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260 Cards in this Set
- Front
- Back
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Define Greek origin of Hematology
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Haima: Blood
Logos: Discourse |
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Define Hematology:
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The science of study of blood.
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What percent of body weight is blood?
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7-8% of human body weight is blood.
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What are Erthrocytes?
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Red Blood Cells
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What are Leukocytes?
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White Blood cells
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What are thrombocytes?
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Platelets
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What is the total volume of blood in the average adult?
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About 6 Litres
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What 2 things is blood composed of?
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Plasma and Cells
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What percent of blood is formed elements?
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45% of blood is formed elements
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What percent of blood is plasma?
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55% of blood is plasma
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What is the name of the fluid portion in blood?
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Plasma.
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How much of plasma is water?
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90% of plasma is water.
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What is the remaining 10% of plasma made up of?
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Proteins (albumin, globulin, fibrinogen),carbohydrates, vitamins, hormones, enzymes, lipids, salts.
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What are the most active sites of blood cell production in early fetal life?
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Most active sites are liver and spleen.
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What happens at the 4th month of fetal like (to the bone marrow?)
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The bone marrow begins functioning as a blood cell producer.
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After birth, the marrow is important because:
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it is the only tissue that continues to produce blood cells.
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Until age 5, the marrow in bones is what colour / quality?
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The marrow in all bones is RED and CELLULAR.
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What happens when long bones become inactive (at ages 5-7 years old)?
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Fat cells replace the active marrow.
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What happens at ages 18-20 to the red marrow?
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Red marrow remains only in vertebrae, ribs, sternum, skull, femur and in the humerus.
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Define Hematopoiesis:
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The production and maturation of peripheral blood cells.
The developmental processes of the formed elements in blood. |
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Where do cellular elements of the peripheral blood come from?
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From the precursor cells in the bone marrow.
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Where is active marrow found in children?
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In the skeletal system.
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Where is active marrow found in adults?
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In central skeleton and long bones.
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Hematopoiesis occurs where?
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In the red bone marrow
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Define: Erythropoiesis:
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Formation of red blood cells.
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Pluripotent stem cell of red bone marrow can develop...
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Pluripotent stem cell of red bone marrow can develop into any type of blood cell.
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Define: Blast cell
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Any immature, undifferentiated, unspecialized cell capable of repeated cell divisions.
Can replace itself, give rise to one or more specific specialized mature cell types (ie. blood cells). |
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What do lymphoid stem cells create / lead to?
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Lymphocytes.
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What 4 main types of cells do Myeloid Stem Cells create?
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Myeloblast, Pronormoblast, Immature Monocyte, Megakaryocyte.
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How many stages are there for Erythrocyte maturation?
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There are 6 stages for Erythrocyte maturation.
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What happens to the RBC in Erythrocyte maturation?
(2 main things) |
- RBC decrease in size and increase in hemoglobin
- RBC nucleus decreases in size until it is extruded (pushed out). |
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What does the nucleus of a Pronormoblast look like? (3 things)
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- Large, round - oval shape
- Fine chromatin - One or more nuclei |
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2 Characteristics of the cytoplasm of a pronormoblast:
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- thin rim of deep blue cytoplasm
- perinuclear clearing |
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Approx. size of Pronormoblast?
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14-24 microns
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What comes after the Pronormoblast (chart)?
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Basophilic Normoblast
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Nucleus characteristics of the Basophilic Normoblast?
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- large, round - oval shape
- moderately coarse chromatin - nucleolus maybe visible |
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Decribe the cytoplasm of a Basophilic Normoblast:
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Blue.
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Size of a Basophilic Normoblast?
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10-17 nm
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What comes after the Basophilic Normoblast:
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Polychromatophilic Normoblast.
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Nucleus of Polychromatophilic Normoblast:
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- round
- coarse chromatin - nucleoli absent |
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Cytoplasm of a polychromatophillic normoblast?
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- light blue to grey.
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What comes after Polychromoticphillic Normoblast?
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Orthochromatic Normoblast:
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Size of Orthochromatic Normoblast?
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About 8 - 12nm
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Nucleus of an Orthochromatic Normoblast:
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- Small, Round
- Dense Chromatin - Nucleoli absent |
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Cytoplasm of Orthochromatic Normoblast:
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Pink to grey
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What cell comes after the Orthochromatic Normoblast?
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The Polychromotic Red Cell / Polychromatic Erythrocyte.
