Hematology Review Flashcards
(340 cards)
1
Q
What is the function of Erythrocytes?
A
O2 transport
2
Q
What is the function of granulocytes?
A
defense against bacterial infection
3
Q
What is the function of lymphocytes?
A
cellular and humoral immunity
4
Q
What is the function of platelets?
A
coagulation
5
Q
Where is the site of production for erythrocytes?
A
bone marrow
6
Q
Where is the site of production for granulocytes?
A
bone marrow
7
Q
Where is the site of production for lymphocytes?
A
lymphoid tissue
8
Q
Where is the site of production for platelets?
A
bone marrow
9
Q
What is the RBC reference range for adults?
A
Male: 4.6-6 x 10^12/L
Female: 4-5.4 x 10^12/L
10
Q
What if the Hgb reference range for adults?
A
Male: 14-18 g/dL
Female: 12-15 g/dL
11
Q
What is the Hct reference range for adults?
A
Male: 40-54%
Female: 35-49%
12
Q
What is the MCV reference range for adults?
A
80-100 fL
13
Q
What is the RDW reference range for adults?
A
11.5-14.5%
14
Q
What is the Retic reference range for adults?
A
0.5-1.5%
15
Q
NRBCs aren’t typically seen in a healthy individual except when?
A
at birth
16
Q
Why do newborns exhibit higher retic values?
A
Newborns tend to have increased polychromasia
17
Q
What is the WBC reference range for adults?
A
4.5-11.5 x 10^9/L
18
Q
What is the reference range for segs in an adult?
A
50-70%
19
Q
What is the reference range for bands in an adult?
A
0-5%
20
Q
What is the reference range for lymphocytes in an adult?
A
18-42%
21
Q
What is the reference range for platelets?
A
150-450 x 10^9/L
22
Q
At 1-2 months gestation, erythropoiesis occurs at which site?
A
yolk sac
23
Q
At 3-6 months gestation, erythropoiesis occurs at which site?
A
Liver (primary sit) and spleen
24
Q
From 7 months gestation until around 4 years, erythropoiesis occurs at which site?
A
bone marrow (all marrow is active)
25
In an adult, only which bone marrow sites are active in erythropoiesis?
pelvis, vertebrae, ribs, sternum, and skull
26
What does extramedullary hematopoiesis mean?
erythropoiesis is occurring outside the bone marrow due to high demands
27
```
How do the following characteristics change with cell maturation?
Size
N:C ratio
cytoplasma
nucleus
```
size: becomes smaller
N:C ratio: becomes smaller
Cytoplasma: becomes less basophilic, granulocytes produce granules, erythrocytes become pink due to Hgb production
Nucleus: becomes smaller, chromatin condenses, nucleoli disappear
28
During cell maturation what occurs so that cytoplasm becomes less basophilic?
loss of RNA
29
What causes erythrocytes to become pink?
Hgb production
30
Name the 6 levels of erythrocyte development using the rubriblast terminology.
```
Rubriblast
prorubricyte
rubricyte
metarubricyte
reticulocyte
mature erythrocyte
```
31
Name the 6 levels of erythrocyte development using the normoblast terminology.
```
pronormoblast
basophilic normoblast
polychromatophilic normoblast
orthochromic normoblast
polychromatophilic erythrocyte
mature erythrocyte
```
32
14-24um, N:C ratio of 8:1, royal blue cytoplasm, fine chromatin, 1-2 nucleoli, and normally confined to the bone marrow are key characteristics of which erythrocytic developmental cell?
rubriblast/pronormoblast
33
12-17 um, N:C of 6:1, coarser chromatin with slightly visible parachromatin, no visible nucleoli, and normally confined to the bone marrow are key characteristics of which erythrocytic developmental cell?
prorubicyte/basophilic normoblast
34
10-15um, N:C of 4:1, polychromatophilic cytoplasma due to Hgb production, clumped chromatin with distinct areas of parachromatin, last stage to divide, normally confined to the bone marrow are key characteristics of which erythrocytic developmental cell?
rubricyte/polychromatophilic normoblast
35
Which erythrocytic developmental stage is the last to divide?
rubricyte/polychromatophilic normoblast
36
8-12um, N:C of 1:2, pyknotic nucleus, last nucleated stage, and normally confined to the bone marrow are key characteristics of which erythrocytic developmental cell?
metarubricyte/ orthochromic normoblast
37
Which is the last nucleated stage in the erythrocytic developmental series?
metarubricyte/ orthochromic normoblast
38
7-10um, no nucleus, cytoplasma is mostly pink with diffuse blue, reticulum seen with supravital stain, and 0.5-1.5% can be seen in adult peripheral blood are key characteristics of which erythrocytic developmental cell?
reticulocyte/ polychromatophilic erythrocyte
39
7-8um, biconcave disk, reddish-pink cytoplasma with central pallor (1/3 diameter of cell) are key characteristics of which erythrocytic developmental cell?
mature erythrocyte
40
Name 2 types of asynchronous erythropoiesis.
