Hematology Exam 4 Flashcards
1
Q
During myeloid proliferation, how long do cells take to mature in the bone marrow before being released in to circulation?
A
5 days
2
Q
Percentage of peripheral blood neutrophils that are typically bands
A
<5%
3
Q
Percentage of white cells that will typically be segmented neutrophils and bands
A
50-70%
4
Q
What are the 2 groups of neutrophils in the peripheral blood? What is the percentage of each group?
A
- Circulating neutrophils 50%
- Marginating neutrophils 50%
5
Q
Neutrophils that are adjacent to the endothelial lining of the vessel and can be mobilized into the blood by epinephrine or go into the tissues via diapedesis
A
Marginating neutrophils
6
Q
Macrophages will remove neutrophils in the spleen after how many days?
A
2 days
7
Q
What are the types of granules in neutrophils?
A
- Primary
- Secondary
- Tertiary
8
Q
Where are primary granules first seen?
A
Promyelocytes
9
Q
This granule type is the first to appear in myeloid cells
A
Primary
10
Q
This granule type is first seen in myelocytes
A
Secondary granules
11
Q
This granule type is not seen with the Wright’s stain.
A
Tertiary granules
12
Q
What are other names for the primary granules?
A
Azurophilic and non-specific
13
Q
What do the primary granules contain?
A
Myeloperoxidase
14
Q
What is the purpose of myeloperoxidase in primary granules?
A
The enzyme aids in killing microorganisms
15
Q
In what cell do we first see primary granules?
A
Promyelocytes
16
Q
What is the purpose of primary granules?
A
Activate proteinases to kill bacteria - but, not as effective as secondary granules
17
Q
What is another name for secondary granules?
A
Specific granules
18
Q
TRUE or FALSE
Secondary granules are first seen in promyelocytes
A
FALSE
secondary granules are first seen in myelocytes
primary granules are first seen in promyelocytes
19
Q
If primary or secondary granules are absent, what will occur?
A
Increased or recurrent infections because the cell is unable to kill the bacteria
20
Q
The primary function of this cell type is the ingestion and destruction of invading microorganisms
A
Neutrophils
21
Q
These granules contain lysozymes and other enzymes that hydrolyze bacteria cell walls and help with inflammation
A
Secondary granules
22
Q
Where are the majority of granulocytes found?
A
Bone marrow
23
Q
What are the steps of phagocytosis in order? (6)
A
- Chemotaxis
- Opsonization
- Phagocytosis
- Degranulation/fusion
- Killing
- Inflammation
24
Q
During this step of phagocytosis cells go to the site of infection
A
Chemotaxis
25
The term for when a cell passes through a vessel wall between endothelial cells and in to tissue in response to infection
Diapedesis
26
This step of phagocytosis is when the neutrophil "recognizes" antibody or complement coated organism
Opsonization
27
The term for a neutrophil ingesting an opsonized organism bu surrounding it and moving it with pseudopods
Phagocytosis
28
Term for the granules of a neutrophil fusing with a phagosome and activating
Degranulation
29
Term for a neutrophil reducing oxygen in order to generate hydrogen peroxide
Oxidative or respiratory burst
30
Myeloperoxidase reacts with the hydrogen peroxide created during the neutrophils oxidative burst and together, what do these form?
Hypochlorous acid (bleach component)
31
What is the effect of hypochlorous acid on the engulfed microorganism?
Causes lipid damage to microbial membrane
32
What can occur if granules and metabolites leak to surrounding tissue?
Inflammation that may cause swelling and fever
33
What granules degrade the extracellular matrix of the neutrophil and act as chemotactic agents?
Tertiary granules
34
TRUE or FALSE:
A function of the neutrophil is as a source of transcobalamin I
TRUE
35
Term for when neutrophils leave thread-like structures from unfolded DNA that can trap and kill bacteria
Neutrophil extracellular traps (NET)
36
Term for the percentage of a cell type based on a 100-cell differential
Relative count
37
How is absolute count calculated?
Relative % x WBC count
38
Term for increased number of neutrophils
Neutrophilia
39
What are the different qualitative neutrophil changes that may be observed in infection?
- Toxic granulation
- Dohle bodies
- Vacuolization
40
TERM:
Prominent cytoplasm primary granules seen in infection
Toxic granulation
41
TERM:
Strands of endoplasmic reticulum RNA observed in infection
Dohle bodies
42
TERM:
Occurs in the cytoplasm due to phagocytosis
Vacuolization
43
Range for WBC count
3,600 - 10,600/uL
44
Relative count for neutrophils
50 - 70%
45
Absolute count for neutrophils
1,700 - 7,500/uL
46
Relative count for lymphocytes
18 - 42%
47
Absolute count for lymphocytes
1,000 - 3,200/uL
48
Relative count for monocytes
2 - 11%
49
Absolute count for monocytes
100 - 1,300/uL
50
What are some causes of neutrophilia?
| (4)
- Bacterial infections
- Stress
- Inflammation
- Malignant disorders such as leukemias
51
Term for decreased neutrophil count
Neutropenia
52
What are some causes of neutropenia?
