside from that, okay. They also are the recycling and the storage of your iron. What is the storage form of iron? Number one, storage form of iron is, okay, storage form of iron is this, transferent. Hello, are you there? Nariling nyo ba ako? Waitang, protein yung, protein yung, protein yung, protein, protein yung, protein, wait lang, balikta ako. Ah, wait lang ha, hindi ako mapakali e, ma, what is the storage form yung, ah, wait lang. Sigehanapin ko muna. Transferring is your transfer protein, transfer protein kaya transfer protein. Okay. Transfer protein, okay. So in your liver, okay in your liver we have there your, your iron reserves, okay. Your iron reserves. So, within your liver dun nag-recycle at nag-store. Remember your bilirubin when we discussed in clinical chem. Your bilirubin, after your hemoglobin, okay, your hemoglobin has hem, iron and globin. Your hem will be excreted as bilirubin. It will also be processed in the liver and the iron that is in the hemoglobin part will be recycled and will be stored. Okay. It will be stored back. Okay. It will be stored back. Aside from that, it also create, it also manufacture your coagulation factor. So, pakikitandaan na lang po yung functions ng liver natin. Okay. Please remember that, guys. Nagigat siya naman pagsinabi natin metabolism of carbohydrates and lipids. Those things kasi are way ahead of clinical chem. Magiging topic pa lang natin. So I'll leave it there nalang. Okay. So in the liver, okay, we have the sinusoids of your liver. These are the different, these are, these are the different cells that can be found in your liver. We have your cup for cell, which is the macrophage within your liver. We have your hepatocytes and we have your endothelial cells. Okay. We have your endothelial cell. So the, when it comes to ano, when it comes to, when it comes to your liver, liver is very important specifically because around 1.5 to 4 liters of blood pass through your liver. So the central vein, okay, the central vein in the liver is the site whereby all your blood flows in kaya nakakapag-function siya na, na nagdidetoxify, nakokolek nyo yung mga things that they need to metabolize and it need to store. Okay. That it need to store. So that is for your liver. Again, please remember, clear ba tayo sa liver? Are we clear? Are we clear? Or do I need to explain pa? Sir, yung sinusoids po ba yung basic structural unit ng liver? Hepatic sinusoid. Wait lang. I'll check kaya bishop. Iba kasi yung ano yung, basic unit yung tanumo na hindi yung cell. Yes, po sir. Correct na nga ba? The basic unit of your liver, the basic functional unit of your liver are your hepatic globule. Hepatic globule siya yung. Or hepatic sinus. Ayun. Your sinusoids, atan mo siya? Yan, yung sinusoid mo contains this particular ya, this particular cells. So sinusoids and I have to confirm that, Mr. Montero. Wait lang. Ya, I have to confirm if the functional unit of your yung functional unit kasi ng liver, kasama na yung portal anon do niy yung, tawag doon, yung anon natin. Yung yung hepatic artery, yung portal areas. Yung parang sa, yung sa hepatic. Portal triad. Yung hepatic triad. So I'll get back to you with that. Okay? So Okay, dito na tayo kay liver. Wala nang tanong sa liver aside sa, what is the basic unit? Basic unit of liver according to vision. Ano? Wala nang tanong. I'll move on na. Okay? So moving forward now, let's go to your spleen. Okay? When we go to your spleen. Okay, one moment. Okay, let's go to your spleen. So spleen is the largest secondary lymphoid organ. I just want to be clear with that ha. Not the largest lymphoid organ, but the largest secondary lymphoid organ. Because the largest lymphoid organ would have to be your bone marrow. Okay? Pakisulat na lang po yan kasi kahit ako, wag kay, wag tamarin magsulat. Kasi even if you get this power point, wala yung part na yun na sinabi ko sa power point. So the spleen once again is the second largest lymphoid, secondary lymphoid organ. So it receives 350 ml of blood. It synthesizes your imunoglobulin M and it stores about 30% of your total platelets. It stores 30% of your total platelets. So some of the platelets are circulating some of the 50% on the other hand. Okay? The other 50% are within your the other how many? 70% is circulating. 