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HEMATOLOGY 1 > LEUKEMIA, FLOWCY, RETICS, AUTOMATION, OTHERS > Flashcards

LEUKEMIA, FLOWCY, RETICS, AUTOMATION, OTHERS Flashcards

1
Q

Overproduction of various types of immature or mature cells in the bone marrow and or peripheral blood

A

Leukemia

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2
Q

Frequently involves WBCs of the myelogenous or lymphocytic cells types

A

Leukemia

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3
Q

Malignant cells easily trespass the blood brain barrier

A

Leukemia

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4
Q

Solid malignant tumors of the lymph nodes and related WBCs in the bone tissue

A

Lymphomas

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5
Q

The distinctive cell type is the lymphocyte

A

Lymphomas

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6
Q

Malignant cells are initially confined to the organs containing mononuclear phagocytic cells such as lymph nodes, spleen, liver, and bone marrow

A

Lymphomas

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7
Q

This can spill over into the circulating blood and demonstrate a leukemia-appearing picture on a peripheral blood film

A

Lymphoma

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8
Q

Leukemia has increased WBC count with shit to the ____

A

Left

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9
Q

Leukemia M:E ratio

A

10:1

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10
Q

Type of anemia usually present in cases of acute leukemia

A

Normocytic normochromic

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11
Q

Numerous immature cell forms in the bone marrow and or peripheral blood; increased total WBC count; symptoms of short duration

A

Acute leukemias

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12
Q

Mostly mature cell forms in the bone marrow and or peripheral blood; total WBC counts range from extremely elevated to lower than normal ; symptoms of long duration

A

Chronic leukemia

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13
Q

The FAB classification of leukemia is based on morphology of cells in what stained smear

A

Romanowsky-stained smear

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14
Q

Cytochemical stains used in FAB classification

A

Myeloperoxidase
Sudan Black B

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15
Q

Enzyme found in primary granules of neutrophils and eosinophils and monocytes

A

Myeloperoxidase

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16
Q

Used in differentiating blasts of AML from those of ALL

A

MYELOPEROXIDASE

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17
Q

Peroxidase stain reaction of ALL

A

POSITIVE

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18
Q

POSITIVE MPO

A

Neutrophilic granulocytes (Except normal blasts)
Auer rods
Leukemia blast in FAB M1, M2, M3
Eosinophils

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19
Q

POSITIVE MPO

A

Neutrophilic granulocytes (Except normal blasts)
Auer rods
Leukemia blast in FAB M1, M2, M3
Eosinophils

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20
Q

Reactions parallels those of the MPOs

A

Sudan black B

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21
Q

Stains sterols, neutral fats, phospholipids (found in the primary and secondary granules of neutrophils and lysosomal granules of monocytes)

A

Sudan black B

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22
Q

Most sensitive stain for granulocytic precursors

A

SBB

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23
Q

SBB POSITIVE

A

STRONGLY POSITIVE:
Promyelocyte, myelocyte, metamyelocytes, bands, and segmented neutrophils

Leukemic blasts
Auer rods
Eosinophils

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24
Q

Weakly positive or negative MPO

A

MONOCYTES

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25
Q

WEAKLY POSITIVE OR NEGATIVE SBB

A

Myeloblasts
Monocytic cells

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26
Q

NEGATIVE MPO

A

Myeloblasts
Basophils
Lymphocytic cell series
Erythrocytic cell series

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27
Q

NEGATIVE SBB

A

Lymphocytes and its precursors

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28
Q

NEGATIVE SBB

A

Lymphocytes and its precursors
Megakaryocytes and platelets
Erythrocytes

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29
Q

Peroxidase positive granules may produce what color

A

Red brown , dark brown, or black color

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30
Q

Rbcs develop diffusely __ color because of the pseudoperoxidase activity of hgb

A

Brown

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31
Q

A carcinogenic substrate used in one of the MPO methods

A

3,3-diaminobenzidine tetrahydrochloride

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32
Q

Peroxidase enzyme is _____ to light

A

Sensitive

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33
Q

May be used to detect eosinophilic leukemia ;

