Part V Hema Terminologies

Rouleaux formation

Refers to the stacking of erythrocytes in a manner resembling a stack of coins, which occurs due to increased plasma proteins, particularly fibrinogen and globulins. This phenomenon is commonly seen in conditions such as multiple myeloma and inflammatory states.

Anisocytosis

refers to variation in red blood cell size.

Poikilocytosis

refers to abnormal variation in red blood cell shape.

Agglutination

refers to irregular clumping of red blood cells, often seen in immune-mediated hemolytic anemias.

Normal

GRADING FOR ANISOCYTOSIS: <10% variation

1+

GRADING FOR ANISOCYTOSIS: 10-25% variation

2+

GRADING FOR ANISOCYTOSIS: 25-50% variation

3+

GRADING FOR ANISOCYTOSIS: 50-75% variation

4+

GRADING FOR ANISOCYTOSIS: >75% variation

platelet satellitism

EDTA-induced thrombocytopenia is an in vitro artifact caused by EDTA-dependent platelet antibodies, leading to platelet clumping and adherence to white blood cells (WBCs), a phenomenon known as___________.

Corrected Platelet Count + Platelet Count in Citrate Tube X 1.1

Formula for Corrected Platelet Count

Drug-induced platelet dysfunction

is the most common cause of acquired platelet disorders.

cyclooxygenase (COX) or ADP-mediated platelet activation

Medications such as aspirin, NSAIDs, clopidogrel, and certain antibiotics impair platelet function by inhibiting ____________

Hemolytic uremic syndrome (HUS)

_____________ is associated with microangiopathic hemolytic anemia and thrombocytopenia.

Disseminated intravascular coagulation (DIC)

___________ leads to widespread clotting and consumption of platelets.

Heparin-induced thrombocytopenia (HIT)

Is a serious, immune-mediated complication of heparin therapy characterized by a drop in platelet count and an increased risk of thrombosis.

platelet factor 4 (PF4)–heparin

HIT is caused by IgG antibodies that recognize _______ complexes , leading to platelet activation, clot formation, and thrombocytopenia.

Shiga Toxin (E. coli O157:H7) or complement dysregulation

HUS is due to _________

ADAMTS13

TTP is cased by a deficiency of _________

HELP Syndrome

A condition caused by pregnancy related occurrence such as preeclampsia/eclampsia

Prolonged: PT, aPTT

Decreased: Platelet count, Fibrinogen

Increased: D-dimer and FDPs

Findings in DIC

200,000 - 400,000

Normal platelet count

Tissue plasminogen activator (tPA)

activates fibrinolysis by converting plasminogen into plasmin , which then degrades fibrin clots.

Plasmin

is the effector of fibrinolysis but requires activation by tPA.

PAI-1 (Plasminogen Activator Inhibitor-1

inhibits fibrinolysis by blocking tPA.

TAFI

inhibits fibrinolysis by stabilizing fibrin clots.

M0

AML with minimal differentiation

M1

AML without maturation

M2

AML with maturation

M3

Acute Promyelocytic Leukemia; faggot cells present; associated with DIC

M4

Acute Monomyelocytic Leukemia; Also known as Naegeli Leukemia

M5a

Acute Monocytic Leukemia, poorly differentiated

M5b

Acute Monocytic Leukemia, well differentiated'; Schilling Leukemia

M6

Acute Erythroleukemia’ Di Guglielmo’s Syndrome

M7

Acute Megakaryocytic Leukemia

Early neutrophilic myelocytes

More azurophilic granules (primary granules) than later stages but fewer specific (secondary) granules, which increase as maturation progresses.

Myeloblasts

Have no granules or only a few azurophilic granules

Late neutrophilic myelocyte

It contain more secondary (specific) granules and fewer azurophilic granules.

Metamyelocytes

have an indented nucleus and predominantly secondary granules.

Myeloblast

15-20 um; Stage with highest nucleus to cytoplasm ratio

Promyelocyte

15-21 um; Synthesis of primary granules start

Myelocyte

12-18 um; Synthesis of secondary granules start'; last stage capable of mitosis

Metamyelocyte

10-15 um; indented nucleus, synthesis of tertiary granules start

Band/ Stab cell

9-15 um’ youngest stage to normally appear in PBS, sausage shaped

R1

Abnormal signals in the lower WBC region (<45fL)

R2

Overlap between lymphocytes and monocytes (90fL)

R3

Overlap between monocytes and granulocytes (160fL)

R4

Abnormalities in the granulocyte region (>450fL)

Scott syndrome

Is a rare autosomal recessive bleeding disorder characterized by defective membrane phospholipid scrambling in response to calcium.

