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
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
BSvWD
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 10Lupus 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
WMWaldenstroms macrobulemia
Kind of leukemia with B cell neoplasms, increase in small/mature lymphs, and smudge cells
CLLchronic lymphocytic leukemia
Leukemia with no peroxidase activity and positive PAS
ALL
Leukemia with increased baso/eos in early stages
CML
Xa-Vaphospholipid-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-8APTT mixing study to testusually w/Hem A/B therapy
Which inhibitor inactivates coag factors thru phospholipids
lupus like anticoaglupus anticoagprolong 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
vWDissue 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
9IX
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)
PlavixClopidogrel
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
0.20.2x0.2=0.04x5
Depth of hemocytometer
0.1
4 things affect hmg/cause falsely high
LipemicIctericHigh WBC Lyse resistant hmg SS, CCaffects 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 structure2.)disorder in # globulin chains3.)disorder of heme synthesis
1.)amino sub: hmg-pathy2.)# globulin chains: thall3.)heme: porphyria
methmg-cytochrome C reductase keeps…
iron the ferrous statekeeps 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
oxyhmgcan 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 hmgcyanmethmg w/K cyanide, ferricyanide
Of these three, which on is irreversible…carboxyhmg, methmg, sulfhmg
sulfhmg
Hmg that becomes insoluble under lowered oxygen tension
Hmg Sit sickles
In hmg C, what replaces glutamic acid…what position…what chain…shape of crystal in hmg C…
lysine6th position of beta chainrod 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 bodiesBite 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 FA1 from Fadult from fetal
Hmg D seen in what race…migrates with…
East Indianmigrates 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/dLplasma 2-3 mg/dL
Free hmg binds to…
haptoglobin
In HA:RBC, hmg, hct are…haptoglobin is…indirect bili is…
RBC,hmg,hct are decreasedhaptoglobin is decreased/used upindirect bili is increased, increased hmg but doesn’t get to liver
HA is what kind of anemia
normo, normosudden, 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
hematocritVolume 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 coatread packed rbc below buffy
How do these affect ESR/rate:acute infectionsrouleauxmacrocytesMM,Waldstrom Manemia vibrations/tilting/increased temp
all increase, make fall faster, rate/mm is biggerbigger cells=fall fasteranemia=less cells, fall fasterproteins/ab fall faster
How do these affect ESR/rate:microcytes, sperocytessickle cellspolycythemiaold 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 squareseach square is 0.2x0.2=0.4,x5 squares=0.2
CSF has 285 rbc in 5 squares, dilute 1:100cell ct
285 x 100/0.2 x 0.1 =28500/0.021,425,000
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 scatterlaser is focused at angles
3 things used to created scatter plots, one that isnt
scatter, volume, conductivityfluorsence isn’t used for the scatter plot
NRBC and lrg PLTs will increase
WBCgranularity counted as WBC
Shistocytes will…rbc # but …PLTs #
decrease rbc, increase PLT ctcounted as PLTs instead of RBC
WBC 6.5RBC 1.69HGB 9.1HCT 22.8MCV 135.0MCH 53.8MCHC 39.9what is cause
cold agg,RBC/HCT decreasedMCV, 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 normalcolor is hypochromic, absorb less iron
WBC ct calc
WBC x DF/vol sq x depth 0.1Each sq 1mm
WBC ct 50, 8squares, 1:100 dil
50x 100/(8x1)x0.16250
Wright stain:fixative…adjust color by adusting… of ….
methanolcolor 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
SBBsudan black Bmyeloblasts, not lymphoblasts
Stain for granulocytes, monocytes but not lymphs
MPOmyelo-peroxidase
leptocyte is also these two
Target, codocyte
Most immature RBC, 3 names
RubriblastPro-erythroblast/normoblast
2nd RBC after most immature, 3 names
ProrubricyteBasophilic- erythroblast/normoblast
Rubricyte, comes after…Two other names…
Comes after ProrubricyteRubricyte is also calledpolychromatic- erythroblast/normoblast
Last stage RBC with nucleus, 3 names
MetarubricyteOrthochromic -erythroblast/normoblast
NASDA 3+, NaF 1+ what leukemia
AMMLacute myelo mono
Leukemia where blasts stain PAS pos
ALLlymphoblasticlymphs not myelo, acute not chronic
Best stain for neutral lipids
Oil red Obetter than sudan black b as it is more red/visible
LAP stands for…differentiates these two…which is incresed, decreased…
leukocyte alkaline phosphataseleukomoid increasedCML decreased
stain that is positive in hairy cell leukemia
TRAPtarte resistantacid 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: 10-12female: 12-15male: 14-18neonate 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,hypopoikilocytosis
low ferritin/ironhigh TIBC/transferrin
IDA
high ferrtinlow iron/TIBC/transferrin
anemia of chronic
cell seen in:-thallasemia-liver disease-postsplenectomy
targetTarget 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…
siderocytespappemheimer
increased iron in the mitochondria of normoblasts is seen in what anemia
sideroblastic anemia
3 cells seen in thallasemia
targets, tearsbasophilic stipplingTear 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 stagessideroblastic, lead
Megaloblastic anemia:WBC seen in BM…3 things seen in smear…
BM: giant metamyelocytessmear: oval macro, hyperseg, less PLTsMegalo: big not small Anemia: less
Hereditary disease where osmotic fragility and autohemolysis are normal…Hereditary disease where osmotic fragility is increased…
elliptocytosisspherocytosis
PNH:3 testsPCH:1 test
PNH: sugar, sucrose, acidifiedPCH: 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
Leukemiaviral infectionchemoWBC will be….
