hemequicklast Flashcards
Vit K dependent Prothrombin group factors
2,7,9,10
Fibrinogen group, thrombin acts on, used up/not in serum
1,5,8,13
Intrinsic, factors…In..it also measures factors..drug it monitors…reagents…NV…phospholipoprotein inhibitor that prolongs aPTT,not corrected by mixing study…
8,9,11,12In aPTT it also measures 1,2,5,10heparinphospholipid+ Ca chloride30-36seclupus like anticoagulant
Common factors…measured in both…and….
1,2,5,10aPTT,PT
Factors in Contact grp, alternate activation of intrinsic
HMWK,PK11,12
extrinsic factors…In…also measures factors..drug names it monitors…reagent…NV….Uses…
TF/3, 71,2,5,10warfarin/coumadin thromboplastin10-13secUses INR/ISI
Prothrombinase complex is in common pathway and acts on prothrombin consist of these two factors and these two cofactors…
5a, 10acalcium+phospholipid
Protein C degrades…and…Protein…is cofactor that accelates inhibition
C degrades 5,8S is cofactor
Primary inhibitor of fibrinolytic system..Principal inhibitor of thrombin/10…
fibrinolytic: alpha2 antiplasmin-plasmin is main fibrinolysis agentInhibitor of thrombin/10: anthrombin 3
Labile coag factors…Severe liver disease coag factors..
5,81,5Fibrinogen is made in liver
Names:1234578910111213
1 fibrinogen2 prothrombin3 Tissue thromboplastin4 calicium5 labile7 stabile8 AHF A9 AHF B, christmas factor10 stuart prower11 AHF C12 Hageman13 fibrin stabilizing
7…9…two names10…12…
7: stabile9: ahf B, Christmas 10: stuart prower12: hageman
3 PLT disorders with increased BT and normal PLT ct…3 PLT disorderrs with increased BT and decreased PLT ct…
normal PLT:aspirin, vWD, Glanzmannsdecreased PLT:May Hegglin, BS, Wiscott-May hegglin has dohle bodies
ITP, TTP, HUS, and DIC all have…PLT cts and …BTTTP has decreased…
decreased PLTs, increased BTTTP decreased ADAMS13
Two disorders with aggregation issues…-primary:-secondary:Two disorders with adhesion issues…
aggregation: G b4 W-primary: Glanzmann only agg with ristocetin-secondary: Wiskott AldrichAdhesion:-vWB, BS
Most common inherited bleeding…2nd most common…Most common acquired inhibitor in hereditary def…Most common PLT disorder…
inherited bleeding:most common vWD,-decreased 8, vWD, PLT normalddavpsecond Hemophilia-A: 8, cryo-B: 9 ffpacquired inhibitor in hereditary def: 8Most common PLT disorder: aspirin
Disorder with no aggregation/flat line with anthing but ristocetin
Glansmann
Disorder with abnormal aggregation with most tests, except no aggregation/flat line with collagen
aspirin
Two disorders with no aggregation/flat line with ristocetin
VWD, BS
Low PLT but normal bleeding/function ok, due to antiplt antibody, destruction of PLTs are virus
autoimmune thrombocytopeniaITP
Test that monitors heparin, FSP, and qual/quant fibrinogen…test that monitors fragments, D, E…test that diff factor def from anticoagulant…test that quantitates factors…
Test that monitors heparin, FSP, and qual/quant fibrinogen…thrombin timetest that monitors fragments, D, E…ddimertest that diff factor def from anticoagulant…-mixing studytest that quantitates factors…factor assay
Coagulation analyzers used
optical photoelectric system
Order of hemotopoesis:
yolk sac, liver, spleen, BM
Embryonic hmg chains:-Gower 1:-Gower 2:-Portland:Newborn hmg and chains:F- what chainsA1/A2 percent
