Hematologie Flashcards
(249 cards)
1
Q
where is erythrocyte produced?
A
bone marrow (after the fetus is 7 months old)
2
Q
where is granulocyte produced?
A
bone marrow
3
Q
where is lymphocyte produced?
A
lymphoid tissu
4
Q
where is platelets produced?
A
bone marrow
5
Q
what is the function of erythrocyte?
A
transport oxygen
6
Q
what is the function of granulocyte?
A
defense againts the bacterial infection
7
Q
what is the function of lymphocyte?
A
cellular et humoral immunity
8
Q
what is the function of platelet?
A
coagulation
9
Q
what are the 3 types of lymphocyte?
A
T-lymp, B-lymp, NK cell
10
Q
All hematopoietic cell start from what
A
Pluripotential hematopoietic stem cell (HSC) and then become multipopential progenitor cell (MPP)
11
Q
Which cells fall under common myeloid progenitor?
A
granulocyte, erythrocyte, monocyte, megakaryocyte
12
Q
which cells fall under common lymphoide progenitor?
A
t-lymph, b-lymph and NK cell
13
Q
Name all of the embryonic hgb
A
Gower I, gower II and portland
14
Q
1-2 months of gestation (fetus) where is the erythropoiesis is form (RBC + Hgb)
A
yolk sac (sac vitellin) and aorta-gonads-meonephros
15
Q
3-6 months of gestation (fetus) where is the erythropoiesis is form (RBC + Hgb)
A
foie et rate
16
Q
Changes during cell maturation
- size
- N:C ration
- cytoplasm
- nucleus
A
- size : becomes smaller
- N:C ration : becomes smaller
- cytoplasm : less basophilic due to loss of RNA, granulocyte produces granules and erythrocyte becomes red because of hgb production
- nucleus : becomes smaller, chromatin condenses, nucleoli disappear.
17
Q
What stain we use for to see reticulum in reticulocyte?
A
supravital stain
18
Q
cause of megaloblastic?
A
defiency in vitamin B12 or folic acide
19
Q
type of megaloblastic anemia
A
pernicious anemia
20
Q
what causes pernicious anemia
A
defiency vitamine B12
21
Q
Characteristics of megaloblastic
A
RBC are oval macrocyte
22
Q
Characteristics of iron deficiency anemia
A
RBC are micro and hypo
23
Q
cause of iron deficiency anemia
A
inadequate iron for hgb synthesis
24
Q
Hgb A molecular structure
A
a2b2
25
Hgb A2 molecular structure
a2e2
26
Hgb F molecular structure
a2g2
27
Hgb S molecular structure
valine substituted for glutamic acid in the 6th position of b chain (glutamic becomes valine)
28
Hgb C molecular structure
lysine substituted for glutamic acid in the 6th position of b chain (glutamic becomes lysine)
29
Which hgb is most common in aldults, second most common and third?
1. Hgb A
2. Hgb A2
3. Hgb F
30
Which hgb is most common in newborns, second most common and third?
1. Hgb F
2. Hgb A
3. Hgb A2
31
Hgb Electrophoresis pH 8.6: which hgb migrates the fastest? (most towards the anode +)
1. Hgb A
2. Hgb F
3. Hgb S
4. Hgb A2 and C
cathode- A2/C----S------F----A anode+
32
Which disorders has anormal hgb?
Sickles cell anemia (anémie falciforme), Thalassemia et Hgb C
33
Hgb in alpha thalassemia
Bart's hgb or H (barts - most severe form a Th.)
34
Hgb Electrophoresis pH 6.2: abnormal conditions which hgb migrates the fastest? (most towards the anode)
1. Hgb C
2. Hgb S
3. Hgb A and A2
4. Hgb F
cathode- F----A-----S----C anode+
35
Cause of methemoglobin
the iron in the heme group is in the Fe3+ (ferric) state
| (normal Hgb = Fe2+ (ferrous))
36
Cause of sulfhemoglobin
sulfur bound to heme
37
Cause of carboxyhemoglobin
carbon monoxide is bound to heme
38
Negative affect of methemoglobin
can't bind O2, cyanosis, can be fatal, blue skin
39
Negative affect of sulfhemoglobin
lower affinity of O2, cyanosis
40
Negative affect of carboxyhemoglobin
diminution of O2 in tissu, can be fatal
41
Which hgb can not be detected in the cyanmethemoglobin method?
sulfhemoglobin
42
Which body inclusion is found in methemoglobin?