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Size of the Polychromatic Erythrocyte?
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8 -12nm
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Nucleus of a Polychromatic Erythrocyte?
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- Absent. There is no nucleus.
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Cytoplasm of a Polychromatic Erythrocyte?
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Light blue to grey.
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What is another name for the Polychromatic Erythrocyte?
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Reticulocyte
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What comes after the Polychromatic Erythrocyte?
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The Erythrocyte.
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Size of an Erythrocyte?
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6-8 nm.
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Does an Erythrocyte have a biconcave disk?
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Yes.
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Nucleus in an Erthryocyte:
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Nucleus is absent.
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Cytoplasm in an Erythrocyte?
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Pink
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What is another name for Leukocytes?
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White Blood Cells
WBC |
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Purpose of Leukocytes:
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Leukocytes are cells of the immune system.
defend the body against infectious disease and foreign materials |
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How many types of leukocytes exist?
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There are 5.
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Where are the 5 types produced and derived?
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From Multipotent cell in bone marrow
(known as the Hematopoietic stem cell). |
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Where are leukocytes found?
(3 places) |
1. in the body
2. blood 3. lymphatic system |
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The 5 types of Leukocytes are placed into which 3 groups?
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Granulocytes
Lymphocytes Monocytes |
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Why is the development of Cytoplasmic granules during Granulocyte Maturation Sequence important?
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Cytoplasmic granules are important for granulocyte function.
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How are Granulocytes further broken down into 3 groups? Based on what?
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Staining characteristics of their granules.
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What are the 3 groups of Granulocyte maturation sequence?
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1. Neutrophillic
2. Eosinophillic 3. Basophilic |
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Basic characteristic of Eosinophils:
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basic pH
stain red with acid dye, eosin 10-15 nm |
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Nucleus characteristics of Eosinophils?
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2-3 lobes
very coarse chromatin nucleoli is absent |
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Cytoplasm of Eosinophils?
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- abundant cytoplasm
- numerous red0orange granules |
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Basic characteristic of Basophils?
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acid pH
Stain blue with dye, Methylene blue 10-15 nm |
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Nucleus characteristics of Basophils?
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- 2-5 lobes
- very coarse chromatin - nucleoli is absent |
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Cytoplasm characteristics of Basophils?
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- dark blue/black granules
- granules overlie nuclei - granules stain loss is common |
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Basic characteristic of Neutrophils?
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neutral pH
stain poorly with both dyes, eosin and methylene blue |
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Nucleus characteristics of Neutrophils?
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- 2-5 lobes
- very coarse chromatin - nuclei is absent |
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Cytoplasm characteristics of Basophils?
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- pale pink
- fine pink/purple granules. |
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How many cells types does it take to get to Neutraphils?
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5 cell types.
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List the cell types required to make neutrophils.
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Start with: Myeloblast
Pro-myelocyte Myeloycyte Meta-myelocyte Band End with: Neutrophil |
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Characteristics of the Myeloblast Nucleus:
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- Nucleus is large
- Delicate chromatin - nucleoli is present |
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Characteristics of the Myeloblast Cytoplasm:
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- scant, blue cytoplasm
- granules are absent |
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Myeloblasts and then comes...
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Promyelocyte
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Characteristics of Promyelocyte nucleus:
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- large, oval/round
- fine to slightly coarse chromatin - nucleoli is present |
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Characteristics of Promyelocyte cytoplasm:
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- sparse, blue cytoplasm
- coarse dark red/purple granules - granules may overlie nucleus |
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Promyelocyte, and the comes...
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Myelocyte
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Characteristics of Myelocyte nucleus:
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- large, round to oval
- coarse chromatin - nucleoli present |
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Characteristics of Myelocyte cytoplasm:
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- light blue to pink
- fine pink/purple granules - Perinuclear clearing |
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Myelocyte and then comes...
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Metamyelocyte
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Characteristics of Metamyelocyte nucleus:
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- indented / kidney shaped nucleus
- coarse chromatin - nucleoli is absent |
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Characteristics of Metamyelocyte cytoplasm:
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- light pink
- fine pink/purple granules |
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Metamyelocytes, then comes...
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Band
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Characteristics of band nucleus:
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- indented with uniform width (more indented than metamyelocyte).
- very coarse chromatin - nucleoli absent |
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Characteristics of band cytoplasm:
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- light pink
- fine pink/purple granules |
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Band and then have...