30% nakastore. Okay? So this is your have you seen a have you seen a spleen? Spleen naman kayo ng histopat ay histology, tama. We have your white pulp and your red pulp. Familiar. Pagafamiliar. Okay, so we have the exterior. So we have the peritonium. We have the peritonium. So the peritonium is the external layer of your spleen. We also have in the interior that is a mixture now of your white pulp and your red pulp. So the connective tissue capsule which is your white pulp and your white pulp contains your lymphocytes, your macrophages and your dendritic cells. Okay? Your periarticular lymphatic sheets contains your nodules containing B lymphocytes. Okay? They contain B lymphocytes. On the other hand, we also have here your red pulp. Your red pulp whereby we can see here your cord of bilroth which is a specialized macrophage. Please write it down on your notes that your spleen is also known as the graveyard of your RBC. The graveyard of your RBC. When we go to your RBC your RBC anomalies, we will be discussing your calling and your pitting. Okay? Your calling and your pitting. Calling means calling means the destruction of your entire cell. Okay? The destruction of your entire cell. Or your red blood cell to be exact. So your cells are phagocytized and are degraded by the different organelles in the red pulp. Aside from that pitting, will cost the removal of inclusion or damage surface membrane of a particular red blood cell. So how does it happen? I don't have my pen right now at mo lang nang 730 pa siya nagsususulat. So take for example okay please remember that anything that any red blood cells matanda, pangit, matanda, mapangit at mataba. Okay, yung tatlong M yung matanda, mapangit at mataba. Lahat ng matanda, mapangit at mataba that will pass through the spleen will either go through calling or pitting. Again, spleen is the graveyard of your red blood cells. Your white pulp is where most of your B cell and your T cell are situated. Sir, why do we have B lymphocytes here? This is where the proliferation take for example, sabi natin kanina di ba your spleen synthesizes immunoglobulin M where specific part in the white pulp because that is where your B lymphocytes are contained. Your red pulp on the other hand contains your specialized macrophage that are responsible in the calling and in the pitting of red blood cells. This is very evident okay, this is very evident in your Heinz bodies. In your Heinz bodies. Heinz bodies. Okay, so let me just get so that I can explain it better. Pardon my drawing but I am going to draw today. Take for example, this is your RBC. One more time. Take for example, this is your RBC. Maliparin. One more time again. Take for example, this is your RBC. We know that your RBC should be by concave in shape. If it is 3M, if it is matanda, meaning to say, matanda, mapangit. Okay, pinilit ko lang ha and mataba, meaning to say it is old senescent already. Mapangit meaning to say they have abnormality in the particular red blood cell. If it is mataba, meaning to say it already swelled, it already nag-swell na yung cell. Once it pass through your cell, take for example, this is your blood vessel. And these are your and these are your RBCs. Your RBCs that will be passing through the cell. Take for example, this is your spleen. This is your spleen. Take for example, it pass through there. It pass through your spleen and then will go out on the spleen. Take for example, just for the sake of illustration, just have the accurate part. So if they pass through it, if they are so spleen will be checking. Okay, spleen will be checking if a particular particular red blood cell is already within the within the within the spleen, they will check the criteria. How old are you? Are you old? Are you ugly? Do you have abnormality? Do you have abnormality? Are you already swelling? If all of those are are clear and then the red blood cell can just simply pass through the spleen, okay? And live for another day since she will be waiting for a, she will be waiting for 30 days pa. Okay? I want 130 days, rather. 120 days. Take for example, we have here your Heinz Bodies. What are Heinz Bodies? I'll explain Heinz Bodies when we reach your RBC abnormality. But in, in short, a Heinz Bodies kasi meron siyang danyan. Meron siyang mga Heinz, eto kay Heinz Bodies. There are inclusions on the surface of the cell. Okay? To take for example, la la la la la dumaan siya, it went it went to your spleen. Okay? It went to your spleen. So what happened now is that we have your RBC under interrogation alongside with its with its inclusion. And then the cycle will go on. Is it old? Not yet. Is it ugly? Well, there is abnormality. Is it ano? No. So what will happen is that your macrophage will try to eat out this one. Okay? They will try to eat that particular part of the red blood cell. So what will happen now? They will try to eat that. They will try to remove that. They will try to remove that. Leaving now your red blood cell. Okay? Leaving now your red blood cell like this. Parang kinagat na donut. That's why in cell we also have your bite cells as we call it. Okay? This is your bite cell. Okay? This will now become your bite cell. Your bite cell goes to live another day. Okay? So go out of the it will go out of the spleen. Okay? But the thing here after that bite cell room around again. So what will happen is that okay? In here what will come? Okay, sorry. Ang hirap naman mag-drawing. This is here on the notes. Wait, I'll