AAB/Jarr Heme Coag Flashcards
3 main sites of hematopoesis during conception and early fetal months
yolk sac, liver, spleen
Adult Bones Hematopoesis, acrynom
SS
PRV
Skull, Sternum
Pelvis, Ribs, Vertebrae
Heme needs these two things
iron and protoporhyrin
Protein that transports Fe
transferrin
Major storage form of iron
Ferritin
Long term storage of insoluble Fe
Hemosiderin
Enzyme def w/build up of heme precursors is called
porhyrias
While in the DELTA,
POR UR COP PRONTO
a cup of HEME
Heme Precursors
Hmg F % in newborns versus adults
newborn 60-90
adults 1
Hmg A in adults
versus newborns
adults 97
newborns 10-40
Hmg A2 in both adults and newborns
2%
Gower I/II, Portland Hmg in…
Hmg F in…
Hmg S in…
embryonic
both newborn and adult
not normal, sickle cell
In Hmg oxy diss curve, oxygen is released or not released in a shift to the left
not released
No, won’t let go
In Hmg oxy diss curve, oxygen is released or not released in a shift to the right
released
won’t hold tight
To determine Hmg, the oxidation of hmg to methmg is done with these two reagents
K-CN and K-Ferric-CN
Cyanide
HCT % NV
Male
Female
Female 37-47
Male 42-52
Diluent used for WBC/PLT CT
1% Ammonium Oxalate
MCV formula
HCT/RBC x 10
volume/cell
MCV NV
80-100fL
MCH formula
HGB/RBC x 10
hmg/cell
MCH NV
27-31pg
MCHC formula
HGB/HCT x 100
concentration=always smaller number at top and percentage
hmg/volume
MCHC NV
32-36 g/dL
RDW NV
11.5-14.5%
RBC ref
female
male
female 3.8-5.2
male 4.5-6.1
Seg ref
45-70
About 1/2-2/3
Lymp ref
20-40
About a quarter almost 2/3
mono ref
3-10
baso
0-2, least
eos
0-3
plt ref
150-400
Romanowsky stain also called
Wright stain, Giesma
4 things in wrights stain
-methanol
-phosphate buffer
-eosin, methylene blue
Calculation of absolute values
Relative% x total cell ct
TB, Syphilis, Malignancies associated with what kind of cell
monocytes
Hypersegmented neutrophils ass with what kind of anemia
megaloblastic anemia
Hyposegmented neu ass with
pelger huet
bacterial infections, burns, chemo ass with what 2 white cell morphologies
toxic granulation and vaculoles
Bacterial infections, burns, and May Hegglin ass with what white cell morph
Dohle bodies
Varient lymphs ass with
IM, viral infections
WBC correct calculation for NRBCS
wbc x100/nrbcs + 100
Abetalipoproteinemia and severe liver disease ass with what rbc shape
acanthocyte
uremia and artifacts cause what kind of rbc shape
echinocyte, burr
DIC causes what rbc shape
shisto
HJ bodies composed of
DNA
Baso stip composed of
RNA
Pappenheimber bodies made of
Iron
Heinz bodies made of
denatured precipitated hemoglobin
cabot ring made of
left over mitotic spindle
Which rbc inclusion is not seen with wright stain
Heinz bodies
Heinz bodies and bite cells ass with what deficiency
G6PD
Kind of rbc inclusion with thall and lead
baso stip
Rule of 3
RBC x 3=Hmgx3=Hct
Increased MCV/MCHC and decreased RBC are ass with
cold agg disease
What replaces glutamic acid in the 6th position of the beta chain in Hmg C
Lysine
What replaces glutamic acid in the 6th position of the beta chain in Hmg S
Valine
Hmg A1 chains
2 alpha
2 beta
Hmg A2 chains
2 alpha
2 delta
Hmg F chains
2 alpha
2 gamma
Order from fastest to slowest in cellulose acetate at pH 8.4 (as opposed to citrate 6.2)
A, F, S, C
Two reagents usedin solubility test of Hmg S
saponin and sodium dithionite
ESR Female
0-20mm
ESR male
0-15mm
ESR show increase in these two plasma proteins
fibrinogen and globulin
decrease temp, old, excess EDTA ESR…
decrease ESR
supravital Stain for retic ct
new methylene blue
Retic ct monitors
etrythropoiesis
Retic ct % calculation
retics/10
Absolute retic
RBCs x retic%
corrected retic ct (corrects for HCT)
retic % x PT HCT/45
retic ref
0.5-1.5%
RPI calculation
corrected retic/maturation time of 2
