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Diagnostic M.'s Sara Peer mentor > Hematology > Flashcards

Hematology Flashcards

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1
Q

What are the cellular components of blood?

A

Erythrocytes
Leukocytes
Thrombocytes

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2
Q

What are erythrocytes?

A

Most abundant blood cells in the body = 3.5-5.5 million

6-8 micrometers

Biconcave disk

120 day lifespan

1% per day destroyed

Gas and oxygen transport

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3
Q

What are Leukocytes?

A

Least abundant blood cells in the body = 4.5-11 thousand

5 types

8-14 micrometers

Lifespan vaires

Fights infections and removes debris

Part of buffy coat

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4
Q

What are thrombocytes?

A

Platelets

Produced from megakaryocytes

1-3 micrometers

LIfe span in peripheral blood = 5-9 days

150-400 thousand

Coagulation

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5
Q

What is pancytopenia?

A

Decrease of all cell lines: RBCs, WBCs, and platelets

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6
Q

What is anemia?

A

Decreased RBCs and RBC parameters

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7
Q

What is polycythemia?

A

Increased RBCs

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8
Q

What is Thrombocytopenia?

A

Decreased platelets

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9
Q

What is thrombocytosis?

A

Increased platelets

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10
Q

What is leukocytosis?

A

Increased WBCs

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11
Q

What is leukopenia?

A

Decreased WBCs

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12
Q

What is neutropenia?

A

decreased neutrophils = absolute count < 1000 microL

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13
Q

What is a leukemoid reaction?

A

benign and temporary leukocytosis

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14
Q

What are the five different types of leukocytes?

A 
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
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15
Q

What is hematopoiesis?

A

Production of blood cells

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16
Q

What is erythropoiesis?

A

Production of RBCs

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17
Q

What is thrombopoiesis?

A

Production of platelets

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18
Q

What is leukopoiesis?

A

Production of WBCs

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19
Q

What is lympopoiesis?

A

Production of lymphocytes

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20
Q

What is medullary myeloid hematopoiesis?

A

production of myeloid blood cells in the bone marrow

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21
Q

What is extramedullary hematopoiesis?

A

Production of blood cells outside of the bone marrow in the liver, spleen, or indirectly by kidney

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22
Q

What is Erythropoietin (EPO)?

A

Hormone produced in the kidney and some in the liver

Stimulates Erythropoiesis

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23
Q

During fetal development, where is most of the bone marrow made?

A

Yolk sac
Liver
Spleen

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24
Q

During postnatal life, where is bone marrow made?