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Neutrophil
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Lymphocyte Maturation Sequence:
Where does it occur (2 sites) |
- bone marrow
- thymus |
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Where do the majourity of mature lymphocytes reside?
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- lymph nodes
- spleen other extra vascular sites |
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Where do mature lymphocytes migrate to?
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extra vascular sites via the peripheral bloodstream.
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How many cell types are involved to get to a lymphocyte (including lymphocyte cell)?
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3 cell types.
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Characteristics of Lymphoblast Nucleus:
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- round
- delicate chromatin - nucleoli present |
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Characteristics of Lymphoblast Cytoplasm:
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- scant blue
- granules absent |
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AFter the Lymphoblast type, we have the...
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Prolymphocyte Type Cell.
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Characteristics of Prolymphocyte Nucleus:
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- round
- moderately coarse chromatin - single prominent nucleolus |
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Characteristics of Prolymphocyte Cytoplasm:
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- moderate amount, blue cytoplasm
- granules are absent |
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After the Prolymphocyte Type then we have:
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Lymphocyte
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Characteristics of Lymphocyte Nucleus:
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- round
- very coarse chromatin - nucleoli absent |
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Characteristics of Lymphocyte nucleus:
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- round
- very coarse chromatin - nucleoli absent |
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Characteristics of Lymphocyte cytoplasm:
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- variable amount of cytoplasm
- light blue - few granules may be present |
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Monocyte Maturation Sequence:
Where is the primary site for this? |
Bone marrow.
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Where does the majority of monocyte reside?
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In Tissues called Macrophages.
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How to monocytes migrate?
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via the peripheral blood.
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What is the first cell type ( in the 2 ) in the formation of a Monocyte?
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Monocyte.
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Characteristics of Monoblast Nucleus:
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- round
- delicate chromatin - nucleoli present |
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Characteristics of Monoblast Cytoplasm:
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- small to moderate amount
- grey to blue - fine granules rarely visible |
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After monoblast comes the:
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Promonocyte
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Characteristics of Promonocyte Nucleus:
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- folded / indented
- slightly coarse chromatin - nucleoli may be present |
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Characteristics of Promonocyte cytoplasm?
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- moderate to abundant
- grey to blue - fine granules maybe present |
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Characteristics of Monocyte Nucleus?
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- indented or folded
- sieve like chromatin - nucleoli absent |
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Characteristics of Monocyte cytoplasm?
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- abundant grey-blue
- vacuoles commonly present - fine granules maybe present |
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Platelet Maturation Sequence:
Where is the primary site of platelet production? |
Bone Marrow
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Platelet Maturation Sequence:
What is another name for platelets? |
Thrombocytes
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Platelet Maturation Sequence:
Where do Platelets/ Thrombocytes arise from? |
- large precursor cell: megakaryocyte.
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Are platelets fragments of megakaryocyte cytoplasm?
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Yes. Platelets are pieces of the megakaryocyte cytoplasm.
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What is the first cell type before Platelets are formed?
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Megakaryoblast
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Characteristics of Megakaryoblast Nucleus?
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- round / oval
- coarse granular chromatin - nucleoli present |
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Characteristics of Megakaryoblast Cytoplasm:
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- scant, blue
- granules absent - budding protrusions at periphery |
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After Megakaryoblast comes:
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Megakaryocyte
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Characteristics of Megakaryocyte Nucleus?
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- multi lobed
- coarse chromatin - nucleoli absent |
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Characteristics of Megakaryocyte Cytoplasm:
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- light blue / pink
- purple granules |
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After Megakaryocytes, have:
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Platelets
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Characteristics of Platelet Nucleus?
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- round or oval
- nucleus is absent |
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Characteristics of Platelet Cytoplasm:
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- pale blue
- purple granules |
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What are the 2 methods used to obtain blood sample?
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1. skin puncture (capillary sample)
2. venipuncture |
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What determines which of the 2 methods are used?
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- age of individual
(older and new borns) - health status |
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New Born babies would use the ____ method, because:
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skin puncture
because a venipuncture would deplete too much of their total blood volume. |
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Where is the capillary puncture site on newborns?
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Plantar surface of big toe or heel.
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What is the capillary puncture site on young children?
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The 3rd or 4th finger tip.
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What is the capillary puncture site for adults with poor veins, ill, IV, etc.
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The 3rd or 4th finger.
The 4th finger is preferred. |
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What does capillary blood test for?
