hematology lab med (not including anemias)

science of blood and the blood forming tissues

hematology

condition with diminished oxygen carrying capacity of the blood (due to destruction/loss/diminished production)

anemia

failure to produce or release mature forms of cells into the peripheral blood or cells destroyed in marrow

ineffective hematopoiesis

formation of blood cells in sites other than bone marrow, primarily in the liver and spleen

extramedullary hematopoiesis

destruction of red blood cells

hemolysis

thin film of EDTA anticoagulated blood on a glass slide, stained and examined microscopically

peripheral blood smear

an increase in the immature forms of cells in the peripheral blood (putting blood cells out too early)

“shift to the left”

blood cell production, starts before birth and continues throughout life

hematopoiesis

where does hematopoiesis happen in the embryo/fetus

embryo- yolk sac

fetus- liver, thymus, spleen and marrow of all bones

where does hematopoiesis happen once youre born

flat bones (sternum, ribs, skull, vertebrae, pelvis) and extra-medullary (spleen and liver)

steps to make RBCs

hematopoeitic stem cell → common myeloid progenitor → proerythroblase → basophilic erythroblast → polychromatic erythroblast → orthochromatic erythroblast (normoblast) → polychromatic erythroblast (reticulocyte) → RBC

steps to make platelets

hematopoeitic stem cell → common myeloid progenitor → megakaryoblast → promegakaryocyte → megakaryocyte → platelets

steps to make WBC’s (either basophil, neutrophil or eosinophil)

hematopoeitic stem cell → common myeloid progenitor → myeloblast → promyelocyte (starts w B, N, or E depending on specific WBC type) → myelocyte (starts w B, N, or E depending on specific WBC type) → metamyelocyte (starts w B, N, or E depending on specific WBC type) → band (starts w B, N, or E depending on specific WBC type) → eosinophil/basophil/neutrophil

steps to make macrophages

hematopoeitic stem cell → common myeloid progenitor → myeloblast → monoblast → promonocyte → monocyte → macrophage or myeloid dendritic cells

steps to make lymphocytes

hematopoetic stem cell → common lymphoid progenitor → lymphoblast → prolymphocyte → natural killer cell or small lymphocyte → (from small lymphocyte) B lymphocyte or T lymphocyte → (from B lymphocyte) plasma cell

types of mature blood cells

RBCs, WBCs (neutrophils, eosiniphils, basophils, monocytes, lymphocytes), platelets (thrombocytes)

protein stimulators for hematopoiesis

erythropoietin, thrombopoietin, interlukins

inhibitors for hematopoiesis

interferons, lymphotoxins

what is the mechanism for stimulating hematopoiesis

low O2 in body → kidneys secrete erythropoietin → erythropoietin stimulates erythropoiesis in bone marrow → increased RBC’s

what are the steps of hemoglobin synthesis that happens in the erythroblast in the bone marrow

basophilic erythroblast → polychromatic erythroblast → orthochromatic erythroblast

during what step does your baby RBC get rid of its nucleus in order to make room for more hemoglobin

orthochromatic erythroblast

what gives RBCs their color

heme binding w O2

where to phagocytes break down RBCs when they got old or if theyre injured

liver, spleen, bone marrow, lymph nodes

what happens to the parts of the RBCs after theyre broken down

protein and iron recycles, waste products excreted in piss and shit

what specimens can we use for EDTA

EDTA (purple top), Heparin (green top), sodium citrate (light blue top), can do a bone marrow biopsy if you need to (bring a lab tech in room w you and they put sample on slides immediately

what could make your CBC results inaccurately low

hemolysis/clotting

a manual method for CBCs where you put the blood on a slide and have to physically count it, not used much anymore unless something is wrong w the automated machine

hemocytometer

method for CBC analysis done more often that gives you a distribution scale for RBCs, WBCs, and platelets

automated hemocytometer

what measurements are included in a CBC

RBC, Hgb, Hct, RBC indices, MCV, MCH, MCHC, RDW, PLT, MVP, WBC, differential (optional, costs more)

CBC measurement that indicates red blood cell count (total number X 10^12)

RBC

CBC measurement that indicates the amount of protein transporting oxygen (indication of oxygen carrying capacity)

Hgb (hemoglobin)

CBC measurement that indicates packed RBCs, expressed as a %; L/L (42%=0.42 L/L); portion of blood occupied by RBCs, directly measured by centrifugation/automation or calculated w a formula, indicator of blood vol changes or hydration status

Hct (hematocrit)

CBC measurement that indicates the average size of RBCs

MCV, mean corpuscular volume

CBC measurement that indicates the average amount of hemoglobin in RBCs

MCH, mean corpuscular hemoglobin

CBC measurement that indicates the average concentration of hemoglobin in RBCs (color of the RBCs)

MCHC, mean corpuscular hemoglobin concentration

CBC measurement that indicates variability in RBC volumes/sizes (anisocytosis)

RDW, red cell distribution width

CBC measurement that indicates platelet (thrombocyte) count, total number X10^9

PLT, platelet count

CBC measurement that indicates average platelet volume

MPV, mean platelet volume

CBC measurement that indicates white blood cell count, total number X10^9

WBC, white blood cell count

CBC measurement that indicates % of each individual type of WBC present, also reported in absolute numbers

differential

if you see reticulocytes on a blood smear what does that mean

the bone marrow is putting out little baby RBCs that arent mature yet which indicates bleeding or some kind of problem

an RBC condition that makes blood thicker with sluggish flow

erythrocytosis aka polycythemia aka too many RBCs

what can cause erythrocytosis

hemoglobinopathies, reactive conditions/hypoxic environments (ppl living at high elevation, smokers, COPD), erythropoietin-producing tumors, myeloproliferative neoplasms (polycythemia vera)

what does erythropenia (low RBC count) indicate

anemia

what does increased hemoglobin (Hb/Hgb) mean

dehydration, COPD, congestive heart failure, cancer, smoking, living in high altitudes, excess erythropoietin

what does decreased hemoglobin (Hb/Hgb) mean

anemia

what is the formula to calculate hematocrit

HCT (%) = (RBC x MCV) / 10

what is hematocrit directly proportional to

RBC and Hbg (“rule of 3” = RBCx3= Hgb, Hgbx3= Hct)

what does low hematocrit indicate

anemia or blood loss

what does high hematocrit indicate

polycythemia or dehydration

MCV calculation formula and use

MCV= Hct/RBC, allows the classification of anemia

formula for MCHC and use

MCHC (%) = Hgb / Hct x 100, used as a more direct index of oxygen carrying capacity

what does low MCHC indicate

iron deficient anemia

what does high MCHC indicate

iron overload, spherocytosis, macrocytic anemia, blood disorders, meds

seeing many different sizes of RBCs on the blood smear

anisocytosis

seeing many different cell shapes on the blood smear

poikilocytosis

calculation of RDW-CV (coefficient of variation)

RDW-CV = SD of MCV x 100/MCV

a direct measurement of RDW that is not affected by MCV

RDW-SD (standard deviation)

when RBCs form a stack on each other like a stack of coins

rouleaux

when RBCs all clump together in a big pile

aggregates