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AMT MT Exam > Review Cards - Hematology > Flashcards

Review Cards - Hematology Flashcards

1
Q

Adult reference ranges - WBC

A

Conventional: 4.5-11.5 x 10^3/uL
SI: 4.5-11.5 x 10^9/L

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2
Q

Adult reference ranges - RBC

A

Conventional:
-Male: 4.6-6 x 10^6/uL
-Female: 4-5.4 x 10^6/uL

SI:
-Male: 4.6-6 x 10^12/L
-Female: 4-5.4 x 10^12/L

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3
Q

Adult reference ranges - HGB

A

Conventional:
-Male: 14-18 g/dL
-Female: 12-15 g/dL

SI:
-Male: 140-180 g/L
-Female: 120-150 g/L

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4
Q

Adult reference ranges - HCT

A

Conventional:
-Male: 40-54%
-Female: 35-49%

SI:
-Male: 0.40-0.54 L/L
-Female: 0.35-0.49 L/L

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5
Q

Adult reference ranges - Mean corpuscular volume (MCV)

A

80-100 fL

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6
Q

Adult reference ranges - Mean corpuscular hemoglobin (MCH)

A

27-31 pg

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7
Q

Adult reference ranges - Mean corpuscular hemoglobin concentration (MCHC)

A

Conventional: 32-36%
SI: 32-36 g/dL

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8
Q

Adult reference ranges - PLT

A

Conventional: 150-450 x 10^3/uL
SI: 150-450 x 10^9/L

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9
Q

Reference ranges for red cell parameters: RBCs (x10^12/L) - birth

A

4.10-6.10 x 10^12/L

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10
Q

Reference ranges for red cell parameters: RBCs (x10^12/L) - 1-2 MO

A

3.4-5 x 10^12/L

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11
Q

Reference ranges for red cell parameters: RBCs (x10^12/L) - 1-3 YR

A

4.3-5.2 x 10^12/L

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12
Q

Reference ranges for red cell parameters: RBCs (x10^12/L) - 8-13 YR

A

4-5.4 x 10^12/L

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13
Q

Reference ranges for red cell parameters: RBCs (x10^12/L) - Adult

A

Males: 4.6-6 x 10^12/L
Females: 4-5.4 x 10^12/L

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14
Q

Reference ranges for red cell parameters: HGB (g/dL) - birth

A

16.5-21.5 g/dL

(g/L): 165-215 g/L

-Preterm infants: about 1 g lower than full-term

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15
Q

Reference ranges for red cell parameters: HGB (g/dL) - 1-2 MO

A

10.6-16.4 g/dL

(g/L): 106-164 g/L

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16
Q

Reference ranges for red cell parameters: HGB (g/dL) - 1-3 YR

A

9.6-15.6 g/dL

(g/L): 96-156 g/L

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17
Q

Reference ranges for red cell parameters: HGB (g/dL) - 8-13 YR

A

12-15 g/dL

(g/L): 120-150 g/L

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18
Q

Reference ranges for red cell parameters: HGB (g/dL) - Adult

A

Male: 14-18 g/dL
Female: 12-15 g/dL

(g/L):
Male: 140-180 g/L
Female: 120-150 g/L

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19
Q

Reference ranges for red cell parameters: HCT (%) - Birth

A

48-68%

(L/L): 0.48-0.68 L/L

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20
Q

Reference ranges for red cell parameters: HCT (%) - 1-2 MO

A

32-50%

(L/L): 0.32-0.5 L/L

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21
Q

Reference ranges for red cell parameters: HCT (%) - 1-3 YR

A

38-48%

(L/L): 0.38-0.48 L/L

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22
Q

Reference ranges for red cell parameters: HCT (%) - 8-13 YR

A

35-49%

(L/L): 0.35-0.49 L/L

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23
Q

Reference ranges for red cell parameters: HCT (%) - Adult

A

Male: 40-54%
Female: 35-49%

(L/L):
Male: 0.40-0.54 L/L
Female: 0.35-0.49 L/L

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24
Q

Reference ranges for red cell parameters: MCV (fL) - Birth

A

95-125 fL

-macrocytes 1st 5 days, MCV higher in preterm infants

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25
Q

Reference ranges for red cell parameters: MCV (fL) - 1-2 MO

A

83-107 fL

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26
Q

Reference ranges for red cell parameters: MCV (fL) - 1-3 YR

A

78-94 fL

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27
Q

Reference ranges for red cell parameters: MCV (fL) - 8-13 YR

A

80-94 fL

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28
Q

Reference ranges for red cell parameters: MCV (fL) - Adult

A

80-100 fL

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29
Q

Reference ranges for red cell parameters: Red Cell Distribution Width (RDW) (%) - Birth

A

14.2-19.9%

(L/L): 0.142-0.199 L/L

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30
Q

Reference ranges for red cell parameters: Red Cell Distribution Width (RDW) (%) - 1-3 YR

A

11.4-14.5%

(L/L): 0.114-0.145 L/L

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31
Q

Reference ranges for red cell parameters: Red Cell Distribution Width (RDW) (%) - 8-13 YR

A

11.5-14.5%

(L/L): 0.115-0.145 L/L

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32
Q

Reference ranges for red cell parameters: Red Cell Distribution Width (RDW) (%) - Adult

A

11.5-14.5%

(L/L): 0.115-0.145 L/L

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33
Q

Reference ranges for red cell parameters: Retic (%) - Birth

A

1.5-5.8%

Newborns: increased polychromasia

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34
Q

Reference ranges for red cell parameters: Retic (%) - 1-2 MO

A

0.8-2.8%

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35
Q

Reference ranges for red cell parameters: Retic (%) - 1-3 YR

A

0.5-1.5%

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36
Q

Reference ranges for red cell parameters: Retic (%) - 8-13 YR

A

0.5-1.5%

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37
Q

Reference ranges for red cell parameters: Retic (%) - Adult

A

0.5-1.5%

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38
Q

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - Birth

A

2-24/100 WBCs

-Preterm infants: up to 25 for >1 week

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39
Q

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - 1-2 MO

A

0/100 WBCs

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40
Q

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - 1-3 YR

A

0/100 WBCs

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41
Q

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - 8-13 YR

A

0/100 WBCs

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42
Q

Reference ranges for red cell parameters: Nucleated RBC (nRBCs) (/100 WBCs) - Adult

A

0/100 WBCs

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43
Q

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - Birth

A

9-37 x 10^9/L

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44
Q

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - 1-2 MO

A

6-18 x 10^9/L

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45
Q

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - 1-3 YR

A

5.5-17.5 x 10^9/L

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46
Q

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - 8-13 YR

A

4.5-13.5 x 10^9/L

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47
Q

Reference ranges for leukocytes and platelets - WBCs (x10^9/L) - Adults

A

4.5-11.5 x 10^9/L

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48
Q

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - Birth

A

37-67%

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49
Q

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - 1-2 MO

A

20-40%

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50
Q

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - 1-3 YR

A

22-46%

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51
Q

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - 8-13 YR

A

23-53%

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52
Q

Reference ranges for leukocytes and platelets - Segmented Neutrophils (Segs) (%) - Adult

A

50-70%

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53
Q

Reference ranges for leukocytes and platelets - Bands (%) - Birth

A

3-11%

-Newborns: occasional metamyelocyte (metas) & myelocyte (myelos)
-More immature granulocytes seen in preterm infants

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54
Q

Reference ranges for leukocytes and platelets - Bands (%) - 1-2 MO

A

0-5%

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55
Q

Reference ranges for leukocytes and platelets - Bands (%) - 1-3 YR

A

0-5%

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56
Q

Reference ranges for leukocytes and platelets - Bands (%) - 8-13 YR

A

0-5%

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57
Q

Reference ranges for leukocytes and platelets - Bands (%) - Adults

A

2-6%

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58
Q

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - Birth

A

18-38%

-Newborns: a few benign immature B cells may be seen (“baby” or “kiddie” lymphs).

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59
Q

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - 1-2 MO

A

42-72%

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60
Q

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - 1-3 YR

A

37-73%

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61
Q

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - 8-13 YR

A

23-53%

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62
Q

Reference ranges for leukocytes and platelets - Lymphocytes (Lymphs) (%) - Adult

A

20-44%

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63
Q

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - Birth

A

150-450 x 10^9/L

Newborns: variation in size & shape

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64
Q

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - 1-2 MO

A

150-450 x 10^9/L

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65
Q

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - 1-3 YR

A

150-450 x 10^9/L

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66
Q

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - 8-13 YR

A

150-450 x 10^9/L

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67
Q

Reference ranges for leukocytes and platelets - PLT (x10^9/L) - Adult

A

150-450 x 10^9/L

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68
Q

Hematopoietic cell differentiation & function

A
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69
Q

Erythropoeisis - 1-2 MO of gestation - site(s)

A

-yolk sac
-aorta-gonads-mesonephros (AGM) region

-primitive erythroblasts
-embryonic hemoglobin (Gower I, Gower II, Portland)

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70
Q

Erythropoeisis - 3-6 MO of gestation - site(s)

A

-liver
-spleen

(Liver is primary site)

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71
Q

Erythropoeisis - 7 MO of gestation to age 4 years - site(s)

A

bone marrow

(all marrow is active)

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72
Q

Erythropoeisis - Adult - site(s)

A

-active sites: pelvis, vertebrae, ribs, sternum, skull

-shafts of long bones are filled with fat
-fatty marrow may be reactivated to compensate for anemia
-liver & spleen may be reactivated (extramedullary hematopoiesis) if bone marrow fails to keep up with demand

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73
Q

Changes during cell maturation - size

A

becomes smaller

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74
Q

Changes during cell maturation - N:C ratio

A

becomes smaller

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75
Q

Changes during cell maturation - cytoplasm

A

-less basophilic due to loss of RNA
-granulocytes produce granules
-erythrocytes become pink due to HGB production

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76
Q

Changes during cell maturation - nucleus

A

-becomes smaller
-nuclear chromatin condenses
-nucleoli disappear
-in granulocyte series, nucleus indents, then segments
-in erythrocyte series, nucleus is extruded

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77
Q

Erythrocyte developmental series - pronormoblast

A

-14-24 um
-N:C ratio 8:1
-royal blue cytoplasm
-fine chromatin
-1-2 nucleoli
-normally confined to bone marrow

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78
Q

Erythrocyte developmental series - basophilic normoblast

A

-12-17 um
-N:C ratio 6:1
-deep blue cytoplasm
-chromatin is coarser with slightly visible parachromatin
-nucleoli usually not visible
-normally confined to bone marrow

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79
Q

Erythrocyte developmental series - polychromatophilic normoblast

A

-10-15 um
-N:C ratio 4:1
-cytoplasm is polychromatophilic due to HGB production
-chromatin is clumped with distinct areas of parachromatin (spoke-like pattern)
-last stage to divide
-normally confined to bone marrow

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80
Q

Erythrocyte developmental series - orthochromatic normoblast

A

-8-12 um
-N:C ratio 1:2
-nucleus is pyknotic
-last nucleated stage
-normally confined to bone marrow

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81
Q

Erythrocyte developmental series - polychromatophilic erythrocyte

A

-7-10 um
-NO nucleus
-cytoplasm is diffusely basophilic (bluish tinge)
-reticulum seen with supravital stain
-0.5-1.5% of RBCs in adult peripheral blood

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82
Q

Erythrocyte developmental series - mature erythrocyte

A

-7-8 um
-biconcave disk
-reddish-pink cytoplasm with area of central pallor 1/3 diameter of cell

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83
Q

List the order of the erythrocyte developmental series.

A
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84
Q

Asynchronous erythropoiesis - megaloblastic

A

Cause: vitamin B12 and/or folic acid deficiency

Explanation: nucleus lags behind cytoplasm in maturation; cells grow larger without dividing

Characteristics: oval macrocytes

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85
Q

Asynchronous erythropoiesis - megaloblastic

A

Cause: vitamin B12 and/or folic acid deficiency

Explanation: nucleus lags behind cytoplasm in maturation; cells grow larger without dividing

Characteristics: oval macrocytes

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86
Q

Asynchronous erythropoiesis - iron deficiency

A

Cause: iron deficiency (reduces erythropoietin production)

Explanation: cytoplasm lags behind nucleus in maturation due to inadequate iron for HGB synthesis

Characteristics: microcytic, hypochromic RBCs

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87
Q

Hemoglobin - Hgb A

A

Molecular structure: 2 alpha + 2 beta chains

Adult reference value: >95%

Newborn reference value: 20%

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88
Q

Hemoglobin - Hgb A2

A

Molecular structure: 2 alpha + 2 delta chains

Adult reference value: 1.5-3.7%

Newborn reference value: <1%

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89
Q

Hemoglobin - Hgb F

A

Molecular structure: 2 alpha + 2 gamma chains

Adult reference value: <2%

Newborn reference value: 50-85%

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90
Q

Hemoglobin - Hgb S

A

Molecular structure: valine substituted for glutamic acid in 6th position of beta chain

Adult reference vale: 0

Newborn reference value: 0

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91
Q

Hemoglobin - Hgb C

A

Molecular structure: lysine substituted for glutamic acid in 6th position of beta chain

Adult reference value: 0

Newborn reference value: 0

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92
Q

Hemoglobin electrophoresis - Cellulose Acetate pH 8.6

A
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93
Q

Hemoglobin electrophoresis - Citrate Agar pH 6.2

A
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94
Q

Hemoglobin derivatives - Methemoglobin

A

Cause: iron oxidized to ferric (Fe3+) state; usually acquired from exposure to oxidants; rarely inherited

Effect: can’t bind oxygen; cyanosis, possibly death

Normal % of HGB: <=1%

Other: Heinz bodies; treat with methylene blue; chocolate blood

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95
Q

Hemoglobin derivatives - Sulfhemoglobin

A

Cause: sulfur bound to heme; acquired from exposure to drugs & chemicals

Effect: O2 affinity 1/100th normal; cyanosis

Normal % of total HGB: 0

Other: can’t be converted back to normal Hgb; not detected in cyanmethemoglobin method; green blood

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96
Q

Hemoglobin derivatives - Carboxyhemoglobin

A

Cause: carbon monoxide bound to heme

Effect: decreased oxygen to tissues; can be fatal

Normal % of total Hgb: <1%

Other: affinity of hgb for CO is 200x greater than for oxygen; skin turns cherry red

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97
Q

How are hemoglobin derivates quantitated?

