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200 Cards in this Set
- Front
- Back
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rbc's erythrocytes
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Identify
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Leukocytes
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Identify
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Band
Segmented |
What is the wbc on the left?
on the right? |
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hypersegmented neutrophils
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Identify
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eosinophils
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Identify
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atypical lymphocytes
Mono, viral hepatitis, CMV, toxoplasmosis |
Identify
When will you see these? |
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microcytic, hypochromic
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What is abnormal about volume/size and color?
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hereditary spherocytosis
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When is this seen?
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Target cells
Thalessemias post splenectomy Liver Disease |
Identify
When are they seen? |
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Basophilic stippling
Seen in Lead poisoning, megaloblastic and refractory anemias, alcoholics, drug exposures |
Identify
When is it seen? |
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rouleaux formation
Seen in multiple myeloma |
Identify
When is it seen? |
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Howell Jolly body
round, purple staining nuclear fragments of DNA in the red blood cell. Seen after splenectomy, megaloblastic anemia |
Identify
What are they? When seen? |
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reticulocytes
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Identify
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Iron deficiency
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What type of anemia?
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Megaloblastic anemia
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What type of anemia?
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Sickle Cells
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Identify
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Auer rods
Indicative of AML |
What are these?
What are they indicative of? |
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chronic myelogenous leukemia
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What Leukemia does this look like?
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Chronic lymphocytic leukemia
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What Leukemia?
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Plasmodium falciparum
ring form |
Identify
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Plasmodium falciparum
schizont |
Identify
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plasmodium malariae
trophozoite |
Identify
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Philadelphia Chromosome
(translocation of 9 and 22) Pathognomic for CML |
What chromosome abnormality is this showing? What is this indicative of?
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This tube contains nothing or something to activate clotting
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Red top
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After centrifuging, the liquid portion of blood is called? How is it different from plasma?
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Serum
It no longer contains clotting factors |
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This tube contains EDTA
Why? What tests are done on it? |
Purple top
It prevents clotting Hematology and hgA1C |
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This tube contains Sodium Citrate
Why? What tests? |
Blue top
It prevents clotting and preserves clotting factors Tests blood's ability to clot |
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What is the difference between a red top and a tiger top?
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both are centrifuged and serum is tested, but tiger has a serum separating gel
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What is a gray top tube used for? Why?
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Used for glucose tolerance testing. It contains sodium fluoride oxalate, which prevents glycolysis
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Yellow top tubes are used for?
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blood cultures if bottles not available
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Green top - what does it contain, what is it used for?
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Contains heparin
Used to test plasma for ammonia and carboxyhemoglobin |
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Blood Composition?
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45% cells (rbcs, wbcs, plts)
55% plasma, 90% of which is water 10% proteins,enzymes, salts cho, lipids |
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3 components of blood after centrifugation
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Top: Serum or plasma
Middle: Buffy Coat: wbcs and plts Bottom: rbcs |
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Sensitivity
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Number of people testing true positive/Number of people who actually have disease
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Specificity
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Number of people testing true negative/Number of people who do not have disease
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Accuracy vs. Precision
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How close you are to the right value vs. how much you can reproduce results (you want both)
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Hematopoeisis
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Process of blood development and production
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All cells are produced from multi-potential stem cells in the ___________.
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Bone Marrow
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What stimulate stem cells to divide and differentiate?
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Colony stimulating factors
Interleukins |
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The two major stem lines
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Myeloid
Lymphoid |
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Is differentiation reversible?
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NO
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Lymphoid cells form:
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B and T cells
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2 groups of Leukocytes
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granulocytic
agranulocytic |
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Granulocytes include:
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neutrophils, eosinophils, basophils
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Agranular, mononuclear cells
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lymphocytes
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Myelopoeisis
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production of neutrophils, eosinophils, basophils, and monocytes
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how long does it take to go from immature "blast" to mature cell?
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7-10 days
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How does EDTA prevent clotting?
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binds to calcium
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What happens to WBC count over lifetime?
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Highest at birth, then slowly falls
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At what age to lymphocytes dominate?
PMNs? |
2 wks to 5-7 yrs
PMN's dominate thereafter |
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How is the # of wbc's reported?
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#wbc/mm3 of blood
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How is the rbc's reported?
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total rbc (millions)/mm3 of blood
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How is Hemoglobin (hb) reported?
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g/dl
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When is hb higher? lower?
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highest at birth
lowest at 3 months higher in men lower in preg. women |
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How is Hematocrit (hct) reported?
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%
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What is hemoglobin?
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Conjugated protein consisting of globin, protoporphyrin, and iron
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What are some normal values for hemoglobin?
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males-14-18 g/dl
females-12-16 g/dl newborns-17-23 g/dl children 12-14.5 g/dl |
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What are panic values for hb?
