Clinical Review Book Hematology Test Alerts

Conditions associated with increased storage of iron

Hemosiderosis

Hemochromatosis (organ damage)

Fe transport Protein

Transferrin

Fe storage forms (Major and Long term)

Ferritin - Major storage form

Hemosiderin - H2O insoluble Fe storage form (long-term)

What is a sign of porphyria in urine?

Red or port wine color

Early Heme precursors and their symptoms

Delta - amniolevulinic acid

Porphobilinogen

Neuropsychiatric symptoms (Acute intermittent porphyria or AIP)

Later Heme precursors and their symptoms

Uroporphyrinogen

Coproporphyrinogen

Protoporphyrin

Heme + globin 4 hemoglobin

Cutaneous symptoms (photosensitivity, facial hair)

How to remember the Heme Precursors:

While in DELTA, POR UR COP PRONTO, a cup of HEME

Hemoglobin-Oxygen Dissociation Curve:

Describe a left shift

O2 is NOT released to tissue adequately

Hemoglobin-Oxygen Dissociation Curve:

What conditions cause a left shift?

Decrease in CO2 and 2,3 DPG

Increase in pH

Hb F

Hemoglobin-Oxygen Dissociation Curve:

Describe a right shift

O2 is released to the tissue more easily

Hemoglobin-Oxygen Dissociation Curve:

What conditions cause a right shift?

Increase in CO2 and 2,3 DPG

Decrease in pH

Mechanism of action on EDTA

Chelates calcium

Mechanism of action of heparin

Anti-thrombin agent

Sources of error in hemoglobin

Lipemia/icterus

High WBC count

Excess hemolysis

Resistant hemoglobins (SS, CC)

Male reference range for HGB

16 ± 2

Female reference range for HGB

14 ± 2

What are the 3 forms of hemoglobin?

Methemoglobin

Sulfhemoglobin

Carboxyhemoglobin

Sources of error in HCT

Cold agglutinins

High WBC count

Male reference range for HCT

47 ± 5

Female reference range for HCT

42 ± 5

Formula for MCV

HCT/RBC x 10

Reference range for MCV

80-100

Formula for MCH

HGB/RBC x 10

Reference range for MCH

28-32

Formula for MCHC

HGB/HCT x 100

Reference range for MCHC

32-36

Female reference range for red cells

3.8 - 5.2

Male reference range for red cells

4.5 - 6.1

Function of red cells

O2 transport to tissue

CO2 removal from tissue

Function of neutrophil

To injest and kill bacteria

Function of lymphocytes

Humoral and cell mediated immunity

Function of monocytes

To injest and kill bacteria

Digest debris

To initiate and regulate adaptive immune response

Function of Basophils

Inflammatory response mediator

Function of Eosinophils

Allergic response regulator

Function of Platelet

Clotting

MCHC <32 is an indicator of

Hypochromic Cells and icterus

MCHC >36 is an indicator of

Spherocytes, lipemia, icterus, Hemoglobin SS and/or CC

If a stain is too blue, its an indicator of

Prolonged staining

If a stain is too red, its an indicator of

Prolonged

Conditions where neutrophils are increased

Bacterial infections

Conditions where lymphocytes are increased

Viral infections

Conditions where monocytes are increased

TB, Syphilis, and Malignancies

Conditions where eosinophils are increased

Allergies and parasites

Conditions where basophils are increased

Immediate hypersensitivity

Conditions associated with hypersegmented neutrophils

Megaloblastic Anemia (B12 and folate deficiency)

Conditions associated with hyposegmented neutrophils

Pelger Huet

Pseudo-Pelger huet (Acute Myeloid Leukemia, AIDS)

Conditions associated with toxic granulation and vacuoles

Bacterial infections

Burns

Chemotherapy

Conditions associated with Dohle bodies (RNA)

Bacterial infection

Burns

May-Hegglin

Conditions associated with variant lymphs (increased in size and basophilia)

Infectious mono

Other viral infections

Low platelets = Checking for…

Platelet clumping on the feathered edge

Satelitism

What is satelitism?

