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Diagnostic Studies > Hematopoiesis and CBC > Flashcards

Hematopoiesis and CBC Flashcards

1
Q

Hematapoiesis

(Definition, 3 categories)

A

Process of blood cell production and development

  • Erythropoiesis
  • Leukopoiesis
  • Thrombopoiesis
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2
Q

Hematopoietic Lines

(list 2, clinical significance)

A

Maturation Lines:

  1. Lymphoid cell line
  2. Myeloid cell line

Significance: A disease to a lymphoid or myeloid stem cell can cause very different diseases. Myeloid stem cell compromise is often more profound, as it precurses many more cells than the lymphoid line

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3
Q

Hematopoiesis Location

(first 10 gestational months)

A

General Progression (see picture for more accurate description):

  1. 1st mo: yolk sac only
  2. 2nd mo: yolk sac declining, liver taking over c help of spleen
  3. 3rd mo: mostly liver, some spleen
  4. 4th mo: still overwhelminly liver, declined spleen, BM and liver start prdctn
  5. 5th mo: declining but dominating liver, stable spleen, rapidly inc. BM, slowly inc. lymph nodes
  6. 6th mo thru 10th month: liver and spleen declining as BM takes over (7 mo) c some assistance from the lymph nodes
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4
Q

Erythropoiesis

(6 stages)

A
  1. —Pronormoblast
  2. —Basophilic normoblast
  3. —Polychromatophilic normoblast
  4. —Orthochromatic normoblast
  5. —Polychromatophilic erythrocyte (exposed c special stain as reticulocyte here)
  6. —Erythrocyte
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5
Q

Polychromatophilic Erythrocyte

(cell line, size, nucleous and cytoplasm descriptions, location)

A

—Size: 7-10 microns (same size as lymphocyte, compare against lymphocyte to eval RBC size)

—Cell line: Erythropoietic cell

Nucleus: None!

—Cytoplasm: blue-gray to pink-gray

Location: In circulation

Just know they exist and should be nucleated in the BM

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6
Q

Mature Erythrocyte

(cell type, size, neucleous and cytoplasm descriptions)

A

Cell type: Erythropoietic cell

—Size: 7-8 microns (easy to measure by comparing to lymphocyte)

—Nucleus: None

—Cytoplasm: Pink c central palor due to bionclave disc shape. Pallor should take up ~1/3 of cell

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7
Q

Reticulocyte

(Structure, Maturation, Evaluation, Clinical Significance)

A

Structure: Immature anucleated RBC that contains increased amounts of RNA

Maturation: Released into BM c reticulum (free RNA) within 24 hours of release

Evaluation: Supravital stain (ex: new methyene blue)

Signiciance: Assess erythopoietic activity of BM

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8
Q

Reticulocyte Count Aspects

(Describe 4 values reported)

A
  1. —Absolute retic count - # per mL of whole blood
  2. —Percent retic - expressed as percentage of total RBC
  3. —Corrected retic - Used in anemic states to better assess RBC production
  4. —RPI - Corrects for premature release of younger retics from the marrow

Note: reticulocytes should be ~1% of circulating RBC count

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9
Q

Myelopoiesis

(list 4 cells produced by this method)

A
  1. —Neutrophils
  2. —Eosinophils
  3. —Basophils
  4. —Monocytes
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10
Q

Myelopoietic Cell Storage and Delivery Times

(Both in marrow and peripheral tissue)

A
  • —Marrow Storage: 7 - 11 days
  • —Peripheral Storage: 7 hours
    • —50% circulate
    • —50% marginate
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11
Q

Granulocyte Maturation

(6 stages)

A
  1. —Myeloblast
  2. —Promyelocyte
  3. —Myelocyte
  4. —Metamyelocyte
  5. —Band
  6. —Segmented (Polymorphonuclear) Cell
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12
Q

Myeloid Margination

A

Large cells roll around the vessels and tissues until they find a spot to stick until activated.

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13
Q

Band Neutrophil

(size, nucleous and cytoplasm descriptions, normal % of [neutrophil], clinical signif.)

A
  • *—Size:** 10 - 16 microns
  • *—Nucleus:** narrow band of uniform thickness, horseshoe-shaped or ribbon-shapped (if curled on top of itself); clumped chromatin
  • *—Cytoplasm:** tan to pink; contains specific granules

% Concentration: Normally 8-10% of neutrophils, 1st stage in peripheral blood

Significance: Increased presence of band cells usually indicates an acute leukemia.