A 
Tibia
Femur
Rib
Sternum
Vertebra
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25
What mature cells originate form myeloid stem cells?
``` Erythrocytes Platelets Eosinophils Basophils Neutrophils Monocytes ```
26
What mature cells originate from lymphoid stem cells?
B lymphocytes | T lymphocytes
27
What cells are granulocytes?
Eosinophils Basophils Neutrophils
28
What are the stages of granulocyte maturation?
1) Blast 2) Promyelocyte 3) Myelocyte 4) Metamyelocyte 5) Granulocyte
29
What are immature cells?
blast cells
30
What is the first nucleated RBC called?
Reticulocyte
31
What are Neutrophils?
Essential blood phagocytes Active engulfers and killers of bacteria Live 8-12 hours in circulation 54-62% of blood; 2500-7500/microliter
32
What are basophils?
Function in inflammatory events and allergies Bad cells Live 8 hours in circulation < 1% in blood; < 100/microliter
33
What are eosinophils?
Active in worm and fungal infections, allergy, and inflammatory reactions Parasitic infections and allergic response LIve 8 hours in circulation 1-3% in blood; 60-600/microliter
34
What are monocytes?
Blood phagocytes that rapidly leave the circulation and mature into macrophages and dendritic cells Phagocytic, immune response, inflammatory response, chronic infection Circulate in blood 3 days Circulate in tissue 2-3 months 3-7% in blood; 200-800/microliter
35
Where do T cells mature?
Thymus
36
Where do B cells mature?
Bone marrow
37
Where do Natural killer cells mature?
Bone Marrow
38
What causes Kidney to release EPO?
``` Decreased RBCs Decreased hemoglobin synthesis Decreased blood flow Hemorrhage Increased O2 consumption by tissues ```
39
What does the biconcave shape of an erythrocyte help with?
Allows flexibility/deformability and increases surface area
40
What are the components of RBCs?
Heme and Globin Proteins
41
Where is iron absorbed?
intestines
42
What is transferrin?
transports iron
43
What is ferritin?
stimple storage form of iron
44
What is hemosiderin?
complex iron stores in macrophages
45
What happens to iron when RBCs are broken down?
It is stored and used for erythopoiesis
46
What is hemolysis?
RBC breakdown
47
What is created when RBCs breakdown?
bilirubin from breakdown of heme component
48
What are lymphocytes?
Viral illness, mononucleosis, involved in immunity Live days to months to years 25-33% in blood; 1500-3500/microliter
49
What cells are agranulocytes?
Monocytes | Lymphocytes
50
What is a left shift?
Increased bands of neutrophils
51
What are hemotologic lab studies?
``` CBC Peripheral Smear Reticulocyte count Serum iron TIBC Ferritin Transferin Bilirubin Serum B12 ``` ``` RBC folic acid level Serum folic acid level Serum LDH Coombs test Cold agglutinin test Schillings test Urine hemosiderin Bone marrow studies Electrophoresis ```
52
What is a complete blood count (CBC)?
Evaluates the blood cells in the body Venous blood sample by venipuncture Lavendar top tube
53
What are indications for getting a CBC?
``` Concern of: Bleeding Infection Anemia Malignancy Heart disease Liver disease renal disease Pulmonary disease GI disease ``` ``` Toxin exposure Monitor a therapy Fatigue pale color Fever Petechiae or ecchymosis Weight loss Infection History of infection Bleeding Jaundice Chest pain Dyspnea ```
54
What is included in a CBC?
``` RBC count Hematocrit Hemoglobin WBC Platelet count ```
55
What are the RBC indices?
Mean Corpuscular volume (MCV) Mean Corpuscular Hemoglobin (MCH) Mean Corpuscular hemoglobin concentration (MCHC) Red cell distribution width (RDW)
56
What is the MCV?
size of RBCs
57
What is the MCH?
mean content of hemoglobin per RBC
58
What is teh MCHC?
Mean content of total hemoglobin
59
What is the RDW?
variation in size of RBCs Are they all big; are they all little; or are they mixed sizes?
60
What is the platelet indice?
Mean platelet volume (MPV)
61
What is the MPV?
average volume of platelets
62
What are normal hemoglobin levels?
12-15 g/dL
63
What are the normal hematocrit levels?
36-45%
64
What is the normal red blood cell count?
4.0-5.5 x 10^6/microliter
65
What is the normal white blood cell count?
5-10 x 10^3/microliter
66
What is the normal platelet count?
150-400 x 10^3/microliter
67
What ANC values indicate mild neutropenia?
ANC >1000 and <1500 cell/microliter
68
What ANC values indicate moderate neutropenia?
ANC >500 and <1000 cells/microliter
69
What ANC values indicate severe neutropenia?
ANC < 500 cells/microliter
70
What are the automated CBC machines called?
Coulter Counter or Abbott cell dyne
71
When would you order a blood smear?
If you are concerned about the immune system or that they are anemic but it can't be explained on iron studies