Megaloblastic and iron deficiency
41
Vitamin B12 or folic acid deficiency can cause what type of asynchronous erythropoiesis?
megaloblastic
42
Megaloblastic asynchronous erythropoiesis can be explained as..
the nucleus lags behind the cytoplasm in maturation, resulting in cells growing larger without dividing
43
Iron deficiency asynchronous erythropoiesis can be explained as...
Cytoplasm lags behind the nucleus in cell maturation due to inadequate iron for hgb synthesis
44
Oval macrocytes are seen in which type of asynchronous erythropoiesis?
megaloblastic
45
microcytic, hypochromic RBCs are seen in which type or asynchronous erythropoiesis?
Iron deficiency
46
Give an example for each type of asynchronous erythropoiesis.
Megaloblastic: pernicious anemia
| Iron deficiency: iron deficiency anemia
47
Which type of hemoglobin has the following molecular structure? 2-alpha, 2-beta chains
Hgb A
48
Which type of hemoglobin has the following molecular structure? 2-alpha, 2-delta chains
Hgb A2
49
Which type of hemoglobin has the following molecular structure? 2-alpha, 2-gamma chains
Hgb F
50
Which type of hemoglobin has the following molecular structure? valine is substituted for glutamic acid in the 6th position of the beta chain
Hgb S
51
Which type of hemoglobin has the following molecular structure? lysine is substituted for glutamic acid in the 6th position of the beta chain
Hgb C
52
Which type of Hgb has the highest reference value?
Hgb A
53
In Hgb electrophoresis using cellulose acetate pH 8.6, the origin is at the cathode or anode or between the anode and cathode?
cathode
54
In Hgb electrophoresis using cellulose acetate pH 8.6, what is the order of migration of the types of hemoglobin starting at the cathode to the anode?
C/A2, S, F, A
55
In Hgb electrophoresis using citrate agar pH 6.2, the origin is at the cathode, anode, or between the cathode and anode?
between the cathode and anode
56
In Hgb electrophoresis using citrate agar pH 6.2, which types of Hgb migrate toward the cathode?
F, A/A2
57
In Hgb electrophoresis using citrate agar pH 6.2, which types of Hgb migrate toward the anode?
C and S
58
In Hgb electrophoresis using citrate agar pH 6.2, what is the order of the types of Hgb from the cathode to the anode?
F, A/A2, S, C
59
When iron gets oxidized to the ferric (Fe3+) state in a RBC, this forms...
methemoglobin
60
Methemoglobin is rarely inherited, but is usually acquired from...
exposure to oxidants
61
Sulfur bound to heme forms...
sulfhemoglobin
62
Sulfhemoglobin is acquired from...
exposure to drugs and chemicals
63
Carbon monoxide bound to heme forms...
carboxyhemoglobin
64
What is the effect of methemoglobin?
Heme can't bind O2, resulting in cyanosis and possibly death
65
What is the affect of sulfhemoglobin?
O2 affinity to heme is significantly decreased, resulting in cyanosis
66
Which heme derivative cannot be converted back to normal hgb?
sulfhemoglobin
67
Name 3 hemoglobin derivatives.
methemoglobin, sulfhemoglobin, carboxyhemoglobin
68
What is the effect of carboxyhemoglobin?
Decreased O2 to tissues, which can be fatal
69
Skin turns cherry red in the presence of which hemoglobin derivative?
carboxyhemoglobin
70
In a methemoglobin event, cells treated with methylene blue will have...
Heinz Bodies
71
Heinz bodies are only visible when stained with...
Methylene blue
72
Hemoglobin derivatives are quantitated by...
differential spectrophotometry
73
Which RBC morphology term is used to describe variation in size?
anisocytosis
74
Which RBC morphology term is used to describe RBCs >9um?
macrocytes
75
Which RBC morphology term is used to describe RBCs <6um?
microcytes
76
Which RBC morphology term is used to describe variation in shape?
poikilocytosis
77
Which RBC morphology term is used to describe oval or pencil shaped?
elliptocytes/ovalocytes
78
Which RBC morphology term is used to describe rounded cell with knobby, uniform projections?
crenated RBCs
79
Which RBC morphology term is used to describe round cells with evenly spaced blunt or pointed projections?
Burr cells (echinocytes)
80
Which RBC morphology term is used to describe small, dense cells with irregularly spaced projections of varying length?
Spur cells/acanthocytes
81
Which RBC morphology abnormality is seen when there is osmotic imbalance?
crenated cells
82
Uremia and pyruvate kinase deficiency can cause which abnormal RBC morphology?
Burr cells (echinocytes)
83
Which abnormal RBC morphology can be seen in severe liver disease and abetalipoproteinemia?
acanthocytes (spur cells)
84
Which RBC morphology term is used to describe RBC fragments?
schistocytes
85
Which RBC morphology term is used to describe crescent, S or C shaped, boat shaped, oat shaped RBCs?
Sickle cells (drepanocytes)
86
Which RBC morphology term is used to describe blunt 6-sided, dark staining projection, "bar of gold," "Washington monument?"
hgb C crystal
87
Which RBC morphology term is used to describe glove-like intracellular crystals?
Hgb SC crystals
88
Which RBC morphology term is used to describe tear drop RBCs?
