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AMT MLS Exam - Hematology > Hematology - Hematopoiesis, Erythropoiesis, & Stains > Flashcards

Hematology - Hematopoiesis, Erythropoiesis, & Stains Flashcards

1
Q

What is a Romanowsky stain?

A

a nonvital (dead cell) polychrome stain

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2
Q

List the 4 Romanowsky stains.

GWML

A
  1. Giemsa stain
  2. Wright and Wright-Giemsa stain
  3. May-Grunwald stain
  4. Leishman stain
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3
Q

List the components of a Wright stain.

A
  1. methylene blue - a basic dye that stains acidic cellular components BLUE (DNA and RNA)
  2. eosin - an acidic dye that stains basic components red-orange (hemoglobin and eosinophilic cytoplasmic granules)
  3. methanol fixative - fixes cells to slide
  4. phosphate buffer (6.4)
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4
Q

What is Prussian blue?

A

a nonvital monochrome stain - stains specific cellular components

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5
Q

Lis the components of a Prussian blue stain.

A
  1. potassium ferrocyanide
  2. HCL
  3. safranin counterstain
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6
Q

What is Prussian blue used to visualize?

IHU

A
  1. iron granules in RBCs (siderotic iron granules)
  2. histiocytes
  3. urine epithelial cells
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7
Q

List the supravital (living cell) monochrome stains.

A
  1. new methylene blue
  2. neutral red with brilliant cresyl green as a counter stain
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8
Q

What is new methylene blue used for?

A

to precipitate RNA in reticulocytes => measure of bone marrow erythropoeisis

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9
Q

What is neutral red/brilliant cresyl green used for?

A

visualize Heinz bodies => G6PD deficiency and other unstable hemoglobin disorders

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10
Q

Are fixatives used in supravital stains?

A

no

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11
Q

Where does hematopoiesis occur in the fetus?

A

1-2 mo: yolk sac (primitive erythroblasts; embryonic hgb - Gower I, Gower II, & Portland)

3-6 mo: liver spleen (liver is primary site)

7 mo - 4 yr: bone marrow (ALL marrow is active)

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12
Q

List the organs of the reticuloendothelial system (RES).

A
  1. bone marrow
  2. spleen
  3. liver
  4. thymus
  5. lymph nodes
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13
Q

List the functions of the reticuloendothelial system.

A
  1. hematopoiesis
  2. phagocytosis
  3. immune defense
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14
Q

List the location of active marrow in adults.

A

flat bones

  1. skull
  2. sternum
  3. pelvis
  4. ribs
  5. vertebrae
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15
Q

Which hormone regulates the rate of erythropoiesis?

A

Erythropoietin (EPO)

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16
Q

Explain blood cell maturation.

A
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17
Q

Where and when is EPO produced?

A

-produced by the kidneys in response to cellular hypoxia and stimulates stem cells in the bone marrow, primarily CFU-E, to mature into erythrocytes

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18
Q

Which cells are derived from a common myeloid progenitor (CMP) cell in the bone marrow?

A

-erythrocytes
-granulocytes
-monocytes
-thrombocytes (platelets)

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19
Q

What is the precursor of the platelet?

A

megakaryocyte

-platelets are fragments of megakaryocyte cytoplasm

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20
Q

Where are lymphocytes produced?

A
  1. primary lymphoid tissue (thymus and bone marrow)
  2. spleen
  3. lymph nodes
  4. intestine-assoc. lymphoid tissue
  5. tonsils
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21
Q

What is the normal lifespan of an erythrocyte?

A

120 days

-phagocytic cells of the RES removed aged RBCs from circulation
-iron and globin chains are recycled
-heme is degraded and excreted as bilirubin

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22
Q

In a normal individual, what % of RBCs is replaced daily?

A

1%

-reticulocytes are released from the bone marrow into the circulation to replace aged cells removed by the RES

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23
Q

In the primary lymphoid tissue, what is the site of pre-B cell differentiation?

