01a: Hematopoiesis

Question 1

Flow cytometry: forward scatter indicates which cell properties?

Answer 1

Cell size

Question 2

Flow cytometry: side scatter indicates which cell properties?

Answer 2

Internal properties of cell (granularity, nuclear shape)

Question 3

Flow cytometry: (X) is proportional to the number of cells in the sample.

Answer 3

X = number of impulses of scattered light

Question 4

IL3 is also referred to as (X)-CSF. In hematopoiesis, it primarily works at (Y) level. Which cells produce it?

Answer 4

X = multi
Y = stem cell and progenitor

NK and T cells

Question 5

GM-CSF is produced by (X) cells and leads to increase in (Y) cells during hematopoiesis.

Answer 5

X = multiple (lymphos, macros, fibros, endothelial)
Y = PMNs, eos, monos, lymphos

Question 6

G-CSF is produced by (X) cells and leads to increase in (Y) cells during hematopoiesis.

Answer 6

X = multiple (mainly macrophages)
Y = circulating PMNs

Question 7

Embryology: stem cells arise in (X), migrate to (Y) during mid gestation and then migrate to (Z) in late gestation/at birth.

Answer 7

X = blood islands in yolk sac
Y = liver
Z = bone marrow

Question 8

In adults red marrow is confined to which parts of (long/flat) bones?

Answer 8

Ends of long bones and middle of some flat bones

Question 9

Hematopoiesis: stem cell gives rise to which basic 4 categories, from which blood cells eventually mature?

Answer 9

1. Erythroid elements (RBCs)
2. Myeloid elements (WBCs)
3. Megakaryocytes (platelets)
4. Lymphocytes

Question 10

Earliest recognizable neutrophilic precursor is the (X). Which forms follow in the maturation process?

Answer 10

X = myeloblast

Promyelocyte, myelocyte, metamyelocyte, band form, neutrophil

Question 11

Which WBCs have the same maturation stages as neutrophils?

Answer 11

Eosinophils and basophils

Question 12

The monoblast precursor is similar to the (X) neutrophil precursor, but in the maturation stages of (Y) WBCs.

Answer 12

X = myeloblast
Y = monocytes

Question 13

Earliest recognizable erythrocytic precursor is the (X). Which forms follow in the maturation process?

Answer 13

X = pronormoblast

1. Basophilic normoblast
2. Polychromatic normoblast
3. Orthochromatic normoblast
4. Reticulocyte
5. Erythrocyte

Question 14

T/F: Reticulocytes reside and develop in marrow until they’re mature erythrocytes.

Answer 14

False - reside for 2 days in marrow then released into blood (where they mature)

Question 15

List the three main compartments of the spleen. Star the one that constitutes the bulk of the organ.

Answer 15

1. White pulp
2. Red pulp*
3. Marginal Zone

Question 16

Red pulp compartment of spleen can be further divided into:

Answer 16

1. Sinus compartment

2. Splenic cords (of Billroth)

Question 17

Red pulp of spleen primarily involved in:

Answer 17

1. filtering blood

2. destroying abnormal/senescent RBCs

Question 18

White pulp of spleen primarily involved in:

Answer 18

Immune reaction to antigens

Question 19

(Red/white) pulp of spleen is involved in Acute/chronic leukemias

Answer 19

Red

Question 20

(Red/white) pulp of spleen is involved in Lymphoproliferative disorders such as:

Answer 20

White;

Hodgkin and malignant lymphomas

Question 21

Iron in plasma is bound to (X) and iron stored in cells is bound to (Y).

Answer 21

X = transferrin
Y = ferritin

Question 22

Beeturia may be a sign of:

Answer 22

Fe deficiency

Question 23

What’s angular cheilosis? It’s a clinical sign of (X).

Answer 23

X = Fe deficiency

Red, swollen patches in the corners of your mouth

Question 24

Plummer-Vinson syndrome is clinical sign of (X) and includes the triad of:

Answer 24

X = Fe deficiency

1. Esophageal webs
2. Anemia
3. Glossitis

Question 25

Measuring (X) is reflective of total iron binding capacity (TIBC). Good iron balance means which value for TIBC?