- Leukemia (typically because of chemotherapy)
- Aplastic anemia
- Infection
53
TRUE or FALSE:
Children have an inverse segmented neutrophil/lymphocyte ratio
TRUE
54
Congenital causes of neutropenia
- Failure of production
- Failure of bone marrow to release
- Destruction
- Misdistribution of cells
55
Causes of acquired neutropenia
- Viral infections
- Depletion of neutrophi storage pool in marrow
- Chemotherapy of other drugs
- Blood malignancies
56
Relative range for eosinophils
1 - 3%
57
High numbers of this cell type are seen in allergies, parasitic infections, and some leukemias
Eosinophils
58
Relative count for basophils
0 - 2%
59
What do the granules in basophils contain?
Histamine and heparin
60
A high count of this cell type is observed in CML and other myeloproliferative disorders.
Basophils
61
This cell type is a receptor for IgE and is involved in anaphylaxis and immediate hypersensitivity
Basophils
62
High numbers of this cell type are seen in some leukemias, bacterial infections, and rickettsial infections
Monocytes
63
DEFINITION:
The term used when any white count is \>12,000/uL
Leukocytosis
64
DEFINITION:
Term used when a white cell count is \<1,500/uL
Leukopenia
65
This qualitative deficiency occurs when the cell does not respond to stimuli
Chemotaxis deficiency
66
This type of qualitative WBC deficiency is autosomal recessive and causes partial albinism as well as recurrent pyrogenic infections
Chediak-Higashi Syndrome
67
TRUE or FALSE:
Chediak-Higashi syndrome is a rare but fatal autosomal recessive condition
TRUE
68
Giant fused lysosome granules are seen in this qualitative WBC disorder
Chediak-Higashi syndrome
69
In this qualtitative WBC disorder there is no respiratory burst to activate H2O2
Chronic Granulomatous Disorder
70
What test do we perform to confirm chronic granulomatous disorder?
Nitroblue Tetrazolium Reduction Test
71
TRUE or FALSE:
The Nitroblue Tetrazolium Reduction Test will cause a dark blue reaction in chronic granulomatous diseased neutrophils
FALSE
CGD neutrophils will have no reaction
72
This qualitative disorder of WBCs is a benign inherited condition that has Dohle body-like inclusions
May-Hegglin Anomaly
73
In May-Hegglin anomaly, what are the Dohle-like inclusions composed of?
Precipitated myosin heavy chains
74
This qualitative WBC disorder has the presence of dark-staining coarse granules in neutrophils, lymphocytes, and monocytes. The granules are composed of partially digested mucopolysaccharides
Alder-Reilly Anomaly
75
How can you differentiate Alder-Reilly anomaly from toxic granulation?
Toxic granulation is seen only in neutrophils and can occur in conjunction with Dohle Bodies, neutrophilia, and a left shift.
Alder-Reilly anomaly is seen in neutrophils, lymphocytes, and monocytes
76
This qualitative WBC disorder includes bleeding problems, giant platelets, and Dohle body-like inclusions
May-Hegglin anomaly
77
In this qualitative WBC disorder neutrophils have 1 or 2 lobes. There is no problem with cell function.
Pelger-Huet anomaly
78
This WBC disorder is due to a mutation on the lamin beta receptor gene
Pelger-Huet anomaly
79
Where might you see pseudo Pelger-Huet?
- Myeloproliferative disorders
- Burns
- Drug reactions
- Infections
80
Bi-lobed nuclues resembling spectacles or dumbells
Pelger-Huet anomaly
81
LE cells was an old method used in the lab for detecting what autoimmune disease?
Systemic Lupus Erythematosus
82
What test(s) replaced LE cells?
ANA and ENA
83
Intracellular homogenous material observed in segmented neutrophils
LE cells
84
Autosomal recessive disorder caused by defect in enzyme needed for glycolipid metabolism. Most commonly observed in ethnic Jews.
Gaucher's disease
85
"Tissue paper" histiocytes caused by a defect in beta-glucocerebrosidase which is necessary for glycolipid metabolism
Gaucher's disease
86
Autosomal recessive lipid storage disease caused by a defect in lysosomal hydrolase enzyme sphingomyelinase.