Teardrops (dacryocytes)
89
Which RBC morphology term is used to describe central pallor >1/3 cell diameter?
hypochromia
90
Which RBC morphology term is used to describe mixture of normochromic and hypochromic PBCs?
anisochrimia
91
Which RBC morphology term is used to describe bluish-gray color?
polychromasia
92
Which abnormal RBC morphology can be seen in microangeopathic hemolytic anemias and prosthetic heart valves?
shistocytes
93
Which abnormal RBC morphology can be significant for myelofibrosis, thalassemia and other anemias?
teardrops
94
Which abnormal RBC morphology can be significant in dimorphic anemia and post-transfusion patients?
anisochromia
95
Which abnormal RBC morphology is significant for young RBCs and is a sign of active erythropoiesis?
polychromasia
96
Which RBC morphology term is used to describe cells with a bull's-eye appearance?
target cells (codocytes)
97
Which RBC morphology term is used to describe RBC with slit-like central pallor or "lip-like" appearance?
stomatocytes
98
Which RBC morphology term is used to describe small, dark-staining RBCs without a central pallor?
spherocytes
99
Which RBC morphology term is used to describe RBCs resembling a stack of coins?
rouleaux
100
Which RBC morphology term is used to describe RBCs in irregular clumps?
agglutination
101
Which abnormal RBC morphology is significant for serum protein abnormality and can be seen in multiple myeloma and macroglobulinemias?
rouleaux
102
Which abnormal RBC morphology is significant for cold autoagglutination or autoantibodies?
agglutination
103
Which abnormal RBC morphology can be significant for alcoholic cirrhosis and Rh null disease?
stomatocytes
104
Which abnormal RBC morphology can be seen in ABO HDFN and incompatible blood transfusions?
spherocytes
105
Which stain(s) can be used to observe basophilic stippling?
Wright's and New Methylene Blue
106
Which stain(s) can be used to observe Howell-Jolly bodies?
Wright's and New Methylene Blue
107
Which stain(s) can be used to observe Cabot rings?
Wright's
108
Which stain(s) can be used to observe pappenheimer bodies?
Wright's
109
When pappenheimer bodies are stained with Prussian blue stain, they are...
siderotic granules
110
Which stain(s) can be used to observe siderotic granules?
Prussian Blue stain
111
Which stain(s) can be used to observe reticulocytes?
New Methylene Blue (polychromasia with Wright's stain)
112
Which stain(s) can be used to observe Heinz bodies?
Supravital stains (crystal violet, brilliant cresyl blue, methylene blue)
113
What RBC inclusion looks like multiple, irregular, purple inclusions evenly distributed in the cell when stained with Wright's or New Methylene Blue?
Basophilic stippling
114
What RBC inclusion looks like round, purple, 1-2um in diameter, and usually only one per cell when stained with Wright's or new methylene blue?
Howell-Jolly bodies
115
Which RBC inclusion looks like a reddish purple ring or figure 8 when stained with Wright's stain?
Cabot ring
116
Which RBC inclusion looks like small, purplish blue granules that vary in size, shape, and number that typically are in clusters around the periphery of the cell?
pappenheimer bodies
117
Which RBC inclusion looks like blue granules of varying shapes and sizes when stained with Prussian blue stain?
siderotic granules
118
Which RBC inclusion has a blue-staining network when stained with new methylene blue?
Reticulocytes
119
Which RBC inclusion looks like round, blue inclusions varying in size and are close to the cell membrane when stained with a supravital stain?
Heinz bodies
120
Which RBC inclusion is caused by aggregation of RNA (ribosomes)?
basophilic stippling
121
Which RBC inclusion is composed of nuclear remnants (DNA)?
Howell-Jolly bodies
122
Which RBC inclusion may be part of mitotic spindles or microtubules?
cabot ring
123
Which RBC inclusion are iron particles when stained with Wright's stain?
pappenheimer bodies
124
Which RBC inclusion are aggregates of iron particles when stained with Prussian blue?
siderotic granules
125
Which RBC inclusion is residual RNA?
reticulocytes
126
Which RBC inclusion is precipitated, oxidized, denatured hemoglobin?
Heinz bodies
127
Coarse basophilic stippling is significant for...
exposure to lead
128
Fine basophilic stippling is significant for...
young RBC
129
Conditions where basophilic stippling can be observed:
exposure to lead, accelerated or abnormal hemoglobin synthesis, thalassemia
130
Which RBC inclusion is usually pitted by the spleen and is typically seen with accelerated or abnormal erythropoiesis?
Howell-Jolly bodies
131
Conditions where Howell-Jolly bodies can be observed:
postsplenectomy, thalassemia, hemolytic anemia, megaloblastic anemia, sickle cell anemia
132
Rapid blood regeneration and/or abnormal erythropoiesis can cause which RBC inclusion?
cabot ring
133
Conditions where cabot rings may be observed:
megaloblastic anemia, thalassemia, postsplenectomy
134
Which RBC inclusions can be observed if there is faulty iron utilization?
pappenheimer bodies, siderotic granules
135
Conditions where pappenheimer bodies and sideritic granules can be observed:
sideroblastic anemia, postsplenectomy, thalassemia, sickle cell anemia, hemochromatosis
136
Greater than 2% retics is significant for...
increased erythropoiesis
137
Less than 0.1% retics is significant for...
decreased erythropoiesis
138
Reticulocytes can be observed in which conditions?
hemolytic anemia, blood loss, following treatment for iron deficiency or megaloblastic anemia
139
Which erythrocyte index is defined as the average volume of RBC?
