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Clinical Hematology > Clinical Hematology Overview > Flashcards

Clinical Hematology Overview Flashcards

1
Q

The total volume of blood in an average adult is about?

A

6 L, or 7% to 8% of the body weight

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2
Q

In the total volume of blood about what % is composed of red blood cells, white blood cells, and platelets?

A

45%

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3
Q

In the total volume of blood about what % is composed plasma?

A

55%

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4
Q

Approximately what % of plasma is water?

A

90%

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5
Q

Soluble biochemicals is what % of plasma?

A

10%

Examples:

  • proteins
  • carbohydrates
  • vitamins
  • hormones
  • enzymes
  • lipids
  • salts
  • and trace metals
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6
Q

What is another term for the production of red blood cells?

A

Hematopoiesis

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7
Q

Blood cell differentiation and maturation occur primarily in what environment?

A

Bone Marrow

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8
Q

How many days do erythrocytes need for maturation?

A

3 to 5 days

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9
Q

What are the 6 stages of development for an RBC?

A

Rubriblast > Prorubricyte > Rubricyte > Metarubricyte > Reticulocyte (bluish hue) > Erythrocyte

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10
Q

Mature RBCs have a total life span of how many days?

A

120 days

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11
Q

Worn-out RBCs are broken down by what system?

A

Mononuclear Phagocytic System

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12
Q

The process by which a cell engulfs and digests foreign material is called what?

A

Phagocytosis

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13
Q

What are the cells which are located in the blood sinusoids and their primary function is to remove worn-out RBCs.

A

Mononuclear Phagocytes

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14
Q

What is the portion of Hb to which a molecule of oxygen binds?

A

Heme (iron)

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15
Q

The concentration of _____ in the blood is a measure of its capacity to carry _____, on which cells are absolutely dependent for energy and therefore life.

A

hemoglobin, oxygen

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16
Q

This term is derived from the diagrammatic representation of cell maturation, in which the more immature forms are shown on the left side.

A

Shift to the Left

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17
Q

After being released in the peripheral blood from the marrow these cells are in circulation for about 10 hours.

A

Neutrophils

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18
Q

In terms of cell size and cytoplasm, as a cell matures there is a progressive decrease in size, cytoplasm, and in the intensity of blue color because of loss of what?

A

RiboNucleic Acid (RNA)

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19
Q

Name the 3 granulocytes.

A

Neutrophil, Eosinophil, Basophil

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20
Q

The granulocytes begin forming with what type of blast?

A

Myeloblast

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21
Q

What stage of development comes prior to a basophilic and neutrophilic myelocyte?

A

Promyelocyte

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22
Q

At what stage of development can one tell the difference between an eosinophil and a neutrophil?

A

Myelocyte

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23
Q

When are eosinophils most active?

A

allergic reactions and certain parasitic infections of the tissues

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24
Q

What is the approximate life span of an eosinophil once released into the peripheral blood from the marrow?

A

8 hours

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25
Q

Basophilic myelocytes are recognizable due to what feature?

A

Basophilic Granules

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26
Q

What is the approximate life span of neutrophils once released into the peripheral blood from the marrow?

A

10 hours

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27
Q

Which of the 3 granulocytes occurs in very low numbers with a mean of 0.6%?

A

Basophils

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28
Q

What is the approximate life span of a basophil once released into the peripheral blood from the marrow?

A

approximately 8 to 10 hours

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29
Q

Which granulocyte is thought to contribute significantly to the local inflammation associated with IgE-dependent immune responses to parasites?

A

basophil

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30
Q

What are the 3 substances the granules within a basophil are made of?

A
  1. heparin
  2. histamine
  3. and perioxidase
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31
Q

List the 3 stages of development for monocytes.

A

Monoblast > Promonocyte > Monocyte

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32
Q

Approximately how long do monocytes remain in the peripheral blood after leaving the bone marrow?

A

Hours to days

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33
Q

When does a monocyte transform into a macrophage?

