Med Case correlation Heme

A condition in which excessive iron is absorbed and deposited in tissues:

is linked to mutations C282Y and H63D, hemochromatosis

A patient's hemoglobin level is 12.3 g/dL. The erythrocytes appear normochromic on Wright-stained smear. The HCT value that correlates with these data is:

37%

Use the rule of 3

RBC x3 ± 1.5 = Hgb

Hgb x 3 ± 3 = HCT

If a WBC count is performed on a 1:100 dilution and the number of cells counted in 8 squares is 50, the total WBC count is:

Formula: # cells (50) X dilution (100)/volume of chamber (0.8)

and then move dot 2 spaces to put it in 10^9/L format

6200 —> 6.3

Which hemoglobins travel together in electrophoresis pattern

C, O, A2, E

S, D

F

A1

What is the speed of the centrifuge used in the hematocrit procedure:

10,000 rpms

On an electronic cell counter, hemoglobin determination may be falsely elevated owing to the presence of:

lipemia and elevated bilirubin

If a blood smear is dried too slowly, the red blood cells are often

crenated

The following results were obtained on an electronic particle counter

WBC 6.3 x 10⁹/L

RBC 1.19 x 10¹²/L

HGB 9.9 g/dL

HCT 21%

MCV 125 fL

MCHC 54.1%

What action should be taken to obtain accurate results:

warm and rerun

The results do not follow the "Rule of 3". The hemoglobin and hematocrit appear to match but the RBC is too low. Also, observe the RBC indices which are all elevated. Cold agglutinins will cause the RBC to agglutinate (clump) at room temperature. This causes a decreased RBC count and an increased MCV as well as affecting any RBC indices which use the RBC count or hematocrit (MCH & MCHC). To correct the problem, warm the specimen to 37 and rerun.

Which of the following would cause a thinner blood smear:

1. Option A

   decreased hematocrit

2. Option B

   spreader too slow

3. Option C

   decreased angle of the spreader

4. Option D

   all of the above

all of the above

The attachment of neutrophils to the blood vessel walls is referred to as:

margination

The following hemoglobin results were obtained for a patient:

Monday morning: 11.8 g/dL

Monday afternoon: 11.3 g/dL

Tuesday morning: 11.7 g/dL

What can be concluded about the results:

no significant change (at least 1.0 would be significant)

If a patient's serum iron is decreased and their TIBC is increased, they most likely have:

iron deficiency anemia

• Decreased Serum Iron: There is not enough iron circulating in the blood.

• Increased TIBC (Transferrin): The liver produces more transferrin (the protein that carries iron) to try and capture any available iron because total body iron stores are low.

Methemoglobin is:

1. Option A

   hemoglobin with hydrogen sulfide

2. Option B

   hemoglobin with carbon monoxide

3. Option C

   hemoglobin with oxygen

4. Option D

   hemoglobin with iron in the ferric state

ferric state

The normal ratio of myeloid to erythroid precursors in the bone marrow is about:

4:1

Which of the following would be characteristic of hemolytic anemia

1. Option A

   marked reticulocytosis

2. Option B

   increase in conjugated bilirubin

3. Option C

   acanthocytes

4. Option D

   Pappenheimer bodies

reticulocytosis

In hemolytic anemia, red blood cells are destroyed prematurely. The bone marrow responds to this loss by working overtime to produce new red blood cells. Reticulocytes are immature red blood cells, and a significantly elevated count (marked reticulocytosis) reflects this healthy, hyperactive marrow response attempting to replace the destroyed cells.

Polychromasia refers to RBCs that are:

1. Option A

   slightly larger than normal due to immaturity

2. Option B

   slightly bluish due to increased amounts of RNA

3. Option C

   nonnucleated

4. Option D

   All of the above

All

Microangiopathic anemias (MAHA) are characterized by

1. Option A

   target cells

2. Option B

   basophilic stippling

3. Option C

   schistocytes

4. Option D

   Cabot rings

schistocyte

Microangiopathic hemolytic anemia (MAHA) is a process where red blood cells are mechanically torn apart as they force their way through damaged, narrowed, or fibrin-clotted small blood vessels

All of the following WBCs are phagocytic EXCEPT:

1. Option A

   neutrophils

2. Option B

   lymphocytes

3. Option C

   monocytes

4. Option D

   eosinophils

lymph

Hemoglobin affinity for oxygen is regulated by:

2,3-DPG

Carboxyhemoglobin is characterized by all of the following EXCEPT:

1. Option A

   it is rapidly fatal at levels more than 80% of the total blood hemoglobin

2. Option B

   it is found in higher blood levels in smokers than nonsmokers

3. Option C

   it cannot be removed from hemoglobin after binding

4. Option D

   it is detectable in blood by a spot screening test

option D

Carboxyhemoglobin is hemoglobin with carbon monoxide. Measurement of carboxyhemoglobin requires a more involved measurement procedure, measuring the reaction at a different wavelength than normal hemoglobin.

Many microspherocytes and schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with:

extensive burns

Increased numbers of basophils are often seen in:

1. Option A

   acute infections

2. Option B

   chronic granulocytic leukemia

3. Option C

   chronic lymphocytic leukemia

4. Option D

   erythroblastosis fetalis (hemolytic disease of the newborn)

option B

In granulocytic leukemia, there is a proliferation of the granulocytic cell line. It is noticed often by an increase in the basophils.

