Hematology Flashcards
1
Q
HEMATOLOGY
A
The clinical and laboratory discipline that pertains to the anatomy, physiology, pathology, symptomatology, and therapeutics related to the blood and blood-forming tissues.
2
Q
Peripheral blood accessible via
A
venipuncture and fingerstick
3
Q
Bone marrow accessible only through a?
A
bone marrow aspiration
4
Q
Bone marrow is often referred to as:
A
Myeloid, Myelogenous, or Intramedullary tissue
5
Q
COMPLETE BLOOD COUNT most common hematologic test t/f?
A
True
6
Q
HEMATOPOIESIS
A
The formation and development of all types of blood cells from their parental precursors
7
Q
Embryo Site of hematopoiesis
A
yolk sac then liver
8
Q
3rd to 7th month Site of hematopoiesis
A
spleen
9
Q
4th and 5th months Site of hematopoiesis
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marrow cavity - esp. granulocytes and platelets
10
Q
7th month Site of hematopoiesis
A
marrow cavity - erythrocytes
11
Q
Birth to maturity Birth Site of hematopoiesis
A
mostly bone marrow; spleen and liver when needed
12
Q
Birth to maturity Site of hematopoiesis
A
number of active sites in bone marrow decreases but retain ability for hematopoiesis
13
Q
Adult Site of hematopoiesis
A
bone marrow of skull, ribs, sternum, vertebral column, pelvis, proximal ends of femurs
14
Q
Red cells require how many days for bone marrow development?
A
5-6 days
15
Q
The nucleus disappears after 2 to 3 days creating
A
marrow reticulocytes
16
Q
blood reticulocytes
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Maturing red cells enter the circulating blood very promptly, even before the last maturational events have occurred.
17
Q
Red cells remain in the circulation for about?
A
120 days before senescence and destruction.
18
Q
Reticulocyte
A
The last immature stage of RBC maturation that occurs after the nucleus is extruded in the bone marrow.
4. A reticulofilamentous material appears when a reticulocytes is stained with a supravital stain
19
Q
Reticulocyte are Slightly larger than mature erythrocyte because?
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the cell is still maturing
20
Q
Reticulocyte Contains residual fragments of cytoplasmic RNA and fragments of mitochondria which give the cell an…
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polychromatic (polychromatophilic, polychromasia) appearance when stained with Wright stain
21
Q
A reticulofilamentous material appears when a reticulocytes is…
A
a reticulocytes is stained with a supravital stain
22
Q
Reticulocytes finish maturing within 1 to 2 days after?
A
entering the peripheral circulation
23
Q
Reticulocyte are what % of circulating red cells
A
0.5 to 2.5%
24
Q
Reticulocyte counts are commonly used in the differential diagnosis of various types
A
of anemia and in monitoring the recovery in factor deficiency anemias.
25
Erythropoietin are Produced by
kidney peritubular interstitial cells and can be assayed
26
Erythropoietin Effective functions
a. Increases the number of stem cells that commit to rubriblasts
b. Speeds maturation time by perhaps 20 to 30%
c. Early release of immature cells into peripheral circulation
27
Hemoglobin is synthesized within the maturing nucleated red cell within?
the bone marrow via a series of biochemical enzymatically driven reactions intimately involving the mitochondria
28
Heme is produced when iron is?
enzymatically inserted into protoporphyrin
29
Polyribosomes produce globin
(polypeptide) chains in pairs
30
Each globin chain provides a site
for insertion of one heme molecule
31
Four globin chains (2 pairs) + four heme molecules constitutes
hemoglobin
32
Various combinations of pairings of globin chains produce different types of hemoglobin based upon?
their speed in an electophoretic separation
33
Types of hemoglobin can be identified and quantified by a test called
Hemoglobin Electrophoresis
34
t/f? Iron is essential for erythropoiesis
true
35
Approximately 10% of ingested iron is absorbed via?
the proximal small intestine; remainder excreted in the feces
36
Small amounts of absorbed iron is excreted into the?
urine
37
Once absorbed into the plasma, iron is complexed with transferrin and is transported to the bone marrow for?
hemoglobin synthesis, and other tissues for the production of myoglobin, enzymes, coenzymes.
