Hematology CLS review 3rd edition

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176 terms · Clinical Laboratory Science review notes. paraentheises contains the acronomy or reminder. by Patsy Jarreau

flat bones

another name for skull, sternum, pelvis, ribs, and vertebrae which are where active adult hemopoietic tissue, aka red marrow, occur.

transferrin

Fe transport protein

heme precursors

DELTA-aminolevulinic acid, PORphobilinogen, URoporphyrinogen, COProporphyrinogen, PROTOporphyrin, and HEME +globin = hemoglobin. (remember: while in DELTA, POUR YOUR COP, PRONTO, a cup of HEME)

porphyrias

excessive formation of porphyrinsoccurs if any enzymatic step in heme synthesis is blocked

hemoglobin-oxygen dissociation curve

shift to left- O2 not released to tissue adequately (no! won't let go). shift to right- O2 released to tissue more easily (won't hold tight)

EDTA

ethylenediamine-tetra-acetate; chelates Ca++ so it can not participate in the coagulation cascade

heparin

anti-thrombin agent

growth factors for erythrocyte

IL-3 (interleukin-3), EPO (erythropoietin), GM-CSF (granulocyte, monocyte-colony stimulating factor)

growth factors for basiophil and eosinophil

IL-3, GM-CSF

growth factors for platelet

IL-3, TPO (thrombopoietin), GM-CSF

growth factors for lymphocyte

IL-1, 2,4,6,7

prenatal hematopoiesis in yolk sac

occurs during 0 to 2 month of conception and following

prenatal hematopoiesis in liver

occurs during 2 to 7 month following conception

prenatal hematopoiesis in spleen, lymph nodes

occurs during 3 to 6 months following conception

prenatal hematopoiesis in bone marrow

occurs during 7 to 9 months following conception and into birth

ferritin

major Fe storage form

hemosiderosis, hemochromatosis (organ damage)

cause excess iron will be stored in tissues and body organs

hemosiderin

H2O insoluble Fe storage form (long-term)

hemoglobin diluent

drabkin solution

hemoglobin sources of error

lipemia, high white count, and extremely icteric sample

hematocrit sources of error

failure to seal tube adequately with clay; incorrect reading due to uneven clay plug; and inapprpriate centrifuge time

1% Ammonium Oxalate

diluent for WBC/platelet manual count with the Unopette

blood smear sources of error

stained blue= pH of buffer/stain too basic, prolong staining; stain red= pH of buffer/stain too acid, prolonged washing

pernicious anemia

hypersegmented neutrophil associated with

pelger heut anomaly, pseudo-pelger huet (AML, AIDS)

hyposegmented neutrophil associated with

bacterial infections, burns, chemotherapy

toxic granulation and vacuoles associated with

bacterial infections, burns, may-hegglin

dohle bodies associated with

atypical lymphs

morphology associated with infectious mono (epstein barr virus) and other viral infections. they are increased in size and basophilia

large platelets

(may) caused by Bernard-Soulier, May-Hegglin, myeloproliferative disorders, stress platelets

hemoglobin C

RBC crystal with a bar-shape

hemoglobin SC

RBC crystal with a "hand in glove" or "Washington monument" shape

acanthocyte

RBC seen in abetalipooproteinemia, severe liver disease

drepanocyte

aka sickle cell seen in Hb SS

echinocyte

aka burr cell seen in uremia, artifact (alkaline glass effect)

elliptocyte

RBC seen in hereditary elliptocytosis (>50%)

macroovalocyte

RBC seen in megaloblastic anemia

keratocyte

aka helmet cell seen in hemolytic processes

schistocyte

aka RBC fragments seen in DIC (disseminated intravascular coagulation) and hemolytic processes

spherocyte

hereditary spherocytosis, (increase MCHC), ABO, HDN (hemolytic disease of the newborn), and other hemolytic processes

