ASCP Hematology Review – Flashcards
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Name the locations of active marrow in adults:
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sternum, skull, ribs, pelvis, vertebrae
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Where does hematopoiesis take place during the first 2 months of gestation?
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yolk sac
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Where does the majority of hematopoiesis take place during the 2nd through 7th month of gestation?
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spleen
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When does the bone marrow take over hematopoiesis?
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after birth
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What are the stages in order of the erythrocyte lineage?
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(1)rubriblast, (2)prorubricyte, (3)rubricyte, (4)metarubricyte, (5)reticulocyte, (6)erytrocyte
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What are the stages in order of the granulocyte (neutrophil, eosinophil, basophil) lineage?
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(1)myeloblast, (2)promyelocyte, (3)myelocyte, (4)metamyelocyte, (5)band, (6)segmented (7)eos/baso
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What are the stages in order of the macrophage lineage?
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(1)monoblast, (2)promonocyte, (3)monocyte, (4)macrophage
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What are the stages in order of the platelet lineage?
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(1)megakaryoblast, (2)promegakaryocyte, (3)megakaryocyte, (4)platelet
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What are the stages in order of the lymphocyte lineage?
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(1)lymphoblast, (2)prolymphocyte, (3)lymphocyte
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Which growth factors stimulate the erythrocyte lineage?
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GM-CSF, EPO, IL-3
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Which growth factors stimulate the granulocyte lineages?
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GM-CSF, IL-3
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Which growth factors stimulate the platelet lineage?
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GM-CSF, IL-3, TPO
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Which growth factors stimulate the lymphocyte lineage?
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IL-2, IL-4, IL-6, IL-7
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Which protein functions in the transport of Fe?
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transferrin
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What is the major storage form of Fe?
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ferritin
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What is the long-term (H20) insoluble Fe storage form called?
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hemosiderin
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Excess Iron is stored where? What does this cause?
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tissues and body organs, hemosiderosis, hemochromatosis
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Porphyrias are attributed to?
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excessive formation of porphrins due to blockages in any enzymatic step in the heme synthesis pathway.
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Red or port wine colored urine can be seen in which condition related to the build up of heme precursors?
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porphyria
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Neuropsychiatirc symptoms are seen when a build up of which precursors occurs?
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early precursors (Delta-aminolevulinic acid/Porphobilinogen)
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Cutaneous symptoms such as photo-sensitivity and facial hair are seen when a build up of which precursors occurs?
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later precursors (uroporphyrinogen/coproporphyrinogen, protoporphyrin/heme)
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Synthesis of heme requires what two components?
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iron, protoporphyrin
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What are the heme precursors in order of synthesis?
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(1)delta-aminolevulinic acid, (2)porphobilinogen, (3)uroporphyrinogen, (4)coproporphyrinogen, (5)protoporphyrin, (6)heme
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What type of hemoglobin is seen primarily in newborns?
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Hgb F
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What type of hemoglobin is seen primarily in adults?
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Hgb A2
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What type of hemoglobin is rarely seen in adults as well as newborns?
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Hgb A
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What hemoglobin types are seen in embryos but not in adults or newborns?
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gower I, gower II, portland
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All non-embryonic hemoglobin types are comprised of what type of globin chain?
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alpha
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Hemoglobin A2 is composed of what types of globin chains?
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alpha, beta
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Hemoglobin A is composed of what types of globin chains?
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alpha, delta
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Hemoglobin F is composed of what types of globin chains?
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alpha, gamma
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Multiple transfusions can cause what kind of shift in the hemoglobin-oxygen dissociation curve?
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left shift
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An increase in hemoglobin F can cause what kind of shift in the hemoglobin-oxygen dissociation curve?
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left shift
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A left shift in the hemoglobin-oxygen dissociation curve causes what changes in the following substances: CO2, pH, 2,3-DPG?
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increased pH, decreased CO2, decreased 2,3-DPG
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A right shift in the hemoglobin-oxygen dissociation curve causes what changes in the following substances: CO2, pH, 2,3-DPG?
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decreased pH, increased CO2, increased 2,3-DPG
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How does EDTA work as an anticoagulant?
