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MTAP 2 MIDTERMS > HEMATOLOGY > Flashcards

HEMATOLOGY Flashcards

1
Q

Blood cell production, maturation, and death occur in organs of the

A

reticuloendothelial system (RES)

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2
Q

reticuloendo-thelial system (RES) includes:

A

bone marrow, spleen, liver, thymus, lymph nodes

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3
Q

Mesoblastic (yolk sac) phase begins at

A

19 days gestation

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4
Q

First cell to be produced

A

Primitive nucleated erythroblast

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5
Q

Embryonic hemoglobins includes:

A

Portland
Gower I
Gower II

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6
Q

Begins at 6 weeks gestation with production of mainly red blood cells, but also granulocytes, monocytes, and megakaryocytes.

A

Hepatic (Liver) Phase

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7
Q

Begins around the fifth month of gestation, with the bone marrow producing mainly granulocytes

A

Myeloid/Medullary phase

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8
Q

A normal ratio of M:E (myeloid:erythroid)

A

3:1or 4:1

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9
Q

Alpha- and gamma-globin chain production predominates at birth, forming

A

Hgb F

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10
Q

Myeloid/Medullary Phase hemoglobin present:

A

Hgb F
Hgb A(1)
Hgb A.2

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11
Q

In newborn, —- of bone marrow is active red marrow

A

80-90%

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12
Q

Young adult (age 20): — of bone marrow is active

A

60%

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13
Q

In young adult, hematopoiesis is confined to the proximal ends of large flat bone namely:

A

bones
pelvis
sternum

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14
Q

Older adult (age 55): percentage of active bone marrow

A

40%

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15
Q

Normocellular— Marrow percentage of hematopoietic cells

A

30-70%

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16
Q

Marrow has >70% hematopoietic cells.

A

Hypercellular/hyperplastic

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17
Q

Marrow has <30% hematopoietic cells

A

Hypocellular/hypoplastic

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18
Q

Marrow has few or no hematopoietic cells.

A

Aplastic

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19
Q

Differentiate into either B or T lymphocytes in response to cytokines/lymphokines/interleukins/ CSFs/growth factors

A

Lymphoid

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20
Q

Gives rise to the multipotential progenitor CFU-GEMM

A

Myeloid

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21
Q

Committed Progenitor Cell: CFU MEG

Growth Factors/ Interleukins: Thrombopoietin, GM-CSF

Mature cells:

A

Thrombocytes

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22
Q

Committed Progenitor Cell: CFU GM, CFU M

Growth Factors/ Interleukins: GM CSF, M-CSF, IL3

Mature cells:

A

Monocytes

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23
Q

Committed Progenitor Cell: CFU GM, CFU G

Growth Factors/ Interleukins: GM CSF, G CSF, IL3

Mature cells:

A

neutrophils

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24
Q

Committed Progenitor Cell: BFU E, CFU E

Growth Factors/ Interleukins: Erythropoietin, GM-CSF, IL-3

Mature cells:

A

Erythrocytes

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25
Q

Committed Progenitor Cell: CFU-Eo

Growth Factors/ Interleukins: GM CSF, IL-3, IL-5

Mature cells:

A

Eosinophils

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26
Q

Committed Progenitor Cell: CFU-Ba

Growth Factors/ Interleukins: IL3, IL4

Mature cells:

A

BASOPHILS

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27
Q

Primary lymphoid tissue

A

Bone Marrow
Thymus

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28
Q

Secondary lymphoid tissue

A

lymph nodes
spleen
gut-associated tissue (Peyer’s patches)

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29
Q

WBC reference range (SI units)

A

4.0-11.0 x 10^9/L

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30
Q

include neutrophils, eosinophils, and basophils

A

granulocytes

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31
Q

the first to reach the tissues and phagocytize (destroy) bacteria

A

neutrophils

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32
Q

lymphocyte that provide cellular immunity

A

T lymphocytes

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33
Q

develop into plasma cells in the tissue and produce antibodies needed for humoral immunity

A

B lymphocytes

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34
Q

destroy tumor cells and cells infected with viruses

A

NK lymphocytes

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35
Q

modulate the allergic response caused by basophil degranulation

A

Eosinophil

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36
Q

mediate immediate hypersensitivity reactions (type I, anaphylactic)