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- Platelet count
- hemoglobin - RBC, WBC counts - Microhematocrit - Blood films (Smears) |
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When is a venipuncture used?
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For collections of large quantities of blood.
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Where is a venipuncture made?
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Directly into a vein (phlebotomy).
Use a syringe na dneedle or vacutainer tube and needle |
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Where is the vein to be punctured located?
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In the upper forearm area.
Veins that are easily palpable and fairly well fixed. |
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What is color of tube top used for Hematological tests?
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Purple tops!
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What is the anti-coagulant in the Purple Tops?
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EDTA
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What does ETA do?
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EDTA prevents coagulation by binding calcium in the plasma.
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EDTA is the anticoagulant for choice for blood tests such as:
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cell counts
hematocrit hemoglobin cell differntials on stained blood films |
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What does EDTA preserve?
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The morphologic structure of the blood cell elements.
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What is the Anti-Coagulant in blue tops?
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Sodium Citrate
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What coagulation procedures uses Sodium Citrate?
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Prothrombin Times (PT)
Partial Prothrombin Time (PTT) |
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How does sodium citrate prevent coagulation?
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Inactivates calcium ions.
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What does citrate do?
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Prevents rapid deterioration of liable coagulation factors.
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In general, the use of anti-coagulants prevents:
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clotting and the blood is maintained in its invo (in the body) state.
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What happens when anti-coagulated blood is centrifuged?
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separates into 3 main layers
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What are the 3 main layers of centrifuged anti-coagulated blood?
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1. Red Cells
2. Buffy Coat (White cells and platelet) 3. Plasma |
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What happens to the blood not treated with anti-coagulant (after it is removed from the body)?
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begin to clot or coagulate in a few minutes.
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What is the texture of a clot?
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A semisolid jelly like mass.
Shrinks with time. |
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What is serum?
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Serum is a pale yellow fluid, when coagulation occurs.
Serum separates from the clot and appears in the upper portion of the tube. |
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What is the main substance required for blood clotting?
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Fibrinogen.
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Does Blood plasma have fibrinogen?
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Yes.
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In a 10mL sample: what percentage is Plasma?
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55%
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What are the other percentages that make up Plasma?
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91% water
7% proteins 2% nutrients |
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Where is the buffy coat located in a test tube?
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Between plasma and RBC
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What is a CBC?
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Complete blood count:
basic in initial evaluation + follow up of patient. |
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What 2 things does CBC measure?
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1. Hemoglobin
2. Hematocrit |
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In a CBC, the platelets are counted by an ____.
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Estimation.
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Morphology is used in the count of ___ blood cells?
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Red Blood cells
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Differential is used in the count of ___ Blood cells.
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White Blood cells.
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What is the most frequently ordered test in hematology lab?
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Hemoglobin (Hb) Test.
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What is the Hemoglobin (Hb) test good for?
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following many disease states (Anemia's).
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What does heme contain?
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Iron
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What does heme combine with?
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Heme combines with Globin.
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What does globin contain?
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Protein.
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What does Hemoglobin transport?
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Oxygen.
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Define: Oxyhemoglobin
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Oxygenated hemoglobin molecule
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Define: Reduced Hemoglobin
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Oxygen is dissociated from the iron in each heme group. replaced by carbon dioxide.
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Define Carboxyhemoglobin:
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Hemoglobin in molecules binds to carbon monoxide.
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Define Methhemoglobin:
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Known as Hemoglobin hi
Oxidized ferrous to the ferric state Capable of combining reversibly with Oxygen |
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Hemoglobin has a greater affinity for:
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Carbon Monoxide than Oxygen.
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What is the affinity of hemoglobin to carbon monoxide?
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Affinity is 200 times greater.
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How is Methhemoglobin formed?
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Aquired.
Chemicals. |
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Define Cyanmethemoglobin:
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Compound formed by combination of hydrocyanic acid adn methemoglobin.
Formed with Methylene Blue administered as antidote in cyanide poisoning |
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Define Hematocrit:
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Proportion of blood that consists of packed red blood cells.
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How is Hematocrit expressed?
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In percentages.
Called packed cell volume (PCV) |
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How are RBC packed?
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By centrifugation.
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What is the equation, when RBC have normal size and shape?
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Hb x 3 = Hct +- 3
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A low hematocrit reflects:
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- A low number of circulating RBC
- decrease in oxygen carrying capacity / over hydration. |
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High hematocrit reflects:
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- absolute increase in number of erythrocytes
- decrease in plasma volume |
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What does MCV mean?