need retic # and HCT
M:E ratio
3:1-4:1
Stain for bone marrow
romanowsky, same for wrights
Cellulose acetate ph8.6, cathode/slowest to fastest/anode
-C, S, F, A+
Cellulose acetate ph8.6, anode/fastest to slowest/cathode
+A, F, S, C-
Hmg D seen in what race, migrates with
East indian, S
Hmg E seen with what race, migrates with
Southeast asian, C
Hmg G seen with what race, migrates with
African, S
Reducing agent in qualitative screen for Sickle Dex, solubility test
sodium di-thionite
In solubility test, what is added to lyse the RBC to release the hmg…
what is added to reduce the hmg…
saponin lyses
sodium dithionite reduces it to become deoxygenated and insoluble; will precipitate out of phosphate buffer
What confirms s positive sickle screen
hmg electrophoresis
Which electrophoresis separates S
citrate agar ph6.2
Lead and Thall trait are what kind of anemias
microcytic/hypochromic
IDA and later phase of anemia of Chronic disease what kind of anemia
micro/hypo
Initially anemia of chronic is normal,normo
In IDA, all Iron studies are low except for
TIBC
Three causes of macrocytic anemia
B12 def, folate def
liver disease/alcholism (B12, folate def)
What does G6PD have that PK doesn’t
Heinz bodies
Possibly bite cells
G6PD def and HbH uses this stain/prep
Heinz body prep
Use as a nonspecific screen for hemolysis due to drugs/toxins, enzyme deficiencies, thalassemias, and unstable hemoglobins.
Test for PCH, IgG, Anti-P Biphasic
Donath Landsteiner TEst
Condition with large Azurophilic granules, mucooplysaccharies (Hunter, Hurler)
Alder Reily
A=azurophilic
Condition with large lysosomes/fushion of primary granules
Chediak-Higashi
Condition with large PLTs, decreased PLTS, Dohle bodies in seg/mono/lymph
MayHegglin
Condition with hyposegmented polys
PelgerHuet
Dry tap is seen in which condition
primary myelofibrosis
myeloid metaplasia: is a disorder in which normal bone marrow tissue is gradually replaced with a fibrous scar-like material. Over time, this leads to progressive bone marrow failure.
Decreased LAP, Ph chromosome in what condition
CML
JAK2 seen in what condition
Polycythemia Vera
Which reaction has toxic granules and Dohle bodies
Leukemoid
WHO acute leukemia how many blasts in BM
FAB
WHO >20%
FAB >30%
Leukemia seen with soccer ball nucleus lymphs
CLL
Lymphoma associated with EBV, HIV
Burkitt
Burkitt lymphoma (BL) is an aggressive non-Hodgkin B-cell lymphoma.
Lymphoma associated with Reed Sternberg cell
Hodgkin
Myeloma with bone involvement, IgG and Bence Jones in urine
Multiple myeloma
Condition with IgM, increased serum viscosity and normal bone
Waldenstrom
Prussion blue stains
iron
LAP in CML
decreased
LAP in Leukamoid rxn
increased
TRAP
tartrate-resistant
ACID PHOSPHATASE
for what condition
Hairy cell leukemia
Auer rods in
AML
acute myeloid leukemia
A=Auer
BM macrophages have wrinkled/striated cyto with accumulation of glucocerebrosidease
Gaucher
G=glucocerebrosidease
Gaucher is wrinkled
BM macrophages w/globular or foamy cyto, sea-blue histiocytes with sphingomyelinase
is a disease in which excess material is stored inside cells (metabolic storage disease). These cells are referred to as foam cells because of their foamy or soap-suds appearance
Niemann-Pick
Niemann is foamy
Stain for AML, myelogenous cells for nonspecific/specific granules/fats…
Sudan black B
Oil red O stains neutral lipids and is replacing SSB
Stain for glycogen deposits in liver, fungi, and blasts in ALL, stains lymphoblasts not myeloblasts
PAS
periodic acid-Schiff
What is added to stabilize WBC when there’s smudge cells causing WBC cts to not match
22% bovine albumin
DF of PLT CT with sodium citrate
1.1
Which inclusion isn’t stained with WRights
Heinz bodies, uses NMB
Peroxidase stains which cell lines..
