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Diagnostic M.'s Sara Peer mentor > Hematology > Flashcards

Hematology Flashcards

1
Q

What are the cellular components of blood?

A

Erythrocytes
Leukocytes
Thrombocytes

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2
Q

What are erythrocytes?

A

Most abundant blood cells in the body = 3.5-5.5 million

6-8 micrometers

Biconcave disk

120 day lifespan

1% per day destroyed

Gas and oxygen transport

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3
Q

What are Leukocytes?

A

Least abundant blood cells in the body = 4.5-11 thousand

5 types

8-14 micrometers

Lifespan vaires

Fights infections and removes debris

Part of buffy coat

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4
Q

What are thrombocytes?

A

Platelets

Produced from megakaryocytes

1-3 micrometers

LIfe span in peripheral blood = 5-9 days

150-400 thousand

Coagulation

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5
Q

What is pancytopenia?

A

Decrease of all cell lines: RBCs, WBCs, and platelets

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6
Q

What is anemia?

A

Decreased RBCs and RBC parameters

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7
Q

What is polycythemia?

A

Increased RBCs

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8
Q

What is Thrombocytopenia?

A

Decreased platelets

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9
Q

What is thrombocytosis?

A

Increased platelets

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10
Q

What is leukocytosis?

A

Increased WBCs

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11
Q

What is leukopenia?

A

Decreased WBCs

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12
Q

What is neutropenia?

A

decreased neutrophils = absolute count < 1000 microL

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13
Q

What is a leukemoid reaction?

A

benign and temporary leukocytosis

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14
Q

What are the five different types of leukocytes?

A 
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
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15
Q

What is hematopoiesis?

A

Production of blood cells

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16
Q

What is erythropoiesis?

A

Production of RBCs

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17
Q

What is thrombopoiesis?

A

Production of platelets

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18
Q

What is leukopoiesis?

A

Production of WBCs

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19
Q

What is lympopoiesis?

A

Production of lymphocytes

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20
Q

What is medullary myeloid hematopoiesis?

A

production of myeloid blood cells in the bone marrow

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21
Q

What is extramedullary hematopoiesis?

A

Production of blood cells outside of the bone marrow in the liver, spleen, or indirectly by kidney

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22
Q

What is Erythropoietin (EPO)?

A

Hormone produced in the kidney and some in the liver

Stimulates Erythropoiesis

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23
Q

During fetal development, where is most of the bone marrow made?

A

Yolk sac
Liver
Spleen

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24
Q

During postnatal life, where is bone marrow made?

A 
Tibia
Femur
Rib
Sternum
Vertebra
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25
Q

What mature cells originate form myeloid stem cells?

A 
Erythrocytes
Platelets
Eosinophils
Basophils
Neutrophils
Monocytes
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26
Q

What mature cells originate from lymphoid stem cells?

A

B lymphocytes

T lymphocytes

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27
Q

What cells are granulocytes?

A

Eosinophils
Basophils
Neutrophils

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28
Q

What are the stages of granulocyte maturation?

A

1) Blast
2) Promyelocyte
3) Myelocyte
4) Metamyelocyte
5) Granulocyte

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29
Q

What are immature cells?

A

blast cells

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30
Q

What is the first nucleated RBC called?

A

Reticulocyte

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31
Q

What are Neutrophils?

A

Essential blood phagocytes

Active engulfers and killers of bacteria

Live 8-12 hours in circulation

54-62% of blood; 2500-7500/microliter

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32
Q

What are basophils?

A

Function in inflammatory events and allergies

Bad cells

Live 8 hours in circulation

< 1% in blood; < 100/microliter

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33
Q

What are eosinophils?

A

Active in worm and fungal infections, allergy, and inflammatory reactions

Parasitic infections and allergic response

LIve 8 hours in circulation

1-3% in blood; 60-600/microliter

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34
Q

What are monocytes?

A

Blood phagocytes that rapidly leave the circulation and mature into macrophages and dendritic cells

Phagocytic, immune response, inflammatory response, chronic infection

Circulate in blood 3 days
Circulate in tissue 2-3 months

3-7% in blood; 200-800/microliter

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35
Q

Where do T cells mature?

A

Thymus

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36
Q

Where do B cells mature?

A

Bone marrow

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37
Q

Where do Natural killer cells mature?

A

Bone Marrow

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38
Q

What causes Kidney to release EPO?

A 
Decreased RBCs
Decreased hemoglobin synthesis
Decreased blood flow
Hemorrhage
Increased O2 consumption by tissues
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39
Q

What does the biconcave shape of an erythrocyte help with?

A

Allows flexibility/deformability and increases surface area

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40
Q

What are the components of RBCs?

A

Heme and Globin

Proteins

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41
Q

Where is iron absorbed?