A

Cyanide-resistant peroxidase stain

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34
Q

Lymphocytic leukemias are generally MPO _ and SBB _

A

Both negative

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35
Q

Most common form of childhood leukemia

A

ALL

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36
Q

70% of childhood ALL

A

L1

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37
Q

70% of ADULT ALL

A

L2

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38
Q

ALL type that is rare in children and adults

A

L3

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39
Q

ALL L1 immunologic markers

A

CALLA (CD10)
TdT
CD19
CD20

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40
Q

ALL L2 immunologic markers

A

TdT

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41
Q

ALL L3 immunologic markers

A

slg
CD19
CD20
CD22
CD24

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42
Q

A homogeneous population of small blasts - ALL type

A

L1

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43
Q

Heterogenous population of large blasts - ALL type

A

L2

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44
Q

Homogenous population of large blasts (with nuclear and cytoplasmic vacuoles) - ALL type

A

L3

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45
Q

PAS, MGP, ORO reaction of ALL L1

A

+ - +

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46
Q

PAS, MGP, ORO reaction of ALL L2

A

+ - +

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47
Q

PAS, MGP, ORO reaction of ALL L3

A
    • +
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48
Q

E rosettes positive

A

T-ALL

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49
Q

Surface Ig positive

A

B-ALL

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50
Q

Serum Anti-ALL positive

A

Common ALL

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51
Q

Most common type of leukemia in elderly characterized by persistent lymphocytosis

A

CLL

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52
Q

In CLL, these cells are present in the pbs

A

Smudge cells
Render cells

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53
Q

Examples of clinical variations of CLL

A

Hairy-cell leukemia
Lymphosarcoma cell leukemia
Prolymphocytic leukemia

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54
Q

Solid tumor counterpart of ALL

A

Lymphoma, poorly differentiated ; lymphocytic

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55
Q

Solid tumor counterpart of CLL

A

Lymphoma, well-differentiated ; lymphocytic

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56
Q

Solid tumor counterpart monocytic leukemia

A

Reticulum cell sarcoma

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57
Q

Solid tumor counterpart of acute myelogenous granulocytic leukemia

A

Chloroma

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58
Q

Solid tumor counterpart of plasma cell leukemia

A

Myeloma/ plasma cell myeloma

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59
Q

Stem cell solid tumor counterpart

A

Lymphoma, undifferentiated

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60
Q

Non-lymphocytic leukemias/myelogenous leukemia are generally MPO _ and SBB __

A

Both positive

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61
Q

AML, minimally differentiated ; MPO and SBB negative

A

M0

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62
Q

AML without maturation ; may demonstrate Auer rods

A

M1

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63
Q

AML with maturation ; most common subtype of AML ; may demonstrate Auer rods

A

M2

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64
Q

Acute promyelocytic leukemia ; DIC ; Faggot Cells

A

M3

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65
Q

Acute promyelocytic leukemia, microgranular variant that has a characteristic “butterfly”, “bow tie”, “coin-on-coin” or “apple core” nuclei

A

M3V

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66
Q

Acute myelomonocytic leukemia ; aka naegli monocytic leukemia ; 2nd most common ; may demonstrate Auer rods

A

M4

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67
Q

An Acute myelomonocytic leukemia with increased marrow eosinophils

A

M4E

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68
Q

Acute monocytic leukemia ; schilling leukemia

A

M5

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69
Q

Acute monocytic leukemia, poorly differentiated ; seen in children ; >80% monoblasts in bone marrow

A

M5a

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70
Q

Acute monocytic leukemia, well differentiated ; seen in children ; <80% monoblasts in bone marrow