not…
Myelogenous: myelos, monos
Not lymphs
NASDA/Naf used for which leukemia
addition of Naf makes monos become negative
AMML
acute myelol, mono
PAS pos in
ALL
acute not chronic lymphoblasts
TRAP pos for whic leukemia
hairy cell
3 names for NRBCs, last nucleated rbc
metarubricyte
Orthochromic normoblast
Orthochromic erythroblast
NRBC is not Polychromotaphilic, it’s Orthochromatic
2 names for retic
reticulocyte
polychromatophilic erythrocyte
Retic is Polychromotaphilic due to RNA
1.)Rubriblast
2.)Pro-rubricyte
3.)Rubricyte
4.)Meta-rubricyte/NRBC
5.)Reticulocyte
6.)RBC
1.)Pro-
2.)Basophilic-
3.)Polychromatophilic-
4.)Orthochromic-
-normoblast
5.)Polychromatophillic
erythrocyte
6.)RBC
Male Hmg
14-18
female hmg
12-15
neonate hmg
19
toddler hmg
11-13
IDA
iron, ferritin…
TIBC/transferrin…
size, color…
iron low
ferritin low
TIBC/transferin high
micro, hypo
Anemia of chronic
iron, TIBC…
ferritin…
size, color…
iron/TIBC low
ferritin high
Normo, normo at first
micro, hypo later on
5 micro, hypo anemias
IDA, anemia of chronic(can become)
sidero, lead
thall
4 macrocytic anemia
B12, folate
liver, alcoholism
2 names for target
codocyte, leptocyte
Target, baso stip, tears in
thallasemia
sugar water test, sucrose hemolysis, and acidified serum test associated with
PNH
Paroxysmal nocturnal
Not PCH
Smudge cells seen in which leukemia
CLL
increased sml, mature lymphs and smudge what leukemia
CLL
Condition with giant, bizarre PLTs, NRBCs, teardrop, pancytopenia
It causes scarring of the bone marrow which makes it more difficult to produce blood cells causing pancytopenia.
It is one of a group of conditions called myeloproliferative neoplasms or myeloproliferative disorders.
myelofibrosis
Condition that’s a subtype of AML, PLTs and WBC decreased
A subtype of acute myeloid leukemia (AML) that is distinguished by erythroblastic proliferation.
Patients usually present with nonspecific signs and symptoms from the anemia, thrombocytopenia, and leukopenia resulting from the replacement of bone marrow by leukemic cells
erythroleukemia
Sydrome where decrease in alpha granules and there is a release in proteins that cause myelofibrosis
An inherited bleeding disorder characterized by macro-thrombocytopenia and absence of platelet α-granules resulting in typical gray platelets on peripheral smears.
It is associated with a bleeding tendency, myelofibrosis, and splenomegaly
gray PLT syndrome
Factor 12 actived by
subendothelium
Vik K dependent factors and what group
2,7,9,10
Prothrombin
Factors in fibrinogen group
1,5,8-13
Factors in contact group
11,12
PK,HMWK
Factors?
Serine proteases form a large family of protein-cleaving enzymes that play an essential role in processes like blood coagulation, apoptosis and inflammation.
-are vit K dependent
-include two factors from contact group
2,7, 9,10 (vit K dep)
and
11,12
70% of PLTs are in the…
30% PLTs are stored in the…
70 % blood
30 % in spleen
Most in blood, rest in spleen
Adhesion requires what factor
VWF
is a platelet agonist that causes platelet shape change and aggregation
Adenosine diphosphate (ADP)
What links the PLTs together after being stimulated by ADP
fibrinogen
What inhibits active plasmin
alpha 2
plasmin inhibitor
Action of plasmin on fibrin. Breaks… Into these 4…
cleaves fibrin into X, Y, D, E fragments
3 clot busters
streptkinase
urokinase
TPA
WB:anticoag ratio
9:1
Screen for extrinsic/common, monifors oral anticoag like warfarin/coumarin
PT
PT ref…
INR ref goal…
<13 sec
INR. 2.0-3.5
Screen for intrinsic,common
monitors heparin
APTT
APTT ref range
20-40sec
Fibrinogen factor and ref range
Factor 1
200-400 mg/dL
Coag test that doesn’t measure intrinsic/extrinsic but is affected by decreased fibrinogen levels and heparin
TT
TT ref
<20sec
Coag test that measures PLT fnc/#s
BT
PFA measures PLT fnc with theses three aggregating agents
collagen, ADP, epi
Rapid dissolution of clot indicates increased fibrinolytic activity in this condition
DIC
Aspirin inhibits 2ndary wave of aggregation by destroying….
