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253 Cards in this Set
- Front
- Back
A complete CBC will give you the percentage and absolute count which white blood cells and for which other elements in the blood?
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platelets, RBC, WBC (neutrophils, basophils, eosinoophils, monocytes, lymphocytes), hemoglobin, hematocrit
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list the red blood cell indices
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MCV MCH MCHC, and RDW
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MCV stands for
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Mean corpuscular volume
|
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what is the mean corpuscular volume
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the average volume of the rbc
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What is the formula for mean corpuscular volume
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the formula for mean corpuscular volume is the hematocrit times ten divided by rbc
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red blood cells that are smaller than normal are refered to as
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microcytes
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how big of a difference is there between males and females reference ranges for hematocrit
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45%
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What is the reference range for the number of RBC in the blood
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4.0 X 10^12/L
or 4.0 X 10^6/mm^3 |
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normacytes have an MCV of
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80-100 fentolitesr
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any rbc witht a MCV less than 80 is considered a
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microcyte
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The formula for MCH is
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hemoglobin X 10 divided by the RBC count and is units are picograms
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what is the reference range for MCH
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27-33pico grams
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what is a normal hemoglobin per dL of blood
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15g/dL
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MCHC stands for
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mean corpuscular hemoglobin concentration, and it is a measure of the concentration of hemoglbin in a given volume of packed red blood cells
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what is the formula for MCHC
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hemoglobin/hematocrit X 100
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a MCHC that is normochromic is
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32-36%
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an MCHC thtat is hypochrmoic is
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below 32%
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what causes hypochromic RBCs
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decreased concentrations of hemoglobin
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do hyperchromic rbc's exist
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no
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the instruments used to count RBC and WBC are called
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Beckman Coulter and Sysmex
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what are the partst to the coulter/sysmex analyzers
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a diluter, analyzer, power supply, and data managment system
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After samples are diluted in the coulter analyzer the samples go in cassets to the first bath where what happens?
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The RBCs and platelets are counted
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After counting the RBCs and platelts, the patient sample is sent to another bath where what is counted
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WBC
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the RBC and WBC bath counts in the coulter analyzer have to agree within
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4SD
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The cassettes in the Coulter LH500 use what type of bar code system and where are the codes
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a double bar code system, one on the tube and one on the cassette
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The coulter analyzer counts anything that is what size as RBCs?
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greater than 36 fL
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What is the coulter principle
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uses electrical current to count and size particles
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how does the coulter analyzer deterime the volume of a particle
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the amount of electrical resistance, represented by a pulse
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pulses are grouped by size and placed on a
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histogram
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on the coulter analyzer histogram what does the x and y axis represent
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the x axis represents the MCV and the y axis the number of cells we have
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what is the reference range for RBCs
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4.0 X 10^6/mm^3
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What is the reference range for WBC
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7 X 10^3/mm^3
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how does the coulter instrument calculate the MCV
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it calculates the area under the curve
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the coulter analyzer calles anything under what volume as platelets
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2-20fL
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platelets give what kind of curve
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a skewed curve
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the first curve generated by the coulter is a platelet curve called the
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smooth curve
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what three criteria have to be met for the smooth curve to be transformed to a normal curve
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the mode has to be within 3-15fL, the platelet distribution width has to be less than 20%
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how many heme groups does hemoglobin have
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four
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how many polpypeptide chains are those heme groups attached to in hemoglobin
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4
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what is the major ttype of hemoglobin in adults
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HbA1
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what are the types of hemoglobin
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HbA1, HbA2, and HbF
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what percentage of hemoglobin A1 do we have in our blood as an adult
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97%
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how many chains does hemoglobin A1 have
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2 alpha and 2 beta
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the beta chains consist of how many amino acids?
