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97 Cards in this Set
- Front
- Back
normal WBC count
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5,000-10,000/mm3
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What is leukocytosis?
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>10,000 WBC
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What is leukopenia?
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<5,000 WBC
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Maturation series of granulocytes
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Myeloblast → promyelocyte → myelocyte → metamyelocyte (juvenile) → band → segmented cells
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What is the last stage of the granulocytic series that can perform mitosis?
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Myelocyte
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Other name for segmented neutrophil
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Polymorphonuclear neutrophil
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Normal relative value and absolute value of segs, bands, eosinophils, and basophils
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Segs – 50-70% or 2,500-7,000 Bands – 0-5% or 0-500 Eosinophils – 0-3% or 0-300 Basophils – 0-2% or 0-200 |
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What is the function of neutrophils?
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They respond to bacterial infections
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What is the function of eosinophils?
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respond to allergic/asthma reactions and parasitic infections
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What test is used to test adrenal function and involves eosinophils? Explain test
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Thorn test Do eosinophil count, give the patient ACTH (should cause eosinophils to leave the bloodstream). Do second eos count. If adrenal gland works, eosinophils should be 1/2 of what they were at the start |
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What is the function of basophils? |
Increased in delayed hypersensitivity reactions and affect IgE in chronic allergic reactions
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What do basophils become when they move into tissue?
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Mast cells
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What is increased in CML (chronic myeloid leukemia)?
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basophils
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What is the lifespan of neutrophilic cells |
Made in bone marrow, takes 10-14 days to progress from myeloblast to seg, and only spends 6-8 hours in the peripheral blood. 50% in CGP and 50% in MGP along vessel walls. Stress causes them to leave marginal and enter circulatory, but if they're not used they go back |
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What is neutrophilia, and what might cause it?
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>7,000 neutrophils Bacterial infections mostly, also fungal, viral, inflammation, and malignancies |
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What is neutropenia, and what might cause it?
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<2,000 neutrophils Infections, drugs, megaloblastic anemia (has pancytopenia) |
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What is agranulocytosis and what normally causes it?
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<1,000 neutrophils Drug induced (chemotherapy, etc.) |
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What is eosinophilia and what causes it?
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>300 eosinophils asthma/allergic reaction and parasite infections |
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What is basophilia and what causes it?
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>200 basophils CML, myeloproliferative disorders, hypersensitivity reactions |
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What is wrong with WBC in toxic granulation and what causes it?
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Primary granules retain basophilia, causing them to be dark purple/black Caused in response to toxic conditions like chemo, infections, drugs, or burn patients |
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What causes vacuoles in WBC?
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Response to infections, drugs, chemo, and burns
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What are Dohle bodies and what causes them?
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They are remnants of RNA that stain blue in WBC and are caused by infections, chemo, drugs, and burns |
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What is the toxic triad?
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Toxic granulation, vacuoles, and Dohle bodies seen together |
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What is May-Hegglin anomaly and what is associated with it?
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Inherited condition, see Dohle-like bodies but larger that appear in nearly all segs, also see large and possibly bizarre platelets. No toxic granulation. Thrombocytopenia
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What are Alder-Reilly bodies and what are they associated with?
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Inherited, possibly Hurler's or Hunter's syndrome. See heavy azurophilic granulation in all segs and sometimes lymphs and monos. Abnormal mucopolysaccharade formation
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What is Chediak-Higashi and what causes it?
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It is delayed degranulation. Granules stain gray-blue or gray-green in granulocytes, and lymphs may have large red-purple granules. Inherited membrane defect of lysosomes. May see in photophobia and albinism
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What is Pelger-Huet and what are some causes? |
hyposegmentation of neutrophils Myeloproliferative disorders (CML and acute leukemias) chemo therapy, burns |
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What is it called when there are bi-lobed neutrophils?
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Pince-Nez form of Pelger-Huet
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What is hypersegmentation of neutrophils and what causes it?
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6 or more lobes of the nucleus. Caused by abnormal DNA synthesis seen in megaloblastic anemias and chemo patients
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What is chronic granulomatous disease (CGD)?
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Inherited disease caused by a defect in neutrophil metabolism. Neutrophils can phagocytize bacteria but then can't destroy them
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What test is used to detect chronic granulomatous disease?
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Nitroblue tetrazolium (NBT) to measure the killing mechanism of the segs
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What is leukocyte adhesion deficiency?