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Panic values <8 and >20 g/dl
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What does hematocrit measure?
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measure of the total blood volume that is made of red cells usually 3x hemoglobin, reported as a %
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What is the panic value for hct?
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<24%
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When is hct increased?
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polycythemia vera, smokers, high altitudes (hypoxia stimulates RBC production), dehydration(decreased fluid, decreased blood volume, same #RBCs)
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When in hct decreased?
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in megaloblastic anemia (folate or B12 deficiency), blood loss, drug or alcohol addiction, FE deficiency or sickle cell anemia, pregnancy
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Hct normal values
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males-40-54%
females-37-47% newborns-50-62% |
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What are the rbc indices?
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MCV
MCH MCHC RDW |
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MCV
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MCV-mean cell volume, the average volume of red cells
MCV= hematocrit(%)x10 /RBCs (millions) |
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MCV by age
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children have lower MCVs than adults, For every year under 10 years of age subtract one unit from 80. Newborns have high MCVs.
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MCH
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mean cell hemoglobin-the weight of hemoglobin of the average RBC
MCH=hemoglobin x 10/RBCs (millions) |
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MCHC
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mean cell hemoglobin concentration-the average concentration of hemoglobin in a given volume of red cells
MCHC= hemoglobin x 100/hct |
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RDW
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Red cell distribution width-a measure of the degree of anisocytosis (variation in RBC size), measured by automated counters
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Normal RDW
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11.5-14.5%
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RDW is helpful when?
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distinguishing uncomplicated thalessemia (low MCV/normal RDW) from iron deficiency anemia (low MCV/high RDW)
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Anisocytosis
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RBC's of different sizes
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Platelet normal values
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140-400,000/mm3
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Platelet panic values
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<50,000 or >1 million
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Where are platelets formed?
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formed in bone marrow from megakaryocytes
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What is the role of platelets in hemostasis?
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forming a plug to ensure vascular integrity
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How are plts counted?
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Manual counts done on Neubauer hemocytometer. These are estimated as part of the differential
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What is done for a CBC with differential?
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100 WBCs are counted and # representing a percentage is reported. RBC morphology and platelet estimate are also given
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Platelets
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Identify
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Summary picture of cell types
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example of cbc smear
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More mature neutrophils are called?
Why? |
Segs (segmented)
there are more lobulations of the nuclei |
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More immature neutrophils are called?
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bands or stabs
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refers to the release of less mature forms, it is defined as when more than 10-12% bands are seen or when the total PMN count (segs plus bands) is greater than 80.
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Left shift
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When is a left shift seen?
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can occur in infection or inflammation/ hemorrhage.
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hypersegmented neutrophils can be seen in megaloblastic anemias and liver disease
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Right Shift
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neutrophilia
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increase in absolute number of neutrophils in response to invading organisms or tumor cells.
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Children respond to infection with a ______ degree of neutrophilia than adults.
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higher
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neutropenia
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may be due to decreased production, excess stored in blood vessel margin, or too many called into action and used up
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eosinophils are capable of?
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phagocytosis of ag-ab complexes
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When do eosinophils become active?
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later stages of inflammation
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eosinophils respond to what type of conditions?
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allergic and parasitic
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when are eosinophil counts lower?
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in the am
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What is the normal amount of eosinophils?
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1-4%
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Eosinophilia Mnemonics:
NAACP PIE |
Neoplasm, Allergy, Addison’s Disease, Collagen –vascular disease, and Parasites.
Pulmonary Infiltrate Eosinophilia |
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What is eosinopenia due to?
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increased adrenal steroids (Cushing’s), drugs- ACTH, epi, prostaglandins, stressful situations, burns, labor, postop states.
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Basophils
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phagocytic, are called mast cells when found in tissues. They contain heparin, histamine, and serotonin.
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Normal amount of basophils
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.5-1%
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Basophilia is seen in?
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CML, Hodgkin’s disease.
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Basopenia is seen in?
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hyperthyroidism, acute phase of infection, stress.
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Largest cell of normal blood
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monocytes
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How do monocytes help with infection?
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are mobile via pseudopods-remove injured or dead cells, microorganisms, and insoluble particles from circulating blood.
Migrate to the tissues where they become macrophages. |
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normal amount of monocytes?
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2-6%
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Monocytosis is seen with?
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recovery state of acute infection, TB, subacute endocarditis
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Monocytopenia is seen with?
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prednisone treatment, RA, hairy cell leukemia
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Lymphocytes are a source of?
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serum immunoglobulins
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B cell Lymphocytes are involved in?
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antibody response to antigens
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T cells are involved in?
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cell mediated immunity - helper, killer, suppressor cells
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T cells mature in?
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Thymus gland
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Normal amt of lymphocytes
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20-40%
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Lymphocytosis, aka
when is it seen? |
inverted or reversed diff- more lymphs than neutrophils,( normal in a child), ALL, CLL, viral infection.