stomatocyte

aka mouth cell seen in hereditary stomatocytosis (>50%), liver disease

codocyte

aka target cell seen in liver disease, Hb C and other hemoglobinopathies

dacryocyte

aka teardrop cell seen in extramedullary hematopoiesis

howell-jolly body

inclusions composed of DNA, stained with Wright, and indicative of distributed erythropoiesis, hemolytic anemias, megaloblastic anemias, post splenectomy

basophilic stippling

inclusion composed of RNA , stained wiht Wright or New Methylene Blue, and indicative of thalassemia and lead poisioning

pappenheimer bodies

aka siderotic granules or siderocyte which are composed of iron, stained with Wright and prusian blue, and indicative of sideroblastic anemias and hemglobinopathies

heinz body

inclusion composed of denatured precipated hemoglobin, stained with supravital stain such as brilliant cresyl blue or new methylene blue, but not wright's, and indicative of G6PD deficiency, thalassemia, and unstable hemoglobins

cabot ring

inclusion composed of remnants of mitotic spindle, stained with Wright, and indicative of megaloblastic anemia

parasite

inclusion composed of marlaria, babesia, trypanosomes, stained with wright, and indicative of parasite infection

rule of 3

Hb x 3 = Hct +/- 3% and RBC (in millions) x 3 = Hb +/- 0.5

rule of 3 failed

clotted sample, cold agglutinin (warm sample and rerun), and lipemic or icteric sample

cold agglutinin disease

increase MCV, increase MCHC, and decrease red cell count. warm sample and rerun

increase ESR sources of error

tilting ESR tube, standing too long, increase temperature, excess EDTA can cause

decrease ESR sources of error

QNS specimen and decrease temperature in finding ESR can cause

reticulocyte count

a count that monitors erythropoiesis

% reticulocytes

#retics in 1000 RBCs / 10

absolute retic

# RBCs x % retics

corrected retic count

% retics x patient hct / 45

RPI (reticulocyte production index)

corrected retic count / maturation time (usually use 2)

RPI >2

adequate bone marrow (BM) response to anemia

RPI <2

inadequate BM response ot anemia

bone marrow prep

megakaryocytes- 5/lpf and meyloid:erythroid ration- 3:1 - 4:1 is reference ranges of

'dry' tap

during a bone marrow, aplastic anemia and myelofibrosis is indicative of

decrease M:E ratio

erythroid hyperplasia, hemolytic anemia, erythroleukemia is indicative of

increase M:E ratio

myeloid hyperplasia and myeloid leukemias is indicative of

bone marrow aspirate

performed on the sternum and hip (illac crest) and most common for morphology review

bone marrow stain

romanowsky stain

50% cells: 50% fat

bone marrown ratio of cells: fat

biopsy

used for overall evaluation of cellularity

WBC differential

used to determin type of leukemia in bone marrow

hemoglobin migration at pH 8.6

in hemoglobin electrophoresis, using cellulose acetate causes hemoglobin C (crawl), S (slow), F (fast), and A (accelerate) to migrate in that order cathode to anode (- to +). origin at the cathode

migrates with hemoglobin A2 at pH 8.6

C, E, O Arab, and C Harlem. (remember: A2, CE Of Clubs = ACE of Clubs)

migrates with hemoglobin S at pH 8.6

D, G, Lepore. (remember: Sad Dog Gets Loved)

hemglobin migration at pH 6.2

in hemoglobin electrophoresis, using citrate agar hemoglobin F, A, S, C migrates in that order. origin in the middle of cathode to anode (- ot +)

hemoglobin S

valine for glutamic acid (6th position beta chain)

hemoglobin C

lysine for glutamic acid (6th position beta chain)

hemoglobin D

east indeian individuals, migrates with Hb S at 8.6

hemoglobin E

southeast asian individuals, migrates with Hb C and A2 at 8.6 (hypochromic, microcytic)

B thalassemia

decrease or absent production of B-chain, increase Hb A2 and F, decrease or absent A, and microcytic, hypochromic anemia

a thalassemia silent carrier

decrease production of a-chains; 1 deleted alpha gene (- a/ a a); normal CBC

a thalassemia mild microcytic, hypochromic anemia

2 deleted alpha genes (- a/ - a) or (- -/ a a)

hemoglobin h disease, Hb H with heinz bodies

a thalassemia with 3 deleted alpha genes (- -/- a)

