Hemetology BIG Questions

What are the 4 classification of leukocytes?

Defense functions, shape of nucleus, site of origin, and type of granulation

What are the 3 non-malignant changes seen in WBCs?

Cell number, cytoplasmic, and nuclear changes

What is the name for the increase and decrease of WBCs and what are the values associated with each?

Leukocytosis → 11.0×10³/μL

Leukocytopenia → < 4.5×10³/μL

How do we measure quantitative changes in WBCs

Total WBC count and differential including relatives and absolutes

How do we measure qualitative changes in WBCs?

Microscopically

What do we often see with neutorphilia?

Left shift (increase in immature)

Starting with the most mature, list the cells seen with left shift

Segs → Bands → Metas → Myelocytes → possibly pros

What causes falsely elevated neutrophil count?

Demargination

What causes neutropenia? (both psuedo and normal)

Increase of immune destruction, neutrophil increase egressing to tissue, and decrease in bone marrow production

What are the characteristics of a Leukamoid reaction?

Elevated WBC count (>25 ×10³/μL), neutrophilia, a left shift, and increased LAP

What is the importance of an LAP?

Enzyme found in secondary granules of neutrophils and an increased activity indicates Leukamoid reaction

What is a Dohle body and what color does it stain?

Cytoplasmic inclusion found in neutrophils made up of rRNA and stains sly blue

What is toxic granulation and what color do they stain?

Dark course granules found in granulocytes and stain deep purple

What are the 3 “toxic” changes that can be seen in neutrophils together?

Toxic granulation, vacuoles, and Dohle bodies

What is CML?

Chronic myeloid leukimia. It is a myeloproliferative neoplasm (MPN)

What is the Philly Chromosome and what does it make?

Translocation specific chromosome 9 to chromosome 22: t(9,22)

It is the BCR-ABL fusion gene and it makes tyrosine kinase

What is the leukerythroblastic reaction?

Presence of nRBCs and neutrophilic left shift

What are the 4 types of cytoplasmic abnormalities of neutrophils?

Dohle bodies, toxc granulation, vacuoles, and intracellular organisms

What are some examples of nuclear changes?

Hyposegmentation, hypersegmentation, and Barr body

What causes hypersegmentation and how many lobes must be present?

B12/folate deficiency and 5 or more lobes must be present

What is a Barr body?

Inactive X chromosome in a female

How do neutrophils kill invaders?

Respiratory burst, lysosome → phagolysosome, degranulation, and NETs

How is neutrophil function impacted in Alder-Reilly?

Despite having large granules they function normally EXCEPT they fail to breakdown mucopolysaccharides

What is the primary disfunction of neutrophils in Chediak-Higashi?

Granules cannot be delivered to phagosome and defective chemotaxis

What causes children with Chediak-Higashi to have a high mortality?

Recurrent bacterial infections

What characteristics are May-Hegglin?

Dohle like inclusions and giant PLTs

What is the presentation of CGD?

Neutrophil count is normal, Ig levels are increased (specifically IgG), and reoccurring infections

What is the difference between qualitative and quantitative tests?

Qualitative → Yes or No

Quantitative → numeric value

What type of bacteria are CGD most susceptible to?

Catalase positive (CAtALASE acronym)

CAtALASE acronym

C → Candida

A → Staph aureus

t

A → Psuedomosis aruginosa

L → Listeria

A → Aspergillus

S → Serratia

E → E. coli

If neutrophil cannot kill CGD, where does it go?

Released from neutrophil when it dies or causes granulomas

What WBCs usually have MPO?

Neutrophils, eosinophils, and monocytes

What enzyme is deficient in Gaucher?

β-glucosidase

What enzyme is deficient in Neimann-Pick?

Sphingomylinase

What macromoleule is accumulating in both Gaucher and Neimann-Pick?

Lipids

What is the neutrophil disorder considered a lysosomal disorder of mucopolysaccharides?

Alder-Reilly

What are histiocytes?

Langerhans cells, DCs, monos, and macros

What are the 2 categories of lysosomal storage disorders based on type of macromolecule?

Lipid and mucopolysaccharides

What type of infection causes increased lymphocytes?

Viral infection

What is the adult reference range for absolute and relative lymphocytosis?

>4.8×10³/μL absolute

>44% relative

How do children differ with lymphocytosis?

Depending on the age children will have more lymphocytes (up to 78% 6mo-1yr)

What do we call an adult with increased lymphs and decreased neutrophils?

Reverse Diff

What causes lymphocytosis?

Response to viral infection or to inflammatory condition

What would a CBC of a patient with mononucleosis look like?

Increased WBCs (absolute 12-25 ×10³/μL), increase lymphs (>50%), increase reactive lymphs (>20%), and slight PLT decrease

What is the heterophile antibody?

Non-specific antibody made when exposed to EBV

What is toxoplasma gondii?

Intracellular protazoan

What is definitive host of toxoplasma gondii?

Cats

What is CMV?

Cytomegalovirus

What causes lymphocytopenia?

Decreased production and increased destruction of lymphocytes

In adults what is the range for lymhocytopenia?

<1.0×10³/μL (absolute)

< 24% (relative)

How do we measure Hgb?

Spectrophotometrically

How do we blank a spec?

Makes sure we are measure what is in the tube rather than around the tube

What is reagent used in Hgb spectrophotometry and what is in it?

Drabkin’s

Potassium ferricyanide and potassium cyanide

What reaction product occurs with Drabkin’s reagent?

Cyanmethemoglobin

What wavelength do we measure Hgb?

540 nm

What law governs Hgb measurement?

Beer’s Law

What are 2 general principles for hematology instrumentation?

Electrical impedance and optical scatter

What is another name for electrical impedance?

Coulter principle

What does the Coulter principle measure?

Displacement/Volume

What is coincidence error?

When 2 cells pass through aperture at the same time

What is coincidence error graphically?

Two particles in sensing zone and histogram will either show two peaks or one peak above threshold entirely

What is another name for radiofrequency?

Conductivity

What do you get with plotting RF VS. Impedence?

Alternating current VS. Direct current

Complexity VS. Size

What is the diagnosis with the following results: WBC = 23.8×10³/μL, LYM% = 8.1%, MXD% = 7.9%, and NEUT% = 84.0%?

Neutrophilia

What is the diagnosis with the following results: WBC = 7.9×10³/μL, LYM% = 64.7%, MXD% = 15.8%, and NEUT% = 19.5%?

Lymphocytosis

What technology does the Coulter utilize?

AC/DC optical scatter (VCS technology)

What does DC/impedance detect?

Size

What does AC/RF detect?

Complexity

What makes sysmex 6 part diff and not a 5 part diff?

IMI channel and detection of immature cells

What makes Seisman ADIVA 6 part diff and not a 5 part diff?

Large unstained cells (LUC)

What instrument would have difficulty detecting MPO disorders?

Seisman AVIDA

For MPO deficiency which cell population is elevated on Seisman AVIDA?

Neutrophil and monocyte shift

What is the major morphological difference between band and meta?

Meta contains a small indent while band is a horeshoe

What is a reticulocyte and what color does it stain?

Immature RBCs that just lost their nucleus and stains blue (due to remaining RNA)

How does instrument measure reticulocytes?

Survival staining with new methylene blue stain

What does NMB stain?

Reticulum and precipitated rRNA

What method is used in lab to measure HCT?

Centrifugation