Hematology

Question 1

Normal values for CBC

Answer 1

RBC (erythrocytes): Normal Adult (female 4.2-5.4 male 4.7-6.1)

Hgb: Normal Adult (female 12-16 g/dL male 14-18 g/dL)

Hct: Normal Adults (female 37-47% & Male 42-52%)

Red blood cell indices: 
MCV: Normal adult 80-95fL
MCH: Normal adult 27-31pg
MCHC: Normal Adult 32-36 g/dL 
RDW: Normal Adult 11-14.5 %

WBC: Normal Adults 5000-10,000/mm3

Platelet (thrombocytes): Normal Adults 150,000-400,000/mm3

Question 2

Normal values for CBC with differential

Answer 2

WBC (leukocytes): 5,000–10,000/µL
Absolute neutrophil count: >1,800/µL

Segments: 38%–71% of total WBC

Bands: 0%–10% of total

Monocytes: 2%–15% of total

Basophils: 0%–1% of total

Eosinophils: 0%–5% of total

Lymphocytes: 20%–40% of total

Question 3

Reticuloendothelial System (RES)

Answer 3

Sx of phagocytic cells, including monocytes and macrophages. Has 2 systems. Also called MPS

Primary lymphoid sx = sites of RES cell production = thymus and bone marrow

Secondary lymphoid sx = sites of RES function = liver, spleen, lymph nodes = functions are to recognize foreign cells and trigger an immune response

Question 4

Classifications for Anemias

Answer 4

• Morphology = size, shape and color
  (normocytic, microcytic, macrocytic)
  (normochromic, hypochromic, hyperchromic)
• Physiologic = hypoproliferation, hemolytic, blood loss
  - Hypo (pernicious/megaloblastic, folate deficiency, iron deficiency, decreased erythropoietin production, anemia of chronic diseases, aplastic anemia)
  - Blood loss (bleeding)
  - Hemolytic (autoimmune hemolytic, acquired, thalassemia, group of inherited forms)

Question 5

Polycythemia

Answer 5

• Polycythemia Vera (myeloid cells have escaped normal control mechanisms, so bone marrow is hyper cellular and erythrocytes, leukocyte and platelet counts in the peripheral blood are elevated)
• Secondary Polycythemia (excessive production of erythropoietin….this may occur in response to a reduced amount of O2)

Question 6

Leukemias

Answer 6

• Acute Myeloid Leukemia (defect in the hematopoietic stem cell that differentiates into ALL myeloid cells: monocytes, granulocytes, erythrocytes and platelets); most common nonlymphocytic leukemia
• Chronic Myeloid Leukemia (arises from mutation in the myeloid STEM cell. Normal myeloid cells still produced but there’s a pathologic increase in production of BLAST cells…so there’s lots of cells, and lots of different cells, in the blood and this causes the marrow to expand and the liver and spleen to produce more cells which enlarges those two organs as well)
• Acute Lymphocytic Leukemia (will discuss in Peds)
• Chronic Lymphocytic Leukemia (caused by malignant cone of B lymphocytes; it appears that these cells can escape apoptosis, resulting in an excessive accumulation of the cells in the marrow and circulation.)

Question 7

Lymphomas

Answer 7

• Hodgkin’s (the malignant extension of the Reed-Sternberg cell throughout the lymph system; the RS cell is suspected to be of immature lymphoid origin; viral etiology is suspected)
• Non-Hodgkin’s (neoplastic growth of lymphoid tissue; thought to arise from a single clone of lymphocytes…most NHL’s involve B lymphocytes; NHL can spread to lymph nodes and to extra nodal tissue outside the lymphoid sx)

Question 8

Multiple Myeloma

Answer 8

Malignant disease of the most mature form of B lymphocyte, the plasma cell.

Plasma cells secrete immunoglobulins, proteins necessary for antibody production to fight infection.

Most commonly affects people over 70 years of age. Chief complaints of back pain and elevated total protein levels in elderly patients should be evaluated for myeloma!!!

Question 9

Bleeding Disorders

Answer 9

• Thrombocythemia (is a stem cell disorder within the bone marrow; is an INCREASE in platelet counts consistently >600,000/mm3….these cells can be abnormal size but usually have same shelf-life; Primary and Secondary types)
• Thrombocytopenia (low platelet levels; arises from a variety of factors)
• Immune Thrombocytopenic Purpura (platelet count is decreased by a combo of autoantibody mediated platelet destruction and impaired platelet production secondary to autoantibody effects on the megakaryocyte and there is also decreased rise in serum thrombopoietin, a hormone that stimulates platelet production)
• Acquired Coagulation Disorders (are a result of abnormal bleeding; and include:
  
  • Vit K deficiency
  • Liver disease
  • DIC