Hematology Final Exam Review

Hematology Final Exam Review Flashcards

Cell Counts Using the Hemacytometer Formula

Number of cells counted X dilution factor X Depth factor / Area counted based on 1 large square (mm3)

Hemoglobin Electrophoresis

Patient sample is loaded at the Cathode, and will travel toward the Anode

Hemoglobin Composition: Hemoglobin A

(α2β2) Adult: >95%, Newborn-2 Years: 10-40%

Hemoglobin Composition: Hemoglobin A2

(α2δ2) Adult: <3.5%, Newborn: <1%

Hemoglobin Composition: Hemoglobin F

(α2γ2) Adult: 1-2%, Newborn to 2 years: 60-90%

Bart’s Hemoglobin Composition

4 gamma chains

Hemoglobin H Composition

4 Beta Chains

Myelocyte

The last granulocyte to undergo mitosis

Primary Granules (Non-Specific)

First seen in Promyelocyte

Secondary Granules (Specific)

First observed in the Myelocyte

Primary Granules Contains

Myeloperoxidase

Secondary Granules Contains

Contains lysozomes

Leukemia

Blood cells which have high N/C ratio, multiple nucleoli, no granules and fine nuclear chromatin implies

Parasitic Infection

Cells with huge red-orange granules and a segmented nucleus implies

Cells usually found in BOTH peripheral blood and bone marrow

Plasma Cells , Lymphocytes, Macrophage with iron, Bands, Segmented neutrophils

Cells found ONLY in bone marrow

Rubricytes, Heinz Bodies, if present, 10 Metarubricytes on a newborn

BEST interpretation for a hematocrit value of 37%

Normal for an adult female

NOT typically part of a differential

Estimation of red cell number

Corrected WBC Calculation

If more than 5 N-RBC are seen on peripheral smear, must correct the count

5 orthochromic normoblasts (metarubricytes) in the peripheral blood per 100 white blood cells

Normal for a newborn; abnormal for an adult

White count of 1,000/µL with 60% neutrophils

Absolute neutropenia

White count of 150,000/µL with 40% neutrophils

Absolute neutrophilia

M:E Ratio; 1:1

Decreased in Erythroid Hyperplasia

M:E Ratio; 20:1

Increased in Myeloid Leukemia

Clinical presentation for all Myeloproliferative Chronic Myeloproliferative Disorders

fatigue, malaise, bone pain, splenomegaly, and symptoms related to cell counts

CML from a severe infection

A low Leukocyte Alkaline Phosphatase (LAP) may help distinguish

AML FAB classification

30% Blasts in Bone Marrow

AML Characteristics

Hypercellular BM

Acute leukemia almost always has which of the following blood counts?

Low platelet count

ALL (L1-L3)

TdT, PAS, and CALLA positive

ALL (L1-L3) Appearance

Mostly blasts with one nucleolus and scanty cytoplasm

CLL

Majority of cells are lymphocytes found in peripheral blood

CLL Appearance

Small, mature lymphocytes with smudge cells

Hairy Cell Leukemia

Pancytopenia with hairy cells

Hairy Cell Leukemia Characteristic

Dry bone marrow type

Hairy Cell Leukemia Characteristic

Positive TRAP

Found in older adults, Malignant plasma cells with high serum immunoglobulins

Observe punched-out bone lesions

Multiple Myeloma Characteristic

Peripheral pancytopenia with rouleaux

Abnormal plasma cells in bone marrow

Flame, Mott, Grape Cells

Hodgkin’s Lymphoma

Reed-Sternberg cell found in Bone marrow

Non-Hodgkin’s Lymphoma

May see Butt Cells, Immature Bizarre lymphoid cells

Typical blood picture in lymphoma without bone marrow involvement

Normal

Qualitative WBC disorders In Infections and Burns

Toxic granulation, Dohle Bodies, Vacuoles

Description for reactive (atypical) lymphocyte

Nucleus is often stretched out, Ballerina skirt, May have granules, Monospot and heterophile positive, Cold agglutinin may be present, RBC agglutination

Hemoglobin value of 7.8 g/dL the patients MCH will be

Low

Megaloblastic Anemia

Treat with replacement vitamin therapy

Pernicious Anemia

Lack of intrinsic factor which is involved in the absorption of B12

Iron deficiency (Hypo, Micro)

Chronic blood loss the most common reason in adults, Poor diet

Beta Thalassemia

Beta Chains reduced or absent, Increase in alpha chains

Peripheral blood in Beta Thalassemia

Target cells, Basophilic stippling

Electrophoresis of Beta Thalassemia

↑ A2 and F

Alpha Thalassemia

Hydrops fetalis (alpha- thalassemia major) : 4 gene deletion

Alpha Thalassemia 4 gene deletion

Serious life threatening disease

Sickle Cell Trait (Hemoglobin AS)

No or minimal clinical disease

Pernicious Anemia

What anemia would produce the most polychromasia on the blood smear?