Answer 25

X = transferrin Over 20%

Question 26

(X) is a measure of storage iron. Good iron balance means which value for TIBC?

Answer 26

X = ferritin Over 40

Question 27

Low MCHC (mean corpuscular hemoglobin concentration) is indicative of:

Answer 27

Severe, long-standing Fe deficiency ("bankruptcy")

Question 28

T/F: Thrombocytosis is common in Fe deficiency.

Answer 28

True

Question 29

Diagnosing Fe deficiency: since (X) is acute phase reactant, it's important to measure in conjunction with (Y), in case inflammation is present.

Answer 29

``` X = ferritin Y = ESR/CRP ```

Question 30

(Fe deficiency/thalassemia) has (low/high) MCV and (low/high) RDW (RBC distribution width).

Answer 30

Both; | Low; high

Question 31

T/F: Long-term Fe supplementation is used for both Fe deficiency and thalassemia.

Answer 31

False - harmful in thalassemia (overload)

Question 32

T/F: RDW is relatively larger in Fe deficiency than in thalassemia.

Answer 32

True

Question 33

Fe deficiency can be primarily distinguished from anemia of chronic disease by measuring:

Answer 33

TIBC (transferrin low in anemia of chronic disease and high in Fe deficiency)

Question 34

T/F: Serum iron, TIBC, and ferritin levels are normal in thalassemia.

Answer 34

True (OR serum Fe and ferritin may be high)

Question 35

Gold standard for Fe deficiency diagnosis:

Answer 35

Bone marrow biopsy

Question 36

Proton pump inhibitors (facilitate/impair) iron absorption. Why?

Answer 36

Impair; gastric acid keeps Fe in ferrous state (soluble)

Question 37

T/F: Fe mainly absorbed in ileum.

Answer 37

False - duodenum

Question 38

Fe deficiency in men or menopausal women: must rule out (X).

Answer 38

X = GI malignancy

Question 39

Standard treatment for oral Fe repletion

Answer 39

Ferrous sulfate 325 mg

Question 40

List examples of dietary intake that augments or inhibits oral Fe repletion.

Answer 40

Augment: vit C Inhibit: milk, tea

Question 41

IV iron contraindications:

Answer 41

1. Inability to tolerate multiple preparations of parenteral Fe 2. Active bac/fungal infection 3. Fe overload

Question 42

T/F: Fe deficiency without anemia is asymptomatic.

Answer 42

False (fatigue, restless leg syn, impaired myocardial fxn)

Question 43

Which main two tests are used to test for Fe overload?

Answer 43

Ferritin and transferrin levels

Question 44

T cell compartment located in (red/white) pulp of spleen. And B cell compartment?

Answer 44

Both in white pulp

Question 45

Why are thalassemia patients iron (depleted/overloaded)?

Answer 45

Overloaded; | ineffective erythropoiesis

Question 46

Patient with autoimmune hemolytic anemia is likely iron (depleted/overloaded).

Answer 46

Overloaded - rapid RBC turnover

Question 47

Hereditary hemochromatosis is mutation in (X), with which inheritance pattern?

Answer 47

X = HFE (C282Y) Autosomal recessive

Question 48

How is hereditary hemochromatosis generally screened for?

Answer 48

TSAT (transferrin saturation) EXCEPT in women of childbearing age due to menses - confirm with genetic testing

Question 49

Patients with hereditary hemochromatosis should be advised to avoid consumption of:

Answer 49

1. Excess dietary iron 2. Liver toxins (ex: EtOH) 3. Raw shellfish (vibrio vulnificans)

Question 50

T/F: Oral iron cannot be absorbed when hepcidin is high.

Answer 50

True

Question 51

T/F: Chronic transfusion may be necessary to fix Fe deficiency in some patients.

Answer 51

False - inappropriate means of fixing deficiency

Question 52

Iron overload can be treated with:

Answer 52

phlebotomy or chelation