Hematology 1 Flashcards
“HAIMA” means
Blood
“LOGOS” means
science/study
Specific gravity of blood
1.055 SG
Hematology
Study of blood forming units
Ph of the blood
7.35-7.45 (slightly alkaline)
Skin puncture
also known as you capillary puncture, or dermal puncture
- use only when small quantities of blood is needed
- preferred sample for newborn screening
Recommended depth skin puncture
infants: <2mm
adults: 2-2.5mm
When doing skin puncture:
-warming the puncture site (40-42C for 2 to 5 min) to increase blood flow by 7-FOLD and to ARTERIALIZE the sample
Order of draw for skin puncture
- ——– BSLOR ——-
- Blood gas analysis sample
- slide smear
- lavender micro-collection tube
- other tubes with anticoagulant
- serum collection tube
Puncture site:
- INFANTS: median or lateral side of the plantar surface of the heel
- ADULTS: palmar surface, distal portion of the 3rd or 4th finger of the non-dominant hand
what is the vein of choice when performing routine venipuncture?
median cubital vein,
- it is also connects cephalic and basilic vein
- less movement of your vein
Angle of the needle
15-30 angle
Tourniquet application
<1 minutes
and 3-4 inches above the venipuncture site
Note: if tourniquet is left on the arm for more than 2 minutes, expect to have H (hemolysis), H (hemoconcentration), dCT (decrease clotting time)
Standard needle length
1-1.5 inches
Standard needle gauge
21 gauge
NOTE: the bigger the number the smaller the bore
Complication of venipuncture
- Ecchymosis: primary complication, leakage of SMALL amount of blood
- Syncope: 2nd most common
- Hematoma: Leakage of LARGE amount of blood that rapidly swells
order of draw for venipuncture
Yellow, Light blue, Red, Green , Lavender, Gray
- Yellow- SPS/ACD, 8times
- Light Blue- Sodium citrate, 1:9 ration, 3-4 times
- Red- Glass or silica particles, 5 times
- Green- heparin, 8 times
-lavender- k2(VERSENE)
k3 (SEQUESTRENE), 8 times
-Gray- potassium oxalate and sodium fluoride, 8 times
All blood cells are derived from a single progenitor stem cell (pluripotential stem cell) which carries your CD marker 34
Monophyletic Theory
Blood cells are derived from its own unique stem cell
Polyphyletic Theory
-chief site of hemopoiesis: YOLK SAC
-during 9 days of gestation the yolk sac would give rise to Primitive erythroblast
from the MESODERMAL CELLS
- during this stage you will be able to find you HSCs, Fetal Hgb, Gower 1, Gower 2, portland
Mesoblastic Stage
chief site of hemopoiesis: LIVER
- peak activity at the 3rd month of gestation
- Spleen, thymus, and lymph node
Hepatic Stage
Chief site of hemopoiesis: BONE MARROW
-begins 5th month of gestation and continuous throughout life (hematopoiesis from the flat bones)
medullary Stage
Examples of your flat bone and THE MAIN SITE OF HEMATOPOIESIS
- RIBS
- VERTEBRA
- STERNUM
- SKULL
- SHOULDER BLADES
- PELVIS
- PROXIMAL ENGD OF LONG BONES
note: Limited only to your red marrow
- and the only haematopoietically active site for adult hematopoiesis
marrow cellularity
-collecting bone marrow aspirate
more than 70%, incase of leukemia, Increase WBC, RBC
Hyperplastic
Hypoplastic
<30%
incases of your aplastic anemia
complete reduction of RBC and WBC
myeloid to erythroid ration
2-4:1 ratio
master regulatory hormone
Hepcidin
Absorption of Iron happens in
Duodenum (site of maximal absorption, 1-2 mg)
if ever in cases you need more iron, it could extend to your JEJENUM
iron is transported through
Transferrin
Note: if the transportation from the enterocyte to the circulation it is the FERROPORTIN
Where is iron being utilized
Mitochondrial iron
Store excess iron in a form of
FERRITIN (soluble) & HEMOSIDIRIN (Insoluble)
What is the reference range of serum ferritin for men and women
15-200 ug/dl (men)
12-150 ug/dl (women)
-serum ferritin reveals the body’s tissue iron stores
in cases where the patient should only have one test to determine if the patient is having iron deficiency anemia, what would be the best test ?