Paroxysmal Nocturnal Hemoglobinuria

Cells sensitive to lysis by complement

Microangiopathic Anemia (DIC)

Cells fragmented by fibrin in vessels

Heme or metheme

Unconjugated bilirubin

Liver

Conjugated bilirubin

Normal amount of bilirubin

Urine urobilinogen: normal, Urine bilirubin: negative, Fecal urobilinogen: Normal

Hemolysis

↓ Haptoglobin, ↑ Bilirubin, ↑ LD, ↑ Retics

Hemosiderin in urine, Urine Free Hemoglobin

Intravascular Hemolysis

Hereditary Spherocytosis

Inherited defect in spectrin, Decreased cell surface

Peripheral smear in Hereditary Spherocytosis

Spherocytes (MCHC >36%), Polychromasia

Hereditary Spherocytosis

Increased Osmotic fragility with hemolysis beginning at a NaCl concentration > 0.5%

HGB= 4.7 g/dL, HCT = 13.6%, RBC = 1.1 x 106/µL, WBC = 2.0 x 103/µL, PLT = 87.0 x 103/µL

Pernicious Anemia

At 0.55% NaCl there was a tinge of color in the supernatant and at 0.35% NaCl there was a dark red color with no red cell button

Hereditary Spherocytosis

Paroxysmal Nocturnal Hemoglobinuria

Clonal stem cell disorder with cells sensitive to complement lysis

Paroxysmal Nocturnal Hemoglobinuria

Sucrose + (Sugar Water), Ham’s test +

Auto Immune Hemolytic Anemia

+DAT

G-6-PD

Sex-linked, decrease in enzyme

Peripheral Smear: G-6-PD

May contain Heinz bodies seen with Methylene Blue

Pyruvate Kinase

Reduced ATP production results in alterations of RBC membrane, failure of cation pumps causing potassium loss as well as sodium loss, which leads to cell dehydration

Peripheral Smear: Pyruvate Kinase

Echinocytes

Lead Poisoning

Basophilic Stippling

Sickle Cell

Beta Chain substitution

Peripheral Smear: Sickle Cell

Sickle Cells, Target Cells

Significance of Reticulocytes

Increased in our hemolytic anemias

Significance of Reticulocytes

Decreased in untreated anemias due to nutritional deficiencies

Low or normal reticulocyte count (untreated), Decreased hemoglobin and hematocrit, Low MCV and MCHC

Iron Deficiency Anemia

Iron Deficiency Anemia, Hypersegmented neutrophils, Schilling test to diagnose

Pernicious Anemia

Howell Jolly Body

DNA; seen in post-splenectomy, megaloblastic anemias, some hemolytic anemias

Reticulocyte

RNA, seen with New Methylene Blue

Reticulocyte Characteristic

Referred to as Polychromasia when seen on Wright Giemsa Stain

Pappenheimer body

Iron; seen in sideroblastic anemia, thalassemia

Heinz Body

Precipitated Hemoglobin; seen in G6PD deficiency

Iron: RBC Inclusions

Ringed Sideroblast

New Methylene Blue stain

Reticulocytes

Supravital stain

Heinz Bodies

Howell Jolly Bodies, Polychromasia, Pappenheimer Bodies, Siderocytes, Basophilic stippling

Wright stain

Factors affecting ESR

Sickle Cell, Polycythemia and PV, Cold temperature

All of the following cause an elevated ESR EXCEPT

Polycythemia

Directly Measured Automated Parameters WBC

Cells are categorized by pulse height

Directly Measured Automated Parameters: Anything between 2-20fL

MPV

Hemoglobin

Cyanmethemoglobin Method, Light passes through cuvette, Read at 525nm

Calculated Parameters

Lower than manual due to no trapped plasma

HCT

HCT= (RBC x MCV)/ 10

MCV

MCV= (HCT/RBC) x 10, 80-100 fL

MCH

MCH= (HGB/RBC) x 10, 27-31pg

MCHC

MCHC= (Hgb/Hct) x 100, 31-35%