A

When they move into the body tissues.

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34
Q

Approximately how long do macrophages remain in the tissues?

A

Months

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35
Q

Which cell interacts with lymphocytes in the synthesis of antibodies?

A

Macrophage

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36
Q

How do macrophages assist T cells?

A

They process and deliver antigens to T cells.

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37
Q

What are the 5 stages of eosinophil development?

A

Myeloblast > Eosinophilic Myelocyte > Eosinophilic Metamyelocyte > Eosinophilic Band > Eosinophil

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38
Q

What are the 3 stages of platelet development?

A

Megakaryoblast > Megakaryocyte > Platelet

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39
Q

What are the 6 stages of neutrophil development?

A

Myeloblast > Promyelocyte > Neutrophilic Myelocyte > Neutrophilic Metamyelocyte > Neutrophilic Band > Neutrophil

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40
Q

What are the 4 stages of basophil development?

A

Myeloblast > Promyelocyte > Basophilic Myelocyte > Basophil

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41
Q

What are 2 types of lymphocytes?

A

T-cells (T lymphocytes) and B-cells (B lymphocytes)

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42
Q

What is another term for platelet?

A

thrombocyte

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43
Q

Where do T-lymphocytes mature in the body?

A

thymus

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44
Q

What is the diameter of an RBC?

A

7 to 8 µm

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45
Q

When an RBC extrudes its nucleus it changes from _____ to _____ on a Wright-stained blood film.

A

blue to orange

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46
Q

An RBC that has just extruded its nucleus is called what?

A

reticulocyte

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47
Q

The number of _____ in the peripheral blood is an indication of the degree of RBC production by the marrow.

A

reticulocytes

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48
Q

About what percent of the circulating RBCs are reticulocytes?

A

1%

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49
Q

What is another term for when a reticulocyte squeezes through the openings in the endothelial cells lining the marrow cavity?

A

insinuating

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50
Q

In Wright’s-stain what colors do reticulocytes appear to be?

A

pink-grey or pale purple; they have a slight bluish tinge

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51
Q

What 6 measurements are taken in a Complete Blood Count (CBC)?

A
  1. Hb
  2. Hematocrit
  3. RBC count w/ morphology
  4. WBC count w/ differential
  5. Platelet estimate
  6. RBC Indices
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52
Q

What are the 3 RBC indices?

A
  1. Mean Corpuscular Volume (MCV)
  2. Mean Corpuscular Hemoglobin (MCH)
  3. Mean Corpuscular Hemoglobin Concentration (MCHC)
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53
Q

What are the 3 commonly used anticoagulants used in hematology?

A
  1. EDTA (K3, Tripotassium Ethylenediaminetetraacetic Acid)
  2. Heparin
  3. Sodium Citrate
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54
Q

Identify the anticoagulant used in these tubes.

A

EDTA (K3, Tripotassium Ethylenediaminetetraacetic Acid)

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55
Q

What is the mode of action for EDTA?

A

It removes ionized calcium (Ca2+) through the process of chelation.

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56
Q

What type of anticoagulant does this tube contain?

A

heparin

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57
Q

Of the 3 commonly used anticoagulants used in hematology which is considered an inappropriate anticoagulant for many tests due to Wright-stained smears staining too blue?

A

heparin

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58
Q

What is the preferred anticoagulant for the Osmotic Fragility Test?

A

heparin

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59
Q

The MCV represents the ________ or ________ of the average RBC.

A

volume or size

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60
Q

What is another word for corpuscular?

A

Cell

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61
Q

MCV measures the ________ of an RBC.

A

volume (or size)

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62
Q

The MCHC represents the ________ concentration or ________ of the average RBC.

A

hemoglobin concentration or color

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63
Q

What does MCHC stand for?

A

Mean Corpuscular Hemoglobin Concentration

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64
Q

The MCH represents the ________ of hemoglobin in the average RBC.

A

weight

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65
Q

What does MCH stand for?