A

differential spectrophotometry

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98
Q

RBC morphology - Size - anisocytosis

A

-variation in size

Significance: seen in many anemias

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99
Q

RBC morphology - Size - macrocytes

A

-RBCs >9 um

Significance:
-megaloblastic anemias
-liver disease
-reticulocytosis
-NORMAL in newborns

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100
Q

RBC morphology - Size - microcytes

A

-RBCs <6 um

Significance:
-iron deficiency anemia (IDA)
- thalassemia
-sideroblastic anemia
-anemia of chronic inflammation

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101
Q

RBC morphology - Shape - poikilocytosis

A

-variation in shape

Significance: seen in many anemias

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102
Q

RBC morphology - Shape - elliptocytes/ovalocytes

A

-oval or pencil/cigar shaped

Significance: membrane defect
-hereditary elliptocytosis/ovalocytosis
- various anemias

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103
Q

RBC morphology - Shape - crenated RBCs

A

-round cell with knobby, uniform projections

Significance: osmotic imbalance
-if seen in most cells in thin part of smear, don’t report; probably artifact due to excess anticoagulant or slow drying

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104
Q

RBC morphology - Shape - echinocytes (Burr cells)

A

-round cell with evenly spaced blunt or pointed projections

Significance: membrane defect
-uremia
-pyruvate kinase deficiency
-may be drying artifact
-a few can present in healthy individuals

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105
Q

RBC morphology - Shape - acanthocytes (spur cells)

A

-small, dense cells with irregularly spaced projections of varying length

Significance: membrane defect
-severe liver disease
-abetalipoproteinemia

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106
Q

RBC morphology - Shape - schistocytes (helmet cells)

A

-RBC fragments

Significance: RBCs split by fibrin strands
-microangiopathic hemolytic anemias (DIC, TTP, HUS)
-prosthetic heart valves

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107
Q

RBC morphology - Shape - sickle cells (drepanocytes)

A

-crescent, S or C shaped, boat shaped, oat shaped

Significance: sickle cell anemia

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108
Q

RBC morphology - Shape - hemoglobin C crystals

A

-blunt, 6-sided (hexagonal), dark-staining projection; can also be rod-shaped or tetragonal

Significance: Hemoglobin C disease

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109
Q

RBC morphology - Shape - hemoglobin SC crystals

A

-finger-like intracellular crystals, often misshapen

Significance: Hemoglobin SC disease

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110
Q

RBC morphology - Shape - teardrops (dacrocytes)

A

-teardrop shaped

Significance:
-myelofibrosis
-thalassemia
-other anemias

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111
Q

RBC morphology - Staining - hypochromia

A

-central pallor >1/3 cell diameter

Significance:
-IDA
-thalassemia

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112
Q

RBC morphology - Staining - anisochromia

A

-mixture of normochromic & hypochromic RBCs

Significance:
-dimorphic anemia
-post-transfusion

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113
Q

RBC morphology - Staining - polychromasia

A

-bluish-gray color

Significance: young RBC; retics with supravital stain; sign of active erythropoiesis; 1-2% in normal adult
-increased with:
–acute blood loss
–hemolytic anemia
–following treatment for anemia (iron deficiency, pernicious anemia, folate deficiency, vitamin B12 deficiency)

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114
Q

RBC morphology - Staining - target cells (codocytes)

A

-bull’s eye

Significance:
-hemoglobinopathies
-thalassemia
-liver disease
-may be artifact if observed in only 1 part of smear

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115
Q

RBC morphology - Staining - stomatocytes

A

-RBC with slit-like central pallor

Significance:
-hereditary stomatocytosis
-hereditary spherocytosis
-thalassemia
-alcoholic cirrhosis
-Rh null disease
-may be artifact in parts of smear that are too thin or too thick

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116
Q

RBC morphology - Staining - spherocytes

A

-small, dark-staining RBCs without central pallor

Significance: membrane defect
-hereditary spherocytosis
-autoantibodies
-burns
-hemoglobinopathies
-hemolysis
-ABO hemolytic disease of fetus and newborn (HDFN)
-incompatible blood transfusion
-transfusion of stored blood
-a few are normal due to aging of RBCs

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117
Q

RBC morphology - Arrangement - rouleaux

A

-RBCs resemble stack of coins

Significance: serum protein abnormality (e.g., increased globulins or fibrinogen)
-multiple myeloma
-macroglobulinemia
-may be artifact due to delay in spreading drop of blood or smear that’s too thick

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118
Q

RBC morphology - Arrangement - agglutination

A

-RBCs in irregular clumps

Significance:
-autoantibodies
-cold autoagglutination

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119
Q

RBC morphology - Shape - Bite cells

A

-RBCs have a “bitten” appearance

Significance:
-G6PD deficiency
-oxidative drug effect
-hemoglobinopathies

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120
Q

RBC inclusions - basophilic stippling - stain

A

-Wright
-new methylene blue

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121
Q

RBC inclusions - basophilic stippling - description

A

multiple, irregular purple inclusions evenly distributed in cell

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122
Q

RBC inclusions - basophilic stippling - composition

A

aggregation of RNA (ribosomes)

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123
Q

RBC inclusions - basophilic stippling - significance

A

Coarse: exposure to lead
Fine: young RBC

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124
Q

RBC inclusions - basophilic stippling - conditions

A

-exposure to lead
-accelerated or abnormal hemoglobin synthesis
-thalassemia

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125
Q

RBC inclusions - Howell-Jolly bodies - stain

A

-Wright
-new methylene blue

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126
Q

RBC inclusions - Howell-Jolly bodies - description

A

-round
-purple
-1-2 um in diameter
-usually only 1 per cell

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127
Q

RBC inclusions - Howell-Jolly bodies - composition

A

nuclear remnants (DNA)

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128
Q

RBC inclusions - Howell-Jolly bodies - significance

A

-usually pitted by spleen
-seen with accelerated or abnormal erythropoiesis

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129
Q

RBC inclusions - Howell-Jolly bodies - conditions

A

-post-splenectomy
-thalassemia
-hemolytic & megaloblastic anemias
-sickle cell anemia

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130
Q

RBC inclusions - Cabot rings - stain

A

Wright

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131
Q

RBC inclusions - Cabot rings - description

A

reddish purple rings or figure-8s

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132
Q

RBC inclusions - Cabot rings - composition

A

may be part of mitotic spindle, remnant of microtubules, or fragment of nuclear membrane

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133
Q

RBC inclusions - Cabot rings - significance

A

-rapid blood regeneration
-abnormal erythropoiesis

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134
Q

RBC inclusions - Cabot rings - conditions

A

-megaloblastic anemia
-thalassemia
-post-splenectomy

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135
Q

RBC inclusions - Pappenheimer bodies - stain

A

Wright (siderotic granules with Prussian blue stain)

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136
Q

RBC inclusions - Pappenheimer bodies - description

A

-small purplish blue granules
-vary in size, shape, number
-usually in clusters at periphery

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137
Q

RBC inclusions - Pappenheimer bodies - composition

A

unused iron particles

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138
Q

RBC inclusions - Pappenheimer bodies - significance

A

faulty iron utilization during hemoglobin synthesis

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139
Q

RBC inclusions - Pappenheimer bodies - conditions

A

-sideroblastic anemias
-post-splenectomy
-thalassemia
-sickle cell anemia
-hemochromatosis

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140
Q

RBC inclusions - siderotic granules - stain

A

Prussian blue

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141
Q

RBC inclusions - siderotic granules - description

A

blue granules of varying size & shape

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142
Q

RBC inclusions - siderotic granules - composition

A

aggregates of iron particles

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143
Q

RBC inclusions - siderotic granules - significance

A

faulty iron utilization in hgb synthesis

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144
Q

RBC inclusions - siderotic granules - conditions

A

-sideroblastic anemias
-post-splenectomy
-thalassemia
-sickle cell anemia
-hemochromatosis

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145
Q

RBC inclusions - reticulocytes - stain

A

new methylene blue (polychromasia on Wright stain)

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146
Q

RBC inclusions - reticulocytes - description

A

blue-staining network

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147
Q

RBC inclusions - reticulocytes - composition

A

residual RNA (ribosomes)

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148
Q

RBC inclusions - reticulocytes - significance

A

> 2% = increased erythropoiesis

<0.1% = decreased erythropoiesis

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149
Q

RBC inclusions - reticulocytes - conditions

A

-hemolytic anemia
-blood loss
-following treatment for IDA or megaloblastic anemia

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150
Q

RBC inclusions - Heinz bodies - stain

A

supravital stain (e.g., crystal violet, brilliant cresyl blue, methylene blue)

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151
Q

RBC inclusions - Heinz bodies - description

A

-round blue inclusions
-varying sizes
-close to cell membrane
-may be >1

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152
Q

RBC inclusions - Heinz bodies - composition

A

precipitated, oxidized, denatured hemoglobin

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153
Q

RBC inclusions - Heinz bodies - significance

A

normal during aging but pitted by spleen

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154
Q

RBC inclusions - Heinz bodies - conditions

A

-glucose-6-phosphate dehydrogenase (G6PD) deficiencies
-unstable hemoglobins
-chemical injury to RBCs
-drug induced hemolytic anemia

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155
Q

Staining of RBC inclusions - reticulum

A

Wright stain: cell appears polychromatophilic

New methylene blue: yes

Prussian blue: no

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156
Q

Staining of RBC inclusions - Howell-Jolly bodies

A

Wright stain: yes

New methylene blue: yes

Prussian blue: no

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157
Q

Staining of RBC inclusions - Pappenheimer bodies

A

Wright stain: yes

New methylene blue: yes

Prussian blue: yes

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158
Q

Staining of RBC inclusions - Siderotic granules

A

Wright stain: yes, but called Pappenheimer bodies

New methylene blue: yes

Prussian blue: yes

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159
Q

Staining of RBC inclusions - Heinz bodies

A

Wright stain: no

New methylene blue: yes

Prussian blue: no

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160
Q

Erythrocyte indices - MCV

A

-average volume of RBC
-used to classify anemias
-combination of microcytes & macrocytes may result in normal MCV
-Normal range: 80-100 fL

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161
Q

Erythrocyte indices - MCH

A

-average weight of hemoglobin in individual RBCs
-varies in proportion to MCV
-Normal range: 27-31 pg

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162
Q

Erythrocyte indices - MCHC

A

-average concentration of hemoglobin per dL of RBCs
-MCHC >37 may indicate problem with specimen (hyperlipidemia, cold agglutinins, icterus, elevated WBC) or instrument
-normal range: 32-36 g/dL

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163
Q

Hemoglobinopathy versus Thalassemia - abnormality

A

Hemoglobinopathy: qualitative abnormality; abnormality in amino acid sequence of globin chain, not in amount of globin produced

Thalassemia: quantitative abnormality; amino acid sequence of globin chains is normal, but underproduction of 1 or more globin chains

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164
Q

Hemoglobinopathy versus Thalassemia - Examples

A

Hemoglobinpathy: Sickle cell anemia & trait, hemoglobin C disease & trait

Thalassemia: beta-thalassemia major & minor

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165
Q

Normocytic anemias: Sickle cell anemia (SS) - etiology

A

-inheritance of sickle cell gene from both parents
-valine substituted for glutamic acid in 6th position of beta chain

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166
Q

Normocytic anemias: Sickle cell anemia (SS) - blood smear

A

-anisocytosis
-poikilocytosis
-sickle cells
-target cells
-nRBCs
-Howell-Jolly bodies
-basophilic stippling
-siderotic granules
-polychromasia

