Hematology CLS review 3rd edition – Flashcards
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flat bones
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another name for skull, sternum, pelvis, ribs, and vertebrae which are where active adult hemopoietic tissue, aka red marrow, occur.
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transferrin
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Fe transport protein
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heme precursors
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DELTA-aminolevulinic acid, PORphobilinogen, URoporphyrinogen, COProporphyrinogen, PROTOporphyrin, and HEME +globin = hemoglobin. (remember: while in DELTA, POUR YOUR COP, PRONTO, a cup of HEME)
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porphyrias
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excessive formation of porphyrinsoccurs if any enzymatic step in heme synthesis is blocked
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hemoglobin-oxygen dissociation curve
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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)
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EDTA
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ethylenediamine-tetra-acetate; chelates Ca++ so it can not participate in the coagulation cascade
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heparin
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anti-thrombin agent
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growth factors for erythrocyte
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IL-3 (interleukin-3), EPO (erythropoietin), GM-CSF (granulocyte, monocyte-colony stimulating factor)
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growth factors for basiophil and eosinophil
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IL-3, GM-CSF
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growth factors for platelet
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IL-3, TPO (thrombopoietin), GM-CSF
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growth factors for lymphocyte
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IL-1, 2,4,6,7
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prenatal hematopoiesis in yolk sac
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occurs during 0 to 2 month of conception and following
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prenatal hematopoiesis in liver
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occurs during 2 to 7 month following conception
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prenatal hematopoiesis in spleen, lymph nodes
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occurs during 3 to 6 months following conception
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prenatal hematopoiesis in bone marrow
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occurs during 7 to 9 months following conception and into birth
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ferritin
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major Fe storage form
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hemosiderosis, hemochromatosis (organ damage)
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cause excess iron will be stored in tissues and body organs
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hemosiderin
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H2O insoluble Fe storage form (long-term)
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hemoglobin diluent
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drabkin solution
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hemoglobin sources of error
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lipemia, high white count, and extremely icteric sample
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hematocrit sources of error
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failure to seal tube adequately with clay; incorrect reading due to uneven clay plug; and inapprpriate centrifuge time
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1% Ammonium Oxalate
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diluent for WBC/platelet manual count with the Unopette
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blood smear sources of error
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stained blue= pH of buffer/stain too basic, prolong staining; stain red= pH of buffer/stain too acid, prolonged washing
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pernicious anemia
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hypersegmented neutrophil associated with
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pelger heut anomaly, pseudo-pelger huet (AML, AIDS)
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hyposegmented neutrophil associated with
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bacterial infections, burns, chemotherapy
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toxic granulation and vacuoles associated with
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bacterial infections, burns, may-hegglin
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dohle bodies associated with
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atypical lymphs
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morphology associated with infectious mono (epstein barr virus) and other viral infections. they are increased in size and basophilia
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large platelets
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(may) caused by Bernard-Soulier, May-Hegglin, myeloproliferative disorders, stress platelets
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hemoglobin C
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RBC crystal with a bar-shape
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hemoglobin SC
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RBC crystal with a "hand in glove" or "Washington monument" shape
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acanthocyte
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RBC seen in abetalipooproteinemia, severe liver disease
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drepanocyte
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aka sickle cell seen in Hb SS
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echinocyte
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aka burr cell seen in uremia, artifact (alkaline glass effect)
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elliptocyte
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RBC seen in hereditary elliptocytosis (>50%)
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macroovalocyte
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RBC seen in megaloblastic anemia
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keratocyte
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aka helmet cell seen in hemolytic processes
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schistocyte
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aka RBC fragments seen in DIC (disseminated intravascular coagulation) and hemolytic processes
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spherocyte
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hereditary spherocytosis, (increase MCHC), ABO, HDN (hemolytic disease of the newborn), and other hemolytic processes
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stomatocyte
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aka mouth cell seen in hereditary stomatocytosis (>50%), liver disease
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codocyte
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aka target cell seen in liver disease, Hb C and other hemoglobinopathies
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dacryocyte
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aka teardrop cell seen in extramedullary hematopoiesis
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howell-jolly body
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inclusions composed of DNA, stained with Wright, and indicative of distributed erythropoiesis, hemolytic anemias, megaloblastic anemias, post splenectomy
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basophilic stippling
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inclusion composed of RNA , stained wiht Wright or New Methylene Blue, and indicative of thalassemia and lead poisioning
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pappenheimer bodies
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aka siderotic granules or siderocyte which are composed of iron, stained with Wright and prusian blue, and indicative of sideroblastic anemias and hemglobinopathies
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heinz body