A

Basophils

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37
Q

Blood cell production within the bone marrow

A

Medullary hematopoiesis

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38
Q

Blood cell production outside the bone marrow

A

Extramedullary hematopoiesis

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39
Q

Erythropoietin is produced mainly by the

A

kidneys

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40
Q

Earliest RBC, size up to 20 |xm, with an N:C ratio of 8:1

1-3 nucleoli, nucleus has dark areas of DNA

Chromatin is fine and uniform, and stains intensely

Deep blue cytoplasm with no granules

A

Pronormoblast (rubriblast)

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41
Q

Size up to 16 jjim with an N:C ratio of 6:1
Centrally located nucleus with 0-1 nucleoli
Chromatin is coarsening.
Cytoplasm is less blue but intensely basophilic (RNA).

A

Basophilic normoblast (prorubricyte)

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42
Q

Size up to 12 (Jim with an N:C ratio of 4:1

Eccentric nucleus with no nucleoli

Chromatin shows significant clumping.

Begins to produce hemoglobin, resulting in gray-blue cytoplasm

A

Polychromatophilic normoblast (rubricyte)

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43
Q

Size up to 10 fxm with an N:C ratio of 0.5:1

Eccentric nucleus with small, fully condensed (pyknotic) nucleus; no nucleoli

Pale blue to salmon cytoplasm

Hemoglobin synthesis decreases

A

Orthochromic normoblast (metarubricyte)

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44
Q

Size up to 10 um

contains no nucleus but has mitochondria and ribosomes

Last stage to synthesize hemoglobin

Last stage in bone marrow before release to the blood

A

Reticulocyte

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45
Q

Reticulocyte reference ranges are —— for adults

A

0.5-1.5%

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46
Q

Size range is 6-8 (Jim.
Round, biconcave discocyte

Salmon with central pallor (clearing in the center)

A

Mature erythrocyte

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47
Q

Erythrocytes reference range for female:

A

4.0-5.4 X 10^12/L

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48
Q

Erythrocytes reference range for male:

A

4.6-6.0 X 10^12/L

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49
Q

Usually orthochromic normoblasts (metarubricyte) but can appear in any erythrocytic stage of maturation

Associated with thalassemia major, sickle cell anemia, and other hemolytic anemias, erythroleukemia, and myeloproliferative disorders

A

Nucleated RBCs (nRBCs, nucRBCs)

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50
Q

Small, round DNA fragments (0.5-1.0 µm in diameter) usually one per cell, but can be multiple

d.Seen in sickle cell anemia, beta-thalassemia major, and other severe hemolytic anemias, megaloblastic anemia, alcoholism, post-splenectomy

A

Howell-Jolly bodies

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51
Q

Multiple, tiny, fine, or coarse inclusions (ribosomal RNA remnants) evenly dispersed throughout the cell; “blueberry bagel” appearance

Seen in thalassemias, megaloblastic anemias, sideroblastic anemia, lead poisoning, and alcoholism

A

Basophilic stippling

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52
Q

Small, irregular, dark-staining iron granules usually clumped together at periphery of the cell

Seen in sideroblastic anemia, hemoglobinopathies, thalassemia, megaloblastic anemia, myelodysplastic syndrome (RARS)

A

Pappenheimer bodies

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53
Q

Thin, red-violet, single to multiple ringlike structures that may appear in loop or figure-eight shapes

Seen in megaloblastic anemia, myelodysplastic syndromes, lead poisoning

A

Cabot rings

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54
Q

Condensed, intracellular, rod-shaped crystal

Seen in hemoglobin C or SC disease, but not in trait

A

Hemoglobin C crystals

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55
Q

1-2 blunt, fingerlike projections extending from the cell membrane

Seen in hemoglobin SC disease

Washington monument

A

Hemoglobin SC crystals

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56
Q

Multiple inclusions ranging in size from 0.3 to 2.0 µm

Invisible with Wright’s stain; must use a supravital stain to visualize

Seen in G6PD deficiency, beta-thalassemia major, Hgb H disease, unstable hemoglobinopathies, drug-induced anemias

