Hematology Exam 3

Front 1

normal WBC count

Back 1

5,000-10,000/mm3

Front 2

What is leukocytosis?

Back 2

>10,000 WBC

Front 3

What is leukopenia?

Back 3

<5,000 WBC

Front 4

Maturation series of granulocytes

Back 4

Myeloblast → promyelocyte → myelocyte → metamyelocyte (juvenile) → band → segmented cells

Front 5

What is the last stage of the granulocytic series that can perform mitosis?

Back 5

Myelocyte

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Other name for segmented neutrophil

Back 6

Polymorphonuclear neutrophil

Front 7

Normal relative value and absolute value of segs, bands, eosinophils, and basophils

Back 7

Segs – 50-70% or 2,500-7,000

Bands – 0-5% or 0-500

Eosinophils – 0-3% or 0-300

Basophils – 0-2% or 0-200

Front 8

What is the function of neutrophils?

Back 8

They respond to bacterial infections

Front 9

What is the function of eosinophils?

Back 9

respond to allergic/asthma reactions and parasitic infections

Front 10

What test is used to test adrenal function and involves eosinophils? Explain test

Back 10

Thorn test

Do eosinophil count, give the patient ACTH (should cause eosinophils to leave the bloodstream). Do second eos count. If adrenal gland works, eosinophils should be 1/2 of what they were at the start

Front 11

What is the function of basophils?

Back 11

Increased in delayed hypersensitivity reactions and affect IgE in chronic allergic reactions

Front 12

What do basophils become when they move into tissue?

Back 12

Mast cells

Front 13

What is increased in CML (chronic myeloid leukemia)?

Back 13

basophils

Front 14

What is the lifespan of neutrophilic cells

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Made in bone marrow, takes 10-14 days to progress from myeloblast to seg, and only spends 6-8 hours in the peripheral blood.

50% in CGP and 50% in MGP along vessel walls. Stress causes them to leave marginal and enter circulatory, but if they're not used they go back

Front 15

What is neutrophilia, and what might cause it?

Back 15

>7,000 neutrophils

Bacterial infections mostly, also fungal, viral, inflammation, and malignancies

Front 16

What is neutropenia, and what might cause it?

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<2,000 neutrophils

Infections, drugs, megaloblastic anemia (has pancytopenia)

Front 17

What is agranulocytosis and what normally causes it?

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<1,000 neutrophils

Drug induced (chemotherapy, etc.)

Front 18

What is eosinophilia and what causes it?

Back 18

>300 eosinophils

asthma/allergic reaction and parasite infections

Front 19

What is basophilia and what causes it?

Back 19

>200 basophils

CML, myeloproliferative disorders, hypersensitivity reactions

Front 20

What is wrong with WBC in toxic granulation and what causes it?

Back 20

Primary granules retain basophilia, causing them to be dark purple/black

Caused in response to toxic conditions like chemo, infections, drugs, or burn patients

Front 21

What causes vacuoles in WBC?

Back 21

Response to infections, drugs, chemo, and burns

Front 22

What are Dohle bodies and what causes them?

Back 22

They are remnants of RNA that stain blue in WBC and are caused by infections, chemo, drugs, and burns

Front 23

What is the toxic triad?

Back 23

Toxic granulation, vacuoles, and Dohle bodies seen together

Front 24

What is May-Hegglin anomaly and what is associated with it?

Back 24

Inherited condition, see Dohle-like bodies but larger that appear in nearly all segs, also see large and possibly bizarre platelets. No toxic granulation. Thrombocytopenia

Front 25

What are Alder-Reilly bodies and what are they associated with?

Back 25

Inherited, possibly Hurler's or Hunter's syndrome. See heavy azurophilic granulation in all segs and sometimes lymphs and monos. Abnormal mucopolysaccharade formation

Front 26

What is Chediak-Higashi and what causes it?

