question

Describe the 3 functions of blood (transportation, regulation, and protection) and provide examples of each.

answer

a. Transportation: gases, nutrients, hormones, waste products b. Regulation: pH, body temperature, osmotic pressure c. Protection: clotting, white blood cells, proteins

question

Describe the physical characteristics and principal components of blood.

answer

a. Blood plasma: 1. 91.5% water, 8.5% solutes (primarily proteins) 2. Hepatocytes synthesize most plasma proteins such as albumins, fibrinogen, and antibodies. 3. Other solutes include electrolytes, nutrients, enzymes, hormones, gases, and waste products. ------------------ b. Formed Elements: cells and cell fragments 1. Red blood cells (RBC) 2. White Blood Cells (WBC) 3. Platelets

question

Summarize the process of hematopoiesis, and discuss the role and function of bone marrow.

answer

a. Initially in the yolk sac, then moves to the liver, spleen, thymus gland, lymph nodes, and red bone marrow. b. After birth, red bone marrow is the only site of hematopoiesis c. At about 4 years of age, red marrow starts decreasing in long bones, and by 18-20 years of age, the red marrow is mostly replaced by yellow marrow in the long bones. d. Sites: Flat bones such as sternum, ribs, and skull; vertebrae; pelvis: All main sites after 20 years of age.

question

Describe the formation of erythrocytes.

answer

a. Starts in the red bone marrow with proerythroblast b. Cell near the end of development ejects nucleus and becomes a reticulocyte c. Develop into mature RBC within 1-2 days d. Negative feedback balances production with destruction e. Controlled condition is amount of oxygen delivery to tissues f. Hypoxia stimulates release of erythropoietin

question

Describe the characteristics of leukocytes

answer

a. Have nuclei b. Do not contain hemoglobin c. Granular or agranular based on staining highlighting large conspicuous granules d. Granular leukocytes - Neutrophils, eosinophils, basophils e. Agranular leukocytes - lymphocytes and monocytes f. Usually live a few days g. Lymphocytes live for months or years h. Far less numerous than RBC i. Leukocytosis is a normal protective response to invaders, strenuous exercise, anesthesia, and surgery. j. Leukopenia is never beneficial k. General function to combat invaders by phagocytosis or immune responses

question

Describe characteristics of thrombocytes

answer

a. Myeloid cells develop eventually into a megakaryocyte b. Splinters into 2000-3000 fragments c. Each fragment enclosed in a piece of plasma membrane d. Disc-shaped with many vesicles but no nucleus e. Help stop blood loss by forming platelet plug f. Granules contain blood clot promoting chemicals g. Short life span: 5-9 days

question

Discuss the mode and use of the three types of anticoagulants used for hematology assays.

answer

a. Ethylenediaminetetraacetate (EDTA) 1. Lavender top tube 2. Removes ionized calcium (Ca++); chelation 3. Most commonly used for CBC b. Heparin (Green top tube) 1. Acts as an antithrombin (inactivates thrombin) 2. Used for osmotic fragility tests c. Sodium Citrate (Blue Top Tube) 1. Precipitates calcium to an unusable form 2. Used for Erythrocyte Sedimitation Rates (ESR), and coagulation studies (PT, aPTT, TT)

question

What are Hypochromic RBC's?

answer

1. RBCs that are very pale and show an increased area of central pallor 2. Hypochromasia is the result of a decrease in the Hb content of the cell. 3. Often accompanies decreased cell size (microcytosis) 4. Typical of iron deficiency anemias, thalassemias, sideroblastic anemia, and lead poisoning.

question

What are Polychromasia RBC's?

answer

1. Refers to RBCs that show a faint blue or blue-orange color with Wright's stain. 2. Mixed staining reaction of both blue RNA and red hemoglobin. 3. Polychromic cells are young cells that stain basophilic because of the presence of cytoplasm RNA. 4. Indication of increase erythrocyte formation typical of various hemolytic anemias.

question

What is Anisocytosis?

answer

term indicating increased variation in the size of RBCs

question

What is Macrocytosis

answer

Macrocytes are large RBCs; Mean diameter greater than 9 um or MCV > 100fL; Associated with liver disease, Vitamin B12 deficiency, Folate deficiency, and neonates

question

What is Microcytosis

answer

Microcytes are small RBCs <6.5 um, with an MCV of less than 78fL; Associated with iron deficiency anemia, thalassemia, lead poisoning, sideroblastic anemia, idiopathic pulmonary hemosiderosis, and anemias of chronic diseases

question

What is Poikilocytosis

answer

General term indicating an increased variation in the shape of RBCs

question

What are Elliptocyte and ovalocyte

answer

Elliptocytes are red blood cells that are oval or cigar shaped. They may be found in various anemias but are found in large amounts in hereditary elliptocytosis.

question

What is a Sickle Cell (Drepanocyte)

answer

Sickle cells are RBCs that have become crescent shaped. When a person with sickle cell anemia is exposed to dehydration, infection, or low oxygen supply, their fragile red blood cells form liquid crystals and assume a crescent shape causing red cell destruction and thickening of the blood.

