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Hematology Flashcards

1
Q

Basic Hematology is the

A

STUDY OF FORMED ELEMENTS OF BLOOD AND BLOOD FORMING TISSUES

- screen, diagnosis, monitor hematologic diseases to give overall health idea

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2
Q

What is the composition of blood?

A

6-8% of total body weight & equals approx. 5 liters

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3
Q

Serum vs. Plasma

A

Both fluid portions

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4
Q

Plasma

A

From ANTICOAGULATED BLOOD

  • HAS CLOTTING FACTORS
  • MAKES UP ABOUT 45-60% OF BLOOD’S VOLUME
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5
Q

Serum

A

FROM CLOTTED BLOOD

  • HAS NO CLOTTING FACTORS
  • (USED UP IN THE CLOTTING PROCESS)
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6
Q

Cellular elements

A

remainder of BV

  • Erythrocytes/RBCs 4/6 million
  • transport O2 & carbon dioxide

Leukocytes/WBCS

  • 4800-10,800 in blood, many more in tissues
  • IMMUNITY, defend against bacteria, viruses, all foreign materials (includes, allergens like pollen)
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7
Q

What are some specific tests?

A

CBC, ESR (erythrocyte sedimentation rate), glycosolated Hemo (HgB A1C), Hemoglobin Electophoresis, Tests of coagulation

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8
Q

Specimen Collection

A

Venipuncture using a 22 gauge needle or larger

Lavender usually anticoagulant hema tube.
Blood for a CBC should be fresh,
< 3 hours

In infants and pediatric patients, a CBC may be collected through a heelstick

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9
Q

CBC consists of

A 
White Blood Cells (WBC)
Red Blood Cells (RBC)
Hemoglobin (Hgb)
Hematocrit (HCT)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Mean Corpuscular Volume (MCV)
Red Cell Distribution Width (RDW)
Platelets (PLT)
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10
Q

WBC

A

White Blood Cells or Leukocytes are cells produced by the immune system and defend against infection/foreign materials.

Produced by the bone marrow.
There are 5 types of leukocytes - neutrophil, eosinophil, basophil, lymphocyte, monocyte.
Average cell life of 3-4 days.
Leukocytosis: elevation in leukocytes above the normal range. (mostly due to neutrophil increase)
Leukopenia: decrease in leukocytes from the normal range.

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11
Q

What are types of granulocytes?

A

Neutrophils->Acute bacterial, inflammation
Basophils->Rare allergic reactions
Eosinophils->Asthma/allergies/parasitic

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12
Q

Lymphocytes are for

A

Acute viral, certain bacterial

Lymphoma, leukemia

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13
Q

Monocytes are for

A

CHRONIC INFECTIONS

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14
Q

WBC & differential

A

LAVENDER TUBE
Normal Adult: 4.5-11.0 x10 3rd/mm3

Breaking It Down (Differential)
Manual Differential Count:
Smear is scanned under low power magnification, fair cell distribution is found, examined under oil immersion magnification
Automated count:
Use laser light beam, low and high angle light, and analysis of volume

Ranges are affected by age
Useful to diagnose infection, inflammatory disorders, malignancies, drug effects.

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15
Q

Neutrophils (PMN)

A

Predominant White Blood Cell (40-76% of cells in humans)

Defend against bacterial and fungal infection. They are the “first responders” to infection.
Active and dead neutrophils in large numbers form PUS.
Average life cycle of 5 days. Cells die after phagocytosing a few pathogens.
Neutrophils have a multilobed nucleus that may appear like multiple nuclei. The degree of nuclear lobulation indicates cell age.

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16
Q

Shift to the LEFT means

A

predominance of immature cells (one or two nuclear lobes) separated by a thick chromatin band.
Common reasons for a left shift include: bacterial infection, toxemia, hemorrhage, myeloproliferative disorders
ACUTE!.

