Hematology Final Exam Review

Flashcards for Hematology Final Exam Review

Total Count=

Formula for cell counts using a hemacytometer.

Cathode

Loading point of Patient sample during Hemoglobin Electrophoresis

Myelocyte

The last granulocyte to undergo mitosis

Primary Granules (Non-Specific)

First seen in Promyelocyte; examples includes Myeloperoxidase

Secondary Granules (Specific)

First observed in the Myelocyte; Contains lysozomes

Leukemia

Cells with high N/C ratio, multiple nucleoli, no granules and fine nuclear chromatin, may indicate:

Plasma Cells and Lymphocytes are found in both:

Peripheral blood and bone marrow.

Rubricytes are found:

Only in bone marrow

Hematocrit Value of 37% is:

Normal for an adult female: 35-49%

NOT typically part of a differential

Estimation of red cell number

Corrected WBC=

WBC X 100 / (#NRBC+100)

Normal for a newborn; abnormal for an adult

5 orthochromic normoblasts (metarubricytes) in the peripheral blood

Patient has a white count of 1,000/µL with 60% neutrophils:1,000 x 0.60 = 600 neutrophils per microliter

Absolute neutropenia

Absolute neutrophilia

Patient has a white count of 150,000/µL with 40% neutrophils:150,000 x 0.40 = 60,000 neutrophils per microliter

M:E Ratio

Myeloid to Erythroid Ratio, Includes Myeloid cells and Erythroid cells but not lymphoid ; Normal 3:1

Clinical presentation for all Myeloproliferative Chronic Myeloproliferative Disorders:

fatigue, malaise, bone pain, splenomegaly, and symptoms related to cell counts

low Leukocyte Alkaline Phosphatase (LAP) helps distinguish:

CML from a leukemoid reaction

Acute Myeloid Leukemia

AML; Acute leukemias have variable WBC with decreased platelet, Patient presents with bruising, Hypercellular BM, >30% Blasts in Bone Marrow, most common type of leukemia in adults; Incidence increases with age

Acute leukemia almost always has these blood counts?

Low platelet count

Acute Lymphocytic Leukemia

ALL (L1-L3)-Mostly blasts with one nucleolus and scanty cytoplasm, TdT, PAS, and CALLA positive, Best chance for survival for acute leukemias

Chronic Lymphocytic Leukemia

CLL- Small, mature lymphocytes with smudge cells, High WBC with low/normal PLT - Best prognosis of all leukemias among adults

Hairy Cell Leukemia

Hairy Cell Leukemia; Pancytopenia with hairy cells, Dry bone marrow type TRAP positive Tartrate Resistant Phosphatase

Multiple Myeloma

Malignant plasma cells with high serum immunoglobulins,Increased calcium and protein, Found in older adults, Observe punched-out bone lesions, Peripheral pancytopenia with rouleaux

Hodgkin’s Lymphoma

Found in younger patients, Reed-Sternberg cell found in Bone marrow, Present with fever of unknown origin

Non-Hodgkin’s Lymphoma

Non-Hodgkin’s Lymphoma; Found in Older patients, Many different varieties, May see Butt Cells Immature Bizarre lymphoid cells

typical blood picture in lymphoma without bone marrow involvement:

Normal

Qualitative WBC disorders:

Toxic granulation, Dohle Bodies, Vacuoles

Reactive Lymphocytes:

Description for reactive (atypical) lymphocyte; Nucleus is often stretched out, May have granules, Ballerina skirt, Monospot and heterophile positive

patient has a hemoglobin value of 7.8 g/dL. The patient's MCH will be?

Could be low, normal, or high

Macrocytic Anemia

Megaloblastic Anemia; Defective DNA synthesis from B 12 or Folate poor diet, Bone marrow will show asynchrony, karryorhexis, giant metamyelocytes and bands, Hypersegmented Neutrophils, Pancytopenia

Macrocytic Anemia

Pernicious Anemia: Lack of intrinsic factor which is involved in the absorption of B 12

Microcytic Anemia

Iron deficiency (Hypo, Micro); Chronic blood loss the most common reason in adults, Poor diet ↓Serum Fe ↑TIBC ↓ Ferritin

Microcytic Anemia

Beta Thalassemia; Hypo,micro, Common in Mediterranean, South East Asians, and Black, Target cells, Basophilic stippling, increase in alpha chains, Electrophoresis ↑ A2 and F

Sports Anemia (march Hemoglobinuria)

loss of 10% of total blood from an acute bleed

Alpha Thalassemia 4 gene deletion

Serious life threatening disease

Which anemia would produce the most polychromasia on the blood smear?

