HEMA Flashcards
Normal adult hemoglobin (hemoglobin A) consists of FOUR HEME GROUPS AND FOUR POLYPEPTIDE CHAINS with a total of 574 AMINO ACIDS.
Noted, composition of adult hemoglobin: 4 heme and 4 polypeptide chains, total of 574 amino acids
One chromosome breaks off and becomes attached to a different chromosome:
Addition
Deletion
Inversion
Translocation
Translocation
CHROMOSOMAL CHANGES
TRANSLOCATIONS
Most common type of DNA change that can lead to leukemia.
A translocation means that a part of one chromosome breaks off and becomes attached to a different chromosome.
The point at which the break occurs can affect nearby genes—for example, it can turn on oncogenes or turn off genes that would normally help a cell to mature.
DELETIONS
Occur when part of a chromosome is lost.
This may result in the cell losing a gene that helped keep its growth in check, for example, a tumor suppressor gene.
INVERSIONS
Occur when part of a chromosome gets turned around, so it is now in reverse order.
This can result in the loss of a gene (or genes) because the cell can no longer read its instructions in protein translation.
ADDITION
An extra chromosome or part of a chromosome is gained.
This can lead to too many copies of certain genes within the cell.
This can be a problem if one or more of these genes are oncogenes.
The most versatile type of stem cell, can develop into any human cell type, including development from embryo into fetus:
Multipotential stem cell
Pluripotential stem cell
Totipotential stem cell
Totipotential stem cell
TYPES OF HUMAN STEM CELLS
Functionally, three types of human stem cells exist:
1. Totipotential stem cells
These cells are present in the first few hours after an ovum is fertilized.
Totipotential stem cells, the most versatile type of stem cell, can develop into any human cell type, including development from embryo into fetus.
- Pluripotential stem cells
These cells are present several days after fertilization.
Pluripotent stem cells can develop into any cell type, except they cannot develop into a fetus. - Multipotential stem cells
These cells are derived from pluripotent stem cells.
They can be found in adults, but they are limited to specific types of cells to form tissues.
For example, bone marrow stem cells can produce all types of blood cells, bone cartilage, and adipose (fat) cells.
The promyelocyte stage lasts about:
4 hours
12 hours
15 hours
24 hours
4.3 days
24 hours
PROLIFERATIVE PHASE
Myeloblast: 15 hours
First identifiable cell in the granulocytic series
Constitute approximately 1% of the total nucleated bone marrow cells
Stage lasts approximately 15 hours
Promyelocyte: 24 hours
Constitutes approximately 3% of the nucleated bone marrow cells
This stage lasts about 24 hours
Myelocyte
Approximately 12% of the proliferative cells existing in this stage
Myelocyte to metamyelocyte lasts an average of 4.3 days
Once the metamyelocyte stage has been reached, cells have undergone four or five cell divisions and the proliferative phase comes to an end
MATURATION-STORAGE PHASE
Metamyelocytes 45%
Band 35%
Segmented granulocytes 20%
Segmented neutrophils in the maturation-storage compartment are frequently referred to as the marrow reserve.
This reserve constitutes a 4- to 8-day supply of neutrophils.
The tourniquet should be applied __________ inches above the venipuncture site.
1 to 2 inches above the venipuncture site
3 to 4 inches above the venipuncture site
5 to 6 inches above the venipuncture site
8 to 9 inches above the venipuncture site
3 to 4 inches above the venipuncture site
The tourniquet should be applied 3 to 4 inches above the venipuncture site and left on for no longer than 1 minute before the venipuncture is performed.
Anticoagulants that remove calcium needed for clotting by forming insoluble calcium salts: RODAK
EDTA
EDTA and heparin
EDTA and citrate
EDTA, citrate and oxalate
EDTA, citrate, oxalate and heparin
EDTA, citrate and oxalate
Ethylenediaminetetraacetic acid (EDTA), citrate, and oxalate remove calcium needed for clotting by forming insoluble calcium salts.
Heparin prevents clotting by binding to anti- thrombin in the plasma and inhibiting thrombin and activated coagulation factor X.
Number of inversions of light blue top evacuated tube:
None
3 to 4
5 to 6
8
3 to 4
Light blue (citrate) 3 to 4x inversions
Green (heparin) 8x inversions
Purple (EDTA) 8x inversions
Test orders: 1. Conduct continuous utilization reviews to ensure that physician laboratory orders are comprehensive and appropriate to patient condition; 2. Inform physician about laboratory test availability and ways to avoid unnecessary orders; 3. Reduce unnecessary repeat testing.