A

M5b

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71
Q

Acute eryhtroleukemia ; Diguglielmo’s syndrome ; may demonstrate Auer rods ; normocytic normochromic ; PAS strongly positive

A

M6

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72
Q

Acute megakaryocytic leukemia ; required immunocytochem for accurate diagnosis ; factor VIII stain positive

A

M7

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73
Q

Acute basophilic leukemia

A

M8

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74
Q

Cytochem reactions of M1, M2, M3

A

+ + + - - -

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75
Q

Cytochem reactions M4

A

+ + + + + -

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76
Q

M7 reaction on a-naphthyl acetate esterase (NSE) and factor VIII stain

A

Localized positivity and positive

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77
Q

Chronic myelogenous leukemia is also known as

A

Chronic granulocyte leukemia

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78
Q

Characterized by the presence of Philadelphia chromosome

A

Chronic myelogenous leukemia

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79
Q

Three clinical phases of CML

A

Chronic phase, accelerated phase, blast crisis

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80
Q

___% of patients with CML have Philadelphia chromosome

A

90%

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81
Q

Presence of Philadelphia chromosome indicates ?

A

Good prognosis

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82
Q

CML must be differentiated from

A

Leukomoid reaction

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83
Q

Philadelphia chromosome is first described by ____ in the year ____

A

Peter C. Nowell in 1960

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84
Q

Philadelphia chromosome - due to reciprocal translocation involving the ___ arms of chromosome _ and __ (results in the formation of the _____ fusion gene)

A

Long ; 9 and 22 ; BCR-ABL1

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85
Q

Excessive leukocytic response in the peripheral blood ; confused with CML ; WBC ct greater than 50 x 10^9/L (with neutrophilia and a marked left shift presence of immature neutrophilic forms)

A

Leukomoid reaction

86
Q

most frequently refers to neutrophils, but the increased count may be due to an increase in other types of WBCs

A

Leukomoid reaction

87
Q

Generally used to distinguish Leukomoid reaction from CML

A

LAP/NAP TEST (LEUKOCYTE (NEUTROPHIL) ALKALINE PHOSPHATASE TEST

88
Q

This can be observed in neutrophils that have undergone normal growth

A

Increased LAP activity

89
Q

Hydrolysis of sodium alpha naphthyl phosphate by alkaline phosphatase produces a colored precipitate with a diazotised amine

A

Kaplow’s method

90
Q

Kaplow’s fixative

A

Methanol and formalin

91
Q

Kaplow’s buffer

A

Propanediole

92
Q

Kaplow’s substrate

A

Sodium alpha napthyl phosphate

93
Q

Kaplow’s initial stain

A

Brentamine-fast garnet salt

94
Q

Kaplow’s counterstain

A

Aqueous Mayer’s hematoxylin

95
Q

Kaplow’s positive color

A

Reddish brown to black precipitate of alkaline phosphate granules

96
Q

LAP score 0

A

NO reddish brown to black precipitate precipitate

97
Q

LAP score of 1+

A

SLIGHTLY DIFFUSED reddish brown to black precipitate

98
Q

LAP SCORE 2+

A

MODERATELY DIFFUSED reddish brown to black precipitate

99
Q

LAP SCORE 3+

A

HEAVILY DIFFUSED reddish brown to black precipitate

100
Q

LAP SCORE 4+

A

VERY HEAVILY DIFFUSED reddish brown to black precipitate

101
Q

Normal Kaplow’s score

A

15-100

102
Q

Within normal or high LAP score (LR or CML?)

A

LR

103
Q

Low LAP score (LR or CML?)