question

What is a Target cell (Codocyte)

answer

Target cells are erythrocytes with a central color spot in the area of pallor, resembling a target. They are seen in many hemolytic anemias, especially sickle cell, HbC disease, and thalassemia.

question

What is a Spherocyte

answer

Spherocytes are red blood cells that are almost spherical in shape. They have no area of central pallor like a normal red blood cell. Large spherocytes (macrospherocytes are seen in hemolytic anemia. Small spherocytes (microspherocytes) are sometimes seen in severe burn cases.

question

What is a Stomatocyte

answer

Stomatocytes are RBCs with an oval or rectangular area of central pallor, sometimes referred to as a "mouth." These cells have lost the indentation on one side and may be found in liver disease, electrolyte imbalance, and hereditary stomatocytosis.

question

What is a Schistocyte

answer

Schitocytes are RBC fragments that result from membrane damage encountered during passage through vessels. They occur in microangiopathic hemolytic anemia, severe burns, uremia, hemolytic anemias caused by physical agaents, and in disseminated intravascular coagulation (DIC). They are sometimes referred to as "bite cells."

question

What is a Dacrocyte (teardrop cell):

answer

Teardrop shaped RBCs are found in myelofibrosis and other myeloproliferative disorders, pernicious anemia, thalassemia, myeloid metaplasia, and some hemolytic anemias.

question

What are Neutrophils

answer

Most abundant. Nucleus has 2-5 lobes connected by thin strands of chromatin; cytoplasm has very fine, pale lilac granules. Functions include phagocytosis; destruction of bacteria with lysozyme, defensins, and strong oxidants, such as superoxide anion, hydrogen peroxide, and hypochlorite anion.

question

What are Monocytes

answer

Nucleus is kidney shaped or horseshoe shaped; cytoplasm is blue-gray and has foamy appearance. Functions include phagocytosis (after transforming into fixed or wandering macrophages).

question

What are Eosinophils

answer

Nucleus usually has 2 lobes connected by a thick strand of chromatin; large, red-orange granules fill the cytoplasm. Functions to combat the effects of histamine in allergic reactions, phagocytize antigen-antibody complexes, and destroy certain parasitic worms.

question

What are Basophils

answer

Nucleus has 2 lobes; large cytoplasmic granules appear deep blue-purple. Function to liberate heparin, histamine, and serotonin in allergic reactions that intensify the overall inflammatory response.

question

What are Lymphocytes

answer

Includes T cells, B cells, and natural killer cells. Nucleus is round or slightly indented; cytoplasm forms a rim around the nucleus that looks sky blue; the larger the cell, the more cytoplasm is visible. Functions to mediate immune responses, including antigen-antibody reactions. B cells develop into plasma cells, which secrete antibodies. T cells attack invading viruses, cancer cells, and transplanted tissue cells. Natural killer cells attack a wide variety of infectious microbes and certain spontaneously arising tumor cells.

question

Describe the life cycle of the red blood cell.

answer

a. Live only about 120 days b. Cannot synthesize new components - no nucleus c. Ruptured red blood cells removed from circulation and destroyed by fixed phagocytic macrophages in spleen and liver d. Breakdown products recycled 1. Globin's amino acids reused 2. Iron reused 3. Non-iron heme ends as yellow pigment urobilin in urine or brown pigment stercobilin in feces.

question

Describe the High and Low Level Significance of Neutrophils

answer

High count may indicate bacterial infection, burns, stress, or inflammation. Low count may indicate radiation exposure, drug toxicity, vitamin B12 deficiency or systemic lupus erythematosus (SLE).

question

Describe the High and Low Level Significance of Lymphocytes

answer

High count may indicate viral infections and/or some leukemias. Low count may indicate prolonged illness, immunosuppression, or treatment with cortisol.

question

Describe the High and Low Level Significance of Monocytes

answer

High count could indicate viral or fungal infections, tuberculosis, some leukemias, or other chronic diseases. Low count could indicate bone marrow suppression or treatment with cortisol.

question

Describe the High and Low Level Significance of Eosinophils

answer

High count could indicate allergic reactions, parasitic infections, or autoimmune diseases. Low count could indicate Drug toxicity or stress.

question

Describe the High and Low Level Significance of Basophils

answer

High count could indicate allergic reactions, leukemias, cancers, hypothyroidism. Low counts could indicate pregnancy, ovulation, stress, or hyperthyroidism.

