Hematology II

Question 1

How do WBC’s look different than RBC’s?

Answer 1

WBC’s appear to be more rounded and fluffy

Question 2

RBC’s do not divide. Do WBC’s?

Answer 2

yes

Question 3

produced in the bone marrow, produced under influence of GM-CSF, maturation occurs within 12 days, transforms from myeloblast to myelocyte, increased demand from body means mitosis increases and maturation decreases, remains in tissues once they are there, primarily for infection and inflammation, lifespan of 8 hours when in peripheral circulation, cytoplasmic components responsible for bacteriocidal activity, migrate to infection due to chemotactic substances

Answer 3

Neutrophils

Question 4

produced in bone marrow by division and maturation, growth stimulated by ECSF and IL-5, attracted to tissue invasion by parasites and allergic reactions, contain cytoplasmic granules that damage parasites and impede replication, decrease anti-inflammatory pathway

Answer 4

Eosinophils

Question 5

produced in bone marrow, enter tissues within several hours after release into circulation, function in hypersensitivity reactions, bind to antigens, cause degranulation of the cytoplasm and release of histamine, body sensitivity to food, medication or autoimmune

Answer 5

Basophil

Question 6

produce in the bone marrow, mature within 4 days, no storage in the marrow, influenced by many growth factors, 3 days in circulation before entering tissues, made on demand, help to remove old RBC’s, function as tissue macrophages or specialized cells in tissues, play vital role in cell mediated and humoral immunity by presenting and processing antigens to both T an B lymphocytes

Answer 6

Monocytes

Question 7

stem from the bone marrow, after maturation cells migrate to occupy peripheral lymphoid tissue including lymph nodes, spleen, tonsils, and mucosal sites, have a long half life, responsible for recognition of self vs. nonself, can proliferate when activated, CD4 and CD8

Answer 7

Lymphocytes

Question 8

undergo differentiation and maturation in the bone marrow

Answer 8

B lymphocytes

Question 9

undergo differentiation and maturation in the thymus

Answer 9

T lymphocytes

Question 10

How are CD4 and CD8 cells named?

Answer 10

based on the glycoproteins in their cells

Question 11

helper cells that signal other immune cells, order lysis, assist in production of antibodies by B cells and active macrophages

Answer 11

CD4 cells

Question 12

killer cells that kills and destroys, moderate immune reactions and are able to lyse viral infected cells

Answer 12

CD8 cells

Question 13

may or may not be T cells, able to cause cell lysis without prior antigen exposure

Answer 13

Natural killer cells

Question 14

Laboratory tests for WBC’s include an anticoagulant. Why cannot the anticoagulant be heparin?

Answer 14

heparin causes WBC clumping and a blue background when examining

Question 15

How long can WBC tests be kept?

Answer 15

counts can performed up to 24 hours after specimen collection if the vial has been stored at 4C

Question 16

Can a traumatic or difficult venipuncture alter WBC results?

Answer 16

yes, the coagulation cascade could be activated which traps WBC and platelets producing falsely low levels

Question 17

How do instruments determine [WBC]?

Answer 17

either electrical impedance or light scattering

Question 18

What can cause falsely elevated WBC levels?

Answer 18

presence of reticulocytes, giant platelets, or blood born parasites

Question 19

What can cause falsely lowered WBC levels?

Answer 19

paraproteins secreted during cancers, especially in leukemias

Question 20

provides individual %’s of each WBC, usually automated report, faster than manual procedure

Answer 20

CBC-differential

Question 21

-penia

Answer 21

decrease in number

Question 22

-philia

Answer 22

increase in number

Question 23

infections caused by bacteria, viruses, rickettsia, protozoa, debilitated patients, nutritional deficiencies, myelotoxic medications, seen regularly in acute leukemia and as a manifestation of myelodysplasia

Answer 23

Neutropenia

Question 24

myelotoxic

Answer 24

kills marrow

Question 25

What are reasons that could cause Neutrophilia?

Answer 25

acute infection, tissue dammage, necrosis, acute hemmorage, eclampsia, corticosteroids

Question 26

-cytosis

Answer 26

elevated levels

Question 27

What are reasons that could cause Lymphocytosis?

Answer 27

in children and young adults almost always non-neoplastic, incidence of neoplasm increases with age, worrisome if infection is not present, pertussis, chronic lymphocytic leukemia, mononucleosis, infections hepatis

Question 28

What could cause Lymphocytopenia?

Answer 28

variety of infections, immune disorders, medications, in HIV patients T helper cells (CD4) used to monitor disease progression

Question 29

What could cause a Monocyte disorder?

Answer 29

numerous infections and neoplasms, TB, malaria, syphillis, typhus, Hodgkin's Disease, multiple myeloma, melanoma

Question 30

What can cause an Eosinophil disorder?

Answer 30

may be seen in healthy individuals, without disease, allergic reactions, parasitic infections, neoplasm such as CML, acute inflammation or stress, corticosteroid use

Question 31

elevated Eosinophil levels indicates

Answer 31

allergies

Question 32

What can cause a Basophil disorder?

