Hematology Collective

Created by jgreff 

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Acanthocytes

Agglutination

Anaplasma marginale

Anaplasma platys

Anisocytosis

Band neutrophil

Basophilic stippling

Codocytes (Target Cells)

Dacryocyte (Tear drop cell)

Decreased M:E Ratio

Echinocytes (Burr Cells)

Eosinophil

Heinz Body

Howell-Jolly Body

Hypersegmented Neutrophil

Hypochromic Red Blood Cells

Increased M:E Ratio

Keratocyte

Lymphocyte

Lymphocyte

Macrophage

Neutrophil

Nucleated Red Blood Cell (Metarubricyte)

Eliptocytes

Plasma Cell

Polychromatophilic Red Blood Cell

Reactive Lymphocyte

Reactive Monocyte

Reticulocyte (Aggregate)

Schistocyte

Spherocyte

Thrombocytes

Toxic Neutrophil

polychromasia

What anemia is polychromasia seen in?

Regenerative anemia

Reticulocyte

What is the dark blue spots called on a reicutocyte?

RNA

Nucleated red blood cell

Howell-Jolly bodies

Hypochromasia

Spherocytes

basophilic stippling

what disease causes basophilic stippling

lead poison

agglutination

neutrophil

what species has rouleaux

horse

echinocytes

why are echinocytes seen on blood smear

slide preparation

poikilocytosis

acanthocytes

keratocytes

hypochromasia

another name for codocytes

target cell

What disease is seen with hypochromasia?

anemia

dacryocyte (tear drop)

drepanocyte (sickle cell)

another name for drepanocyte

sickle cell

eliptocyte

another name for eliptocyte

ovalocyte

stomatocyte

schistocyte

lymphocyte

band neutrophil

eosinophil

myeloblast

metamyelocyte

anisocytosis

What is the timeline for hematopoiesis in fetal development?

months:
1-2: yolk sac
3-7: liver major, 3-6: spleen minor
7-birth and beyond: bone marrow

How does adult marrow differ from older adult marrow?

adult: 50:50 (adipose:cellular)
elderly: 70:30 (adipose: cellular)

What are some of the characteristics of bone marrow tissue?

soft, spongy, very vascular, rich in blood supply
RES endotheial cells provide stucture to marrow

What molecules are involved in controlling differentiation of hematopoiesis cells?

cytokines- chemical signals( are synergistic, lineage specific)
growth factors- hormones- c-kit kigand causes further stem cell proliferation
receptors- binding sites for chemical signals- cell surface(bind cytokines and growth factors)

What are some characteristics of stem cells?

morphology resembles a lymphocytes
high nuclear:cytoplasm ratio
light blue cytoplasm
purple, open nucleus

What is the composition of blood?

fluid portion- plasma- 55%
serum plasma- clotting factors

cellular components- RBC's mass measurment Hct-45%
WBC and platelets- buffy coat

What are the characteristics of RBC's

biconcave disc, anucleated, 6-8 microns, contain Hgb

Characteristics of platelets

not true cells, cytoplasmic fragments produced it the bone marrow. help keep vascular system in tact

hematology specimens(EDTA, WB, citrated plasma,) and capillary specimen

EDTA,WB- CBC, H&H, indices, RBCM, differential, reticulocyte count, platelet count
EDTA, WB, citrated plasma- ESR(no capillary specimen)
citrated plasma- protime, aPTT, factor assay

Why cant we use heparin or Na citrate for specimen collection?

heparin- distorts morphology, clumps plasma
Na citrate- causes dilutional error

how quickly should one perform a blood smear? when is it unacceptable?

within 2 hours of draw. unacceptable after 4 hours

What are the solutions involved in a Wright stain?

polychrom methylene blue
eosin
methanol(fixer)
potassium and sodium phosphate buffers

What does the ideal pH on a wright stain look like?-generally

stains cellular detail with good resolution. cell borders are distinct. chromatin patterns are apparent.

What is the optimum cellular color?