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it chelates Ca++
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How does heparin work as an anticoagulant?
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it is an anti-thrombin agent
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Hemoglobin is measured by its conversion to what? By?
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cyanomethemoglobin, potassium cyanide, potassium ferricyanide
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What are potential sources of error in the measurement of hemoglobin?
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lipemia, icterus, high white count, resistant hemoglobins (SS, CC)
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What is the normal reference range of hemoglobin for males?
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14-18 g/dL
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What is the normal reference range of hemoglobin for females?
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12-16 g/dL
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Methemoglobin carries iron in what state?
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oxidized (Fe3+)
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What color is methemoglobin?
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brown
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True or False: Methemoglobin can bind O2.
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false
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What causes an increase in carboxyhemoglobin?
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smoking, carbon monoxide poisoning
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What color is carboxyhemoglobin?
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cherry red
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What does the hematocrit measure?
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packed cell volume in a percentage
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What are sources of error seen in using the microhematocrit method to measure the hematocrit?
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failure to seal tube adequately, incorrect reading due to uneven clay plug, inappropriate centrifuge specs, excess EDTA resulting in RBC shrinkage
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How is the hematocrit measured using automated methods?
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calculated from MCV and RBC
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What are sources of error seen in using the automated method to measure the hematocrit?
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cold agglutinins, high WBC cound
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What is the normal reference range for hematocrit of males?
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42-52%
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What is the normal reference range for hematocrit of females?
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37-47%
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What is the calculation used for manual cell counts?
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# of cells counted X 1/total volume X dilution factor
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What is the reference range for a WBC?
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5000-10000 ul
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What is the reference range for platelets?
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150 - 400 X 10^3
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What is the reference range for MCV?
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80-100 fl
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What is the reference range for MCH?
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28-32 pg
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What is the reference range for MCHC?
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32-36% g/dl
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What is the reference range for RDW?
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11.5-14.5%
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The function of what cell is to transport O2 to tissues and remove CO2 from tissues?
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RBC
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The function of what cell is a phagocytic response to bacteria?
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neutrophil
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The function of what cell is in humoral and cell mediated immunity?
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lymphocyte
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The function of what cell is an inflammatory response mediator?
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basophil
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The function of what cell is an allergic response regulator?
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eosinophil
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The function of what cell is in clotting?
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platelet
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What are the dyes used in a Wright stain?
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eosin, methylene blue
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What is the pH of the phosphate buffer used in a Wright stain?
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6.4
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What can cause a Wright stained slide to appear more blue?
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prolonged staining, pH too basic
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What can cause a Wright stained slide to appear more red?
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prolonged washing, pH too acidic
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Neutrophil counts are increased in what conditions?
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bacterial infections
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Lymphocyte counts are increased in what conditions?
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viral infections
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Monocyte counts are increased in what conditions?
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TB, syphilis, malignancies
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Eosinophil counts are increased in what conditions?
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allergies, parasites
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Basophil counts are increased in what conditions?
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immediate hypersensitivies
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Hyper-segmented neutrophils are associated with what condition(s)?
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pernicious anemia
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Hypo-segmented neutrophils are associated with what condition(s)?
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pelger huet, pseudo-pelger huet, AML, AIDS
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Toxic granulation and vacuoles are associated with what condition(s)
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bacterial infections, burns, chemotherapy
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Dohle bodies are associated with what condition(s)?
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bacterial infections, burns, May-Hegglin
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Variant lymphs (increased size and basophilia) are associated with what condition(s)?
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infectious mono, other viral infections
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Large to giant platelets are associated with what conditions?
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Bernard-Soulier, May-Hegglin, myeloproliferative disorders, stress platelets
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If platelet count seems low what would be the corrective action?
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check feather edge for clumping and satelitism. (Is an EDTA related phenomenon) If seen redraw in Na citrate
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What type of cells are expected to be seen with a low MCHC? (<32)
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hypochromic
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What type of cells are expected to be seen with a high MCHC (<32)
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hyperchromic
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Acanthocytes are commonly seen in what condition(s)?
