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Hematopoiesis and Peripheral Blood > Hematopoiesis and Peripheral Blood > Flashcards

Hematopoiesis and Peripheral Blood Flashcards

1
Q

Describe the hematopoietic cell compartment

A

highly vascularized, erythroblastic and myeloid areas

hematopoietic stem cells, committed precursor, maturing cells

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2
Q

Describe the components of the marrow stromal compartment

A

endothelial cells= barrier
adipocytes= energy
stromal and fibroblasts= structure
macrophages, GFs from endo cells

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3
Q

What does SCF do?

A

weak factor but 1st in cascade, produced by fetal tissue and bone marrow, makes stem cells responsive to other cytokines

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4
Q

What does IL-3 do?

A

replication and growth potential of progenitors

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5
Q

What does IL-6 do?

A

stimulates megakarocytes and neutrophil production, key in leukmoid reaction

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6
Q

What is/are the GFs fro T cells?

A

IL-2

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7
Q

What is/are the GFs for B cells?

A

IL2 and IL6

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8
Q

What does M-CSF do?

A

increase monocytes and macrophages

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9
Q

What makes G-CSF? What is it affect? What can it be used for?

A

Macrophages, fibroblasts, and endothelial cells

Increase in neutrophils

Treatment for neutropenia after chemo or none marrow transplant

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10
Q

What makes GM-CSF? What is its affect?

A

Endothelial cells, T cells, fibroblasts, and monocytes
Stimulate formation of leukocytes and reticulocytes
comparable to G-CSF but no used therapeutically in US

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11
Q

Where is EPO made? What does it do?

A

Kidneys

RBC production, treatment for anemia

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12
Q

Where is TPO made? What does it do?

A

Liver

Megakarocytes and platelet production

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13
Q

What are the histological features of proerythroblasts?

A

large round cell, mild basophilia

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14
Q

What are the histological features of basophilic erythroblasts?

A

smaller cells, deeply basophilic cytoplasms

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15
Q

What are the histological features of polychromatophilic erythroblasts?

A

basophilic ribosomes, eosinophilic cytoplasm

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16
Q

What are the histological features of normoblasts?

A

eosinophilic cytoplasm, resembles erythrocytes

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17
Q

What are the histological features of reticulocytes

A

enlarged immature erythrocytes with residual reticular network of RER, light purple, polychromatic
count increased in hemolytic anemia

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18
Q

What is the cell progression in granulocytic leukopesis?

A

Myeloblast= no granules, basophilic cytoplams

Promeylocyte= cytoplasm with large black/purple granules, nucleoi

Myelocyte= eccentric round oval nucleus, primary auzophilic and fine 2’ predominates

Metamyelocyte= juvenile granulocyte, indented nucleus

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19
Q

What are the steps in lymphocytic leukopoiesis?

A

B and T lymphoblasts with no cytoplasmic granules

B and T Cells, T cells mature in thymus

B cells –> plasma cell which are produced from activated B-cells in spleen and LN with help of T cells then go back to bone marrow

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20
Q

What are the histological features of plasma cells?

A

eccentrically placed nucleus with perinuclear hoff

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21
Q

What are the histological features of megakaryoblasts?

A

Large oval or kidney shape nucleus, basophilic cytoplasm

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22
Q

What are the features of megakarocytes?

A

Large multi-lobed nucleus due to endomitosis (nuclear division without cell division)
Plasma membrane invaginate and platelets break off

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23
Q

What is the progression of a stem cell to a macrophage and what compartments does this happen in?

A

Stem cell –> monoblast in bone marrow –> monocyte in blood which travels 24 hrs –> tissue macrophage –> activated macrophage, microglia, kupffer cells, alveolar macrophages, and osteoclasts

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24
Q

What is plasma composed of?

A

50% of blood sample

dissolved porteins, glucose, ions, hormones, clotting factors,

25
Q

What is the buffy coat composed of?

A

1% of blood sample

Leukocytes and platelets

26
Q

What does Hg measure?

A

Concentration of hemoglobin per unit volume

27
Q

What does Hct measure?

A

volume % of RBCs in blood

28
Q

What does RDW measure?

A

range of variation of RBC volume

increases with anicosytosis aka variation in size

29
Q

What does MCV measure?

A

Average volume of RBCs= Hct/RBC

Determines if microcytic, normocytic or macrocytic anemia

30
Q

What does MCH measure?

A

average mass of Hb in erythrocytes= Hb x 10/RBC

31
Q

What does MCHC measure?

A

Concentration of Hb in a given volume= Hb/Hct

Determines power aka if hyperchromic, normochromic, or hypochromic

32
Q

What does RPI measure?

A

Corrected % of reticulocyte based on RBC volume, increase with destruction of RBCs
Reticulocyte % x Hct/ normal Hct

33
Q

What disease should we suspect if someone has an MCV < 80 aka microcytic?

