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BL Unit 1 > BL Pan Schowinsky lecture review > Flashcards

BL Pan Schowinsky lecture review Flashcards

1
Q

What information can you get about RBCs directly from a CBC?

A

Number, percentage in blood (also retics), hemoglobin concentration, red cell distribution width

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2
Q

What information can you get about RBCs indirectly from a CBC?

A

RBC volume, Hemoglobin per cell. Equations: MCV = HCT/RBC; MCH = HGB/RBC; MCHC = MCH/MCV

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3
Q

What information can you get about WBCs directly from a CBC?

A

Number, percentage

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4
Q

What information can you get about platelets directly from a CBC?

A

Number, size

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5
Q

What principle is used to obtain RBC and WBC count?

A

Coulter principle. WBCs and Hb on one side,

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6
Q

In general how many RBCs, WBCs, and platelets should an adult have?

A

4-6 trillion RBCs, 4-11 billion RBCs, and 150-400 billion platelets

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7
Q

Neutrophils?

A

40-70%, # 1.8-6.6

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8
Q

Lymphocytes?

A

20-50%, #1.0-4.8

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9
Q

Monocytes?

A

2-11%, #0.2-0.9

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10
Q

Eosinophils?

A

0-6%, #0.01-0.4

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11
Q

Basophils?

A

0-2%, #0.01-0.2

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12
Q

Characteristics of Iron deficiency anemia?

A

Decrease RBC, HGB, MCV, MCH, MCHC, HCT. Increased RDW. Small RBCs, target cells, hypochromic

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13
Q

Characteristics of spherocytosis?

A

Increased MCHC. No central pallor, spherical

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14
Q

Characteristics of G6PD deficiency?

A

Heintz bodies, bite cells

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15
Q

When might you see bite cells?

A

G6PD deficiency

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16
Q

When might you see schistocytes?

A

Mechanical heart valve damage, burns, disseminated intravascular coagulation

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17
Q

When might you see target cells?

A

Thalassemia, Hb C, iron deficiency, liver disease

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18
Q

When might you see sickle cells?

A

Sickle cell disease

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19
Q

When might you see basophilic stipling?

A

Lead poisoning, porphyria. Might also be seen in thalassemia, myelodysplasia, sideroblastic anemia, infection

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20
Q

What are Heintz bodies?

A

Denatured hemoglobin that has precipitated

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21
Q

What is basophilic stipling?

A

Aggregated RNA (ribosomes)

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22
Q

What are Howell-Jolly bodies?

A

Nuclear remnants

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23
Q

When might you see Howell-Jolly bodies?

A

Spleen removal, megaloblastic anemia, myelodysplasia

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24
Q

What is a Dohle body?

A

Condensed RNA in WBCs, neutrophils. Associated with infection, burns, inflammation.

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25
Q

What is toxic granulation?

A

Increase in the number of granules that can be caused due to rapid WBC division during invetion and marrow recovery

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26
Q

When might you see hypersegmented neutrophils?

A

B12 and folate deficiency (megaloblastic anemia)

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27
Q

Name the embryonic sites of hematopoeisis.

A

Yolk sac up to 3 mo.

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28
Q

Name the fetal sites of hematopoeisis.

A

Liver and spleen 2 mo. to 7 mo.

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29
Q

Name the adult sites of hematopoeisis.

A

Bone marrow

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30
Q

What cells produce regulatory factors and adhesion molecules that maintain hematopoiesis?

A

Stromal cells

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31
Q

What are stromal cells?

A

Marrow cells that produce a protein framework, regulatory factors, and adhesion molecules that promote and maintain hematopoeisis.

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32
Q

Describe characteristics of hematopoietic stem cells.

A

Rare, express CD34 and CD117, asymmetric cell division, can become all blood cell types.

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33
Q

What can multipotent hematopoietic progenitor differentiate in to?

A

Can become all lymphoid and myeloid lineages.

34
Q

What can oligopotent hematopoietic progenitor differentiate in to?

A

Either myeloid progenitors or lymphoid progenitors.

35
Q

What can lineage restricted hematopoietic progenitor differentiate in to?

A

Restricted to one type of cell.

36
Q

Approximately how many cells can one burst forming unit produce?

A

2000

37
Q

Describe the changes that occur during the stages of erythropoiesis.

A

As erythropoiesis progresses, progenitors get smaller in size, change from blue staining to red staining, have a decreased NC ratio, eventually lose their nuclei.

38
Q

List the stages of erythropoiesis.

A

Pronormoblast–>basophilic normoblast–>polychromatophilic normoblast–>orthochromic normoblast–>reticulocytes–>erythrocyte

39
Q

At which stage of erythropoiesis does mitosis stop? (also the most common erythrocyte precursor in bone marrow)

A

Polychromaticophilic normoblast

40
Q

How long does erythropoiesis take and how long do mature RBCs survive?

A

2-7 days to get to orthochromic normoblast. 1 day to extrude nucleus. Retics mature for 2-3 days before released into peripheral blood. Approx 1 day to mature in blood. (5-11 days total) RBCs live ~120 days.

41
Q

What triggers EPO release?