38
t/f ron is stored as both hemosiderin and ferritin?
true
39
There are FOUR tests that reflect the status of iron metabolism:
a. Serum iron concentration (SI)
b. Total iron binding capacity (TIBC)
c. % saturation of transferrin (% sat or TSAT)
d. Serum ferritin concentration
40
Serum Iron Concentration (SI)
SI is the concentration of circulating iron that is bound to transferrin. SI alone is not a good indicator of iron metabolism status as there are physiological (non-pathological) causes of altered concentrations.
41
Total Iron Binding Capacity (TIBC)
The TIBC is an indirect assay of transferrin concentration performed by measuring the amount of iron (added in vitro) needed to totally saturate the unbound iron-binding sites on the transferrin molecules. Normally, approximately one-third of the binding sites of transferrin are bound with iron.
42
Transferrin Saturation (% saturation, Tsat)
This is a calculated value estimating the percentage of binding sites on transferrin that are bound with iron.
43
Serum Ferritin
Ferritin is the body’s major iron storage compound. It is found in nearly all cells of the body. The major sites of storage, which are directly available for erythropoiesis, are the hepatocytes, spleen, and bone marrow.
44
GRANULOPOIESIS
Maturation of the leukocytes that contain granules (neutrophils, eosinophils, basophils)
45
BAND NEUTROPHILS
An immature form of neutrophil which is observed both within and outside of the bone marrow
46
SHIFT TO THE LEFT
Any increase in the numbers of immature neutrophils observed in the peripheral circulation. Often indicative of acute infection or other causes of neutrophilia.
47
LYMPHOPOIESIS
Growth and maturation of lymphocytes
48
Lymphocytes mature within the bone marrow and is mediated
by a poorly understood control mechanism
49
Lymphocytes enter the circulation and then repopulate?
lymph nodes and lymphatic tissues
50
Lymphocytes are “conditioned” by either :
the thymus (T-lymphocytes; cellular immunity) or the bone marrow (B-lymphocytes; humoral immunity) which further differentiate into plasma cells
51
ATYPICAL LYMPHOCYTES
Morphologically abnormal appearing (T) lymphocytes usually observed in the peripheral blood of an immunologically stimulated patient, most often viral infections.
52
MEGAKARYOPOIESIS
Production of thrombocytes (platelets)
53
EVALUATION OF HEMATOPOIESIS
1. Complete Blood Count
2. Reticulocyte Count
3. Bone Marrow Aspiration and Biopsy
54
COMPLETE BLOOD COUNT Specimen collection considerations:
1. Routine venipuncture most common method of collecting whole blood for CBC; EDTA anticoagulated whole blood specimen
2. Micro-method via a fingerstick is available
3. No special time of collection
4. No fasting or other specific patient preparation is necessary
5. Patient may be sitting or supine
6. Must be sure that the patient is being regularly adjusted
55
What is the name of WBC when they are elevated and decreased?
Elevated; neutrophilia, lymphocytosis, moncytosis, eosinophilia, basophilia. Decreased; neutropenia, lymphocytopenia, moncytopenia, eosinopenia, basopenia.
56
What can cause neutophilia?
physical or emotional stress, acute suppurative infeciton, myelocytic leukemia, inflammatory disorders.
57
What can cause lymphocytosis?
Chronic bacterial infections, viral infections, lymphocytic leukemias
58
What can cause moncytosis?
Chronic inflammatory disorders, tuberculosis.
59
What can cause eosinophilia?
Parsitic infections, allergic reactions, hodgkin lymphoma.
60
What can cause basophilia?
Myeloproliferative diseases.
61
What can cause neutropenia?
dietary deficiencies (B12 and folate), some overwhelming bacterial infections, viral infections, radiation and chemotherapy
62
What can casue lymphocytopenia?
Immunodeficiency diseases, radiation therapy.
63
How common are moncytopenia, basopenia and eosinopenia?
Very uncommon.
64
Is platelet count part of the CBC?
Yes
65
Are there any special times of collection or patient preparation needed for a CBC?
no
66
What is a RBC count?
Absolute quantification of RBCs in a unit volume of blood.
67
What are the units for conventional and international for a red blood count?
Conventional- mm^3. International- L
68
How often is a Red blood cell count used alone?
Not often not even to determine if a blood transfusion is needed
69
What is the most widely used single test used to evaluate a patient for anemia?