cyclooxygenase
Two adhesion disorders that have abnormal ristocetin agg
BS
vWD
BS is differentiated from vWD by these two things related to PLTs
BS has decreased PLTS and giant PLTS
PLT disorder with normal PLT #/morph but abnormal aggregation and abnormal with all aggregating agents
Glanzmann
DRVVT activates factor… and is prolonged in presence of this anticoagluant
Factor 10
Lupus anticoag
Assay that monitors LMWH
anti-factor 10a
Test similar to TT, uses snke venom enzyme,and is not inhibited by heparin
Reptilase time
Repitilase time ref
18-22sec
Another name for primary myelofibrosis
myeloid metaplasia
Myeloid metaplasia can have increased… and thus have…
Primary myelofibrosis/myeloid metaplasia (MF) is a chronic blood cancer in which excessive scar tissue forms in the bone marrow and impairs its ability to produce normal blood cells
increased uric acid and have gout
BM condition where theres increased IgM, B clonal cells, marked roleaux, and relative/absolute lymphocytosis
WM
Waldenstroms macrobulemia
Kind of leukemia with B cell neoplasms, increase in small/mature lymphs, and smudge cells
CLL
chronic lymphocytic leukemia
Leukemia with no peroxidase activity and positive PAS
ALL
Leukemia with increased baso/eos in early stages
CML
Xa-Va
phospholipid-Ca complex is called what
prothrombinase complex
What cleaves fibrin into soluble fragments X/Y,D/E
plasmin
Which protein inhibitor inactivates/degrades F5,8?
Protein C
Which protein is a cofactor and accelerates Protein C
Protein S
Which factors are inactivated by Protein C
Factor 5,8
Which protein is the primary inhibitor of the fibrinolytic system and inhibits plasmin
alpha 2 antiplasmin
What is the principal inhibitor that neuralizes thrombin, F10, and all serine proteases?
antithrombin III
Most frequently acquired inherited inhibitor leading to factor deficiency?
anti-8
APTT mixing study to test
usually w/Hem A/B therapy
Which inhibitor inactivates coag factors thru phospholipids
lupus like anticoag
lupus anticoag
prolong APTT, no factor def or bleeding
What is the cause of 25yr old male who has a normal PT and INR, but an increased APTT thats not corrected by a mixing study
circulating anticoagulant
possibly lupus anticoag
Most common inherited bleeding disorder with decreased F9/vWF, prolonged APTT, and normal PLT CT
vWD
issue isn’t with number of PLT but can’t adhere to collagen
DDAVP and cryo used to treat
vWD
Trauma, prego issues, liver disease/hepatitis, cancer/leukemia, sepsis, drugs all can cause
DIC
PT/INR, PTT, D-dimer all increased and fibrinogen decreased in
DIC
PT/INR, PTT slight increase with slight decrease in fibrinogen is
liver disease
2 labile coag factors
5,8
plasma fibrinogen nv
200-400mg/dl
Xmas factor
9
IX
hereditary condition with decreased PLT production and Dohle bodies
May Hegglin anomaly
Idiopathic thrombocytopenic purpura has less PLTs due to…
PLT destruction
VWD, Glanzmann, aspirin all have what kind of PLT counts
normal
BS has what kind of PLT CT
decreased
vWD and BS are what kind of PLT issue
adhesion
Glanzmann and aspirin cause what kind of PLT issue
aggregation
F7 def test
PT, extrinsic
What tests 1,2,5,8,9,10,11,12
APTT
Test monitors heparin, FSP, fibrinogen issues
TT
Hemo associated w/F11 and Jews
Hemo C
Hemo ass. w/8, men
Hemo A
Hemo ass. w/9, men
Hemo B
Factor def detected with 5M urea test
F13
Most common specific factor inhibitor, APTT mixing studies
F8 inhibitor
Mutant Factor V, resists action of protein c/s
factor v leiden
drug that blocks ADP receptor(P2Y12)
Plavix
Clopidogrel
Drug that inhibits VitK, monitored w/PT/INR
Wafarin
Drug that inhibits serine protease via AT, monitored with APTT
Heparin unfractionated
Drug that targets F10a, doesn’t require monitoring
LMWH
Chains in Gower 1
2 zeta, 2 epsilon
Chain in Gower 2
2 alpha, 2 epsilon
Portland chains
2 zeta, 2 gamma
RBC count calc if 5 square…
RBCxDF/(0.04)(5)(0.1)
1sq=0.04
Volume of single RBC square
0.04
Total volume of 5 RBC squares
0.2
0.2x0.2=0.04x5
Depth of hemocytometer
0.1
4 things affect hmg/cause falsely high
Lipemic
Icteric
High WBC
Lyse resistant hmg SS, CC
affects the absorption of hmg
Hmg composed of…
heme, iron, globin
4 globulins, 4 heme inside with 4 iron
Defect in heme synthesis leads to
porphyria
1.)disorder in amino structure
2.)disorder in # globulin chains
3.)disorder of heme synthesis
1.)amino sub: hmg-pathy
2.)# globulin chains: thall
3.)heme: porphyria
methmg-cytochrome C reductase keeps…