A

CML

104
Q

Examples of high LAP score

A

Third trimester pregnancy
PV
Infections
Intoxication

105
Q

Examples of low LAP score

A

CML
PNH
Sideroblastic anemia
Myelodysplastic syndrome

106
Q

Most common clinical application of flow cytometry

A

Diagnopposis of leukemias and lymphomas

107
Q

Most significant discovery that led to the improvement of flow cytometry suggests the measurement of a cell, this procedure is successfully applied to study in clinical practice

A

Development of monoclonal antibodies

108
Q

LASER stands for

A

Light amplified by stimulated emission of radiation

109
Q

The basic unit of all radiation is

A

Photon

110
Q

Peripheral blood and bone marrow specimens for flow cytometry must be processed within

A

24-48 hours from time of collection

111
Q

Preferred anticoagulant for flow cytometry

A

Heparin

112
Q

This can be detected directly by flow cytometer

A

Fluorochromes

113
Q

Tumor markers for immature lineage

A

CD34
CD 117
Terminal deoxynucleotidyl transferase

114
Q

Tumor markers for granulocytic/monocytic lineage

A

CD 33
CD 13
CD 15
CD 14

115
Q

Tumor markers for eryhthroid lineage

A

CD 71
Glycophorin A

116
Q

Tumor markers for megakaryocytic lineage

A

CD 41
CD 42
CD 61

117
Q

Tumor markers for B lymphocytes

A

CD 19
CD 20
CD 22
Kappa light chain
Gamma light chain

118
Q

Tumor markers for T lymphocyte

A

CD 2
CD 3
CD 4
CD 5
CD 7
CD 8

119
Q

Study of chemical constituents of cells ; useful for acute leukemias

A

Cytochemistry

120
Q

Differentiate acute granulocytic leukemias from monocytic leukemias

A

Esterase

121
Q

Nonspecific esterase

A

Alpha naphthyl acetate and butyrate

122
Q

Specific esterase

A

Naphthyl AS-D chloroacetate

123
Q

With strong positive reaction in a-naphthyl ACETATE esterase

A

Monocytes

124
Q

Negative for both a-naphthyl acetate/butyrate esterase

A

Monocytes ((with NaF inhibition)

125
Q

Immature non-nucleated RBC which contains 2 or more blue stained granulofilamentous materials after supravital staining

A

Reticulocyte

126
Q

Permits effective assessment of RBC production by the bone marrow ; a measure of EFFECTIVE ERYTHROPOIESIS

A

Reticulocyte count

127
Q

Retics reference range for Adult

A

0.5% to 1.5%

128
Q

Retics reference range in newborns

A

1.8% to 5.8%

129
Q

Considered as the first sign of accelerated erythropoiesis and observed in hemolytic anemias

A

Increased retics

130
Q

Supravital stains for retics

A

New methylene blue
Brillian cresyl blue

131
Q

Large square A of Miller disk is used for?

A

Counting retics

132
Q

Small square B of Miller disk is used for?

A

Counting RBCs

133
Q

Minimum number of RBCs that should be counted in small square B

A

112

134
Q

For routine light microscopy, equal amounts of blood and supravital stain are allowed to incubate at ____ for ____

A

Room temp for 3 to 10 mins

135
Q

Retics formula

A

of retics observed / 1000 rbcs x 100 = retics (%)

136
Q

Calibrated Miller Disk method formula

A

Total retics in square A / (total RBCs in square B x 9) x 100

137
Q

Most rapid accurate and precise method for retic count ; e.g. Sysmex R-3500

A

Flow cytometry

138
Q

Sysmex R-3500 uses what kind of supravital fluorescent dye

A

Auramine O

139
Q

Sum of the middle-fluorescence, or high-fluorescence ratios

A

Immature reticulocyte fraction (IRF)

140
Q

Color of Howell-Jollly bodies in NMB

A

Deep purple

141
Q

Color of papenheimer bodies in NMB

A

PURPLE

142
Q

Color of hemoglobin in NMB

A

GREENISH BLUE

143
Q

Nuclear fragments (DNA)

A

Howell-Jolly bodies

144
Q

Usual present at the peripheral edge of the red cell ; denatured and precipitated hemoglobin

