MLT 120 Final Exam Flashcards by Alex Olsen

What test is the most reliable assessment of the effective erythroid activity of the bone marrow?

retic count

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What conditions (including parasitic infections) produce a macrocytic/normochromic picture?

Ovalocytes: Pernicious Anemia, Hemophilia B, folate deficiency, B12 deficiency
Round macrocytes: Liver disease, alcoholism
D. Latum infection

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Microcytic/ hypochromic blood picture?

Thalassemia, Cooley’s Anemia, iron deficiency, sideroblastic anemia, Pb poisoning, hookworm infection

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What are the typical findings (including RBC, WBC and platelets) in pernicious anemia (or vitamin B12 deficiency)?

Pancytopenia, oval macrocytes, hypersegs (shift to right)

(In BM: Megaloblasts, WBC precursors (Giant bands, metas, etc)).

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What is the Schilling test and what body fluid is used for the test?

The Schilling test is an indirect measure of intrinsic factor. Pernicious Anemia: Intake of radioactive B12, look for it in urine. Not in urine indicates lack of intrinsic factor and no B12 absorption in intestines.

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What are macropolycytes?

large cells with 5-7 lobes in nucleus. They are larger than hypersegs.

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What portion of the red blood cell is damaged leading to the formation of burr cells and thorn cells?

membrane

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What are the distinguishing characteristics of hereditary ovalocytosis?

Ovalocytes are seen. It does not need bone marrow to confirm. It is a cell membrane abnormality.

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What is the most unusual and significant finding in patients suffering from AIHA?

Positive Direct Coombs (Positive DAT)

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What poikilocyte is associated with ABO HDN?

With extramedullary hematopoiesis?

Spherocytes

Tear drop cells

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What are the laboratory findings in PCH?

+ Direct Coombs, + Donath Lansteiner, symptoms after exposure to cold.

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What are the hemoglobin electrophoresis results in sickle cell anemia?

Has Hgb S,F

No Hgb A.

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What hemoglobin is insoluble in reducing agents such as sodium dithionite and sodium metabisufite?

Hgb S

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Which chain of the hemoglobin molecule is abnormal in hemoglobin C disease, sickle cell anemia, and thalassemia major?

Beta chain

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What does the PBS of a patient with sickle cell trait usually show?

occasional target cells

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What does the PBS of a patient with IDA show?

Pale, microcytic/ hypochromic cells

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What are the serum iron and TIBC results in IDA?

decreased iron

increased TIBC

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What is the specific cause of thalassemia?

decreased rate of synthesis of either Alpha or Beta chain

inherited not normal

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What is another name for homozygous alpha thalassemia?

Bart’s disease

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Heterozygous alpha thalassemia?

Hemoglobin H Disease

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What causes relative polycythemia?

stress, dehydration, severe burns, plasma volume is decreased

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What are the typical laboratory findings in acute leukemia?

anemia, thrombocytopenia, young cells

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Auer rods and a positive peroxidase stain

AML

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positive periodic acid-Schiff (PAS) stain

ALL

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positive chloroacetate esterase stain (specific)

AMML

presence of myelomonocyes

Naegli's or AMML

presence of the Philadelphia chromosome

CML

hypermature lymphs and smudge cells

CLL

extreme thrombocytosis

CML

increased incidence of bleeding disorders (i.e. DIC)

APL

What leukemia is most frequently seen in patients over the age of 50?

CLL

What type of cells might be expected to be found in the bone marrow of a leukemic patient?

same cells as in PBS (acute = blasts, CML = all stages of granulocytes) except IM

What is the end stage of DiGuglielmo's syndrome?

AML

What condition would be described as acute granulocytopenia?

severe neutropenia

What are the laboratory findings in Hodgkin's disease?

Increased Eos (Leukomoid reaction with eosinophilia), decreased lymphs, Reed Sternberg cell

What are the laboratory findings in multiple myeloma?

occasional plasma cell, Bence Jones protein, rouleaux, increased sed rate

What is the L.E. factor?

anti-nucleoprotein | IgG antibody

How is a Downey cell described?

Atypical lymph in IM- scalloping around RBC, blue at edges | AKA Reactive Lymphocyte

What disease is indicated by a positive ANA?

SLE(Lupus)

With what conditions is a decreased LAP associated?

CML, AML, increased Leukomoid reactions

What are the causes of bleeding?

trauma, decreased clotting factor synthesis, DIC, increased utilization of clotting factors, genetic defects

What is the immediate response to vessel injury?

vasocontriction

What comprises the initial plug in the wall of an injured vessel?

platelets

What is meant by platelet adhesion? | platelet aggregation?

sticks to surfaces platelets stick to each other

Which platelet factor is most instrumental in the clotting process?

Factor III

Hemophilia A

Factor VIII | labile

Hemophilia B | Christmas Factor

Factor IX | aged serum, vit K dependent

Stuart Prower

Factor X aged serum vit K dependent

Plasma thromboplastin anticedient

Factor XI absorbed plasma aged serum

Hageman's Factor

Factor XII absorbed plasma aged serum

Intrinsic factors

XII XI IX VIII X V II I 12 11 9 8 10 5 2 1 (NOT 7)

Extrinsic factors

VII X V II I | 7 10 5 2 1

Factors in common

X V II I | 10 5 2 1

Vitamin K dependent factors

II VII IX X | 2 7 9 10

Which factor NOT made in the liver is increased in liver disease?