72
What does a CBC Peripheral Blood Smear show?
RBC size and morphology WBC differential Platelets size and number
73
What would you see if patient had ingested lead?
Basophilic stifflings in blood smear
74
What does normocytic mean?
Normal RBC size 6-9 micrometers
75
What does anisocytosis mean?
variation in cell size
76
What does microcytic mean?
smaller RBC size < 5 micrometers
77
What does macrocytic mean?
larger RBC size > 10 micrometers
78
What is hemoglobinization?
color of RBC
79
What does normochromic mean?
normal RBC color
80
What does anisochromia mean?
Variation in color
81
What does Hypochromic mean?
Decreased color
82
What does Hyperchromic mean?
Increased color
83
What are RBC inclusions?
``` Polychromasia Basophilic stippling Howel Jolly bodies Nucleated RBCs Siderocytes Malaria ```
84
What are RBC poikilocytoses?
``` Target cells Ovalocytes Teardrops Spherocytes Burr cells Stomatocytes Schistocytes (fragments) ```
85
What does a macro-ovalocyte RBC indicate?
Megaloblastic anemia
86
What does a microcyte RBC indicate?
Iron deficiency | Thalassemia
87
What does a Pencil cell RBC indicate?
Iron deficiency
88
What does a tear drop RBC indicate?
Myelofibrosis | Extramedullary hemopoiesis
89
What does a target cell indicate?
Liver disease Hemoglobinopathies Post-splenectomy
90
What does a howell-jolly body indicate?
Nuclear infusion | Post-splenectomy
91
What does a supra-vital stain reticulocyte indicate?
Polychromasia
92
What does a spherocyte RBC indicate?
Hereditary sperocytosis | Autoimmune hemolytic anemia
93
What does an Elliptocyte RBC indicate?
Hereditary elliptocytosis
94
What does a Stomatocyte RBC indicate?
Liver disease
95
What does a sickle cell indicate?
Sickle cell anemia
96
What do fragment RBCs indicate?
``` Microangiopathy HUS TTP Cardiac valve DIC ```
97
What do blister cell RBCs indicate?
G6PD deficiency
98
What do spur cell RBCs indicate?
Severe liver disease
99
What is Rouleaux RBC cells?
Stacking of RBCs Seen in increased serum protein or multiple myeloma
100
What is a CBC with manual differential?
More specific A person actually hand counts the number of cells
101
How should you interpret a CBC?
Should be evaluated with clinical context in mind
102
What are the indications for a bone marrow exam?
Patient specific determination Pancytopenia Abnormal cells in circulation ``` Unexplained anemia - not most common forms Macrocytic anemia UNexplained leukopenia Unexplained thrombocytopenia Suspected multiple myeloma Staging of non-hodgkins lymphoma Unexplained splenomegaly Suspected storage disease Fever of unknown origin Suspected chromosomal disorders in neonates ```
103
What are the absolute contraindications for bone marrow exam?
Hemophilia Severe Disseminated intravascular coagulopathy (DIC) Other severe bleeding disorders
104
What are not contraindicated for bone marrow exam?
Thrombocytopenia | Therapeutic anticoagulation
105
What sites are used for bone marrow aspiration?
``` Posterior superior iliac crest and spine ** MOST COMMON*** Anterior iliac crest Greater trochanter of femur Vertebral bodies of rubs Sternum (usually C/I) Tibial (children <12-18 months) ```
106
What are the types of bone marrow exams?
Core biopsy Aspirate ``` Aspirate smear/particle crush smear Buffy coat smear Bone marrow biopsy section Iron stain Clot section Reticulin and/or collagen stains for suspected fibrosis Enzyme cytochemical stains Immunophenotyping/flow cytometry Cytogenic analysis FISH Molecular genetic analysis Culture for mycobacteria, leishmania, histoplasma Acid fast staining for mycobacteria Congo red stain for suspected amyloidosis Cell culture assays ```
107
What is dry tap?
No bone marrow sample can be obtained by aspiration
108
What is a reticulocyte?
Immature RBC
109
What would indicate getting a reticulocyte study?
Erythropoiesis
110
What are the causes of reticulocytosis?
Decreased RBC survival Increased production d/t accelerated loss Recent replacement of deficient nutrient
111
What is a reticulocyte index?
Corrects for anemia Better representation of bone marrow production
112
What is the normal reticulocyte count?
0.5-2%
113
What is the normal reticulocyte index (RPI)?
2.0-3.0
114
What is the erythrocyte sedimentation rate (ESR)?
Measure of inflammation Non-specific test Goal of the test is to measure the height of sedimented RBC after an incubation, often 1 hour
115
What is hemoglobin electrophoresis?
Goal of the test is to identify the hemoglobin types present in a patients RBCs Tests the contents of the RBCs against known band for the various HgB types
