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MLT-MLS Spring 2022 > Hematology Exam 4 > Flashcards

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

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2
Q

Percentage of peripheral blood neutrophils that are typically bands

A

<5%

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3
Q

Percentage of white cells that will typically be segmented neutrophils and bands

A

50-70%

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4
Q

What are the 2 groups of neutrophils in the peripheral blood? What is the percentage of each group?

A
  1. Circulating neutrophils 50%
  2. Marginating neutrophils 50%
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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

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6
Q

Macrophages will remove neutrophils in the spleen after how many days?

A

2 days

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7
Q

What are the types of granules in neutrophils?

A
  • Primary
  • Secondary
  • Tertiary
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8
Q

Where are primary granules first seen?

A

Promyelocytes

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9
Q

This granule type is the first to appear in myeloid cells

A

Primary

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10
Q

This granule type is first seen in myelocytes

A

Secondary granules

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11
Q

This granule type is not seen with the Wright’s stain.

A

Tertiary granules

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12
Q

What are other names for the primary granules?

A

Azurophilic and non-specific

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13
Q

What do the primary granules contain?

A

Myeloperoxidase

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14
Q

What is the purpose of myeloperoxidase in primary granules?

A

The enzyme aids in killing microorganisms

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15
Q

In what cell do we first see primary granules?

A

Promyelocytes

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16
Q

What is the purpose of primary granules?

A

Activate proteinases to kill bacteria - but, not as effective as secondary granules

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17
Q

What is another name for secondary granules?

A

Specific granules

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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

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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

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20
Q

The primary function of this cell type is the ingestion and destruction of invading microorganisms

A

Neutrophils

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21
Q

These granules contain lysozymes and other enzymes that hydrolyze bacteria cell walls and help with inflammation

A

Secondary granules

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22
Q

Where are the majority of granulocytes found?

A

Bone marrow

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23
Q

What are the steps of phagocytosis in order? (6)

A
  • Chemotaxis
  • Opsonization
  • Phagocytosis
  • Degranulation/fusion
  • Killing
  • Inflammation
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24
Q

During this step of phagocytosis cells go to the site of infection

A

Chemotaxis

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25
Q

The term for when a cell passes through a vessel wall between endothelial cells and in to tissue in response to infection

A

Diapedesis

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26
Q

This step of phagocytosis is when the neutrophil “recognizes” antibody or complement coated organism

A

Opsonization

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27
Q

The term for a neutrophil ingesting an opsonized organism bu surrounding it and moving it with pseudopods

A

Phagocytosis

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28
Q

Term for the granules of a neutrophil fusing with a phagosome and activating

A

Degranulation

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29
Q

Term for a neutrophil reducing oxygen in order to generate hydrogen peroxide

A

Oxidative or respiratory burst

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30
Q

Myeloperoxidase reacts with the hydrogen peroxide created during the neutrophils oxidative burst and together, what do these form?

A

Hypochlorous acid (bleach component)

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31
Q

What is the effect of hypochlorous acid on the engulfed microorganism?

A

Causes lipid damage to microbial membrane

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32
Q

What can occur if granules and metabolites leak to surrounding tissue?

A

Inflammation that may cause swelling and fever

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33
Q

What granules degrade the extracellular matrix of the neutrophil and act as chemotactic agents?

A

Tertiary granules

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34
Q

TRUE or FALSE:

A function of the neutrophil is as a source of transcobalamin I

A

TRUE

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35
Q

Term for when neutrophils leave thread-like structures from unfolded DNA that can trap and kill bacteria

A

Neutrophil extracellular traps (NET)

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36
Q

Term for the percentage of a cell type based on a 100-cell differential

A

Relative count

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37
Q

How is absolute count calculated?

A

Relative % x WBC count

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38
Q

Term for increased number of neutrophils

A

Neutrophilia

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39
Q

What are the different qualitative neutrophil changes that may be observed in infection?

A
  • Toxic granulation
  • Dohle bodies
  • Vacuolization
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40
Q

TERM:

Prominent cytoplasm primary granules seen in infection

A

Toxic granulation

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41
Q

TERM:

Strands of endoplasmic reticulum RNA observed in infection

A

Dohle bodies

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42
Q

TERM:

Occurs in the cytoplasm due to phagocytosis

A

Vacuolization

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43
Q

Range for WBC count

A

3,600 - 10,600/uL

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44
Q

Relative count for neutrophils

A

50 - 70%

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45
Q

Absolute count for neutrophils

A

1,700 - 7,500/uL

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46
Q

Relative count for lymphocytes

A

18 - 42%

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47
Q

Absolute count for lymphocytes

A

1,000 - 3,200/uL

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48
Q

Relative count for monocytes

A

2 - 11%

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49
Q

Absolute count for monocytes

A

100 - 1,300/uL

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50
Q

What are some causes of neutrophilia?