RBC's- mauve or salmon. free from artifacts

too acidic ph looks like?

nuclear characteristics are pale blue
cytoplsams looks gray instead of blue
RBC's appear bright red/orange
eosinophils granules are brilliant red-orange
lact cellular contrast

causes of acidic pH?

stain time too short. extended buffer time. excess washing. old stain

too alkaline pH look like?

nuclear details appear deep dark purple blue with little ocntrast in chromatin patterns. neutorphil granules appear large and toxic. RBC are blue-green. eosinophils granules are blue-gray. lymphocytes cytoplasm is gray-lavender

causes of akaline pH?

smear too thick, extended staining time, insufficient washing, fresh stain, not aged

What is rouleax, agglutination?

roulaux- coin like stacking
agglutination- clustering due to antigen interaction

What do you look for in a 10x scan?

overall stain quality, WBC estimate(counted/fields)(200cells/microliter)

what do you look for in a 100x scan?

differential (100 WBC's), RBC size shape color(too much color= increased Hg), platelet estimate (counted/fields)(15,000)

absolute count

calculation of absolute cell numbers based on percentage of type multiplied by the total cell count.

characteristics of banded neutrophil?

less mature than segmented, often seen under stress. released early from bone marrow bc of stress

characteristics of segmented neutrophil?

10-14 microns, pink to tan 2-5 lobed nucleus, coarse, dense chromatins, fine granules
47-80%

characteristics of lymphocytes?

7-10 microns resting, 12-16 micros stimulated. clear to medium blue cytoplasm. dark, dense chromatins.
relative 13-40%
kids have elevated lymphocytes(4000-10500microliter

characteristics of monocytes

12-18 microns (largest). abundant gray blue cytoplasm with ground glass granules. lacy chromatin. phagocytic with prominent vacuoles (not differential)2-11%

characteristics of eosinophils

large red/orange granules contain antihistamines. increased are found with parasitic infections and allergic reactions. 0-3%

characteristics of Basophils

dense, segmented nucleus. large, coarse, blue black granules. granules contain heperain, histamine
0-2%

platelet satellitism

platelets are functionally potent and react iwth a variety of protein receptor and negatively charged surfaces, such as glass, collagin, basement membrane

hematocrits and ESR both rely on what? Microhemtocrit vs. macrohematocrit volume?

Red cell mass.
micro- <0.1ml capillary collection is acceptable
macro- 1.0 ml= ESR. capillary collection unacceptable

hematocrit- measures, expressed as?

hematocrit is a direct measure of red cell mass and an indirect measurement of oxygen carrying potential. is expressed as L/L or %

What effects Hct?

Hct is eveluated to assess anemia(low volume of packed red cells/whole blood volume)
-acute/chronic loss of RBC
-inability to make RBC

Clinical values of Hct?

decide on transfusion= <30%. critical call <18%
evaluates renal function which produces erythropoetic which signals marrow RBC production

monitors dehydration- Hct is elevated due to loss of tissue fluid

sources of error-MCV automated calculation

hyperglycemia- cell swells(increased glucose)
hypernatremia- (increased sodium)
WBC>35,000

What is a improper Hct specimen?

short draw has dilutional effects with liquid anticoagulants
use of herparin(creanates RBC)
IV fluid may dilute sample. tissue fluid alters depending upon time of day
hydration/iv status
hemolysis

What are some adaptations to anemia?

increases hct: high altitude, smokers, newborns
decreased: pregnancy

ESR- macrohematocrit test. priciple of test

erythrocyte sedimentation rate. rate at which cellular elemetns setlle out of whole blood sample. measured in mm/min. distance in 60 min

RBC's have a negative charge and naturally repel each other bc of zeta potential. asymmetric plasma proteins decreases negative charge and decrease zeta potential, cells rouleaux

What are the phases of ESR

10 min of rouleaux formation
40 min of sedimentation phase
10 min of packing phase

some disorders affecting ESR

increase: acute systemetic infection. neoplastic disease. leukemia, multiple myeloma

decreased: sickle cell, HbC disease, HbS disease, polycythemia vera

factors affecting ESR

acute phase reactant- hyperfibrinogenemia(increases)
-tissue necrosis, infection, pregnancy

haptoblobin(increases)
-chronic infection, maglignancy

technical factors effecting ESR

tube length, tilt, temp, timing of test, surface vibrations, bubbles

three methods of ESR testing

westergren, wintrobe, mini- VES

what are the functions of hemoglobin

transfer o2, transfer co2, buffer blood.
hct=3xHgb. 1/3 of RBC volume and 90% of weight=Hgb

what is hemoglobins stucture

Hb is a fluic protein that transports gases. tetramere with 4 globin units. two dimer protein pairs. oxygen attaches to a heme unit(2 alpha and 2 beta chains) must be in 2+ oxidation states

folding of globin units creates a hydrophobic pocket for the heme unit

What kind of Hb dimers are formed for a globin chain?

a2b2, a2g2, a2sigma2

What is the fetal hemoglobin? Where is it produced and what is its affinity for oxygen?

a2gamma2 predominant Hb in fetus. produced in lilver ad spleen. HbF has a higher affinity for o2 than HbA1

What is the adult hemoglobin?