Back 26

It is delayed degranulation. Granules stain gray-blue or gray-green in granulocytes, and lymphs may have large red-purple granules. Inherited membrane defect of lysosomes. May see in photophobia and albinism

Front 27

What is Pelger-Huet and what are some causes?

Back 27

hyposegmentation of neutrophils

Myeloproliferative disorders (CML and acute leukemias) chemo therapy, burns

Front 28

What is it called when there are bi-lobed neutrophils?

Back 28

Pince-Nez form of Pelger-Huet

Front 29

What is hypersegmentation of neutrophils and what causes it?

Back 29

6 or more lobes of the nucleus. Caused by abnormal DNA synthesis seen in megaloblastic anemias and chemo patients

Front 30

What is chronic granulomatous disease (CGD)?

Back 30

Inherited disease caused by a defect in neutrophil metabolism. Neutrophils can phagocytize bacteria but then can't destroy them

Front 31

What test is used to detect chronic granulomatous disease?

Back 31

Nitroblue tetrazolium (NBT) to measure the killing mechanism of the segs

Front 32

What is leukocyte adhesion deficiency?

Back 32

Absence of adhesion proteins. WBC can't adhere to tissues so they keep moving on past the site of infection. Results in lack of pus formation and would healing

Front 33

What is myeloperoxidase deficiency?

Back 33

Lack of myeloperoxidase causes a lack of motility of neutrophils so they can't get to the site of infections

Front 34

List the maturation series of monocytes

Back 34

monoblast → promonocyte → monocyte → tissue macrophage

Front 35

What is the largest normal cell in peripheral blood

Back 35

monocyte

Front 36

Describe the nucleus, chromatin pattern, and cytoplasm of monocytes

Back 36

Nucleus is folded with brain-like convolutions.

Chromtin pattern is lacy.

Cytoplasm is blue-gray with granules that looks like ground glass

Front 37

What is a different name for a tissue macrophage?

Back 37

Histiocyte

Front 38

What are the normal values of monocytes in the peripheral blood and bone marrow?

Back 38

Peripheral blood: 2-8% and 200-800

Bone marrow: 2%

Front 39

What are 4 functions of monocytes?

Back 39

1. immune response

2. defense against fungi, bacteria, viruses

3. phagocytosis

4. motile, can respond to chemotactic factors and become macrophages

Front 40

What is the lifespan of monocytes?

Back 40

Made in the bone marrow, go to peripheral blood and stay 8-10 hours, then go into tissues and stay for several months as macrophages

Front 41

What is monocytosis and what can cause it?

Back 41

>800 monocytes. Indicates current infection, recovery from acute infection (like TB), or recovery after chemo

Front 42

What is monocytopenia and what can cause it?

Back 42

<200 monocytes. Drugs, steroids, chemo

Front 43

What are the qualitative abnormalities of macrophages?

Back 43

Gaucher's disease

Niemann-Pick disease

Tay-sach's disease

Sea blue histiocyte

Front 44

What is the deficiency in Gaucher's disease? What does this disease cause?

Back 44

beta-glucocerberosiadise

mental retardation and hepatosplenomegaly

Front 45

What do Gaucher cells look like?

Back 45

They have large folding cytoplasms and resemble crumpled tissue paper. See in bone marrow, liver, spleen, and other tissue

Front 46

How can Gaucher's disease be improved?

Back 46

Dietary restrictions

No cure

Front 47

What do Niemann-Pick cells look like?

Back 47

Also called "foam cells". They are macrophages with a foamy cytyoplasm and small eccentric nucleus. See in bone marrow and lymphoid tissue

Front 48

What is deficient in Niemann-Pick disease?

What does Niemann-Pick disease cause?

Back 48

Sphingomyelinase

Mental retardation and hepatosplenomegaly

Front 49

What is seen in Tay-sach's disease?

Back 49

In peripheral blood see vacuolated lymphs (sometimes) and cherry red macula in the eye

Front 50

What is deficient in Tay-sach's disease? What does it cause?