A

Heinz bodies

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57
Q

Most common in the US; prevalent in infants, children, pregnancy, elderly with poor diets, and chronic blood loss

A

Iron deficiency anemia

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58
Q

Laboratory: Microcytic/hypochromic anemia

low serum iron, ferritin, hemoglobin/hematocrit, and reticulocyte count

high RDW and TIBC

smear shows ovalocytes/pencil forms

A

Iron Deficiency Anemia

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59
Q

Clinical symptoms: Fatigue, dizziness, pica, stomatitis, glossitis, koilonychia

A

Iron Deficiency Anemia

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60
Q

Anemia due to inability to use available iron for hemoglobin production

A

Anemia of Chronic Disease

61
Q

Impaired release of storage iron associated with increased hepcidin levels

A

Anemia of Chronic Disease

62
Q

Laboratory:

Normocytic/normochromic or slightly microcytic/hypochromic anemia

increased ESR
normal to increased ferritin
low serum iron and TIBC

A

Anemia of Chronic disease

63
Q

Associated with persistent infections, chronic inflammatory disorders

A

Anemia of Chronic disease

64
Q

Caused by blocks in protoporphyrin pathway resulting in defective hemoglobin synthesis and iron overload

A

Sideroblastic anemia

65
Q

Excess iron accumulates in mitochondrial region of immature erythrocyte in bone marrow

Excess iron accumulates in mature erythrocyte in circulation

Pappenheimer bodies

A

Sideroblastic anemia

66
Q

Laboratory:

Microcytic/hypochromic anemia
increased ferritin and serum iron

decreased TIBC

A

Sideroblastic anemia

67
Q

Multiple blocks in protoporphyrin pathway affect heme synthesis

Seen mostly in children exposed to lead-based pain

Symptoms: Abdominal pain, muscle weakness, gum lead line

A

Lead poisoning

68
Q

Laboratory finding:

Normocytic/normochromic anemia with characteristic coarse basophilic stippling

A

Lead poisoning

69
Q

Group of inherited disorders with block in protoporphyrin pathway

Photosensitivity, abdominal pain, CNS disorders

A

Porphyrias

70
Q

Defective DNA synthesis causing abnormal nuclear maturation

A

Megaloblastic anemias

71
Q

Caused by vitamin B12 or folic acid deficiency

A

Megaloblastic anemia

72
Q

Laboratory: Pancytopenia, macrocytic/normochromic anemia with various inclusions

A

Megaloblastic anemia

73
Q

Anemia related to bone marrow failure causing pancytopenia

A

Aplastic anemia

74
Q

Laboratory:

Decreased hemoglobin/hematocrit reticulocytes;

normocytic/normochromic anemia

A

Aplastic anemia

75
Q

Hypoproliferative anemia caused by bone marrow replacement

A

Myelophthisic

76
Q

Laboratory:

Normocytic/normochromic anemia; leukoerythroblastic blood picture

A

Myelophthisic anemia

77
Q

Sudden loss of blood due to trauma or severe injury

A

Acute blood loss anemia

78
Q

Symptoms:

Hypovolemia, rapid pulse, low blood pressure, pallor

A

Blood loss anemia

79
Q

Initially normal reticulocyte count, hemoglobin/hematocrit; later drop in hemoglobin/hematocrit and RBC; reticulocytosis in 3-5 days

A

Acute blood less anemia

80
Q

Gradual, long-term loss of blood, often from gastrointestinal bleeding

A

Chronic blood loss anemia

81
Q

Initially normocytic/normochromic anemia; over time causes decrease in hemoglobin/hematocrit; gradual loss of iron causes microcytic/hypochromic anemia

A

Chronic blood loss

82
Q

Most common membrane defect; autosomal dominant; characterized by splenomegaly, variable degree of anemia, spherocytes on peripheral blood smear

A

Hereditary Spherocytosis

83
Q

Laboratory:

increased osmotic fragility

increased serum bilirubin

A

Hereditary spherocytosis

84
Q

Autosomal dominant; most persons asymptomatic; >25% ovalocytes on peripheral blood smear

