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96 Cards in this Set

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Q: Describe the steps involved in the hematopoietic system.
-first site of hematopoeisis is the yolk sac
-then after a few months (1-3), the stem cells migrate from yolk sac to liver and spleen, after 5 months in utero, goes to bone marrow which is where it remains throughout life
Q: What happens in myelofibrosis?
-disease/malignancy in which fibroblasts infiltrate bone marrow and lay down collagen, basically shove out hematopoietic tissue, when do bone marrow tap, take out nothing (dry tap), just collagen in there
-leads to extramedullary hematopoesis
Q: What is extramedullary hematopoesis?
-occurs when get DEC bone marrow activity and liver/spleen take over for the bone marrow producing of red cells
-liver and spleen have stem cells that are just sitting there and they become stimulated to make red cells
Q: How does the bone marrow differ from someone who is sixty years old compared to someone who is six years old?
-more fat as you get older
Q: What are the various stages of red cell production?
-erythroblast (rubiblast) -> prorubricyte -> rubricyte -> metarubricyte -> reticulocyte -> RBC
-first 4 have a nucleus (nucleated reds)
Q: What are the characteristics of erythrocyte series as they mature?
-cells get smaller as it ages
-nucleus:cytoplasm (N:C ratio) DEC as they mature
-youngest cells have very basophilic cytoplasm (dark, bluish) and as they mature, cytoplasm lightens up, mature cells has pinkish cytoplasm due to Hb
-chromatin condenses as mature
Q: Where are nucleated RBCs found?
-found in bone marrow normally, do not see these in normal peripheral blood smears, on occasion you will see retics (0-1.5%)
Q: When staining how do you differentiate retics from RBCs?
-in normal peripheral blood, will not be able to recognize retics compared to mature RBCs because of the staining (Wright stain)
-Wright stain shows all RBCs staining pinkish
-use supervital stain for retics, exemplifying RNA and ribosomes
Q: Describe retics in the body.
-retics in normal person are excreted and shed from bone marrow a day early and at that time they are about the same size as normal red cell, if earlier than one day they are bigger and they can be recognized
-retics make up 0.5-1.5% of all circulating WBCs
-have residual RNA and ribosomes
Q: How is absolute retic count calculated?
-(retic count X red cells), normal is 50,000
Q: When is it best to use absolute retic count?
-in patients with anemia, we would expect the absolute count to be elevated way above normal, giving a value of ~= 5%, probably the best test (other than bone marrow aspiration) in looking for erythropoiesis
-use to find out if the bone marrow is compensating and putting out enough red cells for that patient
Q: What does it mean to be basophilic?
-stains with basic dyes (dark blue in color)
-RNA present (metabolically active cell) (ex: plasma cell)
Q: What are some general characteristics of RBCs?
-biconcave, depression in the center (called a central pallor which has very little Hb in the center)
-very pliable, can go through small spaces
-in patients with Sickle cell anemia, very rigid RBCs and they are not pliable
-average size is 7.2 microns
Q: Describe the appearance, cause/interpretation and diseases associated with Hypochromic (leptocytes).
-DEC in light absorption (looks like the RBC is cleared out), area of central pallor is huge
-% of Hb in the RBC is less than normal, can be measured by MCHC
-iron deficiency, thalassemias
Q: What is secondary polycythemia?
-abnormal INC in red cells resulting from excess production in bone marrow, occurs in change in alttitudes and smoking, this would also show normal to elevated Hct
-caused by natural or artificial INC in production of erythropoietin
Q: Describe congenital spherocytosis.
-proteins in RBC membrane calledc spectrin and ankyrin are abnormal, can tell it is congenital because see a lot (60%) in the blood, however this can also be an artifact of preparation, these cells have a DEC SA:V ratio
-seen in hemolytic anemias, can also be artifacts
Q: What role does liver disease have on RBC size?
-liver disease leads to cholesterol higher production and leaking, which goes and sticks to the blood cells, causing them to enlarge, leading to macrocytes
Q: What are polychromatophilic cells?
-is one which has the tendency to stain with basic and acid dyes
-a form of polychromatophilic cells are red cells that are large with a blue tinge, which are shift retics, which are reticulocytes that are released from the bone marrow a day early
Q: What are shift retics?
