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Hematology > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Neutrophil Precursors

Myeloblast

A
  • 14-20um
  • nucleus
    • N:C = 4:1
    • round, oval
    • chromatin fine, no clumping
    • 1-3 nuclei
  • cytoplasm
    • blue
    • no granules
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2
Q

Neutrophil Precursor

Promyelocyte

A
  • 15-21um
  • nucleus
    • N:C = 3:1
    • round
    • slight clumping
    • 1-2 nuclei
  • cytoplasm
    • blue
    • coarse, reddish blue primary granules
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3
Q

Neutrophil Precursor

Myelocyte

A
  • 12-18um
  • nucleus
    • N:C = 2:1 or 1:1
    • round, oval or flattened
    • chromatin clumped
  • cytoplasm
    • pink with some blue
    • fine, reddish pink secondary granules
    • some primary granules
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4
Q

Neutrophil Precursor

Metamyelocyte

A
  • 10-18um
  • nucleus
    • N:C = 1:1
    • indented kidney shape
    • chromatin clumped
  • cytoplasm
    • clear pink
    • secondary granules
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5
Q

Neutrophil Precursor

Band Neutrophil

A
  • 9-15um
  • nucleus
    • N:C = 1:1
    • elongated band, horseshoe
      • U or S
    • chromatin clumped
  • cytoplasm
    • clear pink
    • secondary granules
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6
Q

Neutrophil Precursor

Segmented neutrophil

A
  • 9-15um
  • nucleus
    • N:C = 1:1
    • 2-5 distinct lobes
    • chromatin clumped
  • cytoplasm
    • clear pink
    • secondary granules
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7
Q

Neutrophil function

A
  • adherance
  • migration and diapidesis
  • phagocytosis
    • recognition
    • ingestion
  • killing and ingestion
  • stimulation of coagulation
  • stimulation of inflammation
  • production of fever
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8
Q

Function of eosinophils

A
  • secretory
    • defense against helminth infection
    • pro inflammatory
      • may protect or damage host cells
    • modulation of allergic reactions
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9
Q

Function of basophils

A
  • secretion
  • mediate inflammatory response
    • especially type 1 hypersensitivity reactions
    • asthma, urticaria, anaphalaxis
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10
Q

Neutrophil migration

A
  • cytokines cause endothelial cells to express E-selectin
    • neutrophils bind to E-selectin
    • neutrophils roll along VEC
  • chemoattractants cause
    • VEC to express ICAMs
    • neutrophils express B2 integrin
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11
Q

Neutrophil recognition and attachment

A
  • opsonins
    • coat pathogens
    • complement C3B
    • IgG
  • PAMP
    • unique molecule on pathogens
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12
Q

Neutrophil phagocytosis

A
  • ingestion
    • pseudopod extension
    • engulfment
    • phagosome formation
    • lysosome fusion
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13
Q

Neutrophil killing

A
  • intracellular
    • respiratory burst
      • NADPH oxidase
        • super oxide (O2-)
        • hydrogen peroxide (H2O2)
      • hydroxyl radicals (OH-, OH+)
    • myeloperoxidase induces production of
      • hypochlorite (HOCl-)
        • bleach
    • singlet oxygen
      • strongest
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14
Q

Neutrophil digestion

A
  • acid pH
  • lysozyme
  • bactericidal proteins
  • lactoferrin
  • hydrolytic enzymes
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15
Q

Appearance of eosinophils

A
  • same developmental stages as neutrophil
  • 10-16um
    • N:C = 1:1
    • 2 to 3 distinct lobes
    • chromatin clumped
  • cytoplasm
    • clear pink
    • large red/orange specific granules
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16
Q

Appearance of basophils

A
  • same developmental stages as neutrophil
  • 10-16um
  • nucleus
    • N:C = 1:1
    • 2 to 3 distinct lobes
    • chromatin clumped
    • often obscured by granules
  • cytoplasm
    • clear pink
    • large violet/blue specific granules
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17
Q

Growth factors for monocyte development

A
  • colony stimulating factors
    • granulocyte/monocyte-CSF
      • GM-CSF
    • monocyte-CSF
      • M-CSF
  • interleukin
    • IL-3
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18
Q

Function of monocyte/macrophage

A
  • macrophage is a monocyte in the tissue
  • phagocytosis
    • ingest and kill microorganisms
    • killing of tumor cells
      • direct cytolytic effect
    • ingest and degrade other cellular debris
      • aged erythrocytes
      • activated clotting factors
      • antibody/antigen complexes
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19
Q