Heinz bodies
43
What condition does your skin turn cherry red?
carboxyhemoglobin
44
what is anisocytosis?
variation in size of RBC
45
what is macrocyte?
RBC are bigger then 9um
46
what is microcyte?
RBC are smaller then 6um
47
what is poikilocytosis?
variation in shape (couple morphology)
48
what is elliptocyte/ovalocyte?
oval or cigar shape
49
what is crenated?
round cell with knobby, uniform projections
50
what is burr cells (echinocyte)?
evenly spaced blunt or pointed projections
51
what is spur cells (acanthocyte)?
irreguliar blunt or pointed projections
52
what is shistocyte?
RBC fragments
53
what is sickle cells (depranocyte)?
Crescent, S or C shaped
54
what is hgb C crystals?
Blunt, 6 sided, dark staining
55
what is hgb SC crystals?
glove-like intracellular crystals
56
what is teardrop (dacryocyte)?
teardrop shaped
57
what is target cell(codocyte)?
bull's eye
58
what is stomatocyte?
RBC with slit-like central pallor
59
what is spherocyte?
small, dark-staining RBC
60
what is rouleaux?
stack like coins
61
what is agglutination?
irregular clumps
62
what is basophilic stippling?
RNA aggregation (ribosome)
63
what is howell-jolly?
DNA nuclear remnants
64
what is cabot ring?
remnant of microtubules or fragment of nuclear membrane
65
what is pappenheimer?
iron particules
66
what is siderotic?
aggregations of iron particles
67
what is reticulocyte?
RNA residual (ribosome)
68
what is heinz?
denatured hgb
69
Which disorders we see macrocyte?
megaloblastic, liver disease and reticulocytosis
70
Which disorders we see microcyte?
iron defiency anemia, thalassemia, anemia of chronic infection
71
Which disorders we see elliptocyte/ovalocyte?
many anemias, hereditary ovalocytosis, (membrane defect)
72
Which disorders we see echynocyte?
pyruvate kinase deficiency, could be seen in normal individuals
73
Which disorders we see acanthocyte?
severe liver disease or abetalipoproteinemia
74
Which disorders we see schistocyte?
hemolytic anemia
75
Which disorders we see sickle cells?
sickles cell anemia
76
Which disorders we see hgb C crystals?
hgb C disease
77
Which disorders we see hgb SC crystals?
hgb SC disease
78
Which disorders we see teardrop?
myelofibrosis, thalassemia and other anemia
79
Which disorders we see target cell?
hemoglobinopâthie, thalassemia and liver disease
80
Which disorders we see stomatocyte?
hereditary stomatocytosis, hereditary spherocytosis, thalassemia and cirrhosis
81
Which disorders we see spherocyte?
hereditary spherocytosis, autoantibodies, burns, hemoglobinophatie and hemolysis
82
Which disorders we see rouleaux?
abnormal serum protein. seen in multiple myeloma and macroglobulinemia
83
Which disorders we see agglutination?
autoantibodies, cold agglutination
84
Which inclusion are stain with wrigth's?
- Reticulum
- Howell-jolly
- Pappenheimer
- Siderotic
- Heinz
- Reticulum: cell appears polychrome
- Howell-jolly: yes
- Pappenheimer: yes
- Siderotic: yes but called pappenheimer
- Heinz: no
85
Which inclusion are stain with new methylene bleu?
- Reticulum
- Howell-jolly
- Pappenheimer
- Siderotic
- Heinz
all
86
Which inclusion are stain with prussian bleu?
- Reticulum
- Howell-jolly
- Pappenheimer
- Siderotic
- Heinz
- Reticulum: no
- Howell-jolly: no
- Pappenheimer: yes
- Siderotic: yes
- Heinz: no
87
VGM formula
Hct / RBC = average volume RBC
88
TGMH formula
Hgb / RBC = average weight of hgb in each RBC
89
CGMH formula
Hgb / Hct = average concentration hgb per L RBC
90
which erythrocyte indices is use for classify anemias?
VGM
91
When should a prewarm is done?
CGMH over 360 g/L
92
Difference between hemoglobinopathy and thalassemia?