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167
Q

Normocytic anemias: Sickle cell anemia (SS) - hemoglobin electrophoresis

A

S: >=80%
F: 1-20%
A2: normal
A: none

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168
Q

Normocytic anemias: Sickle cell anemia (SS) - decreased O2 & blood pH

A

hemoglobin S polymerizes under decreased O2 & decreased blood pH

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169
Q

Normocytic anemias: Sickle cell anemia (SS) - disease not evident in newborn

A

because of increased hemoglobin F

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170
Q

Normocytic anemias: Sickle cell anemia (SS) - diagnosis (test)

A

positive solubility test

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171
Q

Normocytic anemias: Sickle cell anemia (SS) - CBC

A

-Retics: 10-20%
-may have increased WBC with shift to left & increased platelets
-moderate to severe anemia

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172
Q

Normocytic anemias: Sickle cell trait (AS) - etiology

A

inheritance of sickle cell gene from 1 parent

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173
Q

Normocytic anemias: Sickle cell trait (AS) - blood smear

A

-occasional target cells
-no sickle cells unless hypoxic

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174
Q

Normocytic anemias: Sickle cell trait (AS) - hemoglobin electrophoresis

A

A: 50-65%
S: 35-45%
F: normal
A2: normal to slightly increased

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175
Q

Normocytic anemias: Sickle cell trait (AS) - anemia

A

no anemia

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176
Q

Normocytic anemias: Sickle cell trait (AS) - diagnosis (test)

A

positive solubility test

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177
Q

Normocytic anemias: Hemoglobin C disease (CC) - etiology

A

-inheritance of gene for hemoglobin C from both parents
-lysine substituted for glutamic acid in 6th position of beta chain

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178
Q

Normocytic anemias: Hemoglobin C disease (CC) - blood smear

A

-many target cells
-folded cells
-occasional hemoglobin C crystals

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179
Q

Normocytic anemias: Hemoglobin C disease (CC) - hemoglobin electrophoresis

A

C: >90%
F: <7%
A: none

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180
Q

Normocytic anemias: Hemoglobin C disease (CC) - anemia

A

mild to moderate

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181
Q

Normocytic anemias: Hemoglobin C trait (AC) - etiology

A

inheritance of gene for hemoglobin C from 1 parent

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182
Q

Normocytic anemias: Hemoglobin C trait (AC) - blood smear

A

many target cells

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183
Q

Normocytic anemias: Hemoglobin C trait (AC) - hemoglobin electrophoresis

A

A: 60-70%
C: 30-40%

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184
Q

Normocytic anemias: Sickle cell disease (SC) - etiology

A

inheritance of 1 sickle cell gene & 1 hemoglobin C gene

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185
Q

Normocytic anemias: Sickle cell disease (SC) - blood smear

A

-many target cells
-folded & boat-shaped cells
-occasional SC crystals (finger-like projections)

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186
Q

Normocytic anemias: Sickle cell disease (SC) - hemoglobin electrophoresis

A

> S than C
F: normal to 7%
A: none

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187
Q

Normocytic anemias: Sickle cell disease (SC) - diagnosis (test)

A

positive solubility test

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188
Q

Normocytic anemias: Sickle cell disease (SC) - anemia

A

mild to moderate

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189
Q

Normocytic anemias: Hereditary spherocytosis - etiology

A

defect of cell membrane

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190
Q

Normocytic anemias: Hereditary spherocytosis - blood smear

A

-spherocytes
-polychromasia

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191
Q

Normocytic anemias: Hereditary spherocytosis - CBC

A

-MCHC: usually >36 g/dL
-retics: increased
-increased osmotic fragility

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192
Q

Normocytic anemias: Autoimmune hemolytic anemia - etiology

A

autoantibodies

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193
Q

Normocytic anemias: Autoimmune hemolytic anemia - blood smear

A

-polychromasia
-spherocytes
-nRBCs

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194
Q

Normocytic anemias: Autoimmune hemolytic anemia - hemoglobin electrophoresis

A

normal

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195
Q

Normocytic anemias: Autoimmune hemolytic anemia - labs

A

-increased retics
-increased indirect bilirubin
-decreased haptoglobin
-positive DAT

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196
Q

Normocytic anemias: Hereditary spherocytosis - hemoglobin electrophoresis

A

normal

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197
Q

Macrocytic anemias: Megaloblastic - folate deficiency - etiology

A

Deficiency impairs DNA synthesis.
-nutritional deficiency
-increased cell replication (e.g., hemolytic anemias, myeloproliferative diseases, pregnancy)
-malabsorption
-drug inhibition

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198
Q

Macrocytic anemias: Megaloblastic - folate deficiency - blood smear

A

-oval macrocytes
-Howell-Jolly bodies
-hypersegmentation
-anisocytosis
-poikilocytosis

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199
Q

Macrocytic anemias: Megaloblastic - folate deficiency - hemoglobin electrophoresis

A

normal

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200
Q

Macrocytic anemias: Megaloblastic - folate deficiency - labs

A

-pancytopenia
-increased lactate dehydrogenase (LD)

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201
Q

Macrocytic anemias: Megaloblastic - B12 deficiency - etiology

A

Deficiency impairs DNA synthesis.
-nutritional deficiency
-malabsorption
-impaired utilization
-parasites

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202
Q

Macrocytic anemias: Megaloblastic - B12 deficiency - blood smear

A

-oval macrocytes
-Howell-Jolly bodies
-hypersegmentation
-anisocytosis
-poikilocytosis

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203
Q

Macrocytic anemias: Non-megaloblastic - etiology

A

-alcoholism
-liver disease
-increased erythropoiesis

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204
Q

Macrocytic anemias: Non-megaloblastic - blood smear

A

-round macrocytes
-no hypersegmentation

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205
Q

Macrocytic anemias: Non-megaloblastic - hemoglobin electrophoresis

A

normal

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206
Q

Macrocytic anemias: Non-megaloblastic - WBCs & platelets

A

WBCs & platelets: normal

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207
Q

Microcytic, Hypochromic anemias: Iron deficiency anemia - etiology

A

insufficient iron for hemoglobin electrophoresis

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208
Q

Microcytic, Hypochromic anemias: Iron deficiency anemia - blood smear

A

-anisocytosis
-poikilocytosis
-hypochromic microcytes

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209
Q

Microcytic, Hypochromic anemias: Sideroblastic anemia - etiology

A

enzymatic defect in heme synthesis

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210
Q

Microcytic, Hypochromic anemias: Sideroblastic anemia - blood smear

A

-dual population of RBCs (normocytic & microcytic)
-pappenheimer bodies
-basophilic stippling

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211
Q

Microcytic, Hypochromic anemias: Sideroblastic anemia - RBC indices

A

usually normal

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212
Q

Microcytic, Hypochromic anemias: Sideroblastic anemia - bone marrow

A

ringed sideroblasts

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213
Q

Microcytic, Hypochromic anemias: beta-thalassemia major - etiology

A

decreased beta chain production

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214
Q

Microcytic, Hypochromic anemias: beta-thalassemia major - blood smear

A

-marked anisocytosis & poikilocytosis
-hypochromic microcytes
-target cells
-ovalocytes
-nRBCs
-basophilic stippling

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215
Q

Microcytic, Hypochromic anemias: beta-thalassemia major - hemoglobin electrophoresis

A

A: little to none
F: 95-98%
A2: 2-5%

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216
Q

Microcytic, Hypochromic anemias: beta-thalassemia major - anemia

A

severe

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217
Q

Microcytic, Hypochromic anemias: beta-thalassemia major - inheritance

A

homozygous

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218
Q

Microcytic, Hypochromic anemias: beta-thalassemia major - MCV

A

<67 fL

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219
Q

Microcytic, Hypochromic anemias: beta-thalassemia minor - etiology

A

decreased beta chain production

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220
Q

Microcytic, Hypochromic anemias: beta-thalassemia minor - blood smear

A

-anisocytosis
-hypochromic microcytes
-target cells
-basophilic stippling

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221
Q

Microcytic, Hypochromic anemias: beta-thalassemia minor - inheritance

A

heterozygous

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222
Q

Microcytic, Hypochromic anemias: beta-thalassemia minor - hemoglobin electrophoresis

A

A: >90-95%
A2: 3.5-7%
F: 2-5%

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223
Q

Microcytic, Hypochromic anemias: beta-thalassemia minor - anemia

A

mild

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223
Q

Microcytic, Hypochromic anemias: beta-thalassemia minor - anemia

A

mild

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224
Q

Microcytic, Hypochromic anemias: Anemia of inflammation - etiology

A

-hepcidin inhibits iron absorption & release
-iron in bone marrow macrophages is not released to developing RBCs
-impaired erythropoiesis due to decreased erythropoietin (EPO) production and decreased bone marrow responsiveness to EPO

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225
Q

Microcytic, Hypochromic anemias: Anemia of inflammation - blood smear

A

60-70% of cases have normocytic normochromic RBCs

30-40%: microcytic, hypochromic

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226
Q

Microcytic, Hypochromic anemias: Anemia of inflammation - associated with

A

-chronic infections & inflammation
-malignancies
-autoimmune diseases

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227
Q

Which anemia is the 2nd most common anemia after IDA and the most common anemia in hospitalized patients?

A

Anemia of inflammation

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228
Q

Differentiation of microcytic hypochromic anemias - Iron deficiency anemia:
RBCs:
RDW:
Serum iron:
TIBC:
Serum ferritin:
HGB A2:

A

RBCs: decreased
RDW: increased
Serum iron: decreased
TIBC: increased
Serum ferritin: decreased
HGB A2: normal

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229
Q

Differentiation of microcytic hypochromic anemias - Sideroblastic anemia:
RBCs:
RDW:
Serum iron:
TIBC:
Serum ferritin:
HGB A2:

A

RBCs: decreased
RDW: increased
Serum iron: increased
TIBC: normal
Serum ferritin: increased
HGB A2: normal

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230
Q

Differentiation of microcytic hypochromic anemias - beta-thalassemia major:
RBCs:
RDW:
Serum iron:
TIBC:
Serum ferritin:
HGB A2:

A

RBCs: increased
RDW: normal/increased
Serum iron: increased
TIBC: normal
Serum ferritin: increased
HGB A2: decreased to absent

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231
Q

Differentiation of microcytic hypochromic anemias - beta-thalassemia minor:
RBCs:
RDW:
Serum iron:
TIBC:
Serum ferritin:
HGB A2:

A

RBCs: increased
RDW: normal
Serum iron: normal
TIBC: normal
Serum ferritin: normal
HGB A2: increased

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232
Q

Differentiation of microcytic hypochromic anemias - Anemia of inflammation:
RBCs:
RDW:
Serum iron:
TIBC:
Serum ferritin:
HGB A2:

A

RBCs: decreased
RDW: normal
Serum iron: decreased
TIBC: decreased
Serum ferritin: increased
HGB A2: normal

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233
Q

Acute versus chronic blood loss - acute blood loss - definition

A

rapid loss of >20% blood volume

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234
Q

Acute versus chronic blood loss - acute blood loss - RBCs

A

-normocytic, normochromic
-may be transient macrocytosis when increased retics reach circulation

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235
Q

Acute versus chronic blood loss - acute blood loss - WBCs

A

increased (up to 35 x 10^9/L) with shift to the left for about 2-4 days

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236
Q

Acute versus chronic blood loss - acute blood loss - Retics

A

increased 3-5 days; peak around 10 days

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237
Q

Acute versus chronic blood loss - acute blood loss - HGB/HCT

A

-steady during 1st few hours due to vasoconstriction & other compensatory mechanisms
-can be 48-72 hours before full extent of hemorrhage is evident (after fluid from extravascular spaces moves into circulation to expand volume)

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238
Q

Acute versus chronic blood loss - acute blood loss - platelets

A

immediate fall in platelets, followed by increase within 1 hour

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239
Q

Acute versus chronic blood loss - chronic blood loss - definition

A

loss of small amounts of blood over extended period of time

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240
Q

Acute versus chronic blood loss - chronic blood loss - RBCs

A

microcytic, hypochromic (due to iron deficiency)

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241
Q

Acute versus chronic blood loss - chronic blood loss - WBCs

A

normal

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242
Q

Acute versus chronic blood loss - chronic blood loss - Retics

A

normal or slightly increased

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243
Q

Acute versus chronic blood loss - chronic blood loss - HGB/HCT

A

decreased

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244
Q

Acute versus chronic blood loss - chronic blood loss - serum iron & ferritin

A

decreased

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245
Q

Granulocytic maturation - myeloblast

A

-15-20 um
-small amount of dark blue cytoplasm
-usually no granules
-nucleus has delicate chromatin with nucleoli

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246
Q

Granulocytic maturation - promyelocyte

A

-12-24 um
-similar to myeloblast but has primary (non-specific) granules

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247
Q

Granulocytic maturation - myelocyte

A

-10-18 um
-secondary (specific) granules (eosinophilic, basophilic, or neutrophilic)
-last stage to divide

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248
Q

Granulocytic maturation - metamyelocyte

A

-10-18 um
-nucleus begins to indent
-indentation less than 1/2 the diameter of nucleus (kidney bean)

