Hematology Final Flashcards
According to OSHA standards, when must hands be washed?
Hands must be washed before and after patient contact, after distributing specimens, handling body fluids, when visibly contaminated, after removing gloves/PPE, before leaving the clinical work area/lab, and, of course, after using the restroom.
What are Standard Precautions?
Standard precautions require that when working with blood and specimens they are all assumed to be infectious and should be handled in that way via protective measures.
Reticulocyte Production Index
- greater than 3 seen as adequate bone marrow response and less than 2 as inadequate bone marrow response
3 phases of hematopoiesis
- Mesoblastic phase (yolk sac)
- Hepatic phase
- Medullary (myeloid) phase
Organ functions:
- Bone marrow
- Liver
- Spleen
- Lymph nodes
- Thymus gland
- Bone marrow - red marrow = makes cells (RBC, WBC, platelets). White marrow = sinus = “waiting room”
- Liver = major site of production during hepatic phase; back-up site when BM is shut down. Macrophages remove debris
- Spleen = filters circulating blood
- Lymph nodes = lymphocyte production, immunoglobulin processing, and filter lymph fluid
- Thymus gland = T lymphocyte development
Cytokines
- play a major role in differentiating stem cells
- erythropoiesis, leukopoiesis, megakaryopoiesis
Normoblastic Maturation
- Pronormoblast
- Basophilic normoblast
- Polychromatic normoblast
- Orthochromic normoblast
- Reticulocyte
- Erythrocyte
Hypoxia and EPO
Hypoxia = the lack of oxygen in the blood stimulates erythropoeisis by signaling the release of erythropoietin from the kidney
EPO = erythropoietin decreases release time from bone marrow by stimulating the differentiation of stem cells into RBS. Also inhibits apoptosis.
Extravascular vs. Intravascular Hemolysis
Extravascular = destruction of erythrocytes outside of vessels typically in the spleen = 95%
Intravascular = normally only 5% of destruction may occur in vessels.
Synthesis of Hemoglobin
- Heme + Globin pairs
- alpha + non alpha make dimer
- 2 dimers make tetramer
= hemoglobin
What chains make the following hemoglobin:
- A1
- A2
- F
A1 = 2 alpha + 2 beta A2 = 2 alpha + 2 delta F = 2 alpha + 2 gamma
Oxygen Dissociation curve: Left Shift
- reduced p50 = higher oxygen affinity
- higher pH
- decrease in temperature, 2,3 – bisphosphoglycerate (BPG), or partial pressure of carbon dioxide (PCO2)
Iron absorption molecules:
- Hepcidin
- Ferritin
- Ferroporin
- Transferrin
- Hemosiderin
- Hepcidin - regulates iron absorption by inhibiting release of iron from hepatic stores
- Ferritin – major storage from of iron while in the enterocyte cytoplasm.
- Ferroporin - transports iron from enterocyte cytoplasm to plasma.
- Transferrin – transport protein to move iron (Fe 2+) from plasma to a hematopoietic cell in the bone marrow.
- Hemosiderin - storage form of iron in macrophages (water-insoluble)
“rule of three”
Hct = ( Hgb * 3 ) +/- 3
Embden-Meyerhof Pathway
Hexose monophosphate pathway (shunt) = produces NADPH and reduced glutathione to protect red blood cells from oxidative stress by using G6PD.
Methemoglobin Reductase pathway = maintains heme iron in ferrous state (Iron 2+) by using NADPH and the enzyme methemoglobin reductase to reduce methemoglobin to hemoglobin.
Rapaport-Luebering pathway = produces 2,3 DPG which regulates oxygen delivery to tissues.
RBC life span
120 days
Granules found in Neutrophils, Eosinophils, and Basophils
Neutrophils phagocytize to kill invading organisms.Contain secondary, tertiary, and secretory granules
Eosinophils are associated with allergic reactions, parasitic/helminth infections, and chronic inflammation. (cytokines, chemokines, growth factors, cationic proteins.)
Basophils are associated with the mediation of inflammatory responses and hypersensitivity of allergic responses. (histamine, interleukins, growth factors.)
neutrophils vs. lymphocytes vs. monocytes.
Neutrophils are a part of the innate immune system, meaning they are nonspecific.They are well known for their ability to phagocytize in order to destroy pathogens.
Monocytes become macrophages and present antigens to T and B lymphocytes helping initiate the adaptive immune response. They also help by phagocytizing microorganisms that are coated with antibodies. And are also responsible for cleaning up dead cells, debris, and old red blood cells.
Lymphocytes are important in the adaptive immune response because they include B cells (humoral immunity) that produce antibodies, T cells (cellular immunity), and NK cells. Their main function is regulation of the immune response.
Granulocyte maturation
- Myeloblast
- Promyelocyte
- Myelocyte
- Metamyelocyte
- Band Neutrophil
- Segmented Neutrophil
Four examples of unacceptable blood cell artifacts that occur in smears from EDTA tubes
- echinocytic red blood cells
- spherocytes
- necrobiotic leukocytes
- vacuolated neutrophils