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146 amino acids
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what structural change in hemoglobin A1 causes sickle cell anemia
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a single amino acid change
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how many amino acids are there in the alpha chains of hemoglobin A1
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141 amino acids
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Hemoglobin A2 makes up what percentage of our hemoglobin
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2%
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how many chains does hemoglobin A2 have and what are their names
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Hemoglobin 2A has four chains, 2 are delta, and 2 are alpha
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what percentage of adult hemoglobin is comprised of Hemoglobin F and how many chains does it have and what re their names
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Hemoglobin F comprises 1% of our total hemoglobin as an adult, it thas 4 chains, 2 gamma and 2 alpha
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in order for the oxygen ot be carried on emoglobin what state does the iron moeity have to be in?
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a plus 2 (ferrous) state
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in hemoglobin determination
hemoglobin is convertetd to what using a potasium ferric cyanide, |
cyanomethemoglobin
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hematocrit goes hand in hand with what
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hemoglobin
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what is hematocrit
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hematocrit is the number of packed rc in mm/whole blood in mm x 100
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what does hematocrit measure
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how much RBC you have in your blood
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what is a short hand for obtaining the hematocrit from hemoglobin
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hemoglobin times three plus or minus 3 percent
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what is the formula for MCV
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hematocrit times 10 divided by the RBC
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what does RDW stand for
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rdw stands for red cell distribution width
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when looking at the RDW what else do you have to look at
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MCV
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what does the RDW measure
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the RDW measures anisocytosis
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what is anisocytisis
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anisocytosis is variatin in size
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what is the formula for the coefficeint of variation of the MCV
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the SD divided by the mean times 100
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what is the normal reference range for RDW
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11.5-14.5%
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how does the coulter measure the hematocrit
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it measures the MCV and RBC then calculates the hematocrit
|
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what is the most imature granulocyte
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it is called the myeloblast
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what is the ratio of nucleus to cytoplasm in the myeloblast
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high n/c ratio
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what is the color of a myeloblast cytoplasm
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basophilic (blue)
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where is the myeloblast found
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inside the bone marrow
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what is the stage after myeloblast
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promyelocyte
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what is the nuclear to cytoplasm ratio for a promyelocyte, and what is the color of the cytoplasm
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the promeylocyte has a large n/c ratio, and its cytoplasm is basophilic
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what is the major difference between the myeloblast and the promyelocyte
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the promyelocyte is beginning to form granules
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what is the various names for the granules within the promyelocyte
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the granules are called non-specific, primary or azurophilic
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what is the major enzyme found within the nonspecific granules of the promeylocyte
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myeloperoxidase
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where are promyelocytes normally found
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within the bone marrow
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what stage comes after promyelocyte
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myelocyte
|
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what is the nuclear to cytoplasm ratio for a myelocyte
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the nuclear to cytoplasm ratio for a myelocyte is 50 to 50
|
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what is the major difference between promyelocytes and myelocytes
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the nucleas is relatively round, the chromatin is becoming more clumped, and the formation of secondary granules
|
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what are the various names for the granules found within the myelocyte
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secondary, specific,
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where are myelocytes normally found
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in the bone marrow
|
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what is the stage that follows after myelocyte
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neutrophlic metamyelocytes
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what is the major difference between myelocytes and metamyelocytes
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the nuclear chromatin are becoming more clumped and the nucleus will have an indent
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where are neutrophilic metamyelocytes normally found
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in the bone marrow
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what is the stage after neutrophlic metamyelocytes
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neutrophilic band
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what is the major difference between the neutrophilic metamyelocyte and the neutrophilic band
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the nuclear indentation is deeper than 2/3
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where are neutrophilic bands typically found
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outside the bone marrow
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what is the stage after neutrophilic band
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the band becomes a segmented neutrophil
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what is the reference range for a seg
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50-70%
|
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what is the reference range for bands
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0-6%
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what is the reference range for lymphs
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20-40%
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what is the reference range for monos