Mean corpuscular volume (MCV)
140
Which erythrocyte index is defined as the average weight of hemoglobin in individual RBCs?
Mean corpuscular hemoglobin (MCH)
141
Which erythrocyte index is defined as the average concentration of hgb per dL of RBCs?
Mean corpuscular hemoglobin concentration (MCHC)
142
(HCT% x 10)/(RBCs x 10^12/L) = ?
MCV
143
What is the reference range for MCV?
80-100 fL
144
The MCV is used to...
classify anemia (microcytic, normocytic, macrocytic)
145
(Hgb g/dL x 10)/(RBCs x 10^12/L) = ?
MCH
146
What is the reference range for MCH?
27-31 pg
147
(Hgb g/dL x 100)/HCT% = ?
MCHC
148
What is the reference range for MCHC?
32-36 g/dL
149
A MCHC >37 may indicate which problems with the specimen?
hyperlipidemia, cold agglutinins
150
The MCHC is a way to estimate what physical characteristic of the cell?
the diameter of the central pallor (normochromic, hyperchromic, hypochromic)
151
Classify each of the following abnormalities as being a characteristic of hemoglobinopathy or thalassemia.
Qualitative abnormality
Quantitative abnormality
Abnormality in the amino acid sequence
Abnormal (decreased) production of globin chains
Qualitative abnormality: hemoglobinopathy
Quantitative abnormality: thalassemia
Abnormality in the amino acid sequence: hemoglobinopathy
Abnormal (decreased) production of globin chains: thalassemia
152
Sickle cell anemia is what type of anemia?
normocytic anemia
153
Which anemia is caused by inheriting a gene from both parents that substitutes valine for glutamic acid at the 6th position in the beta chain?
Sickle cell anemia
154
What would you observe in a sickle cell anemia blood smear?
aniso, poik, sickle cells, target cells, nRBCs, Howell-Jolly bodies, basophilic stippling, siderotic granules, polychromasia
155
Why isn't sickle cell disease evident in newborns?
newborns have increased hgb F
156
Decreased O2 and decreased pH will cause hgb S to...
polymerize
157
Sickle cell anemia will have a (positive/negative) solubility test?
positive
158
What is it called when an individual inherits a sickle cell gene from one parent?
sickle cell trait
159
What will you see in a blood smear for sickle cell trait?
occasional target cells, no sickle cells unless hypoxic
160
Which type of anemia is Hgb C disease?
normocytic anemia
161
Which anemia is caused by inheriting a gene from each parent that substitutes lysine for glutamic acid in the 6th position of the beta chain?
Hgb C Disease
162
What may be observed on a Hgb C disease blood smear?
many target cells, folded cells, occasional Hgb C crystals
163
What is it called when a Hgb C gene is inherited from only one parent?
Hgb C Trait
164
What will you observe in a Hgb C trait blood smear?
many target cells
165
Inheritance of one sickle cell gene and 1 Hgb C gene is known as...
SC Disease
166
SC disease is classified as what type of anemia?
normocytic anemia
167
What may be observed on a blood smear of SC disease?
many target cells, folded and boat-shaped cells, occasional SC crystals
168
Hereditary spherocytosis is classified as what type of anemia?
normocytic anemia
169
Hereditary spherocytosis is caused by...
a defect of the cell membrane
170
What may be observed on a blood smear of an individual who has hereditary spherocytosis?
spherocytes, polychromasia
171
In hereditary spherocytosis, which tests/factors may be increased?
MCHC (>36 g/dL), retics, osmotic fragility
172
Autoimmune hemolytic anemia is classified as what type of anemia?
normocytic
173
Autoantibodies cause which anemia?
autoimmune hemolytic anemia
174
What may be seen on a blood smear from autoimmune hemolytic anemia?
polychromasia, spherocytes, nRBCs
175
Which tests/factors will be increased in autoimmune hemolytic anemia? decreased?
increased: retics, indirect bili
decreased: haptoglobin
176
What test will be positive for an individual with autoimmune hemolytic anemia?
DAT
177
What are 2 megaloblastic anemias?
folate deficiency, Vitamin B12 deficiency
178
Megaloblastic anemias are classified as which type of anemia?
Macrocytic anemia
179
Which anemia is caused by a nutritional deficiency, increased cell replication, malabsorption, drug inhibition, resulting in impaired DNA synthesis?
Folate deficiency anemia
180
What type of anemia is folate deficiency classified as?
macrocytic (megaloblastic)
181
Oval macrocytes, Howell-Jolly bodies, hypersegmentation, aniso, and poik may all be found on a blood smear of which anemias?
