Hematology Unit 5 - Hematopoiesis

The process of blood cell production, differentiation and development.

hematopoiesis

The process of RBC production.

erythropoiesis

The process of WBC production.

leukopoiesis

The process of platelet production.

thrombopoiesis

Development of blood cells can occur in what locations?

bone marrow/liver/spleen/lymph nodes/thymus

What main three factors influence the development of cells?

presence of stem cells/environment the cells are in/regulatory proteins and growth factors

Hormone that stimulates the growth/development of RBCs?

erythropoietin

What organ produces erythropoietin?

kidneys

__________ hematopoiesis occurs outside of the bone marrow.

extramedullary

What is the first cells made in a fetus?

immature RBCs

Where does hematopoiesis first occur in a fetus?

yolk sac

After 2-4 months the hematopoiesis in a fetus moves to the _________.

liver

Once a child is born, hematopoiesis moves to the _________.

bone marrow

What are the two preferred locations to aspirate bone marrow specimens?

iliac crest/sternum

This cell has the ability to make any type of cell.

pluripotent stem cell

This cell has the ability to make any of the cellular blood components.

hematopoietic stem cell

What cells can a CLP cell make?

T cells/B cells/NK cells

What does CLP stand for?

common lymphoid precursor

What cells can a CMP cell make? (only give what's next in line)

GMP/MEP

What does GMP stand for?

granulocytic-monocytic progenitor

What does MEP stand for?

megakarocytic-erythroid progenitor

What does CMP stand for?

common myeloid progenitor

What cells can a GMP cell make?

monocytes/granulocytes

What cells can a MEP make?

platelets/RBCs

If you can't determine if the cell is mature or immature, always go with the ________ cell.

mature

Term for when the cytoplasm matures before the nucleus.

megaloblastic maturation

Immature cells tend to stain _________ due to ________ content.

deep blue; RNA

As cells mature, they lose ________ and become more ________ in color.

RNA; pink

As cells mature, the N:C ratio tends to (increase/decrease)

decrease

More immature cells tend to have (small/larger) nuclei.

larger

As cells mature, chromatin transforms from ___________ to __________

fine and delicate; course and clumped

As cells mature, the nucleus goes from ________ to ________ in color.

reddish purple; bluish purple

As a cell matures, its size (increases/decreases)

decreases

This disease involves the proliferation of an abnormal type of bone marrow stem cell.

myelofibrosis

Term for the abnormal replacement of the bone marrow with collagenous connective tissue fibers.

fibrosis

What substances are required to synthesize RBCs?

amino acids/vitamin B12/vitamin B6/folic acid

The stimulation of the release of EPO is triggered by _________.

hypoxia

What are the names for the earliest recognizable RBC (list early stage followed by later stage)

pronormoblast; rubriblast

This stage of the RBC is 12-19 um, deeply basophilic, has an N:C ratio of 4:1, has no granules, has a large, reddish-purple nucleus with 0-2 nucleoli, and a fine chromatin pattern.

pronormoblast/rubriblast

This stage of the RBC is the first stage whre hemoglobin is made. (list early stage followed by later stage)

polychromatophilic normoblast; rubricyte

This stage of the RBC is 12-17 um, has a blue cytoplasm, an N:C ratio of 4:1, it's nucleus chromatin is somewhat clumped, and no nucleoli.

basophilic normoblast/prorubricyte

This stage of the RBC is 11-15 um, has grey-blue to pink-gray cytoplasm, has an N:C ratio of 1:1, small round nucleus, and it's nucleus chromatin is clumped.

polychromatophilic normoblast/rubricyte

This stage of the RBC is the last nucleated stage. (list early stage followed by later stage)

orthochromic normoblast; metarubricyte

This stage of the RBC is 8-12 um, has a reddish-pink cytoplasm, has an N:C r atio of 1:2, it's nucleus chromatin is tightly clumped, and it's nucleus is pyknotic.

orthochromic normoblast/metarubricyte

This stage of the RBC is the last stage in the bone marrow before it's peripheral release.

reticulocyte

This stage of the RBC is 7-10 um, has a pink to blue gray cytoplasm, and has no nuclei is present.

reticulocyte

This stage of the RBC is 6-8 um, looks like a biconcave disk, and is red with a central pallor.

mature RBC

What stain is used to see the RNA in reticulocytes?

new methylene blue

The presence of reticulocytes on a peripheral smear is known as __________.

polychromasia

List the order of RBC development, using the names for the earlier stages.

pronormoblast; basophilic normoblast; polychromatophlic normoblast; orthochromic normoblast; reticulocyte; mature RBC

List the order of RBC development, using the names for the later stages.

rubriblast; prorubricyte; rubricyte; metarubricyte; reticulcyte; mature RBC

What is the formula for a manual retic count?