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249
Q

Granulocytic maturation - band

A

-10-16 um
-nuclear indentation is more than 1/2 the diameter of the nucleus

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250
Q

Granulocytic maturation - segmented neutrophil

A

-10-16 um
-2-5 nuclear lobes connected by thin strands of chromatin

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251
Q

Normal leukocytes of the peripheral blood - segmented neutrophil:
Size:
Nucleus:
Cytoplasm:
Adult reference range (relative - %):
Adult reference range (absolute - x 10^9/L):

A

Size:10-16 um

Nucleus: segmented; 2-5 lobes connected by thread-like filament of chromatin

Cytoplasm: pinkish tan with neutrophilic granules

Adult reference range (relative - %): 50-70%

Adult reference range (absolute - x 10^9/L): 2.4-7.5 x 10^9/L

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252
Q

Normal leukocytes of the peripheral blood - band:
Size:
Nucleus:
Cytoplasm:
Adult reference range (relative - %):
Adult reference range (absolute - x 10^9/L):

A

Size: 10-16 um

Nucleus: horseshoe-shaped; parallel sides with visible chromatin in between; no filament

Cytoplasm: pinkish tan with neutrophilic granules

Adult reference range (relative - %): 2-6%

Adult reference range (absolute - x 10^9/L): 0.1-0.6 x 10^9/L

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253
Q

Normal leukocytes of the peripheral blood - Eosinophil:
Size:
Nucleus:
Cytoplasm:
Adult reference range (relative - %):
Adult reference range (absolute - x 10^9/L):

A

Size: 10-16 um

Nucleus: band shaped or segmented into 2 lobes

Cytoplasm: large red granules

Adult reference range (relative - %): 0-4%

Adult reference range (absolute - x 10^9/L): 0-0.4 x 10^9/L

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254
Q

Normal leukocytes of the peripheral blood - Basophil:
Size:
Nucleus:
Cytoplasm:
Adult reference range (relative - %):
Adult reference range (absolute - x 10^9/L):

A

Size: 10-16 um

Nucleus: usually difficult to see because of overlying granules

Cytoplasm: dark purple granules

Adult reference range (relative - %): 0-2%

Adult reference range (absolute - x 10^9/L): 0-0.2 x 10^9/L

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255
Q

Normal leukocytes of the peripheral blood - Monocyte:
Size:
Nucleus:
Cytoplasm:
Adult reference range (relative - %):
Adult reference range (absolute - x 10^9/L):

A

Size: 12-18 um

Nucleus: round, horseshoe-shaped, or lobulated; convoluted; loose strands of chromatin

Cytoplasm: gray-blue with indistinct pink granules; vacuoles; occasional pseudopods

Adult reference range (relative - %): 2-9%

Adult reference range (absolute - x 10^9/L): 0.1-0.9 x 10^9/L

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256
Q

Normal leukocytes of the peripheral blood - Lymphocyte:
Size:
Nucleus:
Cytoplasm:
Adult reference range (relative - %):
Adult reference range (absolute - x 10^9/L):

A

Size: 7-15 um

Nucleus: round or oval; dense blocks of chromatin; indistinct chromatin/parachromatin separation

Cytoplasm: spars to abundant; sky blue; may contain a few azurophilic granules

Adult reference range (relative - %): 20-44%

Adult reference range (absolute - x 10^9/L): 1.2-3.4 x 10^9/L

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257
Q

Leukocyte abnormalities - shift to the left

A

presence of immature granuloctyes in peripheral blood

Significance:
-bacterial infection
-inflammation

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258
Q

Leukocyte abnormalities - toxic granulation

A

dark-staining granules in cytoplasm of neutrophils

Significance:
-infection
-inflammation

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259
Q

Leukocyte abnormalities - Dohle bodies (May-Hegglin)

A

light blue patches in cytoplasm of neutrophils composed of RNA

Significance:
-infections
-burns

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260
Q

Leukocyte abnormalities - Vacuolization

A

phagocytic vacuoles in cytoplasm of neutrophils

Significance:
-septicemia
-drugs
-toxins
-radiation

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261
Q

Leukocyte abnormalities - hypersegmentation

A

> 5% of segs with 5-lobed nucleus or any with >5 lobes

Significance:
-folic acid deficiency
-B12 deficiency
-pernicious anemia
-one of the 1st signs of pernicious anemia

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262
Q

Leukocyte abnormalities - Pelger-Huet anomaly

A

most neutrophils have round or bilobed nuclei

Significance:
-inherited disorder
-no clinical effect
-may be misinterpreted as shift to the left

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263
Q

Leukocyte abnormalities - Auer rods

A

-red needles in cytoplasm of leukemic myeloblasts
-occasionally in promyelocytes & monoblasts from abnormal function of primary granules

Significance:
-rules of lymphocytic leukemia
-seen in up to 60% of patients with acute myeloid leukemia (AML)

264
Q

Leukocyte abnormalities - variant lymphocytes (atypical or reactive)

A

1 or more of the following:
-large size
-elongated or indented nucleus
-immature chromatin
-increased parachromatin
-nucleoli
-increased cytoplasm
-dark blue or very pale cytoplasm
-peripheral basophilia
-scalloped edges due to indentation by adjacent RBCs
-frothy appearance
-many azurophilic granules

Significance:
-viral infections (e.g., IM, CMV)

265
Q

Quantitative abnormalities of leukocytes - neutrophilia - associations?

A

-bacterial infection
-inflammation
-hemorrhage
-hemolysis
-stress

266
Q

Quantitative abnormalities of leukocytes - neutropenia - associations?

A

-acute infection
-antibodies
-drugs
-chemicals
-radiation

267
Q

Quantitative abnormalities of leukocytes - lymphocytosis - associations?

A

-IM
-CMV
-whooping cough
-acute infectious lymphocytosis

268
Q

Quantitative abnormalities of leukocytes - monocytosis - associations?

A

-convalescence from viral infections
-chronic infections
-tuberculosis
-subacute bacterial endocarditis
-parasitic infections
-rickettsial infections

269
Q

Quantitative abnormalities of leukocytes - eosinophilia - associations?

A

-allergies
-skin diseases
-parasitic infections
-chronic myelogenous leukemia (CML)

270
Q

Quantitative abnormalities of leukocytes - basophilia - associations?

A

-chronic myelogenous leukemia (CML)
-polycythemia vera

271
Q

World Health Organization (WHO) classification of myeloid and lymphoid neoplasms (2016) - criteria

A

-morphology
-cytochemistry
-immunophenotyping via flow chromosomal and molecular abnormalities
-cytogenetics
-clinical features

272
Q

World Health Organization (WHO) classification of myeloid and lymphoid neoplasms (2016) - major groups

A

-MPN
-Myeloid/lymphoid neoplasms with eosinophils and rearrangement of PDGFRA, PDFGRB, or FGFR1 or with PCM1-JAK2
-MDS/MDN
-MDS
-AML & related neoplasms
-Acute leukemias of ambiguous lineage
-B-lymphoblastic leukemia/lymphoma
-T-lymphoblastic leukemia/lymphoma
-Blastic plasmacytoid dendritic cell neoplasm

273
Q

World Health Organization (WHO) classification of myeloid and lymphoid neoplasms (2016) - criteria for diagnosis of AML

A

> =20% blasts

274
Q

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - explanation

A

-pre-malignant HSC disorders involving overproduction of 1 or more myeloid (non-lymphocytic) cell lines
-bone marrow & peripheral blood show increased RBCs, granulocytes, &/or platelets, with 1 cell line usually predominant
-NORMAL maturation & morphology

275
Q

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - examples

A

-polycythemia vera
-CML
-essential thrombocythemia
-primary myelofibrosis

276
Q

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - affected population?

A

usually older adults

277
Q

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - etiology

A

mutations in HSCs

278
Q

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - chronic or acute leukemia?

A

primarily chronic but can transform into acute leukemia

279
Q

Myeloid and lymphoid neoplasms - Myeloproliferative neoplasms (MPN) - symptoms

A

-splenomegaly
-extramedullary hematopoiesis common

280
Q

Myeloid and lymphoid neoplasms - Myelodysplastic syndromes (MDS) - explanation

A

-pre-malignant HSC disorders involving ineffective hematopoiesis in 1 or more myeloid cell lines
-hypercellular bone marrow with maturation abnormalities (dysplasias)
-peripheral blood cytopenias (decreased counts) & morphologic abnormalities

281
Q

Myeloid and lymphoid neoplasms - Myelodysplastic syndromes (MDS) - examples

A

MDS with single lineage dysplasia

282
Q

Myeloid and lymphoid neoplasms - Myelodysplastic syndromes (MDS) - population affected?

A

more common in elderly

283
Q

Myeloid and lymphoid neoplasms - Myelodysplastic syndromes (MDS) - etiology

A

-exposure to chemicals
-radiation
-chemotherapy
-viral infections
-can transform into acute leukemia

284
Q

Myeloid and lymphoid neoplasms - Myelodisplastic/myeloproliferative neoplasms (MDS/MPN) - explanation

A

premalignant neoplasms with both myeloproliferative and myelodysplastic features

285
Q

Myeloid and lymphoid neoplasms - Myelodisplastic/myeloproliferative neoplasms (MDS/MPN) - examples

A

chronic myelomonocytic leukemia (CMML)

286
Q

Myeloid and lymphoid neoplasms - Leukemia - explanation

A

-malignant neoplasms involving unregulated proliferation of HSCs
-abnormal cells in bone marrow & peripheral blood

287
Q

Myeloid and lymphoid neoplasms - Leukemia - examples

A

-acute lymphoblastic leukemia (ALL)
-chronic lymphocytic leukemia (CLL)

288
Q

Myeloid and lymphoid neoplasms - Leukemia - classified as?

A

-acute or chronic
AND
-lymphoid or myelogenous

289
Q

Myeloid and lymphoid neoplasms - Lymphoma - explanation

A

malignant neoplasm of lymphoid cells in lymphatic tissues, bone marrow, or lymph nodes

290
Q

Myeloid and lymphoid neoplasms - Lymphoma - examples

A

-B lymphoblastic leukemia/lymphoma with t(9;22) (q34;q11.1)
-BCR ABL

291
Q

Myeloid and lymphoid neoplasms - Lymphoma - when is this designation used?

A

when mass lesion and 25% or less lymphoblasts are observed in the bone marrow

292
Q

Acute versus chronic leukemia - age

A

Acute: all ages, with peaks in 1st decade & after 50 years

Chronic: adults

293
Q

Acute versus chronic leukemia - onset

A

Acute: sudden

Chronic: insidious

294
Q

Acute versus chronic leukemia - median survival time, untreated

A

Acute: weeks to months

Chronic: months to years

295
Q

Acute versus chronic leukemia - WBC

A

Acute: increased, normal, or decreased

Chronic: increased (may be >50,000)

296
Q

Acute versus chronic leukemia - Differential

A

Acute: peripheral smear greater than or equal to 20% myeloblasts

Chronic: more mature cells

297
Q

Acute versus chronic leukemia - Anemia

A

Acute: mild to severe

Chronic: mild

298
Q

Acute versus chronic leukemia - Platelets

A

Acute: mild to severe decrease

Chronic: usually normal

299
Q

Acute versus chronic leukemia - lymphoid/myeloid

A

Acute: usually lymphoid in children, myeloid in adults

Chronic: myeloid mostly in young to middle-aged, lymphoid in older adults; most go into blast crisis

300
Q

Acute versus chronic leukemia - methods used to diagnose

A

Acute: peripheral blood smear, bone marrow examination, cytochemical stains, immunophenotyping, cytogenetics, molecular genetics

Chronic: same as acute but less use of cytochemical stains; BCR-ABL1+ analyzed for CML

301
Q

Four most common leukemias - AML - WBC (x 10^9/L)

A

usually 5-30 x 10^9/L but can range from 1-200 x 10^9/L

302
Q

Four most common leukemias - AML - blood smear

A

->=20% blasts
-auer rods
-pseduo-Pelger-Huet cells
-Howell-Jolly bodies
-Pappenheimer bodies
-basophilic stippling
-nRBCs
-hypogranular or giant platelets

303
Q

Most common type of leukemia in children <1 year & adults?

304
Q

Four most common leukemias - AML - labs

A

-increased uric acid & LD from increased cell turnover

305
Q

Four most common leukemias - ALL - WBC (x10^9/L)

A

-increased in 50% of patients
-can be normal or decreased

306
Q

Four most common leukemias - ALL - blood smear

A

-small, homogeneous blasts in children
-large, heterogenous blasts in adults
-may not have circulating blasts

307
Q

Four most common leukemias - ALL - population affected

A

-peak incidence: 2-5 yr
-smaller peak in elderly

308
Q

Four most common leukemias - ALL - labs

A

increased uric acid & LD

309
Q

Four most common leukemias - ALL - spreads to?

310
Q

Four most common leukemias - ALL - lineage testing (T or B)

A

immunophenotyping

311
Q

Four most common leukemias - ALL - tests for prognosis

A

-cytogenetics
-molecular analysis

312
Q

Four most common leukemias - CML - WBC (x10^9/L)

A

usually > 100 x 10^9/L

313
Q

Four most common leukemias - CML - blood smear

A

-all stages of granulocytic maturation
-segs & myelocytes predominant
-increased eosinophils & basophils
-Pseudo-Pelger-Huet cells
-nRBCs
-abnormal platelets may be seen

314
Q

Four most common leukemias - CML - population affected

A

most common after age 55 years

315
Q

Four most common leukemias - CML - finding in most patients?