Embryonic hmg chains:-Gower 1: zeta, epilson-Gower 2: alpha, epilson-Portland: zeta, gammaNewborn hmg and chains: -F: alpha, gammaF 50-80A1 20A2 1
Adult hmg and chains: made of, %A1A2F
Adult hmg, chains, %:-A1: alpha, beta 97%-A2: alpha, delta 2%-F: alpha, gamma 1%Embroyonic has zeta, epilsonAdult has deltaq
Hmg electrophoresis:Cellulose acetate 8.4:slowest/cathode/- to fastest/anode+
Cellulose acetate 8.4:*slow(-) C, S, F, A1 fast(+)
Acronym for citrate agar 6.2 slowest/cathod/origin to fastest anode…citrate can be used if cellulose acetate at 8.6 is abnormal to separate…
-FASC+separate S from D, Gseparate E,C
cyanmethmg diluent…separate myoglobin from hmg with…sickle cell reagents, reducer/lyser…
cyanmethmg diluent…Drabkinsseparate myoglobin from hmg with…-ammoniun sulfatesickle cell reagents…-reducer: sodium dithionite-lyser: saponin
Cell ct formula…WBC area of 1 square(usually of 4)…RBC/PLT of each tiny square…-RBC usually count 5-PLT usually count all 25 of middle, which equals total of…
cells x DF/ total square area (#sqsxarea square) x 0.1WBC 1 square is 1mmRBC/PLT 1 square is 0.04PLTs all 25 is 1mm(one WBC square)
3 things used to create scatterplots…1 not used
scatter, volume, conductivitynot fluorescence
Retic % cal…correct retic…RPI:
Retics/10retic % x HCT/45RPI: corrected/maturation time factor
WBC correction for NRBCs
WBC x 100/NRBC+100
4 things that falsely increase Hmg
lipemia, icteric, protein increased WBCAll cloud reading
Normal MCV, hypochromia due to
hyperglycemia
Decreased RBC, HCTIncreased MCV/MCHC due toMCHC >36
cold agg
Decreased RBC, Hmg, HCT…
anemia
Anemia is below…toddler:female:male:neonates:toddlers have the least, but close to adult femalesneonates have the most
Anemia is below…toddler: 12female: 13male: 15neonates: 19
HA…-size/color anemia…-RBC/hmg/HCT, haptoglobin…-indirect bili….
HA…-size/color anemia…normo, normo-RBC/hmg/HCT/haptoglobin…decreased-indirect bili….increased
Another name for reticulocyte, NVno nucleus, reticulum with supravital stainStain name
polychromatophillic erythrocyte, 0.5-1.5%still has RNA, basophillic and orangeNMB
2 names for NRBC, last nucleated red cell normally in BM, pyknotic nucleus
MetarubricyteOrthochromatic normoblast-more orange due to almost being erythrocyte
Alternate name for…1.)Rubriblast2.)Prorubricyte3.)Rubricyteblast before Pro, Pro before, meta after
Alternate name for…1.)Rubriblast: Pro-normoblast2.)Prorubricyte: Basophillic normoblast3.)Rubricyte: Polychormatophilic normoblastPro 1st, basophillic, polychromatophilic
Stages of WBC:-Stage with primary nonspecific granules-Stage with secondary specific granules, oval nucleus-Stage with kidney bean nucleus
Myeloblast-Stage with primary nonspecific granules:Promyelocyte-Stage with secondary specific granules, oval nucleus: Myelocyte-Stage with kidney bean nucleus: metamyelocyte
Life span…PLT…RBC…PLTs located, %…
PLT 8-11 daysRBC 120PLTs located, %-blood 70%-spleen 30%
MCH:calculations, NV
MCH: Hmg/RBC x 10 = 28-32 pg-mean cell hmg/rbc-wt
Normal values: female versus malesRemember rule of 3, know RBC know the rest, unless anemiaRbcx3=Hmgx3=HCTRBC:WBC:Hmg:-plasma hmgHCT:
RBC: 4.5-6 million-females 4.5-5, males 5-6WBC: 4-11 thousand-seg 3-5 lobesHmg: 12-18, plasma 2-3mg/dL-females 13-15-males 14-18HCT: 35-54-females 35-49-males 40-54
WBC NV:Total WBC:-absolute is % x totalSegsLymphsMonosBandsEosBaso