transfer to my demonstration. Okay? So take for example this is your your bite cell now will once again go to your your bite cell will once again go to your take for example this is your bite cell. Okay? Dami nyo ng kagat-kagat sa paligid-ligid. The moment that your bite cell enters again. Okay? This is take for example your bite cell. If for example bite cell enter your your spleen again. Okay? By the way, nakalimutan ko sabihin. Takakawento ko. The process of removal, yung unang nangyari, that is piting. Okay? That is called splenic we call that splenic piting. Okay? That is from the that RBC that RBC with inclusion bodies now becoming your what? Now becoming this RBC here becoming now that RBC there RBC, oh sorry that RBC becoming your what? Becoming your bite cell? bite cell. Okay? Ayaw hindi ko magawa so drawing ko nalang ulit your bite cell. Okay? So that is splenic piting. Okay? Spiting lang siya. Yung ganyan na nangyari this is splenic piting. Mas matagal pa po yung pagdodrowing nyo sir. Habi nila. Okay? That is splenic piting. But the moment that this one enters into your spleen once again it's final destination. Okay? What will happen now is your splenic calling. Okay? Are we clear? So again graveyard of your RBC. Are we clear? Hello? Are we clear? Yes sir. Okay? So that is splenic that is calling eh sorry that is calling and that is piting. Sir? Yes? It needs to attain po yung tatlong yung mapangit. Ang duality, yung old na po. As in, kailangan yung tatlong yun as in attain na siya muna before siya makal, hindi naman, hindi naman kasi take for example. So piting po kait old na siya. I am sorry. That's the reason why usually naman din kasi our red blood cells start to get old. It will also start to swell. Okay? It also will start to swell. That's why but stan nandun siya, it's either pating or calling yung mga yari. Okay? So by the way, hiper splenism is the enlargement of your spleen that result to pancytopinya. Okay? What is pancytopinya despite pancytopinya? Okay, pancytopinya is low. All your blood are, all your blood cells are low. Pancytopinya. Anong kabaliktara ni pancytopinya? Sige nga kung natatandaan nyo pa. Lahat ng ngaalalan yung pinagdidiskas natin clean chem hema. PV, what is PV? Your polycythemia vera. Correct? Your polycythemia vera. But akala natin maganda, no? Because it's my gosh, hindi nag-record. Why? It's recording. So that is for your spleen. Are we clear? May tanong papuba before we go to lymph nodes? Do we have any questions? Please ask your questions now. Please. Do you have any questions? No, sir. Let's move on now to your lymph nodes. Your lymph nodes in tagalog. What is the tagalog of lymph nodes, Mr. Jose? The answer is, I don't know, sir. Okay. What is the tagalog term for, ano? It's your kolani. Okay, kolani. So it's your, it's not beke, beke is mums. J.M. anong pinagasabipong beke? Beke namin? Beke namin? Beke is mums. Okay. And beke is not a swelling of the lymph nodes but a swelling of the parotid gland or the salivary gland. Apakitandaan yan ha? Mums is not the swelling of lymph nodes but the swelling of your parotid gland. Okay. So mums. So going now to lymph nodes. So lymph nodes, what is the function of your lymph nodes? It is the function of lymphocyte proliferation. Similarly, okay, similarly to your ano, similarly to your, what do you call this? Similarly to your spleen, okay, similarly to your spleen, your lymph node also is an avenue whereby B cell and T cell go there. They go there so that they will be exposed to antigen because that is the only time that they get to serve their purpose because becoming a plasma cell for the B cell and becoming a cytotoxic T cell or a T helper cell for the T lymphocytes. Are you getting me there? So ako, take for example, let me just make my self as an example. I am planning to I want to move out so that I would be able to like fully become an adult because whenever you feel like you're still on the bone marrow in the thymos of your parents, you feel like you're still being protected, like for me, there is still part of that sense of responsibility that need to improve in me. So similarly to your B cell, ganon din sila even if they are already mature mature B cell, mature T cell they would need to go to secondary lymphoid tissue for them to encounter their one and only antigen, okay? Parang ganon, ang jok din natin, you cannot find a partner if you confine yourself and isolate yourself on a box. Well, I think now it can happen, you have all the dating apps, but for the lymphocytes it's not going to happen like that. They need to go into the pool where antigens are in there, okay? So IGM, okay? So processing of immunoglobulin, okay? Processing of immunoglobulin and so to speak, please remember that part of your memory cells, okay? Part of your memory cell, when actually memory cell, hindi siya yung memory cell na nakakatanda