1 and 2
1 and 3
2 and 3
1, 2 and 3
1, 2 and 3
Each new assay or assay modification must be validated for: 1. Accuracy, Precision; 2. Linearity; 3. Specificity; 4. Lower limit of detection ability
1 and 3
2 and 4
1, 2 and 3
1, 2, 3 and 4
1, 2, 3 and 4
Each new assay or assay modification must be validated for:
1. Accuracy
2. Precision
3. Linearity
4. Specificity
5. Lower limit of detection ability
Adjuvant for infectious disease therapy:
Interleukin 2
Interleukin 3
Interleukin 6
Interleukin 12
Interleukin 12
Major elements of the flow cytometer: 1. Optics; 2. Fluidics; 3. Computer; 4. Electronics
1 and 2
3 and 4
1, 2 and 3
1, 2, 3 and 4
1, 2, 3 and 4
The basic design of a flow cytometer involves four major elements: optics, fluidics, electronics, and a computer equipped with specialized software.
1. Optics
2. Fluidics
3. Electronics
4. Computer
Total area of the Levy chamber with improved Neubauer ruling:
1 mm2
3 mm2
4 mm2
9 mm2
9 mm2
Levy chamber with improved Neubauer ruling:
It is composed of two raised surfaces, each with a 3 mm x 3 mm square counting area or grid (total area 9 mm2), separated by an H-shaped moat.
For the manual WBC count: After the chamber is filled, allow the cells to settle for___ minutes before counting.
3 minutes
5 minutes
10 minutes
15 minutes
10 minutes
Typical dilution for the manual platelet count:
1:10
1:20
1:100
1:200
1:100
If fewer than 50 platelets are counted on each side, the procedure should be repeated by diluting the blood to:
1:10
1:20
1:100
1:200
1:20
In the cyanmethemoglobin method, full conversion of hemoglobin to cyanmethemoglobin:
3 minutes
5 minutes
10 minutes
15 minutes
10 minutes
WBC count that can interfere with the cyanmethemoglobin method:
Greater than 4 x 10 9/L
Greater than 7 x 10 9/L
Greater than 11 x 10 9 /L
Greater than 20 x 10 9/L
Greater than 20 x 10 9/L
A high WBC count (greater than 20 x 10 9/L) or a high platelet count (greater than 700 x 10 9/L) can cause turbidity and a falsely high result.
In this case, the reagent-sample solution can be centrifuged and the supernatant measured.
Effect of dehydration to hematocrit reading:
Decreased
Increased
Variable
No effect
Increased
The fluid loss associated with dehydration causes a decrease in plasma volume and falsely increases the hematocrit reading.
An MCHC between 36 and 38 g/dL should be checked for:
Codocytes
Drepanocytes
Elliptocytes
Spherocytes
Spherocytes
An MCHC between 36 and 38 g/dL should be checked for spherocytes.
In the manual reticulocyte count, what is the ratio of blood and new methylene blue stain?
1:1
1:2
1:3
1:4
1:1
Mix equal amounts of blood and new methylene blue stain (2 to 3 drops, or approximately 50 mL each), and allow to incubate at room temperature for 3 to 10 minutes.
To improve accuracy of the reticulocyte count, have another laboratorian count the other film; counts should agree within:
Within 1%
Within 5%
Within 10%
Within 20%
Within 20%
The ESR of patients with severe anemia is:
Critical
Of diagnostic significance
Of little diagnostic value
Of little diagnostic value
The ESR of patients with severe anemia is of little diagnostic value, because it will be falsely elevated.
ESR and RBC mass:
Directly proportional
Inversely proportional
Cannot be determined
Directly proportional
The ESR is directly proportional to the red blood cell mass and inversely proportional to plasma viscosity.
ESR of patient with leukemia:
Decreased
Increased
Variable
Increased
ESR of patient with leukocytosis:
Decreased
Increased
Variable
Decreased
An early indication of engraftment success after hematopoietic stem cell transplant. 1. RBC count; 2. Immature reticulocyte fraction; 3. Immature platelet fraction
2 only
1 and 2
2 and 3
1, 2 and 3
2 and 3
The immature reticulocyte fraction and the immature platelet fraction provide an early indication of engraftment success after hematopoietic stem cell transplant.
Conditions associated with DIC: Examples of conditions associated with ENDOTOXINS THAT ACTIVATE CYTOKINES
Acute promyelocytic or myelomonocytic leukemia
Bacterial, protozoal, fungal and viral infections
Coronary artery bypass surgery
Hypovolemic and hemorrhagic shock
Bacterial, protozoal, fungal and viral infections
Fibrinogen concentration in primary fibrinolysis:
Decreased
Increased
Variable
Decreased
Bone marrow reticulocytes have an average maturation of:
1 day
1.5 days
2 days
2.5 days
2.5 days
Bone marrow reticulocytes have an average maturation period of 2.5 days.
Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage for an average of 1 day and represent approximately 0.5% to 1.5% of the circulating erythrocytes.
Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage for an average of:
1 day
1.5 days
2 days
2.5 days
1 day
Bone marrow reticulocytes have an average maturation period of 2.5 days.
Once young reticulocytes enter the circulating blood, they remain in the reticulocyte stage for an average of 1 day and represent approximately 0.5% to 1.5% of the circulating erythrocytes.
Basophils have an average circulation time of about:
7 to 10 hours
8.5 hours
12 hours
2.5 days
8.5 hours
Basophils remain in the maturation-storage phase for approximately 12 hours.
Basophils have an average circulation time of about 8.5 hours.
All identifiable patient information, whether written, computerized, visually, or audio recorded, or simply held in the memory of healthcare professionals, is subject to the duty of confidentiality, EXCEPT:
Any clinical information about an individual’s diagnosis or treatment
A picture, photograph, video, audiotape, or other images of the patient
The patient’s favorite restaurant and food
Who the patient’s doctor is and what clinics patients attend and when
The patient’s favorite restaurant and food
All identifiable patient information, whether written, computerized, visually, or audio recorded, or simply held in the memory of healthcare professionals, is subject to the duty of confidentiality. It covers the following:
1. Any clinical information about an individual’s diagnosis or treatment
2. A picture, photograph, video, audiotape, or other images of the patient 3. Who the patient’s doctor is and what clinics patients attend and when
4. Anything else that may be used to identify patients either directly or indirectly so that any of the information above, combined with the patient’s name or address or full postcode or the patient’s date of birth, can identify them.
It is used by medical laboratories in developing their quality management systems and assessing their own competence and for use by accreditation bodies in confirming or recognizing the competence of medical laboratories:
ISO 11166
ISO 11469
ISO 15189
ISO 15819
ISO 15189
ISO 15189:2007 is for use by medical laboratories in developing their quality management systems and assessing their own competence and for use by accreditation bodies in confirming or recognizing the competence of medical laboratories.
All of the following are examples of pre-analytical errors, EXCEPT:
Specimen obtained from the wrong patient
Specimen collected in the wrong tube or container
Incorrect labeling of specimen
Failure to report critical values immediately
Failure to report critical values immediately
PREANALYTICAL (PREEXAMINATION)
■ Specimen obtained from the wrong patient
■ Specimen procured at the wrong time
■ Specimen collected in the wrong tube or container
■ Blood specimens collected in the wrong order
■ Incorrect labeling of specimen
■ Improper processing of specimen
ANALYTICAL (EXAMINATION)
■ Oversight of instrument flags
■ Out-of-control QC results
■ Wrong assay performed
POSTANALYTICAL (POSTEXAMINATION)
■ Verbal reporting of results
■ Instrument: Laboratory Information System (LIS) incompatibility error
■ Confusion about reference ranges
■ Failure to report critical values immediately
EDTA is used in concentrations of _____ of whole blood
0.5 mg/1 mL of whole blood
1 mg/1mL of whole blood
1.5 mg/1 mL of whole blood
2 mg/1 mL of whole blood
1.5 mg/1 mL of whole blood
Uncommon vascular complications that are not usually related to the technique include:
Pseudoaneurysm
Pseudoaneurysm and thrombosis
Pseudoaneurysm, thrombosis and reflex arteriospasm
Pseudoaneurysm, thrombosis, reflex arteriospasm and arteriovenous fistula formation
Pseudoaneurysm, thrombosis, reflex arteriospasm and arteriovenous fistula formation
Uncommon vascular complications that are not usually related to the technique include pseudoaneurysm, thrombosis, reflex arteriospasm, and arteriovenous fistula formation.
Complications include orthostatic hypotension, syncope and shock
Vascular complications
Cardiovascular complications
Neurological complications
Dermatological comlications
Cardiovascular complications
Cardiovascular complications include orthostatic hypotension, syncope, shock, and cardiac arrest.
Complications include diaphoresis, seizure and pain:
Vascular complications
Cardiovascular complications
Neurological complications
Dermatological comlications
Neurological Complications
Post-phlebotomy patients can exhibit some neurological complications. These include diaphoresis, seizure, pain, and nerve damage. A physician should be consulted immediately.
Sister chromatids move to the equatorial plate.
Prophase
Metaphase
Anaphase
Telophase
Metaphase
Characteristics of the Four Mitotic Periods
PROPHASE
The chromatin becomes tightly coiled.
Nucleolus and nuclear envelope disintegrate.
Centrioles move to opposite poles of the cell.
METAPHASE
Sister chromatids move to the equatorial plate.
ANAPHASE
Sister chromatids separate and move to opposite poles.
TELOPHASE
Chromosomes arrive at opposite poles.
Nucleolus and nuclear membrane reappear.
The chromatin pattern reappears.
Megakaryocytes develop into platelets in approximately __ days.
3 days
5 days
9 days
12 days
5 days
Megakaryocytes develop into platelets in approximately 5 days.