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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
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cabot ring
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inclusion composed of remnants of mitotic spindle, stained with Wright, and indicative of megaloblastic anemia
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parasite
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inclusion composed of marlaria, babesia, trypanosomes, stained with wright, and indicative of parasite infection
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rule of 3
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Hb x 3 = Hct +/- 3% and RBC (in millions) x 3 = Hb +/- 0.5
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rule of 3 failed
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clotted sample, cold agglutinin (warm sample and rerun), and lipemic or icteric sample
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cold agglutinin disease
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increase MCV, increase MCHC, and decrease red cell count. warm sample and rerun
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increase ESR sources of error
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tilting ESR tube, standing too long, increase temperature, excess EDTA can cause
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decrease ESR sources of error
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QNS specimen and decrease temperature in finding ESR can cause
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reticulocyte count
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a count that monitors erythropoiesis
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% reticulocytes
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#retics in 1000 RBCs / 10
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absolute retic
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# RBCs x % retics
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corrected retic count
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% retics x patient hct / 45
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RPI (reticulocyte production index)
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corrected retic count / maturation time (usually use 2)
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RPI >2
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adequate bone marrow (BM) response to anemia
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RPI <2
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inadequate BM response ot anemia
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bone marrow prep
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megakaryocytes- 5/lpf and meyloid:erythroid ration- 3:1 - 4:1 is reference ranges of
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'dry' tap
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during a bone marrow, aplastic anemia and myelofibrosis is indicative of
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decrease M:E ratio
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erythroid hyperplasia, hemolytic anemia, erythroleukemia is indicative of
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increase M:E ratio
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myeloid hyperplasia and myeloid leukemias is indicative of
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bone marrow aspirate
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performed on the sternum and hip (illac crest) and most common for morphology review
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bone marrow stain
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romanowsky stain
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50% cells: 50% fat
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bone marrown ratio of cells: fat
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biopsy
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used for overall evaluation of cellularity
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WBC differential
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used to determin type of leukemia in bone marrow
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hemoglobin migration at pH 8.6
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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
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migrates with hemoglobin A2 at pH 8.6
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C, E, O Arab, and C Harlem. (remember: A2, CE Of Clubs = ACE of Clubs)
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migrates with hemoglobin S at pH 8.6
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D, G, Lepore. (remember: Sad Dog Gets Loved)
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hemglobin migration at pH 6.2
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in hemoglobin electrophoresis, using citrate agar hemoglobin F, A, S, C migrates in that order. origin in the middle of cathode to anode (- ot +)
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hemoglobin S
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valine for glutamic acid (6th position beta chain)
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hemoglobin C
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lysine for glutamic acid (6th position beta chain)
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hemoglobin D
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east indeian individuals, migrates with Hb S at 8.6
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hemoglobin E
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southeast asian individuals, migrates with Hb C and A2 at 8.6 (hypochromic, microcytic)
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B thalassemia
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decrease or absent production of B-chain, increase Hb A2 and F, decrease or absent A, and microcytic, hypochromic anemia
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a thalassemia silent carrier
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decrease production of a-chains; 1 deleted alpha gene (- a/ a a); normal CBC
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a thalassemia mild microcytic, hypochromic anemia
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2 deleted alpha genes (- a/ - a) or (- -/ a a)
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hemoglobin h disease, Hb H with heinz bodies
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a thalassemia with 3 deleted alpha genes (- -/- a)
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Hb Bart's
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a thalassemia present at birth with 3 deleted alpha genes
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hydrops fetalis and nonviable fetus
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a thalassemia with 4 deleted alpha genes (- -/- -)
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problem with heme
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iron deficiency, sideroblastic, chronic disease/inflamation, low MCV (microcytic)
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problem with globin
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thalassemias, hemoglobin E, low MCV (microcytic)
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antibody distruction
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hemolytic disease of newborn, transfusion reaction, autoimmunie hemolytic anemia, normal MCV (normocytic)
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RBC membrane defect
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hereditary shperocytosis (HS), hereditary elliptocytosis (HE), paroxysmal nocturnal hemoglobinuria (PNH), normal MCV (normocytic)
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Enzyme deficiencey
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G6PD, Pyruvate Kinase (PK), normal MCV (normocytic)
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production, loss
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aplastic anemia, acute blood loss, normal MCV (normocytic)
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hemoglobinopathies
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Hb S, C, other variants, normal MCV (normocytic)
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megaloblastic maturation
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B12 deficiency, folate deficiency, high MCV (macrocytic)
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non-megaloblastic maturation
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liver disease, high MCV (macrocytic)
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iron deficiency