Hemoglobin concentration.
70
What is a hemoglobin concentration test testing?
Direct measurment of the weight of hemoglobin in a unit volume of blood
71
What are the conventional and international units used for hemoglobin concentration tests?
Conventional- gm/dL. International- gm/L
72
What is the hematocrit test testing?
The ratio of the volume of the RBCs after centrifugation to that of whole blood.
73
Hematocrit is aka?
crit, and packed cell volume PCV.
74
What are the conventional and international units used for the hematocrit test?
Conv- %. Internat- L/L
75
How can the PCV aka hematocrit(HCT) aka crit approximate the hemoglobin (HGB)?
Divide the HCT by 3.
76
What are the RBC, HGB, HCT tests used to determine?
Anemia, erythrocytosis, and polycythemia.
77
What are the 3 types of polycythemia and what are they?
Polycythemia vera- myeloproliferative disorder. Secondary polycythemia- hypoxia= not getting enough oxygen. Relative polycythemia- dehydration
78
Name the RBC indicies?
mean corpuscular volume MCV, Mean corpuscluar hemoglobin MCH, Mean corpuscular hemoglobin concentration MCHC.
79
What is MCV?
Measure of the intracellular volume of the average circulating RBC. So this is the size of the average circulating RBC.
80
What are the units used for MCV?
fenta Liter.
81
Name 3 types of anemias?
microcytic, macrocytic, normocytic.
82
What will the MCV test be like for the 3 types of anemia?
Microcytic- decreased MCV. Macrocytic- Increased MCV. Normocytic- normal MCV.
83
What is the MCH used for?
Measure of the weight of hemoglobin within the average circulating RBC. It will relate to the intensity of the coloration of the RBCs when stained.
84
What are the types of MCH?
Hypochromic, normochromic, hyperchromic
85
Of the 3 types of MCH which one is very uncommon?
Hyperchromic.
86
What is the MCHC?
% of the intracellular volume of the average circulating RBC that is hemoglobin. This is essentially the same info as the MCH.
87
What are the clinical applications of RBC indicies?
To determine what type of anemia is present.
88
What type of anemia is present with decreased RBC, HGB, HCT and decreased MCV, MCH, MCHC?
microcytic and hypochromic anemia (iron deficiency).
89
What would the blood tests be like for macrocytic anemia and how is this caused?
decreased RBC, HGB, HCT and increased MCV, normal MCH and normal MCHC. This is caused by B12 and folate deficiencies.
90
What would the blood tests be like for normocytic anemia and how is this caused?
Decreased RBC, HGB, HCT and normal RBC indicies and this is caused by chronic illness.
91
What is the Red cell distribution width RDW test?
index of RBC size difference or the variability in RBC size populations.
92
what type of variation in RBC is normal?
Minimal.
93
Increased RDW correlates with what?
increased anisocytosis- variability in cell size populations done by a person looking through a microscope.
94
When will a decreased RDW be given?
It wont, only increased variation
95
What tests will be used to define the presence or absence of anemia?
RBC count, Hemoglobin concentration HGB, hematocrit HCT.
96
What tests wil help to initially categorize the type of anemia?
MCV, MCH, MCHC aka the RBC indicies.
97
What is the RDW test used for clinically?
as an early sign of developing anemia.
98
What type of stain is used to look at a blood smear?
Wright.
99
Can machines report morphological variations in RBC?
Yes with limited capability.
100
What is polychromatophilia, poikilocytosis?
Polychromatophilia a RBC that is a little bluer. Poikilocytosis is abnormal shapes of RBC
101
How will the lab report poikilocytosis?
They shape should be given like teardrop, sickle, etc.
102
When doing a vena puncture what vein should you never try to shift the needle to the side if you did not draw blood?
Bascilic vein.
103
What are the different ways the lab will report microcytes?
Few microcytes, slight microcytes, and a scale of 1-4+ microcytes.
104
What should you do if you are drawing blood and you notice a mound is starting to build under the skin?
Finish the blood draw and then add lots of pressure after to avoid brusing.
105
What is anioscytosis?
Variable size of RBC.
106
What test will be increased with anisocytosis?
RDW.
107
What test will be increased with macrocytosis?
MCV.
108
What test will be decreased with microcytosis?
MCV.
109
What test will be decreased with hypochromia?
