Basic Heme Concepts

What are the active hematopoiesis sites in adults?

bone marrow of skull, sternum, pelvis, ribs, vertebrae

What is the primary erythropoiesis site for 3-6 months gestation?

liver

What is the type of erythropoiesis where the nucleus lags behind cytoplasm in maturation?

megaloblastic

What is the type of erythropoiesis where cytoplasm lags behind nucleus in maturation?

iron deficiency

What is the molecular structure of Hemoglobin A?

2 alpha and 2 beta chains

What is the molecular structure for Hemoglobin A₂

2 alpha and 2 delta chains

What is the molecular structure for Hemoglobin F?

2 alpha and 2 gamma chains

What is the molecular structure for Hemoglobin S?

valine substituted for glutamic acid in 6th position of beta chain

What is the molecular structure of Hemoglobin C?

lysine substituted for glutamic acid in 6th position of beta chain

Hemoglobin derivative caused by iron oxidized to ferric state

methemoglobin

Hemoglobin derivative caused by sulfur bound to heme

sulfhemoglobin

Hemoglobin derivative caused by carbon monoxide bound to heme

Carboxyhemoglobin

What causes crenated RBCs?

osmotic imbalance - water moves out of cell

What causes rouleaux in RBCs?

serum protein abnormality such as increase in globulins or fibrinogen

Average volume of RBCs

Mean corpuscular volume

Average weight of hemoglobin of individual RBCs

Mean Corpuscular HemoglobinA

Average concentration of hemoglobin per dL of RBCs

MCHC

What does a shift to the left in the hemoglobin-oxygen dissociation curve mean?

O2 is not released to tissue adequatelyW

What causes a shift to the left in Hgb-O2 dissociation curve?

decreased CO2, increased pH, Hgb F, multiple transfusions, decrease in 2,3 DPG

What does a shift to the right mean in the Hgb-O2 curve?

O2 is released to tissue more easily

What causes a shift to the right in the Hgb-O2 curve?

increased CO2, decreased pH, increase in 2,3 DPG

Which anticoagulant chelates Calcium?

EDTA

Which anticoagulant is an anti-thrombin agent?

Heparin

What are some sources of error for Hemoglobin levels?

lipemia/icterus sample, high WBC count

what are some sources of error for Hematocrit levels?

inappropriate centrifuge time/speed, excess EDTA, cold agglutination

What causes a wright stain to appear too blue?

pH too basic, prolonged staining

What causes a Wright Stain to appear too pink?

pH too acidic, prolonged washing

What causes increased neutrophils

bacterial infections

what causes increased lymphocytes

viral infections

what causes increased monocytes

TB, syphilis, malignancies

what causes increased eosinophils?

allergies, parasites

what causes increased basophils?

immediate hypersensitivity

what are hypersegmented neutrophils associated with?

pernicious anemia

what are hyposegmented neutrophils associated with?

pelger huet, AML, AIDS

what are toxic granulation and vacuoles associated with?

bacterial infections, burns, chemotherapy

what are Dohle bodies associated with?

bacterial infections, May-Hegglin

What are large platelets associated with?

Bernard-Soulier, May-Hegglin, myeloproliferative disorders

What are Howell-Jolly bodies composed of?

DNA

What is basophilic stippling composed of?

RNA

What are Pappenheimer Bodies and Siderotic Granules composed of?

iron

What are Heinz Bodies composed of?

denatured hemoglobin

What are Cabot Rings composed of?

remnants of mitotic spindle

What is the Rule of 3?

Hemoglobin x 3 = Hematocrit ± 3

What are sources of error that increase ESR?

tilting tube, standing too long, increase in temperature, excess EDTA

What are sources of error that decrease ESR?

QNS specimen, decrease in temperature

What migrates with Hemoglobin A₂ in cellulose acetate (pH 8.6)

A2, C, E, and O

What migrates with Hemoglobin S in cellulose acetate (pH 8.6)

D, G and L

What is the order of migration from cathode to anode (- to +) in cellulose acetate (pH 8.6)

C, S, F, A

What is the preferred bone marrow site in adults?

posterior iliac crest

What is polychromasia?

blueish tinge of immature RBCs (reticulocytes)

What WBC releases lysozymes

Neutrophils

What describes how well RBCs resist breaking down when placed into salt solutions

osmotic fragiity

What is a Miller Disk used for?

counting reticulocytes

What is the form of hemoglobin that has released its oxygen to body tissues?

deoxyhemoglobin

What age will an inverted differential (lymphs higher than segs) be seen?

4 months to 4 yearsw

what is the first stage of erythrocyte maturation where cytoplasm is pink due to hemoglobin formation?

polychromatic normoblast

What WBC contain water soluble granules?

basophils

how long do neutrophils reside in peripheral circulation?

7-8 hours

what is a negative regulator of intestinal iron absorption

hepcidin

where is erythropoietin mainly produced

kidneys

what stain is used for Howell-Jolly bodies

wright

what stain is used for basophilic stippling

wright and new methylene blue

what stain is used for pappenheimer bodies/siderotic granules

wright and prussian blue

what stain is used for reticulocytes

new methylene blue

what stain is used for heinz bodies

supravital stain

what stain is used for cabot rings

wright

what stain is used to differentiate between lymphocytic and granulocytic cells

peroxidase stain