116
What occurs with a shift to the right on the oxygen binding curve?
Lower affinity to oxygen ``` Anemia Increased CO2 Acidosis Elevated temperature Increased 2,3 DPG ```
117
What occurs with a shift to the left on the oxygen binding curve?
higher affinity to oxygen ``` Polycythemia Alkalosis Decreased CO2 Hypothermia Decreased 2, 3 DPG Hemoglobin F ```
118
What are the symptoms of anemia?
``` Fatigue/dizziness/weakness Syncope Pallor - pale color Jaundice Dyspnea Palpitations Chest pain/MI Asymptomatic ```
119
What are the symptoms of severe anemia?
Fainting Chest pain Angina Heart attack
120
What are signs of Anemia?
``` Pallow; pale skin and palm Glossitis Koilonychia Bossy forehead Splenomegaly Hypotension Tachycardia Jaundice/Icteric ```
121
What can anemia be caused by?
Increased RBC destruction/loss | Decreased RBC production
122
What occurs in anemia caused by increased RBC destruction/loss?
Acute blood loss Hemolysis Hypersplenism
123
What occurs in anemia caused by Decreased RBC production?
``` Hemoglobin synthesis lesion DNA sythesis lesion Hematopoietic stem cell lesion Bone marrow infiltration Immune-mediated inhibition ```
124
What is macrocytic anemia?
MCV >100 fL ``` Megaloblastic anemia (B12 and/or folate deficiency) Alcoholism Liver disease Myelodysplasia Drugs and toxins Infection Hypothyroidism ```
125
What is normocytic anemia?
MCV 80-100 fL ``` Anemia of chronic disease Pure red cell aplasia Chronic renal insufficiency Liver disease Endocrine disorders ```
126
What is microcytic anemia?
MCV <80 fL ``` Iron deficiency Thalassemia Sideroblastic anemia Hemoglobin E disease Anemia of chronic disease Lead poisoning ```
127
What are the three types of chronic anemia?
Microcytic Normocytic Macrocytic
128
What are the two things that cause acute anemia?
Bleeding | Hemolysis
129
What are the steps of Hemostasis?
Vessel constriction Platelets Coagulation Cascade
130
What is platelet aggregation?
Irreversible
131
What is platelet activation?
reversible
132
What are the platelet function studies?
``` Platelet count Bleeding time Platelet aggregation Platelet antibody studies Others ```
133
What is the goal of the platelet aggregation test?
To assess the function of circulating platelets
134
What classes of drugs inhibit platelet activation?
``` COX inhibitors = Aspirin P2Y12 Platelet inhibitors = Plavix, Effient, Brilinta ```
135
What classes of drugs inhibit platelet aggregation?
Glycoprotein IIb/IIIa inhibitors = Abcicimab, Eptifibatide, and Tirofiban PDE5 inhibitors = Aggrenox
136
What are factor Xa inhibitors?
Fondaparinux Eliquis Xaralto
137
What are LMWH?
Lovenox | Fragmin
138
What are antithrombin agents?
Angiomax | Argatroban
139
What factors are involved in the extrinsic pathway?
7a
140
What factors are involved in the intrinsic pathway?
11, 9, and 8
141
What factors are involved in the common pathway?
10, 10a, 5, 2, fibrinogen, and fibrin
142
What are the Vitamin K dependent factors?
2, 7, 9, and 10
143
What are the labs that can be used to determine the coagulation pathway?
``` aPTT = activated partial thromboplastin time PT = Protime (PT/INR) TT = thrombin time ```
144
When would you order a coagulation test?
if the patient is having unexplained clots
145
What factors are involved in thromolysis?
Protein C Protein S Anti-thrombin Factor XIIa
146
What does the PT test test for?
Extrinsic pathway | Coumadin
147
What does the aPTT test test for?
Intrinsic pathway | Heparin
148
What is the goal of the PT and PTT mixing studies test?
To determine if a prolonged PT or prolonged PTT is a result of greater than or equal to 1 factor deficiencies or an inhibitor of the PT or PTT clotting reaction
149
What is the Anti-factor Xa activity test?
functional assay used to assess the degree of anticoagulation in patients receiving certain anticoagulants Patient plasma + reagant factor Xa --> measure activity of factor Xa using an artificial Factor Xa substrate taht releases a colored compound when cleaved Can be calibrated to estimate the specific level of an anticoagulant and in such cases, the results of anti-factor Xa activity may be reported as an anticoagulant level The activity of factor Xa is inversely proportional to the amount of heparing or other factor Xa inhibitor in the plasma
150
What is a d-dimer?
terminal fibrin degradation product Indicates thrombosis with thrombolysis
151
What is the d-dimer test?
Latex agglutination or ELISA It is sensitive but not specific so it will tell you there is a clot but not where the clot is

Diagnostic M.'s Sara Peer mentor (27 decks)

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