Answer 32

CML, ulcerative colitis, chronic sinusitis, iron deficiency, smallpox, Hodgins disease

Question 33

metastasize

Answer 33

spreading to other parts of the body

Question 34

unregulated proliferations of hematopoetic cells in bone marrow, acute or chronic, often infiltrate other organs, can live with it for many years

Answer 34

Leukemia

Question 35

characterized by proliferations of immature or precursor cells, rapid clinical course

Answer 35

acute Leukemia

Question 36

proliferations of mature cells, longer clinical course

Answer 36

chronic Leukemia

Question 37

1. ) Establish Diagnosis 2. ) Subtype Leukemia for treatment and prognosis 3. ) Perform cytogenic studies 4. ) Perform monogenic studies 5. ) Examine extramedullary tissues and fluids for involvement 6. ) Evaluate effectiveness of therapy

Answer 37

Goals of a Leukemia Workup

Question 38

What are 3 ways to subtype and diagnose a Leukemia?

Answer 38

1. ) peripheral blood smear 2. ) bone marrow biopsy 3. ) bone marrow aspirate

Question 39

present with nonspecific complaints such as fatigue, persistent infection, most have normocytic normochromic anemia, WBC count can range from high to low, large number of blast cells, in order to make acute diagnosis, blast cells must be 30% or more of all marrow cells

Answer 39

Acute Leukemia

Question 40

commonly seen in children, prognosis favorable in females ages 2-10, favorable with WBC count less than 10, cells usually have a suspicious nuclei, nucleus smaller and darker

Answer 40

Acute Lymphoblastic Leukemia (ALL)

Question 41

What age group of children best responds to ALL treatment?

Answer 41

children aged 2-10

Question 42

predominately disease of middle aged and older adults, most common leukemia in newborns and infants, subtyping depends on tendency toward differentiation, cells have multiple and a large nuclei, presence of an Auer rod is indicative

Answer 42

Acute Myelogenous Leukemia (AML)

Question 43

The presence of this is indicative of AML

Answer 43

Auer rod

Question 44

usually disease of adults, presentation is variable, usually found incidentally upon evaluation for other complaints, blood findings can rage fro pancytopenia (all cells almost gone) to marked leukocytosis

Answer 44

Chronic Leukemias

Question 45

primarily affects adults, median age of 50, males slightly greater than females, nonspecific clinical symptoms, anywhere from weight loss to fatigue, splenomeagly common, lymphadenopathy usual, half of patients are asymptomatic

Answer 45

Chronic Myelogenous Leukemia

Question 46

What does a left shift mean?

Answer 46

population or number is increasing

Question 47

highly suggested by peripheral blood smear, neutrophilic leukocytosis with a left shift, WBC counts typically greater than 25, myelocytes and neutrohils predominate, normally normochromic, normocytic anemia

Answer 47

Chronic Myelogenous Leukemia

Question 48

What is present in 90% of all chromic myelogenous leukemia cases?

Answer 48

the Philadelphia chromosome

Question 49

initial phase lasts 3-4 years, after that patient may develop a blast crisis or accelerated phase, after a blast crisis, median survival is 2-6 months and resistant to chemo

Answer 49

Chronic Myelogenous Leukemia

Question 50

most common adult leukemia, average age of diagnosis is 55, males outnumber females 2.5:1, results of accumulation of small round lymphocytes in the blood, bone marrow and organs, most discovered incidentally

Answer 50

Chronic Lymphocytic Leukemia

Question 51

total WBC count may reach 600 or more, WBC's are small, condensed, blotchy chromatin, inconspicuous nuclei and scant cytoplasm, almost all patients have splenomegaly and lymphadenopathy, increased number of other malignancies such as melanomas, carcinomas of GI ract and lungs

Answer 51

Chronic Lymphocytic Leukemia

Question 52

Hodgkin's Lymphoma vs. Non Hodgins lymphoma, clinical persentation similar due to elevated WBC count, tumors in lymph nodes, hard, non-mobile, non-tender is cancer until proven otherwise, fatigue night sweats and weight loss are common symptoms

Answer 52

Lymphoma

Question 53

What confirms Hodgkin's lymphoma?

Answer 53

presence of Reed- Sternberg cell on biopsy

Question 54

delicate balance is needed to respond to injury and prevent hemorrhage 1. ) vessel wall 2. ) platelets 3. ) coagulation system

Answer 54

platelets

Question 55

What are the 4 steps to primary hemostasis?

Answer 55

1. ) Adhesion to collagen at the site of vascular injury 2. ) Aggregation of additional platelets to "plug" the leak in the blood vessel 3. ) Platelets release chemotatic elements to promote hemostasis, vessel wall constricts 4. ) Body's coagulation cascade activated

Question 56

reference range usually 150-400, hemorrhage not usually apparent until levels drop far below normal, levels below 50 will be dangerous when challenged with surgery or trauma, levels below 20 may result in spontaneous bleeding, young function better than old

Answer 56

platelet count