This cytokine promotes the growth of early hematopoietic cell lines:
Interleukin 1
Interleukin 2
Interleukin 3
Interleukin 6
Interleukin 3
Promotes the growth of early hematopoietic cell lines (e.g., proliferation of CFU-GEMM, CFU-M, CFU-Meg, CFU-Eo, and CFU-Bs colonies from
bone marrow).
IL-3 acts with M-CSF to stimulate proliferation of monocytes and macrophages. It also stimulates granulocyte, monocyte, eosinophil,
and mast cell production
Hemoglobin appears for the first time:
Rubriblast (pronormoblast)
Prorubricyte (basophilic normoblast)
Rubricyte (polychromatophilic normoblast)
Metarubricyte (orthochromic normoblast)
Rubricyte (polychromatophilic normoblast)
Hemoglobin appears for the first time in the third maturational stage, the rubricyte or polychromatic normoblast.
This pathway prevents denaturation of globin of the hemoglobin molecule by oxidation:
Embden-Meyerhof pathway
Hexose-monophosphate shunt
Methemoglobin reductase pathway
Luebering-Rapoport pathway
Hexose-monophosphate shunt
Embden-Meyerhof Pathway
Maintains cellular energy by generating ATP
Oxidative pathway or hexose-monophosphate shunt
Prevents denaturation of globin of the hemoglobin molecule by oxidation
Methemoglobin reductase pathway
Prevents oxidation of heme iron
Luebering-Rapaport pathway
Regulates oxygen affinity of hemoglobin
RBCs inclusions, 0.2 to 2.0 mm in size, that can be seen with a stain such as crystal violet or brilliant cresyl blue; represent precipitated, denatured hemoglobin and are clinically associated with congenital hemolytic anemia, G6PD deficiency, hemolytic anemias secondary to drugs such as phenacetin, and some hemoglobinopathies.
Hemoglobin C crystals
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Heinz bodies
Heinz bodies are inclusions, 0.2 to 2.0 mm in size, that can be seen with a stain such as crystal violet or brilliant cresyl blue. They represent precipitated, denatured hemoglobin and are clinically associated with congenital hemolytic anemia, G6PD deficiency, hemolytic anemias secondary to drugs such as phenacetin, and some hemoglobinopathies.
RBC inclusions that are aggregates of mitochondria, ribosomes, and iron particles. Clinically, they are associated with iron-loading anemias, hyposplenism, and hemolytic anemias.
Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Pappenheimer bodies
RBC inclusions representing granules composed of ribosomes and RNA that are precipitated during the process of staining of a blood smear; associated clinically with disturbed erythropoiesis (defective or accelerated heme synthesis),lead poisoning, and severe anemias.
Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Basophilic stippling
Nuclear remnants predominantly composed of DNA; believed to develop in periods of accelerated or abnormal erythropoiesis, because the spleen cannot keep upwith pitting these remnants from the cell. Its presence is associated with hemolytic anemias, pernicious anemia, and particularly post-splenectomy, physiologicalatrophy of the spleen.
Basophilic stippling
Heinz bodies
Howell-Jolly bodies
Pappenheimer bodies
Howell-Jolly bodies
Howell-Jolly bodies are believed to develop in periods of accelerated or abnormal erythropoiesis, because the spleen cannot keep up with pitting these remnants from the cell. The presence of Howell-Jolly bodies is associated with hemolytic anemias, pernicious anemia, and particularly post-splenectomy, physiological atrophy of the spleen.
Anemias with low MCV and MCHC; microcytic, hypochromic RBCs, EXCEPT:
Iron deficiency anemia
Thalassemia
Sideroblastic anemia
Excessive alcohol ingestion
Excessive alcohol ingestion
Low MCV, MCHC
Microcytic, hypochromic
Typical of maturation defects
Iron deficiency anemia (some)
Thalassemia
Sideroblastic anemia
—
Normal MCV, MCHC
Normocytic, normochromic
Typical of hypoproliferation
Bone marrow disorder
Iron deficiency anemia (some)
Anemia of chronic disorders
Autoimmune disease
—
High MCV
Macrocytic
Typical of maturation defect
Vitamin B12 deficiency
Folate deficiency
Excessive alcohol ingestion
Hypothyroidism
Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is MANY.
0
1+
2+
3+
4+
3+
Grading of Erythrocyte Morphology
0 Normal appearance or slight variation in erythrocytes.
1+ Only a small population of erythrocytes displays a particular abnormality; the terms slightly increased or few would be comparable.
2+ More than occasional numbers of abnormal erythrocytes can be seen in a microscopic field; an equivalent descriptive term is moderately increased.
3+ Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term is many.
4+ The most severe state of erythrocytic abnormality, with the abnormality prevalent throughout each microscopic field; comparable terms are marked or marked increase.