A

Mean Corpuscular Hemoglobin

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66
Q

What is the derived measurement determined electronically for the measurement of the degree of the variability in RBC size?

A

Red Cell Distribution Width

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67
Q

What does RDW stand for?

A

Red Cell Distribution Width

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68
Q

One RBC contains approximately how many molecules of Hb?

A

200-300 million molecules

69
Q

How many hemes are inside one molecule of Hb?

How many atoms of iron does each heme hold?

How many atoms of oxygen can one molecule of hemoglobin?

A

4 hemes

1 atom of iron

4 oxygen atoms

70
Q

Each Fe2+ atom is surrounded by a heme moiety which is also known as a ________.

A

Protoporphyrin Ring

71
Q

How many atoms of O2 can 1 molecule of Hb hold?

A

4

72
Q

Attached to each heme is a globulin aka a ________. A globulin is a large, folded chain of ________.

A

polypeptide chain, amino acids

73
Q

How many polypeptide chains (globulins) are in 1 molecule of Hb?

A

4

74
Q

The principle adult Hb is ________.

A

Hb A

75
Q

Hb A contain what types of globin chains?

A

2 alpha

2 beta

76
Q

What is an additional form of adult Hb?

A

Hb A2

77
Q

What are the chains substituted in A2?

A

Beta for Delta

78
Q

What is the major form of Hb found during intrauterine life and at birth?

A

Hb F

79
Q

What are the substitutions in Hb F?

A

2 Beta chains for 2 Gamma chains

80
Q

Disorders in which the presence of structurally abnormal hemoglobins is considered to play a role pathologically are called ________.

A

hemoglobinopathies

81
Q

Most hemoglobinopathies are the result of what type of chain abnormalities?

A

beta-chain abnormalities

82
Q

What are the 4 clinically important abnormal hemoglobins?

A
  1. Hb S
  2. Hb C
  3. Hb D
  4. Hb E
83
Q

What is the most common abnormal Hb?

A

Hb S

84
Q

Which abnormal Hb is predominantly found in the black population and is responsible for sickle cell anemia?

A

Hemoglobin S (Hb S)

85
Q

Which abnormal Hb is likely from the following data?

  • May occur in homozygous or heterozygous state
  • RBCs may appear as target cells
  • Crystals of precipitated Hb may be seen
A

Hb C

86
Q

Define oxyhemoglobin.

A

A Hb molecule fully saturated with 4 oxygen molecules.

87
Q

Define reduced hemoglobin.

A

A Hb molecule returning from the lungs with carbon dioxide (CO2).

88
Q

What is carboxyhemoglobin (HbO2)?

A

When Hb combines with carbon monoxide (CO).

89
Q

Why does carbon monoxide poisoning occur?

A

Hb has an affinity for CO (200x greater than O2) and when paired together oxygen cannot be carried leading to asphyxiation.

90
Q

What is the cell maturation of a lymphocyte?

A

Lymphoblast > Prolymphocyte > Lymphocyte

91
Q

What cells develop from a lymphocyte?

A

NK Cell, B Cell, T Cell

92
Q

What type of cell does a plasma cell develop from?

A

B Cell

93
Q

Which flat bones contains active adult hemopoietic tissue (colony forming units in red marrow)?

A
  1. Skull
  2. Vertebrae
  3. Sternum
  4. Ribs
  5. Pelvis
94
Q

_______ is an iron-binding protein that transports iron in the blood and other fluids.

A

Transferrin

95
Q

What is the major form of iron storage.

A

Ferritin

96
Q

________: an H2O insoluble form of iron storage derived chiefly from the breakdown of erythrocytes.

A

Hemosiderin

97
Q

What are the early heme precursors?

A

Early Precursors:

  1. Delta (δ) Amino-la-evulinic Acid
  2. Porpho-bilinogen
98
Q

What are the late heme precursors?

A
  • Uro-porphy-rinogen
  • Copro-porphy-rinogen
  • Proto-porphy-rin
  • HEME + 4 globin
99
Q

When excess iron is stored in tissues and body organs it leads to what 2 conditions?