-shift retics are released a day before normal so it takes 2-3 days for them to mature, shift retics are therefore larger than a normal RBC and have residual RNA
-this is done to properly compensate for anemia
Q: Describe hemolytic anemia.
-anemia due to hemolysis
-red cells being destroyed, so bone marrow compensating by puuting out more retics, so keep working backwords, maybe even blast cells, generally speaking, low retic count means anemic
Q: Describe the clinical features seen in iron deficiency.
-hypochromia (3-4+), normal cells, macrocytes and microcytes (anisocytosis 2-3+), and even lymphocytes
-elevated RDW
Q: Describe target cells.
-see them in iron deficiencies, thalassemias, sickle cell anemias, instead of dimple in center they have a peak, they are artifacts and manufactured in slide preparation, if don’t dry blood smears quickly, can possible get cells that look like target cells
Q: Describe macrocytes.
-tend to have more Hb than normal red cells -> makes them hyperchromic
-MCV > 100
Q: What would happen to MCV in a patient with vitamin B12 deficiency and is macrocytic?
-MCV of 120-130, highly elevated
Q: How is it possible that a sample be macrocytic but have a normal MCV?
-MCV may in normal range which could mean there is a combination of macrocytes and microcytes, if that occurs, the MCV may be normal but the RDW should be high and that should suggest that there are 2 populations of big cells and small cells
Q: What are Howell-Jolly Bodies?
-remnants of DNA, staying positive
-Seen in severe cases of anemias, leukemias, and splenectomies (because the spleen cannot pit them, which means it goes in and takes out the occlusions), usually just one per cell
-cause the cells to be larger than normal
Q: What are Cabot rings?
-figure 8 ring, inclusion in the red cell, seen in severe anemia
Q: What is Basophilic stippling?
-seen where there is a defect in Hb synthesis, like thalassemias
-seen in lead poisoning (can be seen in lower SEC populations because they eat paint)
-not retics, because can’t see retics in Wright stain, but see basophilic stippling in a Wright stain, super vital staining allows us to see retics
Q: What is a ringed sideroblast?
-have blue staining granules in the nucleated reds, these blue stains are iron granules that are deposited in mito that line the periphery of the red cell -> this is a normal process that occurs, but when it gets to be too much, that’s where the problem is
-iron is taken up and is necessary for Hb synthesis which takes place in mito, where iron is incorporated in the Hb (mito)
-indicators of abnormalities of heme synthesis, specifically in the incorporation of iron and only seen in bone marrow, never in peripheral blood, indicating a young cell
-use Prussian blue stain to stain iron
Q: What does iron in the mito affect?
-affects ALA synthetase (ALA made from succinyl-CoA and glycine)
Q: What are Pappenheimer bodies?
-iron deposits in mature RBCs, found in phagosomes and mito, look like Howell-Jolly bodies
Q: What are Heinz bodies?
-blue dots seen only in special methylviolet stains, presence suggests unstable Hb
-found in G6PD deficiency
Q: Why are Heinz bodies found in G6PD deficiency?
-G6PD is responsible for maintaining levels of NADPH, NADPH is used to maintain glutathione levels to protect RBCs against oxidative damage (reduces glutathione which maintains proteins in the reduced state)
-if they aren’t reduced they form disulfide bonds which attract macrophages to remove them resulting in hemolytic anemia
Q: What are Rouleaux?
-RBCs that stack on top of each other giving them a stacked coin appearance
-seen in patients with high plasma levels (multiple myeloma)
Q: What is multiple myeloma?
-cancer of plasma cells
-monoclonal disease (plasma cells produce only one type of Ig uncontrollably)
-see elevated levels of serum protein up to 13 grams (normal is 6-8)
Q: Why do you get rouleaux formation in elevated serum proteins?
-because of zeta potential (which is that negative charge around the red cell (net negative charge) and when have proteins that distribute themselves around the red cell, get DEC zeta potential and so that causes the red cells to get closer together and stick together, no more charge pushing
Q: What charge do cells have?
-cells in body have a negative charge because of sialic acid
Q: What is agglutination?
-antigen-Ab reaction or just red cells clumping together
-this is significant because when you count these cells, the # of red cells counted is DEC because the counting machine has a orifice and the clumps won’t go through, look at hct
Q: Describe cold agglutins?