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14
Q

Neutrophils

(function, % [leukocytes])

A

Function: Leave vessels and migrate to tissue damage/infection to phagocytize and kill invading organisms

% [Leukocytes]: 55-65%

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15
Q

Eosinophil

(structure, function %[leukocytes])

A

—Function: Associated with allergic reactions, parasitic infections, and chronic inflammation
—Structure: Granules have cytotoxic effect on parasites and bacteria, stimulate release of histamine from basophils and mast cells
—%[Leukocytes]: 2 - 8%

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16
Q

Basophil

(structure, function, %[leukocytes])

A

Function: Mediate inflammatory responses, especially hypersensitivity and allergic responses
Structure: Enzymes contained in granules are vasoactive, bronchoconstrictive, and chemotactic
—%[Leukocytes]: 0 - 1%

17
Q

Monopoiesis

(3 stages)

A
  1. —Monoblast
  2. —Promonocyte
  3. —Monocyte (only stage in circulation)
18
Q

Monoblast

(size, nucleous and cytoplasm descriptions)

A
  • *—Size:** 12 - 20 microns
  • *—Nucleus:** large, minimally indented; fine lacy chromatin; 1 -3 nucleoli
  • *—Cytoplasm:** deep blue, agranular

Note: “Blast” cells are usually reported in one value, as they are difficult to differentiate

19
Q

Monocyte

(size, nucleous and cytoplasm descriptions, maturation, function, %[leukocytes])

A
  • *—Size:** 15 - 18 microns
  • *—Nucleus:** folded, lobular; irregular in shape
  • *—Cytoplasm:** abundant, pale blue with red dust-like particles; may contain vacuoles

Maturation:

  1. —Remain in the bloodstream for approximately 14 hours before entering the tissues
  2. —In tissues, transform into macrophages

—Function:

  1. Phagocytize microorganisms, cellular products (later recycles many of these products)
  2. —Secrete substances that affect lymphocyte function

—%[Leukocytes]: 2 - 8% of leukocytes

20
Q

Monocytosis Causes

(7 conditions)

A
  • —Neoplastic disorders
    • —CML
    • —CMML
    • —Hodgkins
  • —Inflammation
  • —Immune disease (like RA or lupus)
  • —Collagen disease
  • —Infection (TB, syphillis)
21
Q

Lymphopoiesis

(3 stages)

A
  1. —Lymphoblast (reported as nonspecific “blast” cell)
  2. —Prolymphocyte
  3. —Lymphocyte
22
Q

Lymphocyte

(size, nucleous and cytoplasm descriptions, functions, %[leukocyte])

A
  • *—Size:** 7 - 10 microns (great ruler for RBC size)
  • *—Nucleus:** round, condensed, homogenous
  • *—Cytoplasm:** light blue, varies in amount, granules usually absent

Functions:

  • —Humoral response - B cells - bone marrow
  • —Cellular response - T cells - thymus

—%[Leukocyte]: 25 - 35%

23
Q

Reactive Lymphocytes

(2 types, structure, functions - include 7 specifics)

A

Cell Types:

  1. Reactive/atypical lymphs
  2. Plasma cells (from B-cells)

Structure:

  • contain parachromatin “ballerina skirts”
  • may resemble blast cells
  • Eccentric nucleus, deep cytoplasm (antibody producing), perinuclear halo, dark chromatin-condensed

Function: Specific immunity, especially against viruses

  1. Viral disorders
    • Infectious mono
    • Pertussis (this is a bacteria)
    • Toxoplasmosis (cat, infultrate rat and human brains)
    • Chicken pox
    • Measules
  2. Chronic infections
  3. Malignant lymphoproliferative disorders
24
Q

WBC Examination

(2 categories, 2 exam. points for each)

A
  1. —Quantitative
    • —Leukocytosis, leukopenia
    • —Absolute vs. relative
  2. —Qualitative changes
    • —Nuclear
    • —Cytoplasmic
25
Q

Factors Affecting Neutrophil Distribution

(3)

A
  1. —Influx - production and release
  2. —Circulating vs. marginal (infection or stress if circulating > marginal)
  3. —Exit from blood into tissues
26
Q

Physiologic Leukocyte Activation

(define, 3 causes)

A

—Definiton: Causes a distribution change (increase in circulating, decrease in marginal)

Note: While leukocyte count is elevated, it is much less dramatic than a pathologic leukocyte increase

Causes:

  1. Severe exercise
  2. —Stress, fear, anger
  3. —Hypoxia
27
Q

Pathologic Leukocyte Activation

(define, 7 causes in 2 categories)

A

—Definiton: Leukocyte distribution changes throughout infection progression

Note: This leukocyte number change is much more dramatic than physiologic leukocyte change. Numbers can reach hundreds of thousands

Causes:

