Module1 Hematology

Ch.1,2,4,9

Reference values

normal values determined by patient population

Delta checks

Historical check of lab results, key to identifying pre-analytical errors

Reflex testing

Additional testing to verify abnormal results

Critical values

results markedly increased or decreased from reference range

Hematopoiesis

Production and maturation of all blood cells

Erythropoietent

Erythrocytes are produced from:

hormone that stimulates RBC production

Produced by the kidney

Extramedullary and Intramedullary

outside of bone marrow- liver/ spleen

inside of bone marrow

Hematopoiesis development stages from fetus to adulthood

1. yolk sac

2. liver and spleen

3. bone marrow

Functions of the spleen

1. Filtration

2. Immunologic

3. Reservoir

4. Hematopoiesis

1st site for bone marrow biopsy

posterior iliac crest

Bone marrow functions

production of adult hematopoietic cells,

cell maturation,

responds to anemia

What are Siderotic granules?

Pappenheimer bodies that have been stained with prussian blue

Yellow and red marrow

Yellow marrow- lipids/ fats

Red marrow- blood cells

Myeloid erythroid ratio (M:E)

can predict hematologic problems in the bone marrow

300-500 cells are scanned

Normal- 3:1 or 4:1

All Stem Cells are___?___

and what do they form?

Pluripotent

Myeloid cells and Lymphoid cells (lymphocytes→ B-cells & T-cells)

What is Erythropoietin?

Cytokine, hormone stimulating red cell production, produced in the kidneys

CBC: RBC

4-6

CBC: WBC

4-11

CBC: Hgb

12-18 dl

CBC: Hct

37-52 %

CBC: MCV

& formula

80-100 fl

mcv= hct/ RBC x 10

CBC: MCH

& formula

27-31 pg

mch= hgb/ RBC x 10

CBC: mcHc

& formula

32-36%

mcHc= hgb/ hct x 100

CBC: Red cell Distribution Width (RDW)

what do we look for?

11.5-14.5%

Anisocytosis is determined

CBC: Plt

150-450

What is the “rule of three”

RBC, hgb, hct are each multiplied by 3

Types of anemia

Normochromic/ Normocytic (within range)

Microcytic/ Hypochromic (less than range)

Macrocytic/ Hypercytic (greater than range)

Anisocytosis and Poikilocytosis

Ansiocytosis- variation in size

Poikilocytosis- variation in shape

What causes anemia

and symptoms

reduction in Hgb (hemoglobin) below 7

Vertigo, pallor, fatigue, tachycardia, syncope, hypotension

Red cell life span

120 days

1st stage Red Cell maturation

Rubiblast- large, round nucleus and basophilic cytoplasm

2nd stage Red Cell maturation

Prorubricyte- Small cell, chromatin becomes course and clumped. Mitosis begins to occur.

3rd stage Red Cell maturation

Rubricyte- as result of mitotic division, cell becomes smaller. nucleus’ chromatin is more coarse and irregularly clumped.

4th stage Red Cell maturation

Metarubricyte- nucleus under goes a process known as pyknosis, which degenerates and disappears from cell

5th stage Red Cell maturation

Reticulocyte- nucleus is ejected from the cell, becomes immature red cell.

6th stage Red Cell maturation

Erythrocyte- Fully matured, leaves bone marrow and enters bloodstream to carry oxygen through-out the body.

Red cell membrane is a phospholipid bilayer

T or F?

True

Microcytic cells indicate

Iron deficiency anemia

Macrocytic cells indicate

Vitamin B12 deficiency, liver disease,

Polychromasia

Larger cells, Blue/ gray color (methylene blue stain)

Reticulocytes in response to anemic stress

Hypochromia

large central pallor than normal red cell

seen in IDA and thalassemia

Heinz bodies

denatured hemoglobin

Howell jolly bodies

DNA remnants

Retics

contain RNA

Pappenheimer bodies

contain Iron

Basophilic stippling

also contain RNA

Hexose monophosphate shunt of the embden meyerhof pathway

G6PD is produced and protects RBC from oxidative injury

Methgb reductase pathway in the EMP

keeps iron in ferrous 2+ form instead of ferric 3+ form.

hgb can only deliver oxygen in ferrous form

Rappoport Leubering shunt of the EMP

produces 2,3 DGP - the number one determiner of whether or not hgb will let go of oxygen to the tissue.

What is hemoglobin?

carries oxygen in the red cell

Each hemoglobin molecule contains?

4 globin chains (2 alpha and 2 non-alpha chains)

4 iron molecules (FE2 ferrous 2+)

Types of hemoglobin in adults & percentages:

Hgb A: 2 alpha, 2 beta 95-97%

Hgb A2: 2 alpha, 2 delta 2-3%

Hgb F: 2 alpha, 2 gamma 1-2% (95-98% in fetus/ infant)

OD curve

Left shift- increase in O2; increase in affinity= hgb holds O2

Right shift- decrease in O2; decrease in affinity= hgb releases O2

Methemoglobin (abnormal hemoglobin)

Fe 3+ state

not binding to oxygen

induced by drugs (aniline) or genetics (hemo M)

>10%, individuals appear cyanotic

Carboxyhemoglobin (abnormal hemoglobin)

carbon monoxide poisoning

increased in smokers and industrial workers

Sulfhemoglobins (abnormal hemoglobin)

affinity for oxygen is lower

can come from exposure to sulfonamides or sulfa-containing drugs

What is hemolysis?

premature destruction of RBC’s

Extravascular

occurs 90% of the time

occurs in spleen, liver, lymph nodes, bone marrow

Polychromasia in peripheral smear

spherocytes

Intravascular

lysed directly into blood vessels

Hemoglobinemia; red-pink plasma

Hemoglobinuria

schistocytes

Neutrophil maturation stages

Myeloblast, Promyelocyte, Myelocyte, Metamyelocyte, Band, Segmented neutrophil

What do lymphocytes do and where do they develop?

Fight infections and develop in the bone marrow and thymus

what does cytosis mean?

ex) leukocytosis

increase in blood cells

What does philia mean

ex) neutrophils

increase in granulocytes

what does penia mean?

decrease in blood cells

What is tranferren?

transports iron within the cells

Eosinophil maturation stages:

Myeloblast, Promyelocyte, Eosinophilic myelocyte, Eosinophilic metacyte, Eosinophilic band, Esosinophilic

Monocyte maturation stages:

Monoblast, Promonocyte, Monocyte

Lymphocyte maturation stages:

Lymphoblast, Prolymphocyte, Lymphocyte

T-helper cell and T-cytotoxic/ surpressor cells are also known as:

CD4 and CD8

Eosinophil color

Basophil color

Neutrophil color

Red/ orange

purple

pink/ tan

Segs range

50-70%

fights bacteria

Bands range

2-6%

Lymphocytes range

20-44%

fights viruses

Mono range

2-9%

Eosinophil range

0-4%

fights parasitic

Basophil range

0-2%