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Mean Corpuscular Volume
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What does MCH mean?
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Mean Corpuscular Hemoglobin
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What does MCHC Mean?
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Mean Corpuscular Hemoglobin Concetration
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What does RDW mean?
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Red Cell Distribution Width
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What is the main difference between plasma and serum?
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Their clotting factors.
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When serum and plasma are seperated from the blood, what remains in the plasma?
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Fibrinogen
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When Fibrinogen is seperated from the plasma, what remains
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Serum
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Plasma is the part of the blood that contains both:
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serum and clotting factors.
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Serum is the part of the blood that remains once the ___ are removed:
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clotting factors (fibrin)
have been removed |
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Plasma contains: (2 main things)
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1. clotting factors
2. water |
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Serum contains: (1 main thing)
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Proteins
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Define: Hemacytometer
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Etched white class chamber with sides, with cover slip.
total surface area = 9mm2 |
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What is the calculation of concetration based on?
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Volume underneath the cover slip.
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Hemacytometer is filled with capillary action. Describe more:
|
pipette filled with mix of cells, expels some contents so that fluid is drawn into the chamber by capillary action.
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Peripheral smear: Define:
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Examination of blood smear.
Needs well stained film. Must be made immediatly EDTA Anti-coagulated blood can be used. |
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2 main manual methods of peripheral smear:
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1. 2 slide/ wedge method
2. cover glass method + automated slide makers (in some labs) |
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Describe the coverslip method:
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2-3mm drop of blood on 1 coverglass, place another coverglass over the drop.
As stops spreading, pull coverglasses apart quickly. Dried. |
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Describe the wedge smear method:
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2-3mm drop of blood on the frosted end of a slide.
use a spreader, 30-45 degrees, forward, adn back motion. get a smear. |
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Describe the peripheral smear slide (what is a good process)
|
- smear not cover whole slide
- thick and thin portions with gradual transition - feathered edge is the end of the smear - well stained will have Pink colored red cells - nucleus and leukocytes will be purple - Well differentiated chromatin and parachromatin |
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Process of Staining:
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- films fixed in absolute methanol (1 to 2 minutes)
- Exposed to wright stain for 2 min - equal buffer is added. blow gently. - stain is flushed from slide using water for 30 sec - can be cover slipped |
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Define Aniso-cytosis:
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Variation in RBC size.
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Where is Aniso-cytosis seen?
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iron deficiency anemia,
megaloblastic anemia Burn patients |
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Visualize the following:
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Normocytic
Macrocytic Microcytic |
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Define Poikilo-Cytosis:
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Variation in RBC shape.
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Where are poikilocytosis cells seen?
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Peripherial blood smears:
- sickle anemia - iron deficiency anemia - burn patients |
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Spherocytes are seen:
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In spherocytosis and immune hemolytic anemias.
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Tear drop cells result from:
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Marrow replacement by fibrosis or malignancy.
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Burr cells (Echinocytes) are associate with:
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uremia, chronic renal disease
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Stamatocytes seen in:
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Liver disease
acute alcoholism |
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Acantro-cytes (spur cells)
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sever liver disease
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Schistocytes (keratocytes) are seen in:
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disseminated intravascular coagulation
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Elliptocytosis (ovalovytes) are seen in
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hereditary eliptocytosis
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Sickle cells (drepannocytes) are seen in
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sickle cell anemia
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Target cells (codocytes) are seen in
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Thalassemia, liver disease.
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Visualize each of these cell shapes:
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- sickle cell
- target cell - elliptocyte - schistocyte - acantrocyte - stomatocyte - burr cells - teardrop cells - sphereocytes |
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What color do inclusions stain in erthrycytes?
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red to dark purple.
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what can erthryocytes be?
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remnants
iron particles RNA intracellular parasites |
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What does the erthryocyte appearence depend on?
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depends on composition of cells.
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What causes basophilic stippling?
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dark straining ribosomes
(seen i nled posining) |
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Howell Jolly bodies are nuclear fragments in:
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Erthryocytes from patients who have their spleen removed.
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Pappenheimer bodies are composed of :
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iron.
Seen in sidroblastic anemia. |
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Heinz bodies are composed of:
|
denatured hemoglobin
are round bodies within RBC |
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Malaria caused by
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4 species of plasmodium.