A

splenomegaly

316
Q

What is the most common MPD?

317
Q

Four most common leukemias - CML - Philadelphia chromosome

A

-caused by BCR/ABL gene translocation (9;22)
-found in 90% of CML patients
-prognosis is better if Philadelphia chromosome is present

318
Q

Four most common leukemias - CML - LAP

319
Q

Four most common leukemias - CML - eventually becomes?

A

AML or ALL

320
Q

Four most common leukemias - CLL - WBC (x 10^9/L)

A

30-200 x 10^9/L

321
Q

Four most common leukemias - CLL - blood smear

A

-80-90% small, mature-looking lymphs
-may have hypercondensed chromatin & light-staining parachromatin (“soccer ball appearance”)
-few prolymphocytes
-SMUDGE cells

322
Q

What is the most common type of leukemia in adults?

323
Q

Four most common leukemias - CLL - proliferation of?

A

B lymphocytes

324
Q

AML subtypes (WHO classification vs. FAB) - AML with genetic abnormalities - FAB?

A

No FAB classification

325
Q

AML subtypes (WHO classification vs. FAB) - AML with genetic abnormalities - examples

A

-AML with translocation between chromosomes 8 and 21 (t(8;21)
-AML with translocation between chromosomes 9 and 11 t(9;11)

326
Q

AML subtypes (WHO classification vs. FAB) - AML with myelodysplasia-related changes - FAB?

A

no FAB classification

327
Q

AML subtypes (WHO classification vs. FAB) - AML related to previous chemotherapy or radiation - FAB?

A

no FAB classification

328
Q

AML subtypes (WHO classification vs. FAB) - AML with minimal differentiation - FAB?

329
Q

AML subtypes (WHO classification vs. FAB) - AML without maturation - FAB?

330
Q

AML subtypes (WHO classification vs. FAB) - AML with maturation - FAB?

331
Q

AML subtypes (WHO classification vs. FAB) - Acute myelomonocytic leukemia - FAB?

332
Q

AML subtypes (WHO classification vs. FAB) - Acute monoblastic/monocytic leukemia - FAB?

333
Q

AML subtypes (WHO classification vs. FAB) - Pure erythroid leukemia - FAB?

334
Q

AML subtypes (WHO classification vs. FAB) - Acute megakaryoblastic leukemia - FAB?

335
Q

AML subtypes (WHO classification vs. FAB) - Acute basophilic leukemia - FAB?

A

no FAB classification

336
Q

AML subtypes (WHO classification vs. FAB) - Acute panmyelosis with fibrosis - FAB?

A

no FAB classification

337
Q

Cytochemical stains for differentiation of acute leukemia - myeloperoxidase - AML

338
Q

Cytochemical stains for differentiation of acute leukemia - myeloperoxidase - ALL

339
Q

Cytochemical stains for differentiation of acute leukemia - Sudan black - AML

340
Q

Cytochemical stains for differentiation of acute leukemia - Sudan black - ALL

341
Q

Cytochemical stains for differentiation of acute leukemia - Naphtol AS-D chloroacetate esterase (specific esterase) - AML

342
Q

Cytochemical stains for differentiation of acute leukemia - Naphtol AS-D chloroacetate esterase (specific esterase) - ALL

343
Q

Cytochemical stains for differentiation of acute leukemia - Periodic acid-Schiff (PAS) - AML

A

negative or diffusely positive

344
Q

Cytochemical stains for differentiation of acute leukemia - Periodic acid-Schiff (PAS) - ALL

A

positive (coarse granular or block-like)

345
Q

Leukemoid reaction vs. CML - WBC count

A

Leukemoid reaction: high
CML: high

346
Q

Leukemoid reaction vs. CML - peripheral blood smear

A

Leukemoid reaction: shift to left (blasts rare), toxic granulation, Dohle bodies

CML: shift to left with blasts, eosinophilia, basophilia

347
Q

Leukemoid reaction vs. CML - LAP

A

Leukemoid reaction: high

CML: low

348
Q

Leukemoid reaction vs. CML - Philadelphia chromosome

A

Leukemoid reaction: negative

CML: positive

349
Q

Plasma cell disorders - Multiple myeloma - etiology

A

malignant plasma cells in bone marrow

350
Q

Plasma cell disorders - Multiple myeloma - type of anemia

A

normocytic, normochromic

351
Q

Plasma cell disorders - Multiple myeloma - blood smear

352
Q

Plasma cell disorders - Multiple myeloma - ESR

A

increased due to increased globulins

353
Q

Plasma cell disorders - Multiple myeloma - serum protein electrophoresis

A

M spike

-monoclonal gammopathy

354
Q

Plasma cell disorders - Multiple myeloma - protein in urine

A

Bence Jones

355
Q

Plasma cell disorders - Multiple myeloma - bone disease

A

lytic bone disease

356
Q

Plasma cell disorders - Plasma cell leukemia - form of?

A

multiple myeloma

357
Q

Plasma cell disorders - Plasma cell leukemia - etiology

A

plasma cells in peripheral blood

358
Q

Plasma cell disorders - Plasma cell leukemia - blood smear

A

-pancytopenia
-rouleaux

359
Q

Plasma cell disorders - Plasma cell leukemia - gammopathy

A

monoclonal gammopathy

360
Q

Plasma cell disorders - Waldenstrom macroglobulinemia - type of disorder

A

malignant lymphocyte-plasma cell proliferative disorder

361
Q

Plasma cell disorders - Waldenstrom macroglobulinemia - gammopathy

A

monoclonal gammopathy due to increased immunoglobulin M (IgM)

362
Q

Plasma cell disorders - Waldenstrom macroglobulinemia - blood smear

A

-rare plasmacytoid lymphocytes or plasma cells
-rouleaux

363
Q

Plasma cell disorders - Waldenstrom macroglobulinemia - protein in urine

A

Bence jones

364
Q

Plasma cell disorders - Waldenstrom macroglobulinemia - globulins

A

cryoglobulins

365
Q

Manual hematology procedures - manual WBC count, CSF - purpose

A

differential diagnosis of meningitis

366
Q

Manual hematology procedures - manual WBC count, CSF - method

A

-CSF loaded into Neubauer hemacytometer
-WBCs counted in all 9 squares of each side under 10x

367
Q

Manual hematology procedures - manual WBC count, CSF - used to lyse RBCs

A

Acetic acid

368
Q

Manual hematology procedures - microhematocrit (packed cell volume, PCV) - purpose

A

screening for anemia

369
Q

Manual hematology procedures - microhematocrit (packed cell volume, PCV) - method

A

-microhematocrit tubes centrifuged at 10,000-15,000 rpm for 15 minutes
-% of total volume occupied by RBCs determined

370
Q

Manual hematology procedures - microhematocrit (packed cell volume, PCV) - values versus values from automated analyzes

A

Values may be slightly higher than calculated values from automated analyzers

371
Q

Manual hematology procedures - reticulocyte count - purpose

A

assess rate of erythropoiesis

372
Q

Manual hematology procedures - reticulocyte count - method

A

-blood smear stained with new methylene blue
-1,000 RBCs counted
-% containing reticulum determined

373
Q

Manual hematology procedures - reticulocyte count - used to help with counting

A

Miller ocular

374
Q

Manual hematology procedures - reticulocyte count - adult reference range

375
Q

Manual hematology procedures - reticulocyte count - increased reticulocytes

A

Increased erythropoiesis - e.g., blood loss, hemolytic anemia, following treatment of anemia

376
Q

Manual hematology procedures - ESR - purpose

A

screen for inflammation

377
Q

Manual hematology procedures - ESR - method

A

-whole blood added to Westergren tube & placed in vertical rack
-height of RBC column read after 1 hour

378
Q

Manual hematology procedures - ESR - reference ranges

A

Males: 0-15 mm/hr
Females: 0-20 mm/hr

379
Q

Manual hematology procedures - ESR - what is preferred over ESR

380
Q

Manual hematology procedures - tube solubility screening test for Hemoglobin S - purpose

A

Screening for hgb S

381
Q

Manual hematology procedures - tube solubility screening test for Hemoglobin S - method

A

-blood mixed with reducing agent - e.g., sodium dithionite
-HGB S is insoluble = produces a turbid solution that obscures black lines behind tube

382
Q

Manual hematology procedures - tube solubility screening test for Hemoglobin S - doesn’t differentiate?

A

Doesn’t differentiate SS from AS

383
Q

Manual hematology procedures - tube solubility screening test for Hemoglobin S - follow up with?

A

hemoglobin electrophoresis

384
Q

Manual hematology procedures - osmotic fragility - purpose

A

Dx of hereditary spherocytosis

385
Q

Manual hematology procedures - osmotic fragility - method

A

-blood added to serial dilutions of NaCl & incubated
-amount of hemolysis determined by reading absorbance of supernatant from each tube

386
Q

Manual hematology procedures - osmotic fragility - increased in what conditions?

A

hereditary spherocytosis

387
Q

Manual hematology procedures - osmotic fragility - decreased in what conditions?

A

-target cells
-sickle cell anemia
-IDA
-thalassemia

388
Q

Manual hematology procedures - Donath-Landsteiner (DL) test - purpose

A

Dx of paroxysmal cold hemoglobinuria

389
Q

Manual hematology procedures - Donath-Landsteiner (DL) test - method

A

-blood collected in 2 clot tubes
-tube 1 is incubated at 4C, then 37C
-tube 2 incubated at 37*C only
-POSITIVE = hemolysis in tube 1, none in tube 2

390
Q

Manual hematology procedures - Donath-Landsteiner (DL) test - anemia

A

-rare autoimmune hemolytic anemia due to biphasic antibody (autoanti-P) that binds complement to RBCs in capillaries at <20C & elutes off at 37C
-complement remains attached & lyses cells

391
Q

Changes in blood at room temperature - MCV

A

increased due to RBC swelling

392
Q

Changes in blood at room temperature - HCT

A

increased due to increased MCV

393
Q

Changes in blood at room temperature - MCHC

A

decreased due to increased HCT

394
Q

Changes in blood at room temperature - ESR

A

decreased (swollen RBCs don’t rouleaux)

395
Q

Changes in blood at room temperature - osmotic fragility

396
Q

Changes in blood at room temperature - WBCs

397
Q

Changes in blood at room temperature - WBC morphology

A

-necrobiotic cells
-karyorrhexis (nuclear disintegration)
-degranulation
-vacuolization

398
Q

Methods of automated cell counting & differentiation - electrical impedance (Coulter principle) - principle

A

-low voltage direct current (DC) resistance
-increased resistance (impedance) when non-conductive particles suspended in electrically conductive diligent pass through aperture
-height of pulses indicates cell volume
-number of pulses indicates count

399
Q

Methods of automated cell counting & differentiation - radiofrequency - principle

A

-high-frequency electromagnetic probe measures conductivity
-change in RF signal provides information about nucleus-to-cytoplasm ratio, nuclear density, granularity

400
Q

Methods of automated cell counting & differentiation - optical light scattering (flow cytometry) - principle

A

-hydrodynamically focused stream of cells passes through quartz flow cell past light source (tungsten halogen lamp or laser light)
-scattered light is measured at different angles
-provides information about cell volume & complexity, e.g., granularity
-can also analyze nuclear DNA content, cell surface antigens (CD markers), and intracellular proteins and cytokines

401
Q

Methods of automated cell counting & differentiation - radiofrequency - application

A

WBC differential

402
Q

Methods of automated cell counting & differentiation - electrical impedance(Coulter principle) - application

A

Cell counting & sizing

403
Q

Methods of automated cell counting & differentiation - optical light scattering (flow cytometry) - application

A

-cell counting & sizing
-WBC differential

404
Q

Flow cytometry- principle

A

measurement of physical, antigenic, and functional properties of cells suspended in fluid

405
Q

Flow cytometry- measurements - fluorescence

A

-cells stained with antibodies conjugated to specific fluorochrome pass 1 by 1 in front of laser light source
-electrons of fluorochrome raised to higher energy state;emit light of specific wavelength as they return to ground state
-emitted light detected by photodetectors for specific wavelengths

406
Q

Flow cytometry- measurements - forward scatter

A

-photodetector in line with laser beam measure FS
-proportional to volume or size

407
Q

Flow cytometry- measurements - side scatter

A

-photodetector at right angle measures SS
-reflects granularity, surface complexity, & internal structures

408
Q

Flow cytometry- measurements - cell populations

A

-cell populations with similar characteristics form clusters on dot plot
-specific populations & subpopulations can be selected with cursor (gating)

409
Q

Flow cytometry- applications

A

-immunophenotyping: differentiating cells on basis of surface & cytoplasmic markers; can determine lineage & maturity of cells in hematologic malignancies in order to classify and subclassify the malignancy
-diagnosis, follow-up, & prognosis of leukemias and lymphomas; certain immunophenotypes associated with specific cytogenetic abnormalities
-Dx & monitoring of immunodeficiencies (cell counts and screening panels)
-Dx of paroxysmal nocturnal hemoglobinuria
-enumeration of stem cells
-quantitation of fetal hemoglobin