(4)

A
  • Bacterial infections
  • Stress
  • Inflammation
  • Malignant disorders such as leukemias
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51
Q

Term for decreased neutrophil count

A

Neutropenia

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52
Q

What are some causes of neutropenia?

A
  • Leukemia (typically because of chemotherapy)
  • Aplastic anemia
  • Infection
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53
Q

TRUE or FALSE:

Children have an inverse segmented neutrophil/lymphocyte ratio

A

TRUE

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54
Q

Congenital causes of neutropenia

A
  • Failure of production
  • Failure of bone marrow to release
  • Destruction
  • Misdistribution of cells
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55
Q

Causes of acquired neutropenia

A
  • Viral infections
  • Depletion of neutrophi storage pool in marrow
  • Chemotherapy of other drugs
  • Blood malignancies
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56
Q

Relative range for eosinophils

A

1 - 3%

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57
Q

High numbers of this cell type are seen in allergies, parasitic infections, and some leukemias

A

Eosinophils

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58
Q

Relative count for basophils

A

0 - 2%

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59
Q

What do the granules in basophils contain?

A

Histamine and heparin

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60
Q

A high count of this cell type is observed in CML and other myeloproliferative disorders.

A

Basophils

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61
Q

This cell type is a receptor for IgE and is involved in anaphylaxis and immediate hypersensitivity

A

Basophils

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62
Q

High numbers of this cell type are seen in some leukemias, bacterial infections, and rickettsial infections

A

Monocytes

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63
Q

DEFINITION:

The term used when any white count is >12,000/uL

A

Leukocytosis

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64
Q

DEFINITION:

Term used when a white cell count is <1,500/uL

A

Leukopenia

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65
Q

This qualitative deficiency occurs when the cell does not respond to stimuli

A

Chemotaxis deficiency

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66
Q

This type of qualitative WBC deficiency is autosomal recessive and causes partial albinism as well as recurrent pyrogenic infections

A

Chediak-Higashi Syndrome

67
Q

TRUE or FALSE:

Chediak-Higashi syndrome is a rare but fatal autosomal recessive condition

68
Q

Giant fused lysosome granules are seen in this qualitative WBC disorder

A

Chediak-Higashi syndrome

69
Q

In this qualtitative WBC disorder there is no respiratory burst to activate H2O2

A

Chronic Granulomatous Disorder

70
Q

What test do we perform to confirm chronic granulomatous disorder?

A

Nitroblue Tetrazolium Reduction Test

71
Q

TRUE or FALSE:

The Nitroblue Tetrazolium Reduction Test will cause a dark blue reaction in chronic granulomatous diseased neutrophils

A

FALSE

CGD neutrophils will have no reaction

72
Q

This qualitative disorder of WBCs is a benign inherited condition that has Dohle body-like inclusions

A

May-Hegglin Anomaly

73
Q

In May-Hegglin anomaly, what are the Dohle-like inclusions composed of?

A

Precipitated myosin heavy chains

74
Q

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

A

Alder-Reilly Anomaly

75
Q

How can you differentiate Alder-Reilly anomaly from toxic granulation?

A

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
Q

This qualitative WBC disorder includes bleeding problems, giant platelets, and Dohle body-like inclusions

A

May-Hegglin anomaly

77
Q

In this qualitative WBC disorder neutrophils have 1 or 2 lobes. There is no problem with cell function.

A

Pelger-Huet anomaly

78
Q

This WBC disorder is due to a mutation on the lamin beta receptor gene

A

Pelger-Huet anomaly

79
Q

Where might you see pseudo Pelger-Huet?

A
  • Myeloproliferative disorders
  • Burns
  • Drug reactions
  • Infections
80
Q

Bi-lobed nuclues resembling spectacles or dumbells

A

Pelger-Huet anomaly

81
Q

LE cells was an old method used in the lab for detecting what autoimmune disease?

A

Systemic Lupus Erythematosus

82
Q

What test(s) replaced LE cells?

A

ANA and ENA

83
Q

Intracellular homogenous material observed in segmented neutrophils

84
Q

Autosomal recessive disorder caused by defect in enzyme needed for glycolipid metabolism. Most commonly observed in ethnic Jews.

A

Gaucher’s disease

85
Q

“Tissue paper” histiocytes caused by a defect in beta-glucocerebrosidase which is necessary for glycolipid metabolism

A

Gaucher’s disease

86
Q

Autosomal recessive lipid storage disease caused by a defect in lysosomal hydrolase enzyme sphingomyelinase.