A

intestines

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42
Q

What is transferrin?

A

transports iron

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43
Q

What is ferritin?

A

stimple storage form of iron

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44
Q

What is hemosiderin?

A

complex iron stores in macrophages

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45
Q

What happens to iron when RBCs are broken down?

A

It is stored and used for erythopoiesis

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46
Q

What is hemolysis?

A

RBC breakdown

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47
Q

What is created when RBCs breakdown?

A

bilirubin from breakdown of heme component

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48
Q

What are lymphocytes?

A

Viral illness, mononucleosis, involved in immunity

Live days to months to years

25-33% in blood; 1500-3500/microliter

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49
Q

What cells are agranulocytes?

A

Monocytes

Lymphocytes

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50
Q

What is a left shift?

A

Increased bands of neutrophils

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51
Q

What are hemotologic lab studies?

A 
CBC
Peripheral Smear
Reticulocyte count
Serum iron
TIBC
Ferritin
Transferin
Bilirubin
Serum B12
RBC folic acid level
Serum folic acid level
Serum LDH
Coombs test
Cold agglutinin test
Schillings test
Urine hemosiderin
Bone marrow studies
Electrophoresis
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52
Q

What is a complete blood count (CBC)?

A

Evaluates the blood cells in the body

Venous blood sample by venipuncture

Lavendar top tube

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53
Q

What are indications for getting a CBC?

A 
Concern of:
Bleeding 
Infection
Anemia
Malignancy
Heart disease
Liver disease
renal disease
Pulmonary disease
GI disease
Toxin exposure
Monitor a therapy
Fatigue
pale color
Fever
Petechiae or ecchymosis
Weight loss
Infection
History of infection
Bleeding
Jaundice
Chest pain
Dyspnea
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54
Q

What is included in a CBC?

A 
RBC count
Hematocrit
Hemoglobin
WBC
Platelet count
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55
Q

What are the RBC indices?

A

Mean Corpuscular volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular hemoglobin concentration (MCHC)
Red cell distribution width (RDW)

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56
Q

What is the MCV?

A

size of RBCs

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57
Q

What is the MCH?

A

mean content of hemoglobin per RBC

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58
Q

What is teh MCHC?

A

Mean content of total hemoglobin

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59
Q

What is the RDW?

A

variation in size of RBCs

Are they all big; are they all little; or are they mixed sizes?

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60
Q

What is the platelet indice?

A

Mean platelet volume (MPV)

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61
Q

What is the MPV?

A

average volume of platelets

62
Q

What are normal hemoglobin levels?

A

12-15 g/dL

63
Q

What are the normal hematocrit levels?

A

36-45%

64
Q

What is the normal red blood cell count?

A

4.0-5.5 x 10^6/microliter

65
Q

What is the normal white blood cell count?

A

5-10 x 10^3/microliter

66
Q

What is the normal platelet count?

A

150-400 x 10^3/microliter

67
Q

What ANC values indicate mild neutropenia?

A

ANC >1000 and <1500 cell/microliter

68
Q

What ANC values indicate moderate neutropenia?

A

ANC >500 and <1000 cells/microliter

69
Q

What ANC values indicate severe neutropenia?

A

ANC < 500 cells/microliter

70
Q

What are the automated CBC machines called?

A

Coulter Counter or Abbott cell dyne

71
Q

When would you order a blood smear?

A

If you are concerned about the immune system or that they are anemic but it can’t be explained on iron studies

72
Q

What does a CBC Peripheral Blood Smear show?

A

RBC size and morphology
WBC differential
Platelets size and number

73
Q

What would you see if patient had ingested lead?

A

Basophilic stifflings in blood smear

74
Q

What does normocytic mean?

A

Normal RBC size 6-9 micrometers

75
Q

What does anisocytosis mean?

A

variation in cell size

76
Q

What does microcytic mean?

A

smaller RBC size < 5 micrometers

77
Q

What does macrocytic mean?

A

larger RBC size > 10 micrometers

78
Q

What is hemoglobinization?

A

color of RBC

79
Q

What does normochromic mean?

A

normal RBC color

80
Q

What does anisochromia mean?

A

Variation in color

81
Q

What does Hypochromic mean?

A

Decreased color

82
Q

What does Hyperchromic mean?

A

Increased color

83
Q

What are RBC inclusions?

A 
Polychromasia
Basophilic stippling
Howel Jolly bodies
Nucleated RBCs
Siderocytes
Malaria
84
Q

What are RBC poikilocytoses?

A 
Target cells
Ovalocytes
Teardrops
Spherocytes
Burr cells
Stomatocytes
Schistocytes (fragments)
85
Q

What does a macro-ovalocyte RBC indicate?

A

Megaloblastic anemia

86
Q

What does a microcyte RBC indicate?