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lab findings: decrease Fe, increase TIBC, decrease % saturation, microcytic/hypochromic
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chronic disease/inflamation
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lab findings: decrease Fe and TIBC, microcytic/hypochromic
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lead poisoning
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lab findings: basophilic stippling, increase blood lead level, increase FEP, microcytic/hypochromic
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thalassemia trait
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lab findings: normal Fe, normal TIBC, increase A2, increase F, microcytic/hypochromic
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B12 deficiency
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lab findings: decrease B12 and retics, pancytopenia, oval macrocytes, hypersegmented polys, howell jolly (HJ) bodies, macrocytic
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pernicious anemia (PA)
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lab findings: anti-IF+ (intrinsic factor), increase MMA (methylmalonic acid), increase homocysteine, normal schilling test with IF, macrocytic
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malabsorption
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lab findings: anti-IF-, abnormal schilling test with and without IF, macrocytic
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folate deficiency
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lab findings: decrease serum/erythrocyte folate levels, oval macrocytes, anti-IF-, decrease retics, hypersegmented polys, increase homocysteine, HJ bodies, mmacrocytic
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liver disease/alcoholism
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lab findings: increase liver enzymes, target cells, round macrocytes
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antibody mediated
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lab findings: increase bilirubin, decrease haptoglobin, DAT+, normocytic/normochromic
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paroxysmal cold hemoglobinuria (PCH)
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lab findings: donath landsteiner ab (DL), normocytic/normochromic
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cold agglutinin disease
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lab findings: IgM ab, cold agglutinin titer+, normocytic/normochromic
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warm autoimmune hemolytic anemia
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lab findings: IgG ab, normocytic/normochromic
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hereditary spherocytosis
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membrane defect. lab findings: increase osmotic fragility, sperocytes, increase MCHC, normocytic/normochromic
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hereditary elliptocytosis
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membrane defect. lab findings: elliptocytes (>15% to 100%), normocytic/normochromic
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paroxysmal nocturnal hemoglobinuria (PNH)
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membrane defect. lab findings: Ham's Test+, sucrose hemolysis+, CD55-, CD59-, normocytic, normochromic
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G6PD
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enzyme deficiencey. lab findings: decrease G6PD, heinz bodies, normocytic/normochromic
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pyruvate kinase (PK)
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enzyme deficiencey. lab findings: decrease PK, no heinz bodies, normocytic/normochromic
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aplastic anemia
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decreased production/loss. lab findings: "dry tap" bone marrow (BM), hypocellular BM, decrease retics, pancytopenia, normocytic/normochromic
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acute blood loss
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decreased production/loss. lab findings: normal BM, increase retics, normocytic/normochromic
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hemoglobin defects
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definitive poikylocytes on smear (HbC crytstals, sickle cells, SC crystals, etc.), Hb electrophoresis, normocytic/normochromic
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osmotic fragility
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test that measures RBC surface:volume ratio for indications of a increase in hereditary spherocytosis and a decrease in thalassemia, target cells. salt tolerance
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ham's/acid hemolysis
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test that measures complement mediated lysis for indications of PNH. definitive
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sucrose hemolysis
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test measures for the effect of complement (activated by sucrose) on RBC for indications of PNH. screen only
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heinz body prep (supravital stain)
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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
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sickle cell screen
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test measures for reduced solubility of deoxygenated hemoglobin S for indications of HbS. reducing agent: Na dithionate
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kleihauer-betke acid elution
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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
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hemoglobin electrophoresis
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test measures for migration of various hemoglobins for indications of suspected hemoglobinopathies. may be performed at various pHs
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cold agglutinin screen
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test measures for presence of cold autoantibody for indications of cold autoimmune hemolytic anemia. IgM ab, anti-I specificity
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donath landsteiner test
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test measures for presence of biphasic DL ab for indications of paroxysmal cold hemoglobinuria. IgG ab, anti-P specificity
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chronic granulomatous disease (CGD)
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a condition with characteristics of ineffective killing ofbacteria. x-linked
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alder-reilly
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a condition with characteristics of large azurophilic granules. increase mucopolysacchysaccharides (hunter, hurler)
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chediak-higashi
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a condition with characteristics of large lysosomes (fusion of primary granules). albinism, increase susceptibility to infection
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may-hegglin
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a conditon with characteristics of large platelet, decrease # WBC, dohle bodies in segs, monos, and lymphs. does not affect leukocyte function
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pelger-heut
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a condition with characteristics of hyposegmented polys. normal function
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refractory anemia (RA)
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myelodysplastic syndrome with <5% blasts
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refractory anemia with sideroblasts (RARS)
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myelodysplastic syndrome with <5% blasts with ring sideroblasts
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refractory anemia with excess blasts (RAEB)
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myelodysplastic syndrome with 5-20% blasts
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refractory anemia with excess blasts in transformation (RAEBIT)
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myelodysplastic syndrome with 20-30% blasts
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chronic myelomonocytic leukemia (CMMoL)
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myelodysplastic syndrome with significant peripheral blood and bone marrow monocytosis