A

Niemann-Pick

87
Q

Macrophages with foamy cytoplasm packed with lipid filled lysosomes

A

Neimann-Pick

88
Q

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

89
Q

Types of myeloproliferative disorders (4)

A

Myelofibrosis

CML

Polycythemia Vera

Essential Thrombocythemia

90
Q

DEFINITION:

Clonal hematopoietic stem cell diseases with expansion, excessive production, and over-accumulation of cells

A

Myeloproliferative disorders

91
Q

What is another name for primary myelofibrosis?

A

Agnogenic (unknown origin) myeloid metaplasia

92
Q

This myeloproliferative disorder produces a leukroerythroblastic state in which tear drop RBCs, large bizarre platelets, and micromegakaryocytes are seen.

A

Myelofibrosis

93
Q

What myeloproliferative disorder typically results in a dry marrow tap?

A

Myelofibrosis

94
Q

Bizarre platelets as well as micromegakaryocytes are seen with this myeloproliferative disorder

A

Myelofibrosis

95
Q

What stains can be used on bone marrow samples to show increased reticulin due to myelofibrosis?

A

Trichrome or Silver stain

96
Q

Myeloproliferative Disorders:

  • Very high WBC count
  • Philadelphia chromosome
  • Decreased LAP score
A

Chronic Myelocytic Leukemia

97
Q

Normal LAP score

98
Q

CML LAP score

A

< 20 (typically around 7)

99
Q

Also known as BCR-ABL transolcation or Chromosome 22

A

Philadelphia chromosome

100
Q

This stain is used to distinguish between leukemoid reaction due to infection and CML

A

Leukocyte Alkaline Phosphatase (LAP)

101
Q

Leukemoid reaction LAP score

102
Q

Myeloproliferative Disorders:

Stem cell disorder that affects all three cell lines: RBCs, WBCs, and platelets
Often ends in myelofibrosis

A

Polycythemia Vera

103
Q

Myeloproliferative Disorders:

Often presents with headache, abdominal pain, hypertension, and ruddy complexion

A

Polycythemia Vera

104
Q

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

A

Polycythemia Vera

105
Q

Myeloproliferative Disorders:

What gene mutation is associated with PV?

106
Q

Myeloproliferative Disorders:

  • Increase in all cell lines
  • Decreased erythropoietin levels
  • Increased RBC mass (often >7million/uL)
  • Normal O2 saturation
  • Increased hemoglobin
A

Polycythemia Vera

107
Q

This type of polycythemia is due to dehydration, heavy smoking, or obesity. Decreased plasma causes blood to become too concentrated.

A

Relative polycythemia

108
Q

This type of polycythemia is due to increased erythropoietin or decreased oxygen delivery. Could be due to COPD or emphysema.

A

Secondary polycythemia

109
Q

Myeloproliferative Disorders:

Clonal disorder of platelets involving a single multipotential stem cell
-Platelets are easily activated and clot of malfunction and hemorrhage occurs

A

Essential Thrombocythemia

110
Q

Myeloproliferative Disorders:

  • High platelet count >1,000,000/uL
  • Micromegakaryocytes and bare nuclei may be present on peripheral blood smear
A

Essential Thrombocythemia

111
Q

Disorder caused by an increased platelet count secondary to an existig problem such as acute hemorrhage, trauma, chronic infection, IDA, or malignancy.

A

Relative thrombocytosis

112
Q

Leukemia VS Lymphoma:

Starts in the bone marrow and spreads through the blood and into the reticuloendothelial system

113
Q

Leukemia VS Lymphoma:

Begins in the lymph nodes

114
Q

Most common type of leukemia in adults

A

Acute myeloid leukemia

115
Q

FAB criteria for diagnosis of AML

A

>30% blasts

Hypercellular bone marrow

116
Q

Fusion or bundles of primary granules seen in cells of the bone marrow. Indicates AML, AMML, or AMoL

117
Q

M0 is also known as?

A

Acute Myeloblastic Leukemia with minimal differentiation

118
Q

What stains are negative for M0?

A

Myeloperoxidase and Sudan Black B

119
Q

Will you see Auer Rods in M0 AML?

120
Q

FAB classification for Acute Myeloblastic Leukemia with minimal differentiation?

A

M0 (M-null)

121
Q

FAB classification for Acute Myeloblastic Leukemia without maturation

122
Q

Another name for FAB classification M1

A

Acute Myeloblastic Leukemia without maturation

123
Q
  • Worst type of AML to have
  • 90% of cells are primarily blasts
  • Auer Rods may be seen
A

M1 - Acute Myeloblastic Leukemia without maturation

124
Q

What cytochemical stains are positive for M1?