A

Iron deficiency

Thalassemia

87
Q

What does a Pencil cell RBC indicate?

A

Iron deficiency

88
Q

What does a tear drop RBC indicate?

A

Myelofibrosis

Extramedullary hemopoiesis

89
Q

What does a target cell indicate?

A

Liver disease
Hemoglobinopathies
Post-splenectomy

90
Q

What does a howell-jolly body indicate?

A

Nuclear infusion

Post-splenectomy

91
Q

What does a supra-vital stain reticulocyte indicate?

A

Polychromasia

92
Q

What does a spherocyte RBC indicate?

A

Hereditary sperocytosis

Autoimmune hemolytic anemia

93
Q

What does an Elliptocyte RBC indicate?

A

Hereditary elliptocytosis

94
Q

What does a Stomatocyte RBC indicate?

A

Liver disease

95
Q

What does a sickle cell indicate?

A

Sickle cell anemia

96
Q

What do fragment RBCs indicate?

A 
Microangiopathy
HUS
TTP
Cardiac valve
DIC
97
Q

What do blister cell RBCs indicate?

A

G6PD deficiency

98
Q

What do spur cell RBCs indicate?

A

Severe liver disease

99
Q

What is Rouleaux RBC cells?

A

Stacking of RBCs

Seen in increased serum protein or multiple myeloma

100
Q

What is a CBC with manual differential?

A

More specific

A person actually hand counts the number of cells

101
Q

How should you interpret a CBC?

A

Should be evaluated with clinical context in mind

102
Q

What are the indications for a bone marrow exam?

A

Patient specific determination

Pancytopenia

Abnormal cells in circulation

Unexplained anemia - not most common forms
Macrocytic anemia
UNexplained leukopenia
Unexplained thrombocytopenia
Suspected multiple myeloma
Staging of non-hodgkins lymphoma
Unexplained splenomegaly
Suspected storage disease
Fever of unknown origin
Suspected chromosomal disorders in neonates
103
Q

What are the absolute contraindications for bone marrow exam?

A

Hemophilia
Severe Disseminated intravascular coagulopathy (DIC)
Other severe bleeding disorders

104
Q

What are not contraindicated for bone marrow exam?

A

Thrombocytopenia

Therapeutic anticoagulation

105
Q

What sites are used for bone marrow aspiration?

A 
Posterior superior iliac crest and spine ** MOST COMMON***
Anterior iliac crest
Greater trochanter of femur
Vertebral bodies of rubs
Sternum (usually C/I)
Tibial (children <12-18 months)
106
Q

What are the types of bone marrow exams?

A

Core biopsy
Aspirate

Aspirate smear/particle crush smear
Buffy coat smear
Bone marrow biopsy section
Iron stain
Clot section
Reticulin and/or collagen stains for suspected fibrosis
Enzyme cytochemical stains
Immunophenotyping/flow cytometry
Cytogenic analysis
FISH
Molecular genetic analysis
Culture for mycobacteria, leishmania, histoplasma
Acid fast staining for mycobacteria
Congo red stain for suspected amyloidosis
Cell culture assays
107
Q

What is dry tap?

A

No bone marrow sample can be obtained by aspiration

108
Q

What is a reticulocyte?

A

Immature RBC

109
Q

What would indicate getting a reticulocyte study?

A

Erythropoiesis

110
Q

What are the causes of reticulocytosis?

A

Decreased RBC survival
Increased production d/t accelerated loss
Recent replacement of deficient nutrient

111
Q

What is a reticulocyte index?

A

Corrects for anemia

Better representation of bone marrow production

112
Q

What is the normal reticulocyte count?

A

0.5-2%

113
Q

What is the normal reticulocyte index (RPI)?

A

2.0-3.0

114
Q

What is the erythrocyte sedimentation rate (ESR)?

A

Measure of inflammation

Non-specific test

Goal of the test is to measure the height of sedimented RBC after an incubation, often 1 hour

115
Q

What is hemoglobin electrophoresis?

A

Goal of the test is to identify the hemoglobin types present in a patients RBCs

Tests the contents of the RBCs against known band for the various HgB types

116
Q

What occurs with a shift to the right on the oxygen binding curve?

A

Lower affinity to oxygen

Anemia
Increased CO2
Acidosis
Elevated temperature
Increased 2,3 DPG
117
Q

What occurs with a shift to the left on the oxygen binding curve?

A

higher affinity to oxygen

Polycythemia
Alkalosis
Decreased CO2
Hypothermia
Decreased 2, 3 DPG
Hemoglobin F
118
Q

What are the symptoms of anemia?

A 
Fatigue/dizziness/weakness
Syncope
Pallor - pale color
Jaundice
Dyspnea
Palpitations
Chest pain/MI
Asymptomatic
119
Q

What are the symptoms of severe anemia?