- hemoglobinopathy: qualitative abnormaly, abnormaly in globin chain, not in amount of globin produced
- thalassemia: quantative abnormaly, normal globin chains, but underproduction of globin chains
93
In coagulation we should run the controles every?
8 hours
94
How long do we have to do the following test
- PT
- PTT
- heparin
- PT : 24h
- PTT: 4h
- heparin: 1h
95
What is the blood to anticoagulation ratio in sodium citrate tube
9:1
96
If the blood to coagulation ratio can not be achieved, what can we do?
calculate the amount of anticoagulation we need
volume anticoagulation=(1.85 x 10-^3)(100-hct) x volume total du tube
97
quel % hct pour reduire le montant anticoagulant?
55%
98
What action does coumadin(warfarin) have?
vitamin K antagonist
99
What action does heparin have?
inhibition of thrombin
100
between PT and PTT which one is affected by coumadin?
PT
101
between PT and PTT which one is affected by heparin?
PTT
102
what cause Hgb C trait?
inheritance of gene for Hgb C from 1 parent (non trait = receive gene frrom both parents)
103
what cause Hgb SC trait?
inheritance of 1 sickle cell gene and 1 hgb C gene
104
what cause hereditary spherocytosis trait?
defect of cell membrane
105
what cause autoimmune hemolytic anemia trait?
autoantibodies
106
what is positif in the solubility test?
Sickle cell anemia and SC disease
107
Hereditary spherocytosis
- CGMH usually
- Osmotic fragility
- CGMH usually : over 360 g/L
| - Osmotic fragility : high (more fragile)
108
how to differenciate megaloblastic and nonmegaloblastic anemia?
megaloblastic has hypersegmentation and oval macrocyte
nonmegalo : does not have hyperseg and has round macrocyte
109
name normochrotic anemia
Sickle cell, hgb c, hereditary spherocytosis and autoimmune hemolytic anemia
110
name microcytic anemia
iron deficiency, siderolastic, thalassemia, chronic inflammation
111
Cause of sideroblastic anemia?
enzymatic defect in heme synthesis
112
difference between major and minor b-thalassemia
major: homozygous, severe anemia, has aniso and poik
| minor : heterozygous, mild anemia
113
cause of b thalassemia
decreased production in beta chains
114
Which micro/hypo anemia has a high level hgb A2?
b-thalassemie
115
Iron defiency anemia
- serum iron
- TIBC
- serum ferritin
- serum iron: low
- TIBC : high
- serum ferritin : low
116
Which micro/hypo anemia has a low level TIBC?
anemia of chronic inflammation
117
Which micro/hypo anemia has a high level RBC?
b-thalassemia
118
sideroblastic anemia
- serum iron
- TIBC
- serum ferritin
- serum iron : high
- TIBC : normal
- serum ferritin : high
119
Difference between acute blood loss and chronic blood loss
acute blood loss: normo/normo, low WBC
| chronic blood loss: micro/hypo, normal WBC, hgb and hct low, iron low
120
Order of maturation granulocyte (youngest to oldest)
- myeloblast
- promyelocyte
- myelocyt
- metamyelocyte
- band
- segmented neutrophil
121
differience between myeloblast and promyelocyte
promyelocyte has specific granules
122
differience between myeloblast and myelocyte
myeloblast has nucleoli
123
differience between myelocyte and metamyelocyte
metamyelocyte has a indent in the nucleas (bean shaped)
124
What color is the cytoplasm of a lymphocyte
blue sky, few azurophilic granules
125
What color is the cytoplasm of a monocyte
gray-bleu, vacuoles or pseudopods
126
is there more/less oxygen in the tissu when 2.3 DPG is low
more oxygen in tissu
127
what does left shift mean?
presence of immature granulocyte
128
significance of toxic granulation
infection or inflammation
129
significance of dohle body
infection or burns
130
significance of vacuolization in neutrophile?
septicemia, drugs, toxins and radiation
131
significance of hypersegmentation
first sign of pernicious amenia (more then 5 lobes)
132
Which anomaly we fond hyposegmentartion of the neutrophile?
Pelger-Huet
133
significance of auer rods
only found in myeloblast (rules out CLL)
134
significance of variant lymph (atypical or reactive)
viral infection (ex : mononucleosis)
135
Causes of high basophile (basophilia)
CML or polycythemia vera
136
How do we detect lupus anticoagulant?
unexplained prolongation of APTT that is not corrected after addition of equal volume normal plasma (not factor deficiency)
137
What cause Factor V Leiden
Mutation that makes V resistant to activity of activated protéine C
138
what is protein S
cofacteur protéine C
139
what is protein C
coagulation inhibiteur, inactives FV and VIII
140
Which test is used to diagnosed Factor V leiden?