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3-11%
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what is the reference range for eosins
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0-5%
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what is the reference range for basophils
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0-1%
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what cells comprise the marginal pool aka the mitotic pool for the neutrophil series
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the myeloblast, promyelocyte, and the myelocyte
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how lon gdoes it take for a cell myeloblast to go from blast tot myelocyte
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4 days
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what cells comprise the post mitotic pool for neutrophils
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the metamyelocyte, neutrophilic band, the segmented neutrophils, these do not divide inside the bone marrow
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how long does it take to go from neutrophlic myeloblast to segmented neutrophil
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9 days
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how long do neutrophils usually circulate in the circulating pool until they enter the tissues, unless theres an infection
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8 hours
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what is the usual ratio of marginal to circulating pool for wbc
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50/50
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what are the two examples that maser gave that could ofset the ratio of marginal to circulating for the wbc
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women in labor, infection, and extreme exercise
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what is a term for only a change in the marginal and circulating pool but not in the production of WBC
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pseudoneutrophilia
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what are the stages for eosinophils
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they start the same as the neutrophil, you go from myeloblast, to promeylocyte, to eosinophilic myelocyte, to eosinphilic meta myelocyte, to eosinophilic bands, the eosinophils
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eosinophils are usually involved in what types of reactions
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parasitic infections and allergic reactions
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what are the stages in the maturation of basophils
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they go from myeloblast, to promyelocyte, to basophilic metamyelocyte, to basophilic band, to basophil
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what are the three ways that neutrophils take care of bacterial infections
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direct hit, acidic environment, and ionization of hydrogen peroxide
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what size are monocytes
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monocytes are 12-20um
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how long do monycytes stay in the peripheral blood once released into the blood stream
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about 70 hours
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when moncytes enter the tissues what do they differentiate into and how long do they remain there
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monocytes differentiate into macrophages in the tissues and remain there for several months
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list the functions monocytes
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they phagocytize cellular debri, the process antigens and present these to T cells, they release IL2 which stimulates T cells, and they produce interferon which protects against viral infections
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what is the maturation series of a lymbocyte
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lymphoblast, to prolymphocyte to lymphocyte
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what types of lymphocyte are there
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T cells and B cells
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list the functions of T cells
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T cells are involved with cell mediated immunity, IL-2 stimulates their prolifferation and differentiation of activated T cells, they have gamma interferon which may enhance NK cell motility
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What are the functions of B cells
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B cells diferentiate into plasma cells that secrete imunoglobulins
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in the coulter machine, after the mixing cell the sample will go into the
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flow cell
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the process in which we put these white blood cells in single file is called
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hydrodynamic focusing
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a laser interrogates a cell for what three things once in the flow cell
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volume, conductivity, and light scatter
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how is the volume measured in the coulter using vcs technology
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a direct or low frequency current is used to measure the impedance (resistance) which is proprtitonal to the volume of the cell. the resulting voltage pulse is proportional to the volume
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how does the coulter measure conductivity using vcs technology
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conductivity is measured using high frequency current which penetrates the cell to evaluate teh internal constituents such as granules and nucleur content
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what information does scatter provide in the vcs
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scatter provides information about cell shape, morphology, surface, characteristics, and granularity
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where is the flow cell located
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in the triple transducer module
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on the graph generated from vcs where are the cells located
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lymphs are in the bottom left, monocutes are higher than limphs bud they do not scatter as much light, neutrophils are in the center, nd they are the same size as monocytes but will scatter more light. eosinophils are on the top right
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What does MPV stand for
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mean platelet volume
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what is the mpv
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the mpv is the average volume of a platelt found under the curve once it has been fitted
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what are the steps in the red blood cell maturation series
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rubriblast to prorubricyte, to rubricyte, to metarubricyte to (if wright stain is used) polychromatophilic cell, or (if new methylene blue is used) reticulocyte, to finally erythrocyte
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how does new methtylene blue work on rbcs
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it preciipates out RNA so the cell can be seen better
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at what stage is the nucleus of the red cell dead
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at the metarubricyte, after this step the cell will loose the nucleus
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what are the characteristics of a rubriblast