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17
Q

Shift to the right means

A

predominance of cells with four nuclear lobes.
Common reasons for a right shift include: liver disease, megaloblasticanemia, iron deficiency anemia, glucocorticoid use, stress reaction.
CHRONIC

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18
Q

Eosinophils

A 
Bi-lobed Nucleus
Age Dependent = 0-450
Lifetime of 8-12 days
Elevated in parasitic infections and allergies PARASITIC INFECTIONS AND ALLERGIES (such as asthma, hay fever and hives).
Make up 1-3% of leukocytes.
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19
Q

Basophils

A

Commonly elevated in allergic and antigen responses.
Release the chemical HISTAMINE resulting in vasodilation.
Bi or Tri-lobed nucleus.
Lifetime of a few hours to a few days.
Make up <1% of leukocytes.
0-1%

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20
Q

Lymphocytes

A 
More common in the lymphatic system.
Have a deep staining nucleus.
Make up 24-44% of leukocytes.
There are three types of lymphocytes: 
-T cells
-B cells
-Natural Killer Cells
Lymphocyte subsets are useful in the diagnosis of HIV/AIDS and various types of leukemia/lymphoma.
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21
Q

B cells

A

make antibodies that bind to pathogens to enable their destruction.

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22
Q

T cells

A

CD4+ T cells

CD8+ cytotoxic cells

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23
Q

CD4+ T Cells

A

the helper cells. They bind antigens to the surface of cells, activating B cell antibodies to destroy the cell.
used in acute HIV infection to identify an individual’s immune response.

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24
Q

CD8+ Cytotoxic Cells

A

able to kill virus infected or tumor cells.

