Hemedeck_14325469 Flashcards
3 main sites of hematopoesis during conception and early fetal months
yolk sac, liver, spleen
Adult Bones Hematopoesis, acrynom
SSPRVSkull, SternumPelvis, Ribs, Vertebrae
Heme needs these two things
iron and protoporhyrin
Protein that transports Fe
transferrin
Major storage form of iron
Ferritin
Long term storage of insoluble Fe
Hemosiderin
Enzyme def w/build up of heme precursors is called
porhyrias
While in the DELTA, POR UR COP PRONTO a cup of HEME
Heme Precursors
Hmg F % in newborns versus adults
newborn 60-90adults 1
Hmg A in adultsversus newborns
adults 97newborns 10-40
Hmg A2 in both adults and newborns
2%
Gower I/II, Portland Hmg in…
embryonic
In Hmg oxy diss curve, oxygen is released or not released in a shift to the left
not releasedNo, won’t let go
In Hmg oxy diss curve, oxygen is released or not released in a shift to the right
releasedwon’t hold tight
To determine Hmg, the oxidation of hmg to methmg is done with these two reagents
KCN and KFerricyanide
HCT % NVMale Female
Male 47 +-5Female 42 +-5
Diluent used for WBC/PLT CT
1% Ammonium Oxalate
Calculation of cell ctsvolume cal by
cells x 1/vol x DFvol: 1mmx1mmx0.1mm x #squares
MCV formula
HCT/RBC x 10
MCV NV
80-100fL
MCH formula
HGB/RBC x 10
MCH NV
28-32pg
MCHC formula
HGB/HCT x 100
MCHC NV
32-36 g/dL
RDW-CW formula
SDx100/Mean
RDW NV
11.5-14.5%
.
.
RBC reffemalemale
female 3.8-5.2male 4.5-6.1
Seg ref
45-70
Lymp ref
20-40
mono ref
3-10
baso
0-2
eos
0-3
plt ref
150-400
Romanowsky stain also called
Wright stain
4 things in wrights stain
methanol, phosphate buffer, eosin, methylene blue
Calculation of absolute values
Relative% x total cell ct
TB, Syphilis, Malignancies associated with what kind of cell
monocytes
Hypersegmented neutrophils ass with
megaloblastic anemia
Hyposegmented neu ass with
pelger huet
bacterial infections, burns, chemo ass with what 2 white cell morphologies
toxic granulation and vaculoles
Bacterial infections, burns, and May Hegglin ass with what white cell morph
Dohle bodies
Varient lymphs ass with
IM, viral infections
WBC correct calculation for NRBCS
wbc x100/100 + nrbcs
Abetalipoproteinemia and severe liver disease ass with what rbc shape
acanthocyte
uremia and artifacts cause what kind of rbc shape
echinocyte, burr
DIC causes what rbc shape
shisto
HJ bodies composed of
DNA
Baso stip composed of
RNA
Pappenheimber bodies made of
Iron
Heinz bodies made of
denatured precipitated hemoglobin
cabot ring made of
left over mitotic spindle
Which rbc inclusion is not seen with wright stain
Heinz bodies
Heinz bodies ass with what deficiency
G6PD
Kind of rbc inclusion with thall and lead
baso stip
Rule of 3
RBC x 3=Hmgx3=Hct
Increased MCV/MCHC and decreased RBC are ass with
cold agg disease
What replaces glutamic acid in the 6th position of the beta chain in Hmg C
Lysine
What replaces glutamic acid in the 6th position of the beta chain in Hmg S
Valine
Hmg A chains
2 alpha2 beta
Hmg A2 chains
2 alpha2 delta
Hmg F chains
2 alpha2 gamma
Order from fastest to slowest in cellulose acetate
A, F, S, A2/C
Two reagents usedin solubility test of Hmg S
saponin and sodium dithionite
ESR Female
0-20mm
ESR male
0-15mm
ESR show increase in these two plasma proteins
fibrinogen and globulin
2 Factors that increase ESR
tilting, increase temp
3 factors that decrease ESR
decrease temp, old, excess EDTA
supravital Stain for retic ct
new methylene blue
Retic ct monitors
etrythropoiesis
Retic ct % calculation
retics/10
Absolute retic
RBCs x retic%
corrected retic ct (corrects for HCT)
retic % x PT HCT/45
retic ref
0.5-1.5%
RPI
corrected retic/maturation time of 2
M:E ratio
3:1-4:1
Stain for bone marrow
romanowsky
Cellulose acetate ph8.6, anode/slowest to fastest
-C/A2, S, F, A+
Cellulose acetate ph8.6, cathode/fastest to slowest
+A, F, S, C/A2-
.
.