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Lymphopenia is seen in?
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chemo, radiation, normal in 22% of population
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Platelets are important in?
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Important in hemostasis, may be normal in count but not in function.
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How to assess abnormalities in plt function?
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Abnormalities in platelet function can be assessed with a bleeding time.
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Thrombocytosis - seen when?
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sudden exercise, post trauma, post-surgical esp. after splenectomy
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Thrombocytopenia - seen when?
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Thrombocytopenia-ITP, TTP, DIC, burns, snakes and insect bites, marrow suppressants-chemo radiation, alcohol addiction
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Erythropoeisis
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rbc production in the bone marrow, controlled by erythropoietin (Procrit) produced in the kidneys. Cells develop through four stages of mitosis, taking 4-5 days.
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Erythrocyte avg size and shape
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7-8 um in size, biconcave disc, capable of altering shape
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Normal life span of erythrocyte
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120 days
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normocytic
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7-8 microns
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microcytic
seen when? |
<7 microns, MCV <80
Fe def anemia, thalessemias, children |
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macrocytic
seen when? |
>8 microns, MCV >101
liver disease, B12/folate def., newborns |
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Poikilocytosis
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variation in shape of RBC
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Spherocytes, describe
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no central area of pallor, no biconcavity, MCHC >36%, osmotic fragility, can easily burst; breakdown of RBCs can develop gallstones. hereditary spherocytosis, hemolytic anemia, ABO transfusion reactions
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ovalocytes, describe
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ovalocytes-oval shaped RBC with white area in the center, hereditary ovalocytosis, sickle cell, Fe def, thalessemia, megaloblastic anemia
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Target cells, describe
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aka(leptocytes)-small clump of Hgb in center surrounded by area of pallor, a thin rim of Hgb. Cell appears slightly larger since it is flatter than normal. Liver disease, thalessemias, hemoglobinopathies, post-splenectomy
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Schistocytes
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-fragmented or pieces of cell, prosthetic heart valves
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Burr cells (Acanthocytes)
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RBCs with evenly placed blunt or rounded projections. Severe liver disease, uremia, DIC, TTP, carcinoma. Acanthocytes have more thorny projections and can be seen in anorexia, severe burns and hypothroidism
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Tear drop cells
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tennis racket, “Patient crying for a bone marrow”, fibrotic bone marrow, ineffective erythropoesis
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Stomatocytes
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-“smiley cells”-slitlike areas of central pallor. -liver disease, artifact, lupus
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Helmet cells
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“bite cells”, “Pac Man”, G6PD crisis, DIC, pulmonary emboli
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Heinz bodies
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denatured or precipitated protein seen in G6PD Deficiency, drug-induced hemolytic anemia
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rouleaux formation
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stack of coins, due to abnormal proteins found in blood such as in multiple myeloma
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Reticulocytes
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last stage of development prior to becoming a mature RBC, retics have remnant of RNA and circulate for approx. 24 hours, reflects responsiveness and potential of bone marrow (erythropoietic activity).
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reticulocytes are suggested by?
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basophilia or polychromasia on Wright's Stain
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How is retic count reported?
What are normal values? |
Percentage
Normal ranges-0.5-2.0% for adults, 2.5-6.5% for children |
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Corrected retic count = ?
(aka retic index) What should it equal? |
reported count x patient’s HCT/normal HCT
Should = 1.0 |
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What may happen to retic ct. after adequate iron dosage for fe def. anemia. What does this indicate?
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rise over 20%
Indicates good response to tx. |
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What is the retic count measuring clinically?
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the ability of bone marrow to react to anemia and make rbc's.
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Erythrocyte sedimentation rate
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The rate at which RBCs settle out of anticoagulated blood in one hour.
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What to inflammatory and necrotic processes do the the esr?
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cause an alteration in blood proteins resulting in the aggregation of red cells. They become heavier and fall more rapidly leading to a higher ESR.
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When is the esr most useful?
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polymyalgia rheumatica and temporal arteritis
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causes esr to increase
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increased in infection, inflammation, multiple myeloma, macrocytic disorders, acute MI
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causes esr to decrease
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decreased in microcytic disorders, polycythemia vera, hereditary spherocytosis, sickle cell anemia, hemoglobin C disease
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normal esr
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normal in allergies, viral infections, cirrhosis, malaria
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heinz bodies
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Identify
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reticulocytes
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Identify
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describe 1, 2, and 3 by color
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see picture
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ID 1,2,and 3 based on shape
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see image
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ID 1,2,and 3 based on shape
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see image
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The most common cause of microcytic anemia
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Fe deficiency
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signs and symptoms of Fe deficiency anemia
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fatigue, doe, pica – hallmark of Fe def., may crave ice or complain of a sore mouth.
signs: pallor, epithelial cell shedding-atrophic glossitis, cheilitis, spooning of nails |
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Lab studies in Fe def anemia
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microcytic, hypochromic anemia, increased RDW, retic monitors response to treatment, ferritin, TIBC, serum Fe, % saturation.