Megaloblastic (folate or Vitamin B12 deficiency)
182
Pancytopenia and increased LDH will be seen in which anemia?
folate deficiency, vitamin B12
183
Which anemia is caused by nutritional deficiency, malabsorption, impaired utilization, parasites and impairs DNA synthesis?
Vitamin B12 deficiency
184
What is needed in order for vitamin B12 to be absorbed?
intrinsic factor
185
What is the most common Vitamin B12 deficiency?
pernicious anemia
186
What is pernicious anemia?
An autoimmune disease where gastric atrophy leads to decreased intrinsic factor, which is needed to B12 absorption.
187
Nonmegaloblastic macrocytic anemias can be caused by...
alcoholism, liver disease, increased erythropoiesis
188
Round macroctyes and no hypersegmentation can be seen on the blood smear of which anemia?
nonmegaloblastic macrocytic anemia
189
Iron deficiency anemia is classified as which type of anemia?
microcytic, hypochromic
190
What is the most common anemia?
iron deficiency aniemia
191
What can be seen on an iron deficiency anemia blood smear?
aniso, poik, hypochromic, microcytes
192
Which anemia is caused by insufficient iron for Hgb synthesis?
iron deficiency anemia
193
Sideroblastic anemia is classified as which type of anemia?
microcytic, hypochromic
194
Which anemia is caused by an enzymatic defect in heme synthesis?
sideroblastic anemia
195
What may be observed in a blood smear for sideroblastic anemia?
dual population of RBCs (normocytic and microcytic), pappenheimer bodies, basophilic stippling
196
What may you see in the bone marrow of a patient with sideroblastic anemia?
ringed sideroblasts
197
Beta-thalassemia is classified as which type of anemia?
microcytic, hypochromic
198
Which anemia is caused by a decrease in beta-chain production?
beta-thalassemia
199
What may be seen on a blood smear from a patient with beta-thalassemia major?
marked aniso, poik, hypochromic microcytes, target cells, ovalocytes, nRBCs, basophilic stippling
200
What may be seen in a blood smear from a patient with beta-thalassemia minor?
aniso, poik, hypochromic microcytes, target cells, basophilic stippling
201
Which microcytic, hypochromic anemia will have little or no Hgb A, but 95-98% Hgb F?
Beta-thalassemia major
202
anemia of chronic inflammation is formerly known as ...
anemia of chronic disease
203
Anemia of chronic inflammation is classified as which type of anemia?
Microcytic, hypochromic
204
Which anemia is caused by acute phase reactants that affect iron absorption and release (I.e. hepcidin), therefore the iron in the bone marrow macrophage is not released to developing RBCs?
Anemia of chronic inflammation
205
What is the 2nd most common anemia after IDA?
Anemia of chronic inflammation
206
What is the most common anemia in hospitalized patients?
anemia of chronic inflammation
207
Which microcytic hypochromic anemia will have increased RBCs while the others will have decreased RBCs?
beta-thalassemia
208
Which microcytic hypochromic anemia typically has the following results:
decreased RBCs, increased RDW, decreased serum iron, increased TIBC, decreased serum ferritin, and normal Hgb A2
IDA
209
Which microcytic hypochromic anemia typically has the following results:
decreased RBCs, increased RDW, increased serum iron, normal TIBC, increased serum ferritin, and normal Hgb A2
sideroblastic anemia
210
Which microcytic hypochromic anemia typically has the following results:
increased RBCs, normal RDW, normal iron studies, and increased Hgb A2
beta-thalassemia minor
211
Which microcytic hypochromic anemia typically has the following results:
decreased RBCs, normal RDW, decreased serum iron and TIBC, increased serum ferritin
anemia of chronic inflammation
212
Rapid loss of >20% blood volume is termed:
acute blood loss
213
Loss of small amounts of blood over extended period of time is termed:
chronic blood loss
214
How can you differentiate acute versus chronic blood loss with the following values:
RBCs
WBCs
Hgb/Hct
Acute blood loss:
RBCs - normocytic, normochromic
WBCs - increase with shift to left
Hgb/Hct - steady at first due to vasoconstriction
Chronic blood loss:
RBCs: microcytic, hypochromic
WBCs: normal
Hgb/Hct - decreased
215
If serum iron and ferritin is decreased, you can expect acute or chronic blood loss?
chronic blood loss
216
Name the 6 stages of granulocyte maturation.
```
Myeloblast
promyelocyte
myelocyte
metamyelocyte
band
segmented neutrophil
```
217
15-20um, small amounts of dark blue cytoplasm, usually no granules, nucleus has delicate chromatin with nucleoli are key characteristics of which stage of granulocytic maturation?
myeloblast
218
12-24um, similar to myeloblast, but has primary (nonspecific) granules are key characteristics of which stage of granulocytic maturation?
promyelocyte
219
10-18um, secondary (specific) granules, and last stage to divide are key characteristics of which stage of granulocytic maturation?
myelocyte
220
10-18um and nucleus begins to indent are key characteristics of which stage of granulocytic maturation?
metamyelocyte
221
10-16um, and nuclear indentation is more than half are key characteristics of which stage of granulocytic maturation?
band
222
10-16um, and 2-5 nuclear lobes connected by a thin strand of chromatin are key characteristics of which stage of granulocytic maturation?
segmented neutrophil
223
Myelocytes have secondary granules that can specify which cells?
neutrophils, basophils, and eosinophils
224
What are the normal leukocytes found in peripheral blood?
segmented neutrophils, bands, eosinophils, basophils, monocytes, and lymphocytes
225
The presence of immature granulocytes in peripheral blood describes which leukocyte abnormality?