410
Q

Common cluster of differentiation (CD) markers - CD2

A

early T lymphocytes

411
Q

Common cluster of differentiation (CD) markers - CD3, CD4, CD5, CD7, CD8

A

T lymphocytes

412
Q

Common cluster of differentiation (CD) markers - CD10

A

precursor B lymphocyte

413
Q

Common cluster of differentiation (CD) markers - CD19, CD20, CD21, CD22

A

B lymphocytes

414
Q

Common cluster of differentiation (CD) markers - CD34

A

stem cells

415
Q

Common cluster of differentiation (CD) markers - CD41, CD61

A

megakaryocytes and platelets

416
Q

Common cluster of differentiation (CD) markers - CD15

A

promyelocyte

417
Q

Common cluster of differentiation (CD) markers - CD13, CD33

418
Q

Common cluster of differentiation (CD) markers - CD14, CD64

419
Q

Common cluster of differentiation (CD) markers - CD45

A

all leukocytes

420
Q

Common cluster of differentiation (CD) markers - CD16, CD56

421
Q

Technologies used in automated hematology analyzers - Impedance instruments (Beckman Coulter - LH series)

A

-cell counting & sizing: electrical impedance
-WBC differential: VCS (volume, conductivity, scatter) technology

Parameter: Volume
-measurement: DC impedance
-information: cell volume

Parameter: Conductivity (opacity)
-measurement: RF
-information: cell size & internal structure

Parameter: Scatter
-measurement: light scatter as cells pass through laser beam
-information: cell surface structure & cellular granularity

422
Q

Technologies used in automated hematology analyzers - Impedance instruments - Sysmex (X-series)

A

impedance, RF, absorption spectrophotometry, & flow cytometry with fluorescent dyes

423
Q

Technologies used in automated hematology analyzers - Impedance instruments - Abbott (CELL-DYN)

A

impedance, fluorescence staining, flow cytometry, multiple polarized scatter separation (MAPSS)

424
Q

Technologies used in automated hematology analyzers - Light-scattering instruments - Siemens (Advia)

A

light scattering, cytochemical analysis & cyanmethemoglobin

425
Q

Automated CBC - cell counts - various methods used

A

-impedance
-light scatter

426
Q

Automated CBC - WBC differential - various methods used

A

-VCS technology
-fluorescent flow cytometry & light scatter
-MAPSS technology (multiangle polarized scatter separation)
-cytochemistry (peroxidase) & optical flow cytometry

427
Q

Automated CBC - HGB - various methods used

A

-cyanmethemoglobin method
-modified cyanide-free cyanmethemoglobin method
-sodium lauryl sulphate (SLS-hgb) method

428
Q

Automated CBC - HCT - various methods used

A

-calculated from RBC & MCV
-cumulative pulse heights detection

429
Q

Automated CBC - MCV - various methods used

A

-mean of RBC volume histogram
-calculated from HCT & RBC

430
Q

Automated CBC - MCH - various methods used

A

calculated from HGB & RBC

431
Q

Automated CBC - MCHC - various methods used

A

calculated from HCG & HCT

432
Q

Automated CBC - RDW - various methods used

A

CV of RBC histogram

433
Q

Automated CBC - Retics - various methods used

A

-staining with new methylene blue; VCS technology
-staining with auramine O; fluorescence detection
-staining with fluorescent dye; light scatter & fluorescence detection
-staining with oxazine; optical scatter & absorbance

434
Q

Graphic representation of cell populations - Histogram

A

-size distribution graph that plots cell size (x axis) vs. relative number (y axis); size thresholds separate cell populations

-use: RBC, WBC, & PLT

435
Q

Graphic representation of cell populations - Scatterplot or cytogram

A

-cells are plotted based on 2 characteristics, e.g., size vs. granularity
-separates cells into distinct populations and subpopulations

-use: WBC differential

436
Q

Quality assurance/quality control (QA/QC) for automated hematology analyzers

A

-periodic calibration with stabilized whole blood calibrators (every 6 months at a minimum or as specified by manufacturer)
-periodic calibration verification
-analysis of at least 2 levels of control material each day of testing (more if specified by manufacturer)
-instrument maintenance
-participation in proficiency testing program
-delta checks

437
Q

Hematology calculations - Retic %

438
Q

What is the retic count if reticulum is observed in 15 of 1,000 RBCs?

439
Q

Hematology calculations - Reticulocyte % using Miller Disc

440
Q

What is the retic count if 60 retics are counted in square A and 300 RBCs are counted in square B?

441
Q

Hematology calculations - Absolute retic count (ARC) (x10^9/L)

442
Q

What is the ARC if the retic count is 2% and the RBC is 5.2 x 10^12/L?

443
Q

Hematology calculations - corrected retic count (CRC)

444
Q

What is the CRC if the uncorrected retic count is 5% and the HCT is 36%?

445
Q

Hematology calculations - Retic production index (RPI)

446
Q

What is the RPI if the corrected retic is 5% and the HCT is 35% (maturation time correction factor for HCT of 35% is 1.5)?

447
Q

Hematology calculations - MCV

448
Q

Calculate the MCV if the RBC is 3 x 10^12/L, the HGB is 6 g/dL, & the hematocrit is 20%.

449
Q

Hematology calculations - MCH

450
Q

Calculate the MCH if the RBC is 3 x 10^12/L, the HGB is 6 g/dL, & the HCT is 20%.

451
Q

Hematology calculations - MCHC

452
Q

Calculate the MCHC if the RBC is 3 x 10^12/L, the HGB is 6 g/dL, & the HCT is 20%.

453
Q

Hematology calculations - Rules of Three

454
Q

What should the HGB be if the RBC is 4.1 x 10^12/L?

455
Q

What should the HCT be if HGB is 12.3 g/dL?

456
Q

Hematology calculations - Manual cell count

457
Q

Calculate the CSF WBC count if 18 WBCs were counted in 9 mm^2 on 1 side of a Neubauer hemacytometer using undiluted CSF.

458
Q

Hematology calculations - Absolute WBC

459
Q

Calculate the absolute lymphocyte count if the total WBC is 10 x 10^9/L and there are 70% lymphocytes.

460
Q

Hematology calculations - Corrected WBC

461
Q

The automated hematology analyzer reports a WBC of 30 x 10^9/L. The technologist counts 115 NRBCs per 100 WBCs while performing the differential. What is the corrected WBC?

462
Q

Overview of hemostasis - primary hemostasis

A

-vasoconstriction
-platelet adhesion
-platelet aggregation to form primary hemostatic plug at injury site

463
Q

Overview of hemostasis - secondary hemostasis

A

-interaction of coagulation factors to produce fibrin (secondary hemostatic plug)
-fibrin stabilization by factor XIII

464
Q

Overview of hemostasis - fibrinolysis

A

-release of tissue plasminogen activator
-conversion of plasminogen to plasmin
-conversion of fibrin-to-fibrin degradation products

465
Q

Coagulation factors - Fibrinogen (I) - pathway

466
Q

Coagulation factors - Fibrinogen (I) - inherited deficiency

467
Q

Coagulation factors - Fibrinogen (I) - converted to?

A

Fibrin by thrombin

468
Q

Coagulation factors - Prothrombin (II) - pathway

469
Q

Coagulation factors - Prothrombin (II) - inherited deficiency

470
Q

Coagulation factors - Prothrombin (II) - precursor of?

471
Q

Coagulation factors - Tissue factor (TF) (III) - pathway

472
Q

Coagulation factors - Tissue factor (TF) (III) - what is it?

A

Phospholipid released from injured vessel wall; not normally in blood

473
Q

Coagulation factors - Ca2+ (IV) - pathway

474
Q

Coagulation factors - Ca2+ (IV) - bound by?

A

Anticoagulant sodium citrate

(In assays using citrated plasma, must be supplied by reagents)

475
Q

Coagulation factors - Labile factor (proaccelerin) (V) - pathway

476
Q

Coagulation factors - Labile factor (proaccelerin) (V) - inherited deficiency

477
Q

Coagulation factors - Labile factor (proaccelerin) (V) - deterioration

A

Rapidly deteriorated

478
Q

Coagulation factors - Stable factor (proconvertin) (VII) - pathway

479
Q

Coagulation factors - Stable factor (proconvertin) (VII) - inherited deficiency

480
Q

Coagulation factors - Antihemophilic factor (VIII) - pathway

481
Q

Coagulation factors - Antihemophilic factor (VIII) - inherited deficiency

A

Common (hemophilia A)

482
Q

Coagulation factors - Antihemophilic factor (VIII) - circulates in association with?

A

VWF - stabilizes VIII, prolonging half-life

483
Q

Coagulation factors - Antihemophilic factor (VIII) - VIII:C

A

coagulant portion; extremely labile

484
Q

Coagulation factors - Christmas factor (plasma thromboplastin component) (IX) - pathway

485
Q

Coagulation factors - Christmas factor (plasma thromboplastin component) (IX) - inherited deficiency

A

Common (hemophilia B)

486
Q

Coagulation factors - Stuart factor (X) - pathway

A

Intrinsic, extrinsic, common

487
Q

Coagulation factors - Stuart factor (X) - inherited deficiency

488
Q

Coagulation factors - Plasma thromboplastin antecedent (XI) - pathway

489
Q

Coagulation factors - Plasma thromboplastin antecedent (XI) - inherited deficiency

A

-rare (hemophilia C)
-may or may not cause bleeding

490
Q

Coagulation factors - Hageman factor (contact factor) (XII) - pathway

491
Q

Coagulation factors - Hageman factor (contact factor) (XII) - inherited deficiency

A

No bleeding

492
Q

Coagulation factors - Hageman factor (contact factor) (XII) - activation factor

A

Glass activation factor - not part of in vivo coagulation

493
Q

Coagulation factors - Fibrin stabilizing factor (XIII) - pathway

A

intrinsic, extrinsic, common

494
Q

Coagulation factors - Fibrin stabilizing factor (XIII) - inherited deficiency

A

-rare
-poor wound healing

495
Q

Coagulation factors - Fibrin stabilizing factor (XIII) - function

A

stabilizes fibrin clot

496
Q

Coagulation factors - High molecular weight kininogen (Fitzgerald factor) (HMWK) - pathway

497
Q

Coagulation factors - High molecular weight kininogen (Fitzgerald factor) (HMWK) - inherited deficiency

A

-rare
-no bleeding

498
Q

Coagulation factors - High molecular weight kininogen (Fitzgerald factor) (HMWK) - in vivo coagulation

A

Not part of

499
Q

Coagulation factors - Prekallikrein (Fletcher factor) (PK) - pathway

500
Q

Coagulation factors - Prekallikrein (Fletcher factor) (PK) - inherited deficiency

A

No bleeding

501
Q

Coagulation factors - Prekallikrein (Fletcher factor) (PK) - in vivo coagulation

A

Not part of

502
Q

Functional classification of coagulation factors - substrate

A

-substance changed by an enzyme
-factors: fibrinogen

503
Q

Functional classification of coagulation factors - cofactor

A

-protein that accelerates enzymatic reactions; no enzymatic activity of its own
-factors: V, VIII (V is cofactor for Xa; VIII is cofactor for IXa)

504
Q

Functional classification of coagulation factors - enzyme

A

-protein that catalyzes a change in specific substrate; secreted in inactive form (proenzyme, zymogen); must be activated to function
-factors:
—serine proteases: thrombin (IIa), VIIa, IXa, Xa, XIa, XIIa, prekallikrein)
—transglutaminase: XIIIa

505
Q

Summary of coagulation factors - contact group

A

-factors involved in initiation of intrinsic pathway
-factors: PK, HMWK, XII, XI

506
Q

Summary of coagulation factors - prothrombin group

A

-Vitamin K-dependent factors
-factors: II, VII, IX, X

507
Q

Summary of coagulation factors - fibrinogen group

A

-factors acted on by thrombin (V, VIII, & XIII are activated; I is converted to fibrin); ALL are high molecular weight proteins
-factors: I, V, VIII, XIII

508
Q

Summary of coagulation factors - factors in extrinsic pathway

A

TF and VII

509
Q

Summary of coagulation factors - factors in intrinsic pathway

A

PK, HMWK, XII, XI, IX, VIII

510
Q

Summary of coagulation factors - factors in common pathway

A

X, V, II, I

511
Q

Summary of coagulation factors - extrinsic tenase complex

A

-acts on X
-factors: VIIa/TF

512
Q

Summary of coagulation factors - intrinsic tenase complex

A

-acts on X
-factors: IXa/VIIIa

513
Q

Summary of coagulation factors - prothrombinase complex

A

-acts on prothrombin
-factors: Xa/Va

514
Q

Summary of coagulation factors - factor VIII complex

A

-factors:
—VIII:C = procoagulant
—von Willebrand factor (VWF) = carrier protein

515
Q

Which coagulation factors are produced in the liver?