total wbc: 4-11 thousandSegs: 45-70, mostLymphs: 20-40Monos: 3-10Bands: 0-5Eos: 0-3Baso: 0-2, least
Diluent for WBC/PLT cts
ammonium oxalate
2 normal cells seen in CSF
arachnoid and choroidboth very large clumps, pink/blue/purple
Normal cell seen in pleural fluid
mesothelial (only in serous)nucleated: round to oval, can be multi large, clumped, more round than synovialMaintain cytoplasm borders, clear spaces between
normal cell seen in synovial/joint
synovial cells, nucleated, not as uniform as pleural mesothelial
What 4 things increase WBC
NRBC, large platelets, Sickle cell, Cryoglobin-Based off granularity, size
Schistocytes: affect on RBC, plts
RBC decreased because counted as plts
3 things decrease plt1 thing increase plt
Decrease plt: clumps, satellitosis, giant PLTsIncrease: schistocytes-counted as plts not rbcs
Plt ct with sodium citrate DF…Citrate in Coag tube…Ratio WB:anticoagEDTA type anticoag…
DF 1.1Tube 3.2%WB: anticoag 9:1EDTA type anticoag…di potassium
PAS stains which blasts…Chronic or acute…
LymphoblastsAcute
conditions with target cells…1 not related to target…
Thallesemia, HmgpathiesIDA, post splenectomyLiver disease-Decreased hmgNot myelofibrosis
Diluent for wbc, plt…Reagent to diff myoglobin from hmg…Reducer for sickle cell screen…
Diluent for wbc, plt…ammonium oxalate Reagent to diff myoglobin from hmg…Ammonium sulfateReducer for sickle cell screen…Sodium dithionite
Vit K dependent group called
Prothrombin group
Citrate agar: 6.2:slowest/cathod- to fastest/anode+
Citrate agar: 6.2:*slow(-) F,A,S,Cin some ways opposite of celluose acetate
MCV calc, NVRBC size microm nvMicro is, macro is
MCV: HCT/RBC x 10 = 80-100fL-In a volume of packed rbc, volume of rbc-volume: micro <80, macro>80-RBCs are 6-8 microns, <6 micro, 9+macro
MCHC: calc, NV
MCHC: Hmg/HCT x 100= 32-36%-Hmg concentration in volume-color: hypo <32, hyper >36-percentage so smaller number on top->36 spherocytes
RDW: NV, indicates
RDW: 11-14.5, diff sizes/anisocytosis >15%
HCT: NV…Measures…
HCT: 35-54% packed cell volume
Hmg electrophoresis:nationality, migrates withD:E:G:
D: east indian, D-SE: Southeast asian, E-CG: Blacks, G-S
3 things that have leukopenia and 1 that has increased leukocytes
decreased:leukemia, viral, chemoincreased:leukemoid rxn
Myelocyte maturation from youngest to oldest
myeloblastpromyelocyte(pro b4 myelo)myelocytemetamyelocyte(meta after myelo)band
6 rbc inclusions
HJ bodiesPapemheimer bodies/siderocytes in PBBaso stippling: RNAShuffners dotsCabot ringHeinz bodies-denaured hmg-not seen with wright, G6PD-no Heinz in PK
Specific WBC that phagocytizes nucleoprotein in lupus erythematosus
NeutrophilLE cellcan also be macrophage
Characteristic findings:CLL:CML:ALL:AML:AMML:Hodgkin:Sezary:
CLL: smudge cells, sml BlymphsCML: Ph, basophilia, eosinophilia-decreased LAPALL: PAS+, MPO-, TdtAML: Auer rod, trans 8:21AMML: NASDA 3+, NaF 1+Hodgkin: Reed SternburgSezary: lrg bizarre cerebriform
what engulfs what…LE:Tart:Mott:
what engulfs what…LE: neutrophil,macro engults nucleoprotein-seen in lupusTart: mono/macrophage engulfs nuclearMott: plasma cell engulfs Ig, russel bodies
In reactive leukocytosis, absolute GRANULOCYTES are
> 7.0
ALL: -How many classes-which one has heterogenous?-which one has vacuolization/abundant cyto?-which one seen in kids/homogenous?