Leukocytosis

A
  • increase in leukocytes
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20
Q

Leukopenia

A
  • decrease in leukocytes
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21
Q

Neutropenia

A
  • decrease in neutrophils
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22
Q

Neutrophilia

A
  • increase in neutrophils
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23
Q

Agranulocytosis

A

absence of granulocytes

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24
Q

Granulocytosis

A

increase in all granulocytes

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25
Q

Antigen independent lymphocytes

A
  • begins with stem cells in bone marrow
  • leads to development of “immune competent cells”
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26
Q

Antigen dependent lymphocytes

A
  • B and T cells
  • occurs in secondary lymph tissue
  • contact with antigen causes further proliferation of cells able to interact with that antigen
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27
Q

Gene rearrangement

A
  • genes randomly split in certain areas then recombine
  • allows each cell to code for unique proteins that react with specific antigens
    • T cells
      • T cell receptor chain
    • B cells
      • immunoglobulins
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28
Q

B cell function

A
  • humoral immunity
    • proliferate and mature into plasma cells
    • secrete immunoglobulins
  • posses CD19, CD20, CD24 markers
  • each plasma cell produces antibodies directed at a single antigen
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29
Q

T cell function

A
  • CD2 marker is shared by all T cells
  • rearrangement of TCR gene produces T cell able to react with specific antigens
  • cell mediated immunity
    • CD4 helper/inducer
      • release factors that increase activation of other lymphocyte subsets
        • CD8 and B cells
    • CD8 cytotoxic/suppressor subset
      • lyse cells by direct surface to surface contact
      • supress immune response through negative
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30
Q

Natural killer cell function

A
  • 15% of lymphocytes
  • CD16 and CD56 positive but CD3 negative
  • functions
    • recognize and kill tumor cells and virus infected cells
    • attack antigens with IgG attached
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31
Q

What is anemia?

A
  • inability of blood to supply tissues with adequate oxygen
  • reduction of more than 10% of the number of red blood cells
    • circulating hemoglobin and red cell mass
  • if destruction exceeds production
  • production is impaired
  • compensating for anemia
    • increased oxygenated blood flow
    • increased oxygen release
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32
Q

Anemia patient symptoms

A
  • fatigue, weakness, vertigo, syncope, dyspnea (SOB), headache
  • physical exam
    • pallor
      • skin
    • heart abnormalities
      • tachycardia
      • hypotension
    • organomegaly
      • liver or spleen
    • bruising
33
Q

Red cell indices

Rule of three

A
  • Hgb x 3 = Hct
  • RBC x 3 = Hgb
34
Q

Red cell indices

MCV

A
  • average volume of red cells in femtoliters
    • Hct in L/L = MCV = (hct/RBC)x1000
    • Hct in % = MCV = (hct/RBC)x10
    • reference interval
      • 80 to 100 fL
35
Q

Red cell indices

MCH

A
  • average weight of hgb in a red cell in picograms
    • hgb in g/dL = MCH = (hgb/RBC)x10
    • reference range
      • 28 to 34pg
36
Q

Red cell indices

MCHC

A
  • comparison of weight of hgb to volume of cell
    • Hct in % = MCHC = (hgb/hct)x100
    • reference interval
      • 32 to 36g/dL
37
Q

Normocytic

A

80 to 100fL

38
Q

Microcytic

A

<80 fL

39
Q

Macrocytic

A

>100fL

40
Q

Normochromic

A

32 to 36g/dL

41
Q

Hypochromic

A

<32 g/dL

42
Q

Hyperchromic

A

>36 g/dL

43
Q

What is RDW?

A
  • expression of variance in red cell volume
    • high RDW indicates anisocytosis
      • variation in red cell size
44
Q

Bone marrow response to anemia

A
  • reticulocyte count indicates level of bone marrow activity
    • high count = high activity
45
Q

Classification of anemia

By onset

A
  • hereditary
    • hemoglobin S disease
    • thalassemia
  • aquired
    • iron deficiency
    • aplastic anemia
46
Q

Classification of anemia

Morphology

A
  • microcytic
    • MCV decreased
      • iron deficiency
      • thalassemia
  • macrocytic
    • MCV increased
      • Vitamin B12 deficiency
      • liver disease
  • normocytic
    • hemoglobin S disease
    • aplastic anemia
47
Q

