LD-Heme Exam

what are the types of cells called that have no granules in cytoplasm

agranulocytes

the 3 granulocytes are differentiated into 3 cell lines based upon __

staining characteristics

neutrophils stain __

pink/neutral

eosinophils stain __

red

basophils stain __

dark blue

what is another name for granulocytes

polymorphonuclear cells

what is one of the most common tests ordered to evaluate fro illness that reveals general composition of formed elements in blood

complete blood count

the “first line of defense” is the tissue __

macrophage

what are the first responders that proliferate and increase in # very quickly in response to infection

neutrophils

what is the abbrv for hematocrit

HT

what is the abbrv for platelets

platelets

what is the abbrv for hemoglobin

HGB

what is the abbrv for red blood cells

RBC

what is the abbrv for white blood cells

WBC

elevations in leukocytes are indication of what

infection &/or inflammation & described by WBC count in CBC

what is the normal leukocyte level

4,500-11,000 cells/mm3

abnormal levels for leukocytosis are __

>11,000

abnormal levels for leukopenia are __

<4,500

what doe sthe WBC with Diff provide

results of which WBCs are cause

the # of WBC most often measured as __

component of complete blood count

what is provided when CBC is ordered w/ differential

count and % of 5 different WBC subtypes

what type of differentials are more accurate than manual, but some conditions that require manual differential, such as when leukemia or platelet clumping suspected

automated differential

why is a differential count rarely needed w/ initial evaluation of CBC or WBC but still ordered

helpful in DDX if leukocytosis/leukopenia is detected

what levels define hyperleukocytosis

leukocytosis >100 × 103 cells/uL

why is hyperleukocytosis a clinical emergency

risk of leukostasis

what are the problems usually seen with hyperleukocytosis

leukemias and myeloproliferative disorders

what leukocytes have the largest role

neutrophils

what are elevations of WBC and ANC (absolute neutrophil count) are sometimes used to evaluate

bacterial infections

what is the ANC

measurement of neutrophils specifically

—absolute neutrophil count

what happens if too many neutrophils are consumed during infection response

bone marrow increase production and release into circulation at more immature stage

what is a left shift and when seen

-more bands of immature neutrophils, metamyelocytes, and/or myelocytes seen in circulation than usual

-seen when increase in band # in circulation and indicated acute bacterial infection

bands make up <5% of circulating neutrophils normally, while many banded forms are present where

bone marrow

T/F: a left shift is usually only seen in more severe bacterial infections

true

if infection severe enough for left shift to occur, when is it seen

12-24 hrs while WBC decreased and before it recovers

what is resolution of infection signaled by

movement of WBC back to normal reference intervals and disappearance of left shift

what should an unexplained, persistent elevation or decrease warrant

consideration for hematology referral

neutrophilia with high # of bands suggests what source

bone marrow

what is the enzyme that catalyzes formation for lactate from pyruvate in anaerobic metabolic pathway (of glucose)

lactate dehydrogenase (LDH)

what do cancer cells employ to increase their aerobic metabolism

LDH

what are high LDH levels assoc. with

advanced stages of cancer and is important prognostic factor for different tumors and used as marker for staging of dz

what has been used for years as part of clinical evaluation of malignancies and noted to be a clinical biomarker in lymphoid malignancies

serum LDH

what is one of the most useful serum biomarkers for assessing metastatic melanoma since it has been found to be independent prognostic factor

LDH

LDH can be ordered as part of diagnostic workup along w/ __ and other test when individual has condition believed to be causign degree of cellular or tissue damage such as malignancies

CMP

what are the 2 main types of proteins in the body and what are they called when measured together

-albumin and globulin

-total protein

what is electrophoresis in regards to proteins

proteins characterized by way they move in electric field

T/F: serum protein electrophoresis can be performed on any body fluid

true

what does the serum protein electrophoresis do

detect and quantify existence of atypical proteins and lack of normal proteins and identifies pattern of migration across electric field linked with selected states of health

what can SPEP help with

suggesting disease or health disorder that impacts protein production in the body

what is the gold standard medium for SPEP and why

IFE

-increased sensitivity

what the advantage of SPEP

differentiates between monoclonal and polyclonal proteins

which test has higher sensitivity and less likely to have bias

SPEP

what is SPEP preferred over

urine protein electrophoresis

the normal reference range of UPEP is the lack of what

atypical monoclonal protein, M protein/M spike

what % of multiple myeloma pt have protein in urine and what is the MC band elevation seen

20%

gamma band

what populations should screenings for protein electrophoresis be considered

-s/s of immunocompromised

-known monoclonal gammopathy of undetermined significance (MGUS)

-suspected/known multiple myeloma including present of: bone fracture/pain, hypercalcemia, anorexia, lethargy, anemia, carpal tunnel syndrome

-suspected/known Waldenstrom macroglobulineumia

what is Waldenstrom macroglobulinemia

rare type of non-Hodgkin’s characterized by overproduction of IgM

consider protein electrophoresis testing for what PE or lab findings

-unexplained neurologic sx such as peripheral neuropathy

-night/unexplained sweating

-splenomegaly

-proteinuria

should dx be considered solely on SPEP?