Hb Bart's

a thalassemia present at birth with 3 deleted alpha genes

hydrops fetalis and nonviable fetus

a thalassemia with 4 deleted alpha genes (- -/- -)

problem with heme

iron deficiency, sideroblastic, chronic disease/inflamation, low MCV (microcytic)

problem with globin

thalassemias, hemoglobin E, low MCV (microcytic)

antibody distruction

hemolytic disease of newborn, transfusion reaction, autoimmunie hemolytic anemia, normal MCV (normocytic)

RBC membrane defect

hereditary shperocytosis (HS), hereditary elliptocytosis (HE), paroxysmal nocturnal hemoglobinuria (PNH), normal MCV (normocytic)

Enzyme deficiencey

G6PD, Pyruvate Kinase (PK), normal MCV (normocytic)

production, loss

aplastic anemia, acute blood loss, normal MCV (normocytic)

hemoglobinopathies

Hb S, C, other variants, normal MCV (normocytic)

megaloblastic maturation

B12 deficiency, folate deficiency, high MCV (macrocytic)

non-megaloblastic maturation

liver disease, high MCV (macrocytic)

iron deficiency

lab findings: decrease Fe, increase TIBC, decrease % saturation, microcytic/hypochromic

chronic disease/inflamation

lab findings: decrease Fe and TIBC, microcytic/hypochromic

lead poisoning

lab findings: basophilic stippling, increase blood lead level, increase FEP, microcytic/hypochromic

thalassemia trait

lab findings: normal Fe, normal TIBC, increase A2, increase F, microcytic/hypochromic

B12 deficiency

lab findings: decrease B12 and retics, pancytopenia, oval macrocytes, hypersegmented polys, howell jolly (HJ) bodies, macrocytic

pernicious anemia (PA)

lab findings: anti-IF+ (intrinsic factor), increase MMA (methylmalonic acid), increase homocysteine, normal schilling test with IF, macrocytic

malabsorption

lab findings: anti-IF-, abnormal schilling test with and without IF, macrocytic

folate deficiency

lab findings: decrease serum/erythrocyte folate levels, oval macrocytes, anti-IF-, decrease retics, hypersegmented polys, increase homocysteine, HJ bodies, mmacrocytic

liver disease/alcoholism

lab findings: increase liver enzymes, target cells, round macrocytes

antibody mediated

lab findings: increase bilirubin, decrease haptoglobin, DAT+, normocytic/normochromic

paroxysmal cold hemoglobinuria (PCH)

lab findings: donath landsteiner ab (DL), normocytic/normochromic

cold agglutinin disease

lab findings: IgM ab, cold agglutinin titer+, normocytic/normochromic

warm autoimmune hemolytic anemia

lab findings: IgG ab, normocytic/normochromic

hereditary spherocytosis

membrane defect. lab findings: increase osmotic fragility, sperocytes, increase MCHC, normocytic/normochromic

hereditary elliptocytosis

membrane defect. lab findings: elliptocytes (>15% to 100%), normocytic/normochromic

paroxysmal nocturnal hemoglobinuria (PNH)

membrane defect. lab findings: Ham's Test+, sucrose hemolysis+, CD55-, CD59-, normocytic, normochromic

G6PD

enzyme deficiencey. lab findings: decrease G6PD, heinz bodies, normocytic/normochromic

pyruvate kinase (PK)

enzyme deficiencey. lab findings: decrease PK, no heinz bodies, normocytic/normochromic

aplastic anemia

decreased production/loss. lab findings: "dry tap" bone marrow (BM), hypocellular BM, decrease retics, pancytopenia, normocytic/normochromic

acute blood loss

decreased production/loss. lab findings: normal BM, increase retics, normocytic/normochromic

hemoglobin defects

definitive poikylocytes on smear (HbC crytstals, sickle cells, SC crystals, etc.), Hb electrophoresis, normocytic/normochromic

