Hematology Polansky Review Flashcards
Erythropoesis
1-2 mos gestation
yolk sac and gonads, primative erythroblasts
3-6mos gestation erythropoesis
liver and spleen, Liver is primary site
7mos - age 4 erythropoesis
bone marrow, all marrow active
Adult erythropoesis
bone marrow, pelvis vertebrae, sternum and skill, long bones filled with fat
Rubriblast
pronormoblast
proubricyte
basophilic normoblast
rubricyte
polychromatophilic normoblast, last stage to divide
metarubricyte
orthochromic normoblast
last nucleated stage
reticulocyte
poly erythro, seen with supravitial stain
pH 8.6 hgb electrophoresis
A2/C, S, F, A
(crawl, slow, fast, accelerated)
pH 6.2 hgb electrophoresis
F, A/A2, S, C
Methemoglobin
iron oxidized to ferric state, can’t bind 02 cyanosis, death,
Heinz bodies
Sulfhemoglobin
sulf bound to heme, aquired from drugs/chem
cyanosis, cant be converted back
carboxyhemoglobin
carbon bound, decreased O2 to tissues, affinity 200x greater
cherry red skin
Macrocytes
megaloblastic, liver disease, retics, normal in newborns
microcytes
IDA, thalassemia, ACI
Elliptocytes/ovalocytes
membrane defect, HE
Crenated cells
osmotic imbalance
Burr cells (echinocytes)
membrane defect, uremia, PK def
Acanthocytes
membrane defect, severe liver disease, abetalipoproteinemia
Teardrops (dacryocytes)
myelofibrosis, thalassemias
hypochromia
IDA, thalassemia
Target cells
hgbop, thalassemia, liver disease
Stomatocytes
HS, HS, thalassemia, RH null, alc cirrhosis
Rouleax
serum protein abnormality, MM macrogolbulinemia
Basophilic stipping
RNA aggregates, lead, abn hgb synth
HJ bodies
DNA remnents, pitted by spleen, post splenectomy, hemolytic anemias
Cabot rings
mitotic spindle, fragments, rapid blood regen, MBA, thal, splenectomy
pappenheimer
iron, faulty iron utilization, SBA, Post splen, thal, hemochromatosis
Reticulocytes
residual RNA
Heinz bodies
precipitated, oxidized hgb, G6PD, chemical injuries
Hemoglobinopathy
qualitative abnormality, abnormality in amino acid sequences
(ex. sickle cell, hgb c..etc)
Thalassemia
quantitative abnormality, under production of 1 or more globulin chains
(B-thal minor)
Folate Deficiency
n
m
h
impaires?
pan
increases?
nutritional deficiency, megaloblastic, HA, impaires DNA synth
pancytopenia, Increase LD
Vit B12 dEF
Megaloblastic, nutritional def, malab, parasites
pernicious anemia most common type
Sideroblastic anermia
defect in heme synth, dual RBC pop, rbc indicies normal, ringed sideroblasts
B-thal major
dec betal chain production,
micro hypo
B-thal minor
mild anemia, micro hypo,
Anemia of chronic inflammation
Micro hypo, AFR affect iron absorbtion, iron in bone marrow not released, 2nd most common
Promyelocyte
primary (nonspecific) granules
myelocyte
specific granules, last stage to divide
MPN/MPD
overproduction of 1 or more myelod cell lines, increased RBCs, 1 cell line dominant
(ex PV, CML)
myelodysplastic syndroms (MDS)
ineffective hematopoesis in 1 or more cell lines, hypercellular bone marrow
common in elderly
Myeloperoxidase
+ AML
= ALL
Sudan Black
+ AML
= ALL
Nap AS-D (specific esterase)
+ AML
= ALL
PAS
= AML
+ ALL
Multiple myeloma
plasma cells in marrow, norm/norm, rouleaux, M spike, bence jones, osteolytic lesions
Plasma cell leukemia
form of MM, plasma cells in peripheral, pancytopenia, monoclonal gamm
Walderstroms
malig Lymphs-plasma cells, increased IgM
