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176 terms

Hematology CLS review 3rd edition

Clinical Laboratory Science review notes. paraentheises contains the acronomy or reminder. by Patsy Jarreau
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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
hairy cell leukemia (HCL)
a lymphoproliferative disorder with mature lymphocytes with cytoplasmic projections, tartrate-resistant acid phosphatase postive
Hodgkin lymphoma
a lymphoproliferative disorder with reed sternberg cell present, bi-modial incidence, and stepwise spread (predictable)
Non-Hodgkin lymphoma
a lymphoproliferative disorder with reed sternberg cell absent, no pattern incidence, adn unpredictable spread
multiple myeloma
plasma cell dyscrasias with signs of bone pain (multiple lytic lesions), sheets of plasma cells in BM, rouleaux, increase serum protein (IgG or IgA monolconal spike), increase Ca++, and urinary excretion of light chains (bence jones protein)
plasma cell leukemia
plasma cell dyscrasias with signs of increase plasma cells in BM and peripheral circulation
waldenstrom macroglobulinemia
plasma cell dyscrasias with signs of normal bone scan, IgM (heavy chain), and increase serum viscosity
World Health Organization (WHO) criteria classification for acute leukemia
criteria: >20% blasts in BM
periodic acid schiff (PAS)
a stain indicative of glycogen. significance is erythroleukemia; ALL ("chunky"+)
prussian blue
stain indicative of iron. significance of sideroblasitc anemia
LAP
stain indicative of alkaline phosphatase. significance of increase leukemoid reaction, PV, decrease CML
peroxidase/sudan black
stain indicative of myeloperoxidase/lipid. significance of AML M1-M4+, AML M5-, ALL-
specific esterase
stain indicative of esterase in granulocyte precursors. significance of AML M1-M4+, AML M5-
non-specific esterase
stain indicative of non-specific esterase in monocyte precursors. significance of AML M4+, AML M5++ (with fluoride inhibition step, M5-)
TRAP
stain indicative of tartrate-resistant acid phosphatase. significance of hairy cell leukemia
abnormal NBT (nitroblue-tetrazolium)
stain indicative for abnormal granulocyte function. significance of chronic granulomatous disease
auer rods
an inclusion in cytoplasm indicative of coalition of 1 degree granules. significance of AML+, ALL-
CD13, CD33
cell marker indicative of myeloblasts. significance of AML+, ALL-
CD2, CD3, CD5, CD7
cell marker indicative of T-lineage. significance of T-ALL+, B-ALL-, AML-
CD10 (CALLA), CD19, CD22
cell marker indicative of B-lineage. significance of B-ALL+, T-ALL-, AML-
t(15; 17)
cell marker indicative of chromosome translocation involving retinoic acid receptor gene. significance of acute progranulocytic leukemia (AML M3), treat with ATRA (ALL Trans Retinoic Acid)
CD34
cell marker indicative of stem cells. significance of stem cells for transplantation
CD42, CD61
cell marker indicative of megakaryocytes. significance of AML M7
CD11, CD14
cell marker indicative of monoblasts. significance of AML M4 and AML M5
gaucher disease
a disease with glucocerbrosie as the accumulated lipid. lab diagnosis is macrophage. macrophage cytoplasm looks like an unfolded crumpled piece of paper
niemann-pick disease
a disease with sphingomyelin as the accumlated lipid. lab diagnosis is macrophage. macrophage has globular cytoplasm, sea-blue histocytes
tay-sach disease
a disease with spingolipids (GM2 Ganglioside) as the accumulated lipid. lab diagnosis vaculoated lymphocytes, foam cells (BM). diagnosed by increase startle reflex, cherry red spot in macula of eye and CNS studies
hurler, hunter disease
a disease with mucopolysaccharides as the acumulated lipid. lab diagnosis is large granules in lymphocytes (alder reilly bodies); also in histiocytes and lymphocytes (BM). unmetabolized products detectable in urine (toluidine blue spot test)