iron the ferrous state
keeps it reduced
when iron in hmg is oxidized to the ferric state, it becomes…
methmg
hmg with 200x affinity for oxygen than hmg has
carboxyhmg (carbon monoxide)
type of hmg that carries iron in ferrous/reduced state
oxyhmg
can carry oxygen
type of hmg that can’t transport oxygen; irreversible oxidation by drugs
sulfhmg
type of hmg that is in ferric state, cannot bind oxygen, but is reversible
met hmg
Ferric state of iron is in this hmg
methmg
cyanmethmg used to
measure hmg
cyanmethmg w/K cyanide, ferricyanide
Of these three, which on is irreversible…
carboxyhmg, methmg, sulfhmg
sulfhmg
Hmg that becomes insoluble under lowered oxygen tension
Hmg S
it sickles
In hmg C, what replaces glutamic acid…
what position…what chain…
shape of crystal in hmg C…
lysine
6th position of beta chain
rod shaped, washington monument
what kind of RBC inclusion seen in lead and thall
basophillic stippling
what kind of inclusion in rbc seen in G6PD def…
What kind of rbc abnormality…
Heinz bodies
Bite cell
Hmg F made of 2…2…
2 alpha, 2 gamma
Hmg A1 made of 2..2…
2 alpha, 2 beta
Hmg A2 made of 2…2..
2 alpha, 2 delta
Gower 2 made of 2…2…
2 alpha, 2 epsilon
Gower 1 made of 2..2…
2 zeta, 2 epsilon
Portland made of 2…2..
2 zeta, 2 gamma
Hmg resistant to alkali denaturation
Hmg F
Kleihauer Betke screens for what hmg…
Can differentiate between…and….
hmg F
A1 from F
adult from fetal
Hmg D seen in what race…
migrates with…
East Indian
migrates with S
D can be separated from S with … … at ph…
cellulose acetate at ph 8.6
Only hmg not measured by cyanmethmg
sulfhmg
Drabkins sln is used to determine…
in the …..method
hmg in cyanmethmg methodf
Hmg in WB..
Hmg in plasma..
WB 14-16 g/dL
plasma 2-3 mg/dL
Free hmg binds to…
haptoglobin
In HA:
RBC, hmg, hct are…
haptoglobin is…
indirect bili is…
RBC,hmg,hct are decreased
haptoglobin is decreased/used up
indirect bili is increased, increased hmg but doesn’t get to liver
HA is what kind of anemia
normo, normo
sudden, doesn’t have enough time to affect size/color yet
What reagent do you saturate specimen with to separate myoglobin from hmg
ammonium sulfate
PACKED rbc VOLUME is also called
hematocrit
Volume of packed cells
3 factors that influence degree of packing during centrifugation
radius, speed, time
WBC are found in what part of spun hematocrit…
where is the packed rbc % read from….
wbc buffy coat
read packed rbc below buffy
How do these affect ESR/rate:
acute infections
rouleaux
macrocytes
MM,Waldstrom M
anemia
vibrations/tilting/increased temp
all increase, make fall faster, rate/mm is bigger
bigger cells=fall faster
anemia=less cells, fall faster
proteins/ab fall faster
How do these affect ESR/rate:
microcytes, sperocytes
sickle cells
polycythemia
old specimen, decreased temp, EDTA increased
all decrease, fall less, smaller rate/mm
RBC cell count calculation
RBCs x DF/total vol sq x depth(0.1)
ie. 5 small squares
each square is 0.2x0.2=0.4,
x5 squares=0.2
CSF has 285 rbc in 5 squares, dilute 1:100
cell ct
285 x 100/0.2 x 0.1 =28500/0.02
1,425,000
method where cells pass thru aperture increasing resistance of electrical flow between electrodes making a pulse
electrical impedance
Name of principle that uses laminar flow and hydrodynamic focusing to characterize cells based on granularity and reflectivity
laser light scatter
laser is focused at angles
3 things used to created scatter plots, one that isnt
scatter, volume, conductivity
fluorsence isn’t used for the scatter plot
NRBC and lrg PLTs will increase
WBC
granularity counted as WBC
Shistocytes will…rbc # but …PLTs #
decrease rbc, increase PLT ct
counted as PLTs instead of RBC
WBC 6.5
RBC 1.69
HGB 9.1
HCT 22.8
MCV 135.0
MCH 53.8
MCHC 39.9
what is cause
cold agg,
RBC/HCT decreased
MCV, MCH, MCHC increased
DF for PLT ct when using sodium citrate instead of EDTA
1.1
Adding 22% bovine albumin to hematology specimen will prevent…cells by…WBCs
will prevent smudge cells by stabilizing WBC
Action if cryoglobulin or cold agg cause issues
incubate 37C 15min
manual WBC ct on hemacytometer can help count …WBC from… ….. leukemia patients
count fragiles WBCs from pseudoleukopenic patients
lipemic specin, can perform a .. …
saline replacement
hyperglycemia:
MCV is…
red cell color is…
MCV is normal
color is hypochromic, absorb less iron
WBC ct calc
WBC x DF/vol sq x depth 0.1
Each sq 1mm
WBC ct 50, 8squares, 1:100 dil
50x 100/(8x1)x0.1
6250
Wright stain:
fixative…
adjust color by adusting… of ….