Niemann-Pick
87
Macrophages with foamy cytoplasm packed with lipid filled lysosomes
Neimann-Pick
88
Autosomal recessive lysosomal enzyme neurodegenerative disorder caused by a gene mutation or deletion of hexosaminidase A (HEXA) which leads to the accumulation of GM2 ganglioside and a destruction of neurons
Tay-Sachs
89
Types of myeloproliferative disorders (4)
Myelofibrosis
CML
Polycythemia Vera
Essential Thrombocythemia
90
DEFINITION:
Clonal hematopoietic stem cell diseases with expansion, excessive production, and over-accumulation of cells
Myeloproliferative disorders
91
What is another name for primary myelofibrosis?
Agnogenic (unknown origin) myeloid metaplasia
92
This myeloproliferative disorder produces a leukroerythroblastic state in which tear drop RBCs, large bizarre platelets, and micromegakaryocytes are seen.
Myelofibrosis
93
What myeloproliferative disorder typically results in a dry marrow tap?
Myelofibrosis
94
Bizarre platelets as well as micromegakaryocytes are seen with this myeloproliferative disorder
Myelofibrosis
95
What stains can be used on bone marrow samples to show increased reticulin due to myelofibrosis?
Trichrome or Silver stain
96
Myeloproliferative Disorders:
- Very high WBC count
- Philadelphia chromosome
- Decreased LAP score
Chronic Myelocytic Leukemia
97
Normal LAP score
20-100
98
CML LAP score
\< 20 (typically around 7)
99
Also known as BCR-ABL transolcation or Chromosome 22
Philadelphia chromosome
100
This stain is used to distinguish between leukemoid reaction due to infection and CML
Leukocyte Alkaline Phosphatase (LAP)
101
Leukemoid reaction LAP score
\>100
102
Myeloproliferative Disorders:
Stem cell disorder that affects all three cell lines: RBCs, WBCs, and platelets
Often ends in myelofibrosis
Polycythemia Vera
103
Myeloproliferative Disorders:
Often presents with headache, abdominal pain, hypertension, and ruddy complexion
Polycythemia Vera
104
Myeloproliferative Disorders:
Red cell line is most affected in this disorder causing an increase in blood viscosity. This in turn increases the risk of stroke and heart attack
Polycythemia Vera
105
Myeloproliferative Disorders:
What gene mutation is associated with PV?
JAK-2
106
Myeloproliferative Disorders:
- Increase in all cell lines
- Decreased erythropoietin levels
- Increased RBC mass (often \>7million/uL)
- Normal O2 saturation
- Increased hemoglobin
Polycythemia Vera
107
This type of polycythemia is due to dehydration, heavy smoking, or obesity. Decreased plasma causes blood to become too concentrated.
Relative polycythemia
108
This type of polycythemia is due to increased erythropoietin or decreased oxygen delivery. Could be due to COPD or emphysema.
Secondary polycythemia
109
Myeloproliferative Disorders:
Clonal disorder of platelets involving a single multipotential stem cell
-Platelets are easily activated and clot of malfunction and hemorrhage occurs
Essential Thrombocythemia
110
Myeloproliferative Disorders:
- High platelet count \>1,000,000/uL
- Micromegakaryocytes and bare nuclei may be present on peripheral blood smear
Essential Thrombocythemia
111
Disorder caused by an increased platelet count secondary to an existig problem such as acute hemorrhage, trauma, chronic infection, IDA, or malignancy.
Relative thrombocytosis
112
Leukemia VS Lymphoma:
Starts in the bone marrow and spreads through the blood and into the reticuloendothelial system
Leukemia
113
Leukemia VS Lymphoma:
Begins in the lymph nodes
Lymphoma
114
Most common type of leukemia in adults
Acute myeloid leukemia
115
FAB criteria for diagnosis of AML
\>30% blasts
Hypercellular bone marrow
116
Fusion or bundles of primary granules seen in cells of the bone marrow. Indicates AML, AMML, or AMoL
Auer Rods
117
M0 is also known as?
Acute Myeloblastic Leukemia with minimal differentiation
118
What stains are negative for M0?
Myeloperoxidase and Sudan Black B
119
Will you see Auer Rods in M0 AML?
No
120
FAB classification for Acute Myeloblastic Leukemia with minimal differentiation?
M0 (M-null)
121
FAB classification for Acute Myeloblastic Leukemia without maturation
M1
122
Another name for FAB classification M1
Acute Myeloblastic Leukemia without maturation
123
- Worst type of AML to have
- 90% of cells are primarily blasts
- Auer Rods may be seen
M1 - Acute Myeloblastic Leukemia without maturation
124
What cytochemical stains are positive for M1?