Iron Deficiency Anemia

Paroxysmal Nocturnal Hemoglobinuria

Cells sensitive to lysis by complement

Cells fragmented by fibrin in vessels

Microangiopathic Anemia (DIC)

Product involved in heme synthesis

Hemosiderin

Hemosiderin in urine; Urine Free Hemoglobin

Intravascular Hemolysis

Inherited defect in spectrin, Decreased cell surface, Peripheral smear: Spherocytes (MCHC >36%), Polychromasia,↑ Osmotic fragility

Hereditary Spherocytosis

Pernicious Anemia

50-year-old white female who was experiencing shortness of breath on exertion, and numbness and tingling of her fingers. She is thin and pale with a slight yellow tinge to her skin. Her tongue is very smooth and slightly reddened. HGB= 4.7 g/dL HCT = 13.6% RBC = 1.1 x 10 6/µL WBC = 2.0 x 10 3/µL PLT = 87.0 x 10 3/µL

Hereditary Spherocytosis

At 0.55% NaCl there was a tinge of color in the supernatant and at 0.35% NaCl there was a dark red color with no red cell button. This osmotic fragility test is helpful for

Paroxysmal Nocturnal Hemoglobinuria

Red urine, Urine hemosiderin +, Sucrose + (Sugar Water), Ham’s test +

Auto Immune Hemolytic Anemia

Warm, Spherocytes, Polychromasia,+DAT

Sex-linked, decrease in enzyme Oxidant; drugs cause hemoglobin to denature and precipitate

G-6-PD; Heinz bodies seen with Methylene Blue

Pyruvate Kinase; Reduced ATP production results in alterations of RBC membrane

Peripheral Smear: Echinocytes

Lead Poisoning; Chronic exposure can lead to Hypochromic, Microcytic

Basophilic Stippling

Sickle Cell Beta Chain substitution ( β7[A3]Glu→Val)

Cells form rods at low O 2, Sickle Dex +

Significance of Reticulocytes:

Increased in our hemolytic anemias

Iron Deficiency Anemia

Low or normal reticulocyte count (untreated)

Pernicious Anemia

hypersegmented neutrophils; schilling test to diagnose

Seen with New Methylene Blue associated with decreased RBC survival/hemorrhage, erythroid hyperplastic marrow; Referred to as Polychromasia when seen on Wright Giemsa Stain

Reticulocyte-RNA

Heinz Bodies can only be seen with:

supravital stain

ESR A mechanism for cells falling (settling) A screening test

Factors affecting the ESR- Fibrinogen/protein, Rouleaux, Inflammation, infections, malignancies

All of the following cause an elevated ESR EXCEPT

Polycythemia

Platelet Impedence

are counted in same bath as RBC Anything between 2-20fL

RDW

red cell distribution curve width 12-15%

Which of the following would have a normal MCHC?

Macrocytes will have increased MCH, but normal MCHC.

Which of the following would have a low MCH?

Thalassemia trait

How is the hematocrit determined on most automated cell counters?

Calculated using red count and MCV: HCT= (RBC x MCV)/ 10

Which of the following measurements must have the red cells lysed?

Hemoglobin

Polychromasia would most likely be associated with:

Acute blood loss, a couple of days later

WBC Histogram R1 Lymphocyte population

does not begin at baseline (35fL)-Clumped or Giant Platelets, NRBC, Intracellular parasites

Interfering Substances for Cell Counters Interference

High Glucose

Which of the following will NOT affect the automated hematocrit?

Cold Agglutinin

What should be done before reporting these results?

Warm the sample to 37 degrees and rerun

the best course of action when hematocrit results dropped 5% after IV therapy

Report the results-it makes sense in view of the therapy

Anisocytosis

Variation in cell size

Poikilocytosis

variation of RBC shape

interfere with hemoglobin determination on the Coulter analyzer

Lipemia, High WBC, decreased RBC lysing reagent

What is the defect in Beta Thalassemia Major?

Rate of globin chain synthesis

What is the defect in Hemoglobin SC disease?

structural defect in globin chain

What is the problem in microangiopathic anemia?

Cells fragmented by fibrin in the vessels

What is the problem in PNH?

Cells are sensitive to lysis by complement

What is the best test to distinguish IDA from anemia of chronic disease?

Ferritin

What is the best test to distinguish PV from secondary polycythemia?

Oxygen saturation

M5 (monocytic)

a patient has peripheral smear containing blasts that react with the non-specific esterase stain, a positive murimadase, and bleeding gums, what is the most likely leukemia?

What cells are increased in Myeloid Hyperplasia?

blast

What would the M:E ratio be in myeloid hyperplasia?

Increased

a normal finding in adults?

an occasional echinocyte

Change their Shape

what must RBCs be able to do to escape the macrophages in the spleen?

Nuclear clumping.

What distinguishes a Myeloblast from a Lymphocyte? This image is of a myeloblast.

Distinguish from a left shift

Why should Pelguer-Huet anomaly be identified?

Administering Chloramphenicol

Often causes aplastic anemia?

Intravascular Hemolysis

What does urine hemosiderin indicate?

Why should Pelguer-Huet anomaly be identified?

Distinguish from a left shift

Which of the following is a product involved in heme synthesis?

Coproporphyrin