decreasedleukemia: sick cells push out good cellsviral: HIV chemo: kill
euchormatindarker cytonucleolinonspecific granules charasteristic in…
immature blood cells*most characteristic of immature is euchromatin
Light blue endoplasmic reticulum found in neutrophilsseen in infections, burns, MayHegglin
Dohle bodies
nonspecific primary granules in…specific secondary granules in…
non/primary: promyelocytespecific/secon: myelocyte
Order of myeloid…1-6
1.)Myeloblast2.)Promyelocyte3.)Myelocyte4.)Metamyelocyte5.)Band6.)Seg
WBC NV most to least…
Seg 50-70Lymph 20-40Mono 3-10Eos 0-3Baso 0-2
Largest leukocyte in blood…Largest cell in BM:
monomegakaryo
Inclusions of blue black, coarse mucopolysaccharide granulesHurlers/Hunters
Alder Reilly
Giant PLTs, Dohle bodiesdecreased 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 materialsimilar to LE but no diagnositic value
tart cell
cell that neutraphil/macrophage engulfed denatured nuclearlupus erythromatosus
LE cell
cell that is plasma cell with cytoplasmic inclusions called russell bodies packed with immunoglobulinsconstipated plasma cell
Mott cells
reactive leukocytosis occurs when absolute granulocyte count is >…
7.0 x10^9/LGranulocytes 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 ferricMethmg to hmg, iron becomes reduced to ferrous
Eosinophilia and basophilia associated with what leukemia
CML
Smudge cells seen in this leukemia
CLLchronic not acute
L1 kids, homo, high N/CL2 adults, hetero, nucleoliL3 Burkitts, vacuolization, abundant cyto
FAB classifications of acute lymphocytic leukemia
ALL L1 3 main characteristics
homgenoushigh N/Ckids
ALL L2 3 main characteristics
heteroadultsnucleoli
ALL L3 2 main characteristics
vacuolization, abundant cyto
FAB ALL classification for mostly homo, high N/C ratio
L1
FAB ALL prominent cytoplasmic vacuolization
L3also 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 granulesM1/type 1 has granules
FAB AML that has no cytoplasmic granules
M0
M0 no granulesM1 granulesM2 traces of primary/fewM3 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 PLTsNRBCsTears 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 5,82.)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 2antiplasmin
What is the principal inhibitor of thrombin and factor Xa
anti-thrombin IIIalso neutralizes serum proteases
Most ACQUIRED inhibitor in hereditery deficiencies(acquire during treatment of this hereditary deficiency)
anti 8usually 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
StopClotsCleave 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: promyelocyteSecondary: myelocyte
Infections you will see toxic granulation in neutrophils and these three things…
shift to leftDohle bodiesvacuolizations
Neutrophil that phagocytizes/engulfs nuclear material/nucleoprotein in lupus
LE cellnot a tart (mono/histiocyte)
Only heterogenous cell Acute leukemia FAB classification
L2
L3 ALL has prominent
vacuoles
L1 has high…with…cells
high N/Chomogenous 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
MPOas opposed to SBB
chronic lymphocytic leukemias are usually neoplasms of what cell
B cells
Hemostasis 3 processes
vasoCONSTRICTIONadhesionaggregation
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 destructioncause not known
Idiopathic thrombocytopenia purpuraITP
vWD, Glazmann, and aspirin all have …PLT cts but abnormal…time
normalabnormal BT
PLTdisorder with abnormal-primary agg…-secondary agg..
primary agg: Glanzmannsecondary 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 abBUT not affected in…
autoimmune thrombocytopeniawho knows why, stupid AAB
Test that monitors heparin, FSP, and fibrinogen ab
TT
