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253 Cards in this Set

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A complete CBC will give you the percentage and absolute count which white blood cells and for which other elements in the blood?
platelets, RBC, WBC (neutrophils, basophils, eosinoophils, monocytes, lymphocytes), hemoglobin, hematocrit
list the red blood cell indices
MCV MCH MCHC, and RDW
MCV stands for
Mean corpuscular volume
what is the mean corpuscular volume
the average volume of the rbc
What is the formula for mean corpuscular volume
the formula for mean corpuscular volume is the hematocrit times ten divided by rbc
red blood cells that are smaller than normal are refered to as
microcytes
how big of a difference is there between males and females reference ranges for hematocrit
45%
What is the reference range for the number of RBC in the blood
4.0 X 10^12/L

or

4.0 X 10^6/mm^3
normacytes have an MCV of
80-100 fentolitesr
any rbc witht a MCV less than 80 is considered a
microcyte
The formula for MCH is
hemoglobin X 10 divided by the RBC count and is units are picograms
what is the reference range for MCH
27-33pico grams
what is a normal hemoglobin per dL of blood
15g/dL
MCHC stands for
mean corpuscular hemoglobin concentration, and it is a measure of the concentration of hemoglbin in a given volume of packed red blood cells
what is the formula for MCHC
hemoglobin/hematocrit X 100
a MCHC that is normochromic is
32-36%
an MCHC thtat is hypochrmoic is
below 32%
what causes hypochromic RBCs
decreased concentrations of hemoglobin
do hyperchromic rbc's exist
no
the instruments used to count RBC and WBC are called
Beckman Coulter and Sysmex
what are the partst to the coulter/sysmex analyzers
a diluter, analyzer, power supply, and data managment system
After samples are diluted in the coulter analyzer the samples go in cassets to the first bath where what happens?
The RBCs and platelets are counted
After counting the RBCs and platelts, the patient sample is sent to another bath where what is counted
WBC
the RBC and WBC bath counts in the coulter analyzer have to agree within
4SD
The cassettes in the Coulter LH500 use what type of bar code system and where are the codes
a double bar code system, one on the tube and one on the cassette
The coulter analyzer counts anything that is what size as RBCs?
greater than 36 fL
What is the coulter principle
uses electrical current to count and size particles
how does the coulter analyzer deterime the volume of a particle
the amount of electrical resistance, represented by a pulse
pulses are grouped by size and placed on a
histogram
on the coulter analyzer histogram what does the x and y axis represent
the x axis represents the MCV and the y axis the number of cells we have
what is the reference range for RBCs
4.0 X 10^6/mm^3
What is the reference range for WBC
7 X 10^3/mm^3
how does the coulter instrument calculate the MCV
it calculates the area under the curve
the coulter analyzer calles anything under what volume as platelets
2-20fL
platelets give what kind of curve
a skewed curve
the first curve generated by the coulter is a platelet curve called the
smooth curve
what three criteria have to be met for the smooth curve to be transformed to a normal curve
the mode has to be within 3-15fL, the platelet distribution width has to be less than 20%
how many heme groups does hemoglobin have
four
how many polpypeptide chains are those heme groups attached to in hemoglobin
4
what is the major ttype of hemoglobin in adults
HbA1
what are the types of hemoglobin
HbA1, HbA2, and HbF
what percentage of hemoglobin A1 do we have in our blood as an adult
97%
how many chains does hemoglobin A1 have
2 alpha and 2 beta
the beta chains consist of how many amino acids?
146 amino acids
what structural change in hemoglobin A1 causes sickle cell anemia
a single amino acid change
how many amino acids are there in the alpha chains of hemoglobin A1
141 amino acids
Hemoglobin A2 makes up what percentage of our hemoglobin
2%
how many chains does hemoglobin A2 have and what are their names
Hemoglobin 2A has four chains, 2 are delta, and 2 are alpha
what percentage of adult hemoglobin is comprised of Hemoglobin F and how many chains does it have and what re their names
Hemoglobin F comprises 1% of our total hemoglobin as an adult, it thas 4 chains, 2 gamma and 2 alpha
in order for the oxygen ot be carried on emoglobin what state does the iron moeity have to be in?