%retic = (#retic/#RBCs) X 100

What is the formula for a retic count using a miller disc?

%retic = [#retic/(#RBCs X 9)] X 100

When doing a manual retic count, how many RBCs should you count?

1000

When doing a retic count using a miller disc, how many RBCs should you count?

111

Normal percent range for retics in adults.

0.5-1.5%

Normal range for retics in infants.

2.5-6.5%

How would you calculate an absolute retic count?

%retic X RBC count

How would you correct for an anemia in regards to a retic count?

%retic X (patient Hct/45) (don't convert %retic into a decimal)

Hemoglobin carries iron in the ________ form.

ferrous

What primary phosphate group is responsible for regulating a hemoglobin molecules affinity for oxygen?

2, 3 DPG

When 2, 3 DPG is bound to hemoglobin, this (increases/decreases) hemoglobins affinity for oxygen?

decreases

What environmental factors affect a hemoglobin molecules affinity for O2?

pH/temperature

A decreased pH leads to hemoglobin having a(n) (increased/decreased) affinity for O2.

decreased

An increased pH leads to hemoglobin having a(n) (increased/decreased) affinity for O2

increased

A decrease in temperature leads to hemoglobin having a(n) (increased/decreased) affinity for O2.

increased

An increase in temperature leads to hemoglobin having a(n) (increased/decreased) affinity for O2.

decreased

65% of hemoglobin synthesis occurs in ______.

NRBCs

35% of hemoglobin sythesis occurs in ______.

retics

Heme is formed within _______.

red marrow/liver

The first step of forming heme involves the combination of _________ and _______ in the presence of _______ to form _______.

succinyl-coA/glycine; B6 vitamin; ALA

The second step of forming heme involves two molecules of _______ are combined with the help of ________ to create ________.

ALA; ALA dehydrogenase; PBG

In the third step of forming heme, 4 molecules of ________ combine to make __________ which is then converted by various enzymes into ________.

PBG; uroporphyrinogen; protoporphyrin

The final step in the formation of heme _________ is combined with the ________.

iron; protoporphyrin ring

Defects in the enzymes required for the production of heme are called

porphyrias

Hemoglobin A is made from __________ and _______ globin chains.

2 alpha/2 beta

Hemoglobin A2 is made from __________ and _______ globin chains.

2 alpha/2 delta

Hemoglobin F is made from __________ and _______ globin chains.

2 alpha/2 gamma

Embryonic hemoglobin uses _________ chains instead of alpha chains.

zeta

What is the predominate hemoglobin type in adults?

hemoglobin A

What is the predominate hemoglobin type in fetuses and newborns?

hemoglobin F

How is embryonic hemoglobin made?

immature RBCs in the yolk sac

Term for hemoglobin that is attached to oxygen.

oxyhemoglobin

Term for hemoglobin that is not attached to oxygen.

deoxyhemoglobin

Term for hemoglobin attached to CO2.

carboxyhemoglobin

carboxyhemoglobin has a _________ color.

cherry red

What hemoglobin level is increased in smokers?

carboxyhemoglobin

This form of hemoglobin is associated with the presence of drugs or bacteria.

sulfahemoglobin

This form of hemoglobin contains iron in the ferric state.

methemoglobin

What pathway is primarily responsible for maintaining iron in the ferrous state?

methemoglobin reductase pathway

What pathway prevents iron from oxidizing agents in the bloodstream?

Hexose monophosphate shunt pathway

How does hemoglobin migrate in an electrophoresis using cellulose acetate? (list in order from anode to cathode)

A>F>S>C

What type of hemoglobin travels with hemoglobin S in an electrophoresis using cellulose acetate?

D

What type of hemoglobin travels with hemoglobin C in an electrophoresis using cellulose acetate?

A2/E

How does hemoglobin migrate migrate in an electrophoresis using citrate agar? (list in order from anode to cathode)

F>A>D>E>S>C

The denaturation of hemoglobin is used as a guide for __________.

Rhogam shots

What stain is used for an acid hemoglobin denaturation test?

Kleihauser Betke

The acid type of hemoglobin denaturation is based off of the principle that hemoglobin F is _________ to acid elution.

resistant

90% of the glycolysis in the RBC follows the _______ pathway.

entner meyerhof

10% of the glycolysis in the RBC follows the _______ pathway.

hexose monophosphate