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125 Cards in this Set
- Front
- Back
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-osis means
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increase
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-penia means
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decrease
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-leukoerythroblastic reaction
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immature WBC and RBC in peripheral smear. From metastatic marrow tumors, leukemia, polycythemia, infections
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-leukamoid reaction
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nonleukemic WBC > 50,000mm3 or differential count w/ < 5% metamyelocytes
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LAP
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leukocyte alkaline phosphatase- in neutrophil granules.
High in Leukemoid reactions Good to distinguish between Leukemia |
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Panic WBC high
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> 30,000mm3
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Panic WBC low
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< 500mm3
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Ground glass cytoplasm WBC
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monocytes
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granulocytes
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basophils, eosinophils, neutrophils
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agranulocytes
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lymphocytes & monocytes
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lavendar staining WBC
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Neutrophil
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Orange staining WBC
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Eosinophil
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Blue/Black staining WBC
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Basophil
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Nucleus binds basic/acidic dye and what color?
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Binds basic dye = Blue
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Cytoplasm binds basic/acidic dye and what color?
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Binds acidic dye = red/orange
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Panic WBC high
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> 30,000mm3
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Panic WBC low
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< 500mm3
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Ground glass cytoplasm WBC
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monocytes
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granulocytes
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basophils, eosinophils, neutrophils
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agranulocytes
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lymphocytes & monocytes
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lavendar staining WBC
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Neutrophil
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Orange staining WBC
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Eosinophil
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Blue/Black staining WBC
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Basophil
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Nucleus binds basic/acidic dye and what color?
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Binds basic dye = Blue
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Cytoplasm binds basic/acidic dye and what color?
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Binds acidic dye = red/orange
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agranulocyte with little cytoplasm
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lymphocyte
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horse-shoe shaped nucleus
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monocyte
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WBC order most to least common
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N - Neutorphils
L - Lymphocytes M - Monocytes E - Eosinophils B - Basophils |
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Neutrophil shift to left
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Increase in immature neutrophils, bands, due to bacterial infection
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Neutrophil toxic granulation
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severe burns and infections see dark granules in ctoplasm
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neutrophil hypersegmentation
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B12/Folic acid deficiencies
5+ Lobes |
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Atypical lymphocytes
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Due to viral infections such as mono
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Plasma Cells
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B lymphocytes make antibodies. Not seen in healthy adult peripheral smears.
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Early infection what happens to the granulocyte pools?
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WBC's leave circulating granulocyte pool and marginate. DECREASE IN WBC COUNT
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Masked Neutropenia
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Bone marrow increases WBC's due to margination however WBC count is still low due to margination
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when do the circulating and marginal granulocyte pools equilibrate?
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Late infections
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An increase in WBC's with a left shift is found in?
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Late infections
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Left shift of WBC's disappears during the _ stage of infection
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Recovery stage
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Thrombocytosis
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Platelets > 400,000. Increase in abnormal platelet function - thrombosis danger
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Thrombocythemia
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Platelets > 1,000,000. Spontaneous bleeding and thrombosis common w/normal aggregation.
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Thrombocytopenia
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Platelets < 150,000
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Normal Platelet Values
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140,000 - 4000,000 mm3
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Critical Low Value for Platelets
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< 50,000 - Spontaneous hemorrhage
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Neutrophil function
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Primary defense against microbial invasion. Puss formation. > WBC count
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Lymphocyte function
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T- Natural Killer cells. Cause apoptosis in tumor cells and infections
B- Plasma cells. Produce antibodies |
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Monocytes function
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Phagocytosis. Remove necrotic debris from blood
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Eosinophils function
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Parasites & Allergies
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Basophils function
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Phagocytose immune complexes. mast cells in tissues. Release histamine etc.
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Platelets function
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Blood clotting, vasoconstriction, carries serotonin, aids in healing of vascular endothelium
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Wright's Stain components
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Methylene Blue & Eosin. Stains nucleus and cytoplasmic structures.
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Relative WBC count
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% out of 100 WBC counted
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Absolute WBC count
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multiply the relative WBC count by the total WBC count.
Determines if have a sufficient # of specific cells |
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Stages of granulocyte maturation
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Blast - Pro - Cyte - Meta - Band - Segmented Cell!