a plus 2 (ferrous) state
in hemoglobin determination
hemoglobin is convertetd to what using a potasium ferric cyanide,
cyanomethemoglobin
hematocrit goes hand in hand with what
hemoglobin
what is hematocrit
hematocrit is the number of packed rc in mm/whole blood in mm x 100
what does hematocrit measure
how much RBC you have in your blood
what is a short hand for obtaining the hematocrit from hemoglobin
hemoglobin times three plus or minus 3 percent
what is the formula for MCV
hematocrit times 10 divided by the RBC
what does RDW stand for
rdw stands for red cell distribution width
when looking at the RDW what else do you have to look at
MCV
what does the RDW measure
the RDW measures anisocytosis
what is anisocytisis
anisocytosis is variatin in size
what is the formula for the coefficeint of variation of the MCV
the SD divided by the mean times 100
what is the normal reference range for RDW
11.5-14.5%
how does the coulter measure the hematocrit
it measures the MCV and RBC then calculates the hematocrit
what is the most imature granulocyte
it is called the myeloblast
what is the ratio of nucleus to cytoplasm in the myeloblast
high n/c ratio
what is the color of a myeloblast cytoplasm
basophilic (blue)
where is the myeloblast found
inside the bone marrow
what is the stage after myeloblast
promyelocyte
what is the nuclear to cytoplasm ratio for a promyelocyte, and what is the color of the cytoplasm
the promeylocyte has a large n/c ratio, and its cytoplasm is basophilic
what is the major difference between the myeloblast and the promyelocyte
the promyelocyte is beginning to form granules
what is the various names for the granules within the promyelocyte
the granules are called non-specific, primary or azurophilic
what is the major enzyme found within the nonspecific granules of the promeylocyte
myeloperoxidase
where are promyelocytes normally found
within the bone marrow
what stage comes after promyelocyte
myelocyte
what is the nuclear to cytoplasm ratio for a myelocyte
the nuclear to cytoplasm ratio for a myelocyte is 50 to 50
what is the major difference between promyelocytes and myelocytes
the nucleas is relatively round, the chromatin is becoming more clumped, and the formation of secondary granules
what are the various names for the granules found within the myelocyte
secondary, specific,
where are myelocytes normally found
in the bone marrow
what is the stage that follows after myelocyte
neutrophlic metamyelocytes
what is the major difference between myelocytes and metamyelocytes
the nuclear chromatin are becoming more clumped and the nucleus will have an indent
where are neutrophilic metamyelocytes normally found
in the bone marrow
what is the stage after neutrophlic metamyelocytes
neutrophilic band
what is the major difference between the neutrophilic metamyelocyte and the neutrophilic band
the nuclear indentation is deeper than 2/3
where are neutrophilic bands typically found
outside the bone marrow
what is the stage after neutrophilic band
the band becomes a segmented neutrophil
what is the reference range for a seg
50-70%
what is the reference range for bands
0-6%
what is the reference range for lymphs
20-40%
what is the reference range for monos
3-11%
what is the reference range for eosins
0-5%
what is the reference range for basophils
0-1%
what cells comprise the marginal pool aka the mitotic pool for the neutrophil series
the myeloblast, promyelocyte, and the myelocyte
how lon gdoes it take for a cell myeloblast to go from blast tot myelocyte
4 days
what cells comprise the post mitotic pool for neutrophils
the metamyelocyte, neutrophilic band, the segmented neutrophils, these do not divide inside the bone marrow
how long does it take to go from neutrophlic myeloblast to segmented neutrophil
9 days
how long do neutrophils usually circulate in the circulating pool until they enter the tissues, unless theres an infection
8 hours
what is the usual ratio of marginal to circulating pool for wbc
50/50
what are the two examples that maser gave that could ofset the ratio of marginal to circulating for the wbc
women in labor, infection, and extreme exercise
what is a term for only a change in the marginal and circulating pool but not in the production of WBC
pseudoneutrophilia
what are the stages for eosinophils
they start the same as the neutrophil, you go from myeloblast, to promeylocyte, to eosinophilic myelocyte, to eosinphilic meta myelocyte, to eosinophilic bands, the eosinophils
eosinophils are usually involved in what types of reactions
parasitic infections and allergic reactions
what are the stages in the maturation of basophils
they go from myeloblast, to promyelocyte, to basophilic metamyelocyte, to basophilic band, to basophil
what are the three ways that neutrophils take care of bacterial infections
direct hit, acidic environment, and ionization of hydrogen peroxide
what size are monocytes
monocytes are 12-20um
how long do monycytes stay in the peripheral blood once released into the blood stream