HvA1(alpha2beta2)- predominant hgemoglobin of adults. beta chain synthesis does not exceed gamma chain synthesis until after birth. following birth, HbA will increae fo rthe next 12 months and HbF will be made in small amounts

What is the alternate hemoglobin?

HbA2 (alpha2 sigma 2) occurs late in fetal life. delta chain production begins 7.5-8 months gestation. 2.5% normally found post birth

What are the proportions of Hb at birth? In adulthood?

at birth- HbF-70% HbA1-30%
adult: AbF-1%. HbA1-97%. HbA2-2.5%

What are some important steps in globin synthesis?

cells must have DNA. 65% of hemoglobinization is complete while thenucleus is intact
35% of Hb is assembed after nucleus is extruded
assembly of chain occurs attached to ribosome.

What are some important steps in heme synthesis?

Heme is porphyrin ring + ferrous iron
synthesis of heme occurs between the mitochondria nd cytoplasm of the red cell
goes to cytoplasm when heme unit is complete and combines with globin chain

What are the steps of heme synthesis?

Delta-aminolevulinic aci is the rate limiting step

What is a normal hemoglobin value? Units?

13-17 g/dl males
12-15 g/dl females
anemia= Hb<10 g/dL

What is a critical call for Hb?

<6.6 g/dL
>19.9g/dL

What conditions increase red cell needs for Hb?

high altitude, emphysema, cigarette smokers, long distance runners, pregnancy(appears to benet decrase bc plasma volume increases greatly)

What are some adaptations to anemia?

immedite response:increase HR, respiration, circulation

What is the molecule that causes O2 to be released more readily?

2,3 diphosphoglycerate

Factors that shift Hb curve right?

dec pH, dec pO2, inc temp, inc pCO2, in 2,3 DPG

Excess H+ is bound to what?

deoxyhemogloin

What is the Bohr effect and chloride shift

chloride shift accounts for 70% of CO2 transpotation to lungs.
25% of CO2 is directly bound to Hb and transported
5% is dissolved in the plasma

How is Hb measured? How is the test completed?

Whole blood is added to modified Drabkin's reagent. The red cells are lysed: Hb is released. All Hb is converted to the ferric state Fe+3 of metHb. MetHb is converted to cyanmethemoglobin by KCN. Absorbance measured at 540nm.
RUN IN DUPLICATE

What is Drabkin's reagent chemical name?

potassium ferricyanid (K3Fe(CN)6

What is carboxyhemoglobin and what are some symptoms?

CO bound to heme. lips and nails have a cherry red color. CO: heme binding is 200% stronger than 2
acute carboxyhemoglobinemia=death
smkers ahve increased CO level

What is extravascular degradation and what are the important steps?

Histiocyte reticular endothelial cells phagocytize red cells.

What is the clinical utility of MCV, MCH, MCHC?

indices help categorize enemias- abnormal morphology can be calssic for a disease state
indicate iron storage levels.
monitor transfusion therapy- MCV is patient specific

What is the MCV equation and reference range?

MCV=Hctx10/RBC
normocytic= 80-100 fL
microcytic= <80fL
macrocytic= >100fL

Macrocytosis= associated with what disease?

Young blood cells- diffusely basophylic erythrocytes.
newborns, pos surgical, post partum, pregnancy, iron replacement therapy, hemolytic anemia, hemolytic deficiency fetal/newborn

B1 deficiency, alcholism, liver disease, chemotherapy

Microcytosis= associated with what disease?

Iron deficiency, Thalassemia(genetic disorder), decreased iron utilization, RBC fragmentation

MCH equation and reference range?

MCH= Hbx10/RBC (picograms)
26-34 pg reference range
not sex dependent, related to Hb within red cells.
"times 3" rule for QA Hbx3=HCT
RBCx3=Hb

MCHC equation and reference range?

MCHC=Hbx100/Hct (grams/dL) (%)
indicates color of red cells
normal 32-36%
hypochormic <32%
hyperchormic >36%

RDW(red cell distribution width) equation and reference range?

RDW=SDx100/MCV (%)
reference range: 11.5-14.5%
RDW>16 indicaes anisocytosis- cell population with lots of variation. Individual size difference of red cells

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