Exam I Hematology

Front 1

1.1 Define Hematopoiesis

Back 1

Production and development of blood cells. This occurs in the bone marrow under the influence of hematopoietic growth factors.

Front 2

1.2 Sites of hematopoiesis in fetal life, children, adult

Back 2

Fetal life: Embryonic (yolk sac), Hepatic (extramedullary, spleen, liver)

Children: BM

Adult: BM

Front 3

1.3 Bone marrow location, composition, function

Back 3

3.4-4.6% of total body weight

Supplies circulating blood cells

Removes senescent and abnormal cells

Red and Yellow marrow

Front 4

1.4 Bone marrow cellularity; red and yellow marrow

Back 4

Red: Hematopoietically active cells

Yellow: fatty inactive cells

100-age for cellularity

Hyper: 90/Hypo: 10

At birth 100%

Front 5

1.5 Stem cells

GEMM

CFU

Back 5

Stem cells: non-identifiable

GEMM- multipotential cell granulocyte, erythroid, monocyte megakaryocyte

Colony forming unit: the cell which gives rise to the colony

Front 6

1.6 M/E ratio

Back 6

The ratio betwee myeloid/erythroid producing cells

Ratio between all granulocytes and nucleated red cell precursors

Front 7

1.7 M/E ratio

Back 7

3/1

Front 8

1.8 Conditions that require bone marrow studies

Back 8

Leukopenia/Leukocytosis

Anemia

Thrombocytopenia/thrombocytosis

Front 9

1.9 Define: Growth factors, CSF; applications in the treatment of hematologic disorders

Back 9

GF: cytokines (CSF, IL-3, G-CSF, GM-CSF, EPO, M-CSF) stimulate hematopoiesis

CSF: colony stimulating factor

Front 10

1.10 Hematopoiesis: Stem cell, bm, peripheral blood pools

Back 10

1. Stem cells- morphologcially non-identifiable, pluripotent/Multipotent cells(GEMM 0.4%)

2. Immature and mature cells; morphologically identifiable cells

3. Adult cells

Front 11

1.11 Stages of hematopoiesis before and after birth

Back 11

Before: 1. yolk sac, liver, spleen (extramedullary), BM (intramedullary), Lymph nodes

After: BM (Adults: vertebra, sternum rib)(Children- adult sites +femur and tibia), lymph nodes

Front 12

1.12 Define Extramedullary and Intramedullary hematopoiesis

Back 12

Sites of hematopoiesis

E: hepatic stage

I: bone marrow

Front 13

1.14 The function of RBCs and WBCs

Back 13

RBC: transport O2 excrete CO2

Granulocytes: Fight infection

Mnoncytes: phagocytosis

Lymphocytes: Immune function

Platelet: maintain hemostasis

Front 14

1.15 Maturation stages of RBC

Back 14

Pronormoblast, basophilic normoblast, polychromatophilic normoblast, orthochromic normoblast, Polychromatophilic erythrocyte (reticulocyte), RBC

Front 15

1.16 Morphological characteristics of red cell in different stages of maturation: Cell size, N/C ratio, nucleus cytoplasm

Back 15

Pronormoblast 14-19um 6:1, 1-3 nucleoli, chromatin fine

Basophilic Normoblast 12-17um, um 4:1, coarser chromatin, indistinct nucleoli

polychromatophilic normoblast 12-15um 2:1 1:1, condense chromatin

orthochromic normoblast 8-12um, 1:1, chromatin very condense

polychromatophilic 7-10 no nucleus, basophilic

RBC:no nucleus 7-8 um pink

Front 16

1.17 Erythropoietin what does it do, where is it made?

Back 16

Growth factor secreted by the kidney; influences the formation and maturation of RBCs by stimulating the stem cells in the bone marrow

Front 17

2.1 Principle and procedure: Hgb, Hct, and sedimentation (Westergren method)

Back 17

• Hgb in g/dL: Cyanmethemoglobin (EDTA) spectrophotometric measurement Drabkins reagent, specific gravity copper sulfate soln
• Hct: microhematocrit (red/blue band tubes) pack RBC vol, automated dervied from MCVXRBC
• Sed: tube 30cm long predilute with saline 1hr

Front 18

2.2 Normal values for Hgb, Hct and sed rate in adults and childern

Back 18

Sed: <20 mm/h

Front 19

2.3 Results of Hgb, Hct, and sed rate with disorder

Back 19

Sed: Non-specific response to tissue damage

Front 20

2.4 Name hemoglobins measured by cyanmethemoglobin method

Back 20

Potassium ferricyandie (Drabkins)

methemoglobin-----------------> cyanmethemoglobin

Front 21

2.5 Rule of three in regard to Hgb/Hct

Back 21

HgbX3=Hct +/-3%

Front 22

2.6 Type of blood sample used for routine hematology tests

Back 22

Purple top EDTA

Front 23

2.7 Sources of error in Hgb, Hct, Sed rates

Back 23

Hbg: insoluble rbc, abnormal hgb, lipemic, increase WBC

Hct: dehydration, improperly filled tube, read buffy coat, improperly: centrifuged, mixed or sealed, stopping centrifuge