Russell viper venom time
141
What method is use for he D dimer test
ELISA, antibody vs D-dimer
142
What is D-dimer
fragment that results from lysis of fibrin by plasmin
143
what is fibrinogen?
product of action of plasmin on fibrinogen
144
What can cause factor deficiencies?
- liver disease
- vitamine K deficiency
- Disseminated intravascular coagulation
- primary fibrinolysis
- inhibitors
145
Why is the liver important in coagulation?
coagulation proteins are synthesized in liver
146
Which factors need vitamine K
II, VII, IX and X
147
Other name for christmas disease?
hemophilia B
148
which factor is deficient in hemophilia B
IX
149
which factor is deficient in hemophilia A
VIII
150
Which inherited coagulation disorder is sex linked
Hemophilia (occurs in male and mothers are carriers)
151
Which test is use for Von Willebrand disease?
- platelet agregation : abnormal with ristocetin
- FVIII: low
- VWF:Ag : low
152
In a mixing study what does it mean if the time is corrected?
factor defiency
153
In a mixing study what does it mean if the time is not corrected?
factor inhibitor
154
Except for PTT what other test we can do to monitor heparin?
anti-factor Xa assay
155
Is the reptilase time affected by heparin?
No
156
Name common factors
I, II, V, X
157
Name extrinsèque factors
VII
158
name intrinsèque factors
XIII, IX, XI, XII
159
What reagent is used for PT
thromboplastin phospholipid and Calcium
160
What reagent is used for PTT
phospholipide activator and CaCL
161
RNI calcul
RNI = (PT patient / normal PT)ISI
162
Acute vs chronique leukemia
- Acute: WBC high, normal or low, usually blast
| - chronique: WBC very high, more mature cells
163
which leukemia is more then 20% blast?
AML
164
which leukemia is most common in children
AML
165
which leukemia has usually 5-30 WBC
AML
166
Which leukemia that 50% of WBC affected can be elevated, N or low
ALL
167
which leukemia is over 100 WBC?
CML
168
Which leukemia has 30-200 WBC?
CLL
169
Which leukemia has usually smudge cells (ombre de gumpretch)
CLL
170
Which is the most common type of leukemia in older adults?
CLL
171
The philadelphia chromosome is related with what
CML
172
Which leukemia is most common for people after the age of 55?
CML
173
Which leukemia is positive with myeloperoxidase stain
AML
174
Which leukemia is positive with sudan noir stain
AML
175
Which leukemia is positive with specific esterase stain
AML
176
Which leukemia is positive with periodic acid-Schiff PAS stain
ALL
177
Which couting-chamber is used for WBC count in CFS?
Neubauer hemacytometer
178
what is the purpose of a retic count
assess rate of erythropoiesis
179
what stain is used for retic?
methylene blue
180
What is the purpose of ESR erythrocyte sedimentation rate?
screen for inflammation
181
what is the method of ESR erythrocyte sedimentation rate?
whole blood added to Westergren tube and placed in vertical rack. height of RBC colum read after 1 h
182
what is the best way to determine Hgb S?
electrophoresis (not solubilty test)
183
what is the reagent in the solubilty test for hgb S?
sodium dithionite
184
what is the reagent in the osmotic fragility test?
NaCl
185
which morphology has a low osmotic fragility
target cells and sickle cells
186
Which antibody is Donath-landsteiner
autoanti-P
187
What is the purpose of the donath-landsteiner test
diagnose of paroxysmal cold hemoglobinuria
188
what is a positive Donath-landsteiner test
```
patient = hemolysis (disolved)
control = no hemolysis
```
189
What does the electrical impedance (coulter principal) used for?
cell counting and sizing
190
What is the optical light scattering (flow cytometry) used for?
cell counting, sizing and WBC differential
191
What does the X and Y axes in a histogramme mean?
```
x = cell size
y= number of cells
```
192
how does the cytogram group the cells?