Citrate agar ph6.2 cathod to anode
+C,S,A,F-
Hmg D seen in what race, migrates with
East indian, S
Hmg E seen with what race, migrates with
Southeast asian, C
Hmg G seen with what race, migrates with
African, S
Reducing agent in Sickle Dex
sodium di-thionite
What confirms s positive sickle screen
hmg electrophoresis
Which electrophoresis separates S
citrate agar ph6.2
Lead and Thall trait are what kind of anemias
microcytic/hypochromic
IDA and Chronic dis/infla what kind of anemia
micro/hypo
In IDA, all Iron studies are low except for
TIBC
Three causes of macrocytic anemia
B12 def, folate def, liver disease/alcholism
What does G6PD have that PK doesn’t
Heinz bodies
.
.
G6PD def and HbH uses this stain/prep
Heinz body prep
Test for PCH, IgG, Anti-P Biphasic
Donath Landsteiner TEst
Condition with large Azurophilic granules, mucooplysaccharies (Hunter, Hurler)
Alder Reily
Condition with large lysosomes/fushion of primary granules
Chediak-Higashi
Condition with large PLTs, decreased PLTS, Dohle bodies in seg/mono/lymph
MayHegglin
Condition with hyposegmented polys
PelgerHuet
Dry tap is seen in which condition
primary myelofibrosis
Decreased LAP, Ph chromosome in what condition
CML
JAK2 seen in what condition
Polycythemia Vera
Which reaction has toxic granules and Dohle bodies
Leukemoid
WHO acute leukemia how many blasts in BM
> 20%
Leukemia seen with soccer ball nucleus
CLL
Lymphoma associated with EBV, HIV
Burkitt
Lymphoma associated with Reed Sternberg cell
Hodgkin
Myeloma with bone involvement, IgG and Bence Jones in urine
Multiple myeloma
Condition with IgM, increased serum viscosity and normal bone
Waldenstrom
Prussion blue stains
iron
LAP in CML
decreased
LAP in Leukamoid rxn
increased
TRAP tartrate-resistant acid phosphatase for what condition
Hairy cell leukemia
Auer rods in
AMLacute myeloid leukemia
BM macrophages have wrinkled/striated cyto with accumulation of glucocerebrosidease
Gaucher
BM macrophages w/globular or foamy cyto, sea-blue histiocytes with sphingomyelinase
Niemann-Pick
Stain for AML, myelogenous cells for nonspecific/specific granules
Sudan black B
Stain for glycogen deposits in liver, fungi, and blasts in ALL
PASperiodic acid-Schiff
What is added to stabilize WBC when there’s smudge cells causing WBC cts to not match
22% bovine albumin
DF of PLT CT with sodium citrate
1.1
Which inclusion isn’t stained with WRights
Heinz bodies, uses NMB
Peroxidase stains which cell lines…excluding…
myelos, monosexcluding lymphs
NASDA/Naf used for which leukemia
AMML
PAS pos in
ALL
TRAP pos for whic leukemia
hairy cell
Two names for NRBCs
metarubricyteorthochromic normoblast
Two names for retic
reticulocytepolychromatophilic erythrocyte
1.)Rubriblast2.)Pro-rubricyte3.)Rubricyte4.)Meta-rubricyte5.)Reticulocyte6.)RBC
1.)Pro-2.)Basophilic-3.)Polychromatophilic-4.)Orthochromic- -normoblast5.)Polychromatophillic erythrocyte6.)RBC
Male Hmg
14-18
female hmg
12-15
neonate hmg
19
toddler hmg
11-13
IDAiron, ferritin…TIBC/transferrin…
iron lowferritin lowTIBC/transferin high
Anemia of chroniciron, TIBC…ferritin…
iron/TIBC lowferritin high
2 names for target
codocyte, leptocyte
Target, baso stip, tears in
thallasemia
sugar water test, sucrose hemolysis, and acidified serum test associated with
PCH
Smudge cells seen in which leukemia
CLL
increased sml, mature lymphs and smudge what leukemia
CLL
Condition with giant, bizarre PLTs, NRBCs, teardrop, pancytopenia
myelofibrosis
Condition thats a subtype of AML, PLTs and WBC decreased
erythroleukemia
Sydrome where decrease in alpha granules and there is a release in proteins that cause myelofibrosis
gray PLT syndrome
Factor 12 actived by
subendothelium
Vik K dependent factors and what group
2,7,9,10 Prothrombin
Factors in fibrinogen group
158-13
Factors in contact group
11,12PK,HMWK
Serine proteases
2,7 9,10,11,12
70% of PLTs are in…30% PLTs are in…
70 % blood30 % in spleen
Adhesion requires what factor
VWF
What stimulates PLT change in shape
ADP
What links the PLTs together after being stimulated by ADP
fibrinogen
What inhibits active plasmin
alpha 2 plasmin inhibitor
Action of plasmin on fibrin
cleaves fibrin into X, Y, D, E fragments
3 clot busters
streptkinaseurokinaseTPA
WB:anticoag ratio
9:1
Screen for extrinsic/common, monifors oral anticoag like warfarin/coumarin
PT
PT ref, INR ref goal
<13 secINR. 2.0-3.5
Screen for intrinsic,commonmonitors heparin
APTT
APTT ref range
20-40sec
Fibrinogen factor and ref range
Factor 1200-400 mg/dL
Coag test that doesn’t measure intrinsic/extrinsic but is affected by decreased fibrinogen levels and heparin
TT
TT ref
<20sec
Coag test that measures PLT fnc/#s
BT
PFA measures PLT fnc with theses three aggregating agents
collagen, ADP, epi
Rapid dissolution of clot indicates increased fibrinolytic activity in this condition
DIC
No clot retration indicates
Glanzmann thrombasthenia
Aspirin inhibits 2ndary wave of aggregation by destroying….