-normal Abs that react with cells in colder temperatures, the red cells clump in colder temps (but really can be room temperature)
Q: What are schistocytes?
-fragmented cells
-red cells can go through clothesline-effect from vascular walls being broken and having fibrin hanging out
Q: Where are schistocytes found?
-seen in microangiopathic hemolytic anemias (MAHA), includes DIC (disseminated intravascular coagulation), TTP, HUS (hemolytic uremic syndrome), prostethic valves
Q: Describe tear drop cells?
-seen in normal peripheral blood, but in DEC numbers
-found primarily in myelofibrosis (myeloid metaplasia) and in certain types of leukemias and occasionally in very severe anemias
Q: Describe stomatocytes?
-if there are many, they probably hereditary which is quite rare, occasionally get slight hemolytic anemia (primarily artifact)
Q: Describe eliptocytosis?
-hereditary kind in which the majority are elipitical shape, person may have some problems, but usually perfectly normal, shape different
Q: Describe Acanthocytes?
-look like schistocytes, have projections coming out of them
-indicator of abetalipoproteinemia
Q: What is abetalipoproteinemia?
-do not produce a lot of cholesterol, which is normal component of the cell membrane, interferes with normal absorption of fat and fat-soluble vitamins from food, can’t make lipoproteins
Q: Describe crenated cells and burr cells.
-have spiny projections that are evenly distributed
- seen in renal failure
Q: What happens to the cells in sickle cell?
-in DEC O2 tension, will see sickling of cells, very common to see target cells associated with this
Q: What are the different forms of sickle cell?
-there is an S form and a C form
-CC (Hb crystals, less severe than SC, seen in African Americans, 2nd most common Hbopathy, get INC viscosity and DEC filterability)
-SC (less severe than SS, has copy of both C and S, look rod-like, C interacts with S to produce some of the abnormalities/symptoms seen in SS)
-SS (sickled cells)
Q: In a patient with nucleated reds and elevated retics, what is happening?
-bone marrow is not doing its job, would see elevated RDW, normal MCV
-if the patient bone marrow is not compensating we would expect to see severely anemic and elevated retic count
Q: What is the M:E ratio?
-myeloid:erythroid (nucleated reds) ratio, normally 3:1
Q: Describe the frequency with which we see lymphocytes in the bone marrow.
-take up 5% of total cells in bone marrow, most reside in the lymph nodes (adults) and mature in the thymus, in children, find lymphocytes in thymus, but by the time hit puberty, very little found there
-in the cortex there are the germinal centers in the lymph nodes (B lymphocytes predominant in cortex) while T cells are at junction between cortex and medulla
Q: What do plasma cells do?
-function to make antibodies
-mature B cell
-will find less than 2% in bone marrow
-Chromatin material is very clumped, but clumped in bundles, Cytoplasm is very basophilic, because it is metabolically active cell, See paranuclear halo (which is the Golgi, plasma cells have very active Golgi (add carb to Igs))
-indicator of some type of monoclonal disease
Q: Describe monocytes?
-make up 2-3% of all the cells in the bone marrow
-majority of white cells in bone marrow are granulocytes, myeloid series in various stages of development
Q: What are blasts?
-first recognizable cell that we see in the myeloid series, normally not found in peripheral blood (presence suggests there is some underlying disease (maybe leukemia))
-big cell, high N:C ratio, blue color (the younger the bluer), loose chromatin
Q: What is Poikocytosis?
-difference in shapes of cells
Q: Describe promyelocytes.
-big cells
-first appearance of granules
-high N:C ratio (lower than blasts)
Q: Describe myelocytes.
-smaller cell, chromatin starts to condense, high N:C, but nucleus is starting to elongate and gets a flattened side, still has the ability to divide
Q: Describe metamyelocytes.
-can no longer divide
-nucleus has elongated, oval looking, start seeing an indentation in the nucleus (signature features of this cell), chromatin is still condensing
Q: Describe band or stab cells.
-immediate precursor to the mature neutrophil, normally find 10% in peripheral blood smear, larger indentation than meta
-up to 10 bands are normal, any more then called a left shift
Q: Describe neutrophils.
-60-75% in peripheral blood (predominant WBC in peripheral blood)
-3-5 lobes to nucleus, anything more is hypersegmented
Q: What do left shifts show?