A

Hereditary elliptocytosis

85
Q

Membrane defect caused by polarization of cholesterol

A

Hereditary elliptocytosis (ovalocytosis)

86
Q

Autosomal dominant; variable degree of anemia; up to 50% stomatocytes on blood smear

A

Hereditary stomatocytosis

87
Q

Membrane defect due to abnormal permeability to sodium and potassium

A

Hereditary stomatocytosis

88
Q

Autosomal recessive; mild anemia associated with steatorrhea, neurological and retinal abnormalities; 50-100% acanthocytes

A

Hereditary acanthocytosis (abetalipoproteinemia)

89
Q

Increased cholesterol:lecithin ratio in membrane

A

Hereditary acanthocytosis

90
Q

Sex-linked enzyme defect; common deficiency in hexose monophosphate shunt

A

G6PD deficiency

91
Q

Autosomal recessive; common enzyme deficiency in Embden-Meyerhof pathway

A

Pyruvate kinase (PK) deficiency

92
Q

Lack of ATP causes impairment of cation pump and decreased erythrocyte deformability

A

Pyruvate kinase (PK) deficiency

93
Q

Acquired membrane defect with increased sensitivity for complement binding

A

Paroxysmal nocturnal hemoglobinuria (PNH)

94
Q

Characterized by: Pancytopenia, chronic intravascular hemolysis, hemoglobinuria, hemosiderinuria, low leukocyte alkaline phosphatase (LAP) score

A

Paroxysmal nocturnal hemoglobinuria (PNH)

95
Q

All cause normocytic/normochromic anemia due to defects extrinsic to the RBC, acquired disorders causing accelerated destruction with reticulocytosis

A

Hemolytic anemias due to extrinsic/immune defects

96
Q

RBCs coated with IgG and/or complement, leading to membrane loss and spherocytes

A

Warm autoimmune hemolytic anemia (WAIHA)

97
Q

60% idiopathic; others secondary to diseases altering immune response.

A

Warm autoimmune hemolytic anemia (WAIHA)

98
Q

Laboratory: Spherocytes, increased osmotic fragility, bilirubin, reticulocyte count; positive direct antiglobulin test (DAT)

A

Warm autoimmune hemolytic anemia (WAIHA)

99
Q

RBCs coated with IgM and complement at temperatures below 37°C

A

Cold autoimmune hemolytic anemia (CAIHA)

100
Q

Can be idiopathic or secondary to infections

A

Cold autoimmune hemolytic anemia (CAIHA)

101
Q

Laboratory: Seasonal symptoms, RBC clumping, increased MCHC, bilirubin, reticulocyte count; positive DAT

A

Cold autoimmune hemolytic anemia (CAIHA)

102
Q

IgG biphasic Donath-Landsteiner antibody fixes complement to RBCs in cold, leading to lysis when warmed

A

Paroxysmal cold hemoglobinuria (PCH)

103
Q

Can be idiopathic or secondary to viral infections

A

Paroxysmal cold hemoglobinuria (PCH)

104
Q

Laboratory: Variable anemia, increased bilirubin and plasma hemoglobin, decreased haptoglobin; positive DAT, Donath-Landsteiner test

A

Paroxysmal cold hemoglobinuria (PCH)

105
Q

Recipient antibodies to donor RBC antigens result in destruction

A

Hemolytic transfusion reaction

106
Q

ABO incompatibility causes immediate reaction with intravascular hemolysis.

A

Hemolytic transfusion reaction

107
Q

Laboratory: Positive DAT, increased plasma hemoglobin.

A

Hemolytic transfusion reaction

108
Q

Rh or ABO incompatibility causing severe anemia, positive DAT, high bilirubin.

A

Hemolytic disease of the newborn (HDN)

109
Q

Rh incompatibility treated with Rh immunoglobulin; ABO incompatibility leads to mild anemia, weakly positive DAT

A

Hemolytic disease of the newborn (HDN)

110
Q

Skin puncture collection site for under 1 year of age

A

lateral or medial plantar surface of the heel

111
Q

Collection site for skin puncture of children older than 1 year of age and in adults

A

Palmar surface of the distal portion of the third or fourth finger

112
Q

Capillary blood contains more glucose than venous blood

amount:

A

10-20 mg/dL

113
Q

Capillary blood contains more leukocytes than venous blood

Amount

A

up to 1000/uL

114
Q

Capillary blood has lower RBC count and hemoglobin value than venous blood

amount

A

5%

115
Q

Hematopoietically inactive bones .