A

Hemochromatosis and Hemosiderosis

100
Q

What is the difference between hemochromatosis and hemosiderosis?

A

Hemochromatosis is an inherited condition that causes you to absorb too much iron from food.

Hemosiderosis is an overload of iron in your organs or tissues resulting from bleeding within an organ or area of tissue and/or red blood cells breaking down within your bloodstream.

101
Q

What are conditions/symptoms as a result of enzyme deficiencies from the early heme precursors?

A

Neuropsychiatric Porphyrias that typically cause nervous system symptoms i.e. Acute Intermittent Porphyria (AIP)

102
Q

What types of porphyrias can arise from enzyme deficiencies from the late heme precursors?

A

Cutaneous Porphyrias i.e. skin symptoms such as photosensitivity, excessive hair growth in affected areas

103
Q

What symptom does acute and cutaneous porphyria share?

A

red or brown colored urine aka “port wine”

104
Q

What is the name of the inherited condition that causes you to absorb too much iron from food that leads to serious conditions such as diabetes, heart problems and liver disease.

A

Hemochromatosis

105
Q

What is the name of the condition which is caused by an overload of iron in your organs or tissues often as a result from bleeding within an organ or area of tissue, and red blood cells breaking down within your bloodstream.

A

Hemosiderosis

106
Q

What are the male and female hemoglobin reference ranges?

A
  • Male: 16 ±2g/dl
  • Female: 14 ±2g/dl
107
Q

________ measures packed cell volume in percent.

A

Hematocrit

108
Q

What is the microhematocrit method?

A

A fingerstick using EDTA or heparinized sample.

109
Q

The automated hematocrit method is calculated from ________ and ________.

A

MCV and RBC

110
Q

The following are examples of sources of error for what type of measurement?

  • cold agglutinins
  • high WBC counts
A

Automated Hematocrit Method

111
Q

What do these reference ranges apply to?

  • Male: 47 ±5%
  • Female: 42 ±5%
A

Hematocrit

112
Q

What is the mechanism of action for heparin?

A

Anti-thrombin agent

113
Q

What is the mechanism of action for EDTA?

A

EDTA in lavender-top tubes chelates ionized calcium which binds and withholds calcium ions thereby blocking the activation or progression of the coagulation cascade – ultimately inhibiting clot formation.

114
Q

What are examples of errors when measuring hemoglobin resulting in falsely elevated values?

A
  1. Lipemia/Icterus: due to increased turbidity of the sample
  2. High WBC count
  3. Resisting hemoglobins (i.e. SS, CC)
115
Q

What are examples of errors for the Microhematocrit Method?

A
  1. Failure to seal tube properly
  2. Incorrect reading due to uneven clay plug
  3. Inappropriate centrifuge time/speed
  4. Excess EDTA resulting in RBC shrinkage
116
Q

The MCV is calculate by…

A

manually dividing the volume of packed red blood cells (hematocrit) by the number of red blood cells then multiplying by 10 to convert the hematocrit reading from volume of PRBCs per 100mL to volume per liter.

(HCT ÷ RBC) × 10 = MCV (fL)

117
Q

If the Hct is 45% and the red cell count is 5 x 1012 cells per liter then what is the MCV?

A

45 / 5 = 9

9 x 10 = 90 fL

118
Q

The MCH is calculated by…

A

manually dividing the hemoglobin by the red cell count then multiplying by 10 to convert the Hb from grams per deciliter to grams per liter.

(HB ÷ RBC) × 10 = MCH (pg)

119
Q

Calculate the MCH:

  • Hb is 15g/dL
  • RBC is 5 x 1012 cells per liter
A

15 x 10 =

150 / 5 = 30 pg

120
Q

The MCHC is calculated by…

A

manually dividing the hemoglobin by the hematocrit then multiplying by 100

(HB ÷ HCT) × 100 = MCHC g/dL

121
Q

The Red Cell Distribution Width Coefficient of Variation (RDW-CV) is calculated by…

A

(Standard Deviation of MCV ÷ Mean MCV) × 100

122
Q

What are the 5 components of Wright stain?