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severe liver disease, abetalipoproteinemia
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Another word for sickle cells is?
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drepanocyte
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Echinocytes are commonly seen in what condition(s)?
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uremia (can also be an artifact)
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Spherocytes are commonly seen in what condition(s)?
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hereditary spherocytosis, increased MCHC, ABO HDN, other hemolytic processes
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Elliptocytes are commonly seen in what condition(s)?
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hereditary elliptocytosis, iron deficiency, thalassemia
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Stomatocytes are commonly seen in what condition(s)?
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hereditary stomatocytosis, liver disease
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Macroovalocytes are commonly seen in what condition(s)?
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megaloblastic anemia
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Target cells are commonly seen in what condition(s)?
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liver disease, Hb C, thalassemia, other hemoglobinopathies
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Helmet cells are seen in what condition(s)?
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hemolytic processes
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Another name for helmet cells is?
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keratocyte
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Teardrop drop cells are seen in what condition(s)?
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extramedullary hematopoiesis, thalassemias, pernicious anemia
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Schistocytes are seen in what condition(s)?
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DIC, hemolytic processes
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Howell-Jolly bodies are composed of?
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DNA
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What condition(s) are howell-jolly bodies seen in?
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disturbed erythropoiesis, hemolytic anemias, megaloblastic anemia, post-splenectomy
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The inclusions seen in basophilic stippling are composed of?
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RNA
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What condition(s) is basophilic stippling seen in?
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thalassemia, lead poisoning
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What stains are utilized to see basophilic stippling?
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wright, new methyene blue
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Pappenheimer bodies are composed of?
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iron
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What stains are utilized to see pappenheimer bodies?
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wright, prussian blue
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What conditions are pappenhemier bodies seen in?
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sideroblastic anemia, hemoglobinopathies
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What are heinz bodies composed of?
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denatured precipitated hemoglobin
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What stain can you NOT see heinz bodies? What stain is used instead?
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Wright, supravital stain (brilliant cresyl blue/new methylene blue)
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What conditions are heinz bodies seen in?
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G6PD deficiency, thalassemia, unstable hemoglobins
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What are cabot rings composed of?
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remnants of the mitotic spindle
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What conditions are cabot rings seen in?
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megaloblastic anemia
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How does the value for hemoglobin compare to the value for the hematocrit?
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Hgb X 3 = Hct +/-3%
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How does the value for RBCs compare to the value for Hgb?
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RBC X 3 = Hgb +/-3%
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An increased MCV with MCHC and decreased RBC is associated with what condition?
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cold agglutinin disease
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What can be done to circumvent interference from cold agglutinin disease?
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warming the sample
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What does the erythrocyte sedimentation rate measure?
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rate of fall of red cells through plasma
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What is the normal reference range of the ESR for women?
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0-20 mm/hr
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What is the normal reference range of the ESR for men?
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0-15 mm/hr
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An increase in the ESR value is see in conditions involving?
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the presence of abnormal plasma proteins (inflammatory conditions)
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A falsely elevated ESR can be attributed to?
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tilting tube, standing too long, increased temperature, excess EDTA
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A falsely decreased ESR can be attributed to?
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QNS specimen, decreased temperature
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What types of stains are used to view reticulocytes?
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supra vital (new methylene blue, brilliant cresyl blue)
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Reticulocyte counts are used to monitor?
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erythropoiesis
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What is the normal reference range for a reticulocyte count?
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0.5-1.5%
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A reticulocyte production > 2 indicates?
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adequate bone marrow response to anemia
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A reticulocyte production < 2 indicates?
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inadequate bone marrow response to anemia
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Retic counts are increased in which of the following conditions>
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hemolytic anemias, post-acute blood loss, following therapy (iron, folate, B12)
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What is the normal amount of megakaryocytes seen per lpf in a bone marrow prep?
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5
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What is the normal reference range for the myeloid to erythroid ratio?
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3:1-4:1
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Dry bone marrow taps are associated with what pathological condition(s)?
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myelofibrosis, aplastic anemia
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What condition(s) can lead to a decreased myeloid to erythroid ratio?
