lab diagnostics: hematology

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multi-colony stimulating factors (multi-CSF) to stimulate differentiation to:

-erythroblasts that become erythrocytes

-megakaryocytes that become platelets

-myeloblasts

-monocytes

lymphoid stem cells differentiate to:

-natural killer cells

-B-lymphoblasts which are antigen driven to form B-cells then plasma cells

-T-lymphoblasts are antigen driven to form T-cells

what are leukocytes an indicator of?

infection and/or inflammation

what 2 groups are WBCs classified into?

granulocytes and agranulocytes

what 3 Basic Groups are WBCs classified functionally into?

-myelocytic

-monocytic

-lymphocytic

granulocytes are differentiated into 3 cell lines based upon what?

staining characteristics

neutrophils staining

pink staining

eosinophils staining

red-staining granules

basophils staining

dark blue-staining granules

circulating pool

-contains the cells which are actively circulating in the bloodstream

-main function is to locate, ingest, and kill bacteria and other foreign invaders

what can the shift from the marginal pool (MP2) to the circulating pool (CP) result in?

transient leukocytosis and can last 4-6 hours

life span of neutrophils

10 days

what is the primary defense for bacterial infections?

neutrophils

mature neutrophils have:

nuclei with multiple lobes

causes of neutropenia

-decreased production of WBC

-increased neutrophil destruction

-drugs: PCN

-physiologic: pseudoneutropenia

causes of neutrophilia

-acute bacterial infection

-acute inflammation

-pseudoneutrophilia

-drugs

neutrophilia: left shift

an increase in the number of immature neutrophils cells in the CP

cell inclusions

various nutrients or pigments that can be found within the cell, but no have have normal activity like other organelles

visualization of inclusions within the neutrophils indicate:

severity of disease

shift from the MP2 to the CP can occur with:

stress, trauma, catecholamines, etc

eosinophils life span

14 days

eosinophils

bilobed nucleus with granules that stain red

where are eosinophils draw to?

sites of hypersensitivty reactions by Mast Cell chemotactic factors

what type of infection do eosinophils play a role in?

has a direct destruct effect on tissue-invasive parasites

what do eosinophils produce?

histaminase

histaminase

an enzyme that breaks down histamines released by basophils in an effort to reduce inflammation

what do eosinophils have receptors for?

IgE, histamine, and Fc portion of IgG

causes of eosinophilia

parasitic infections- tissue invasive parasites

-trichinosis

-visceral larva migrans

-filariasis

basophils

least common WBC type, making up less than 1% of the total circulating population of WBCs

what can basophils increase in response to?

the same conditions that cause eosinophils to respond

what basophils migrate into?

the peripheral tissue and become fixed, Mast Cells

basophils have large cytoplasmic granules which contain:

heparin and histamine

cell membranes of basophils contain which antibodies?

IgE

primary role of monocytic line

phagocytosis

monocytes account for __% of WBCs

5

characteristics of monocytes

single, large nucleus which is indented, giving it a horseshoe appearance

lymphocytic line

life span quite varied

may mature to natural killer cells

main function of lymphocytic line

antigen recognition and immune response

2 main types of mature lymphocytes

T-cells or B-cells

2 phases of maturation of lymphocytes

-antigen independent

-antigen dependent

some pre-T cells move directly into the circulating pool (CP), bypass the thymus and mature into:

Natural killer cells

lymphocytes make up approximately ___ of the total circulating WBC population

30%

which is the smallest of the WBC types?

lymphocytes

lymphocytes characteristics

single large, round nucleus which may occupy most of the cell in a small lymphocyte

what should you always consider if you see atypical or reactive lymphocytes on a CBC report

EBV infectious mononucleosis

the microscopic review of the peripheral blood smear provides information about the size, shape, and number of:

red blood cells, the different populations of white blood cells, an approximation of the number of platelets

acute myelogenous leukemia (AML) CBC

-hyperleukocytosis >100,000 with markedly elevated levels of circulating myeloblast cells

-pancytopenia

AML peripheral blood smear

-increased number of immature cells with many myeloblasts and promyelocytes

-a severe decrease in thrombocytes

-Auer rods

acute lymphocytic leukemia (ALL) CBC

-pancytopenia

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

ALL peripheral blood smear

-blasts with high nuclear to cytoplasmic ratio and bluish cytoplasm or absence of cytoplasmic granules

-decreased number of platelets and RBC

chronic myelogenous leukemia (CML) CBC

leukocytosis with a median WBC count of 150,000 is the hallmark

CML bone biopsy

-hypercellular with a left shift

-PCR to identify BCR-AB: gene

chronic lymphocytic leukemia (CLL) CBC

isolated leukocytosis with a WBC >20,000 is the hallmark

lymph cells involved in CLL

B-cell CD19

T-cell CD5

what is the most common leukemia overall?