A

iron deficiency
thalassemia
anemia of chronic disease

34
Q

What diseases should we suspect if someone has a normal MCV (80-100) but a low reticulocyte count?

A

marrow failure
aplastic anemia
leukemia or metastatic disease
renal failure

35
Q

What disease should we suspect if someone has a normal MCV with a high reticulocyte count?

A 
erythroid hyperplasia in bone marrow
G6PD def. 
hereditary spherocytosis
Autoimmune hemolytic anemia 
paroxysmal nocturnal hemoglobinuria
36
Q

What disease should we suspect if someone has a high MCV aka macrocytic (>100)?

A

megablastic anemia due to a B12 or folate def.

alcoholic liver disease

37
Q

What are 2 distinct histological features of G6PD anemia?

A

bite cells and heinz bodies

38
Q

What are histological features of megablastic anemia?

A

hyper-segmented neutrophil

hypercell bone marrow with metamelocytes and band forms can lead to erthyroid hyperplasia

39
Q

What are the 3 causes of iron deficiency anemia?

A

dietary lack or decreased absorption due to diet, cows milk to infant, etc

impaired absorption due to spure, partial gastrectomy etc

chronic blood or iron loss due to tumor, ulcer, menomettornagia, etxreme distance running

40
Q

What are characteristics that can lead you to a diagnosis of iron deficiency anemia?

A

microcytic with elevated RDW

no changes in RBC shape

41
Q

What can cause aplastic anemia?

A

Hypocellular bone marrow –> reduced hematopoiesis

ex. chemo –> pancytopenia of all cell lines

42
Q

What is compensatory erythropoiesis caused by?

A

sever anemia and chronic hypoxemia

43
Q

What can cause hyposplenism or asplenia?

A

Sickle cell, traumatic splenectomy

44
Q

What can cause marrow deplacement/invasion?

A

tumor
infection (Tb granulomas, fungal)
myelofibrosis (idiopathic, chronic toxin or radiation)
meyloproliferatiave disorder

45
Q

How do leukoerythroblastosis appear and what do they suggest?

A

nucleated and teardrop RBCs, immature WBCs

displacement of hematopoietic elements by another process

46
Q

What are instances where extramedullary hematopoiesis is a compensatory mechanism?

A 
severe chronic thalassemia
sickle cell
stem cell failure (toxic, aplastic)
infection (parovirus B19)
B12 or folate deficiency 
malignant transformation and replacement
47
Q

What is a “left shift”

A

increased immature leukocytes especially band forms

neutrophilia with infection

48
Q

How does toxic granulation appear and what is it caused by?

A

dark coarse granules with neutrophils

common in inflammation reactions due to accelerated neutrophil differentation

49
Q

What is the criteria for a leukmoid rxn and how does the bone marrow appear?

A

WBCs > 50,000 with increased neutrophils and no evidence of leukemia as determined by leukocyte phosphatase levels

Bone shows complete maturation without blasts

50
Q

What are the phases of CML? Is it more common in children or adults?

A

chronic phase –> accelerated phase with 10-19% blasts in marrow –> blast phase with > 20% blasts in marrow

Adults

51
Q

What is AML? What is the peak age for it?

A

accumulation of immature myoblasts, anemia thrombocytopenia and neutropenia due to bone marrow crowding, R rods of primary granules

60

52
Q

What can causes inadequate granulopoiesis leading to neutropenia?

A

suppression of granulocytic precursors due to chemo, drugs, and toxins

suppression of hematopoietic stem cells due to aplastic anemia or marrow replacement/ invasion

ineffective hematopoiesis due to B12 or folate megablastic anemia

53
Q

What can cause increased destruction leading to neutropenia?

A

immune injuries to neutrophils like in lupus or autoimmune disease

splenomegaly due to portal hypertension

increased peripheral utilization due to overwhelming bacteria of fungi

54
Q

What causes mono and what are characteristics of it?

A

epstein barr virus

atypical t-lymphocytes, tonsillar abscess, fever, lymphogatosis

55
Q

What are defining features of chronic lymphocytic leukemia?

A

older
>500 ALC
lymphadenopathy
hepatosplenomegaly

56
Q

What are defining features of acute lymphoblastic leukemia?

A

Children

numerous blast on peripheral smear or bone marrow

57
Q

What are signs of thrombocytopenia?

A

Mucocutaneous bleeding
petichae
ecchymosis

58
Q

What can cause thrombocytopenia? (3 main causes)

A

increased platelet destruction due to ITP, HIT, autoimmune (SLE, HIV), DIC, TTP/HUS

decreased production due to bone marrow replacement or liver disease (decreased EPO)

sequestering leading to hypersplenism

Hematopoiesis and Peripheral Blood (1 decks)

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