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hemolytic anemia, erythroleukemia
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What condition(s) can lead to an increased myeloid to erythroid ratio?
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myeloid hyperplasia, myeloid leukemias
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What are the most common aspirate sites for bone marrows?
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sternum, hip (iliac crest)
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What stain is used on a bone marrow?
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romanowsky stain
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What is the normal ratio of cells to fat seen in a bone marrow
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50/50
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Bone marrow biopsies are performed to in order to evaulate what?
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overall cellularity of the bone marrow
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A WBC differential is performed on a bone marrow in order to do what?
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determine the type of leukemia present if diagnosed
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When using cellulose acetate for hemoglobin electrophoresis what is the pH used?
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8.6
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When using citrate agar for hemoglobin electrophoresis what is the pH used?
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6.2
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What is the order of migration of hemoglobin from the cathode to the anode in celluose acetate?
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(1)C, (2)S, (3)F, (4)A
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What is the order of migration of hemoglobin from the cathode to the anode in citrate agar?
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(1)F, (2)A, (3)S, (4)C
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What other hemoglobin types migrate to the same position as A2?
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C, E, O, CHarlem
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What other hemoglobin types migrate to the same position as S?
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D, G, L
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Hemoglobinopathies are the result of?
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structural changes to the globin chains
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What hemoglobin chain is most commonly affected by hemoglobinopathies?
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beta
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What is the mutation that results in the formation of hemoglobin S? Which globin chain is affected?
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valine for glutamic acid (6th position), beta chain
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What is the mutation that results in the formation of hemoglobin C? Which globin chain is affected?
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lysine for glutamic acid (6th position), beta chain
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Individuals who are heterozygous for hemoglobin S are said to?
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carry the sickle cell trait
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True or False: Individuals who are heterozygous for hemoglobin S have few sickle cells on their blood slides?
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false
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Sickle dex is a reducing agent that does what?
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it causes Hgb S to precipitate producing turbidity
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Individuals who are homozygous for hemoglobin C suffer from what condition?
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mild chronic anemia
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What is commonly seen in the blood smear of individuals who have hemoglobin C?
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Hgb C crystals (bar shaped), target cells
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In what condition is there a decrease or absence of the production of either beta or alpha globin chains?
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thalassemia
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What type of anemia is seen in individuals with beta thalassemia?
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microcytic hypochromic anemia
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In individuals with beta thalassemia, what other hemoglobin types are produced to make up for the lack of beta chain synthesis? What type of hemoglobin is decreased in production (or absent)?
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A2 and F are increased, A is decreased or absent
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Individuals suffering from alpha thalassemia with 2 deleted alpha genes experience what type of anemia?
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mild microcytic hypochromic anemia
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Hemoglobin H disease is characterized by the deletion of how many alpha genes?
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3
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What type of anemia do individuals suffering from hemoglobin H disease experience?
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chronic hemolytic anemia
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Hgb Bart's may be present at birth in individuals suffering from what condition?
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hemoglobin H disease
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4 deleted alpha genes can result in the development of?
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hydrops fetalis, nonviable fetus
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What problems/conditions can lead to the development of microcytic hypochromic anemia?
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iron deficiency, chronic disease (inflammation), lead poisoning, thalassemia trait
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What lab findings are commonly seen in iron deficiency anemia?
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decreased serum ferritin, iron, and % saturation and increased TIBC
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What lab findings are commonly seen in anemia of chronic disease?
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decreased serum iron and TIBC and increased to normal serum ferritin
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What lab findings are commonly seen in lead poisoning leading to a microcytic hypochromic anemia?
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basophilic stippling, increased blood Pb
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What lab findings are commonly seen in individuals who have the thalassemia trait?
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normal serum iron and TIBC, increased A2 and F
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What lab findings are commonly seen in individuals who have macrocytic anemia?
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decreased folate/B12, retics and increased MMA, homocysteine
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What types of cells and inclusions are seen in individuals with a folate/B12 deficiency?
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macroovalocytes, hypersegmented neutrophils, howell jolly bodies
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A normal schilling test with IF indicates what type of problem or anemia?