about 70 hours
when moncytes enter the tissues what do they differentiate into and how long do they remain there
monocytes differentiate into macrophages in the tissues and remain there for several months
list the functions monocytes
they phagocytize cellular debri, the process antigens and present these to T cells, they release IL2 which stimulates T cells, and they produce interferon which protects against viral infections
what is the maturation series of a lymbocyte
lymphoblast, to prolymphocyte to lymphocyte
what types of lymphocyte are there
T cells and B cells
list the functions of T cells
T cells are involved with cell mediated immunity, IL-2 stimulates their prolifferation and differentiation of activated T cells, they have gamma interferon which may enhance NK cell motility
What are the functions of B cells
B cells diferentiate into plasma cells that secrete imunoglobulins
in the coulter machine, after the mixing cell the sample will go into the
flow cell
the process in which we put these white blood cells in single file is called
hydrodynamic focusing
a laser interrogates a cell for what three things once in the flow cell
volume, conductivity, and light scatter
how is the volume measured in the coulter using vcs technology
a direct or low frequency current is used to measure the impedance (resistance) which is proprtitonal to the volume of the cell. the resulting voltage pulse is proportional to the volume
how does the coulter measure conductivity using vcs technology
conductivity is measured using high frequency current which penetrates the cell to evaluate teh internal constituents such as granules and nucleur content
what information does scatter provide in the vcs
scatter provides information about cell shape, morphology, surface, characteristics, and granularity
where is the flow cell located
in the triple transducer module
on the graph generated from vcs where are the cells located
lymphs are in the bottom left, monocutes are higher than limphs bud they do not scatter as much light, neutrophils are in the center, nd they are the same size as monocytes but will scatter more light. eosinophils are on the top right
What does MPV stand for
mean platelet volume
what is the mpv
the mpv is the average volume of a platelt found under the curve once it has been fitted
what are the steps in the red blood cell maturation series
rubriblast to prorubricyte, to rubricyte, to metarubricyte to (if wright stain is used) polychromatophilic cell, or (if new methylene blue is used) reticulocyte, to finally erythrocyte
how does new methtylene blue work on rbcs
it preciipates out RNA so the cell can be seen better
at what stage is the nucleus of the red cell dead
at the metarubricyte, after this step the cell will loose the nucleus
what are the characteristics of a rubriblast
they have an open chrmoatin pattern, nucleoli, they are synthesizing RNA, they have ribosomes that synthesize alpha and beta polypeptide chains which are needed to make hemoglobin, the have mitochondria that synthesize ALA, and the are receiving iron but not sytnehsizing hemoglobin, only preparing for hemoglobin synthesis
what are the characteristics of the prorubricyte
it under goes RNA synthesis, and it is the beginning of hemoglobin synthesis
what is the major characteristic of a rubricyte
it is where the peak hemoglobin synthtesis takes place
the characteristics of a metarubricyte are
they are fully of hemoglobin, theyir nucleus is a degenerated mass, and the macrophages will phagosytize the extruded nucleaar material
RBC maturation takes how many dayas
4-6
how long does it take to form a reticulocyte from a rubriblast
72 hours
how long do reticulocytes normally circulate
24-48 hours
a mature RBC circulates for how long
120+ or - 20 days
what are the basic changes a RBC undergoes when it is maturing
the nuclear to cytoplasm ratio decreases, the chormatin clumps, nucleoli are lost, the cell decreases in size, and the cytoplasm goes from blue to pink
what are poikilocytes
they aare rbcs that vary in shape
what factors effect RBC shape
environment, age of cell, and metabolic status of cell
what are burr cells aka echinocytes
spiculated cells that have an even number of spicules (short and nubby) around the periphery of cells usually more than 10
what are the 2 causes of burr cells
a decrease in ATP, and an increase in fatty acid and change in pH
when do we see burr cells the majority of the time
in renal failure, when BUN (blood urea and nitrogen) and creatinine are elevated, indicating renal failure
what are acantyhocytes
they have 2-10 spicules that are not as evenly spaced around the membrane, the spicules are longer
what are the nunber one cause for acanthocytes
the stagnation of cholesetrol in the RBC membrane
spherocytes are
compacted smaller rbcs, without the central palor,
what happens when a cell has a foreign object on its membrane