A

Heinz bodies

145
Q

Color of Heinz bodies in NMB

A

LIGHT BLUE GREEN

146
Q

Generally appear as several granules in a small cluster ; a wright stained or a Prussian blue stained smear may be examined to confirm their presence ; hemosiderin in the mitochondria

A

Papenheimer bodies

147
Q

Multiple small dots ; seen in a form of alpha thalassemia

A

Hemoglobin H bodies

148
Q

Multiple small dots ; seen in a form of alpha thalassemia

A

Hemoglobin H bodies

149
Q

Actual number of Reticulocyte in 1 liter of whole blood

A

Absolute reticulocyte count

150
Q

Absolute reticulocyte count formula

A

Retics (%) x RBC ct (x10^12/L) / 100 x 1000

151
Q

Absolute reticulocyte count formula

A

Retics (%) x RBC ct (x10^12/L) / 100 x 1000

152
Q

Reference range for absolute reticulocyte count

A

20 to 115x10^9/L

153
Q

Sometimes referred to as reticulocyte index, hematocrit correction, poor man’s bone marrow aspirate

A

Corrected recticulocyte count

154
Q

Corrects the observed reticulocyte count to a normal HCT of 0.45 L/L to allow correction for the degree of patients anemia

A

Corrected rectic count

155
Q

CRC formula

A

Retics (%) x (HCT in L/L / 0.45 L/L)

156
Q

Also known as shift correction which provides a further refinement of the CRC

A

Reticulocyte production index

157
Q

A general indicator of the rate of erythrocyte production increase above normal in anemias

A

Reticulocyte production index

158
Q

RPI formula

A

CRC / Maturation time in the peripheral blood

159
Q

Maturation time of Hct of 40 to 45%

A

1.0

160
Q

Maturation time of Hct of 35 to 39%

A

1.5

161
Q

Maturation time of Hct of 25 to 34%

A

2.0

162
Q

Maturation time of Hct of 15 to 24%

A

2.5

163
Q

Maturation time of Hct of <15

A

3

164
Q

RPI that generally indicates adequate bone marrow response

A

> 3

165
Q

RPI that generally indicates inadequate bone marrow response

A

<2

166
Q

Aka electronic resistance or low voltage direct current or “Coulter Principle”

A

Electrical impedance

167
Q

_____ is proportional to the change in direct current

A

Total volume of cell

168
Q

_____ is proportional to pulse size/change in the radiofrequency signal

A

Cell interior density

169
Q

Plots conductivity (RF) and impedance (DC) of the cells

A

2D distribution cytogram or scatterplot

170
Q

Displays clusters of cells ; Number of dots represents the concentration of a specific cell type

A

Scatterplot

171
Q

Most common problem in cell counting ; produce POSITIVE ERROR

A

APERTURE PLUGS

172
Q

Produces negative error in automated cell counting

A

Excessive lysing of RBC

173
Q

In blood cell histogram, the number of cells is on what axis

A

Y-axis

174
Q

In blood cell histogram, the cell size is on what axis

A

X-axis

175
Q

If the RBCs are larger than normal, the curve will shit toward ___

A

The right

176
Q

If the RBCs are smaller than normal, the curve will shift to the

A

Left

177
Q

Distribution peak with small mononuclear population of cells (lymphocytes)

A

Fist peak (45-90 fL)

178
Q

Distribution peak with small mononuclear population of cells (lymphocytes)

A

Fist peak (45-90 fL0

179
Q

Distribution peak with minor population of large mononuclear cells ; an increase in the number of cells in this size range can also represent abnormal cell types

A

Second peak (90-160 fL)

180
Q

Minor population of LARGE MONONUCLEAR cell ( monocytes ) ; an increase in the number of cells in this size range can also represent an abnormal cell types

A

Second peak (90-160 fL)

181
Q

Distribution peak with normal mature types of granulocytes

A

Third peak (160-450 fL)