Shift to the left
226
Dark-staining granules in the cytoplasm of neutrophils describes which leukocyte abnormality?
toxic granules
227
Light blue patches in cytoplasm of neutrophils describes which leukocyte abnormality?
Dohle bodies
228
phagocytic vacuoles in cytoplasm of neutrophils describes which leukocyte abnormality?
vacuolization
229
>5% of segs with 5 lobed nuclei or any with >5 lobes describes which leukocyte abnormality?
hypersegmentation
230
Most neutrophils have round or bilobed nuclei describes which leukocyte abnormality?
Pelger-Huet anomaly
231
Red needles in cytoplasm of leukemic myeloblasts and occasionally promyelocytes and monoblasts describes which leukocyte abnormality?
auer rods
232
Large size, increased cytoplasm, peripheral basophilia, scalloped edges due to indentation by adjacent RBCs, frothy appearance, many azurophilic graules describes which leukocyte abnormality?
atypical/reactive lymph
233
A shift to the left is a leukocyte abnormality significant for...
bacterial infection, inflammation
234
Toxic granules are a leukocyte abnormality significant for...
infection, inflammation
235
Dohle bodies are a leukocyte abnormality significant for...
infection, burns
236
Vacuolization is a leukocyte abnormality significant for...
septicemia, drugs, toxins, radiation
237
hypersegmentation is a leukocyte abnormality significant for...
Pernicious anemia (one of the first signs)
238
Pelger-Huet anomaly is a leukocyte abnormality significant for...
inherited disorder, no clinical effect. May be misinterpreted as a shift to the left
239
Auer rods are a leukocyte abnormality significant for...
AML, rules out lymphocytic leukemia
240
Auer rods are formed from...
abnormal fusion of primary granules
241
Variant (atypical/reactive) lymphs are a leukocyte abnormality significant for...
viral infections (IM, CMV, etc)
242
Neutrophilia, neutropenia, lymphocytosis, monocytosis, eosinophilia, basophilia are what type of leukocyte abnormalities?
quantitative
243
Neutrophilia is a quantitative leukocyte abnormality associated with...
bacterial infection, inflammation, hemorrhage, hemolysis, stress
244
neutropenia is a quantitative leukocyte abnormality associated with...
acute infection, antibodies, drugs, chemicals, radiation
245
Lymphocytosis is a quantitative leukocyte abnormality associated with...
IM, CMV, whooping cough, acute infectious lymphocytosis
246
Monocytosis is a quantitative leukocyte abnormality associated with...
Convalescence from viral infections, chronic infections, TB, subacute bacterial endocarditis, parasitic infections, rickettsial infections
247
Eosinophilia is a quantitative leukocyte abnormality associated with...
allergies, skin diseases, parasitic infections, CML
248
Basophilia is a quantitative leukocyte abnormality associated with...
Chronic myelogenous leukemia, polycythemia vera
249
Neoplasm stands for...
new growth
250
Which hematopoietic neoplasm can be explained as premalignant hematopoietic stem cell disorder involving overproduction of 1 or more myeloid cell lines? Normal maturation and morphology.
Myeloproloferative neoplasms (MPN) or Myeloproliferative disorders (MPD)
251
Which hematopoietic neoplasm can be explained as premalignant hemoatopoietic stem cell disorders involving ineffective hematopoiesis in 1 or more myeloid cell lines? Peripheral cytopenias and morphological abnormalities.
myelodysplastic syndromes (MDS)
252
Which hematopoietic neoplasm can be explained as malignant neoplasms involving unregulated proliferation of hematopoietic stem cells with abnormal cell in bone marrow and peripheral blood?
leukemia
253
Which hematopoietic neoplasm can be explained as malignant neoplasm of lymphoid cells in lymphatic tissues or lymph nodes?
lymphoma
254
What are some examples of myeloproliferative neoplasms/disorders?
polycythemia vera, CML, essential thrombocythemia, primary myelofibrosis
255
What are some examples of myelodysplastic syndromes?
refractory anemia, refractory neutropenia, refractory thrombocytopenia
256
What is an example of Myelodysplastic/Myeloproliferative disorders?
Chronic myelomonocytic leukemia (CMML)
257
What are some examples of leukemias?
Acute lymphoblastic leukemia (ALL) and chronic lymphocytic leukemia (CLL)
258
What are some examples of lymphomas?
Hodgkin lymphoma and non-Hodgkin lymphoma
259
Which hematopoietic neoplasm occurs usually in adults and is typically caused by mutations in hematopoietic stem cells?
Myeloproliferative neoplasms/disorders
260
Myeloproliferative neoplasms/disorders and myelodysplastic syndromes can transform into...
acute leukemia
261
splenomegaly, extramedullary hematopoiesis is common in which hematopoietic neoplasm?