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White Cell Variation caused by:
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maturation defects, inflammation, infections.
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Maturation defects in WBC variations are caused due to:
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genetic or metabolic disorders
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Bacterial infections cause
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Toxic changes to neutrophils.
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Hyposegmented neutrophils are seen in:
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patients with pelger-huet / myelodysplastic syndrome
- granulocytes with 1 or 2 poorly segmented nuclear lobes |
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Hypersegmented neutrophils are seen in:
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patients with anemia due to vitamin B12 or folate dificiency.
- neutrophil with 6+ nuclear segments |
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Auer rods seen in:
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patients with mylegenous leukemia.
- pink rod shaped inclusions in myeloblast cytoplasm |
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Toxic granulation / vacuolation is seen in patients with:
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severe bacterial infections.
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Toxic granulation has a neutrophil with increased:
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dark granules in its cytoplasm
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Toxic vacuolation will have:
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round clear spheres with granulocyte cytoplasm.
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Dohle bodies consist of:
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ribosomes / Rough Endoplasmi Recticulum.
Seen in severe bacterial infections. - pale blue irregular shaped inclusion in neutrophil cytoplasm |
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Visualize the following cells:
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- Hyposegmentation
- Hypersegmentation - Auer rods |
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Where are White cell variation (lymphotcytes) located?
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- extravascular sites
- lymph nodes - gastrointestional tract - spleen |
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What happens when lymphocytes are activated by contact with antigens?
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lymphocytes undergo morphological changes.
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Specific morphological change is related to:
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the specific lymphocyte function.
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Define relative lymphocytes:
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have abundant cytoplasm, often indented by surrounding red blood cells.
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Define Large granular lymphocyte:
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lymphocyte with abundant cytoplasm containing granules
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Define cleaved lymphocyte:
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lymphocytes with large nuclear clefts.
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Define a plasma cell:
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Blue cytoplasm, eccentric nucleus, prominent peri-nuclear clearing.
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Reactive lymphocytes (atypical lymphocyte) may be associated with...
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vital infections.
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Large granular lymphocytes may be associated with...
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viral infections or neutropenia.
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Lymphocyte with cleaved nucleus are associated with...
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pertussis
( whooping cough) in children |
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Plasma cells are rarely seen in peripheral blood in except....
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in cases of severe inflammation or end stage multiple myeloma.
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What is a reticulocyte?
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Non-nucleated immature erthyrocytes that contain nuclear remants of RNA.
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What is supravital staining?
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When red cell is stained while living, to detect presence of RNA.
RNA appears as a reticulum within the red cell. |
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2 regents used in supravital staining:
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1. new methylene blue solution
2. brilliant cresyl blue solution |
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What is the process of obtaining a retic count?
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- 3 to 4 drops of each (methylene blue, and blood) in a test tube
- mix, stand for 15 min - mic again - drop on glass plate, thin smear, air dry - use low oil immersion, microscope - count number of reticulocyte in 5 fields of 200 RBCs. |
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In automated counting, the Coulter Principle, what does Electrical Impedance mean?
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Resistance or change in current when a cell passes between 2 electrodes in NaCl solution.
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In automated counting: Flow Cytometry, how does it work?
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Uses lasers to measure both forward and side scatter.
Forward = measures size Side = measures granularity |
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Lists some sources of error:
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- inadequate mixing of specimen.
- homolyzed or lipemic speciments - cold aggulations - clotted specimens - platelet clumps / satelliosis - diluted specimens |
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When identifying leukocytes:
More mature cells are (color, shape, chromatin, nucleus) |
- less blue
- variable shape - coarse, clumping chromatin - nucleus is rare |
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When identifying leukocytes:
More immature cells are (color, shape, chromatin) |
- More bluish
- rounder in shape - fine chromatin - frequent nucleus |
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Erthryocytes:
shape, diameter, use, life span? |
biconcave shape
7 microns cells transport O2,CO2 Life span is 120 days |
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Leukocytes:
number of types, size, involved in...? |
5 types (they are: neutrophil, basophil. eosinophil, monocyte, lymphocytes)
8-20 microns involved in fighting infection, combat allergic rxns, immune responses |
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Once again, what are the 5 types of leukocytes?
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eosinophil
basophil neutraphil lymphocytes monocytes |
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Thrombcytes:
size, acitve where? |
- smallest cells in the blood
- active role in coagulation and hemostasis |