VIII | 8

Labile factors

V VIII | 5 & 8

Adsorbed plasma factors

V VIII XI XII (I) | 5 8 11 12 (1)

Aged serum factors

VII IX X XI XII (II) | 7 9 10 11 12 (2)

Factors which don't have an enzymatically active form

NOT labile | 5 & 8

Components of thromboplastin

Activated factor X platelet factor 3 Calcium Factor V

End result of Stage I

Plasma thromboplastin

End result of Stage II

thrombin

End result of Stage III

fibrin

Substance which initiates the extrinsic system tissue

factor 3 | + thromboplastin

Substance which initiates the intrinsic system

platelet factor 3, Plasma Factor XII (12), contact with exposed collagen *NOT tissue factor III*

Precursor of thrombin

prothrombin

Substance which converts fibrinogen to fibrin

thrombin

Activated substance responsible for clot lysis

plasmin (activated)

Final end products of the breakdown of fibrin and of fibrinogen

frag 1E | 2 D frag

Components which are depleted in DIC

I V VIII | platelet factor 3

Factor deficiency that would be incompatible with life

IV (calcium)

Principle of the coagulyzer (or MLA)

formation of clot changes ocular density of light detected by photoelectric cell

Principle of the Fibrometer

completion of electrical circuit due to formation of clot

Bleeding time (Duke, Ivy, and Simplate)

Duke: ear 1-3 min Ivy: forearm 1-7 min

Tourniquet test

capillary fragility

Thrombin time

availability of fibrinogen | 15-20 sec

Lee-White clotting time (use)

monitoring heparin therapy, detect intrinsic defects

Prothrombin consumption test

Measures amount of prothrombin remaining in serum after clotting.

fibrinogen (normal values)

200-400 mg/dl

Clot retraction (factors which influence it)

fibrinogen level, platelet count, thrombosthenin VI Platelet function test only if fibrinogen level is normal, normal platelet count, thombosthenin produced by platelets is present. (Normal HCT?)

PT (What deficiency is it especially sensitive to?)

deficiency in factor VII

PTT (What abnormalities could be indicated by an ^ PTT?)

liver disease Hemophilia A & B **Any intrinsic defect, no platelet abnormality. Cannot detect platelet abnormality**

Plasma recalcification time

Amount of time required for a clot to form in plasma (add Ca to plasma, time to clot)

Stypven time (factor for which it is most useful for diagnosis of deficiency)

Russels viper venom - factor VII

Substitution testing (how to use adsorbed plasma & aged serum)

know what factors increase PT & PTT

Euglobulin lysis (use)

fibrinolysis measure

ThromboWellco test (especially normal values)

If agglutination occurs: in 1:5 dilution but not in 1:20: FDP >1040 in neither:

TGT (use of adsorbed plasma & aged serum)

Thromboplastin generation time Know factors for increased not factor 7

5 M urea test (what factor does it detect?)

factor 13 only

Tests useful in the diagnosis of DIC

bleeding time, abnormal PT/PTT, fibrinolysis, 1,5,8 platelets

Effect of aspirin on testing (esp. BT and Saltzman glass bead test)

increased BT, abnormal decreased glass bead test

Hemophilia A

Deficiency of VIII sex-linked recessive increased PTT (NOT PT)

Hemophilia B

Christmas disease Deficiency of factor IX Increased PTT Clinically cannot be distinguished from Hemophilia A

VonWillebrand's disease

increased PTT, abnormal bleeding time (Factor VIII def) | Bleeding time distinguishes Hem A from VonWillebrands

idiopathic thrombocytopenic purpura (ITP)

due to anti-platelet Ab, increased bleeding time, decreased platelets, pinpoint hemorrhages petechiae BM increased megacaryocytes

Glanzmann's thrombasthenia

platelets are functionally defective

Hereditary telangiectasia

vascular abnormality

Parahemophilia

factor V def

What is the mode of action of the common anticoagulants coumadin and heparin?

Coumadin: anti-Vitamin K, PT heparin: neutralized/inactivates thrombin, PTT

What level (expressed as a percentage of normal) must be reached for a clotting factor to cause an abnormality in coagulation?

30-40% | norm 50-150%

What is anti-thrombin III?

natural anticoagulant required for heparin to work

Name a test that will distinguish between primary and secondary fibrinolysis

D-Dimer

What factors are removed when plasma is adsorbed?

vitamin K dependent factors II VII IX X

BONUS What reagents can be used to prepare adsorbed plasma?

barium sulfate or aluminum hydroxide

What is viscous metamorphosis?

irreversible aggregation of platelets | 1st aggregation is reversible 2nd is irreversible

What plasminogen activators are now being used to treat heart attack and stroke victims?

streptokinase, urokinase, TPA if stroke within 4hrs