Fibrinolysis

involves the degradation of fibrinogen and fibrin by plasmin, producing specific fibrin degradation products (FDPs).

Volume, Conductivity, Scatter

VCS stands for

Lymphocytes

WBC threshold: 45-50 fL

Monocytes

WBC threshold: 90-160 fL

Granulocytes

WBC threshold: 160-450 fL

1% ammonium oxalate

1% HCl

3% acetic acid

WBC diluting fluid

Isotonic saline

RBC diluting fluid

1% ammonium oxalate

Plt diluting fluid

Petechiae

Small pinpoint hemorrhages.

Purpura

Larger purple lesions (>3 mm)

Ecchymosis

Bruises (>1 cm), often seen post-trauma.

Most common complication; bruising due to escape of small amount of blood.

Hematemesis

(vomiting blood) is an anatomic bleeding type, often due to coagulation factor deficiencies (e.g., hemophilia, liver disease) rather than platelet dysfunction.

Syncope

2nd MC Complication; A cardiovascular problem: “fainting”

Hematoma

Rapid swelling due to escape of a large amount of blood

Hemolysis

Rupture of RBC that cause plasma to appear pink

Hemoconcentration

↑ concentration of cells in the sample; ↑HCT

Toxic granulations

azurophilic cytoplasmic granules seen in severe Infections, other toxic conditions, and reactive conditions

Cytoplasmic vacuoles

seen in infection, indicating phagocytosis

Dohle bodies

pale blue, oval cytoplasmic remnants of ribosomes seen in infection and other toxic conditions

May-Hegglin Anomaly

rare autosomal dominant condition with pale blue cytoplasmic ribosomal inclusions resembling Döhle bodies

Alder-Reilly Anomaly

prominent azurophilic granulation not related to infection

Pelger-Huet Anomaly

bilobed or rounded nuclei with pince-nez shape

Chediak-Higashi Syndrome

autosomal recessive disorder with giant granules, likely representing giant fused lysosomes, and abnormal leukocyte function

lymphocytes

Monocytes can resemble large __________when:

○ Their cytoplasm stains too lightly.

○ Granules are indistinct, making them appear smoother.

○ The nucleus is rounded or slightly indented, rather than the typical kidney-shaped or lobulated appearance.

Kupffer cells

Tissue Macrophages: Liver

Microglia

Tissue Macrophages: Brain

Alveolar macrophages/ Dust cells

Tissue Macrophages: Lungs

Osteoclast

Tissue Macrophages: Bone

Littoral cells

Tissue Macrophages: Lymph nodes

Hofbauer cells

Tissue Macrophages: placenta

Mesangial cells

Tissue Macrophages: Kidneys

Skin/ Mucosa

Tissue Macrophages: Langerhan cells

Histiocytes

Tissue Macrophages: Connective tissue

26-32 pg

Normal range for MCH

MCH

Average weight of hemoglobin in a red blood cell, expressed in pictograms

32-36%

Normal value for MCHC

MCHC

Concentration of hemoglobin in each red blood cell

Hemolytic anemia

Myelophthisic anemia

Bone marrow failure

Chronic renal disease

Normo, normo is found in

IDA

Anemia of inflammation

Thalassemia

Hb E disease and trait

Sideroblastic anemia

Micro, hypo is found in

Megaloblastic anemia

Chronic liver disease

myelodysplastic syndrome

Macro, Normo can be found on

Perlʼs Prussian blue stain

Is a histochemical reaction used to detect iron (hemosiderin) deposits in tissues and bone marrow.

2% potassium ferrocyanide [K₄Fe(CN)₆]

2% hydrochloric acid (HCl)

Perlʼs Prussian blue stain reagent consist of ___________in a 1:1 ratio .

Dehydration

Hemoconcentration

Insufficient centrifugation

Buffy coat inclusion

Falsely Increased Hct is due to

Improper sealing of tube

Hemolysis

Excess interstitial

Overanticoagulation

Causes falsely decreased hct

Leishman

Giemsa

May-Grunwald

Wright’s stain

Examples of Romanowsky stain

Acanthocytes/ Spur cell

Few irregularly spaced projections of varying length and width

Codocyte/ Target cell

Hemoglobin concentrated in the center and around the periphery resembling a target

Dacryocyte/ Tear drop cell

Has single pointed extension resembling a teardrop

Drepanocyte/ Sickle cell

Crescent-shaped cell caused by crystallization of Hemoglobin S due to decreased O 2 tension

Echinocytes/ Burr cell

Many regularly spaced, pointed, short projections

Elliptocyte

Narrow oval cells, cigar shaped cells