methanol
color change with ph of buffer
Giesma can stain which organism
malarial parasites
Cannot be stained with wrights, needs to use NMB
Heinz bodies
Stain that stains both nonspecific and specific granules in myelogenous cells
SBB
sudan black B
myeloblasts, not lymphoblasts
Stain for granulocytes, monocytes but not lymphs
MPO
myelo-peroxidase
leptocyte is also these two
Target, codocyte
Most immature RBC, 3 names
Rubriblast
Pro-erythroblast/normoblast
2nd RBC after most immature, 3 names
Prorubricyte
Basophilic- erythroblast/normoblast
Rubricyte, comes after…
Two other names…
Comes after Prorubricyte
Rubricyte is also called
polychromatic-
erythroblast/normoblast
Last stage RBC with nucleus, 3 names
Metarubricyte
Orthochromic -erythroblast/normoblast
NASDA 3+, NaF 1+ what leukemia
AMML
acute myelo mono
Leukemia where blasts stain PAS pos
ALL
lymphoblastic
lymphs not myelo, acute not chronic
Best stain for neutral lipids
Oil red O
better than sudan black b as it is more red/visible
LAP stands for…
differentiates these two…
which is incresed, decreased…
leukocyte alkaline phosphatase
leukomoid increased
CML decreased
stain that is positive in hairy cell leukemia
TRAP
tarte resistant
acid phosphatase (not alkaline phosphatase)
MOST reliable criterion for cells age
nuclear chromatin
Last cell to retain nucleus before becoming erythrocyte/NRBC two names
metarubricyte, orthochromatic normoblast
toddler hmg range…
female…
male range…
Neonate hmg range…
toddler has the least: 10-12
female: 12-15
male: 14-18
neonate has the most: 16-22
anemia based off three things
rbc, hmg, hct
reticulocytosis is….due to…
polychromatophillic due to residual RNA
3 things seen in IDA:
size, color, shape
micro,hypo
poikilocytosis
low ferritin/iron
high TIBC/transferrin
IDA
high ferrtin
low iron/TIBC/transferrin
anemia of chronic
cell seen in:
-thallasemia
-liver disease
-postsplenectomy
target
Target cells are erythryoctes with an increased cell membrane-to-volume ratio, due either to gain of membrane lipids or to a reduction in cell volume.
Liver disease: Decreased enzymatic activity increases the cholesterol to phospholipid ratio, producing an absolute increase in surface area of the red blood cell membranes or may be increased red cell membrane fluidity.
Post splenectomy: altered erythrocytes will not be removed from the circulation efficiently. Therefore, increased numbers of target cells may be observed.
aggregated RNA in RBC causes
basophilic stippling
best supravital stain for RNA remnants
NMB
RBC iron stained granules stained with PB..
stained with wrights…
siderocytes
pappemheimer
increased iron in the mitochondria of normoblasts is seen in what anemia
sideroblastic anemia
3 cells seen in thallasemia
targets, tears
basophilic stippling
Tear drop cells appear in the peripheral blood as a response to red cell alterations by thalassemia when red cell inclusions are expelled by a stripping process through splenic cords.