Myeloproliferative neoplasms/disorders
262
Which hematopoietic neoplasm has solid tumors, classified and B or T cell, and can spread to the bone marrow, resulting in malignant cells in peripheral blood?
Lymphomas
263
What does "leukemic phase" refer to regards to lymphomas?
The lymphoma spread to the bone marrow, which then can cause malignant cells to be present in peripheral blood.
264
What would you see on a differential of acute leukemia versus chronic leukemia?
acute: blasts are usually present
chronic: more mature cells
265
What would expected platelet counts be in acute leukemia versus chronic leukemia?
acute: mild to severely decreased
chronic: usually normal
266
If acute, what type of leukemia usually occurs in children and adults?
children: lymphoid
adults: myeloid
267
If chronic, what type of leukemia usually occurs in children and adults?
children: myeloid
adults: lymphoid
268
What is the most common leukemia in children less than 1 year and in adults?
acute myeloid leukemia
269
Name the 4 types of common leukemias.
Acute myeloid leukemia (AML)
Acute lymphoblastic leukemia (ALL)
Chronic myelogenous leukemia (CML)
Chronic lymphocytic leukemia (CLL)
270
>20% blasts, possiple auer rods, pseudo-pelger huet cells, Howell-jolly boies, pappenheimer bodies, basophilic stippling, nRBCs, and hypogranular or giant platelets may be seen on the blood smear of which leukemia?
Acute myelogenous leukemia (AML)
271
small, homogeneous blasts in children; larger heterogeneous blasts in adults may be seen on the blood smear of which leukemia?
Acute lymphoblastic leukemia (ALL)
272
Due to increased cell turnover in acute leukemia, which analytes may be increased?
uric acid and LDH
273
Which leukemia can spread to the central nervous system, required immunophenotyping to determine lineage, and cytogenetics and molecular analysis for prognosis?
acute lymphoblastic leukemia (ALL)
274
What is the most common Myeloproliferative disorder?
Chronic myelogenous leukemia (CML)
275
All stages of granulocytic maturation with predominant segs and myelocytes, increase in eos and basos, hyposegmentation of neutrophils, nRBCs, and abnormal platelets may be seen on the blood smear of which leukemia?
Chronic myelogenous leukemia (CML)
276
The Philadelphia chromosome (Ph) is associated with which leukemia?
Chronic myelogenous leukemia (CML)
277
Which leukemia will eventually become AML or ALL?
Chronic myelogenous leukemia (CML)
278
80-90% small, mature-looking lymphs, possible hypercondensed chromatin and light staining parachromatin ("soccer ball appearance"), few prolymphocytes, and smudge cells may be seen on the blood smear of which leukemia?
Chronic lymphocytic leukemia (CLL)
279
What is the most common leukemia in older adults and is caused by the proliferation of B lymphs?
Chronic lymphocytic leukemia (CLL)
280
Cytochemical stains can be used to differentiate which type of leukemias?
acute leukemias
281
What would be the expected result for AML and ALL when stained with myeloperoxidase?
AML - pos
| ALL - neg
282
What would be the expected result for AML and ALL when stained with Sudan Black?
AML - pos
| ALL - neg
283
What would be the expected result for AML and ALL when stained with Napthol AS-D chloroacetate esterase (specific esterase)?
AML -pos
| ALL - neg
284
What would be the expected result for AML and ALL when stained with Periodic acid-Schiff (PAS)?
AML - neg (or diffusely pos)
| ALL- pos (course granular or block-like)
285
ALL with typically only have a positive result with which cytochemical stain?
PAS (Periodic acid-Schiff)
286
How can you use the following tests to differentiate leukemoid reaction versus CML (both have high WBCs)?
Blood smear
Leukocyte alkaline phosphatase (LAP)
Ph Chromosome
Leukemoid reaction:
blood smear - shift to left with rare blasts, toxic granulation, and dohle bodies
LAP - high
Ph Chromosome - neg
CML:
blood smear - shift to left with blasts, eosinophilia, and basophilia
LAP - low
Ph Chromosome - pos
287
Name 3 plasma cell disorders.
Multiple myeloma
Plasma cell leukemia
Woldenstrom's macroglobulinemia
288
Malignant cells in marrow, normocytic, normochromic anemia, rouleaux on blood smear, increased ESR, M-spike on serum protein electrophoresis, lytic bone disease, and possible bence-jones protein in the urine are key characteristics of which plasma cell disorder?
Multiple myeloma
289
Plasma cells in peripheral blood, pancytopenia, rouleaux, monoclonal gammapathy, a form of multiple myeloma are key characteristics of which plasma cell disorder?
plasma cell leukemia
290
Malignant lymphocyte-plasma cell proliferative disorder, monoglonal gammapathy, rare plasmacytoid lymphocytes or plasma cells on peripheral blood smear, rouleaux, cryoglobins are key characteristics of which plasma cell disorder?