  • —Leukemia
    • —Acute
    • —Chronic
  • —Infection
    • —Toxins, (uremia, spider bite, Pb poisoning)
    • —Tissue necrosis (MI, burns)
    • —Malignant neoplasm
    • —Hemorrhage, especially in gut
    • —Acute hemolysis
28
Q

Pathologic Leukocyte Count Progression

A
  • —Response to infection
    • —Increased WBC - higher WBC indicates good response
    • —Left Shift
    • —Decreased eosinophils
  • —Recovery from infection
    • —Decrease neutrophils
    • —Increase monos
    • —Increase lymphs, eos

*Decrease results from cell migration into tissues *

29
Q

Factors Influencing Pathologic Leukocyte Response

(3)

A
  1. —Age
  2. —Nutritional status
  3. —Kind of invading organism
30
Q

Toxic Neutrophil Changes

(3 changes, 4 causes, 1 explaination of causes)

A

Changes:

  1. Toxic granulations - immature azurophilic granules due to rapid WBC production. Trying to pump out extra cells to fight the tissue distrubance but not leaving enough time for maturation
  2. Dohle bodies - cytoplasmic, residual RNA
  3. Cytoplasmic vacuoles - contains phagocytized material

Causes:

  1. Infection
  2. Poisoning
  3. Burns
  4. Chemotherapy

Explaination: These are reactions to rapidly increased production and action.

Pictured: Dohle Bodies

31
Q

Left Shift

(define, significance)

A

Definition: Presence of excess band forms (>10% circulating WBCs) -or- immature neutrophils in circulation

Signif: indicates bacterial infection. Trying to produce extra WBC to respond to acute infection but not allowing them enough time to mature in BM

32
Q

Complete Blood Count Tests

(8)

A
  1. —White blood cell count
  2. —Red blood cell count
  3. —Hemoglobin
  4. —Hematocrit
  5. —MCV
  6. —MCH
  7. —MCHC
  8. —Platelet count

Notes:

  • *MCV, MHC, and MCHC are called “indices” *
  • *Normal values will be reported by each laboratory to account for variability in equipment and environment. While there are general norms, these values should be benchmark for comparison. *
33
Q

Hemoglobin

(definition, normal values)

A

—Definiton: Protein in RBC which carries O2 to tissues and CO2 the lungs
—Normal values:

  • —Male adult: 13.5 - 17.5 g/dL
  • —Female adult: 12.0 - 16.0 g/dL
34
Q

Hematocrit

(definition, normal values, 3 “normal abnormal” situations + explainations)

A

—Definitnion: Percent of RBC volume in whole blood
—Normal values:

  • —Male adult: 41 - 53%
  • —Female adult: 36 - 46%

—”Normal Abnormals,” Reference range higher in:

  • —High altitudes - more RBC due to lower oxygen concentration in the air
  • —Smokers/COPD patients - damaged lungs cannot absorb adequate oxygen, body reacts to hypoxia by increasing number of RBCs
  • —Newborns
35
Q

Uses for Hematocrit Evaluation

(5)

A
  1. —anemia (decrease of red blood cells)
  2. —polycythemia (increase in red blood cells)
  3. —dehydration
  4. —blood transfusion decisions
  5. —the effectiveness of those transfusions.
36
Q

RBC Indices

(list 3, definitions, normal values)

A
  1. —Mean Cell Volume (MCV)
    • Average volume of RBC
    • Normal values = 80-100 fL
      • Increased - macrocytic
      • Decreased - microcytic
  2. —Mean Cell Hemoglobin (MCH)
    • Average weight of hemoglobin in RBC
    • Normal = 27-31 pg
      • Increased - macrocytic anemias and some spherocytoses
      • Decreased - microcytic aneia and normocytic hypochromic anemia
    • Rarely Used
  3. —Mean Cell Hemoglobin Concentration (MCHC)
    • Average expression of hemoglobin per RBC
    • Normal = 32-36%
      • Increased - hyperchromia (spherocytes)
      • Decreased - hypochromia
37
Q

Clinical Significance of Reticulocytes

A

Reticulocyte count can evaluate the integrity of your hematopoietic system. The number of RBCs getting produced can change in certain conditions. Suspect the following, given the reticulocyte evaluation:

  • Low - May be a bone marrow problem, difficulty in producing more RBC
  • Normal - Functioning bone marrow, often valuable information when evaluating for hemolytic anemia
  • High - Overactive bone marrow. While this is expected in some instances (high altitudes, infancy, smokers), others may indicate hemorrhage, hemolytic anemia, or inability for the body to recognize oxygen
38
Q

Clinical Significance - Hemoglobin

A

Since hemoglobin carries oxygen, an impaired or deficient amount of hemoglobin will prevent oxygenation of tissues. This presents in body-wide hypoxia, or anemia.

Diagnostic Studies (11 decks)

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