cyclooxygenase
Two adhesion disorders that have abnormal ristocetin agg
BSvWD
BS is differentiated from vWD by these two things related to PLTs
BS has decreased PLTS and giant PLTSD
PLT disorder with normal PLT #/morph but abnormal aggregation and abnormal with all aggregating agents
Glanzmann
DRVVT activates factor… and is prolonged in presence of this anticoagluant
Factor 10Lupus anticoag
Assay that monitors LMWH
anti-factor 10a
Test similar to TT, uses snke venom enzyme,and is not inhibited by heparin
Reptilase time
Repitilase time ref
18-22sec
Another name for primary myelofibrosis
myeloid metaplasia
Myeloid metaplasia can have increased… and thus have…
increased uric acid and have gout
BM condition where theres increased plasma cells, marked roleaux, and relative/absolute lymphocytosis
WMWaldenstroms macrobulemia
Kind of leukemia with B cell neoplasms, increase in small/mature lymphs, and smudge cells
CLLchronic lymphocytic leukemia
Leukemia with no peroxidase activity and positive PAS
ALL
Leukemia with increased baso/eos in early stages
CML
Xa-Vaphospholipid-Ca complex is called what
prothrombinase complex
What cleaves fibrin into soluble fragments X/Y,D/E
plasmin
Which protein inhibitor inactivates/degrades F5,8?
Protein C
Which protein is a cofactor and accelerates Protein C
Protein S
Which factors are inactivated by Protein C
Factor 5,8
Which protein is the primary inhibitor of the fibrinolytic system and inhibits plasmin
alpha 2 antiplasmin
What is the principal inhibitor that neuralizes thrombin, F10, and all serine proteases?
antithrombin III
Most frequently acquired inherited inhibitor leading to factor deficiency?
anti-8APTT mixing study to testusually w/Hem A/B therapy
Which inhibitor inactivates coag factors thru phospholipids
lupus like anticoaglupus anticoagprolong APTT, no factor def or bleeding
What is the cause of 25yr old male who has a normal PT and INR, but an increased APTT thats not corrected by a mixing study
circulating anticoagulant possibly lupus anticoag
Most common inherited bleeding disorder with decreased F9/vWF, prolonged APTT, and normal PLT CT
vWDissue isn’t with number of PLT but can’t adhere to collagen
DDAVP and cryo used to treat
vWD
Trauma, prego issues, liver disease/hepatitis, cancer/leukemia, sepsis, drugs all can cause
DIC
PT/INR, PTT, D-dimer all increased and fibrinogen decreased in
DIC
PT/INR, PTT slight increase with slight decrease in fibrinogen is
liver disease
2 labile coag factors
5,8
Coag factors most indicative of severve liver disease
1,5
plasma fibrinogen nv
300-400mg/dl
Xmas factor
9IX
hereditary condition with decreased PLT production and Dohle bodies
May Hegglin anomaly
Idiopathic thrombocytopenic purpura has less PLTs due to…
PLT destruction
VWD, Glanzmann, aspirin all have what kind of PLT counts
normal
BS has what kind of PLT CT
decreased
vWD and BS are what kind of PLT issue
adhesion
Glanzmann and aspirin cause what kind of PLT issue
aggregation
Condition with abnormal secondary agg
Wiskott-Aldrich
F7 def test
PT, extrinsic
What tests 1,2,5,8,9,10,11,12
APTT
Test monitors heparin, FSP, fibrinogen issues
TT
Hemo associated w/F11 and Jews
Hemo C
Hemo ass. w/8, men
Hemo A
Hemo ass. w/9, men
Hemo B
Factor def detected with 5M urea test
F13
Most common specific factor inhibitor, APTT mixing studies
F8 inhibitor
Mutant Factor V, resists action of protein c/s
factor v leiden
drug that blocks ADP receptor(P2Y12)
PlavixClopidogrel
Drug that inhibits VitK, monitored w/PT/INR
Wafarin
Drug that inhibits serine protease via AT, monitored with APTT
Heparin unfractionated
Drug that targets F10a, doesn’t require monitoring
LMWH
Chains in Gower 1
2 zeta, 2 epsilon
Chain in Gower 2
2 alpha, 2 epsilon
Portland chains
2 zeta, 2 gamma
RBC count calc if 5 squares
RBCxDF/0.02
Volume of single RBC square
0.04
Total volume of 5 RBC squares
0.2
Depth of hemocytometer
0.1
4 things affect hmg
LipemicIctericHigh WBC Lyse resistant hmg SS, CC