-are probably bacterial shifts, but if it is viral infection or fungal see lymphocytosis (INC in lymphocytes)
-indicates more immature cells than normal
Q: What are the two types of mononuclear cells?
-lymphocytes and monocytes
Q: Describe lymphocytes.
-make up 35% of total WBC in peripheral blood
Q: What is a reverse dip?
-when there are more lymphocytes than neutrophils (or when there is lymphocytosis and neutropenia)
-normal dip has more neutrophils than lymphocytes
Q: Describe monocytes.
-5-6% in peripheral blood
-cytoplasm has a gray-blue appearance, nucleus is not segmented or folded, not usually indented, chromatin material is a cross between what we see in lymphocytes and blasts
-made in bone marrow, found in peripheral blood stream and in transit to other organs and tissues where they mature into macrophages
Q: What does the presence of vacuoles in monocytes mean?
-presence indicates infectious process is occurring
Q: Describe eosinophils.
-0-3% in peripheral blood
-granules contain proteins and antihistamine
-seen in the allergic response and parasite infections
-the control system for allergies, if have too much histamine, will have anaphylactic shock, so eosinophils go there with their antihistamine to control the amount of histamine
Q: Describe basophils.
-0-1% in peripheral blood, found in the smallest number in peripheral blood stains
-has big, dark granules that contain histamine and heparin
-become mast cells
Q: What are mast cells?
-are involved in allergic reactions because they bind IgE Ab and release the histamine into the blood stream, they are found around blood vessels in the tissues (paravascular)
Q: What happens if CBC comes back with elevated basophils?
-probably leukemia (specifically myelogenous leukemia)
Q: How does the CBC look for a bacterial infection?
-elevated neutrophils, bands
Q: How does the CBC look for viral infection?
-lymphocytosis, 40% lymphocytes, white count can vary from person to person (can be elevated (leukocytosis), normal, or depressed (leucopenia)), look at differential
Q: Describe atypical lymphocytes.
-found in everyone, at least a few, up to about 5-6%, Have a very soft cytoplasm, so it can mold to other cells
-INC in viral infections
Q: 19 y/o patient isn’t feeling good, no energy, sleeps all the time, what do you think of?
-think of infectious mono, caused by EB virus, so do a CBC: White count is normal. Differential shows lymphocytosis and 20% atypical lymph -> this suggests infectious mono! Other viral infectious could be the cause as well -> but anytime viral infection, see increase in atypical lymph most of the time
Q: Describe Chediak Higashi disease.
-large granules in neutrophils
-genetically inherited (autosomal recessive), in which individuals have fusion of the lysosomes, delayed killing and delayed degranulation, pt with this disease are susceptible to infection. treat prophylactically
-toxic granulations present (suggest bacterial infections)
Q: Describe Chronic Ganulomas disease (CGD).
-Inherited disease, 1:250,000 live births, sex linked in males
-Mutation in 1 or more of the proteins in the NADPH oxidase complex, affects all neutrophils, monocytes, macrophages, and eosinophils
-Cannot generate oxidative species for killing, these cells take up pathogens but can’t kill them, so get granulomas. Patients die from overwhelming infection
-Defect occurs in the lymph nodes, liver, and skin
-Get abscesses everywhere – brain and lungs
-Something like Strep can’t kill patient because doesn’t need oxidative process to be eliminated
-Patients are incapable of developing a respiratory burst, lack NADPH oxidase
Q: What is nitrotetrazolian blue assay?
-agent that in the presence of supraoxide anion turns from yellow to blue. In lab, can isolate neutrophils, maintain and culture and stimulate them, then feed them this solution and wait 45 minutes incubation, stain the cells and look at neutrophils and see if they have taken up, if they have, see a blue dye precipitating in cytoplasm, means that the neutrophil is functioning and producing supraoxide anion
Q: What is an Auer body?
-Sliver in a blast cell, presence suggests acute leukemia, acute myelogenous leukemia, never found in acute lymphoblastic leukemia (99% of the time). represents condensed lysosomes
-represents condensed lysosomes, found in myeloblasts and monoblasts (in the series as well), almost never in lymphoblasts
Q: What is Pelger Hewitt Anomoly?
-Case: 20% neutrophils, 50% bands, 5% metas, and rest monocytes -> left shift!
