Weeks 1 and 2 Lecture Updates

Question 1

Besides Hbg and Hct what is a key indicator of Iron Def. on the CBC?

Answer 1

MCV

Question 2

What are the normal parameters for the following: 
• Hbg
• Hct
• RBC
• WBC
• MCV
• Platelets 
• Retic. Ct.

Answer 2

Men: 
• Hbg: 14.0-17.5 (W = 12-15) 
• Hct:  42 - 50 (W= 36-45)
• RBC: 4.5 - 6.0 (10^6 per µL) (W = 4.5-5.1) 
• WBC: 4.5 - 11.5
• MCV: 80 - 100
• Platelets: 150 - 450,000 per µL 
• Retic. Ct.: 0.5 - 2.5%

Question 3

What type of Anemia is an increased Reticulocyte count most indicative of?

Answer 3

Hemolytic Anemia

•Chronic blood loss won’t be as elevated because of iron deficiency associated with it

Question 4

In what disease is it advantageous to have hereditary persistence of Fetal hemoglobin?
• What if you don’t have a disease that accompanies this disorder?

Answer 4

• HgF is advantageous in ß-thalessemia because the additional gamma globulin produced can pair with alpha globulin and prevent it from precipitating out
• HgF persistence is insignificant if you don’t have a ß-thal.

Question 5

In what two microcytic anemias does hepcidin play a major role in?

Answer 5

• Anemia of Chronic Inflammation - INCREASED hepcidin causes iron deficiency
• ß-thalessemia - DECREASED hepcidin causes hemachromatosis

Question 6

What’s the principle cause of ineffective erythropoeisis in ß-thalessemia?

Answer 6

Accumulation and Precipitation of Excess Alpha globulin

Question 7

You perform 2 blood draws and both times you fail to separate the hematocrit from the plasma. What might be the cause?

Answer 7

Severe Hemolysis (by something such as C. Perfringes) can cause this

Note: traumatic blood draw probably wouldn’t cause this symptom twice.

Question 8

T or F: a positive DAT is diagnostic of warm autoimmune hemolytic anemia.

Answer 8

False, DAT is not that specific

Question 9

How do you calculate Hct from RBC count?

Answer 9

Hct = RBC X MCV

Question 10

On gross inspection what should you see if the crossmatch is good?

Answer 10

No Pellet in the Bottom of the Tube

**Note: if the crossmatch is bad the next step is to identify the antibodies

Question 11

What do you do if an B- man walks into the ER but all you have is O+, and A- blood?

Answer 11

Give him O+, ASSUMING HE’S NEVER BEEN TRANSFUSED BEFORE.

note: He DEFINITELY has anti-A IgM but probably does not have anti-Rh IgG and he’ll never have a baby so it doesn’t matter if you transfuse him ONCE with it

Question 12

What the most antigenic blood group antigen?

Answer 12

D aka RhD

Question 13

Someone walks into the ER with angina. Do you transfuse them?

Answer 13

NO, transfuse AFTER Myocardial INFARCTION has occurred (don’t treat the symptom)

Question 14

What should you do for your frequently transfused sickle cell patients before given them blood even if the lab performs a crossmatch and says they didn’t have any antibodies?

Answer 14

Order an Extended cross-match to look for MINOR bloodgroup antigens like C, E, and K.

Question 15

What are the major differences between a cancer blast and a lymphocyte?

Answer 15

• Smudgy Chromatin
• Much Larger (way bigger than an RBC)
• Prominent Nucleoli
• A LOT OF CELLS THAT LOOK ALIKE NEAR EACHOTHER

Question 16

What is the most accurate way to measure blasts?

• why?

Answer 16

Manual Count using Bone Marrow ASPIRATE

• It won’t be hemodilute

Question 17

Don’t forget to look at the Myeloid to Erythroid Ratio in the marrow (3:1 - 5:1 is normal)

Answer 17

Don’t forget to look at the Myeloid to Erythroid Ratio in the marrow

Question 18

T or F: inhibiting DNMT is a good thing in some cancers.

Answer 18

True, inhibiting DNMT may promote proliferation by de-repressing the FLT tyrosine kinase, HOWEVER it will also promote DIFFERENTIATION in the case of a Tet defect

Question 19

What is the highest you should see the WBC even in sepsis?

Answer 19

40 or 50 K/µL, much higher and you need to start thinking about ALL

Question 20

What’s the best way to determine between sepsis and leukemia?

Answer 20

Look at the manual differential

Question 21

When you see elevated EPO, think about lung disease or something that would make your patient hypoxic, like anemia*

Answer 21

When you see elevated EPO, think about lung disease or something that would make your patient hypoxic, like anemia*

Question 22

With what diseases do you see hematoxylin bodies?

• Is this suggestive of malignancy?

Answer 22

Hematoxylin Bodies are associated with SLE and other autoimmune diseases, these are NOT suggestive of malignancy

Question 23

When you see paracortical hyperplasia, what should you look for histologically to confirm that its reactive and not cancer/

Answer 23

Variation in the Cell Types

Question 24

Why would you order flow cytometry after seeing lots of smudge cells on a smear?

Answer 24

It can help you differentiate between mantle cell and chonic lymphocytic leukemia because they both can present with smudge cells in the peripheral smear