only 3 class, no L4L1: homogenous, kidsL2: heterogenous, adultsL3: vacuolization, abundant cyto, homoL1/L2: L is younger than L2, start out homoL3: odd one with vacuoles
AML:-granules? least to most?-Auer rod, DIC?-Mono?-Erythroblast? Megakaryoblast?M0:M1:M2:M3:M4/5:M6:M7:
AML:M0: no granulesM1: granulesM2: few/trace granulesM3: intense granules, DIC, AuerM4/5: monoM6: erythroblastM7: megakaryoblast
Waldenstrom versus Multiple Myeloma:both have increased…and….WM Ig…MM Ig…MM also has…issues
both have extra plasma cells/lymphs and rouleauxWM Ig MMM IgG and bone issues
Condition with -elevated WBC/segs-increased ESR/fibrinogen-decreased iron
Hodgkins, Reed Sternberg
Tears, giant bizarre plts, increased uric acid most ass with
myelofibrosis
Least seen wbc
Basophil 2%
Order of early stem cells etc
HSC, MPP, common,Lymph-myeloid, then CFU
PLTs-NV-NV in 1000x-fLcells youngest to oldest
PLTs140-450,0008-2010fL-Megakaryoblast: BM-Promegakaryocyte: BM-Megakaryocyte: BM-PLT blood
Monocytes youngest to oldest….Lymphocytes youngest to oldest….
Monocyte:-Monoblast-Promonocyte, more oval nucleus-MonocytLymphocyte:-Lymphoblast-Prolymphocyte: lrg single nuclei-lymphocyte: scant cyto
Hmgpathies..Hmg S…HmgC..
hmgs: valine replaces glutamic acid, 6th position on betahmgc: lysine replaces glutamic acid, 6th position on beta-washington monument, rodSC: glove
Sudan B:PAS:Oil RedO:LAP:TRAP:NASDA 3+/NaF1+:
Sudan B: nonspecific/specific granules, myelogenous granulocytes-Brown BlackPAS: acute lymphoblasts, not chronic-magentaOil RedO: neutral lipidsLAP: Leukomoid, decreased CMLTRAP: hairy cell-tartrate resistant, acid phosphataseNASDA 3+/NF1+: AMML
Hmg in reduced state..-what keeps it reduced…Hmg in ferric state/oxidized…Hmg w/carbon monxide, 200 greater affinity to hmg than oxygen…Hmg with irreversible oxidation, cant carry oxygen, isn’t tested with cyanmethmg…
Hmg in reduced state..oxyhmg-what keeps it reduced…methmg-cytochrome C reductaseHmg in ferric state,oxidized…methmgHmg w/carbon monxide, 200 greater affinity to hmg than oxygen…carboxyhmgHmg with irreversible oxidation, cant carry oxygen, isn’t tested with cyanmethmg…sulfhmg
Increased ESR
increased…-inflammation-rouleax-increased proteins: fibrinogen -MM, WM-macro-anemia-tilting/vibration
Decreased ESR
decreased:-microcytes, sperocytes-sickle, can’t rouleaux-polycythemia-edta, cells shrink-old specimen or decreased temp
Optical light scattering is also called
laser light scatter, flow cytometryfocuses laser with laminar flow of cells to id granularity/reflectivity90 side: granularityForward: size
Fragile WBC causing pseudoleukopenia…Smudge cells issues with WBC ct…addCryoglobin issues with WBC and cold agg issues…lipemia…
Fragile WBC causing pseudoleukopenia…manual WBCSmudge cells issues with WBC ct…add 22% albumin to stabilizeCryoglobin issues with WBC and cold agg issues…warm 37, 15minlipemia: saline replacement
TRAP: hairy cell
-tartrate resistant, acid phosphatase
IDA:-iron-ferritin-TIBC, transferrin:Anemia of Chronic:-iron:-ferritin:-TIBC, transferrin:
IDA: chronic blood loss-iron, ferritin: decreased-TIBC, transferrin: increasedAnemia of Chronic:-iron: decreased-ferritin: increased-TIBC, transferrin: decreased
Leptocyte:Drepanocyte:Dacrocyte:Basostilling made of…
Leptocyte: codocyte, targetDrepanocyte: sickleDacrocyte: tearBaso stil RNA
Macrocytic anemias: MCV>100decreased PLTs, macros, hyper segmentedMegaloblastic: -main WBC in BM-2 def-type of macrocytesNonmegaloblastic:-2 causes-type of macrocytes:
Macrocytic anemias:Megaloblastic:-giant metamyelocytes-2 def: folate/B12/PA IF-type of macrocytes: ovalNonmegaloblastic:-2 causes: liver disease, alcoholism-type of macrocytes: round
Microcytic anemias:-5 main
IDA, anemia of chronicsideroblasticthalllead
3 tests for PNH1 test for PCHPNH is a … Defect
PNH-sugar water-sucrose-Hams acidified serumPCH-Donath landsteiner autoab test, PMembrane defect
most common thallasemia
beta thall minor, Cooley’s trait
4 neutrophil incusions/anomolies
dohle bodiestoxic granvacuolitionPelger Huet
TT tests for, reagent ,NVMonitors 3 thingsFibrinogen test,Reagent, concentration is….to time, NV
TT time it takes thrmobin to convert fibrinogen to fibrin, thrmobin reagent, 10-15 SecMonitors: heparin, FSP, fibrinogen levelsFibrinogen test:Thrmobin reagent, AMT inversely proportional to time, 200-400
Factor with all tests normal except 5M urea solubility, clot dissolves
Factor 13Not involved in coagulation
Factor def with no history of bleeding, only abnormal aPTT
Factor 12
Same and Difference between liver disease and vitK
Both decreased 2,7,9,10 Liver disease has increased factor 8
Normoblast/erythroblast:-Pro-Basophillic-Polychromatophillic-Orthochromatic(NRBC)
Rubri-Rubri-blast-Pro-rubricyte-Rubricyte-meta-rubricyte(NRBC)
Chediak Higashi: defect ofAlder Riley: defect of
Chediak Higashi: defect of lysosomesAlder Riley: defect of mucopollysacharridesA=azurophilic
IM:CMV:Infectious lymphotosis:
All have increased WBC,Lymphs, reactiveIM:EBV, POS monospotCMV:Neg monospot Infectious lymphotosis:<5yrs Old, neg monospot
Hemo A,B,C all normal
PT, 8.9.11 not in extrinsic or common(1,2,5,10)
Lupus anticoag
PTT not corrected by missing.PT normal
Signs on immature cell
Euchromatin, less packedDark cytoplasmNucleoliNonspecific granules
Plt, lymph, mono maturation 3 cells
Mono/lympho/megakaryo-blastPro-mono/lympho/megakaro-cyteMonocyte, lymphocyte, megakarocyte
Factor assay normal range
50-150%
Romanowsky stain…Azure is, stains, examples…Eosin Y is, stains, examples…
Romanowsky stain…Azure is, stains, examples…-Purple, basic-stains acidic, nuclei, immature cytoEosin Y is, stains, examples…-is red, acidic-stains basic, hmg, azure granules
Pink or light due to…Blue or dark due to…
Pink or light due to…-too acidic, not enough stain, long rinse Blue or dark due to…-too alkaline, to long stain, not rinsed enough
Alpha thallAlpha thall major: HmgH:Alpha thall minor:Silent carrier:
Alpha thallAlpha thall major: -hydrops fetalis-all 4 alpha deleted-no normal adult hmg-Barts/PortlandHmgH:-3/4 deleted-Heinz bodies-BartsAlpha thall minor:-2/4 deleted-MICRO/hypoSilent carrier:-1/4 deleted
Cell with older males, large bizarre cerebriform nuclei
Sezary
Test that tests PLT fnc, affected by #, vascular integrity, less than 10 min NV
BT
Test that measures PLT fnc, defects plug, closure time/time to occlude aperture; Depends on count and activity
PFA100
Thrombocytopenia due to heparin induced ab, heparin/PF4 complex sensitizes PLT and removed from spleen, <50% PLT ct
HIT
Condition with giant/decreased PLTs/increased BTabnormal aggregation to Ristocetin, abnormal adhesion
Bernard Soulier
Condition dohle bodies, giant/decreased PLTs, increased BT due to decreased Plts
May hegglin
Condition due to adhesion, abnormal aggregation to Ristocetin, normal PLT ct but increased BT
VWD
Condition with normal PLT ct but increased BT, only aggregates with Ristocetin/primary agg issue
Glannsmann thrombostenia