Exam 1 Week 1 Flashcards
5 Types of WBC’s and precursors
Lymphocytes (lymphoid, B and T cells) Neutrophils (myeloid) Monocytes (myeloid) Eosinophils (myeloid) Basophils (myeloid)
Leukemia vs. lymphoma
Leukemia: arise from bone marrow, in blood Lymphoma: arise from lymph system, in lymph
Serum vs. plasma
Serum: blood without the clotting factors (post-clot) Plasma: blood without RBC, WBC, and platelets
Red part of CBC
Hemoglobin, Hematocrit, RBC count MCV, MCH, MCHC Platelet count, mean platelet volume Red cell distribution width (CV and SD) NRBC Percent, NRBC Absolute
White part of CBC
WBC count Segmented neutrophil % and abs Lymphocyte % and abs Monocyte % and abs Eosinophil % and abs Basophil % and abs
MCV MCH MCHC Red cell distribution width
MCV - average volume of RBC’s MCH - content (weight) of hemoglobin in average RBC MCHC - average concentration of hemoglobin in RBC vol RCW - variation of size of RBCs (histogram)
Calculate: MCV MCH MCHC
MCV = Hct/RBC x 10 (tallest peak on RCW histogram) MCH = Hgb/RBC x 10 MCHC = Hgb/Hct x 100
CBC lab techniques
Impedance (Coulter Principle) Light scattering techniques Flow cytometry/cytochemistry Platelet counting can be complicated by clumping
Scattergrams
Forward scatter: size Side florescent: type and quantity of nuc acids/organelles Side scatter: internal cell information Basophils/lymphocytes will be same scatter Basophils resistant to acid cyto stripping
Limitations of reference intervals
Based on patient populations 2 SD (p=.05) Normal can be abnormal and vice versa
CBC Differential
Automatic vs. manual (requested or flagged) 1. Make blood film 2. Examine at low power for obvious morphologic 3. Examine at high power for detail
RBC and Platelets on peripheral smear
RBC - little variation Platelets - small/fine granules, often clumped
WBC on peripheral smear
Neutrophils: distinct lobes, granules Lymphocytes: smaller, scant cyto with round nuc Monocytes: largest, irregular/lobed, vaculoes Eosinophils: bi-lobed, larger granules (red/orange) Basophils: large purple/black granules (obscure nuc)
PRR TLR PAMP DAMP
PRR: pattern-recognition receptor, on body cell TLR: toll-like receptor, subtype of PRR, ~10 PAMP: pathogen pattern, on foreign cell DAMP: damage pattern, on body cell
Most common/TLR final transcription factor
NF-kB
4+1 hallmarks of inflammation
- rubor (erythremia) 2. calor (warmness) 3. tumor (swelling) 4. dolor (pain) +1. Loss of function
Dendritic cells
aka. antigen presenting cell Bridge between innate and adaptive immunity Located in skin, lung, mucus mmbr etc Immature DC take anything they can and travel
6 Types of Immunopathology
Type I: immediate hypersensitivity, IgE, allergies Type II: autoimmunity Type III: antibodies against soluble antigen, tissue injury Type IV: T-cell mediated, bystander injury Chronic, frustrated immune response HIV/AIDS
Anemia Flow Chart
Associated with other hematologic abnormalities? Appropriate reticulocyte response? What are red blood cell indices?
Labs tests for anemia
CBC Wright’s stain to look at morphology Reticulocyte count (rate of production)
Reticulocyte count
RC = % of 1000 RBC’s (0.4-1.7%) mRNA presence in RBC’s 3 days in marrow, 1 day in blood Marker of RBC production
Absolute reticulocyte count
ARC = % RC x RBC count Determines relevance of RC >50,000/ul is high
Reticulocyte index
RI = RC x (patient hgb/normal hgb) x (1/sf) Corrects for stress 1.0-2.0 2 = increased destruction
Iron storage
Hemoglobin 65% Myoglobin 6% Herritin/hemosiderin (plasma) 25% Transferrin/ferroportin Enzymes
Intralumenal factors for iron absorption
presence of amino acids (up) presence of vit c (up) more iron (up) phytates, oxalates, iron precipitates (down) less iron (down)
Extralumenal factors for iron absorption
increased RBC creation (even if excess iron)
Iron Cycle
Transferrin: made in liver, binds 2 ferric iron, receptor
RE Cycle: macrophage breakdown, ferritin store
Ferritin = hemosiderin, stores 4500 Fe
Hepcidin: negative regulator of Fe absorption
Timeline of Iron Deficiency
Normal
Iron Deficiency
Iron Deficient Erythropoiesis
Iron Deficiency Anemia
Iron Deficiency Anemia Lab Findings
Decreased Hgb, Hct, RC, RI
Later: decreased MCV, increased RDW
Elliptocytes, spherocytes, fragemented RBC, target cells
Iron Overload Etiologies
Increased iron in diet
Increase iron absorption (HFE mutation, hemochromatosis)
Repeated transfusions (hemosiderosis)
Iron Overload Effects and Treatment
Heart, liver, endocrine (pancreas) damage
Hemochromatosis = therapeutic phlebotomy
Hemosiderosis = iron chelators (desferal, exjade)