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What does ferritin do?
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stores iron
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Tmt of Fe def anemia
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iron replacement (Slow FE, Feosol) given between meals for better absorption, stools remain black, may be constipating- consider Colace for better tolerability, consider transfusing packed RBCs if Hgb is < 6 gms/dl
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B12 deficiency causes?
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Pernicious Anemia
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What is pathophys of pernicious anemia?
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atrophy of gastric mucosa (parietal cell) leads to lack of intrinsic factor and HCL secretion. B12 needs intrinsic factor for absorption. Impaired DNA synthesis results in RBCs with immature chromatin and appears enlarged or megaloblastic
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What is avg age for pernicious anemia?
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60
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Risk factors for pernicious anemia
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alcoholism, ascorbic acid, cimetedine (Tagamet), oral contraceptives, strict vegens who avoid dairy, gastric bypass
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Labs for pernicious anemia
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MCV > 95, decreased retics, hypersegmented neutrophils, Howell-Jolly bodies (DNA remnant
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Schilling test
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radioactive B12 is given orally and then measure the amount excreted in the urine. If no IF, no B12 is absorbed and none is excreted. Then give exogenous IF- if normalized excretion you have the diagnosis of pernicious anemia. If not excreted then consider intestinal cause of B12 malabsorption.
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Treatment for Pernicious Anemia
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IM or SC B12 (cyanocobalamin) once weekly for eight weeks, then one monthly lifelong.
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Sickle cells
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ID
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Sickle cell disease
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What anemia may cause this?
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spherocytes
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ID
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spherocytes
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ID
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Reed-Sternberg cells
Pathognomic for Hodgkin's |
ID
What are they pathognomic for? |
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How do you streak a plate?
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see image
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gram positive cocci, cluster
eg: staph |
describe type of bacteria
give example |
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Gram positive cocci, chain
eg: strep |
Describe type of bacteria
Give example |
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gram neg rods
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describe type
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Acid fast stain
acid fast bact: mycobacteria |
What type of stain
give example of bacteria |
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Treponema pallidum (syphillis)
Dark field microscopy |
Id
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MacConkey Plate
Pink: lactose positive Clear: Lactose negative |
What type of plate
What is pink? What is clear? |
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Hektoin plate
This is neg pos would be bluish-green |
What type of plate
Is this pos or neg? |
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Swarming
Proteus species |
What phenomenon?
What species? |
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Lactose positive, mucoid
Klebsiella species |
Describe this lactose plate, what species may it be?
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pseudomonas
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What species?
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Strep hemolysis
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What species?
What is this called? |
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Beta hemolysis with halos
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describe
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1 - alpha hemolysis
2 - optochin sensitive |
What's happening at 1 and 2?
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Catalase test
the one one L is pos, (gas bubbles) eg staph |
What test is this?
Which one is positive? Give example of pos bact |
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L - pos
R - neg staph aureus is pos, other staph's are not |
Which is pos, which is neg?
bact that is pos? |
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“P” (optochin) disc – three way streak for “lawn” of bacteria, incubated at 35 degrees Celsius for 24 hrs. (CO2 will enhance the growth but will decrease the zone size) 14 mm in diameter zone of inhibition is indicative of Strep pneumoniae ) Old Quelling reaction for capsular swelling
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What is this?
What does it indicate? |
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candida albicans
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ID
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neutrophils with gram negative coccobacillary
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describe
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satellitism
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what does this show?
|
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oxidase positive
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What test is this showing?
is it pos or neg? |
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H. Influenza
|
Identify
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Zone of inhibition
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What's being measured?
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Group A strep
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What does this kid probably have?
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Clue cells, indicating bacterial vaginitis
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What are these?
What do they indicate |
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trichomonas vaginitis
|
ID
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Trichomonas vaginalis
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ID
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N. gonorrhea
|
Identify
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Yeast
Epithelial cells Calcium oxalate crystals |
ID 1,2 and 3
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Hyaline Cast
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Type of cast
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cellular cast
WBC cast- pyelonephritis, glomerulonephritis, inflammatory nephritis RBC casts- glomerulonephritis, interstitial nephritis pyelonephritis, renal trauma/tumor, acute necrosis Epithelial casts- glomerulonephritis |
Type of cast
what are the different types of this, what are they caused by? |
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Fatty casts/lipids
Nephrotic syndrome/ nephrosis |
Identify
Caused by? |
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Granular cast
Can be fine or coarse- disintegration of WBC or epithelial cast |
ID
|
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Associated with renal failure and CRI- further degeneration of cellular casts
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What are waxy casts from?
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