Back 50

beta-hexoamidase

CNS involvment, mental retardation

Front 51

What is Sea blue histiocyte?

Back 51

Might be subclass of Niemann-Pick disease. Blue green granules in macrophages, seen in liver, spleen, and bone marrow. Causes hepatosplenomegaly and neurologic abnormalities

Front 52

What is the maturation series of lymphocytes?

Back 52

Lymphoblast → prolymphocyte → lymphocyte → plasma cell

Front 53

How big is a small resting lymph?

Back 53

9 um

Front 54

Normal values of lymphocytes

Back 54

Adults: 18-42% and 800-4800

Children < 10 years have increased lymphs

Front 55

What are the functions of B cells?

Back 55

They are stimulated by antigens to become plasma cells and produce antibodies and are part of the humoral mediated immunity

Front 56

What percent of lymphs are B cells, T cells, and NK cells?

Back 56

B cells: 10-20%

T cells: 80%

NK cells: small %

Front 57

What are the functions of T cells?

Back 57

Part of cell mediated immunity. Respond to intracellular organisms like viruses, work to fight tumors, and have a role in delayed hypersensitivity reactions

Front 58

What are the primary and secondary lymphoid tissues?

Back 58

Primary: thymus

Secondary: spleen, tonsils, adenoids, lymph nodes, Peyer's patches in GI tract

Front 59

What is the life cycle of lymphocytes?

Back 59

Made in the bone marrow and primary and secondary lymphoid tissues. B cells stay in bone marrow to mature, T cells go to thymus to mature. B cells live 3-4 days, T cells can live 2-10 years

Front 60

What is lymphocytosis and what usually causes it?

Back 60

>4,000 lymphs. Caused by acute viral infections

Front 61

What are the symptoms of infectious lymphocytosis, and what are the WBC and lymph counts?

Back 61

GI symptoms

WBC 40,000-50,000

Small lymphs 60-70%

Usually children

Front 62

What is the WBC count in someone with pertussis?

Back 62

25,000-50,000

Front 63

What are some types of acquired lymphocytosis? (specific diseases)

Back 63

Infectious lymphocytosis

Pertussis

Infectious mononucleosis

Cytomegalovirus (CMV)

Toxoplasmosis

Front 64

What are the symptoms of infectious mononucleosis?

Back 64

WBC 12,000-25,000 (both relative and absolute lymphocytosis)

Lots of reactive lymphs

Decreased platelets

Enlarged spleen and liver

Malaise

Front 65

What virus causes mono?

Back 65

Epstein Bar Virus (EBV)

Front 66

What type of virus is the Cytomegalovirus (CMV)?

Back 66

Herpes virus

Front 67

What are the symptoms of cytomegalovirus?

Back 67

Absolute lymphocytosis

Reactive lymphs

Fever and malaise

Front 68

What do reactive or atypical lymphs look like?

Back 68

Bigger, up to 30 um. Blue cytoplasm, or may be peripheral basophilic. Cytoplasm might squeeze between RBC

Front 69

What is lymphocytopenia and what can cause it?

Back 69

<1,000 lymphs. Inherited immunodeficiency, drugs, chemo, radiation, AIDS

Front 70

What are some diseases that cause lymphocytopenia?

Back 70

SCID

Wiskott-Aldrich

DiGeorge

X-linked agammaglobulinemia

Plasmacytosis

Front 71

What is SCID?

Back 71

Severe combined immunodeficiency disease

T and B cells decreased, T cells almost gone

"bubble boy syndrome"

death before age 2

Front 72

What is Wiskott-Aldrich?

Back 72

X-linked recessive disease that affects T and B cells. Progressive decrease in T cells. IgM decreased but IgG normal

Front 73

What is DiGeorge?

Back 73

Deletion on the 22nd chromosome, T cells only are affected. Causes mental retardation and lots of fungal infections

Front 74

What is x-linked agammaglobulinemia?