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pernicious anemia
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An abnormal schilling test with or without IF indicates what type of problem or anemia?
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malabsorption problem
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An increase in liver enzymes, target cells, and round macrocytes can indicate what conditions/problems?
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liver disease, alcholism
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What lab findings are commonly found in antibody mediated anemia?
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increased bilirubin, decreased haptoglobin, positive DAT
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What conditions are associated with antibody mediated anemia?
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PCH, CAD, WAIHA
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What type of antibody is associated with WAIHA-related anemia?
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IgG
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What type of antibody is associated with CAD-related anemia?
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IgM with anti-I specificity
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What type of antibody is associated with PCH-related anemia?
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anti-P
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A positive Ham's test and a positive sucrose hemolysis test helps to diagnose what condition
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PNH
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A G6PD deficiency is characterized by what lab findings?
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decreased G6PD, heinz bodies
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A PK deficiency is characterized by what lab findings?
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decreased PK, no heinz bodies
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What lab findings are commonly seen in individuals with aplastic anemia?
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hypocellular bone marrow, decreased retics, panycytopenia
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The osmotic fragility test measures?
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salt tolerance
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Osmotic fragility is increased in what condition?
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hereditary shperocytosis
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Osmotic fragility is decreased in what condition?
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thalassemia
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Ham's/Acid Hemolysis testing measures?
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complement mediated lysis
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The sucrose hemolysis test measures?
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the effect of complement (activated by sucrose) on RBCs
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Heinz body preps measure?
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the effect of oxidizing agents on hemoglobin.
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A heinz body prep can indicate what conditions?
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G6PD deficiency, unstable hemoglobins, HbH
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Anti-malarial drugs and fava beans can exacerbate what condition?
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G6PD deficiency
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A sickle cell screen measures?
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the reduced solubility of deoxygenated hemoglobin S
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A kleihauer-betke acid elution measures?
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the resistance of fetal hemoglobin to acid elution
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Kleihauer-betke acid elution testing can indicate what conditions?
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FMH, hereditary persistence of fetal hemoglobin
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A cold agglutinin screen determines?
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the presence of a cold autoantibody
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What is the name of the condition that is related to an overall increase in the number of RBCs?
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polycythemia
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In relative polycythemia, a decrease in what leads to the relative increase in RBCs?
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plasma
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In what type of polycythemia is there a decrease in EPO with normal O2 saturation?
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primary (vera)
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In what type of polycythemia is there an increase in EPO with a decrease in O2 saturation?
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secondary
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Alder-Reilly is an anomaly which is characterized by?
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large azurophilic granules (due to the increased presence of mucopolysaccharides)
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The chediak-higashi condition is characterized by?
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large lysosomes (they are the result of the fusion of primary granules)
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Individuals with the chediak-higashi condition are susceptible to?
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infections
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The May-Hegglin anomaly is characterized by?
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cytoplasmic inclusions of RNA resembling dohle bodies (this condition may also affect platelets leading to bleeding tendencies, leukocyte function is not altered)
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The pelger-Huet condition is characterized by?
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hyposegmented neutrophils (leukocyte function is not altered)
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Myelodysplastic syndromes are neoplastic, clonal, stem cell disorder that are characterized by?
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cytopenias, bone marrow dyspoiesis
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What are the four major categories of myelodysplastic syndromes?
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RA, RARS, RAEB, CMML
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Refractory anemia (with ringed sideroblasts too) is characterized by?
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<5% type I and II blasts present in the bone marrow
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Refractory anemia with excess blasts is characterized by?
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<5% blasts in peripheral blood, 5-10% blasts of type I and II found in the bone marrow (if above 20% of blasts it is diagnosed as a leukemia)
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Myeloproliferative disorders are neoplastic, clonal disorders that are characterized by?
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increases in RBCs,WBCs, and/or platelets
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What lab findings are commonly seen in individuals with idiopathic myelofibrosis?
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dry tap, dacrocytes, bone marrow fibrosis
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What lab findings are commonly seen in individuals with essential thrombocytopenia?
