B3-048 Hematologic Diagnostics Flashcards
1
Q
plasma contains
A
water
electrolytes
plasma proteins
2
Q
middle section of centrifuged blood contains
A
thrombocytes, leukocytes
3
Q
bottom section of centrifuged blood contains
A
erythrocytes
4
Q
top section of centrifuged blood contains
A
plasma
5
Q
oxygen transport
A
RBCs
6
Q
inflammation/immunity
A
WBCs
7
Q
hemostasis
A
platelets, plasma proteins, coagulation factors
8
Q
lab evaluations of oxygen transport
A
CBC: RBC, Hgb, MCV, MCHC, MCH, Hct, RDW
reticulocyte count
blood smear
9
Q
lab evaluations of inflammation/immunity
WBCs
A
CBC: WBC count
differential
blood smear
flow cytometry (heparin)
10
Q
proportion of different cell types
A
differential leukocyte count
11
Q
left shift indicates
A
circulating immature granulocytes
12
Q
toxic granules
Dohle bodies indicate
A
left shift
13
Q
left shift + circulating nucleated RBCs
A
leukoerthroblastosis
myelofibrosis
bone marrow infiltration
14
Q
A
toxic granules
15
Q
A
dohle body
16
Q
A
top: metamyelocyte
bottom: myelocyte
17
Q
A
nucleated RBC
18
Q
lab evaluations of hemostasis
A
CBC: platelets, immature platelet fraction
Tests of platelet function (citrate)
coagulation tests: PT, PTT, TT (citrate)
19
Q
extrinsic pathway
A
tissue factor (thromboplastin)
factor VII
20
Q
intrinsic pathway
A
prekallikrein
HMWK
XII
XI
IX
VIII
21
Q
common pathway
A
factors X
V
II (prothrombin)
I (fibrinogen)
22
Q
fibrin stabilization
A
XIII
23
Q
clotting test for extrinsic and common pathway
A
PT
24
Q
clotting test for intrinsic and common pathway
A
PTT
25
PT and PTT are not abnormal until
level of clotting factors is less than 30%
26
tests for platelet function
PFA-100, aggregation studies
27
bone marrow architecture features
sinusoids
hematopoietic cells
fat
28
normal ratio of hematopoietic cells:fat in bone marrow
1:1
29
normal ratio of myeloid to erythroid cells in bone marrow
3:1
30
bone marrow aspirate provides
cellular morphology, cell counts
31
bone marrow biopsy provides
architecture, infiltrates
32
bone marrow immunophenotype provides
assessment of lymphoid cells or blasts
| flow cytometry
immunohistochemistry
33
cgenetic analysis of bone marrow can be done via
cytogenetics
FISH
molecular techniques
| PCR, Sanger, next-gen
34
B cells are found in the .... of lymph nodes
cortex
35
T cells are found in the ...... of lymph nodes
paracortex
36
lymphocytes, macrophages, interdigitating reticulum cells are found
paracortex of lymph nodes
37
primary follicles of lymph nodes are
immunologically inactive
38
secondary follicles of lymph nodes are
immunologically active
39
centrocytes, centroblasts, tingible body macrophages, dedritic reticulum cells are found
germinal center of secondary follicles
cortex of lymph node
40
mantle zone is found in the
secondary follicles,
cortex of lymph node
41
biopsy of lymph nodes provides
architecture, cell size and distribution, infiltrates
42
immunophenotype of lymph nodes provides
flow cytometry
immunohistochemistry
43
CD20 and CD30 are targets for
immunotherapy in neoplastic disorders
44
serum + coagulation factors =
plasma
45
does serum contain coagulation factor proteins?
No
46
anticoagulants commonly used in hematology and coagulation
EDTA, heparin, citrate
47
chelates Ca2+
EDTA
| blood can't clot
48
EDTA sequestration of Calcium is
irreversible
49
when testing blood for coagulation testing, what anticoagulant is used?
citrate
50
when you are not worried about coagulation testing, what anticoagulants can be used?
EDTA or heparin
51
CBC
Reticulocyte Count
Blood Smear
what anticoagulant is used for these tests?
