Hematology exam 2 review (for finak study more on cell morphology+characteristics)

At what structure level is a heme group inserted into each of the four globin chains?

Tertiary 3^0 level

Normal hemoglobin production is dependent on what processes?

adequate iron delivery and supply, adequate synthesis of protoporphyrin, and adequate globin synthesis

What form is the majority of iron mostly stored as in macrophages?

Ferritin

How many atoms of ferric iron can transferrin transport through the plasma so it goes into RBCs?

2

Best description of heme transport

Heme leaves the mitochondria and travels to the cytosol (cytoplasm) to join the globin chains

How to describe the tertiary hemoglobin structure

Helically coiled, third structural level of one globin molecule has primarily alpha helices (NO beta pleats)

How many polypeptide chains? How many pairs? are associated with the Hgb quarternary level structure?

4 polypeptide chains, 2 pairs

Describe the quarternary structure of a Hgb molecule

spherical, has four heme groups attached to four polypeptide chains, and can carry four molecules of oxygen

Primary structure of Hgb is best described as

A sequence of a chain of amino acids (polypeptide chain)

how is a secondary level Hgb structure formed?

Occurs when the sequence of amino acids are linked by hydrogen bonds

How is the teriarty level of a Hgb molecule formed?

Occurs when certain attractions are present between alpha helices and pleated sheets

What types of hemoglobin accumulation/conditions would shift the oxygen dissociation curve left?

Carboxyhemoglobin and methemoglobin

2,3-BPG/DPG = _____ form = decreased O2 affinity = increased O2 offloading (in ____ ?)

No 2,3-BPG/DPG = ______ form = increased O2 affinity = increased O2 uptake (in ____?)

Tense, tissues

Relaxed, lungs

Bohr effect is phenomenon in which

increased pH (= decreased acidity) causes left shift.

Embryonic Hgbs formed at the first three months after conception are

Portland, Gower I and Gower II

Gower I is made up of what chains?

2 zeta and 2 epsilon

Portland Hgb is made of what globin chains?

2 zeta 2 gamma

Gower II is made up of what chains?

2 alpha 2 epsilon

Glycosylated Hemoglobin

- Hgb can be modified by nonenzymatic binding of various sugars with the globin

- Most common is Hgb A1C – glucose attaches to the N-terminal valine of the β chain

→Older cells typically contain more due to prolonged exposure (4-6% normal)

→ Normally, 4-6% of Hgb A circulates as Hgb A1c, but increases with diabetes (proportional to the mean glucose level over 2-3 months

What is the largest cell in the bone marrow

Megakaryotcytes

Normal range for platelets

150,000-450,000/ul

What is the major growth factor that regulates megakaryocytopoiesis?

thrombopoietin

What doesLD-CFU stand for?

Light Density colony forming units

What happens to the nucleus size as a megakaryocyte matures?

It increases

Fe3+ ferric or ferrous?

Ferric

Which type of megakaryocyte is the largest cell in the bone marrow?

Basophilic/ Granular megakaryocyte (MK III)

A mature megakaryocyte should have what characteristics?

All of the choices are correct

________ stimulates production of platelets, ________ activates platelets

Thrombopoietin (TPO), thrombin

Where do granulocytes develop? What type of cells are produced there?

bone marrow; segs, eos, monos, basos

What form is ferrous iron?

Fe2+

Each Hgb molecule consists of

4 globin chains and 4 heme groups, each w/ a center iron molecule (4 iron)

What type of “pocket” does each globin chain contain? What do they contain? Why?

Each globin chain has a hydrophobic “pocket” containing a heme group

→Arrangement prevents the Fe2+ from oxidation into the ferric form (Fe3+)

Heme is produced how?

Protoporhyrin IX + Fe2+

What is each heme iron directly bonded to in the globin chain?

2 histidines of the globin chains

Proximal histidine function

Increases oxygen affinity

Oxygen tension occurs

In tissues

Oxygen affinity occurs

in the RBCs

How is oxygen tension regulated?

Through the oxygen affinity of Hgb

How is oxygen affinity regulated?

modulated by the concentration of phosphates in cell

When tissue is hypoxic

Hgb decreases which reduces oxygen affinity (bc oxygen will move from Hgb into tissue to compensate)

Oxygen dissociation curve

The affinity of Hgb for O2 depends on the partial pressure of O2 (PO2).

graph plots the O2 content of Hgb (% saturation) versus the PO2

A shift to the left on the oxygen dissociation curve would affect oxygen affinity in what way? Where?

Increased oxygen affinity that would occur in the lungs

think left→lungs

What causes a shift left in the oxygen association curve (inc. oxygen affinity)

Decreased CO2, decreased 2,3-DPG, decreased body temp.

increased pH, increased oxygen affinity

Carbon Dioxide Is transported from the tissues to the lungs by what methods?

Dissolution directly into the blood, binding to hemoglobin-carbaminohemoglobin, carried as a bicarbonate ion (~75%)

carbonic anhydrase (CA) function

Catalyses the conversion of CO2 (given up by tissues) and H2O, to produce carbonic acid (H2CO3)

About 90% of the blood CO2 is converted to

Bicarbonate and H+ ions

What type of iron is contained in methemoglobin?

Ferric (Fe3+)

Accumulation of methemoglobin shifts the oxygen dissociation curve-

Left, leading to hypoxia

Leukopoeisis produces and proliferates white blood cells except

Where does leukopoiesis occur?

Lymphocytes, in the bone marrow,lymphnodes,&thymus. “BLT”

Production of neutrophils, eosinophils, basophils is called

Myelopoiesis

Why are mononuclears Not considered granulocytes?