A
  • Polychrome (Romanowsky) stain
  • Phosphate buffer (pH 6.4)
  • Eosin
  • Methylene blue
  • Methanol (fixative)
123
Q

What are the likely sources of error when a stained slide is too blue?

A
  • pH buffer or stain is too basic
  • prolonged staining
124
Q

What are the likely sources of error when a stained slide is too red?

A
  • pH buffer or stain is too acidic
  • prolonged washing
125
Q

The Absolute Value is calculated by…

A

Absolute Value = (Relative % * Total Cell Count)

i.e. for Neutrophils

  • total cell count: 6,000/μL
  • Relative: 60%

0.6 × 6,000 = 3,600/μL

126
Q

Which cell is increased in bacterial infections?

A

Neutrophils

127
Q

Which cell is increased in viral infections?

A

Lymphocytes

128
Q

Which cell is increased in Tuberculosis, Syphilis, and Malignancies?

A

Monocytes

129
Q

Which cell is increased in allergies and parasites?

A

Eosinophils

130
Q

Which cell is increased in immediate hypersensitivities?

A

Basophils

131
Q

The ________ is the percentage of RBCs in a volume of whole blood. It is expressed as units of percent or as a ratio in the SI system and is used in evaluating and classifying various types of anemias according to red cell indices.

A

hematocrit (Hct)

132
Q

What type of cell has the following Reference Range and Function?

  • Females: 3.8-5.2 x 106 μL (microliter)
  • Males: 4.5-6.1 x 106 μL (microliter)
  • O2 transport to tissue and CO2 removal from tissue
A

Red Blood Cell

133
Q

What type of cell has the following Reference Range and Function?

  • Relative: 45-70%
  • Absolute: 2250-7000/μL (microliter)
  • Ingest and kill bacteria
A

Neutrophil

134
Q

What type of cell has the following Reference Range and Function?

  • Relative: 20-40%
  • Absolute: 1000-4000/μL (microliter)
  • Humoral and cell mediated immunity
A

Lymphocyte

135
Q

What type of cell has the following Reference Range and Function?

  • Relative: 3-10%
  • Absolute: 150-1000/μL (microliter)
  • Ingest and kill bacteria, digest debris, initiate and regulate adaptive immune response
A

Monocyte

136
Q

What type of cell has the following Reference Range and Function?

  • Relative: 0-2%
  • Absolute: 0-200/μL (microliter)
  • Inflammatory response mediator
A

Basophil

137
Q

What type of cell has the following Reference Range and Function?

  • Relative: 0-3%
  • Absolute: 0-300/μL (microliter)
  • Allergic response regulator, specific parasitic infections
A

Eosinophil

138
Q

What type of cell has the following Reference Range and Function?

  • Relative: N/A
  • Absolute: 15,000-400,000/μL (microliter)
  • Clotting
A

Platelet (thrombocyte)

139
Q

The ________ is the average volume (or size) of an RBC expressed in ________.

A

Mean Corpuscular Volume (MCV)

femtoliters (fL)

140
Q

Which cell has the following Reference Ranges?

  • Relative: 45-70%
  • Absolute: 2250-7000/μL
A

Neutrophil

141
Q

Which cell has the following Reference Ranges?

  • Relative: 20-40%
  • Absolute: 1000-4000/μL
A

Lymphocyte

142
Q

Which cell has the following Reference Ranges?

  • Relative: 3-10%
  • Absolute: 150-1000/μL
A

Monocyte

143
Q

Which cell has the following Reference Ranges?

  • Relative: 0-2%
  • Absolute: 0-200/μL
A

Basophil

144
Q

Which cell has the following Reference Ranges?