When platelets stick in a ring around WBCs

EDTA related- redraw in Na citrate

Large platelets indicate…

Bernard - Soulier

May - Hegglin

Myeloproliferative disorders

Stress platelets

Formula for corrected WBCs when NRBCs are present

WBC count x 100 / 100 + NRBCs

Normocytic rbc size

MCV: 80 - 100

Microcytic rbc size

MCV: <80

Macrocytic rbc size

MCV: >100

Indication of anisiocytosis

RDW: >14.5

Normochromic cell indicator

MCHC: 32-36

Hypochromic cell indicator

MCHC: <32

Hyperchromic cell indicator

MCHC: >36

Conditions associated with acanthocytes

Abetalipoproteinemia

Severe Liver Disease

Conditions associated with echinocytes (burr cells)

Uremia

Artifact (alkaline glass effect)

Conditions associated with elliptocytes

Hereditary elliptocytosis

Iron deficiency

Thalassemia

Conditions associated with macroovalocytes

Megaloblastic anemia

Conditions associated with keratocyte (helmet cell)

Hemolytic processes

Conditions associated with schistocyte (rbc fragments)

Disseminated intravascular coagulation

Hemolytic processes

Conditions associated with drepanocytes (sickle cells)

Hb SS

Conditions associated with spherocyte

Hereditary spherocytosis

Increased MCHC

ABO Hemolytic Disease of the Newborn

Other hemolytic processes

Conditions associated with stomatocytes (mouth cell)

Hereditary stomatocytosis

Liver disease

Conditions associated with codocytes (target cells)

Liver disease

Hb C

Thalassemias

Other hemoglobinopathies

Conditions associated with dacrocytes (tear drop cells)

Extramedullary hematopoesis

Thalassemias

Pernicious anemia

Howell - Jolly Bodies are composed of…

DNA

What do Howell-Jolly bodies indicate?

Disturbed erythropoiesis

Hemolytic anemias

Megaloblastic anemia

Post-splenectomy

What is basophilic stippling composed of?

RNA

What does basophilic stippling indicate?

Thalassemia

Lead poisoning

What are pappenheimer bodies composed of?

Iron

Another name for pappenheimer bodies

Siderotic granules (siderocytes)

What do pappenheimer bodies/siderocytes indicate?

Sideroblastic anemia

Hemoglobinopathies

What are heinz bodies composed of?

Denatured precipitated hemoglobin

What do heinz bodies indicate?

G6PD deficiency

Thalassemia

Unstable hemoglobins

What are cabot rings composed of?

Remnants of mitotic spindle

What do cabot rings indicate?

Megaloblastic anemia

Rule of 3 for HGB and HCT

Hgb x 3 = HCT ± 3%

Rule of 3 for RBCs and Hgb

RBC x 3 = Hgb ± 0.5

What to consider if the rule of 3 doesn’t fit

Clotted sample

Cold agglutinin

Hemolysis, icterus, or lipemic sample

Resisting Hgb (ss, cc)

Abnormal red cells

Increased MCV and MCHC along with decreased red cell count is associated with..

Cold agglutinins

Female Heme Normals

Hgb: 14 ± 2

Hct: 42 ± 5

Rbc: 4.5 ± 0.7 × 10⁶ /uL

Wbc: 5,000 - 10,000/uL

Plt: 150,000 - 400,000/uL

Male Heme Normals

Hgb: 16 ± 2

Hct: 47 ± 5

Rbc: 5.3 ± 0.8 × 10⁶ /uL

Wbc: 5,000 - 10,000

Plt: 150,000 - 400,000

Female sedimentation rate reference range

0-20mm

Male sedimentation rate reference range

0-15mm

Increased sedimentation rates are associated with

Presence of increased plasma proteins, primarily fibrinogen and globulin (inflammation/infection)

Sources of error for increased sedimentation rate

Tilting tube

Standing for too long

Increased temperature

Excess EDTA

Sources of error for decreased sedimentation rate

QNS sample

Decreased temperature

Excess EDTA

Stains used for reticulocyte count

New Methylene Blue

Brilliant Cresyl Blue

What do reticulocyte counts monitor?

Erythropoiesis

Calculation for % retics

#of retics in 1000 rbcs/ 10

Calculations for absolute retic

#rbcs x % retics

Calculation for corrected retic count

% retic x patient hct / 45

Normal Reticulocyte reference range

0.5 - 1.5%

Increased retic count is associated with

Hemolytic anemias

Post - acute blood loss

Following therapy (iron, folate, B12)