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Myeloblast
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Non-granular cytoplasm and red round nucleus
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Promyelocyte
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Blast becomes granular
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Myelocyte
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Granules differentiate enough to be a basophil/eosinophil or neutrophil. Cell division is possible
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Metamyelocyte
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Slightly indented nucleus
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Band
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Indentation nucleus more than half
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Segmented cell
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Mature granulocyte
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General granulocyte maturation scene
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Nucleus gets smaller and absent
Nucleoli gets smaller and absent Cell size decreases Less cytoplasm |
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Abnormal neutrophil segmentation
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B12/Folate deficiency
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Basophil Granules Contain
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Heparin, histamine and serotonin
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Eosinophil Granules Contain
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Peroxidase, Major Basic Protein, Cationic Protein, Derived Neurotoxin
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Neutrophil Granules Contain
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LAP
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What do Nucleated RBC's do to the total WBC count?
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falsely elevate
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Normal ratio of CD4:CD8 T- Lymphocytes is
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>1.0
decreases to <1 for HIV/immune-compromised patients |
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What test is used to determine a leukemoid reaction from leukemia?
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LAP - High in Leukemoid Reactions, Low in Leukemia
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Platelet life span
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7-10 days
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Platelets formed in/by
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Bone marrow/Megakaryocytes
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Organs of platelet reservoir
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Spleen and Liver (25-30%)
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Patients with abnormal platelet counts are at risk for...
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50% > rate of malignancy (CML)
Spontaneous hemorrhage/thrombosis |
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Platelet interfering factors
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High altitude
Strenuous exercise estrogens Drugs Before Menses EDTA |
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MPV tells you the state of the...
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bone marrow
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Thrombocytopenia with Normally reactive bone marrow creates
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Large immature platelets
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Thrombocytopenia with Suppressed bone marrow creates
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Small platelets
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An unexpected increase in platelet count can indicate
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50% rate of malignancy/CML
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4 Myeloproliferative disorders
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Polycythemia Vera, Myelofribrosis, Essential Thrombocythemia, Chronic Myelogenous leukemia
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Myeloproliferative diseases definition
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Group of disorders with abnormal proliferation of one or more Bone Marrow hematopoietic cell lines
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Clonal expansion from a pluripotent stem cell is a unifying concept for
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Myeloproliferative diseases
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Polycythemia Vera definition
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Chronic myeloproliferative disorder characterized by increased HgB and RBC
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Relative Polycythemia Vera
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Due to low plasma volume (dehydration/burns)
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Reactive Polycythemia Vera
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Hypoxia (high altitude/lung disease)
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Myeloproliferative Polycythemia Vera
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O2 level of blood increased with low saturation of tissues. Raynaud's phenomonan
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Cells seen in Polycythemia Vera
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Panmyelosis
decreased EPO Dacrocytes |
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Myelofibrosis
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Idiopathic condition where the Bone Marrow becomes fibrotic
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Myelofibrosis etiology
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secondary to other conditions or from exposure to chemicals such as benzene, x-rays, gamma rays
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Cells seen in Myelofibrosis
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Leukoerythroblastic cells
Normocytic, normochromic Nucleated RBC's Dacrocytes |
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Essential Thrombocythemia
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Idiopathic platelet count increase above 50,00 with no other myeloproliferative features
(NO BM fibrosis, dacrocytes, philadelphia chromosome) |
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Chronic Myelogenous Leukemia - CML
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Leukemia characterized by a sustaine absolute lymphocytosis > 5,000
skyrocketing WBC Increased eosinophils/basophils |
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Consider Polycythemia Vera when you see these symptoms
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Frequent Pruritus
Red Face Hepatomegaly Splenomegaly Frequent Epistaxis Weakness, headache, fatigue, dyspnea |
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What Hematocrit levels do you suspect Polycythemia Vera?
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WHhite Males >52%
Females and Blacks >47% |
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What Hemoglobin values do you suspect Polycythemia Vera
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> 18g/dL white males
> 16g/dL blacks and females |
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EPO is increased in what kind of PV?
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Secondary/Reactive
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EPO is decreased in what kind of PV?
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Primary
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EPO is normal in what kind of PV?
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Relative
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Total RBC Mass is Increased in what kind(s) of PV?