MCH and or MCHC.
110
What is a WBC count?
The absolute quantification of the total number of circulating WBC.
111
What are the conventional and international units for the WBC count?
Convent- mm^3. Intern- L.
112
What info is important about WBC's?
The proportion of each, not the total leukocyte count.
113
What are the 2 types of WBC differential counts and how are they done?
Relative- performed by microscopic evaluation, and counting 100 WBC. Absolute- more accurate and is done by modern hematology instuments.
114
How can absolute differential be calculated if only relative WBC differential count is given?
Relative % X total WBC = absolute count.
115
What would the diagnosis be given; WBC- 3.5 x10^3/ mm^3 (reference 4-11 x 10^3/ mm^3), neutrophils- 30% (reference 50-70% or 4.7x10^3), lymphocytes 70% (reference 20-40% 2.4x10^3).
Neutropenia.
116
What will the RBC morphology tests help to determine?
Correlates with changes in indices and RDW, may provide specific evidence of certain hematologic abnormalities.
117
WBC Count is used to determine what?
Leukopenia or leukocytosis.
118
What is the WBC differential count used for?
Provides more specific info about underlying pathology causing altered WBC count.
119
What type of test is a platelet count?
Absolute quantification of the number of circulating thrombocytes and this test is considered a hemostatic test.
120
What is the correlation of platlet function and platelet count?
There is none.
121
What are the conventional units and international units for the platelet count?
Convet- mm^3. Inter- L
122
Spontaneous bleeding can occur at what platelet count
40-50 X 10^3/mm^3.
123
How serious is gaining platelets?
Not very the serious part is droping down.
124
What is the reference range for normal platelet count?
150-450.
125
What is the mean platelet volume (MPV)?
This calculates the internal volume of the average circulating platelet, therefore it is the size of the average platelet.
126
What may correlate with an abnormal MPV?
Autoimmune disorders and some hematologic malignancies.
127
Will the MPV be inculded in the CBC?
Maybe but many labs do not report the MPV.
128
Is a reticulocyte count part of a CBC, and what is a reiculocyte count used for?
No. This is used to determine if the bone marrow is responding to therapy in factor deficiency anemias such as iron, folate, and vitamin B12 deficiencies.
129
How is a reticulocyte count calculated?
Count 1000 RBC and determine the # of them that are reticulocytes. Take the total amount of reticulocytes and multiply this by 100 and then divide by 1000.
130
What is essential for redering a definitive diagnosis about reticulocyte count?
Aspiration and biopsy of marrow. This would be needed for lymphoproliferative disorders such as leukemia and others.
131
How is aspirated marrow studied?
Histologicaly and cytochemically by a MD clinical pathologist.
132
What happens to Hemoglobin when RBC undergo senescence?
Heme is converted to unconjugated-bilirubin in the blood, and globin will go to the AA pool to be recyled.
133
What happens to unconjugated-bilirubin?
It is transferred to the liver and then it is converted to conjugated-bilirubin.
134
What are the paths that conjugated-bilirubin can take?
Leave the liver as bile or become part of urine and be excreted (however there is only the smallest of amounts of conjugated-bilirubin in urine).
135
What happens to bile as it leaves the liver?
It is concentrated in the gallbladder and then gets
136
What are the options for urogilinogen?
It can be converted to stercobilin and be excreted in the feces. It can be recycled into the liver. It can be sent to the kidney and excreted in urine (urobilinogen is the major part of urine that comes from heme).
137
What part of the heme is converted into unconjugated-bilirubin?
The porphyrin component.
138
How is unconjugated-bilirubin transported to the liver?
By the protein albumin.
139
How will the RBC count be different for pediatrics?
It will be high 0-1 months after birth and then be low 2months-1year.
140
how will the Hematocrit be different for pediatrics?
High for the first 2 months and then low until 1 year old
141
How will the hemoglobin be different for pediatrics?
High for the first 2 months and then low until 1 year old.
142
How will the MCV be different for pediatrics?
High for the first 6 months and then low until 1 year
143
How will the white cell count be different for pediatrics?
High for the first 4 years.
144
How will the neutrophils be different for pediatrics?
High for the first 3 months and then normal.
145
How will the lymphocytes be different for pediatrics?
normal from 0-1 month and then high until 4 years.