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Absence of adhesion proteins. WBC can't adhere to tissues so they keep moving on past the site of infection. Results in lack of pus formation and would healing
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What is myeloperoxidase deficiency? |
Lack of myeloperoxidase causes a lack of motility of neutrophils so they can't get to the site of infections
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List the maturation series of monocytes
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monoblast → promonocyte → monocyte → tissue macrophage
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What is the largest normal cell in peripheral blood |
monocyte
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Describe the nucleus, chromatin pattern, and cytoplasm of monocytes
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Nucleus is folded with brain-like convolutions. Chromtin pattern is lacy. Cytoplasm is blue-gray with granules that looks like ground glass |
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What is a different name for a tissue macrophage?
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Histiocyte
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What are the normal values of monocytes in the peripheral blood and bone marrow?
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Peripheral blood: 2-8% and 200-800 Bone marrow: 2% |
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What are 4 functions of monocytes?
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1. immune response 2. defense against fungi, bacteria, viruses 3. phagocytosis 4. motile, can respond to chemotactic factors and become macrophages |
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What is the lifespan of monocytes?
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Made in the bone marrow, go to peripheral blood and stay 8-10 hours, then go into tissues and stay for several months as macrophages
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What is monocytosis and what can cause it?
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>800 monocytes. Indicates current infection, recovery from acute infection (like TB), or recovery after chemo
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What is monocytopenia and what can cause it?
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<200 monocytes. Drugs, steroids, chemo
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What are the qualitative abnormalities of macrophages?
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Gaucher's disease Niemann-Pick disease Tay-sach's disease Sea blue histiocyte |
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What is the deficiency in Gaucher's disease? What does this disease cause?
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beta-glucocerberosiadise mental retardation and hepatosplenomegaly |
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What do Gaucher cells look like?
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They have large folding cytoplasms and resemble crumpled tissue paper. See in bone marrow, liver, spleen, and other tissue
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How can Gaucher's disease be improved?
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Dietary restrictions No cure |
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What do Niemann-Pick cells look like?
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Also called "foam cells". They are macrophages with a foamy cytyoplasm and small eccentric nucleus. See in bone marrow and lymphoid tissue
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What is deficient in Niemann-Pick disease? What does Niemann-Pick disease cause? |
Sphingomyelinase Mental retardation and hepatosplenomegaly |
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What is seen in Tay-sach's disease?
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In peripheral blood see vacuolated lymphs (sometimes) and cherry red macula in the eye
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What is deficient in Tay-sach's disease? What does it cause? |
beta-hexoamidase CNS involvment, mental retardation |
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What is Sea blue histiocyte?
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Might be subclass of Niemann-Pick disease. Blue green granules in macrophages, seen in liver, spleen, and bone marrow. Causes hepatosplenomegaly and neurologic abnormalities
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What is the maturation series of lymphocytes? |
Lymphoblast → prolymphocyte → lymphocyte → plasma cell |
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How big is a small resting lymph?
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9 um
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Normal values of lymphocytes
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Adults: 18-42% and 800-4800 Children < 10 years have increased lymphs |
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What are the functions of B cells?
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They are stimulated by antigens to become plasma cells and produce antibodies and are part of the humoral mediated immunity
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What percent of lymphs are B cells, T cells, and NK cells?
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B cells: 10-20% T cells: 80% NK cells: small % |
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What are the functions of T cells?
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Part of cell mediated immunity. Respond to intracellular organisms like viruses, work to fight tumors, and have a role in delayed hypersensitivity reactions
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What are the primary and secondary lymphoid tissues?
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Primary: thymus Secondary: spleen, tonsils, adenoids, lymph nodes, Peyer's patches in GI tract |
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What is the life cycle of lymphocytes?
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Made in the bone marrow and primary and secondary lymphoid tissues. B cells stay in bone marrow to mature, T cells go to thymus to mature. B cells live 3-4 days, T cells can live 2-10 years
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What is lymphocytosis and what usually causes it?
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>4,000 lymphs. Caused by acute viral infections
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What are the symptoms of infectious lymphocytosis, and what are the WBC and lymph counts?
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GI symptoms WBC 40,000-50,000 Small lymphs 60-70% Usually children |
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What is the WBC count in someone with pertussis?
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25,000-50,000
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What are some types of acquired lymphocytosis? (specific diseases)
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Infectious lymphocytosis Pertussis Infectious mononucleosis Cytomegalovirus (CMV) Toxoplasmosis |
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What are the symptoms of infectious mononucleosis?
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WBC 12,000-25,000 (both relative and absolute lymphocytosis) Lots of reactive lymphs Decreased platelets Enlarged spleen and liver Malaise |
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What virus causes mono?
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Epstein Bar Virus (EBV)
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What type of virus is the Cytomegalovirus (CMV)?