-Immediately think leukemia
-Benign, inherited disease called Pelger Hewitt anomaly – neutrophils do not segment so they all go to the band stage and just stop, few segment but most remain in band stage. These individuals are normal, band and neutrophils just look funny, but do normal function. Can be misread in CBC, and makes it hard to know exactly what is going on if something really is wrong.
-If see left shift, think bacterial infection, Pelger Hewitt, or leukemia
Q: What happens to M:E ratio in leukemia?
-20:1 or 30:1, also has all stages of development of the myeloid series (probably chronic granuloma (or myelogenous) leukemia
Q: Describe the energy producing capacity of RBC.
-get ATP through glycolysis, and HMPS
-rubrio pathway (takes 1,3 DPG to 2,3 DPG)
-methemoglobin reductase pathway-normal Hb is 2+ and met is 3+ for iron, for O2 carrying capacity, methemoglobin, pushes O2-association curve to right (this pathway reduces metHb to Hb so it can bind iron)
Q: What else moves O2-assocaition curve to right?
-INC CO2, DEC pH, INC 2,3 DPG, INC temperature, erythropoietin (made in kidney), INC cardiac output
Q: Have patient, goes to surgery, out of surgery have crit of 28%, when went in it was 33%, 25% next day and want to give transfusion, are you going to see an INC in O2 carrying capacity within the first three hours?
-metabolism slows down when in refrigerator, levels of 2,3 DPG in these cells DEC, so it will take time for these cells to make 2,3 DPG, the driving force for O2 dissociation
-this is why when have transfusions on newborns, want fresh blood
Q: What function does the spleen have that deals with inclusions in RBCs?
-has a pitting process which removes inclusions in RBCs
-that is why if have splenectomy can have Howell-Jolly bodies
Q: What is the histological feature of malaria?
-Schuffner’s dots
Q: Describe a normal response to infection.
-WBC count = 25,000, usually see INC in bands or left shift, rarely do you see metas in this normal response, about 50% of leukocytes are flowing in the bloodstream while the other are attached to the wall
-if there is a need for rapid response, the attach RBCs to wall will come off
-if see patient immediately there will be leukocytosis (and even neutrophilia), but may not see left shift right away because using the ones on the wall first
Q: Which types of bacteria infection actually show a lymphocytosis (not a neutrophilia with a left shift)?
-prototype is TB, there is a leukocytosis unlike viral (which can be leucopenia or leukocytosis)
Q: What is seen with fungal infections?
-usually see monocytosis
Q: If have B cell deficiency, what would a lymph node section look like?
-would see less nodules and germinal centers in the cortex
Q: What is done if there is an elevation in serum proteins?
-protein electrophoresis, want to know if they have a monoclonal response (multiple myeloma common in people over 60)
-see Abs (in gamma region of protein electrophoresis), there is DEC in gamma region if have immunodeficiency disease
Q: What type of elevation inj protein electrophoresis do we see in kidney disease?
-alpha 2 region elevation, someone with end stage kidney disease excretes a lot of protein
Q: What happens with someone who has a monoclonal gammopathy?
-if producing the same Ig, those Ig’s will all be the same size, shape and charge, all gonna migrate in gamma region (a church steeple response)
-in multiple myeloma there is an INC in protein produced (almost all the same protein)
Q: When do protein electrophoresis what are the five fractions you see?
-albumin, alpha1, alpha2, beta, gamma
-if take someones serum and place it in a matrix and buffer it at 8.6 or 8.8, all the proteins are negatively charged, all migrate to the anode, get 5 fractions -albumin is the smallest, alpha1…
-Ig all migrate in the gamma region
-each fraction is a group of proteins
-transferrin in beta, alpha regions is complement proteins
-migrate based on size shape and charge
Q: What does it mean to have a polyclonal response?
-means broad base and elevated
-suggests that individual is making lots and lots of different types of Abs, seen in chronic infections, even some acute infections, migrate at different rates that is why you get broad base
Q: Describe hypersegmented neutrophils.
-More than 5 lobes
-Neutrophils are referred to as PMN (polymorphonuclear cell), poly’s, and segs (or segmented cell)
-Seen in Megaloblastic anemias, folic acid and B12 deficiency (rare in any other conditions)