A

Hypoxia

42
Q

What does EPO do? (4 things)

A

Promotes stem cells to become pronormoblasts, increase mitosis and maturation, increases hemoglobin production, inreases retic release.

43
Q

Name the granulocytes.

A

Neutrophil, eosinophil, basophil

44
Q

List the stages of granulopoiesis.

A

Myeloblast–>promyelocyte–>myelocyte–>metamyelocyte–>band–>seg

45
Q

What are Auer rods?

A

Feature of myeloblasts seen only in abnormal conditions.

46
Q

Describe the changes that occur during the stages of granulopoiesis.

A

Decrease in size, decrease in primary granules, increase in secondary granules, decrease # of nucleoli, nucleus becomes a kidney shape then band then seg

47
Q

Which cytokine initiates neutrophil production?

A

Granulocyte-colony stimulating factor

48
Q

How long does granulopoiesis take?

A

3-6 days for myeloblast to myelocyte. 5-7 from metamyelocyte to seg. (9-13 days total)

49
Q

Which pool is represented more in marrow - younger granulocytes or older?

A

Younger - metas to segs

50
Q

What is the life span of a neutrophil?

A

~5 days in the blood. 1-2 days when activated in the tissue.

51
Q

What are in neutrophil granules?

A

Myeloperoxidase

52
Q

What is the life span of an eosinophil?

A

8-12 days

53
Q

What cytokin initiates eosinophil production?

A

IL-5

54
Q

What cytokin initiates basophil/mast cell production?

A

Basophils: IL-3; Mast cells: Stem Cell Factor

55
Q

Which features distinguish a mast cell from a basophil?

A

Mast cells have prominent blue granules, but the nucleus is visible and the nucleus is round rather than lobed. Also mast cells are mostly found in solid tissues.

56
Q

How long do monocytes live?

A

20 days in peripheral blood before becoming macrophages.

57
Q

What stimulates monocyte production?

A

Monocyte-colony stimulating factor

58
Q

Name the stages of monopoiesis.

A

Monoblast–>promonocyte–>promonocyte–>monocyte

59
Q

Describe the changes that occur during the stages of monopoiesis.

A

While the cells stay approx the same size, cytoplasm stays blue but gains vacuoles, nucleus goes from pink to dark blue and ovoid to kidney/seg shaped.

60
Q

Which cytokine initiates platelet production?

A

Thrombopoietin

61
Q

What kind of sample can you take to look at proper hematopoiesis?

A

Bone marrow biopsy or aspiration

62
Q

What is the most common site of bone marrow aspiration?

A

Inominate bone - posterior iliac crest

63
Q

What things to pathologists look for in bone marrow smear?

A

Cell differential, cell morphology, iron content

64
Q

What things to pathologists look for in bone marrow biopsy?

A

Cellularity, myeloid:erythroid ratio, megakaryocyte frequency, focal findings

65
Q

What is the normal myeloid:erythroid ratio in bone marrow?

A

2:1-4:1

66
Q

What is the rule of thumb for normal bone marrow cellularity?

A

100%-age

67
Q

Define cytopenia.

A

A decrease in the number of blood cells.

68
Q

Describe the clinical findings of a cytopenia due to increased destruction.

A

Decreased peripheral cells but compensatory marrow hyperplasia

69
Q

Describe the clinical findings of a cytopenia due to decreased production.

A

Marrow may be depleted and growth factor levels may be increased or decreased. If increased, then they are not getting a response.

70
Q

What dermatological finding is indicative of thrombocytopenia?

A

Petechiae

71
Q

Petechiae may be indicative of what hematological condition?

A

Thrombocytopenia

72
Q

Differential for thromocytopenia due to increased destruction?

A

Immune thrombocytopenic purpura, post-transfusion thrymbocytopenia, drug induced (quinidine), mechanical (disseminated intravascular coagulation, heart valve)

73
Q

What unusual type of platelet might be seen in increased thrombopoiesis?

A

Giant platelet

74
Q

Differential for neutrophilia?

A

Infection, inflammation, drugs (steroids), stress, tumors, neoplasm

75
Q

What clinical findings favor leukemoid reaction as a cause of neutrophilia?

A

Symptoms of infection or inflammation, toxic appearing neutrophils (like they?ve been eating bad stuff), normal basophils (because basophils is rare outside of cases of leukemia), normal megakaryocytes

76
Q

What clinical findings favor CML as a cause of neutrophilia?

A

asymptomatic, enlarged spleen and liver, neutrophils look healthy, absolute basophilia

77
Q

What is the differential diagnosis for microcytic and hypochromic anemia?

A

Iron deficiency, anemia of chronic disease, hemoglobinopathy, primary marrow disease

78
Q

What additional information is necessary to determine the cause of microcytic anemia?

A

Serum iron, tranferrin, TIBC, serum soluble transferrin receptor, percent transferrin saturation, fecal occult blood test, colonoscopy. For B12 or folate deficiency: serum B12 and folate, homocysteine, methylmalonic acid, schilling test, bone marrow examination

79
Q

Besides RBC values, what might be seen in the CBC if anemia is due to bleeding?

A

Increased platelet count

80
Q

What type of cell is characteristic of chronic lymphocytic leukemia?

A

Smudge cells

BL Unit 1 (5 decks)

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