AABHemeCoagBook2.6.24 Flashcards
3 main sites of hematopoesis during conception and early fetal months
yolk sac, liver, spleen
Adult Bones Hematopoesis, acrynom
SSPRVSkull, SternumPelvis, 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 60-90adults 1
Hmg A in adultsversus newborns
adults 97newborns 10-40
Hmg A2 in both adults and newborns
2%
Gower I/II, Portland Hmg in…Hmg F in…Hmg S in…
embryonicboth newborn and adultnot normal, sickle cell
In Hmg oxy diss curve, oxygen is released or not released in a shift to the left
not releasedNo, won’t let go
In Hmg oxy diss curve, oxygen is released or not released in a shift to the right
releasedwon’t hold tight
To determine Hmg, the oxidation of hmg to methmg is done with these two reagents
K-CN and K-Ferric-CNCyanide
HCT % NVMale Female
Female 37-47Male 42-52
Diluent used for WBC/PLT CT
1% Ammonium Oxalate
MCV formula
HCT/RBC x 10volume/cell
MCV NV
80-100fL
MCH formula
HGB/RBC x 10hmg/cell
MCH NV
27-31pg
MCHC formula
HGB/HCT x 100concentration=always smaller number at top and percentagehmg/volume
MCHC NV
32-36 g/dL
RDW NV
11.5-14.5%
RBC reffemalemale
female 3.8-5.2male 4.5-6.1
Seg ref
45-70About 1/2-2/3
Lymp ref
20-40About 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 x100/100 + nrbcs
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 alpha2 beta
Hmg A2 chains
2 alpha2 delta
Hmg F chains
2 alpha2 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 2need 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-
Citrate agar ph6.2 anode to cathode
+C,S,A,F-
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 lysessodium 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/hypoInitially anemia of chronic is normal,normo
In IDA, all Iron studies are low except for
TIBC
Three causes of macrocytic anemia
B12 def, folate defliver disease/alcholism (B12, folate def)
What does G6PD have that PK doesn’t
Heinz bodiesPossibly bite cells
G6PD def and HbH uses this stain/prep
Heinz body prepUse 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 ReilyA=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 myelofibrosismyeloid 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 BMFAB
WHO >20%FAB >30%
Leukemia seen with soccer ball nucleus lymphs
CLL
Lymphoma associated with EBV, HIV
BurkittBurkitt 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
AMLacute myeloid leukemiaA=Auer
BM macrophages have wrinkled/striated cyto with accumulation of glucocerebrosidease
GaucherG=glucocerebrosideaseGaucher 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-PickNiemann is foamy
Stain for AML, myelogenous cells for nonspecific/specific granules/fats…
Sudan black BOil red O stains neutral lipids and is replacing SSB
Stain for glycogen deposits in liver, fungi, and blasts in ALL, stains lymphoblasts not myeloblasts
PASperiodic 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, monosNot lymphs
NASDA/Naf used for which leukemiaaddition of Naf makes monos become negative
AMMLacute myelol, mono
PAS pos in
ALLacute not chronic lymphoblasts
TRAP pos for whic leukemia
hairy cell
3 names for NRBCs, last nucleated rbc
metarubricyteOrthochromic normoblastOrthochromic erythroblast NRBC is not Polychromotaphilic, it’s Orthochromatic
2 names for retic
reticulocytepolychromatophilic erythrocyteRetic is Polychromotaphilic due to RNA
1.)Rubriblast2.)Pro-rubricyte3.)Rubricyte4.)Meta-rubricyte/NRBC5.)Reticulocyte6.)RBC
1.)Pro-2.)Basophilic-3.)Polychromatophilic-4.)Orthochromic- -normoblast5.)Polychromatophillic erythrocyte6.)RBC
Male Hmg
14-18
female hmg
12-15
neonate hmg
19
toddler hmg
11-13
IDAiron, ferritin…TIBC/transferrin…size, color…
iron lowferritin lowTIBC/transferin highmicro, hypo
Anemia of chroniciron, TIBC…ferritin…size, color…
iron/TIBC lowferritin highNormo, normo at firstmicro, hypo later on
5 micro, hypo anemias
IDA, anemia of chronic(can become)sidero, leadthall
4 macrocytic anemia
B12, folateliver, alcoholism
2 names for target
codocyte, leptocyte
Target, baso stip, tears in
thallasemia
sugar water test, sucrose hemolysis, and acidified serum test associated with
PNHParoxysmal nocturnalNot 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 decreasedA 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 myelofibrosisAn 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
1,3,5,8-13
Factors in contact group
11,12PK,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)and11,12
70% of PLTs are in the…30% PLTs are stored in the…
70 % blood30 % in spleenMost 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
streptkinaseurokinaseTPA
WB:anticoag ratio
9:1
Screen for extrinsic/common, monifors oral anticoag like warfarin/coumarin
PT
PT ref…INR ref goal…
<13 secINR. 2.0-3.5
Screen for intrinsic,commonmonitors heparin
APTT
APTT ref range
20-40sec
Fibrinogen factor and ref range
Factor 1200-400 mg/dL
Coag test that doesn’t measure intrinsic/extrinsic but is affected by decreased fibrinogen levels and heparin
TT
TT ref
<20sec