Chronic Lymphocytic Leukemia (CLL)

CLL bone biopsy

hypercellular with a left shift

Hodgkin's lymphoma lymph node biopsy show:

Reed-Sternberg cells

Non-Hodgkins lymphoma lymph node biopsy will show:

invasion of prolymphocytic-like cells

Plasma Cell Myeloma

produces an abundance of Monoclonal Paraprotein

monoclonal paraprotein

a component of immunoglobulin produced in excess by B cell-derived clonal cell populations

serum protein electrophoresis

-detects and quantifies the existence of atypical proteins and the lack of normal proteins

-identifies the pattern of migration across the electrical field

what are erythrocytes stimulated by?

erythropoietin from the kidneys

life span of erythrocytes

120 days

what gives RBCs the characteristics of strength and deformability?

the RBC membrane skeleton, made up primarily of the proteins spectrin and actin

rule of three

RBC count x3 = hemoglobin x3= hematocrit

anemia

a condition in which blood is deficient in RBCs, in HgB, or in total volume

polycythemia

a condition characterized by an abnormal increase in the number of RBCs in the blood

erythropoietin

a glycoprotein hormone that stimulates the production of RBC by bone marrow

anisocytosis

variation in RBC size

poikilocytosis

variation in RBC shape

hypchromia

deficiency of Hgb in the red blood cells

polychromasia

-increased number of abnormal colored RBC

-indicative of increased reticulocytes in the peripheral circulation

reticulocytes

immature erythrocytes that are produced from erythroblasts during bone marrow erythropoiesis

reticulocyte increase indicates:

anemia due to blood loss

reticulocyte decrease indicates:

anemia due to bone marrow disease

reticulocyte count

the percentage of reticulocytes per all RBC

reticulocyte index calculation

reticulocyte count x (patient's hemoglobin/normal hemoglobin)

reticulocyte production index

divide the RI by reticulocyte maturation time in the blood

what does an RPI reflect?

an appropriate bone marrow response and is seen with hemolytic anemia, hemorrhage, or response to nutritional deficiency replacement

what is a decreased RPI associated with?

ineffective erythropoiesis and is seen in iron-deficiency anemia or vitamin B12/folate deficiencies to treatment

ESR

-measures the rate at which cells settle out of anticoagulated blood in 1 hour

-non-specifically measures inflammation

what is ESR useful in evaluating?

polymyalgia rheumatica, joint infectino, temporal arteritis

anemia workup

-UA

-CMP

-CBC with Diff

-RBC

-blood and urine smears

-bone marrow biopsy

-retic count

-retic distribution width

-iron

-transferrin saturation %

-total iron binding capacity

-ferritin

-Hgb electrophoresis

-erythropoietin

-intrinsic factor

-B12 levels

-B9

-antibodies

-stool

UA

to assess blood in urine

CMP

to assess function of liver and kidney function

CBC w Diff

to assess for infection and/or inflammation, RBC cell counts, HgB, HcT

retic count

to assess presence of immature RBC

retic distribution width

to assess any variations in RBC shapes

transferrin saturation percentage

to assess the ability of the body to transport iron and its absorption

ferritin

to assess the total-body iron status

total iron binding capacity

correlates with serum transferrin

mean corpuscular volume

a gauge of cell size

mean corp Hgb conc

the average concentration of Hgb per erythrocyte

-color

mean corpuscular hemoglobin

the average weight of Hgb per erythrocyte

labs to evaluate morphology of cells

-MCV

-MCHC

-MCH

-RDW

red cell distribution width (RDW)

-used in conjunction with MCV to gauge anemia

-an estimate of variation in RBC size

causes of anemia

-impaired production

-blood loss

-hemolysis

chronic renal failure

impaired production of the stimulating hormone Erythropoietin which leads to suppression of bone marrow production of erythrocytes

aplastic anemia

condition of bone marrow failure that arises from suppression of, and/or injury to the hematopoietic stem cell

hallmark of aplastic anemia

pancytopenia