A

bone marrow

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24
Q

In the primary lymphoid tissue, what is the site of pre-T cell differentiation?

A

thymus

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25
Q

What is antigen-independent lymphopoiesis?

A

pre-B and pre-T cell differentiation in the primary lymphoid tissues

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26
Q

What is antigen-dependent lymphopoiesis?

A

lymphopoiesis that depends on antigenic stimulation of T and B lymphocytes

-occurs in secondary lymphoid tissue - lymph nodes, spleen, gut-associated tissue (Peyer’s patches)

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27
Q

What happens to the nuclear:cytoplasmic (N:C) ratio as most cells mature?

A

the ratio decreases as the volume of the nucleus decreases

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28
Q

What is the best indicator of the age of a cell?

A

that amount of chromatin clumping in the nucleus

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29
Q

What is the color of the cytoplasm in blasts?

A

royal blue due to the presence of RNA

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30
Q

What is the significance of nucleoli in a cell nucleus?

A

they are sites of ribosomal RNA synthesis

-seen in the nuclei of immature cells and reactive lymphocytes

-indicate that the cell is capable of mitosis

31
Q

How are leukocytes classified?

A
  1. phagocytes (granulocytes, monocytes)
  2. immunocytes (lymphocytes, plasma cells, monocytes)
32
Q

List the granulocytes.

A
  1. neutrophils
  2. basophils
  3. eosinophils
33
Q

What leukocyte is the first to reach the tissues and phagocytize bacteria?

A

neutrophils

34
Q

Which leukocyte arrives at the site of inflammation after neutrophils?

A

macrophages (monocytes in tissues)

35
Q

What type of immunity do T lymphocytes provide?

A

cellular immunity

36
Q

What lymphocyte makes up 80% of lymphocytes in the blood?

A

T lymphocytes

37
Q

When activated, what to T lymphocytes produce?

A

cytokines/interleukins

38
Q

What do B lymphocytes develop into in the tissue?

A

plasma cells

39
Q

What do B lymphocytes produce?

A

antibodies

40
Q

What type of immunity do B lymphocytes provide?

A

humoral immunity

41
Q

What is the function of natural killer (NK) lymphocytes?

A

destroy tumor cells and cells infected with viruses

-also known as large granular lymphocytes (LGLs)

42
Q

What is the function of eosinophils?

A

modulate allergic response caused by basophil degranulation

43
Q

What is the function of basophils?

A

mediate immediate hypersensitivity reactions (type I, anaphylactic)

44
Q

Name the stages of development in the erythrocytic series, using 2 systems of nomenclature.

A
  1. rubriblast (pronormoblast)
  2. prorubricyte (basophilic normoblast)
  3. rubricyte (polychromatophilic normoblast)
  4. metarubricyte (orthochromic normoblast)
  5. diffusely basophilic erythrocyte (polychromatophilic erythrocyte/reticulocyte)
  6. mature erythrocyte
45
Q
A

Pronormoblast

14-24 um
N:C ratio is 8:1
royal blue cytoplasm
fine chromatin
1-2 nucleoli
normally confined to the bone marrow

46
Q

-14-24 um
-N:C ratio is 8:1
-royal blue cytoplasm
-fine chromatin
-1-2 nucleioli
-normally confined to the bone marrow

A

Pronormoblast

47
Q
A

Basophilic normoblast

12-17 um
N:C ratio of 6:1
deep blue cytoplasm
chromatin is coarser with slightly visible parachromatin
nucleoli usually not visible
normally confined to the bone marrow

48
Q

-12-17 um
-N:C ratio of 6:1
-deep blue cytoplasm
-chromatin is coarser with slightly visible parachromatin
-nucleoli usually not visible
-normally confined to the bone marrow

A

basophilic normoblast

49
Q
A

polychromatophilic normoblast

10-15 um
N:C ratio is 4:1
cytoplasm is polychromatophilic due to hemoglobin production
chromatin is clumped with distinct areas of parachromatin (spoke-like pattern)
last stage to divide
normally confined to the bone marrow