the spleen sees it and phagocytizes it, but if the cell is young enough it can regrou and reform, but it will be small nd look like a spherocyte, the decreases surface to volume ratio means it has lost its surface
what are long oval shaped rbc, that occur when a cell gows through something like a narrow capilary
eliptocytes
what are schistocytes
fragmented RBCS caused by DIC and TTP
what are teardrop cells
teardrop cells are cells that are pulled in a certain direction (the fancy term is cryocytes)
what are stomatocytes
when the cells central palor is rectangular, this could be an artifact. In liver assays, if the ALT and AST is increased, then these stomatocytes are true
what causes sickle cells
cells that are losing oxygen,
what is sickle cell anemia
the 6th position of the beta chian in hemoglobin, which normally carries glutamic acid, but in sickle cell anemia it carries valine instead, so oxygen cannot be carried
what are target cells
target cells have a decreased hemoglobin (causing them to be hypocrhomic i.e. light in color) and an increased surface area creating a dome shape
what are pappenheimer bodies
they have iron inclusions that tend to cluster together at the peripheral of te cells
what stain is used as a confirmatory stain of iorn in pappenheimer bodies
prussian blue
howel jolly bodies are
howel jolly bodies contain a single cluster which is comprised of pieces of DNA
what is basophilic stippling
basophilic stippling is the precipitation of ribosomes, looks like the cell has thte measles. it is usually seen in lead poisoning cases
what is the size of a eosinophil
10-15 microns
what color are eosinophils
pinkishy orange
what is the function of a eosinophil
an eosinophil phagocytizes , but less so than does segs
how long do eosinophils survive in the tissues
6 days
after maturation where are eosinophils stored before being released into the peripheral blood
bone marrow
what is the size of a basophil
it is 10-15um
how long do basophils circulate
for about the same time as neutrophils which is 8 hours
what is thte function of a basophil
they participate in immediate hypersensitivyt immune reactions because their granules have hestamines and heparin
what are mast cells
basophils in the tissues are called mast cells
what is poikilocytosis
poikilocytosis is variation in shape
where are cells made in utero
liver and spleen
in utero when does the bone marrow become the major organ in the body that develops cells
the third trimester, 5 months
after birth where are the majority of cells made
the bone marrow
where can red active marrow be found
in the illiac crest, skull, sternum, proximal end of thte large bones, and the axial skeleton
what type of marrow are we interested in for bone marrow aspirates
red active marrow
what is the number one place for a bone marrow aspirate
the illiac crest
what is the number twto site for a bone marrow aspirate
the sternum
what is the number 2 place for a bone marrow aspirate
the sternum
when the bone marrow isn't working, how does the body compensate?
it starts to produce cells in the liver and the spleen like it did in utero
what is it called when a person starts to produce stem cells in the liver and spleen like they did in utero
hepatosplenaglmaly (enlarged liver and spleen)
what is the highest concentration of hemoglobin in utero
fetal hemoglobin
what chains comprise fetal hemoglobin
alpha and gama
what is the structure of heme
heme is a photophorphyrin ring with an iron in the middle
what starts out the heme synthesis pathway
succinyl CoA and clycine
protoporphyrin X ring plus ferrous =
heme
lead can stop the heme synthesis at how many places
3
90 percent of RBC metatbolism occurs via what pathway
the embden meyerhoff pathway
what is the final product of the embden meyerhoff pathway
ATP
what does ATP do for a RBC
ATP allows the RBC to maintain its biconcave shape, it gives flexibility to the RBC membrane, and provides energy for the sodium ptassium pump, the RBC has a high level of potassium in it and sodium outside
where does the RBC get the other 10 percent of its energy
the hexose monophosphate shunt, in order to keep the iorn moeity in the ferrous state
what does the rapaport-luberbering pathway produce
2,3 BPG
what is a quick but short term response to low oxygen tension
2,3 BPG
what does the MCV tell you
the average red blood cell size in fL
what does the MCH tell you
the hemoglobin amount per red blood cell in pg
what does the MCHC tell you
the MCHC tells you the amount of hemoglobin relative to the size of teh cell (hemoglobin concentration) per red blood cell in percent or g/dL
what are the units for RDW
%
What is the reference range for RBC in an adult male
4.6-6.0 x10^6/ul
what is the adult female reference range for RBC
4.0-5.4 x 10^6/uL
what is the adult male reference range for hemoglobin
14.0-18.0 g/dL
what is the adult female reference range for hemoglobin
12.0-14.0 g/dL
what is the MCV adult reference range for both males and females
80-100 fL
what is the adult male and female reference range for MCH