ng information. Well, it's like that. But memory cell are your plasma cell will become your memory cell so they also filter debris in your bacteria, okay? So these are like the lymphatic system, okay? Are usually the comprise of your lymph nodes that filters your blood from any debris or your bacteria, okay? That is why this is a perfect part for B cell and T cell to go to because they will be exposed to different antigens here, okay? They will be exposed to different antigens here. In addition to that, we have your lymph, okay? Your lymph is what? Your lymph is a fluid portion of blood that escape into connective tube which are low protein and there is absence of there is absence of there is absence of RBC. One moment lang, okay? There was an advisory from SMART NPLDT that there will be interruption until September 30, 5am. Buto nalang 5am kasi yung exam niyo magstart ng 7.30am, okay? So moving forward, okay? So moving forward that is your lymph node and one nice thing to know adenitis, okay? Adenitis is the infection of your lymph nodes so moving forward, let's go now to your basic region of your lymph node. One moment lang guys, I'm just, it's okay pala, I don't have to rush, okay? Kasi meron papalatayos sa Tuesday if ever na kulangin ako nang time sa Thursday sa bukas, it's okay pala I don't have to rush, okay? Kasi meron papalatayos sa Tuesday at Thursday sa bukas sa Eretropoasis may time pa naman ako. Okay? Anyways, okay. Okay, I'll be finishing in time most. Two slides away from that. So your lymph nodes and then we'll go to systematic and constant error. So lymph nodes the three basic regions are your cortex, your paracortex and your medala. Your cortex contains your germinal centers and this is an active site of B-cell proliferation. Your paracortex contains your T-cell and your macrophages and your medala contains your B lymphocytes and your plasma cells, okay? Your plasma cell. So meaning to say, this are actively okay, dun sa cortex in the cortex, they are actively multiplying in the paracortex in the paracortex, these are now your T-cell and lymphocytes. I don't know if you I hope you appreciate the beauty of the lymph node, no? Kasi ang galing ng pagkakagawa ng lymph node. Why? Because in the germinal area take for example, let's go to your cortex. Take for example, this is your paracortical. So this is your cortex. This is your cortex here. This is the proliferation. Imagine that the antigen are encountering this this cell. We have antigen presenting cell. Immuno kasi medyo sobrang fascinated lang ako sa ganon. So your B-cell now your B-cell will be encountering the lymphocytes, the antigen the bacteria, the virus and then will be presenting them in the paracortex. Once they are presented in the paracortex to the bilimphocyte. The bilimphocyte will now become the bilimphocyte will now differentiate into becoming your plasma cell. So even the layering has its purpose. Has its purpose. They identify it. They ID they identify that those are antigen in the T-cell they actually would release cytokines T-helper cells cytotoxic T-cell to initiate the production of your antibodies. So yan si Lymphnose bakitandaan yung regions and last but not the least is the thymus. Thymus is the site for the proliferation of your T lymphocytes. They populate the primitive lymphoid cell populate in the thymus. Remember what we mention that thymus is the what thymus is actually one of the well-developed organ in your infant. Your well-developed organ in your infant. So I guess guys, you will also do your best in reviewing for the prelim exam. So this one so it retains the capability to produce T lymphocytes and its size are related to age. It actually atrophies. So as you grow older your thymus grows smaller and smaller and smaller and smaller. Are we clear? Clear po tayo. Okay, do you have any questions with regards to our discussion for today? Because I'm finished. Do you have any questions? Sir, Sir, Miss Magtotoffer. Miss Magtotoffers. Yes. Sir, yung Heinz bodies ko, sir. Ano ko bang ano nang, sir? Sir, kasi nakalimutan mo ata kasi nag-pocus kasi kainik tsaka sa... Ayung Heinz bodies talaga, hindi ko pa yung explain. Okay, sir. So yung Heinz body will be explained naman when we go to RBC anomaly. Okay po. So merong enzyme na kulang sa loob kaya nagkaraon ng ganon. Miss Leyba, what is your question? Sir, yung sa storage form po ng iron? Ferritine. It is your ferritine. Thank you po. Yung functional unit yun pa rin yung hindi. Kasi and lobules kasi dito, lobules dito, okay, bishop. Okay, anyways. Ay but nakikita yung pala. Okay. Anyways, so let's go not to your carry na. Okay. Si Aziba nan dito? Are you here? Yes, sir. Okay. So first, I hope you already saw di ano na, I hope you already saw, dalawang ulit ko, pangatlo na pala. Ay hindi pang-apat kasi it's the fourth time. Wait lang, I'll just try to stop the recording.