Sed: viscosity, sickle cell, spherocytes (decrease), rouleaux, sickle cell increase, fibrinogen, poikilocytosis (increase). 2hr old sample, tilt, bubbles, clotted, significant temp change

Front 24

2.8-9 RBC indices include formula and calculate

Back 24

MCH: HgbX10/RBC= Mean corpuscular hemoglobin

MCV: HctX10/RBC= mean corpuscular vol

MCHC: HbgX100/Hct= mean corpuscular hemoglobin concentration

Front 25

2.10 Values for adults and children RBC indices

Back 25

Adults Children

MCH: 27-31pg 28-34pg

MCV: 80-100fL 95-118fL

MHCH: 32-36% 30-34%

Front 26

2.11 RBC indices and morphology with anemias

Back 26

MCV: normo/micro/macrocytic anemia

MCHC: normochromic/hypochromic anemia

Front 27

2.12 Reticulocytes

Back 27

Immature RBC in peripheral blood contain remnant cytoplasmic RNA

Assess bone marrow activity

Front 28

2.13 Appropriate stain for reticulocyte counts

Back 28

New methylene blue/supervital stain

Front 29

2.14 Reticulocyte and stage of bone marrow erythropoiesis

Back 29

>3 effective bone marrow response

Front 30

2.15 Normal values of reticulocytes for Adults, children and infants

Back 30

Adult: 0.5-2.0%

Infant: 2.5-6.5%

Children: 0.5-3.1%

Front 31

2.16 Clinical application of a retic count

Back 31

Monitoring anemia

Front 32

2.17 Significance of an decreased or increased Retic count in anemic patient

Back 32

Reflects the rate of erythropoiesis during anemia

Front 33

2.18 calculate reticulocyte using a miller disk and 1000 red cell count method

Back 33

Manual: count 1000, % retic

Miller disk: count 200 RBC in small box, retic in both box

Front 34

2.19 calculate absolute retic count and RPI

Back 34

% reticX HCT/45

_________________

Maturation time

>3 effective bone marrow response

Front 35

2.20 RPI and it's clinical application

Back 35

Monitoring of anemia

Front 36

2.2a type of stain used for peripheral smear

Back 36

Wright stain

Eosin-basic components (Hgb)

Methylene blue- acid components (DNA, RNA)

Front 37

2.3a pH on a slide

Back 37

High pH- blue/purple alkaline

Low pH- orange acidic

Brown- hemoglobin

Front 38

3.1 Structural components of a RBC

Back 38

Peripheral and Integral protiens

Carbohydrates

Lipids (Hydrophobic/philic)

Front 39

3.2 Basic chemical composition of the RBC membrane

Back 39

Lipids: 40%

Proteins: 52%

Carbohydrates: 8%

Front 40

3.3 Peripheral and Integral proteins

Back 40

Integral: glycophorin A, B,C, and D, anion pumps

Peripheral: actin, spectrin, protein 4.11, ankyrin

Front 41

3.4 Function of integral and peripheral proteins

Back 41

Integral: sialic acid (60% carbs neg charge), ion exchange, RBC antigens

Peripheral: spectrin 75% shape and flexibility; related to integrity of RBCs

Front 42

3.5 Lipid component of the RBC membrane

Back 42

Cholesterol (25%) accumulation acanthocytes

Phospholipids

Glycolipids

Front 43

3.6 Structural composition of normal hemoglobin

Back 43

Heme: Fe + protoporphyrin ring

Globin: 2 sets of polypeptides

Front 44

3.7 Hemoglobin synthesis

Back 44

Starts and ends in the mitochondria

Starts with delta- amino levulinic acid

Front 45

3.8 Types and concentrations of normal adult hemoglobin

Back 45

Oxyhemoglobin and deoxyhemoglobin

95-97% A1 (alpha and beta)

2-3% A2 (delta and alpha)

1-2% HgbF (alpha and gamma)

Front 46

3.9-10 Abnormal hemoglobin

Back 46

Carboxyhemoglobin (smoking, CO)- 5%

Methemoglobin (well water, drugs)-1.5%

Suflhemoglobin (sulfa drugs, irreversible)-0.5%

Front 47

3.11 Hemoglobin function dissociation curve

Back 47

The amount of oxygen needed to saturate 50% of hgb; depends on the partial pressure of oxygen (pO2)

26-30mmHg: Normal

Increased P50: shift to the right

Decrease P50: shift to the left

Front 48

3.12 Shift to the left and right

Back 48

Due to pressure- Increased O affinity with a left shift, Decreased O afffinity with a right shift