3 main causes of macrocytic anemia
B12/folate def (d.latum, taperworm B12)
liver/alcoholism
4 main causes of micro,hypo anemia
IDA, anemia of chronic in later stages
sideroblastic, lead
Megaloblastic anemia:
WBC seen in BM…
3 things seen in smear…
BM: giant metamyelocytes
smear: oval macro, hyperseg, less PLTs
Megalo: big not small
Anemia: less
Hereditary disease where osmotic fragility and autohemolysis are normal…
Hereditary disease where osmotic fragility is increased…
elliptocytosis
spherocytosis
PNH:
3 tests
PCH:
1 test
PNH: sugar, sucrose, acidified
PCH: Donath Landsteiner
Most common thallasemia in US
beta thall MINOR
Disorder with enzyme defect in aerobic glycolysis
G6PD
Pancytopenia seen in this anemia
aplastic
Panhyperplasia of BM seen in
polycythemia vera
Leukemia
viral infection
chemo
WBC will be….
decreased
leukemia: sick cells push out good cells
viral: HIV
chemo: kill
euchormatin
darker cyto
nucleoli
nonspecific granules
charasteristic in…
immature blood cells
*most characteristic of immature is euchromatin
Light blue endoplasmic reticulum found in neutrophils
seen in infections, burns, MayHegglin
Dohle bodies
nonspecific primary granules in…
specific secondary granules in…
non/primary: promyelocyte
specific/secon: myelocyte
Order of myeloid…
1-6
1.)Myeloblast
2.)Promyelocyte
3.)Myelocyte
4.)Metamyelocyte
5.)Band
6.)Seg
WBC NV most to least…
Seg 50-70
Lymph 20-40
Mono 3-10
Eos 0-3
Baso 0-2
Largest leukocyte in blood…
Largest cell in BM:
mono
megakaryo
Inclusions of blue black, coarse mucopolysaccharide granules
Hurlers/Hunters
Alder Reilly
Giant PLTs, Dohle bodies
decreased PLTs
May Hegglin
giant lysosomal granules,
defective PLTs/WBCs,
albinism
Chediak Higashi
Things that can be seen with…. …
are shift to left, vacuolization, Dohle bodies
toxic granulation
In lupus, what cell phagocytizes the nucleoprotein
neutrophil
monocyte/histiocyte thats engulfed nuclear material
similar to LE but no diagnositic value
tart cell
cell that neutraphil/macrophage engulfed denatured nuclear
lupus erythromatosus
LE cell
cell that is plasma cell with cytoplasmic inclusions called russell bodies packed with immunoglobulins
constipated plasma cell
Mott cells
reactive leukocytosis occurs when absolute granulocyte count is >…
7.0 x10^9/L
Granulocytes not all WBC
Smudge cells seen in this leukemia but not in this
seen in CLL not in acute
Use as a nonspecific screen for hemolysis due to drugs/toxins, enzyme deficiencies, thalassemias, and unstable hemoglobins.
Heinz body prep
Heinz, hmgH
Cyanide can be used to oxidize … To…
Hmg to methmg
Hmg to methmg iron becomes…to…
Methmg to hmg iron becomes…to…
Hmg to methmg, iron becomes oxidized to ferric
Methmg to hmg, iron becomes reduced to ferrous
Eosinophilia and basophilia associated with what leukemia
CML
Smudge cells seen in this leukemia
CLL
chronic not acute
L1 kids, homo, high N/C
L2 adults, hetero, nucleoli
L3 Burkitts, vacuolization, abundant cyto
FAB classifications
of acute lymphocytic leukemia
ALL L1
3 main characteristics
homgenous
high N/C
kids
ALL L2
3 main characteristics
hetero
adults
nucleoli
ALL L3
2 main characteristics
vacuolization, abundant cyto
FAB ALL classification for mostly homo, high N/C ratio
L1
FAB ALL prominent cytoplasmic vacuolization
L3
also abundant cyto
FAB ALL hetero, nucleoli, seen in more adults
L2
FAB AML,
M2/type 2 has … … …
as compared to M1/type 1 that has… and ….