Serum Ferritin test
indirectly measure the concentration of transferrin by measuring its ability to bind iron
Total Iron binding capacity
Reference range: 250-450ug/dl
main component of the red blood cell
- composed of 2 sets of 2 different polypeptide chains
- 4 molecules of protoporphyrin IX
- 4 iron atoms in its ferrous form
HEMOGLOBIN
carries deoxygen from the lungs
oxyhemoglobin
- Oxygen that is already in our veins
- oxygen is given to the tissues
Deoxyhemoglobin
hemoglobin which carries your carbon dioxide
Carboxyhemoglobin
hemoglobin where the iron is oxidizes from the ferrous to the ferric stage
Methemoglobin
Hemoglobin that is bound to anisole hydro compound
Sulfhemoglobin
mauve lavender color
RBC metabolic pathways
- Embden-Meyerhof
- Hexose Monophosphate Shunt
- Methemoglobin Reductase Pathway
- Rapaport-Luebering Shunt
Reference method for hemoglobin determination
Hemoglobinometry
Turbidity of your solution can result to
False increase or your measurement
Normal Value of your hemoglobin
- Male: 14-18 g/dl
- Female: 12-15 g/dl
Common hemoglobinopathies
- Hemoglobin S: the 6glutamine is change to Valine
- Hemoglobin C: 6Glu-Lys
- Hemoglobin E: 26Glu- Lys
Hemoglolbin S
- 6Glu- Val
- When it is OXYGENATED it is soluble
- when it is DEOXYGENATED, the hb S would be POLYMERIZE and will form SICKLE CELLS
Non-functional hemoglobins which carries the ferric ion of you hemoglobin
- Hb M-Saskatoon
- Hb M-milwaukee-1
- Hb M-Milwaukee-2
Hemoglobin Variants that has an INCREASE OXYGEN AFFININTY
- Hb Hiroshima
- Hb Rainer
- Hb Bethesda
Hemoglobin variants that has an DECREASE OXYGEN AFFINITY
- Hb Agenogi
- Hb Beth-Israel
- Hb Yoshizuka
- we use cellulose acetate : pH 8.4-8.6
- primary screening procedure for variant hemoglobin
HEMOGLOBIN ELECTROPHORESIS
Fastest Hemoglobin
Hemoglobin H, hemoglobin A1
Slowest hemoglobin
Hb A2, Hb C, Hb E, Hb C harlem, Hb O arab
Formation of RBC
Erythropoiesis
Morphologically the Earliest recognizable erythroid precursor using light microscope -side: 14-20um -nucleoli: present 1:2 -thin nuclear membrane -homogenous basophilic cytoplasm
Pronormoblast
Size: 12-17 um
- nucleoli: 0:1
- cytoplasm appears more abundant than in pronormoblast
- LAST stage with a nucleolus
Basophilic Normoblast
- Dawn of Hemoglobinization
- LAST STAGE CAPABLE OF MITOSIS
- basophilic to diffusely LILAC in color
- size: 10-15
Polychromatic Normoblast
- Last stage with a nucleus
- Salmon Pink cytoplasm
- size: 7-12 um
- pkynotic nucleus
Orthochromatic normoblast
Last stage of Hemoglobin
-last immature erythrocyte stage
-Size: 7-10 um
Spends 2-3 days in the bone marrow and 1 day in the peripheral blood
Reticulocyte
- Size of 6-8um
- Bioncave Disk
- Average life span is 120 days
Mature erythrocyte
RBC membrane is compose of
10% Carbohydrates
40%Lipids
50% proteins
Span the entire thickness of the cell, carry the RBC Ag and attach the skeletal lattice to the membrane
Integral
inner side of the membrane from a skeletal support6 of the membrane lipid bilayer
Peripheral
Alpha and beta spectrin, fibrous polypeptide that forms loosely wound helix
Spectrin
Fixes the spectrin meshwork to the membrane, connects to band 3
Ankyrin
stabilizes the connection of ankyrin and anion exchanger protein
band 4.2
links transmembrane protein to glycoprotein C
bands 4.1
maintains the negative charge of the cell
Glycophorin A