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they have an open chrmoatin pattern, nucleoli, they are synthesizing RNA, they have ribosomes that synthesize alpha and beta polypeptide chains which are needed to make hemoglobin, the have mitochondria that synthesize ALA, and the are receiving iron but not sytnehsizing hemoglobin, only preparing for hemoglobin synthesis
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what are the characteristics of the prorubricyte
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it under goes RNA synthesis, and it is the beginning of hemoglobin synthesis
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what is the major characteristic of a rubricyte
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it is where the peak hemoglobin synthtesis takes place
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the characteristics of a metarubricyte are
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they are fully of hemoglobin, theyir nucleus is a degenerated mass, and the macrophages will phagosytize the extruded nucleaar material
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RBC maturation takes how many dayas
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4-6
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how long does it take to form a reticulocyte from a rubriblast
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72 hours
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how long do reticulocytes normally circulate
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24-48 hours
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a mature RBC circulates for how long
|
120+ or - 20 days
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what are the basic changes a RBC undergoes when it is maturing
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the nuclear to cytoplasm ratio decreases, the chormatin clumps, nucleoli are lost, the cell decreases in size, and the cytoplasm goes from blue to pink
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what are poikilocytes
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they aare rbcs that vary in shape
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what factors effect RBC shape
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environment, age of cell, and metabolic status of cell
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what are burr cells aka echinocytes
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spiculated cells that have an even number of spicules (short and nubby) around the periphery of cells usually more than 10
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what are the 2 causes of burr cells
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a decrease in ATP, and an increase in fatty acid and change in pH
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when do we see burr cells the majority of the time
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in renal failure, when BUN (blood urea and nitrogen) and creatinine are elevated, indicating renal failure
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what are acantyhocytes
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they have 2-10 spicules that are not as evenly spaced around the membrane, the spicules are longer
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what are the nunber one cause for acanthocytes
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the stagnation of cholesetrol in the RBC membrane
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spherocytes are
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compacted smaller rbcs, without the central palor,
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what happens when a cell has a foreign object on its membrane
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the spleen sees it and phagocytizes it, but if the cell is young enough it can regrou and reform, but it will be small nd look like a spherocyte, the decreases surface to volume ratio means it has lost its surface
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what are long oval shaped rbc, that occur when a cell gows through something like a narrow capilary
|
eliptocytes
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what are schistocytes
|
fragmented RBCS caused by DIC and TTP
|
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what are teardrop cells
|
teardrop cells are cells that are pulled in a certain direction (the fancy term is cryocytes)
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what are stomatocytes
|
when the cells central palor is rectangular, this could be an artifact. In liver assays, if the ALT and AST is increased, then these stomatocytes are true
|
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what causes sickle cells
|
cells that are losing oxygen,
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what is sickle cell anemia
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the 6th position of the beta chian in hemoglobin, which normally carries glutamic acid, but in sickle cell anemia it carries valine instead, so oxygen cannot be carried
|
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what are target cells
|
target cells have a decreased hemoglobin (causing them to be hypocrhomic i.e. light in color) and an increased surface area creating a dome shape
|
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what are pappenheimer bodies
|
they have iron inclusions that tend to cluster together at the peripheral of te cells
|
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what stain is used as a confirmatory stain of iorn in pappenheimer bodies
|
prussian blue
|
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howel jolly bodies are
|
howel jolly bodies contain a single cluster which is comprised of pieces of DNA
|
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what is basophilic stippling
|
basophilic stippling is the precipitation of ribosomes, looks like the cell has thte measles. it is usually seen in lead poisoning cases
|
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what is the size of a eosinophil
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10-15 microns
|
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what color are eosinophils
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pinkishy orange
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what is the function of a eosinophil
|
an eosinophil phagocytizes , but less so than does segs
|
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how long do eosinophils survive in the tissues
|
6 days
|
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after maturation where are eosinophils stored before being released into the peripheral blood
|
bone marrow
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what is the size of a basophil
|
it is 10-15um
|
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how long do basophils circulate
|
for about the same time as neutrophils which is 8 hours
|
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what is thte function of a basophil
|
they participate in immediate hypersensitivyt immune reactions because their granules have hestamines and heparin
|
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what are mast cells
|
basophils in the tissues are called mast cells
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what is poikilocytosis
|
poikilocytosis is variation in shape
|
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where are cells made in utero
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liver and spleen
|
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in utero when does the bone marrow become the major organ in the body that develops cells
|
the third trimester, 5 months
|
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after birth where are the majority of cells made
|
the bone marrow
|
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where can red active marrow be found
|
in the illiac crest, skull, sternum, proximal end of thte large bones, and the axial skeleton
|
|
what type of marrow are we interested in for bone marrow aspirates
|
red active marrow
|
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what is the number one place for a bone marrow aspirate
|
the illiac crest
|
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what is the number twto site for a bone marrow aspirate
|
the sternum
|
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what is the number 2 place for a bone marrow aspirate
|
the sternum
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when the bone marrow isn't working, how does the body compensate?
