Exam 1 Week 1

Question 1

5 Types of WBC’s and precursors

Answer 1

Lymphocytes (lymphoid, B and T cells) Neutrophils (myeloid) Monocytes (myeloid) Eosinophils (myeloid) Basophils (myeloid)

Question 2

Leukemia vs. lymphoma

Answer 2

Leukemia: arise from bone marrow, in blood Lymphoma: arise from lymph system, in lymph

Question 3

Serum vs. plasma

Answer 3

Serum: blood without the clotting factors (post-clot) Plasma: blood without RBC, WBC, and platelets

Question 4

Red part of CBC

Answer 4

Hemoglobin, Hematocrit, RBC count MCV, MCH, MCHC Platelet count, mean platelet volume Red cell distribution width (CV and SD) NRBC Percent, NRBC Absolute

Question 5

White part of CBC

Answer 5

WBC count Segmented neutrophil % and abs Lymphocyte % and abs Monocyte % and abs Eosinophil % and abs Basophil % and abs

Question 6

MCV MCH MCHC Red cell distribution width

Answer 6

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)

Question 7

Calculate: MCV MCH MCHC

Answer 7

MCV = Hct/RBC x 10 (tallest peak on RCW histogram) MCH = Hgb/RBC x 10 MCHC = Hgb/Hct x 100

Question 8

CBC lab techniques

Answer 8

Impedance (Coulter Principle) Light scattering techniques Flow cytometry/cytochemistry Platelet counting can be complicated by clumping

Question 9

Scattergrams

Answer 9

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

Question 10

Limitations of reference intervals

Answer 10

Based on patient populations 2 SD (p=.05) Normal can be abnormal and vice versa

Question 11

CBC Differential

Answer 11

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

Question 12

RBC and Platelets on peripheral smear

Answer 12

RBC - little variation Platelets - small/fine granules, often clumped

Question 13

WBC on peripheral smear

Answer 13

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)

Question 14

PRR TLR PAMP DAMP

Answer 14

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

Question 15

Most common/TLR final transcription factor

Answer 15

NF-kB

Question 16

4+1 hallmarks of inflammation

Answer 16

1. rubor (erythremia) 2. calor (warmness) 3. tumor (swelling) 4. dolor (pain) +1. Loss of function

Question 17

Dendritic cells

Answer 17

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

Question 18

6 Types of Immunopathology

Answer 18

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

Question 19

Anemia Flow Chart

Answer 19

Associated with other hematologic abnormalities? Appropriate reticulocyte response? What are red blood cell indices?

Question 20

Labs tests for anemia

Answer 20

CBC Wright’s stain to look at morphology Reticulocyte count (rate of production)

Question 21

Reticulocyte count

Answer 21

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

Question 22

Absolute reticulocyte count

Answer 22

ARC = % RC x RBC count Determines relevance of RC >50,000/ul is high

Question 23

Reticulocyte index

Answer 23

RI = RC x (patient hgb/normal hgb) x (1/sf) Corrects for stress 1.0-2.0 2 = increased destruction

Question 24

Iron storage

Answer 24

Hemoglobin 65% Myoglobin 6% Herritin/hemosiderin (plasma) 25% Transferrin/ferroportin Enzymes

Question 25

Intralumenal factors for iron absorption

Answer 25

presence of amino acids (up) presence of vit c (up) more iron (up) phytates, oxalates, iron precipitates (down) less iron (down)

Question 26

Extralumenal factors for iron absorption

Answer 26

increased RBC creation (even if excess iron)

Question 27

Iron Cycle

Answer 27

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

Question 28

Timeline of Iron Deficiency

Answer 28

Normal

Iron Deficiency

Iron Deficient Erythropoiesis

Iron Deficiency Anemia

Question 29

Iron Deficiency Anemia Lab Findings

Answer 29

Decreased Hgb, Hct, RC, RI

Later: decreased MCV, increased RDW

Elliptocytes, spherocytes, fragemented RBC, target cells

Question 30

Iron Overload Etiologies

Answer 30

Increased iron in diet

Increase iron absorption (HFE mutation, hemochromatosis)

Repeated transfusions (hemosiderosis)

Question 31

Iron Overload Effects and Treatment

Answer 31

Heart, liver, endocrine (pancreas) damage

Hemochromatosis = therapeutic phlebotomy

Hemosiderosis = iron chelators (desferal, exjade)