26-32 pg
what is the adult male and female MCHC reference range
32-36 %
what is the adult reference range for RDW male and female
11.5-14.5 %
what is the NRBCs reference range for both adult males and females
0 /100 WBC
what is the WBC reference range for adult males and females
4.5-11.5 x10^3/uL
what is the normal range for PMNs in a peripheral
50-70 %
what is the reference range for bands in the peripheral smear
0-5 %
what is the reference range for lymphs in the peripheral blood smear
18-42 %
what is the reference range for monos in the peripheral blood smear
2-11 %
what is the reference range for basophils in the peripheral blood smear
0-2 %
what is the reference range for eosinophils in the peripheral blood smear
1-3 %
what is the reference range for platelets
150-450 x10^3/uL
what is the reference range for MPV
6.8-10.2 fL
red blood cells that have a MCV less than 80 fL are
microcytic
red blood cells that have a MCV between 80-100 fL are
normocytic
red blood cells that have a MCV greater than 100 fL are
macrocytic
RBCs with a MCH less than 26 pg are
are hypochromic
RBCs with a MCH within 26-32 pg are
are normochromic
RBCs with a MCH greater than 32 pg are
hyperchormic
a measure of anisocytosis is
RDW
anisocytosis is
how much variation in size there is of those red blood cells
how do we get a feel for anisocytosis
RDW
what is the formula for RDW
1SD*100/MCV
what is the normal reference range for RDW
11.5-14.5%
what is the relationship between hemoglobin and hematocrit?
our hematocrit is are hemoglobin times 3 plus or minus 3 %
the most immature granulocyte is the
myeloblast
what is the morphology of a myeloblast
it is basically all nucleus, with a high nucleus to cytoplasm ratio, the cytoplasm is basophlic or immature (blue), the chromatin is very smooth and there may be a nucleolus
the myeloblast divides to form what cell?
the promyelocyte
what is the chromatin pattern for a promyelocyte?
smooth and homogenous
what is the difference between a myeloblast and a promyelocyte?
the promyelocyte shows the formation of granules
what are the three names for the granules within a promyelocyte?
non-specific (maser likes this name), primary, and azurophilic
what is the enzyme in the promyelocyte that maser wants us to know
myeloperoxidase
how big are the granules in the promyelocyte and wat color do they stain?
they are 0.5 microns and they stain black/purple/red depending on your eyes
what is the neutrophil maturation series?
myeloblast-->promyelocyte-->myelocyte-->metamyelocyte-->neutrophilic band-->seg/poly
when do we start tto see specific/secondary granules in the neutrophlic cell series?
at the neutrophilic myelocyte stage
what three cells in the bone marrow are considered to be in the mitotic pool
the blast, the pro, and the myelocyte
what about cells makes them part of the mitotic pool?
they can divide
how long does it take for the the myeloblast to develop into the myelocyte
4 days
which cells of the neutrophil series are considered to be post mitotic pool?
the meta, band and seg, when in the bone marrow
how long does it take for a metamyelocyte to mature to a seg and be released into the peripheral blood?
5 days
how long does it take for the neutrophlic cell series to complete?
9 days
what is the reference range for lymphs
20-40 %
what is the reference range for monos
3-11 %
what is the reference range for eosins
0-5 %
what is the reference range for basos
0-1 %
how long do segs stay in the tissues?
5 days unless there is an infection
what is the marginal pool?
the cells lining the vessels
which pool do we normally inform the physician about
the circulating pool
how long does the circulating pool normally circulate?
for about 8 hours then they go into the tissues and stay for up to 5 days
in what situations do we have more cells in thte circulating pool than the marginal?
in cases where the total white cell count increase, examples include women in labor for an extended period of time, infectiton,
what is the development series for an erythrocytet
rubtriblast--> prorubricyte-->metarubricyte-->polychromatic erythricyte if wright stain, or reticulocyte if methylene blue, then erythrocyte
how long do erythrocytes cycle
for about 120+/- 20
what facors affect the rbc shape
the environment (circulatory), the age of the cell, and the metabolic status of the cell
what is the morphology of a burr cell
a burr cell has an even number of spicules and it usually has more than ten, they are short and nubby
what causes burr cells/echinocytes
decreased atp and increased fatty acid and pH
what test would a physician order to check for renal problems
BUN
what test goes hand in hand with BUN
creatinine, if both are elevated there is some problem with renal function
what type of disorers are acanthocytes normally seen in
abetalipoproteinemia, post spleectomy
what is the major difference between burr cells and acanthocytes
acanthocytes have 3-10 spicules that are long and not evenly distributed