A

All of them

516
Q

Summary of coagulation factors - require vitamin K for synthesis

A

II, VII, IX, X

517
Q

Summary of coagulation factors - affected by anticoagulant therapy (Coumadin)

A

-all that require vitamin K; Warfarin is a vitamin K antagonist
-factors: II, VII, IX, X

518
Q

Summary of coagulation factors - consumed during clotting

A

-not present in serum
-factors: I, II, V, VIII, XIII

519
Q

Summary of coagulation factors - labile factors

520
Q

Coagulation theories - Cascade model - overview

A

-focuses on role of coagulation factors
-sees coagulation as chain reaction in which each coagulation factor is converted to active form by preceding factor
-intrinsic & extrinsic pathways converge on common pathway

521
Q

Overview of hemostasis - Cascade model - steps

A

Extrinsic pathway (TF, factor VII):
-TF from injured blood vessel wall activates factor VII
-TF:VIIa activate factor X

Intrinsic pathway (factors XII, XI, IX, VIII):
-factor XII activated by exposure to collagen
-factor XIIa, HMWK, & PK activate factor XI
-factor XIa activates factor IX
-IXa:VIIIa activates factor X

Common pathway (factors X, V, II, I):
-Xa-Va converts prothrombin (II) to thrombin (IIa)
-thrombin cleaves fibrinogen (I) into fibrin & activates factor XIII to stabilize clot

522
Q

Coagulation theories - Cell-based or physiological model - overview

A

-focuses on role of receptors for coagulation factors on surface of TF-bearing cells (e.g., fibroblast or monocyte) & platelets
-sees coagulation as 3 overlapping phases that begin with small amount of thrombin formation on surface of TF-bearing cells, followed by large-scale thrombin production on platelet surface

523
Q

Coagulation theories - Cell-based or physiological model - steps

A
  1. Initiation (on surface of TF-bearing cell):
    -break in vessel wall exposes extravascular TF-bearing cell to plasma
    -factor VII binds to TF on cell membrane
    -TF:VIIa activates factors IX & X
    -factor Xa combines with factor Va
    -Xa:Va generates small amount of thrombin, but no fibrin formed at this point
  2. Amplification:
    -thrombin & collagen activate platelets
    -platelets release factor V from granules
    -thrombin activates factors V, VIII, & XI
    -factor XIa supplements activation of factor IX
  3. Propagation (on surface of activated platelet):
    -factor Xa binds to factor VIIIa on platelet
    -IXa:VIIIa activates factor X
    -Xa:Va converts prothrombin (II) to thrombin (IIa)
    -thrombin cleaves fibrinogen (I) into fibrin & activates factor XIII to stabilize clot
524
Q

Quantitative platelet disorders - thrombocytopenia - explanation

A

-decreased production (e.g., aplastic anemia, MDS, chemotherapy, severe viral infection)
-increased destruction (e.g., immune thrombocytopenic purpura, drugs, DIC, mechanical destruction by artificial heart valves)
-splenic sequestration
-massive transfusion (dilution effect)
-heparin-induced thrombocytopenia (HIT)

525
Q

Quantitative platelet disorders - thrombocytopenia - clinical manifestations

A

<30 x 10^9/L: petechiae, menorrhagia, spontaneous bleeding

<10 x 10^9/L: severe spontaneous bleeding

526
Q

Quantitative platelet disorders - thrombocytopenia - lab tests

A

PLT <150 x 10^9/L

527
Q

Quantitative platelet disorders - Primary thrombocytosis - explanation

A

-unregulated production of megakaryocytes in bone marrow
-seen in myeloproliferative neoplasms with essential thrombocythemia having the highest platelet count

528
Q

Quantitative platelet disorders - Primary thrombocytosis - clinical manifestations

A

thrombosis or hemorrhage

529
Q

Quantitative platelet disorders - Primary thrombocytosis - lab tests

A

PLT usually >600 x 10^9/L
-giant platelets may be seen in blood smear
-leukocytosis, or slight anemia may be present
-platelet aggregation may be abnormal

530
Q

Quantitative platelet disorders - Secondary or reactive thrombocytosis - explanation

A

-increased platelets due to another condition (e.g., hemorrhage, surgery, splenectomy, & IDA)

531
Q

Quantitative platelet disorders - Secondary or reactive thrombocytosis - clinical manifestations

A

thrombosis or hemorrhage infrequent

532
Q

Quantitative platelet disorders - Secondary or reactive thrombocytosis - lab tests

A

PLT >450 x 10^9/L but usually <1,000 x 10^9/L

533
Q

Qualitative platelet disorders - Hereditary - Von Willebrand disease - explanation

A

-deficiency in VWF
-platelets can’t adhere to collage to form platelet plug
-most common inherited bleeding disorder
-autosomal dominant (both sexes affected)
-3 primary types (1, 2, and 3)

534
Q

Qualitative platelet disorders - Hereditary - Von Willebrand disease - lab tests

A

PLT: Normal
Closure time (PFA): Normal or increased
Platelet aggregation: abnormal with ristocetin (do not aggregate)
PT: normal
APTT: normal or increased
Factor VIII: normal or decreased
VWF: Ag: decreased

535
Q

Qualitative platelet disorders - Hereditary - Bernard-Soulier syndrome - explanation

A

-lack of functional glycoprotein GPIb-IX complex (receptor for VWF) on platelet surface prevents interaction with VWF
-abnormal platelet adhesion to collagen

536
Q

Qualitative platelet disorders - Hereditary - Bernard-Soulier syndrome - lab tests

A

-giant platelets with dense granulation
-increased closure time (platelet function assay (PFA))
-abnormal aggregation with ristocetin

537
Q

Qualitative platelet disorders - Hereditary -Glanzmann thrombasthenia - explanation

A

-deficiency or abnormality of platelet membrane GP IIb/IIIa
-fibrinogen can’t attach to platelet surface & initiate platelet aggregation

538
Q

Qualitative platelet disorders - Hereditary -Glanzmann thrombasthenia - lab tests

A

-increased closure time (PFA)
-abnormal aggregation with all aggregating agents except ristocetin

539
Q

Qualitative platelet disorders - Acquired - explanation

A

-functional platelet disorders occur with chronic renal failure, myeloproliferative disorders, cardiopulmonary bypass, use of aspirin & other drugs
-mechanisms vary

540
Q

Qualitative platelet disorders - Acquired - lab tests

A

abnormal platelet aggregation

541
Q

Tests of platelet function - platelet aggregation - method

A

-aggregating agent (e.g., ADP, collagen, ristocetin, epinephrine) added to platelet suspension
-as platelets aggregate, increase in light transmittance
-platelet aggregation curves generated (time vs. % transmittance)

542
Q

Tests of platelet function - platelet aggregation - clinical significance

A

-abnormal curves with platelet dysfunctions such as von Willebrand disease, Bernard-Soulier syndrome, platelet storage pool defects, idiopathic thrombocytopenia purpura, drugs

543
Q

Tests of platelet function - PFA - method

A

-citrated whole blood drawn through capillary tubes coated with ADP/collagen or epinephrine/collagen
-platelets adhere & aggregate when exposed to collagen
-closure time = length of time for platelets to form platelet plug & close aperture of capillary tube

544
Q

Tests of platelet function - PFA - clinical significance

A

-screening test for qualitative platelet defects
-replaces bleeding time
-Von Willebrand disease: prolonged with collagen/ADP & collagen/epinephrine
-defects related to drugs (e.g., aspirin): normal with collagen/ADP, prolonged with collagen/epinephrine

545
Q

Tests of platelet function - von Willebrand factor (VWF): Ag - method

A

immunologic tests (e.g., enzyme immunossay [EIA]) using monoclonal antibodies to VWF

546
Q

Tests of platelet function - von Willebrand factor (VWF): Ag - clinical significance

A

-VWF connects platelets to collagen
-decreased in von Willebrand disease, so platelets don’t function normally

547
Q

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - PT - purpose

A

to detect deficiencies in extrinsic & common pathways & to monitor coumadin (Warfarin) therapy

548
Q

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - PT - reagent(s)

A

thromboplastin reagent (thromboplastin, phospholipid, Ca2+)

549
Q

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - PT - prolonged results

A

-anticoagulant therapy
-deficiency of VII, X, V, II, or I
-circulating inhibitors

550
Q

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - PT - INR

A

-the INR standardizes the PT value regardless of instrument and reagent combination used or location
-Prothrombin ratio (PR) and International Sensitivity Index (ISI) are used to calculate the INR:
PR = PT (patient)/PT (mean normal)
INR = PR^(ISI)
NOTE: geometric mean of normal is used, not the population mean

551
Q

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - APTT - purpose

A

-to detect deficiencies in intrinsic & common pathways & to monitor unfractionated heparin (UFH) therapy

552
Q

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - APTT - reagent(s)

A

-activated partial thromboplastin reagent (phospholipid, activator)
-CaCl2

553
Q

Prothrombin time (PT) & Activated partial thromboplastin time (APTT) - APTT - prolonged results

A

-heparin therapy
-deficiency of HMWK, PK, XII, XI, IX< VIII, X, V, II, or I
-circulating inhibitors

554
Q

Interpretation of PT/APTT:
-PT = prolonged
-APTT = Normal

Possible deficiency?

555
Q

Interpretation of PT/APTT:
-PT = Normal
-APTT = Prolonged

Possible deficiency?

A

-HMWK (Fitzgerald factor)
-PK (Fletcher factor)
-XII
-XI
-IX
-VIII

556
Q

Interpretation of PT/APTT:
-PT = Prolonged
-APTT = Prolonged

Possible deficiency?

A

X, V, II, I

557
Q

Other coagulation tests - mixing studies

A

-follow up to abnormal PT or APTT
-test is repeated on 1:1 mixture of patient plasma & normal plasma
-if patient has factor deficiency, time will be corrected because normal plasma supplies missing factor
-if time is not corrected, an inhibitor is present, e.g., antibody or anticoagulant

558
Q

Other coagulation tests - Activated clotting time (ACT)

A

-whole blood clotting method using point-of-care analyzer
-often used with cardiac surgery to monitor heparin

559
Q

Other coagulation tests - Thrombin time (TT)

A

-measures time required for thrombin to convert fibrinogen
-prolonged with hypo- or dysfibrinogenemia, heparin, fibrin(ogen) degradation products (FDP)

560
Q

Other coagulation tests - Reptilase time

A

-similar to TT except uses reptilase (snake venom enzyme) instead of thrombin
-prolonged results with afibrinogenemia & most congenital dysfibrinogenemias
-variable results with hypofibrinogenemia

561
Q

Other coagulation tests - Fibrinogen

A

-estimation of fibrinogen level by modified TT
-thrombin added to dilution of patient plasma
-results obtained from calibration curve prepared from testing dilutions of fibrinogen standard
-Normal: 200-400 mg/dL

562
Q

Other coagulation tests - Factor assays

A

-% of factor activity determined by amount of correction of PT or APTT when dilutions of patient plasma are added to factor-deficient plasma

563
Q

Other coagulation tests - Factor XIII screening test

A

-patient’s platelet-rich plasma mixed with CaCl2
-clot placed in urea or monochloroacetic acid & incubated at 37*C
-clots from individuals with normal factor XIII are stable for at least 24 hours, while in factor XIII deficiency, clot dissolves rapidly

564
Q

Other coagulation tests - Anti-Factor Xa assay

A

-test to measure therapy with low molecular weight heparin (LMWH)
-can also be used instead of APTT to monitor therapy with UFH
-patient plasma added to excess factor Xa & substrate specific factor Xa
-Heparin in sample forms complex with AT & inhibits factor Xa
-residual factor Xa cleaves substrate to produce colored product whose intensity is inversely proportional to concentration of heparin

565
Q

Other coagulation tests - Thromboelastography (TEG)

A

-citrated whole blood using POCT analyzer
-measures the strength of a clot using a torsion wire

566
Q

Coagulation disorders - Hemophilia A - deficiency

A

Factor VIII

567
Q

Coagulation disorders - Hemophilia A - clinical findings

A

varies from asymptomatic to crippling bleeding into joints, muscles, & fatal intracranial hemorrhage

568
Q

Coagulation disorders - Hemophilia A - laboratory findings

A

PLT: normal
PT: normal
APTT: increased
Factor VIII: decreased

569
Q

Coagulation disorders - Hemophilia A - inheritance

A

-sex-linked recessive
-occurs primarily in males
-mothers are carriers

570
Q

What is the 2nd most common inherited bleeding disorder?

A

Hemophilia A

571
Q

Coagulation disorders - Hemophilia B (Christmas disease) - deficiency

572
Q

Coagulation disorders - Hemophilia B (Christmas disease) - clinical findings

A

varies from asymptomatic to crippling bleeding into joints, muscles, & fatal intracranial bleeding

573
Q

Coagulation disorders - Hemophilia B (Christmas disease) - laboratory findings

A

PLT: normal
PT: normal
APTT: increased
Factor IX: decreased

574
Q

Coagulation disorders - Factor XIII deficiency - deficiency

A

Factor XIII

575
Q

Coagulation disorders - Factor XIII deficiency - clinical findings

A

-poor wound healing
-keloid formation

576
Q

Coagulation disorders - Factor XIII deficiency - laboratory findings

A

PT: normal
APTT: normal
Screen for with 5 mol/Urea test

577
Q

Coagulation disorders - Factor XIII deficiency - why is it unique?

