PAS 604 Intro to Hematology

Plasma, Red Blood Cells, White Blood Cells, and Platelets

What are the components of whole blood?

55%; 45%

Blood is made up of ______ plasma and ______ blood cells

- Liquid component of blood, made up of water, sugar, fat, protein, and salts

- Transports blood cells as well as nutrients, waste, antibodies, hormones, proteins

What is plasma?

number of blood elements in relation to volume

What is a Complete Blood Cell Count (CBC)

lavender top tube

What tube is CBC collected in?

EDTA anticoagulant

What is in CBC tube?

inversion of tube several times

What is done after CBC tube is filled to prevent coagulaiton?

ratio of the volume of RBCs to the volume of whole blood expressed as percentage

What is Hematocrit (Hct)?

40

Hct 40% means _____ milliliters of RBCs per 100 milliliters of blood)

plasma

Hbg & Hct are dependent on ________ volume

higher ("hemoconcentrated")

If a patient is dehydrated, the Hgb and Hct will appear:

lower ("hemodiluted")

If a patient is fluid overloaded, the Hgb and Hct will appear:

Hgb

Hct should be equal to 3x:

RBC count

Hgb should be equal to 3x:

average volume of the RBC

What does Mean Corpuscular Volume (MCV) measure?

Hct and RBC count

What is MCV value derived from?

normocytic

MCV = 80-100 fL

microcytic

MCV < 80 fL

macrocytic

MCV > 80 fL

Average mass of hemoglobin per RBC

What is Mean Corpuscular Hemoglobin (MCH)?

MCV

MCH variation tracks along with:

Measure of the concentration of hemoglobin in a given volume of packed RBCs

Mean Corpuscular Hemoglobin Concentration (MCHC)

dividing the hemoglobin by the hematocrit

How is MCHC calculated?

- Electronic counter problem

- Spherocytosis

What conditions cause elevated MCHC?

- Iron deficiency anemia

- sideroblastic anemia

- chronic disease anemia

What conditions cause decreased MCHC?

Measure of the variation of RBC volume (size)

What is Red Cell Distribution Width (RDW)?

more variation in size

High RDW indicates:

less variation in size

Lower RDW indicates:

Elevated RDW, unequal size

What is anisocytosis?

anisocytosis

iron deficiency anemia

What condition has high RDW with low MCV?

Folate and vitamin B12 deficiency anemia

What condition has high RDW and high MCV?

Recent Hemorrhage

What condition has high RDW with normal MCV?

Thalassemia

What should be suspected in the setting of anemia with normal RDW?

- Complements RBC indices and RDW

- Size

- Morphology

- Shape and staining characteristics

- Should not see nucleated RBCs

What does peripheral smear show?

unusual shape

What is Poikilocytosis?

less intense staining

What is Hypochromasia?

variation in Hgb content

What is Polychromasia?

elliptical shaped

What are Elliptocytes?

stack of coins

What is Rouleux formation?

spur, thorn, spiculated cells

What are Acanthocytes?

hypochromasia

hyperchromasia

immature and released early from the bone marrow

Polychromasia: blue-staining RBCs indicate they are:

thalassemia and iron deficiency

When is hypochromasia seen?

dehydration or presence of spherocytes

When is Hyperchromasia seen?

sickled cells

spherocytes

elliptocytes

target cells

teardrop cells

rouleax

acanthocytes

Basophilic stippling

What are -Small, dark blue, dot like structures scattered through cell?

- lead poisoning

- nutritional deficiencies

- myelofibrosis

When is Basophilic stippling seen?

Howell-Jolly bodies

What are blue black inclusions, larger than basophilic stippling and usually one per RBC?

severe anemia, especially hemolytic anemia and after splenectomy

When are Howell-Jolly bodies seen?

Basophilic stippling

Howell-Jolly bodies

CBC + WBC

What is a CBC with differential?

granulocytes and agranulocytes

What are the two major types of leukocytes?

T-cells, B-cells, Natural Killer Cells

What are the lymphocytes?

lymphocyte

atypical lymphocyte

Normal Neutrophils (segmented)

Band Neutrophils

Hypersegmented Neutrophils

lymphocyte

What is A?

monocyte

What is B?

platelet

What is C?

erythrocyte

What is D?

eosinophil

What is E?

neutrophil

What is F?

basophil

What is G?

- Disease in the bone marrow (e.g. leukemia)

- Infection

- Immune system disorder

- Reaction to a drug

What can cause leukocytosis?

- Severe infection that use up WBC faster than they are produced

- Drugs, such as antibiotics

- Autoimmune disease that destroy WBC

- Cancer

- Viral infections that disrupt work of the bone marrow

What can cause leukopenia

- increased proportions of younger neutrophils in the blood

- early or premature myeloid cells from the bone marrow

- indicates infection

What is a left shift on WBC?

Non-leukemic WBC count >50,000

What is Leukemoid Reaction?

infections (C. difficile, infectious mononucleosis, tuberculosis, pertussis); certain drugs; organ necrosis; asplenia

What causes Leukemoid Reaction?

(% neutrophils + % bands) x WBC

How is Absolute Neutrophil Count (ANC) calculated?

Neutropenia

ANC < 1000

Severe Neutropenia

ANC < 500

Profound Neutropenia

ANC < 100

dark purple spots, about 20% the diameter of RBCs

How do platelets appear on smear?

platelets

average volume (size) of platelets

What is Mean Platelet Volume (MPV)?

measure and identify the different types of Hemoglobin

What is hemoglobin electrophoresis?

C, D, E, M, and S

What are abnormal Hgb?

An electrical current is passed through a blood sample and Hgb separates into different bands

How is hemoglobin electrophoresis done?

abnormal

Nucleated Red Blood Cells (NRBC) are __________ in adults

blood loss or RBC destruction (hemolytic anemia)

When is increased reticulocyte count seen?

Rate at which RBCs sediment in a period of one hour

What is Erythrocyte Sedimentation Rate (ESR)?

non-specific

Erythrocyte Sedimentation Rate (ESR) is a ___________ measure of inflammation

temporal arteritis, polymyalgia rheumatica, lupus, IBD

What is Erythrocyte Sedimentation Rate (ESR) used in dx of?

C-Reactive Protein

What is Erythrocyte Sedimentation Rate (ESR) in conjunction with?

Protein synthesized in the liver found in blood plasma that rises in response to inflammation

What is C-Reactive Protein (CRP)?

non-specific

C-Reactive Protein (CRP) is a ________ measure of inflammation

cylindrical core sample that preserves the marrow's structure

What is collected in a bone marrow biopsy?

sample of the fluid that contains cells

What is collected in a bone marrow aspiration?

iliac crest

Where is Bone Marrow Biopsy and Aspiration collected from?