Waldenstrom's macroglobulinemia
291
Why in the ESR increased in multiple myeloma?
due to increased globulins
292
What causes Waldenstrom's macroglobulinemia to be a monoclonal gammapathy?
due to increased IgM
293
What can be used to lyse RBCs?
acetic acid
294
What is the purpose of a CSF manual WBC count?
deiiferenial diagnosis of meningitis
295
How is a CSF manual WBC count performed?
load specimen into a hemacytometer, count all 9 squares on both sides under low power
296
What is the purpose of a microhematocrit/packed cell volume (PCV)?
screening for anemia
297
What is the purpose of a reticulocyte count?
assess rate of erythropoiesis
298
How is a reticulocyte count performed?
Stain a blood smear with new methylene blue, count the number of retics within 1000 RBCs, determine the % of retics
299
What is the purpose of an erythrocyte sedimentation rate (ESR)?
screen for inflammation
300
How is an ESR performed?
Whole blood is added to a Westergren tube and placed in a vertical rack. The height of the RBCs is measured after 1 hour.
301
Other than staining a blood smear with new methylene blue, what else can facilitate counting retics?
miller ocular
302
Reticulocyte counts increase with...
increased erythropoiesis
303
ESR increases with ...
inflammation
304
What is the purpose for a tube solubility test?
screen for Hgb S
305
What is the method for a tube solubility test?
Blood is mixed with a reducing agent, Hgb S is insoluble, which produces a turbid solution.
306
What is the purpose of the osmotic fragility test?
diagnosis of hereditary spherocytosis
307
What is the method for performing an osmotic fragility test?
Blood is added to serial dilutions of NaCl and incubated. Hemolysis is determined by reading the absorbance or the supernatant in each tube.
308
Osmotic fragility increases in...
hereditary spherocytosis
309
Osmotic fragility decreases with...
target cells, sickle cell anemia, IDA, and thalassemia
310
What is the purpose of the Donath-Landsteiner (DL) test?
diagnosis of paroxysmal cold hemoglobinuria
311
What is the method to perform the Donath-Landsteiner (DL) test?
blood is collected in two clot tubes, 1 tube is incubated at 4 degrees C, then 37 degrees. Tube 2 is incubated at 37 degrees only.
312
What is a positive Donath-Landsteiner (DL) test?
hemolysis in tube 1 (incubated at 4 and 37 degrees) and no hemolysis in tube 2 (incubated at 37 degrees only)
313
What is a rare autoimmune hemolytic disease due to biphasic antibody that binds complement to RBCs in capillaries?
Paroxysmal cold hemoglobinuria
314
What change occurs to the MCV at room temperature and why?
MCV increased due to RBCs swelling
315
What change occurs to the HCT at room temperature and why?
increases due to the increased MCV (swelling RBCs)
316
What change occurs to the MCHC at room temperature and why?
decreases due to increased HCT
317
What change occurs to the ESR at room temperature and why?
decreases (swollen RBCs don't rouleaux)
318
What change occurs to osmotic fragility at room temperature?
increases (due to cells swelling)
319
What change occurs to WBCs at room temperature?
decreases
320
What changes to WBCs can be seen if a sample sits at room temperature?
necrobiotic cells, karyorrhexis (nuclear disintegration), degranulation, vacuolization
321
```
The following is the principle for which automated method?
Low-voltage direct current resistance.
increased resistance (impedance) when nonconductive particles suspend in electrically conductive diluent pass through aperture. Height of impulses indicates cell volume, # of pulses indicates count.
```
Coulter Principle (Electrical impedance)
322
The coulter principle (electrical impedance) can be applied to which hematology practices?
cell counting and sizing
323
The following is the principle for which automated method?
High-frequency electromagnetic probe measures conductivity. Change in signal provides information about N:R, nuclear density, and granularity.
Radio Frequency (RF)
324
Radio frequency (RF) can be applied to which hematology procedures?
WBC differential
325
The following is the principle for which automated method?
Hydrodynamically focused stream of cells passes through, past a light source. Scattered light is measured at different angles, providing information about cell volume and complexity.
Flow cytometry (optical light scattering)
326
Flow cytometry can be applied to which hematology procedures?
cell counting and sizing, WBC differential
327
Retics per 1000 RBCs/10 = ?
Retic %
328
(Retics in square Ax100)/(retics in square Bx9) = ?
Reticulocyte % using Miller Disc
329
retic% x (HCT%/45) = ?
Corrected retic count (CRC)
330
corrected retic count/maturation time correction factor =?
retic production index (RPI)
331
What is the calculation for MCV?
(HCT% x 10)/RBC = fL
332
What is the calculation for MCH?
(Hgbx10)/RBC = pg
333
What is the calculation for MCHC?
(Hgb x 100)/ Hct% = %
334
In the rule of 3, RBC x 3 = ?
Hgb +/- 0.5
335
In the rule of 3, Hgb x 3 = ?
Hct +/- 3%
336
In the rule of 3, hgb +/- 0.5 = ?
RBC x 3
337
In the rule of 3, Hct +/- 3% =
Hgb x 3
338
(#cells counted x depth factor)/(dilution x area counted) = ?
manual cell count (cells/uL)
339
total WBC x relative count (% from differential) = ?
Absolute WBC
340
(uncorrected WBC x 100)/(100+nRBCs per 100 WBCs) = ?
corrected WBC