Classification of anemia

MCV and RDW

A
  • MCV decreased, RDW normal
    • thalassemia minor
  • MCV increased, RDW increased
    • vitamin B12 deficiency
    • folate deficiency
  • MCV normal, RDW increased
    • hemoglobin S disease
48
Q

Iron cycle

A
  • normal
  • enteric absorption = through gut
    • 1mg/day
  • bone marrow uses the most iron
  • storage in liver
  • loss through urine, sweat, bile, ect
49
Q

Hepcidin

A
  • master iron regulating protein
  • regulates iron recycling/balance
    • inhibits activity of genes involved in iron absorption
  • increased hepcidin = decreased iron absorption
  • made in liver
50
Q

Transferrin

A
  • transports iron found in blood
  • each transferrin can bind 2 irons
  • binds to receptors on developing erythrocytes
  • increases in response to increased need of iron
  • measured transferrin = # of molecules
    • TIBC = # of iron binding sites
51
Q

Transferrin receptor (TfR)

A
  • receptors on developing cells that receive iron and bring it into the cell
  • released into the plasma as cell matures
  • measurement can assess the rate of erythropoiesis in bone marrow
52
Q

Ferritin

A
  • iron storage in liver
  • serum levels directly proportional to tissue levels
53
Q

Hemosiderin

A
  • iron storage
  • used when levels exceed ferritin capacity
  • not measurable in blood
54
Q

Causes of iron deficiency

A
  • chronic blood loss
    • abnormal menstrual flow
    • ulcers
    • malignancies
    • parasitic infections
    • intravascular hemolysis
    • hemodialysis
  • dietary deficiency
    • inadequate intake
    • increased physiologic need
      • growth, pregnancy, lactation
  • malabsorption
55
Q

Symptoms of iron deficiency

A
  • koilonychia
    • spoon nails
  • glossitis
    • sore tongue
  • cheilitis
    • sore lips
  • cravings
    • pica
  • chills
  • gastritis
56
Q

Morphology of Iron deficiency anemia

A
  • microcytes
  • hypochromia
  • elliptocytes
  • target cells
57
Q

Transferrin saturation (%TS)

A
  • serum iron divided by TIBC x 100
58
Q

Unsaturated iron binding capacity

UIBC

A

TIBC - serum iron

59
Q

Stages of iron deficiency

A
  • ferritin is the first to show abnormalities
  • stage 3
    • hemoglobin
      • decreased
    • MCV, MCHC
      • decreased
    • serum iron
      • decreased
    • TIBC
      • increased
    • %TS
      • decreased
    • Ferritin
      • decreased
60
Q

Serum transferrin receptor

sTfR

A

can differentiate IDA from ACD

61
Q

What are hemoglobinopathies?

A
  • genetic defect
    • substitution of amino acid
    • deletion of amino acid
  • over 900 alterations
  • effects
    • altered solubility
      • Hb S and Hb C
    • altered function
      • Hb M
    • altered stability
62
Q

Hemoglobin electrophoresis

A
  • medium
    • cellulose acetate
  • pH
    • 8.6
  • Hb A1 = fastest
  • Hb A2 = slowest
  • Hb C migrates with A2
  • Hb S, D, G migrate between A2 and F
  • A1, F, S, C, and A2
63
Q

Prevalance of Hb S and C

A
  • Hb S
    • 8-10% of african americans carry the gene
    • 0.3-1.3% are homozygous
  • Hb C
    • 2-3% of african americans carry the gene
    • 0.02% have the disease
64
Q

Globin chain defects

Hemoglobin S

A
  • defect of beta-globin
  • substitution of valine for glutamic acid in position 6
  • changes electrical charge and allows polymerization
65
Q

Globin chain defects

Hemoglobin C

A
  • defect of beta-globin
  • substitution of lysine for glutamic acid in position 6
  • changes electrical charge allowing polymerization
66
Q

Clinical findings associated with SCD and trait

A
  • chronic moderate to severe anemia caused by extravascular hemolysis
  • hemolytic crisis
    • increased hemolysis
  • aplastic crisis
    • bone marrow temporarily shuts down
  • vaso-occlusive crisis
    • capillaries plugged by abnormal cells
  • infection
  • spenic sequestration
    • pooling of damaged cells in spleen
  • chest syndrome
67
Q