Made up of adipocytes

The remaining 50% of the space occupied

A

Yellow Marrow

116
Q

Largest structure of the lymphoid system

Reticuloendothelial organ

A

Spleen

117
Q

Graveyard of old cells

A

Spleen

118
Q

Reference range for MCV

A

80-100 fL

119
Q

Increased in megaloblastic anemia, hemolytic anemia with reticulocytosis, liver disease, and normal newborn.

A

MCV

120
Q

Decreased in iron deficiency anemia, thalassemia, sideroblastic anemia, and lead poisoning

A

MCV

121
Q

Reference range for MCG

A

26-34 picograms

122
Q

indicator of the average weight of hemoglobin in individual RBCs.

A

MCH

123
Q

Increased in macrocytic anemia

A

MCH

124
Q

Indicator of the average/mean volume of erythrocytes (RBCs).

A

MCV

125
Q

Decreased in microcytic, hypochromic anemia

A

MCH

126
Q

Reference range for MCHC

A

32-37 g/dL

127
Q

Measure of the average concentration of hemoglobin in grams per deciliter

A

MCHC

128
Q

Normochromic RBCs

A

32-37 g/dL MCHC

129
Q

Hypochromic RBCs:

A

Lesser than (<) 32 g/dL

130
Q

RBC indices seen in iron deficiency and thalassemia.

A

Hypochromic RBCs

131
Q

Reference range for RDW

A

11.5-14.5%

132
Q

Increased proportional to the degree of anisocytosis (variation in size); coefficient of variation of the mean corpuscular volume

A

RDW

133
Q

Seen post-transfusion, post-treatment (e.g., iron, B12, or folic acid therapy), idiopathic sideroblastic anemia, in the presence of two concurrent deficiencies (iron and folic acid deficiencies)

A

High RDW

134
Q

Reference range for platelets

A

150-450 X 10^9/L (conventional units 150,000-450,000/^L)

135
Q

Most commonly used routine peripheral blood smear stain

A

Wright’s stain

136
Q

basic dye, which stains acidic cellular components (DNA and RNA) blue

A

Methylene blue

137
Q

an acidic dye, which stains basic components- red-orange

A

Eosin

138
Q

used in the staining process to fix the cells to the slide

A

Methanol fixative

139
Q

phosphate buffer pH range

A

pH 6.4- 6.8

140
Q

Contains potassium ferrocyanide, HCl, and a safranin counterstain

A

Prussian blue stain

141
Q

Used to visualize iron granules in RBCs (siderotic iron granules), histiocytes, and urine epithelial cells

A

Prussian blue stain

142
Q

Used to stain specific cellular components

A

Supravital monochrome stain

143
Q

used to precipitate RNA in reticulocytes; measure of bone marrow erythropoiesis

A

New methylene blue

144
Q

a counterstain is used to visualize Heinz bodies; clinical disorders associated with Heinz bodies include G6PD deficiency and other unstable hemoglobin disorders

A

Neutral red with brilliant cresyl green

145
Q

Earliest RBC, size up to 20 um, with an N:C ratio of 8:1

A

Pronormoblast (nutriblast)

146
Q

Chromatin is coarsening.in RBC maturation

A

Basophilic normoblast (prorubricyte)

147
Q

RBC maturation stage:

Begins to produce hemoglobin, resulting in gray-blue cytoplasm

A

Polychromatophilic

148
Q

Eccentric nucleus with small, fully condensed (pyknotic) nucleus; no nucleoli

Pale blue to salmon cytoplasm

A

Orthochromic normoblast (metarubricyte)

149
Q

RBC maturation stage:

contains no nucleus but has mitochondria and ribosomes

A

Reticulocyte

MTAP 2 MIDTERMS (4 decks)

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