  • Relative: 0-3%
  • Absolute: 0-300/μL
A

Eosinophil

145
Q

Which cell has the following Reference Ranges?

  • Absolute: 150,000-400,000/μL
A

Platelet

146
Q

What are the Reference Ranges for Red Cells?

A
  • Female: 3.8 - 5.2 x 106/μL
  • Male: 4.5 - 6.1 x 106/μL
147
Q

What are sources of error when performing an automated hematocrit?

A
  • Cold agglutinins
  • High WBC count
148
Q

What are blood disorders cause by enzyme deficiencies which causes build-up of heme precursors resulting in red or port wine colored urine?

A

Porphyrias

149
Q

What are the Protoporphyrin Synthesis precursors?

(Hint: There are 6 of them.)

A
  1. Delta Aminolaevulinic Acid
  2. Por-pho-bilinogen
  3. Uro-porphy-rinogen
  4. Copro-phorphy-rinogen
  5. Proto-porphy-rin
  6. Heme + globin 4 hemoglobins
150
Q

What is the formula to correct the WBC count if nucleated red cells are included in the count?

A

(WBC # X 100) / (100 + NRBCs) = corrected WBC count

151
Q

Megaloblastic Anemia (B12 and folate deficiency) is associated with what type of WBC morphology?

A

Hypersegmented Neutrophils

152
Q

Pelger Huet (inherited-Acute Myeloid Leukemia), and Pseudo-Pelger Huet (acquired-AIDS) are associated with what type of WBC morphology?

(Hint: it is important to differentiate from bandemia with a left-shifted peripheral blood smear.)

A

Hyposegmented Neutrophils

153
Q

Bacterial infections, Burns, and Chemotherapy are associated with what type of WBC morphology?

(Hint: occurs regularly with bacterial infection and often with other causes of inflammation.)

A

Toxic granulation and Vacuoles

154
Q

Bacterial Infections, Burns, and May-Hegglin are associated with what type of WBC morphology?

May-Hegglin Anomaly is a rare, inherited, blood platelet disorder characterized by abnormally large and misshapen platelets (giant platelets) and defects of the white blood cells known as leukocytes.

A

Döhl Bodies (RNA)

155
Q

Infectious Mono and other Viral Infections are associated with what type of WBC morphology?

A

Variant Lymphs (increased size and basophilia)

156
Q

What is the RR for MCV?

A

80-100fl

<80 microcytes

>80 macrocytes

157
Q

What is the RR for MCH?

A

28-32pg

158
Q

What is the RR for MCHC?

A

32-36% (g/dL)

<32 Hypochromic cells, Icterus

>36 Spherocytes, Icterus, Lipemia, Hb SS, CC

159
Q

What is the RR for RDW-CV?

A

11.5-14.5%

>14.5% anisocytosis

160
Q

What is the RR for RDW-SD?

A

39-47fL

>47fL anisocytosis

161
Q

Identify this abnormal RBC shape.

A

Acanthocyte

162
Q

What type of abnormal RBC shape is seen in:

  • Abetalipoproteinemia
  • Severe Liver Disease
A

Acanthocyte

163
Q

Identify this abnormal RBC shape.

A

Echinocyte “Burr” Cell

164
Q

What type of abnormal RBC shape is seen in:

  • Uremia
  • Artifact (alkaline glass effect)
A

Echinocyte “Burr” Cell

164
Q

What type of abnormal RBC shape is seen in:

  • Uremia
  • Artifact (alkaline glass effect)
A

Echinocyte “Burr” Cell

165
Q

Identify this abnormal RBC shape.

A

Elliptocytes

166
Q

What type of abnormal RBC shape is seen in:

  • Hereditary Elliptocytosis
  • Iron Deficiency
  • Thalassemia
A

Elliptocyte

167
Q

Identify this abnormal RBC shape.

A

Macroovalocyte

168
Q

What type of abnormal RBC shape is seen in:

  • Megaloblastic Anemia
A

Macroovalocyte

Clinical Hematology (3 decks)

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