182
Q

Signal irregularities in the WBC distribution and will appear next to the differential parameters that are in error

A

Region code flags (R)

183
Q

Region code : warns of increased interference in the area left of the lymphocyte peak (approx 35 fL); typically caused by sickled RBCs, nucleated RBC, or clumped and giant platelets being counted in the WBC aperture bath

A

R1

184
Q

Region code: warns of excessive overlap of cell populations at the lymphocyte/mononuclear cell boundary (approx 90 fL) caused by the presence of abnormal cell types, such as atypical lymphocytes, blast, or plasma cells

A

R2

185
Q

Region code : warning is caused by excessive overlap of cell populations at mononuclear/granulocyte boundary (Approx 160 fL) which is due to the increased presence of immature granulocytes (bands, metamyelocytes)

A

R3

186
Q

Region code ; warning is caused by the extension of the cell distribution past the upper end of the threshold (approx 450 fL); this most commonly occurs when the granulocyte population is very high

A

R4

187
Q

Region code ; is the error code for MULTIPLE REGION OVERLAP

A

R5

188
Q

The actual counting of platelet histogram takes place in the ____ aperture

A

RBC

189
Q

Master of regulatory hormone of systemic iron metabolism

A

Hepcidin

190
Q

Protein produced by hepatocyte membrane

A

hemochromatosis protein (HFE)
transferrin receptor 2 (TfR2)
Bone morphogenic protein receptor (BMPR)
Hemojuvelin (HJV)

191
Q

Secreted product of macrophage

A

Bone morphogenic protein (BMP)

192
Q

Produced by hepatocyte (and other cells) cytoplasm

A

Sons of mothers against decapentaplegic (SMAD)

193
Q

Sites of maximal absorption of iron

A

Duodenum and upper jejunum

194
Q

These enhance the reduction of ferric form to the ferrous form and release of iron from those that bind it

A

Gastric acid
Acidic food such as citrus
Duodenal cytochrome B

195
Q

A form of iron that is more readily absorbed than ionic iron

A

Heme

196
Q

A form of iron that is carried across the luminal side of the enterocyte by divalent metal transporter 1 (DMT1)

A

FERROUS IRON

197
Q

Once ferrous iron is absorbed into enterocytes, it requires ______ to deliver it into the blood

A

Ferroportin

198
Q

Reoxidizes ferrous into ferric form as it exits for transport into the blood

A

Hephaestin

199
Q

Partially degraded ferritin ; appears in cases of iron overload ; may be seen microscopically using the Prussian blue iron stain

A

Hemosiderin

200
Q

A plasma protein that is able to save free hemoglobin

A

Haptoglobin

201
Q

A plasma protein that is able to save heme

A

Hemopexin

202
Q

Gold standard stain for assessment of body iron

A

Prussian blue stain

203
Q

Indicator of functional iron available in cells

A

Soluble transferrin receptor level (sTfR)
Log ferritin index

204
Q

Aka bronze diabetes

A

Hereditary hemochromatosis

205
Q

Characterized by increased iron accumulation in body tissues leading to tissue damage

A

Hemochromatosis

206
Q

Most common form of iron overload disease ; autosomal recessive disorder that cause body to absorb and store too much iron ; arthritis, liver cirrhosis, congestive heart failure, impotence, bronze skin, diabetes, thyroid deficiency

A

Hereditary hemochromatosis

207
Q

Hereditary hemochromatosis is caused by the mutations in the ___ gene

A

HFE gene

208
Q

The gene that regulates the amount of iron absorbed from food

A

HFE gene

209
Q

Hereditary hemochromatosis treatments

A

PHLEBOTOMY
Avoiding food that contains iron
DEFEROXAMINE (DESFERAL)

210
Q

Increased tissue iron stores without accompanying tissue damage ; may progress to hemochromatosis

A

Hemosiderosis

HEMATOLOGY 1 (8 decks)

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