|
it starts to produce cells in the liver and the spleen like it did in utero
|
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what is it called when a person starts to produce stem cells in the liver and spleen like they did in utero
|
hepatosplenaglmaly (enlarged liver and spleen)
|
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what is the highest concentration of hemoglobin in utero
|
fetal hemoglobin
|
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what chains comprise fetal hemoglobin
|
alpha and gama
|
|
what is the structure of heme
|
heme is a photophorphyrin ring with an iron in the middle
|
|
what starts out the heme synthesis pathway
|
succinyl CoA and clycine
|
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protoporphyrin X ring plus ferrous =
|
heme
|
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lead can stop the heme synthesis at how many places
|
3
|
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90 percent of RBC metatbolism occurs via what pathway
|
the embden meyerhoff pathway
|
|
what is the final product of the embden meyerhoff pathway
|
ATP
|
|
what does ATP do for a RBC
|
ATP allows the RBC to maintain its biconcave shape, it gives flexibility to the RBC membrane, and provides energy for the sodium ptassium pump, the RBC has a high level of potassium in it and sodium outside
|
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where does the RBC get the other 10 percent of its energy
|
the hexose monophosphate shunt, in order to keep the iorn moeity in the ferrous state
|
|
what does the rapaport-luberbering pathway produce
|
2,3 BPG
|
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what is a quick but short term response to low oxygen tension
|
2,3 BPG
|
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what does the MCV tell you
|
the average red blood cell size in fL
|
|
what does the MCH tell you
|
the hemoglobin amount per red blood cell in pg
|
|
what does the MCHC tell you
|
the MCHC tells you the amount of hemoglobin relative to the size of teh cell (hemoglobin concentration) per red blood cell in percent or g/dL
|
|
what are the units for RDW
|
%
|
|
What is the reference range for RBC in an adult male
|
4.6-6.0 x10^6/ul
|
|
what is the adult female reference range for RBC
|
4.0-5.4 x 10^6/uL
|
|
what is the adult male reference range for hemoglobin
|
14.0-18.0 g/dL
|
|
what is the adult female reference range for hemoglobin
|
12.0-14.0 g/dL
|
|
what is the MCV adult reference range for both males and females
|
80-100 fL
|
|
what is the adult male and female reference range for MCH
|
26-32 pg
|
|
what is the adult male and female MCHC reference range
|
32-36 %
|
|
what is the adult reference range for RDW male and female
|
11.5-14.5 %
|
|
what is the NRBCs reference range for both adult males and females
|
0 /100 WBC
|
|
what is the WBC reference range for adult males and females
|
4.5-11.5 x10^3/uL
|
|
what is the normal range for PMNs in a peripheral
|
50-70 %
|
|
what is the reference range for bands in the peripheral smear
|
0-5 %
|
|
what is the reference range for lymphs in the peripheral blood smear
|
18-42 %
|
|
what is the reference range for monos in the peripheral blood smear
|
2-11 %
|
|
what is the reference range for basophils in the peripheral blood smear
|
0-2 %
|
|
what is the reference range for eosinophils in the peripheral blood smear
|
1-3 %
|
|
what is the reference range for platelets
|
150-450 x10^3/uL
|
|
what is the reference range for MPV
|
6.8-10.2 fL
|
|
red blood cells that have a MCV less than 80 fL are
|
microcytic
|
|
red blood cells that have a MCV between 80-100 fL are
|
normocytic
|
|
red blood cells that have a MCV greater than 100 fL are
|
macrocytic
|
|
RBCs with a MCH less than 26 pg are
|
are hypochromic
|
|
RBCs with a MCH within 26-32 pg are
|
are normochromic
|
|
RBCs with a MCH greater than 32 pg are
|
hyperchormic
|
|
a measure of anisocytosis is
|
RDW
|
|
anisocytosis is
|
how much variation in size there is of those red blood cells
|
|
how do we get a feel for anisocytosis
|
RDW
|
|
what is the formula for RDW
|
1SD*100/MCV
|
|
what is the normal reference range for RDW
|
11.5-14.5%
|
|
what is the relationship between hemoglobin and hematocrit?