osmotic fragility

test that measures RBC surface:volume ratio for indications of a increase in hereditary spherocytosis and a decrease in thalassemia, target cells. salt tolerance

ham's/acid hemolysis

test that measures complement mediated lysis for indications of PNH. definitive

sucrose hemolysis

test measures for the effect of complement (activated by sucrose) on RBC for indications of PNH. screen only

heinz body prep (supravital stain)

test measures for the effect of oxidizing agent on hemoglobin for indications of G6PD deficiency, unstabe hemoglobins, and HbH. formation triggered by oxidants such as anti-malarial drugs, fava beans, and sulpher drugs

sickle cell screen

test measures for reduced solubility of deoxygenated hemoglobin S for indications of HbS. reducing agent: Na dithionate

kleihauer-betke acid elution

test measures for resistance of fetal hemoglobin to acid elution for indications of fetal-maternal hemorrhage; hereditary persistence of fetal hemoglobin. cells with increase HbF stain pink; normal adult cells appear as ghost cells

hemoglobin electrophoresis

test measures for migration of various hemoglobins for indications of suspected hemoglobinopathies. may be performed at various pHs

cold agglutinin screen

test measures for presence of cold autoantibody for indications of cold autoimmune hemolytic anemia. IgM ab, anti-I specificity

donath landsteiner test

test measures for presence of biphasic DL ab for indications of paroxysmal cold hemoglobinuria. IgG ab, anti-P specificity

chronic granulomatous disease (CGD)

a condition with characteristics of ineffective killing ofbacteria. x-linked

alder-reilly

a condition with characteristics of large azurophilic granules. increase mucopolysacchysaccharides (hunter, hurler)

chediak-higashi

a condition with characteristics of large lysosomes (fusion of primary granules). albinism, increase susceptibility to infection

may-hegglin

a conditon with characteristics of large platelet, decrease # WBC, dohle bodies in segs, monos, and lymphs. does not affect leukocyte function

pelger-heut

a condition with characteristics of hyposegmented polys. normal function

refractory anemia (RA)

myelodysplastic syndrome with <5% blasts

refractory anemia with sideroblasts (RARS)

myelodysplastic syndrome with <5% blasts with ring sideroblasts

refractory anemia with excess blasts (RAEB)

myelodysplastic syndrome with 5-20% blasts

refractory anemia with excess blasts in transformation (RAEBIT)

myelodysplastic syndrome with 20-30% blasts

chronic myelomonocytic leukemia (CMMoL)

myelodysplastic syndrome with significant peripheral blood and bone marrow monocytosis

myelofibrosis/agnogenic myeloid metaplasia

a myeloproliferative disorder with "dry tap", tear-drop shaped rbc, bone marrow fibrosis

essential thrombocythemia

a myeloproliferative disorder with increase megakaryocytes, platelets (>1 million/mm3)

chronic myelocytic leukemia

a myeloproliferative disorder with increase myelocytic precursors (from blast to mature neutrophil), decrease LAP, presence of Philadelphia chromosome, no dohle bodies

polycythemia vera (PV)

increase LAP, pancytosis

FAB

french-american-british classification

M0

AML with a myeloblast without differentiation the predominant cell seen in BM

M1

AML with a myeloblast with minimal maturation the predominant cell seen in BM

M2

AML with a myelobast with maturation the predominant cell seen in BM

M3

AML with a promyelocyte (APL) the predominant cell seen in BM

M4

AML with a myeloblast adn monoblast (AMMoL) the predominant cell seen in BM

M5

AML with a monoblast (AMoL) the predominant cell seen in BM

M6

AML with a erythrocytic series the predominant cell seen in BM

M7

AML with a megakaryocyte the predominant cell seen in BM

L1

acute lymphocytic leukemia; small lymphoblasts

L2

acute lymphocytic leukemia; large and small lymphoblasts

L3

acute lymphocytic leukemia; large lymphoblasts with vacuoles (Burkitt lymphoma)

chronic lymphocytic leukemia (CLL)

a lymphoproliferative disorder with mature lymphocytes,"smudge" cells

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