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Secondary and Primary with a relative increase in relative!
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Peripheral Blood Picture for PV?
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Immature RBC & WBC
Anisocytosis & Poikilocytosis Dacrocytes or eliptocytes or microcytes Abnormal Neutrophilia Abnormal Thrombocytosis |
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Define Myeloid Metaplasia
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Extramedullary hematopoiesis - tissues that do not normally produce blood cells start producing blood cells (usu tissues that make in utero)
Liver and Spleen |
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When might myeloid metaplasia occur?
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Myelofibrosis
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What is the difference between the Peripheral blood picture of polycythemia vera and myelofibrosis?
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PV has marked aniso and poikilo, thrombocytosis
Myelofibrois has normocytic/normochromic anemia, Leukoerythoblastic cells |
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Essential thrombocythemia is easily distinguished from other myeloproliferative diosorders by:
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normal RBC mass
No dacrocytes No bone marrow fibrosis No philadelphia chromosome |
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Myelodysplastic syndrome CBC picture is
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< 30% blasts
Macrocytic anemia with anisocytosis Thrombocytopenia WBC's all over the place 5% blasts in PB Monocytosis |
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Consider myelodysplastic syndrome when you have
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fatigue
hepatomegaly splenomegaly increased bleeding anorexia abdominal fullness |
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ALL - Acute Lymphocytic Leukemia
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Most common children 3-5 years
Anemia Thrombocytopenia > 30% lymphoblasts in BM |
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AML - Acute Myelogenous Leukemia
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Adults
Anemia Thrombocytopenia AUER RODS > 30% Myeloblasts in BM |
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CLL - Chronic Lymphocytic Leukemia
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Middle-aged to elderly > men
SUSTAINED absolute lymphocytosis Low platelets Hepatomegaly General Lymphadenopathy |
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CML - Chronic Myelogenous Leukemia
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Ages 20-50. Rare Children
50% of patients with high platelets PHILADELPHIA chromosome Blasts in PB Basophilia Eosinophilia |
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Hairy Leukemia
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40-60yo Men
Neoplasm of B-lymphocytes Normochromic, normocytic Pancytopenia Hairy Cells |
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Hodgkin's disease characteristics
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Reed Sternberg Cells
Contiguous Lymph Nodes Pain with alcohol Fever Night Sweats Pruritus Slight Neutrophilia Eosinohilia Lymphocytopenia Thromocytosis Increased ESR and LAP Microcytic hypochromic anemia |
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Non-Hodgkin's disease characteristics
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In lymph nodes + tonsils/spleen/liver/GI
Non-contiguous spread Can be painless Anemia |
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Burkitt's Lymphoma
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Highly undifferentiated B cell lymphoma
Can be extra-nodal EBV Central Africa |
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Plasma Cell Disease's Characteristics
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Proliferation of one clone of plasama cells producing one immunogloulin (IgG mostly)
Multiple Myeloma & Waldenstrom's Macroglubulinemia |
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Multiple myeloma
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Plasma cell tumor in Bone Marrow
Monoclonal Ig URINARY BENCE JONES PROTEINS |
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Waldenstrom's Macroglobulinemia
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Expansion of plasma cells that normally secrete IgM.
Recurrent bacterial infections Raynaud's Hyperviscosity syndrome Rouleaux formation High ESR |
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TIBC - Total Iron BInding Capactiy
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Indirect measurement of transferritin. Measurement of all proteins that bind iron
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Serum Iron measures
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Iron bound to transferrrin
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Ferritin
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Major iron-storage protein, primarily in Liver.
Good indicator of iron stores in body 1ng/ml = 8mg of STORED IRON LEVELS BELOW 10-12 mg/dl BAD! |
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Stress does what to serum iron levels?
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Decreases by as much as 65%!
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What diseases increase TIBC?
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Polycythemia Vera
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What diseases decrease TIBC?
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Hypoproteniemia
Cirrhosis Hemoytic anemias |
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Anemia cut off level for pregnant female
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< 11g/dL
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Anemia cut off level for nonprego females
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<12g/dL
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Anemia cut off level for males
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<13g/dL
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What are the three most common causes of anemia?
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Iron deficiency, Thalassemia, Chronic Disease
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What binds free Hemoglobin
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Haptoglobin
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