Back 74

"Burton syndrome"

B cells affected, all Ig levels are decreased. Patients get bacterial infections and can be given IVIg for treatment

Front 75

What is formula for corrected WBC for nRBC?

Back 75

Corrected WBC = ((WBC)/(100+nRBC)) X 100

Front 76

What are acceptable sites for bone marrow biopsy?

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Posterior iliac crest

Sternum

Front 77

What are some indications a bone marrow specimen should be obtained?

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Last resort, can't figure out what's wrong

Pancytopenia

Staging for Hodgekin's and non-Hodgekind's lymphoma

Blasts in peripheral blood

Front 78

Describe the touch prep for a bone marrow biopsy

Back 78

Get core and gently roll between 2 slides (might do if you get a dry tap)

Front 79

What is a normal M:E ratio?

Back 79

3:1

Example: 60 myeloid : 20 nRBC

Front 80

What is the most common granulocytic cell seen in the bone marrow?

Back 80

Metamyelocyte

Front 81

In what cells is myeloperoxidase found in?

Back 81

Primary granules of granulocytes and azurophilic granules in monocytes

Front 82

What is the interpretation of the myeloperoxidase stain (MPO)?

Back 82

Granulocytes are strongly (+), monocytes weakly (+), lymphs (-)

>3% activity, AML (acute myeloid leukemia)

Front 83

What does the Sudan Black B (SBB) stain for?

Back 83

lipids present in the primary and secondary granules of granulocytes and azurophilic granules of monocytes

Front 84

What is the interpretation of the SBB stain?

Back 84

Granulocytes strongly (+), monocytes weakly (+)

>3% suggests AML

Front 85

What do you do if you see a lot of blasts in peripheral blood?

Back 85

MPO or SBB stain. If >3% it's AML, if <3% it's ALL.

If you get the (-) results (<3%) stop and call ALL. If (+), go onto specific or non-specific esterase stains

Front 86

How does the chloroacetate esterase stain work?

Back 86

"Specific esterase"

Stains for enzyme naphthol AS-D chloroacetate esterase

Granulocytes strongly (+), monocytes weakly (+) to (-)

Front 87

How does the non-specific esterase stain work?

Back 87

Stains for 2 enzymes: alpha-naphthol acetate or alpha-naphthol buterate

Monocytes strongly (+), granulocytes weakly (+) to (-)

Front 88

What does a (+) specific esterase test mean?

Back 88

AML: M1, M2, or M3

M4 is positive in both

Front 89

What does a (+) non-specific esterase test mean?

Back 89

AML M5

M4 is positive in both

Front 90

What does the Periodic Acid Schiff (PAS) stain for, and what is the interpretation?

Back 90

Stains for intracellular glycogen

RBC and precursors (-)

AML M6 (Erythroleukemia or DiGuglielmos) nRBC stain (+)

Normal lymphs weakly (+)

Lymph malignancies (ALL or CLL) stain (+) with blocking pattern

Front 91

What does LAP stand for?

Back 91

Leukocyte alkaline phosphatase

Front 92

How does the LAP stain work?

Back 92

Stains LAP enzyme in secondary granules of granulocytes.

Count 100 neutrophils and score 0-4 based on staining activity. Multiply scores by frequency and add up

Front 93

What are the interpretations of LAP stain?

Back 93

Normal: 20-100

Increased: leukomoid reaction, P-vera, pregnancy

Decreased: CML (close to 0), PNH, sideroblastic anemia

Front 94

What is a leukomoid reaction?

Back 94

Increased WBC of myelocytic line, usually due to infections. Left shift, may be confused with CML

Front 95

What is another name for the leukocyte acid phosphatase stain?

Back 95

TRAP stain (tartrate resistant acid phosphatase)

Front 96

What is the interpretation of the leukocyte acid phosphatase stain?

Back 96

All (-) is good (Normal cells are inhibited by the addition of tartrate)

Hairy cell leukemia stains (+)

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Back 97