- Myeloperoxidase
- Sudan Black B
- Specific Esterase
125
This AML has chromosome abnormality t(8;21) as well as \>20% blasts
M2- Acute Myeloid Leukemia with maturation
126
Name for FAB classification M2
Acute Myeloid Leukemia with maturation
127
TRUE or FALSE:
You will see maturation beyond promyelocytes in the bone marrow with M2 AML
TRUE
128
Will you see Auer Rods in Acute Myeloid Leukemia with maturation?
Yes
129
Name for M3
Acute Promyelocytic Leukemia
130
This AML has the chromosome abnormality t(15;17) and the majority of cells seen are promyelocytes with large granules as well as prominent Auer Rods in bundles
M3 - Acute Promyelocytic Leukemia
131
DIC often occurs with which AML?
M3 - Acute Promyelocytic Leukemia
132
What stains are positive with M3?
Peroxidase and Sudan Black B
133
Name(s) for FAB M4
Acute Myelomonocytic Leukemia
or
Naegli
134
In this AML, cells have features of monocytes and immature granulocytes. Myeloblasts and monoblasts are present.
M4 - Acute myelomonocytic leukemia
135
What stains are positive with AML M4?
Specific and non-specific esterase
136
Name(s) for FAB M5 AML
Acute monocytic leukemia
or
Schilling leukemia
137
With this AML, \>80% of the bone marrow cells are of monocytic origin. There is a high prevalence of extramedullary tumors, especially in the gums.
M5 Acute monocytic leukemia
138
What stain is positive with M5?
What stain is negative with M5?
Positive: Non-specific esterase
Negative: Specific esterase
139
Name(s) for FAB M6 AML
Acute erythroid leukemia
or
Erythroleukemia
or
DiGuglielmo's
140
With this AML NRBCs, and myeloblasts are seen in the peripheral blood. \>50% of nucleated bone marrow cells are normoblasts and \>20% are myeloblasts.
M6 Acute erythroid leukemia
141
When diagnosing M6 AML, you need to be able to differentiate it from what other disorders?
-Megaloblastic anemia - has hypersegmented neutrophils
and
-Myelodyplastic syndrome Polycythemia Vera - has less NRBCs and bone marrow will look different
142
Name for FAB M7 AML
Acute megakaryoblastic leukemia
143
This AML is very rare
- Related to myelofibrosis
- Blasts have abundant budding cytoplasm
- Platelet count is normal or high
- Platelet peroxidase is specific
M7 - Acute megakaryoblastic leukemia
144
This cytochemical stain is useful in differentiating blasts in AML from ALL blasts because the enzyme is found in primary granules of myeloid cells
Myeloperoxidase
145
This cytochemical stain is useful in differentiating AML from ALL. It stains the phospholipids, neutral fats, and sterols found in primary and secondary granules.
Sudan Black B
146
These cytochemical stains are used to differentiate neutrophilic granulocytes from cells on monocytic origin
Esterases
147
Specific esterase is positive for which cell type?
Myeloid cells
148
Naphthol AS-D Chloroacetate is which esterase cytochemical stain?
Specific esterase
149
Non-specific esterase is positive for which cell line?
Monocytes
150
Alpha-naphthyl acetate or butyrate is which esterase cytochemical stain?
Non-specific esterase
151
Which is most specific for monocytes: Acetate or Butyrate?
Butyrate
152
Which is more sensitive for monocytes:
Acetate or Butyrate?
Acetate
153
Butyrate or Acetate non-specific esterase stain
Acetate
154
Butyrate or Acetate non-specific esterase stain?
Butyrate
155
This cytochemical stain stains glycogen and related components. It is helpful in diagnosing erthroleukemia. Lymphocytes, segmented neutrophils, and nucleated red cells are positive for this stain.
Periodic Acid-Schiff (PAS)
156
Which AMLs are positive for Sudan Black B and Myeloperoxidase?
M1, M2, M3, M4
157
Which AMLs are positive for Non-specific esterase stain?
M4, M5, M6, M7
158
Which leukemias are positive for Specific esterase?
M1, M2, M3, M4
159
Which leukemias are positive for Periodic Acid-Schiff stain?
M6, M7, and Acute lymphocytic leukemia
160
If only PAS is positive and all other stains are negative, what leukemia are we looking at?
ALL
161
If non-specific esterase is positive and all other stains are negative, what leukemia are we looking at?
M5 - Acute Monoblastic Leukemia
162
If both non-specific and specific esterase stains are positive, what leukemia are we looking at?
M4 - Acute Myelomonocytic Leukemia
163