Microhematocrit
screening for anemia
Osmotic fragility
increased in HS, decreased with target cells, SS, IDA
Donathan-landsteiner test
Paroxymal cold hgb, auto-P ab
Electrical impedance (coulter principle)
cell counting and size
Radio frequency
WBC differential
Opitcal light scatter (flow)
cell counting size and diff
Forwards scatter
volume/size of cell
Side scatter
complexity/internal structures, gating
Rule of three
RBC X 3 = hgb
Hgb X 3 = HCT
Primary Hemostasis
vasocontrisction
plt adhesion
plt aggregation
plt plug
Secondary hemostasis
coag factors to produce fibrin
XIII
Fibrinolysis
relase of TPa
plasminogen to plasmin
Fibrin to FDP
Bernard Soulier
lack of GP IB on plt w VWF, abn plt adhesion
giant plts, abn to ristocetin
Glanzmanns thrombastheina
def of GP IIB/IIIa, fibrinogen cant attach,
abn agregg w ADP, Epi and Collagen
Delta storage pool def
dense gran def
lack of ADP release
abn secondary agg with ADP and EPI
I
fibrinogen
converted to fibrin by thrombin
II
prothrombin, precoursor of thrombin
III
TFIII, released from vessle walls, not norm in blood
IV
Ca+, bound by sodium citrate
V
labile
VII
stable
VIII
hemophilia A, circulates with VWF, extremely labile
IX
christmas factor, hemophilia B
X
stuart factor
XI
hemophilia C, may or may not cause bleeding
XII
hageman, no bleedig, contact factor, not in vivo
XIII
fibrin stabilizing, poor wound healing
HMWK
fitzgerald, no bleeding, not part in vivo
PK
fletcher, thrombosis, not in vivo
Contact factors
PK, HMWK, XII, XI
Prothrombin group
II, VII, IX, X
Fibrinogen group
I, V, VIII, XIII
Common path
I, II, V, X
Extrinsic tenase complex
VIIa/Tf acts on X
Intrinsic complex
IXa/VIIIa acts on X
prothrombinase complex
Xa/Va acts on II
Vit K dependent factors
II, VII, IX, X
Affected by coumadin (warfarin)
II, VII, IX, X
all require vit K
consumed during clotting
I, II, V, VIII, XIII not present in serum
PT
extrinsic and common path
monitors coumadin (warfarin)
INR
APTT
intrinsic/common
UFH
Pt prolomged Aptt norm
VII
Pt norm
Aptt prolonged
HMWK, PK, XII, XI ,IX, VIII
both PT, APTT prolonged
X, I, II, V
Mixing studies
1:! mix of pt and normal plasma, if pt has a def it will be corrected with normal plasma, if not corrected, it is an inhibitor
ACT (activated clotting time)
cardiac care unit/surgery to monitor heparin
TT. (thrombin time)
measures fibringogen to fibrin, prolonged with hypo/dys fibrinogenemia, heparin FDPs
Reptilase time
using snake venom, prolonged with afibrinogenemia, not affected by heparin
XIII factor screening test
Cacl2 urea clot lysis, clot dissolves in 24hr
Anti Xa assay
LMWH, UFH, color inversely proportional to heparin concentration
VW disease
bleeding, abn w ristocetin, normal plts
increased APTT
most common inherited disorder
Hemophilia A
VIII, bleeding, norm PLts,
Inc APTT
dec VIII,
sex linked in males
Hemophilia B
IX, bleeding, sex linked
D-Dimer
lysis of fibrin by plasmin, marker for DIC, neg in primary fibrinolysis
FDP
plasmin on fibrin or fibrinogen, increased fibrinolytic activity, DIC
AT
plasma inhibitor, increased thrombosis w def
Protein C
coag inhibitor, inactivates Va, VIIIa, def = thrombosis
Protein S
cofactor for C
Factor V leiden
APC, V resistant to APC, thrombiosis, APTT/DRVVT
Lupus anticoagulants
thrombosis/abortion, phospholipids
HCT >555
prolonged times, anticoag must be reduced