A

Fainting
Chest pain
Angina
Heart attack

120
Q

What are signs of Anemia?

A 
Pallow; pale skin and palm
Glossitis
Koilonychia
Bossy forehead
Splenomegaly
Hypotension
Tachycardia
Jaundice/Icteric
121
Q

What can anemia be caused by?

A

Increased RBC destruction/loss

Decreased RBC production

122
Q

What occurs in anemia caused by increased RBC destruction/loss?

A

Acute blood loss
Hemolysis
Hypersplenism

123
Q

What occurs in anemia caused by Decreased RBC production?

A 
Hemoglobin synthesis lesion
DNA sythesis lesion
Hematopoietic stem cell lesion
Bone marrow infiltration
Immune-mediated inhibition
124
Q

What is macrocytic anemia?

A

MCV >100 fL

Megaloblastic anemia (B12 and/or folate deficiency)
Alcoholism
Liver disease
Myelodysplasia
Drugs and toxins
Infection
Hypothyroidism
125
Q

What is normocytic anemia?

A

MCV 80-100 fL

Anemia of chronic disease
Pure red cell aplasia
Chronic renal insufficiency
Liver disease
Endocrine disorders
126
Q

What is microcytic anemia?

A

MCV <80 fL

Iron deficiency
Thalassemia
Sideroblastic anemia
Hemoglobin E disease
Anemia of chronic disease 
Lead poisoning
127
Q

What are the three types of chronic anemia?

A

Microcytic
Normocytic
Macrocytic

128
Q

What are the two things that cause acute anemia?

A

Bleeding

Hemolysis

129
Q

What are the steps of Hemostasis?

A

Vessel constriction
Platelets
Coagulation Cascade

130
Q

What is platelet aggregation?

A

Irreversible

131
Q

What is platelet activation?

A

reversible

132
Q

What are the platelet function studies?

A 
Platelet count
Bleeding time
Platelet aggregation
Platelet antibody studies
Others
133
Q

What is the goal of the platelet aggregation test?

A

To assess the function of circulating platelets

134
Q

What classes of drugs inhibit platelet activation?

A 
COX inhibitors = Aspirin
P2Y12 Platelet inhibitors = Plavix, Effient, Brilinta
135
Q

What classes of drugs inhibit platelet aggregation?

A

Glycoprotein IIb/IIIa inhibitors = Abcicimab, Eptifibatide, and Tirofiban
PDE5 inhibitors = Aggrenox

136
Q

What are factor Xa inhibitors?

A

Fondaparinux
Eliquis
Xaralto

137
Q

What are LMWH?

A

Lovenox

Fragmin

138
Q

What are antithrombin agents?

A

Angiomax

Argatroban

139
Q

What factors are involved in the extrinsic pathway?

A

7a

140
Q

What factors are involved in the intrinsic pathway?

A

11, 9, and 8

141
Q

What factors are involved in the common pathway?

A

10, 10a, 5, 2, fibrinogen, and fibrin

142
Q

What are the Vitamin K dependent factors?

A

2, 7, 9, and 10

143
Q

What are the labs that can be used to determine the coagulation pathway?

A 
aPTT = activated partial thromboplastin time
PT = Protime (PT/INR)
TT = thrombin time
144
Q

When would you order a coagulation test?

A

if the patient is having unexplained clots

145
Q

What factors are involved in thromolysis?

A

Protein C
Protein S
Anti-thrombin
Factor XIIa

146
Q

What does the PT test test for?

A

Extrinsic pathway

Coumadin

147
Q

What does the aPTT test test for?

A

Intrinsic pathway

Heparin

148
Q

What is the goal of the PT and PTT mixing studies test?

A

To determine if a prolonged PT or prolonged PTT is a result of greater than or equal to 1 factor deficiencies or an inhibitor of the PT or PTT clotting reaction

149
Q

What is the Anti-factor Xa activity test?

A

functional assay used to assess the degree of anticoagulation in patients receiving certain anticoagulants

Patient plasma + reagant factor Xa –> measure activity of factor Xa using an artificial Factor Xa substrate taht releases a colored compound when cleaved

Can be calibrated to estimate the specific level of an anticoagulant and in such cases, the results of anti-factor Xa activity may be reported as an anticoagulant level

The activity of factor Xa is inversely proportional to the amount of heparing or other factor Xa inhibitor in the plasma

150
Q

What is a d-dimer?

A

terminal fibrin degradation product

Indicates thrombosis with thrombolysis

151
Q

What is the d-dimer test?

A

Latex agglutination or ELISA

It is sensitive but not specific so it will tell you there is a clot but not where the clot is

Diagnostic M.'s Sara Peer mentor (27 decks)

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