A

because Factor XIII is a transglutaminase not a protease

578
Q

Coagulation disorders - Hemophilia B (Christmas disease) - inheritance

A

sex-linked recessive

579
Q

Acquired factor deficiencies - liver disease

A

coagulation proteins are synthesized in the liver

580
Q

Acquired factor deficiencies - vitamin K deficiency

A

vitamin K is needed for synthesis of II, VII, IX, X

581
Q

Acquired factor deficiencies - DIC

A

-uncontrolled formation & lysis of fibrin in blood vessels
-fibrinogen, II, V, VIII, XIII, & plts are consumed

582
Q

Acquired factor deficiencies - primary fibrinolysis (fibrinogenolysis)

A

-plasminogen activated to plasmin; degrades fibrinogen, V, VIII, XIII
-no fibrin formation

583
Q

Acquired factor deficiencies - acquired inhibitors (circulating anticoagulants)

A

-antibodies against coagulation factors
-inhibitors to VIII & IX are most common & usually in patients who have received replacement therapy for hemophilia A or B
-occasionally associated with other diseases or in normal individuals

584
Q

Tests of fibrinolytic system - D-dimer - explanation

A

fragment that results from lysis of fibrin by plasmin

585
Q

Tests of fibrinolytic system - D-dimer - method(s)

A

-latex agglutination using monoclonal antibodies against D-dimer
-ELISA

586
Q

Tests of fibrinolytic system - D-dimer - clinical significance

A

-marker for DIC
-also positive with deep vein thrombosis, pulmonary embolism, & after lytic therapy
-negative in primary fibrinolysis

587
Q

Tests of fibrinolytic system - FDP - explanation

A

product of action of plasmin on fibrin or fibrinogen

588
Q

Tests of fibrinolytic system - FDP - method(s)

A

latex agglutination using antibodies against FDP

589
Q

Tests of fibrinolytic system - FDP - clinical significance

A

-sign of increased fibrinolytic activity
-doesn’t differentiate between fibrin degradation products & fibrinogen degradation products
-present in DIC, primary fibrinolysis, deep vein thrombosis, pulmonary embolism, & after lytic therapy

590
Q

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - PT

A

DIC: prolonged
Primary fibrinolysis: prolonged

591
Q

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - APTT

A

DIC: prolonged
Primary fibrinolysis: prolonged

592
Q

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - Fibrinogen

A

DIC: decreased
Primary fibrinolysis: decreased

593
Q

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - Platelets

A

DIC: decreased
Primary fibrinolysis: normal

594
Q

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - FDP

A

DIC: present
Primary fibrinolysis: present

595
Q

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - D-dimer

A

DIC: positive
Primary fibrinolysis: negative

596
Q

Disseminated intravascular coagulation (DIC) vs. Primary fibrinolysis - RBC morphology

A

DIC: schistocytes
Primary fibrinolysis: normal

597
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Antithrombin (AT) - significance

A

-plasma inhibitor that neutralizes all serine proteases, including thrombin
-deficiences associated with increased risk of thrombosis

598
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Antithrombin (AT) - assays

A

-chromogenic substrate assay
-immunologic assay
-nephelometry for AT concentration

599
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Protein C - significance

A

-coagulation inhibitor
-inactivates Va & VIIIa
-deficiencies associated with increased risk of thrombosis

600
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Protein C - assays

A

-immunologic assa
-chromogenic substrate assay
-clot-based assay

601
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Protein S - significance

A

cofactor for protein C

602
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Protein S - assays

A

-clotting assay
-immunologic assay

603
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Factor V Leiden - significance

A

-most common cause of hereditary activated protein C resistance (APC)
-mutation that makes V resistant to activity of activated protein C
-increased risk of thrombosis

604
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Factor V Leiden - assays

A

-APC resistance assays is most frequent screening test
-patient plasma diluted in V-deficient plasma
-activated protein C added
-APTT or dilute Russell viper venom time (dRVVT) performed
-abnormals must be confirmed by molecular testing (e.g., PCR, restriction fragment length polymorphism)

605
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Lupus anticoagulants - significance

A

-risk factor for thrombosis & recurrent spontaneous abortion
-acquired antiphospholipid antibodies that interact with phospholipid in APTT reagent & prolong time
-in vitro phenomenon
-patient doesn’t have factor deficiency or bleeding
-present in patients with lupus, other autoimmune diseases, neoplasms, infections, drugs
-also present in some normal individuals

606
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - Lupus anticoagulants - assays

A

-detected by unexplained prolongation of APTT that isn’t corrected by addition of equal volume of normal plasma
-no definitive assay

607
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - HIT - significance

A

antibodies form against heparin-platelet factor 4 complex, which causes thrombocytopenia and thrombosis via platelet activation

608
Q

Tests to assess risk of thrombosis (hypercoagulability assessment) - HIT - assays

A

functional assays to measure platelet activation or aggregation as well as immunoassays to detect heparin-platelet factor 4 antibodies

609
Q

Antithrombic therapy - Coumadin (Warfarin) - administration

610
Q

Antithrombic therapy - Coumadin (Warfarin) - action

A

vitamin K antagonist

611
Q

Antithrombic therapy - Coumadin (Warfarin) - effect

A

slow acting

612
Q

Antithrombic therapy - Coumadin (Warfarin) - duration

613
Q

Antithrombic therapy - Coumadin (Warfarin) - test(s) for

A

PT and INR

614
Q

Antithrombic therapy - Coumadin (Warfarin) - decreases production of

A

II, VII, IX, X

615
Q

Antithrombic therapy - UFH - administration

616
Q

Antithrombic therapy - UFH - action

A

catalyzes inhibition of thrombin, Xa, & IXa by AT

617
Q

Antithrombic therapy - UFH - effect

618
Q

Antithrombic therapy - UFH - duration

619
Q

Antithrombic therapy - UFH - test(s) for

A

-APTT
-anti-factor Xa (colorimetric assay where amount of free Xa is inversely proportional to the heparin concentration - more accurate than APTT)

620
Q

Antithrombic therapy - UFH - requires what to be effective?

621
Q

Antithrombic therapy - LMWH - administration

A

subcutaneous

622
Q

Antithrombic therapy - LMWH - action

A

catalyzes inhibition of Xa by AT

623
Q

Antithrombic therapy - LMWH - effect

624
Q

Antithrombic therapy - LMWH - duration

A

longer than UFH; shorter than Warfarin

625
Q

Antithrombic therapy - LMWH - test(s) for

A

-monitoring usually not required
-if needed, anti-factor Xa should be used

626
Q

Antithrombic therapy - LMWH - APTT

A

insensitive to LMWH

627
Q

Antithrombic therapy - Aspirin (antiplatelet drug) - administration

628
Q

Antithrombic therapy - Aspirin (antiplatelet drug) - action

A

inhibits COX enzyme & the formation of TXA2

629
Q

Antithrombic therapy - Aspirin (antiplatelet drug) - effect

630
Q

Antithrombic therapy - Aspirin (antiplatelet drug) - duration

A

effect on platelets lasts for the entire platelet lifespan

631
Q

Antithrombic therapy - Aspirin (antiplatelet drug) - test(s) for

A

-platelet aggregation
-VerifyNow/PFA-100 POCT devices

632
Q

Antithrombic therapy - Aspirin (antiplatelet drug) - complication

A

immune-mediated complication associated with HIT suspected with a reduction in platelet count by 40% of baseline along with lack of patient response to heparin; therapy must be stopped immediately

633
Q

Coagulation instrumentation - endpoint detection - mechanical - principle

A

change in electrical conductivity between 2 probes or change in movement of steel ball when clot forms

634
Q

Coagulation instrumentation - endpoint detection - photometric - principle

A

-turbidity: decrease in light transmittance as fibrin forms
-nephelometry: increased side and forward scatter as clot forms (quantitative)

635
Q

Coagulation instrumentation - endpoint detection - chromogenic - principle

A

increase in light absorbance at 405 nm as para-nitroaniline (pNA) is cleaved from synthetic substrate by coagulation enzyme

636
Q

Coagulation instrumentation - endpoint detection - immunologic - principle

A

increase in light absorbance as latex particles coated with specific antibody are agglutinated by antigen

637
Q

Sources of error in coagulation testing - incorrect anticoagulant

A

-3.2% sodium citrate should be used
-labile factors are preserved better

638
Q

Sources of error in coagulation testing - drawing coagulation tube after other anticoagulant tubes

A

contamination with other anticoagulants can interfere

639
Q

Sources of error in coagulation testing - probing to find vein

A

tissue thromboplastin activates coagulation & decreases times

640
Q

Sources of error in coagulation testing - incorrect ratio of blood to anticoagulant

A

-need 9:1 blood to anticoagulant ratio
-tubes <90% full will have longer times

641
Q

Sources of error in coagulation testing - failure to mix anticoagulant with blood

A

blood will clot

642
Q

Sources of error in coagulation testing - polycythemia

A

HCT >55% leads to longer times - anticoagulant must be reduced

643
Q

Sources of error in coagulation testing - heparin contamination from catheter or heparin lock

A

-will prolong times
-lines must be flushed with saline, first 5 mL drawn discarded

644
Q

Sources of error in coagulation testing - hemolysis

A

-hemolyzed RBCs may activate clotting factors
-hemolysis may interfere with photometric reading

645
Q

Sources of error in coagulation testing - lipemia

A

-may interfere with optical methods
-test by mechanical method

646
Q

Sources of error in coagulation testing - improper storage of specimen

A

-should be stored in vertical position at RT with stopper on to prevent change in pH
-specimens for PT must be tested within 24 hours of collection, APTT within 4 hours
(if APTT is for monitoring heparin, must be centrifuged within 1 hour of collection)

647
Q

Sources of error in coagulation testing - improper storage or reconstitution of reagents

A

run normal & abnormal controls every 8 hours & with each change of reagents to verify system performance

648
Q

Sources of error in coagulation testing - equipment malfunction (e.g., temperature, timer, detector, volumes dispensed)

A

run normal & abnormal controls every 8 hours & with each change of reagents to verify system performance

649
Q

In which age group would 60% lymphocytes be a normal finding?

A. At birth
B. 1-3 years
C. 8-13 years
D. 40-60 years

A

B. 1-3 years

650
Q

All of the following occur as an RBC matures EXCEPT:

A. Size of cell becomes smaller
B. Cytoplasm turns pink due to formation of hemoglobin
C. The N:C ratio increases
D. The nucleus is extruded by mature phase

A

C. The N:C ratio increases

651
Q

During hemoglobin electrophoresis, at a pH of 8.6, which of the following hemoglobins migrated to the same position as hemoglobin A2?

A. Hemoglobin H
B. Hemoglobin F
C. Hemoglobin S
D. Hemoglobin C

A

D. Hemoglobin C

652
Q

If a patient has had a splenectomy, which of the following RBC inclusions will most likely be observed on a peripheral blood smear?

A. Basophilic stippling
B. Heinz bodies
C. Howell-Jolly bodies
D. Reticulocytes

A

C. Howell-Jolly bodies

653
Q

In which hypochromic, microcytic anemia do patients have little or no hemoglobin A produced?

A. Thalassemia major
B. Thalassemia minor
C. Iron deficiency anemia
D. Anemia of chronic infection

A

A. Thalassemia major

654
Q

Which of the following is associated with hemoglobin C disease?

A. 35-45% hemoglobin S
B. Target cells
C. Nucleated nRBCs
D. Increased osmotic fragility

A

B. Target cells

655
Q

Iron deficiency anemia is characterized by which set of laboratory values?

A. Decreased serum iron, increased TIBC, & decreased ferritin
B. Increased serum iron, increased TIBC, & increased ferritin
C. Decreased serum iron, decreased TIBC, & decreased ferritin
D. Decreased serum iron, increased TIBC, & increased ferritin

A

A. Decreased serum iron, increased TIBC, & decreased ferritin

656
Q

CML can be differentiated from leukemoid reaction by:

A. CML will have high WBC count whereas leukemoid reaction will have low WBC count
B. CML will have low LAP whereas leukemoid reaction will have high LAP
C. CML will have high LAP whereas leukemoid reaction will have low LAP
D. The Philadelphia chromosome will only be found in leukemoid reaction

A

B. CML will have low LAP whereas leukemoid reaction will have high LAP

657
Q

Which coagulation factors would be deficient in someone with vitamin K deficiency?

A. II
B. VII
C. X
D. All of the above

A

D. All of the above

658
Q

Which of the following is TRUE of hemophilia A?

A. Associated with factor X deficiency
B. Patients would have prolonged APTT and normal PT
C. Patients with hemophilia A have abnormal platelet function
D. Patients would have a prolonged PT and a normal APTT

A

B. Patients would have prolonged APTT and normal PT

AMT MT Exam (12 decks)

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