no because interpretation cause will likely be in context of other labs needed

what are other terms for peripheral blood smear

-blood smear scan

-platelet scan

-platelet estimate

-blood smear review

-blood smear interpretation

-physician review of blood smear

-hematomorphology evaluation

-blood smear exam w/o differential

what can you use peripheral blood smear to dx/evaluate

-underlying cause of cytopenia, lymphoproliferative findings, hemolytic anemia

-suspecte dmalignancy/stem cell d/o

-infection w/ microorganisms that would show up on peripheral smear (malaria, babesia, borellia, C. perfringens, ehrlichiosis)

-pt w/ positive international society on thrombosis and hemostasis bleeding assessment tool score

a CBC of acute myelogenous leukemia will show what

-Hyperleukocytosis >100,000 with markedly elevated levels of circulating blast cells

-decreased # of other WBC, RBC, platelets

a peripheral blood smear of acute myelogenous leukemia will show what

• Increased number of immature (blasts) cells with many myeloblasts and promyelocytes

• A severe decrease in thrombocytes 

• Auer rods (rods-shaped structures in the cell cytoplasm)

what is the MC leukemia in children

acute lymphocytic leukemia

a CBC of acute lymphocytic leukemia will show what

• Hyperleukocytosis >100,000 with markedly elevated levels of circulating blast cells 

• Decreased number of the other WBC, RBC, and platelets

a blood smear of acute lymphocytic leukemia will show what

• Lymphoblasts with high nuclear to cytoplasmic ratio and bluish cytoplasm or absence of cytoplasmic granules

• Decreased number of platelets and RBC

a terminal deoxynucleotidyl transferase (TdT) stain will show what on acute lymphocytic leukemia

positive: will aid in dx of ALL in children

what are considered diagnostic in distinguishing myeloblastic form lymphoblastic leukemias

auer rods (bodies)

in which type of leukemia will lymphoblasts with high nuclear to cytoplasmic ratio and bluish cytoplasm/absence of cytoplasmic granules be found

Acute lymphocytic leukemia

a CBC for chronic myelogenous leukemia will show what

• Leukocytosis with a median WBC count of 150,000 is the hallmark of CML

a bone biopsy for chronic myelogenous leukemia will show what

• Hypercellular with a left shift

• Polymerase Chain reaction (PCR) done to identify BCR-ABL gene (aka Philadelphia Chromosome) is the Hallmark of CML

  • Philadelphia chromosome t(9;22):

         aka (BCR::ABL fusion Gene)

what is the most common leukemia overall

chronic lymphocytic leukemia

a CBC for chronic lymphocytic leukemia will show what

• CBC: Isolated Leukocytosis with a WBC >20,000  is the hallmark of CLL

a bone biopsy for chronic lymphocytic leukemia will show what

hypercellular w/ left shift

a peripheral blood smear for chronic lymphocytic leukemia will show what

-increase in mature but small lymphocytes

-smear aka “smudge” cells are pathognomonic

what will a lymph node biopsy show for Hodgkin’s dz

Reed-Sternberg cells in tissue and confirm dx

90% of non-Hodgkin’s are from what cells

B cells

T/F: EBV present in half the cases of Hodgkin dz

true

what is the anti-VCA reference range in Hodgkin dz

negative for EBV ab by IFA or ELISA

what will the lymph node biopsy show for non-hodgkin dz

invasion of prolymphocytic-like cells

what is another name for the gene (BCR-ABL fusion gene) associated w/ chronic myelogenous leukemia

Philadelphia Chromosome

what is another name for plasma cell myeloma (PCM)

multiple myeloma

what is PCM

clonal proliferation of malignant plasma cells, typically arising in the bone marrow, that produce an immunoglobulin or components of immunoglobulin

what are produced in abundance in PCM

monoclonal paraprotein (M protein) or Bence-Jones proteins

what are Bence-Jones proteins also referred to as

M proteins, myeloma proteins, paraproteins, free ig light chains

what are Bence-Jones proteins

proteins that are component of ig produced in excess by B-cell derived clonal cell populations

where can Bence-Jones proteins be found and why

urine because small molecular size

what will you see on a SPEP for PCM

monoclonal spike

what will you see on CBC for PCM

• WBC increase in lymphocytes

• RBC will show anemia with rouleaux (stacking) formation

what will you see on serum protein for PCM

paraprotein levels increased

what will you see on urine and serum test for PCM

positive for “Bence-Jones proteins”

when is dx established for PCM w/ bone marrow biopsy

when monoclonal plasma cells (either kappa or lambda light chain restricted) are found in the bone marrow (any percentage) or in a tumor (plasmacytoma). 

what are RBC stimulated by

erythropoietin (EPO) from kidneys

what is the immature version of a RBC called and what does it contain

reticulocyte

contains nucleus

what is the typical life span of RBC

120 days

what B vitamin # is cobalamin levels

B12

what B vitamin # is folate levels

B9

what are RBC reported on and what does it reflect

-reported on CBC

-reflects # RBC present per microliter or liter of blood

what is anemia

decrease in RBC countwha

what is erythrocytosis and what is it also known as

increased RBC count and aka polycythemia

what does the Hgb conc reflect

amt of Hgb present in specified volume of blood