Front 49

3.13 Conditions with a left and right shift

Back 49

Right: hypoxia, acidosis, anemia, high temps, increase 2,3-DPG, decreased Hgb O2 affinity; increased erythropoiesis, cardiac output

Left: old blood, alkalosis, low body temp, abnormal hemoglobin, increase O2 affinity, decrease 2,3-DPG

Front 50

3.14. The role of 2,3-DPG in O2 delivery

Back 50

Helps regulate hemoglobins affinity for oxygen

Front 51

3.15 Function of normal hemoglobin

Back 51

transport O2 to tissue

Remove CO2 from tissue

Front 52

3.16-17 RBC metaboloic pathways

Back 52

• Embden-Meyerhoff Anaerobinc pathway- 90% ATP
• Hexose monophosphate shunt: 10% glu metabolized, reduced glutatfhione, can have G-6-PD deficiency in this pathway
• Methemoglobin Reductase pathway- reduces methemoglobin
• Luebering-Rapoport pathway- 2,3-DPG

Front 53

3.18 RBC life span

Back 53

120 days

Travel 200-300 miles

Front 54

3.19 RBC production and destruction rates and sites

Back 54

Destruction 1% a day in BM

5-10 Intravascular

Front 55

4.1 Applications of hemocytometer

Back 55

Platelet and WBC counts

Front 56

4.2 Steps of using a hemocytometer

Back 56

Dilute, Load, count, calculate, interpret

Front 57

4.3 Unopette system: reservoir pipet dilution: WBC Platelet

Back 57

precalibrated pipet: 20ul/1.98mL diluent 1:100 dilution

Front 58

4.4 Diluent used in unopette

Back 58

ammonium oxolate

Front 59

4.7 Normal WBC, RBC, and platelets in adults and children

Back 59

WBC adult: 4,800-10,800 mm^3

RBC adult:4.7-6.1X10^6/4.2-5.4X10^6

Platelet adult: 150,000-400,000/uL

Children

RBC: 3.8-5.5X10^6 mm^3

Front 60

5.1 Three essential parts of examining a peripheral smear

Back 60

Est of WBC

WBC diff

Morphological evaluation of RBC, WBC, platelets

Front 61

5.6 WBC estimate, diff count, plt est, evaluation of WBC and RBC morphology

Back 61

WBC/hpf: 2-4 (4.0-7.0), 4-6 (7-10), 6-10 (10-13), 10-20 (12-18)

Plt est: avg 10 fieldsX 20,000

WBC est: avg 10 fieldsX 2000

Corrected WBC: uncorr. WBC X100/100+nRBC

Front 62

5.7 The normal values for WBCs In adults, infants and children

Back 62

Seg N: 50-70%

Band: 2-6%

Eos: 0-4%

Baso: 0-2%

Lymph: 20-44%

Mono: 2-9%

Front 63

5.8-9 Relative vs. absolute value of WBC type

Back 63

Relative: % value of various cell types in peripheral blood

Absolute: Based on total WBC of 10.0X10^3mm^3

Front 64

5.10 What is the criteria for counting more than 100 WBC

Back 64

Leukemia

High WBC

Front 65

5.12 Indicate what is examined at 10X, 40x, 100X

Back 65

10x: overall staining quality

40x: est WBC count

100x: platelet est, WBC diff, RBC and WBC morphology

Front 66

6.1 Define anemia

Back 66

decrease competence of blood to carry oxygen to tissue, causing hypoxia; decrease in hemoglobin

Front 67

6.2 Three physiological causes of anemia

Back 67

Blood loss

Decrease production or ineffective RBC

Increased RBC destruction

Front 68

6.3 Body's physiological response to anemia

Back 68

Increase 2,3-DPG, EPO, cardiac output

Front 69

6.4 3 morphological classifications of anemia

Back 69

N/N

M/N

M/H

Front 70

6.5 Clinical signs and symptoms associated with anemia

Back 70

Bleeding, Splenic enlargement, lymphadenopathy, organ dysfunction, pallor, dyspnea, lethargy, headache, nausea, decreased appetite, tachycardia, angina pectoris

Front 71

6.6 RBC indicies and anemia

Back 71

MCV: cytic

MCHC: chromic

Mod Anemia Hgb 8-10, Hct 24-30%

Severe: Hgb <7, Hct <22

Front 72

6.8 Routine lab tests and results for anemia

Back 72

CBC: hgb, hct, indices

Retic

BM smear

Front 73

6.10-11 M/H, M/N, N/N and indices

Back 73

M/H: IDA, SA, Thalassemias MCV<80fl MCHC <32%

M/N: B12 def, folic acid def, liver disease, malignancies, alcoholism, drugs MCV>100fl MCHC 32-36%

N/N: Intracorpuscular inherited defects/Extracorpuscular acquired immune hemolytic, infections MCV 80-100fL, MCHC 32-36%

Front 74

Hgb

Hct

Back 74

Adult:

14-18/12-16 g/dL

37-47%

Children:

11-16 g/dL

30-43%