Volume and light scatter
193
What is a method to mesure hgb
cyanmethemoglobin
194
What is the formula for retic %
(retics in square A x100) / (RBS in square B x 9)
195
rules of three
RBC x 3 = hgb +- 0.5
| HGB X 3 = HCT +- 3%
196
What is the corrected WBC formula?
(uncorrecte WBC x 100) / (100 + NRBC)
197
manual cell count formula
WBC =
(#cell counted x dilution x 10^6) /
(carré compté x profondeur(=0.1))
198
Name the steps in primary hemostatis
1. vasoconstriction
2. platelet adhesion
3. platelet aggregation
199
Name the steps in secondary hemostatis
1. interaction with coagulation factors
| 2. fibrin stabilized by XIII
200
Name the steps in fibrinolysis
1. release of tissu plasminogen activator
2. conversion of plasminogen to plasmin
3. conversion of fibrin to fibrin degradation products
201
What is the Bernard-Soulier syndrome
GP Ib/IX/V unfunctional, abnormal plt adhesion to collagen
202
What is the Glanzmann
GP IIb/IIIa unfunctional, fibrinogen can not attach to plt surface and initiate plt aggregation
203
What is the Glanzmann
GP IIb/IIIa unfunctional, fibrinogen can not attach to plt surface and initiate plt aggregation
204
Giant plt with granules can be seen in which disorder?
Bernard-Soulier
205
which test can be used for Glanzmann
collagen, epinephrine, abnormal aggregation with ADP, and PFA
206
which test can be used for bernard-soulier
abnormal aggregation with ristocetin and PFA
207
which reagent is in PFA
ADP, collagen and epinephrine
208
which reagent is in platelet aggregation?
ADP, collagen, epinephrine and ristocetin
209
which anormality can the platelet aggregation test detect?
Von willebrand and bernard-soulier
210
Why do Von willebrand can be diagnose with platelet based tests ?
platelets dont function normally in Von willebrand disease
211
Other name for FI?
fibrinogen
212
Other name for FII?
prothrombine
213
Other name for FIII?
tissu factor
214
Other name for FIV?
calcium
215
Other name for FV?
labile factor
216
Other name for FVII?
stable factor
217
Other name for FVIII?
antihemophilic factor
218
which factor deteriorates rapidly?
FV
219
where is the FIII (tissu factor) released?
phospholipide released in vessel wall. not normally in blood
220
Other name for FIX?
Christmas
221
Other name for FX?
stuart
222
Other name for FXI?
plasma thromboplastin antecedent
223
Other name for FXII?
hageman
224
Other name for FXIII?
fibrin stabilizing
225
Other name for HMWK?
fitzgerald
226
Other name for PK?
fletcher
227
which factor is hemophilia C
XI
228
Name the factors for the contact group
PK, HMWK, XII, XI
229
Name the factors for the fibrinogen group
I, V, VIII, XIII
230
labile factors
V, VIII
231
which factors is not in the serum
I, II, V, VIII, XIII
232
Where are the factors produced ?
liver
233
what is the extrinsic tenase complex and acts on what?
VIIa/TF acts on X
234
what is the intrinsic tenase complex and acts on what?
IXa/VIIIa acts on X
235
what is the protrombinase complex and acts on what?
Xa/Va acts on prothrombin
236
what is the vitamine K required factors also called?
prothrombin group
237
start of extrinsic patheway : The TF from injured blood vessel all activates what?
VII
238
TF:VIIa activates what?
X
239
start of intrinsic patheway: collagen activates which factor?
XII
240
IIa and what else activates XI?
HMWK and PK
241
XIa activates what?
X
242
when does the extrinsic and intrinsic pathway meet in the cascade of coagulation?
when IXa:VIIIa activates X (intrinsic)
| when VIIa/TF acitvates X (extrinsic)
243
How does the common pathway start?
Xa:Va converts prothrombine(II) to thrombin(IIa)
244
What dos the thrombin do in the cascade?
splits fibrinogen(I) into fibrin and activates factor XIII to stabilize clot
245
Which lymphocyte is produced in thymus and which in bone marrow
thymus : T-lymph (T-helper and T-suppressor)
| bone marrow : B-Lymph and NK cells
246
function of NK cells
first line of defense againts tumor cells and cells with virus
247
Which lymphocyte defense against bacteria?
Lymph B
248
Which lymphocyte defense against virus/fungi?
lymph T
249
What cell releases histamine
basophile during allergic reaction