M2/type 2 has few cytoplasmic granules
M1/type 1 has granules
FAB AML that has no cytoplasmic granules
M0
M0 no granules
M1 granules
M2 traces of primary/few
M3 intense granules, DIC
This is stupid
Auer rods seen in which leukemia
AML
DIC ass with what AML class
M3
Stain to differentiate AML from ALL
MPO
Leukemia with Philadephia chromosome and increased baso/eos in early stages
CML
Condition with increased LAP, toxic granulation, dohle bodies
Leukomoid
DIC seen in what leukemia
AML
BM of this condition has increased plasma cells, IgM, rouleaux, lymphocytosis
Waldenstroms macroglobulinemia
giant bizarre PLTs
NRBCs
Tears
seen in…
myelofibrosis
Hereditary with decreased alpha granules resulting in tiny, decreased PLTs
gray PLT syndrome
Prothrombinase complex (acts on prothrombin)
10a+5a
phospholipid+Ca
1.)C will degrade 5,8
2.)S cofactor acclerates
…
Which protein degrades factor Va and 8a…
C
Which protein is a cofactor of C and helps accelerate the degradation of Va/VIIIa
S
Primary inhibitor of fibrinolytic system;
stops this from breaking down fibrin
alpha 2
antiplasmin
What is the principal inhibitor of thrombin
and factor Xa
anti-
thrombin III
also neutralizes serum proteases
Most ACQUIRED inhibitor in hereditery deficiencies
(acquire during treatment of this hereditary deficiency)
anti 8
usually acquired from HemA(8) therapy
acquired inhibitor against phospholipoproteins inactivating coagulation factors prolonging aPTT
lupus like anticoag
disease with:
-abnormal adhesion to collagen
-decreased VIII:C, VIIIR:Co
-increased BT, aPTT
-normal PLT ct
vWD
Condition with slightly increased PT,INR, PTT but low fibrinogen
liver disease
Severe liver disease monitor these two factors
I, 5
Factor 5 Leiden
Helps make clots,
Protein C supposed to slow 5 down,
Most common cause of hypercoaguable State, thromboembolism
Protein S And C roles
Stop
Clots
Cleave 5,8
Anemia with inhibition of DNA, -decreased megakaryocytes, -decreased PLTs
-giant metamyelocytes in BM
-oval macrocytes
-hypersegmented segs
Megaloblastic anemia
Hereditary red cell membrane deformation with >25% cells deformed, normal osmotic fragility, and most people are asymptomatic and few have HA
Hereditary elliptocytosis
Most common thallasemi
beta thall minor
Cooleys anemia, increased A2, decreased A1
beta thall major
Thall with 2 of 4 alpha deleted, micro/hypo
alpha thall minor
hydrops fetalis, thall with no normal Hmg, all 4 alpha deleted
alpha thall major
Enzyme def that is x linked, oxidative stress leads to RBCs breaking down/HA, aerobic glycolysis ineffective
G6PD
Dohle body is seen in which cell
neutrophil
Primary granules in…
Secondary granules in…
Primary: promyelocyte
Secondary: myelocyte
Infections you will see toxic granulation in neutrophils and these three things…
shift to left
Dohle bodies
vacuolizations
Neutrophil that phagocytizes/engulfs nuclear material/nucleoprotein in lupus
LE cell
not a tart (mono/histiocyte)
Only heterogenous cell Acute leukemia FAB classification
L2
L3 ALL has prominent
vacuoles
L1 has high…with…cells
high N/C
homogenous cells
L2 has …cells
heterogenous
FAB AML that is hypergranular and related to DIC
M3
FAB AML with no granules
M0
Monocytic FAB classfications
M4/5
M2 has …granules
few
Best stain that differentiates AML from ALL
MPO
as opposed to SBB
chronic lymphocytic leukemias are usually neoplasms of what cell
B cells
Hemostasis 3 processes
vasoCONSTRICTION
adhesion
aggregation
Two PLT disorders with decreased and giant PLTs
May Hegglin, BS
WASP issue in males, small/decreased PLTS, impaired immune, increase in IgA/E
Wiskott Aldrich anomaly
PLT disorder where ab attack own PLTs, leads to increased PLT destruction
cause not known
Idiopathic thrombocytopenia purpura
ITP
vWD, Glazmann, and aspirin all have …PLT cts but abnormal…time
normal
abnormal BT
PLTdisorder with abnormal
-primary agg…
-secondary agg..
primary agg: Glanzmann
secondary agg: Wiskott
PLT disorders with adhesion issues
BS, VWD
Condition where BM makes too many PLTs and is ass with polycythemia vera
Thrombocy-themia
How many PLTs/1000x is normal
8-20
BT increased in destruction of PLTs, decreased PLTs, blood vessel damage,
-qualitative,quantitative PLT disorder
-primary vascular ab
BUT not affected in…
autoimmune thrombocytopenia
who knows why, stupid AAB
Test that monitors heparin, FSP, and fibrinogen ab
TT
At alkaline pH slowest Hmg…
Fastest….
C slowest
H is fastest
-C, S, F, A/H
Biliary obstruction has…. As major serum component
Conjugated bilirubin
Biliary obstruction has…. As major serum component
Conjugated bilirubin