EDTA
52
what anticoagulant is used in flow cytometry?
heparin
53
normal circulating lymphocytes
band neutrophils
neuetrophils
eosinophils
basophils
lymphocytes
monocytes
54
circulating immature granulocytes
left shift
| toxic granulation
Dohle bodies
55
tests of platelet function are done using what anticoagulant?
citrate
56
PT, PTT, TT are done with what anticoagulant?
citrate
57
immature platelet fraction tells you
if the bone marrow is able to make platelets
58
injury to a vessel exposes
subendothelial collagen
59
platelet adhesion factor
vWF
60
vWF binds
Gp1b
61
platelet secretion and aggregation is mediated by
Gp2b-3a
62
crosslinks gp2b-3a proteins
fibrinogen
63
in vivo, the clotting cascade starts with
tissue factor
64
in vitro, the clotting cascade starts with
XII
65
all of the catalytic reactions in the coagulation cascade require
Calcium
66
fragments of crosslinked fibrin that are formed after fibrinolysis occurs
D dimer
67
elevated D dimers tell you
clotting has occurred
68
what test is helpful in differentiating cells of unknown lineage?
flow cytometry
| not helpful if you can easily tell lineage
69
clotting time becomes normal of significantly decreases in mixing study, this indicates
factor deficiency
| factors in pooled plasma are enough to overcome deficiency in pateints p
70
clotting time remains prolongs without significant decrease in mixing study, this indicates
factor inhibitor
| inhibitor is not factor specific, the pooled plasma does not alter react
71
what study should follow results of prolonged PTT?
1:1 mixing study to determine if factor deficiency or factor inhibitor
72
prior to surgery, what is most important information to get rather than PT/PTT screening?
personal/family hx of bleeding
drug hx
physical exam
| no point in identifying asymptomatic factor deficiencies prior to surger
73
basic differential for all -cytopenias
decreased production
increased utilization/destruction
ineffective production
74
macrocytic anemia differential
megaloblastic anemia
myelodysplasia
drugs
hypothyroidism
75
after each cycle of chemotherapy,
transient pancytopenia takes a bit longer to recover
76
clonal stem cell disorders characterized by ineffective hematopoiesis
myelodysplastic syndromes
77
peripheral cytopenias + hypercellular marrow + abnormal maturation
myelodysplastic syndrome
| maturation problem, not proliferation but can progress to AML over time
78
etiologic associations for myelodysplastic syndromes
benzene
ionizing radiation
alkylating chemotherapeutic drugs
topoisomerase II inhibitors
79
myelodysplastic syndromes may be asymptomatic until
pancytopenia becomes severe
80
10-40% of myelodysplastic syndromes transform into
AML
81
clonality in lymphoid lineage can be established via
receptor gene rearrangement (Ig, TCR)
receptor restriction (kappa/lamda)
clonal genetic marker
82
clonality in myeloid lineage can be established via
clonal genetic markers
| cytogenetics, FISH, PCR, Sanger, next-gen
83
broad screening test
cytogenetics
84
cytogenetics has low
sensitivity
85
cannot detect submicroscopic changes
cytogenetics
86
indentifies only the abnormality being tested for
FISH
PCR/Sanger
87
FISH sensitivity
intermediate
88
cannot detect point mutations, small insertions, deletions
FISH
89
PCR/Sanger sensitivity
high
90
can detected point mutations, small insertions/deletions
PCR/Sanger
NGS
91
indentifies broad array of abnormalities
NGS
92
NGS sensitivity
high
93
might miss an entire translocation if it does not result in fusion
NGS
94
what test would indentify favorable/unfavorable translocations?
cytogenics, FISH
95
what test would be used to identify KIT, p53, FLT3 mutations?
PCR/Sanger
96
what test can perform a myeloid malignancy panel?
NGS
| 50+ genes
97
test selection should consider
indication
prior probability
significance of test
clinical desicion to be made
98
before ordering a test consider
what will you do with the results? will it change the outcome?
99
the more tests you order the more likely
a result will fall out of reference range, simply by chance.
| misleading information, daily blood draws can cause anemia
100
when you need 1 specific test that is part of a panel, order
that one test individually