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myelofibrosis/agnogenic myeloid metaplasia
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a myeloproliferative disorder with "dry tap", tear-drop shaped rbc, bone marrow fibrosis
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essential thrombocythemia
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a myeloproliferative disorder with increase megakaryocytes, platelets (>1 million/mm3)
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chronic myelocytic leukemia
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a myeloproliferative disorder with increase myelocytic precursors (from blast to mature neutrophil), decrease LAP, presence of Philadelphia chromosome, no dohle bodies
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polycythemia vera (PV)
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increase LAP, pancytosis
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FAB
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french-american-british classification
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M0
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AML with a myeloblast without differentiation the predominant cell seen in BM
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M1
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AML with a myeloblast with minimal maturation the predominant cell seen in BM
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M2
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AML with a myelobast with maturation the predominant cell seen in BM
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M3
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AML with a promyelocyte (APL) the predominant cell seen in BM
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M4
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AML with a myeloblast adn monoblast (AMMoL) the predominant cell seen in BM
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M5
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AML with a monoblast (AMoL) the predominant cell seen in BM
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M6
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AML with a erythrocytic series the predominant cell seen in BM
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M7
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AML with a megakaryocyte the predominant cell seen in BM
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L1
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acute lymphocytic leukemia; small lymphoblasts
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L2
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acute lymphocytic leukemia; large and small lymphoblasts
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L3
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acute lymphocytic leukemia; large lymphoblasts with vacuoles (Burkitt lymphoma)
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chronic lymphocytic leukemia (CLL)
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a lymphoproliferative disorder with mature lymphocytes,"smudge" cells
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hairy cell leukemia (HCL)
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a lymphoproliferative disorder with mature lymphocytes with cytoplasmic projections, tartrate-resistant acid phosphatase postive
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Hodgkin lymphoma
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a lymphoproliferative disorder with reed sternberg cell present, bi-modial incidence, and stepwise spread (predictable)
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Non-Hodgkin lymphoma
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a lymphoproliferative disorder with reed sternberg cell absent, no pattern incidence, adn unpredictable spread
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multiple myeloma
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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)
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plasma cell leukemia
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plasma cell dyscrasias with signs of increase plasma cells in BM and peripheral circulation
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waldenstrom macroglobulinemia
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plasma cell dyscrasias with signs of normal bone scan, IgM (heavy chain), and increase serum viscosity
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World Health Organization (WHO) criteria classification for acute leukemia
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criteria: >20% blasts in BM
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periodic acid schiff (PAS)
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a stain indicative of glycogen. significance is erythroleukemia; ALL ("chunky"+)
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prussian blue
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stain indicative of iron. significance of sideroblasitc anemia
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LAP
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stain indicative of alkaline phosphatase. significance of increase leukemoid reaction, PV, decrease CML
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peroxidase/sudan black
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stain indicative of myeloperoxidase/lipid. significance of AML M1-M4+, AML M5-, ALL-
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specific esterase
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stain indicative of esterase in granulocyte precursors. significance of AML M1-M4+, AML M5-
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non-specific esterase
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stain indicative of non-specific esterase in monocyte precursors. significance of AML M4+, AML M5++ (with fluoride inhibition step, M5-)
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TRAP
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stain indicative of tartrate-resistant acid phosphatase. significance of hairy cell leukemia
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abnormal NBT (nitroblue-tetrazolium)
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stain indicative for abnormal granulocyte function. significance of chronic granulomatous disease
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auer rods
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an inclusion in cytoplasm indicative of coalition of 1 degree granules. significance of AML+, ALL-
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CD13, CD33
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cell marker indicative of myeloblasts. significance of AML+, ALL-
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CD2, CD3, CD5, CD7
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cell marker indicative of T-lineage. significance of T-ALL+, B-ALL-, AML-
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CD10 (CALLA), CD19, CD22
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cell marker indicative of B-lineage. significance of B-ALL+, T-ALL-, AML-
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t(15; 17)
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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)
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CD34
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cell marker indicative of stem cells. significance of stem cells for transplantation
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CD42, CD61
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cell marker indicative of megakaryocytes. significance of AML M7
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CD11, CD14
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cell marker indicative of monoblasts. significance of AML M4 and AML M5
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gaucher disease
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a disease with glucocerbrosie as the accumulated lipid. lab diagnosis is macrophage. macrophage cytoplasm looks like an unfolded crumpled piece of paper
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niemann-pick disease
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a disease with sphingomyelin as the accumlated lipid. lab diagnosis is macrophage. macrophage has globular cytoplasm, sea-blue histocytes
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tay-sach disease
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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
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hurler, hunter disease
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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)