|
our hematocrit is are hemoglobin times 3 plus or minus 3 %
|
|
the most immature granulocyte is the
|
myeloblast
|
|
what is the morphology of a myeloblast
|
it is basically all nucleus, with a high nucleus to cytoplasm ratio, the cytoplasm is basophlic or immature (blue), the chromatin is very smooth and there may be a nucleolus
|
|
the myeloblast divides to form what cell?
|
the promyelocyte
|
|
what is the chromatin pattern for a promyelocyte?
|
smooth and homogenous
|
|
what is the difference between a myeloblast and a promyelocyte?
|
the promyelocyte shows the formation of granules
|
|
what are the three names for the granules within a promyelocyte?
|
non-specific (maser likes this name), primary, and azurophilic
|
|
what is the enzyme in the promyelocyte that maser wants us to know
|
myeloperoxidase
|
|
how big are the granules in the promyelocyte and wat color do they stain?
|
they are 0.5 microns and they stain black/purple/red depending on your eyes
|
|
what is the neutrophil maturation series?
|
myeloblast-->promyelocyte-->myelocyte-->metamyelocyte-->neutrophilic band-->seg/poly
|
|
when do we start tto see specific/secondary granules in the neutrophlic cell series?
|
at the neutrophilic myelocyte stage
|
|
what three cells in the bone marrow are considered to be in the mitotic pool
|
the blast, the pro, and the myelocyte
|
|
what about cells makes them part of the mitotic pool?
|
they can divide
|
|
how long does it take for the the myeloblast to develop into the myelocyte
|
4 days
|
|
which cells of the neutrophil series are considered to be post mitotic pool?
|
the meta, band and seg, when in the bone marrow
|
|
how long does it take for a metamyelocyte to mature to a seg and be released into the peripheral blood?
|
5 days
|
|
how long does it take for the neutrophlic cell series to complete?
|
9 days
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what is the reference range for lymphs
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20-40 %
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what is the reference range for monos
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3-11 %
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what is the reference range for eosins
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0-5 %
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what is the reference range for basos
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0-1 %
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how long do segs stay in the tissues?
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5 days unless there is an infection
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what is the marginal pool?
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the cells lining the vessels
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which pool do we normally inform the physician about
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the circulating pool
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how long does the circulating pool normally circulate?
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for about 8 hours then they go into the tissues and stay for up to 5 days
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in what situations do we have more cells in thte circulating pool than the marginal?
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in cases where the total white cell count increase, examples include women in labor for an extended period of time, infectiton,
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what is the development series for an erythrocytet
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rubtriblast--> prorubricyte-->metarubricyte-->polychromatic erythricyte if wright stain, or reticulocyte if methylene blue, then erythrocyte
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how long do erythrocytes cycle
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for about 120+/- 20
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what facors affect the rbc shape
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the environment (circulatory), the age of the cell, and the metabolic status of the cell
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what is the morphology of a burr cell
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a burr cell has an even number of spicules and it usually has more than ten, they are short and nubby
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what causes burr cells/echinocytes
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decreased atp and increased fatty acid and pH
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what test would a physician order to check for renal problems
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BUN
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what test goes hand in hand with BUN
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creatinine, if both are elevated there is some problem with renal function
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what type of disorers are acanthocytes normally seen in
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abetalipoproteinemia, post spleectomy
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what is the major difference between burr cells and acanthocytes
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acanthocytes have 3-10 spicules that are long and not evenly distributed
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