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Herpes virus
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What are the symptoms of cytomegalovirus?
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Absolute lymphocytosis Reactive lymphs Fever and malaise |
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What do reactive or atypical lymphs look like?
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Bigger, up to 30 um. Blue cytoplasm, or may be peripheral basophilic. Cytoplasm might squeeze between RBC
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What is lymphocytopenia and what can cause it?
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<1,000 lymphs. Inherited immunodeficiency, drugs, chemo, radiation, AIDS
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What are some diseases that cause lymphocytopenia? |
SCID Wiskott-Aldrich DiGeorge X-linked agammaglobulinemia Plasmacytosis |
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What is SCID?
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Severe combined immunodeficiency disease T and B cells decreased, T cells almost gone "bubble boy syndrome" death before age 2 |
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What is Wiskott-Aldrich?
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X-linked recessive disease that affects T and B cells. Progressive decrease in T cells. IgM decreased but IgG normal
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What is DiGeorge? |
Deletion on the 22nd chromosome, T cells only are affected. Causes mental retardation and lots of fungal infections
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What is x-linked agammaglobulinemia?
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"Burton syndrome" B cells affected, all Ig levels are decreased. Patients get bacterial infections and can be given IVIg for treatment |
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What is formula for corrected WBC for nRBC?
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Corrected WBC = ((WBC)/(100+nRBC)) X 100
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What are acceptable sites for bone marrow biopsy?
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Posterior iliac crest Sternum |
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What are some indications a bone marrow specimen should be obtained?
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Last resort, can't figure out what's wrong Pancytopenia Staging for Hodgekin's and non-Hodgekind's lymphoma Blasts in peripheral blood |
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Describe the touch prep for a bone marrow biopsy
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Get core and gently roll between 2 slides (might do if you get a dry tap)
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What is a normal M:E ratio?
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3:1 Example: 60 myeloid : 20 nRBC |
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What is the most common granulocytic cell seen in the bone marrow?
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Metamyelocyte
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In what cells is myeloperoxidase found in?
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Primary granules of granulocytes and azurophilic granules in monocytes
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What is the interpretation of the myeloperoxidase stain (MPO)?
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Granulocytes are strongly (+), monocytes weakly (+), lymphs (-) >3% activity, AML (acute myeloid leukemia) |
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What does the Sudan Black B (SBB) stain for?
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lipids present in the primary and secondary granules of granulocytes and azurophilic granules of monocytes
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What is the interpretation of the SBB stain?
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Granulocytes strongly (+), monocytes weakly (+) >3% suggests AML |
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What do you do if you see a lot of blasts in peripheral blood?
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MPO or SBB stain. If >3% it's AML, if <3% it's ALL. If you get the (-) results (<3%) stop and call ALL. If (+), go onto specific or non-specific esterase stains |
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How does the chloroacetate esterase stain work?
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"Specific esterase" Stains for enzyme naphthol AS-D chloroacetate esterase Granulocytes strongly (+), monocytes weakly (+) to (-) |
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How does the non-specific esterase stain work?
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Stains for 2 enzymes: alpha-naphthol acetate or alpha-naphthol buterate Monocytes strongly (+), granulocytes weakly (+) to (-) |
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What does a (+) specific esterase test mean?
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AML: M1, M2, or M3 M4 is positive in both |
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What does a (+) non-specific esterase test mean?
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AML M5 M4 is positive in both |
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What does the Periodic Acid Schiff (PAS) stain for, and what is the interpretation?
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Stains for intracellular glycogen RBC and precursors (-) AML M6 (Erythroleukemia or DiGuglielmos) nRBC stain (+) Normal lymphs weakly (+) Lymph malignancies (ALL or CLL) stain (+) with blocking pattern |
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What does LAP stand for?
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Leukocyte alkaline phosphatase
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How does the LAP stain work? |
Stains LAP enzyme in secondary granules of granulocytes. Count 100 neutrophils and score 0-4 based on staining activity. Multiply scores by frequency and add up |
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What are the interpretations of LAP stain?
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Normal: 20-100 Increased: leukomoid reaction, P-vera, pregnancy Decreased: CML (close to 0), PNH, sideroblastic anemia |
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What is a leukomoid reaction?
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Increased WBC of myelocytic line, usually due to infections. Left shift, may be confused with CML
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What is another name for the leukocyte acid phosphatase stain?
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TRAP stain (tartrate resistant acid phosphatase)
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What is the interpretation of the leukocyte acid phosphatase stain?
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All (-) is good (Normal cells are inhibited by the addition of tartrate) Hairy cell leukemia stains (+) |
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