50
Q

-10-15 um
-N:C ratio is 4:1
-cytoplasm is polychromatophilic due to hemoglobin production
-chromatin is clumped with distinct areas of parachromatin (spoke-like pattern)
-last stage to divide
normally confined to the bone marrow

A

polychromatophilic normoblast

51
Q
A

Orthochromic normoblast

-8-12 um
-N:C ratio is 1:2
-nucleus is pyknotic
-last nucleated stage
-normally confined to the bone marrow

52
Q

-8-12 um
-N:C ratio is 1:2
-nucleus is pyknotic
-last nucleated stage
-normally confined to the bone marrow

A

orthochromic normoblast

53
Q
A

polychromatophilic erythrocyte

-7-10 um
-no nucleus
-cytoplasm is diffusely basophilic (bluish tinge)
-reticulum seen with supravital stain
-0.5-1.5% of RBCs in adult peripheral blood

54
Q

-7-10 um
-no nucleus
-cytoplasm is diffusely basophilic (bluish tinge)
-reticulum seen with supravital stain
-0.5-1.5% of RBCs in adult peripheral blood

A

polychromatophilic erythrocyte

55
Q
A

mature erythrocyte

-7-8 um
-biconcave disk
-reddish-pink cytoplasm with area of central pallor 1/3 diameter of cell

56
Q

-7-8 um
-biconcave disk
-reddish-pink cytoplasm with area of central pallor 1/3 diameter of cell

A

mature erythrocyte

57
Q

What is the last nucleated stage in the development of an erythrocyte?

A

orthochromic normoblast (metarubricyte)

58
Q

What is asynchronous erythropoiesis?

A

the nucleus and cytoplasm mature at different rates

59
Q

What causes megaloblastic asynchronous erythropoiesis?

A

vitamin B12 and/or folic acid deficiency

60
Q

Explain megaloblastic asynchronous erythropoiesis.

A

-nucleus lags behind cytoplasm in maturation
-cells grow larger without dividing

61
Q

What characteristics of megaloblastic asynchronous erythropoiesis are seen on the peripheral smear?

A

oval macrocytes

62
Q

What causes iron deficiency asynchronous erythropoeisis?

A

iron deficiency - reduces erythropoietin production

63
Q

Explain iron deficiency asynchronous erythropoiesis.

A

-cytoplasm lags behind nucleus in maturation due to inadequate iron for hemoglobin synthesis

64
Q

What characteristic is seen on the peripheral smear in iron deficiency asynchronous erythropoiesis?

A

microcytic, hypochromic RBCs

65
Q

What is the best way to judge the size of an erythrocyte on a Wright-stained smear?

A

a normocytic RBC is approx. the same size, or slightly smaller than the nucleus of a mature lymphocyte

66
Q

What is the first sign of accelerated erythropoiesis?

A

increased reticulocyte count

67
Q

What substances are needed for erythropoiesis?

A
  1. iron
  2. amino acids
  3. folic acid/B12
  4. erythropoietin
  5. vitamin B6
  6. trace minerals
68
Q

Why is iron needed for erythropoiesis?

A

transports oxygen

(ferrous state - Fe2+)

69
Q

Why are amino acids needed for erythropoiesis?

A

globin-chain synthesis

70
Q

Why are folic acid and B12 needed for erythropoiesis?

A

DNA replication/cell division

71
Q

How does the size of a cell change during maturation?

A

becomes smaller

72
Q

How does the N:C ratio of a cell change during maturation?

A

becomes smaller

73
Q

How does the cytoplasm of a cell change during maturation?

A

-less basophilic due to loss of RNA
-granulocytes produce granules
-erythrocytes become pink due to hemoglobin production

74
Q

How does the nucleus of a cell change during maturation?

A

-becomes smaller
-nuclear chromatin condenses
-nucleoli disappear
-in granulocyte series = nucleus indents, then segments
-in erythrocyte series = nucleus is extruded

AMT MLS Exam - Hematology (6 decks)

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