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increase in megakaryocytes in bone marrow, very high platelet count (1000-5000)
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What lab findings are commonly seen in individuals with chronic myelocytic leukemia?
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increase in myelocytic precursors, decreased LAP score, ph chomosome
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In a leukemoid reaction, the LAP score is?
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increased
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In CML, the LAP score is?
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decreased
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In a leukemoid reaction, toxic granulation is?
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increased
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In CML, toxic granulation is?
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decreased
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Are Dohle bodies present in a leukemoid reaction or CML?
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leukemoid reaction
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The Ph' chromosome is present in?
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CML
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The M0 classification corresponds to what AML type?
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myeloblast without differntiation
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The M1 classification corresponds to what AML type?
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myeloblast with minimal maturation
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The M2 classification corresponds to what AML type?
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myeloblast with maturation
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The M3 classification corresponds to what AML type?
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promyelocyte
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The M4 classification corresponds to what AML type?
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myeloblast and monoblast
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The M5 classification corresponds to what AML type?
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monoblast
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The M6 classification corresponds to what AML type?
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erythrocyte
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The M7 classification corresponds to what AML type?
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megakaryocyte
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A t(15;17) genetic aberration is associated with what condition?
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M3 AML
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A t(9:22) Philadelphia chromosome is associated with what condition?
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CML
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A t(8;21) genetic aberration is associated with what condition?
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M3 AML
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An 11q/23 genetic aberration is associated with what condition?
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M5 AML
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The L1 classification corresponds to what type of ALL?
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small lymphoblasts
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The L2 classification corresponds to what type of ALL?
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large and small lymphoblasts
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The L3 classification corresponds to what type of ALL?
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large lymphoblasts with vacuoles
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Burkitt's lymphoma falls under which classification of ALL?
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L3
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Smudge cells are seen in what type of leukemia?
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CLL
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What type of leukemia is tartrate-resistant acid phosphatase positive?
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hairy cell leukemia
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Reed Sternberg cells are seen in what type of lymphoma?
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hodgkins
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In which type of lymphoma are Reed Sternberg cells not present?
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non-hodgkins
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Is there bone involvement in multiple myeloma or Waldenstroms macroglobulinemia?
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multiple myeloma
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Which involves increased serum viscosity: multiple myeloma or Waldenstroms macroglobulinemia?
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waldenstroms
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Multiple myeloma is associated with what immunoglobulin type?
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IgG (Bence-Jones)
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Waldenstroms macroglobulinemia is associated with what immunoglobulin type?
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IgM (heavy chain)
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The periodic acid schiff test indicates? Which is significant for?
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glycogen; erythroleukemia, ALL
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The prussian blue test indicates? Which is significant for?
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iron; sideroblastic anemia
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The LAP test indicates? Which is significant for?
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alkaline phosphatase; leukemoid reaction, P.vera, CML
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The peroxidase/Sudan Black test indicates? Which is significant for?
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myeloperoxidase, Lipid; AML1-4+, AML5-, ALL-
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The specific esterase test indicates? Which is significant for?
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granulocyte precursors; AML1-4+, AML5-
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The non-specific esterase test indicates? Which is significant for?
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monocyte precursors; AML4+, AML5++
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The TRAP (Tartrate-Resistant Acid Phosphatase) test indicates? Which is significant for?
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TRAP; hairy cell leukemia
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Auer rods are diagnostic for what condition?
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AML
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>20% defines what type of leukemia?
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acute
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Gaucher's disease is characterized by an increase in what?
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glucocerebroside
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What is a significant lab finding that is indicative of Gaucher's disease?
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bone marrow macrophages with wrinkled or striated cytoplasm
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Neimann-Pick's disease is characterized by an increase in what?
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sphingomyelin
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What is a significant lab finding that is indicative of Neimann-Pick's disease?
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bone marrow macrophages with globular or foamy cytoplasm, sea-blue histiocytes
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What are the criteria for classification of hematologic neoplasms by WHO?
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cell lineage, morphology, immunophenotye, genetics, clinical presentation
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True or False: Solid tumor presentation defines lymphoma.
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true