Heinz bodies are:

denatured hemoglobin inclusions that are readily removed by the spleen

What is the relative reference range for reticulocytes:

0.5- 2.2 %

The majority of body iron is found in the form of:

hemoglobin

RBCs containing granules of residual RNA evenly distributed are called:

basophilic stippling

An MLT intern has made 10 blood smears. All ten show the presence of large amounts of rouleaux. One possible explanation for this is:

Option D

there was prolonged time between the moment the spreader slide contacted the blood and the beginning of the push

RBCs containing granules of residual RNA evenly distributed are called:

basophilic stippling

EVENLY distributed

What kind of hemoglobin disorder are thalassemia and sickle cell anemia

Thal- quantitative

sickle- qualitative

what is pernicious anemia relating to

DNA synthesis

When schistocytes are reported on a peripheral blood smear, you would expect to see:

red cell fragments

A hemoglobin and hematocrit are ordered on an EDTA specimen with lipemic plasma. In performing the manual cyanmethemoglobin procedure using spectrophotometry, the tech should:

1. Option A

   centrifuge the hemoglobin dilution and read the supernatant

2. Option B

   dilute the sample 1/2 with distilled water; read and multiply results by 2

3. Option C

   add 0.01 mL of patient plasma to 5 mL of cyanmethemoglobin reagent and use this as the test blank

4. Option D

   add 0.02 mL of pateint plasma to 10 mL of cyanmethemoglobin reagent; read and multiply result by 2

C

“both possible” but mostly intravascular

Intrinsic or extrinsic, Intravascular or extravascular: MAHA

extrinsic, intravascular

Intrinsic or extrinsic, Intravascular or extravascular: Thalassemia

intrinsic, extravascular

Intrinsic/extrinsic vs intravascular/extravascular

Intrinsic vs. extrinsic = WHY the RBC is being destroyed

Intravascular vs. extravascular = WHERE the RBC is destroyed

intrinsic vs extrinsic problems

IN: membrane defects, enzyme deficiencies, globin abnormalities\

EX: mechanical, physical, or chemical damage

intravascular vs extravascular locations

IN: inside blood vessel

EX: mainly spleen and liver

Intrinsic or extrinsic, Intravascular or extravascular: prosthetic valves

extrinsic, extravascular

Intrinsic or extrinsic, Intravascular or extravascular: G6PD deficiency

intrinsic, intravascular

Intrinsic or extrinsic, Intravascular or extravascular: hemoglobinopathies

intrinsic, extravascular

Intrinsic or extrinsic, Intravascular or extravascular: autoimmune anemia

extrinsic, extravascular

Intrinsic or extrinsic, Intravascular or extravascular: PNH

intrinsic, intravascular

Intrinsic or extrinsic, Intravascular or extravascular: bacterial toxins

extrinsic, intrvascular

the formula for absolute cell count:

% of cells counted x total count

Which of the following will result in a falsely decreased erythrocyte sedimentation rate (ESR):

1. Option A

   presence of target cells

2. Option B

   inflammatory reaction

3. Option C

   marked anemia

4. Option D

   slight tilting of the ESR tube

A

The process of RBC sedimentation requires rouleaux formation as the first step. Any condition that interferes with formation of rouleaux by RBCs will result in a falsely decreased ESR value. The presence of target cells impairs rouleaux formation. Severe anemia and tilting of the tube during the test will result in a falsely elevated sedimentation rate value. The presence of an inflammatory state will cause a true increase in the value.

Hemoglobin H disease results from:

Hemoglobin H results when there is an absence of 3 of the 4 alpha genes. This is a quantitative hemoglobin disorder.

What other RBC inclusions are seen on a reticulocyte smear:

1. Option A

   Howell-Jolly bodies

2. Option B

   Heinz bodies

3. Option C

   Pappenheimer bodies

4. Option D

   All of the above

all

At what point does the production of hemoglobin F begin:

developing embryo

In a reticulocyte count, 14 reticulocytes were counted/1000 RBCs.What is the retic count?

1.4%

To obtain the reticulocyte %, 14/1000 = X/100, X = 1.4. The approximate reference range is 0.5 - 2.0%.

Blood collected in an EDTA undergoes which of the following changes if kept at room temperature for 24 hours:

1. Option A

   increased hematocrit and MCV

2. Option B

   increased ESR and MCV

3. Option C

   increased MCHC and MCV

4. Option D

   decreased reticulocyte count and hematocrit

A

When blood collected in an EDTA tube sits at room temperature for 24 hours, the RBCs begin to swell.

Vitamin B₁₂ and folate deficiency, combined with an increase of this analyte in the plasma, have been linked to vascular occlusions and thrombosis. Name this analyte:

homocysteine

2 alpha and 2 gamma chains hemoglobin

F (4 heme 4 O2)

2 alpha 2 delta hemoglobin

A2 (4 heme 4 O2)

2 alpha 2 beta hemoglobin

A1 (4 heme 4 O2)

Which of the following technical factors will cause a decreased erythrocyte sedimentation rate:

1. Option A

   gross hemolysis

2. Option B

   small fibrin clots in the sample

3. Option C

   increased room temperature

4. Option D

   tilting the tube

B (Fibrin clots will prevent the RBCs from settling, thus causing a decreased ESR.)

pancytopenia

seen in megaloblastic anemias because they slow DNA synthesis so it drops WBC, RBC, and PLT counts

what is acceptable range inn Levy Jenings

2 standard deviations

Valine substituted for glutamic acid in the 6^th position of the beta chain

sickle cell hemoglobin S

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

hemoglobin C

wbc range

4.5- 11 10^9/L

osmotic fragility used for

spherocytes

dithionite solubility used for

hemoglobin S