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25
Natural Killer Cells
kill cells in the body that display signs to kill them, such as cells infected with a virus or cancerous cells.
26
Monocytes
Monocytes circulate in the blood and then enter the tissue and terminally differentiate into tissue macrophages which are important antigen-presenting cells. Monocytes share the "vacuum cleaner" (phagocytosis) function of neutrophils, but are much longer lived as they have an additional role: they present pieces of pathogens to T cells so that the pathogens may be recognized again and killed, or so that an antibody response may be mounted. Monocytes eventually leave the bloodstream to become tissue macrophages, which remove dead cell debris as well as attacking microorganisms. Kidney shaped nucleus. Lifetime of hours to days. Make up 3-7% of leukocytes.
27
WBC morphologies
Auer Rods -> AML.. type of leukemia Dohle Inclusion Bodies->severe infection, burns, malignancy, pregnancy Hypersegmentation-> Megaloblastic Anemia Toxic Granulation-> severe illness (sepsis, burn, high fever)
28
RBC are the
Red blood cells are the most common blood cell in the human. Deliver oxygen in humans. Cells develop in the bone marrow and circulate through the circulatory system for 100-120 days. RBCs cytoplasm is rich in hemoglobin which binds oxygen and is responsible for blood's red color
29
High altitude training...
BLOOD DOPING.. Boosting the number of RBC in the bloodstream in order to enhance athletic performance. RBC carry O2 from lungs to muscles Higher concentration of RBC in the blood can improve an athlete’s aerobic capacity and endurance (VO2 max) Many methods of blood doping are illegal, particularly in professional sports.
30
RBC disease Anemia
a disease caused by low red blood cell count, abnormality of red blood cells, or abnormality of hemoglobin resulting in a low oxygen transport capacity in the blood.
31
RBC disease Hemolysis
excessive break down of red blood cells.
32
RBC disease Polycythemia or erythrocytosis
diseases resulting in a surplus of red blood cells which causes increased viscosity in blood.
33
RBC disease Disseminated intravascular coagulation (DIC)
pathologic activation of clotting mechanisms caused by multiple diseases.
34
RBC disease transfusion reactions...
Body rejects, doesn't happen often!
35
Hematocrit is % volume of RBC in blood
Calculated from the MCV and RBCs = the percentage volume of red cells in a given volume of blood. Men = 40-54% Women = 37-47% It may take 2-3 hours for the HCT to drop in acute blood loss as equal parts plasma and red cells are lost. Is about 3x Hgb.
36
Increased Hematocrit happens when
``` primary polycythemia secondary polycythemia (dehydration) heart and lung disease high altitude Smoking tumors ```
37
Decreased Hematocrit is when
``` megaloblastic anemia (folate/B12 deficiency) iron deficiency anemia acute of chronic blood loss sideroblastic anemia hemolysis, anemia of chronic disease dilution,alcohol/drugs. ```
38
Hemoglobin (HGB)
The iron containing oxygen carrying metalloprotein in red blood cells. Carries oxygen from the respiratory system to tissue and then carries carbon dioxide back to respiratory system. Anemia = low hemoglobin
39
Hemoglobin Electrophoresis is a
blood test to detect different Hgb types (sickle cell, thalassemia, etc.)
40
Increased HGB
high altitudes Smoking Dehydration some tumors
41
Decreased HGB
``` Anemia blood loss Pregnancy nutritional deficiency bone marrow problems Chemotherapy kidney failure abnormal hemoglobin (such as that of sickle-cell disease). ```
42
How many hemolobinopathies are there?
``` 400 diff kinds, most common are S: Sickle cell C: Does not carry well E: Southeast Asian descent.. genetic D: sickle cell disorder, component H: Heavy hemoglobin types of thalassemia ```
43
What are the most common types of hemolobinopathies picked up by electrophoresis?
S & C
44
Hemoglobin A
Most common type of HGB to be in adults
45
Hemoglobin F
Fetal hemoglobin Fetuses and newborns Replaced by Hemoglobin A (Aduld Hgb) shortly after birth Only small amounts of Hgb F are made after birth SCD, Aplastic Anemia and Leukemia may have higher than normal levels of HgbF
46
Carboxyhemoglobin
``` Carbon Monoxide Levels: Non-smoker: <2% Smoker: <9% Toxic: >15% Not a routine test, only order if suspect CO poisoning ```
47
Hgb A1c
Glycated Hemoglobin (HbA1c) When blood glucose enters the erythrocytes, it glycates the ϵ-amino group of lysyl residues and the amino terminals of hemoglobin. * The fraction of hemoglobin glycated (normally about 5%) is proportionate to blood glucose concentration. Since the half-life of an erythrocyte is typically 60 days, the level of glycated hemoglobin (HbA1c) reflects the mean blood glucose concentration over the preceding 6–8 weeks. Measurement of HbA1ctherefore provides valuable information for management of diabetes mellitus.
48
MCH (mean cellular/corpuscular hemoglobin)
amount of Hgb in the avg. red cell | MCH= Hgb/RBC.
49
MCHC (mean cellular/corpuscular hemoglobin concentration)
avg. concentration of Hgb in a given volume of red cells. MCHC=Hgb/HCT. -Increased in severe dehydration. -Decreased in iron deficiency anemia, over hydration, thalassemia, sideroblastic anemia.
50
MCV (mean cell/corpuscular volume)
avg. volume of red blood cells. - Increased megaloblastic anemia, macrocytic anemia, Down syndrome, chronic liver disease, chronic alcoholism, chemotherapy, radiation, hypothyroid, newborn. - Decreased in iron deficiency, thalassemia, some case of lead poisoning or polycythemia.
51
RDW (red cell width)
measure of degree of variation in RBC size. | -Increased in many anemias and liver disease.
52
MCV useful in
the evaluation of anemia and nutritional disorders
53
Cell size
Normocytic, Microcytic, Macrocytic
54
Hemoglobin content/ color
Normochromic, hypochromic, hyperchromic
55
Anemia is