Mononuclears can have very fine granules, but granulocytes all have large noticeable granules and segmented nuclei

The presence or absence of nucleoli indicate what for nuclear characteristics?

Immaturity

Eosinophils contain granules that mostly contain what?

Crystalloid form Major Basic Protein (MBP)

Largest cell in the peripheral blood (p.b)

Monocytes

Primary phagocytes are what types of cells?

Monocytes and neutrophils

Name blood cells that are capable of phagocytosis

Eosinophils, basophils, neutrophils, monocytes, macrophages,

Chemotaxis is best described as

Process of phagocytes movement along gradient of increasing chemotaxis (generated by infection or inflammation)

what cells get to the site of inflammation/infection first?

Segmented neutrophils

Place the following WBCs in order of their phagocytic activity (NOT SPEED)

Eos, Basos, Monos, & Segs

Monos > segs > eos > basos

CFU-L differentiates the lymphoid maturation pathways into what?

B-lymphocyte precursor

T -lymphocyte precursor

Basophilic in hematology refers to

Bluish color (NOT related to whether cell s a basophil!)

Secondary lymphopoiesis occurs where

Spleen, lymph nodes

Plasma cells physical description

Type of lymphocytes with eccentric (off to the side) nucleus

Plasma cell functions

Secrete immunoglobulins and are responsible for antibody production

Helper T cells, other name and function

CD4+ cells, induce other lymph’s to carry out certain functions (ex. Inducing B cells to produce Antibodies)

Delayed hypersensitivity T cells function

Produce chemotactic lymphokines(cytokines produced by lymphs) in response to antigens

Majority of natural killer T cells are, what is their function?

CD56+ or CD16+

Kills tumor/virus infected cells

Cells that confuse lymphocyte identification

Blasts, monocytes, rubricytes/polychromatic normoblasts

Monocyte difference from lymphocytes

Monocyte cytoplasm tends toward blue gray color and have an opaque, “ground glass” appearance

Rubricyte difference from lymphocytes

Rubricyte cytoplasm has a grayish blue appearance, lymph cytoplasm is a clearer blue. Rubricyte chromatin is much denser than lymphocytes’ chromatin

describe an primary/nonspecific/azurophilic neutrophil granule contents

red-purple color, contains: lysosomes, acid hydrolases, myeloperoxidase (MPO), proteases, superoxide, positive for peroxidase

secondary/ specific/ neutrophilic neutrophil granule contents

pale- lavender pink , contain lysozyme, NO peroxidase

tertiary neutrophil granule contents

color is invisible/clear, appears in very late stages, contains lysozymes and gelatinase, NO peroxidase

Lymphocytosis

Above normal range in adults - 4.0 × 10³/ ul

Above normal range in children - 9.0× 10³/ul

Type II atypical lymph’s other name

Aka Downey cells

Downey cells

Classical reactive or atypical lymphs

Indicative of Epstein-Barr virus!

Seen in infectious mononucleosis!!!

Abundant cytoplasm, irregularly shaped, and edges indented by surrounding structures

Fried egg appearance, no nucleoli

Type III atypical lymphocytes are

Largest of the atypical lymphocytes

Immature chromatin with nucleoli

Myelopoiesis refers to the production of which cells?

Neutrophils, eosinophils, basophils

What WBCs are classified as granulocytes?

Basophils, Neutrophils, Eosinophils

Rmemorize five main types of WBCs and their prominence in the bone marrow

Neutrophils- 50-70%

Lymph- 18-42%

monos- 2-11%

eos- 1-3%

basophils 0-2%

CFU-GM functions and what it matures into

ILs and CSFs control the stability of cell numbers and their functions

Matures into a myeloblast

CFU-GEMM matures into

CFU-GM

Multi-CSF / IL-3 production is stimulated by what?

Endotoxin released from infection

Source of multi CSF/IL-3

Secreted by marrow fibroblasts , t-lymph’s, macrophages and monocytes

function of G-CSF

Stimulates AND enhances the functional response of neutrophils

Band nucleus traits

Curved band- like nucleus, straight C or S shaped nucleus with no segments

Possess full motility, active adhesion properties and some phagocytic activity

A maturation shift to the left occurs when neutrophil bands are increased in pb in comparison to the number of sets

Segmented neutrophil traits

Comprise 50-70% of total WBC population in normal adult

Cell is completely functional

Should have 2-5 lobes

Maturation shift to the right occurs when there is more than 5 lobes (inc. maturation)

Circulating pool (CP)

Neutrophils circulating in the blood

Marginating pool (MP)

Neutrophils that lie against endothelial lining of blood vessels

diapedesis

Performed by granulocytes, process which they squeeze through tight junctions between endothelial cells of the blood vessels and exit into the tissues. Once in the tissues, they do not return

Eosinophils granule contents

Major Basic Protein

Major basic protein (MBP) are

Granulocytes of eosinophils which is lysine and arginine rich

Functions of eosinophils

Control parasitic infections and dampen allergic/hypersensitivity reactions

which of the following are granulopoiesis regulators?

all of them

which is the most EPO / Erythropoietin sensitive?

CFU-E

function of IL-2

growth factor that produces lymphocytes

what Hgb is never found in adults?

epsilon

which colony stimulating factor is important for myeloid maturation in the bone marrow?

GM-CSF

which neutrophilic stage comes first?

bands

A cell has water soluble, large bluish-black lysosomes that contain heparin and histamine. These granule contents also can overlie the nucleus. What cell is this?

Basophils