Abnormal test results

Hb S disease

A
  • Hb
    • 6-10g/dL
    • severe anemia
  • MCV and MCHC
    • normal
  • RDW
    • increased
  • Morphology
    • target cells, sickle cells, NRBCs
  • White cells and platelets
    • increased
  • increased reticulocytes
    • 10-20%
  • Hb S solubility test
    • positive
  • electrophoresis
    • positive for hb S
      • 85-100%
    • increased hb F
68
Q

Abnormal test results

Hb S trait

A
  • CBC
    • Hb level usually normal
  • morphology
    • few target cells
  • Hb S solubility test
    • positive
  • electrophoresis
    • Hb A
      • 50-65%
    • Hb S
      • 35-45%
69
Q

Abnormal test results

Hb C disease

A
  • mild anemia
    • 8-12g/dL
  • morphology
    • target cells, hb C crystals
  • slightly increased reticulocytes
  • electrophoresis
    • Hb C
      • >90%
    • Hb F
      • <7%
70
Q

Abnormal test results

Hb C trait

A
  • target cells
  • electrophoresis
    • Hb C
      • 30-40%
    • Hb A1
      • 60-70%
71
Q

Abnormal test results

Hb SC disease

A
  • mild to moderate anemia
    • 10-14g/dL
  • morphology
    • target cells
    • SC crystals
  • solubility test
    • positive
  • electrophoresis
    • Hb S and Hb C equal amounts
    • increased Hb F
      • up to 70%
72
Q

Abnormal test results

Hb E

A
  • microcytes and target cells
  • slight erythrocytosis
  • hypochromic
  • electrophoresis
    • 30-40& Hb E
73
Q

A-thalassemia

Major

A
  • (–/–)
  • Hb Bart’s
  • no functional genes
  • incompatible with life
    • 4 gamma chains form hb Barts
    • binds but does not release oxygen
  • extreme anemia present at birth
    • 3-10g/dL
  • 80-90% barts
  • up to 20% portland
74
Q

A-thalassemia

Intermedia

A
  • (–/-a)
  • Hb H disease
  • excess beta chains form hb H
  • anemia not as severe as major
    • occasional transfusion
    • no iron overload
  • splenomegaly, hepatomegaly, bone deformities
  • moderate anemia
    • 8-10g/dL
  • morphology
    • microcytic, hypochromic
    • target cells
    • NRBCs
  • increased reticulocytes
    • 5-10%
  • electrophoresis
    • 25-40% hb barts
    • 2-40% hb H
75
Q

A-thalassemia

Minor

A
  • (–/aa) or (-a/-a)
  • trait
  • slight to no anemia
    • 10-12g/dL
  • morphology
    • microcytes, hypochromia, target cells, elliptocytes, basophilic stippling
  • electrophoresis
    • 5-6% hb barts at birth
    • normal pattern in adults
76
Q

A-thalassemia

Silent carrier

A
  • (aa/a-)
  • no symptoms
  • MCV may be slightly abnormal
    • 78-80fL
  • electrophoresis
    • 1-2% barts at birth
77
Q

B-thalassemia

Major

A
  • (B0/B0), (B0/B+), (B+/B+)
  • 2 abnormal genes
  • little to no Hb A1 produced
  • increased production of delta and gamma chains
  • severe anemia
    • 3-4g/dL
  • morphology
    • microcytic and hypochromic
      • MCV
        • 50-60fL
    • target cells, tear drop cells, elliptocytes, basophilic stippling, NRBCs
  • reticulocytes increased
    • 1-8%
  • electrophoresis
    • adult
      • 0-30% hb A1
      • 60-95% Hb F
      • hb A2 may be normal, increased or decreased
    • newborns
      • <2% hb A1
  • serum bilirubin increased
  • iron studies
    • serum iron = increased
    • TIBC = normal to increased
    • %TS = >80%
    • ferritin = increased
    • zpp = normal
  • bone deformities
  • hepatomegaly and splenomegaly
  • high risk of infection
  • iron overload
78
Q

B-thalassemia

Minor

A
  • (B0/B0), (B/B+)
  • asymptomatic unless stressed
  • mild anemia
    • Hb 9-14g/dL
  • MCV/MCHC low
    • 55-70fL/29-33
  • hypochromic, target cells, elliptocytes, basophilic stippling
  • electrophoresis
    • slightly elevated Hb A2
      • 3.5-7.0%
    • normal or slightly increased Hb F
      • 1-5%

Hematology (4 decks)

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