Anemia is defined as subnormal hemoglobin level two standard deviations below the normal for the age and sex of the patient. From the CBC report, one can classify anemia as microcytic, normocytic or macrocytic if the MCV is low, normal or high, respectively.
56
What is the most common reason for anemia?
Blood loss, can be acute or chronic. A reticulocyte count along with a detailed history and physical will help guide you in diagnosing this as your cause for anemia.
57
If the anemia is not caused by blood loss or hemolysis it can be classified
be classified as microcytic, normocytic, or macrocytic.
58
RDW
is a very useful measure in the assessment of anemia. Combined with red cell indices, it can narrow down the diagnostic possibilities. For example, a patient with microcytic anemia and high RDW is very likely to have iron deficiency. If the RDW is normal thalassemia become much more likely.
59
Microcytic anemia
Small RBC represented by a LOW MCV - Iron deficient - Thalassemias - some pts with anemic chronic disorder
60
Normocytic anemia
normal size RBC represented by a normal MCV - Anemia of chronic disorder - anemia of renal failure - anemia due to endocrine disorders
61
Macrocytic anemia
Larger RBC with a high MCV - megaloblastic (impaired DNA) - B12 deficient - folate deficient - nonmegaloblastic - liver disease, alcoholism - some cases of hypothyroidism - hemolytic anemias (high reticulocyte count)
62
A reticulocyte count
is a blood test that measures how fast red blood cells called reticulocytes are made by the bone marrow and released into the blood. -Reticulocytes are in the blood for about 2 days before developing into mature red blood cells. Normally, about 1% to 2% of the red blood cells in the blood are reticulocytes.
63
When does Retic count rise?
rises when there is a lot of blood loss or in certain diseases in which red blood cells are destroyed prematurely, such as hemolytic anemia. Also, being at high altitudes may cause reticulocyte counts to rise, to help you adjust to the lower oxygen levels at high altitudes.
64
A reticulocyte count is done to:
See whether anemia is caused by fewer red blood cells being made or by a greater loss of red blood cells. Check how well bone marrow is working to make red blood cells. Check to see if treatment for anemia is working. For example, a higher reticulocyte count means that iron replacement treatment or other treatment to reverse the anemia is working.
65
What is the Diagnostic Approach to Anemia?
History: bleeding systemic illness, drugs, exposure, diet, FH CBC w/ DIff: MCV, RDW calculate reticu index: RI >2% Bone marrow response <2% hypoproliferation Peripheral smear: RBC size, shape, nucleus, WBC morph, plt count PRN: Hemolysis if RI >2%..good -iron/TIBC/ferritin/folate, B12 -LFT, electrophoresis, gene mutation Bone marrow aspirate w/ cytogenetics
66
Categories of anemia
RI<2% UNDERPRODUCTION (1) low MCV: microcytic (2) nl MCV: normocytic (3) high MCV: macrocytic RI>2% INC DESTRUCTION or LOSS (4) high LDH, bilirubin, low haptoglobin: hemolysis (5) s/s of bleeding: recent acute blood loss
67
TQ... Hemoglobin Low, Reticu Low, MCV Low what is the next test?
Iron studies | then check RBC count
68
TQ.... HBG low, Reticulo low, MCV high whats next test?
Check B12, folate, LFT
69
TQ... HBG low, reticulo low, MCV normal what next test?
check creatinine
70
Anemia work up
iron levels Total Iron Binding Capacity (TIBC) Measures proteins in blood that can bind with iron, mainly transferrin, increases when iron is low Increased: dx of iron def anemia Decreased: hemochromatosis (excessive iron storage) % Saturation of Transferrin Iron to TIBC ratio (Transferrin bound to iron/total Transferrin (bound+unbound) Decreased: Iron Deff Anemia Increased: Hemochromatosis Ferritin Major storage protein for iron Differentiate btw iron def anemia, and anemia of chronic disease Erythropoietin (EPO) Renal hormone that stimulates RBC production Decreased: anemia of chronic disease Increased: iron def anemia, aplastic anemia
71
Iron deficiency is when
Iron: Low TIBC: High % transferrin sat: Low Ferritin: Low
72
Hemochromatosis (opposite)
Iron: high TIBC: low % transferrin Sat: High Ferritin: High
73
Abnormal RBC is
Changes in size or morphology of a red blood cell that may be reported in a CBC
74
Basophilic Stippling
associated with lead or heavy metal poisoning, thalassemia, severe anemia
75
Burr cells
associated with severe LIVER DISEASE, high levels of bile, fatty acids, or toxins
76
Heinz bodies
DRUG induced hemolysis
77
Helmet cells
MICROANIGOPATHIC HEMOLYSIS, hemolytic transfusion reaction
78
HOWELL-JOLLY BODIES
ASPLENIA
79
SICKLING
SICKLE CELL ANEMIA
80
Nucleated RBC
SEVERE BONE MARROW STRESS, tumor
81
Schistocytes
excessive blood clotting
82
spherocytes
genetic
83
target cells
thalessmia, liver disease, hemoglobinopathies
84
Osmotic Frag Test
All red cells expand and eventually undergo lysis in a hypotonic environment spherocytic red cells do so at a faster rate than normal biconcave red cells. *basis of the osmotic fragility test
85
The most common acquired cause of red cell spherocytosis
Red cells are incubated in progressively more hypotonic solutions, parallel with normal controls. Enhanced lysis: positive test. (+spherocytes) is autoimmune hemolytic anemia.
86
Platelets
Small, irregularly shaped cell fragments that do not have a nucleus. Circulate in the blood and are involved in hemostasis, leading to the formation of blood clots. If platelets become too low, excess bleeding may occur. If platelets become too high, clots may form.
87
Thrombocytopenia
low plt count
88
Thrombocytosis
elevated plt count
89
Erythrocyte Sedimentation Rate (ESR
A nonspecific test to measure inflammation Not clinically useful unless it is being used to measure the response of certain diseases to treatment (temporal arteritis, polymyalgia rheumatica and rheumatoid arthritis)

Lab Med (4 decks)

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