A
  • Myeloperoxidase
  • Sudan Black B
  • Specific Esterase
125
Q

This AML has chromosome abnormality t(8;21) as well as >20% blasts

A

M2- Acute Myeloid Leukemia with maturation

126
Q

Name for FAB classification M2

A

Acute Myeloid Leukemia with maturation

127
Q

TRUE or FALSE:

You will see maturation beyond promyelocytes in the bone marrow with M2 AML

128
Q

Will you see Auer Rods in Acute Myeloid Leukemia with maturation?

129
Q

Name for M3

A

Acute Promyelocytic Leukemia

130
Q

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

A

M3 - Acute Promyelocytic Leukemia

131
Q

DIC often occurs with which AML?

A

M3 - Acute Promyelocytic Leukemia

132
Q

What stains are positive with M3?

A

Peroxidase and Sudan Black B

133
Q

Name(s) for FAB M4

A

Acute Myelomonocytic Leukemia

or

Naegli

134
Q

In this AML, cells have features of monocytes and immature granulocytes. Myeloblasts and monoblasts are present.

A

M4 - Acute myelomonocytic leukemia

135
Q

What stains are positive with AML M4?

A

Specific and non-specific esterase

136
Q

Name(s) for FAB M5 AML

A

Acute monocytic leukemia

or

Schilling leukemia

137
Q

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.

A

M5 Acute monocytic leukemia

138
Q

What stain is positive with M5?

What stain is negative with M5?

A

Positive: Non-specific esterase

Negative: Specific esterase

139
Q

Name(s) for FAB M6 AML

A

Acute erythroid leukemia

or

Erythroleukemia

or

DiGuglielmo’s

140
Q

With this AML NRBCs, and myeloblasts are seen in the peripheral blood. >50% of nucleated bone marrow cells are normoblasts and >20% are myeloblasts.

A

M6 Acute erythroid leukemia

141
Q

When diagnosing M6 AML, you need to be able to differentiate it from what other disorders?

A

-Megaloblastic anemia - has hypersegmented neutrophils

and

-Myelodyplastic syndrome Polycythemia Vera - has less NRBCs and bone marrow will look different

142
Q

Name for FAB M7 AML

A

Acute megakaryoblastic leukemia

143
Q

This AML is very rare

  • Related to myelofibrosis
  • Blasts have abundant budding cytoplasm
  • Platelet count is normal or high
  • Platelet peroxidase is specific
A

M7 - Acute megakaryoblastic leukemia

144
Q

This cytochemical stain is useful in differentiating blasts in AML from ALL blasts because the enzyme is found in primary granules of myeloid cells

A

Myeloperoxidase

145
Q

This cytochemical stain is useful in differentiating AML from ALL. It stains the phospholipids, neutral fats, and sterols found in primary and secondary granules.

A

Sudan Black B

146
Q

These cytochemical stains are used to differentiate neutrophilic granulocytes from cells on monocytic origin

147
Q

Specific esterase is positive for which cell type?

A

Myeloid cells

148
Q

Naphthol AS-D Chloroacetate is which esterase cytochemical stain?

A

Specific esterase

149
Q

Non-specific esterase is positive for which cell line?

150
Q

Alpha-naphthyl acetate or butyrate is which esterase cytochemical stain?

A

Non-specific esterase

151
Q

Which is most specific for monocytes: Acetate or Butyrate?

152
Q

Which is more sensitive for monocytes:

Acetate or Butyrate?

153
Q

Butyrate or Acetate non-specific esterase stain

154
Q

Butyrate or Acetate non-specific esterase stain?

155
Q

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.

A

Periodic Acid-Schiff (PAS)

156
Q

Which AMLs are positive for Sudan Black B and Myeloperoxidase?

A

M1, M2, M3, M4

157
Q

Which AMLs are positive for Non-specific esterase stain?

A

M4, M5, M6, M7

158
Q

Which leukemias are positive for Specific esterase?

A

M1, M2, M3, M4

159
Q

Which leukemias are positive for Periodic Acid-Schiff stain?

A

M6, M7, and Acute lymphocytic leukemia

160
Q

If only PAS is positive and all other stains are negative, what leukemia are we looking at?

161
Q

If non-specific esterase is positive and all other stains are negative, what leukemia are we looking at?

A

M5 - Acute Monoblastic Leukemia

162
Q

If both non-specific and specific esterase stains are positive, what leukemia are we looking at?

A

M4 - Acute Myelomonocytic Leukemia

MLT-MLS Spring 2022 (14 decks)

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