question

What is the Mean Corpuscular Volume (MCV)

answer

1. Average volume of an RBC in femtoliters; Calculated manually from volume of packed red cells (Hct) and the number of RBCs, or directly with automated instruments. MCV in normal adults is 80-96 fL (femtoliter = 10 -15) 2. 100 fL = Macrocytic

question

What is the Mean Corpuscular Hemoglobin (MCH)

answer

1. Content (weight) of Hb in the average RBC 2. Calculated by dividing Hb value by the RBC count 3. Normal MCH is 27-33 pg (pictograms; 10 -12) 4. Should always correlate with MCV and MCHC

question

What is the Mean Corpuscular Hemoglobin Concentration (MCHC)

answer

1. Average Hb concentration in a given volume of packed RBCs 2. Calculated from MCV and MCH, or from Hb and Hct values 3. Normal range is 33-36 g/dL (normochromic) a. <32 g/dL indicate hypochromasia b. 37 g/dL is near the physiological upper limits for Hb concentration so do not expect to see elevated values. c. Increase may e seen in spherocytosis

question

What is Red Cell Distribution Width (RDW)

answer

1. Measurement of the degree of anisocytosis present. 2. Reported from an automated cell counter 3. Normal range is 11-15%

question

What is the normal Hemoglobin Reference Ranges: (Adult Males are slightly higher than Adult Females)

answer

1. Adult Males: 13.0 - 18.0 g/dL 2. Adult Females: 11.0 - 16.0 g/dL 3. Infants: 10.0 - 14.0 g/dL

question

What is the normal RBC Count Reference Range (Females may be slightly lower than males)

answer

1. Adults: 4.8 - 5.4 x 10 6/uL (4,800,000 - 5,400,000 cells/uL)

question

What is the normal WBC Count Reference Range (Usually quantify neutrophil, lymphocyte, monocyte, eosinophil, basophil)

answer

1. 5 - 10 x 10 3/ uL (5,000 - 10,000 cells/uL) 2. Shift to the Left: an increase in the number of immature forms of neutrophils in the peripheral blood

question

What is the normal Platelet Count Reference Range

answer

1. Reference Range: 150 - 400 x 10 3/uL (150,000 - 400,000 cells/uL)

question

What is the normal Hematocrit Reference Ranges

answer

1. Age - 1 Day: Male = 44-72%; Female = 44-72% 2. Age - 6 Months: Male = 32-40%; Female = 32-40% 3. Age - 10 years: Male = 33-45%; Female - 33-45% 4. Adult: Male = 40-52%; Female = 35-47%

question

List the component tests of the Complete Blood Count

answer

Hemoglobin: Index of the oxygen carrying capacity of blood. Total amount of blood hemoglobin depends on the number of RBCs as well as the amount of hemoglobin in each RBC Hematocrit: the volume of packed RBCs that occupies a given volume of whole blood, stated as a percentage Red Cell count with Morphology: Provides a count of the number of RBCs present in the specimen and also serves as an indirect estimate of the hemoglobin content of the blood. Reticulocyte count: Serves as an index for RBC production by the bone marrow. An absolute reticulocyte count can be calculated using the reticulocyte count and the RBC count. The retic count must be correlated to the degree of anemia, if present, by calculating a corrected retic count. White Cell count with differential: a. Provides a count of the number of WBCs present in the specimen. b. Also includes percent of each cell type: Usually quantify neutrophil, lymphocyte, monocyte, eosinophil, basophil Platelet estimate: - Provides a count of the number of platelets present in the specimen

question

Morphology of Hypochromic RBC?

answer

RBCs that are very pale and show an increased area of central pallor. Hypochromasia is the result of a decrease in the Hb content of the cell. Often accompanies decreased cell size (microcytosis). Typical of iron deficiency anemias, thalassemias, sideroblastic anemia, and lead poisoning

question

Morphology of Polychromasia RBC?

answer

Refers to RBCs that show a faint blue or blue-orange color with Wright's stain. Mixed staining reaction of both blue RNA and red hemoglobin. Polychromic cells are young cells that stain basophilic because of the presence of cytoplasm RNA. Indication of increase erythrocyte formation typical of various hemolytic anemias.

question

Morphology of Anisocytosis RBC?

answer

General term indicating increased variation in the size of RBCs

question

Morphology of Macrocytosis RBC?

answer

Macrocytes are large RBCs; mean diameter greater than 9 um or MCV >100 fL. Associated with liver disease, vitamin B12 deficiency, Folate deficiency, and neonates.

question

Morphology of Microcytosis RBC?

answer

Microcytes are small RBCs <6.5 um, with an MCV of less than 78 fL. Associated with Iron deficiency anemia, thalassemia, lead poisoning, sideroblastic anemia, Idiopathic Pulmonary Hemosiderosis, and anemias of chronic diseases.

question

Morphology of Poikilocytosis RBC?

answer

General term indicating an increased variation in the shape of RBCs.

question

Morphology of Elliptocyte and Ovalocyte RBC?

answer

Elliptocytes are red blood cells that are oval or cigar shaped. They may be found in various anemias but are found in large amounts in hereditary elliptocytosis.

question

Morphology of Sickle Cell (Drepanocyte) RBC?

answer

Sickle cells are red blood cells that have become crescent shaped. When a person with sickle cell anemia is exposed to dehydration, infection, or low oxygen supply, their fragile red blood cells from liquid crystals and assume a crescent shape causing red cell destruction and thickening of the blood.

question

Morphology of Target Cell (Codocyte) RBC?

answer

Target cells (codocytes) are erythrocytes with a central color spot in the area of pallor, resembling a target. They are seen in many hemolytic anemias, especially sickle cell, HbC disease, and thalassemia.

question

Morphology of Spherocyte RBC?

answer

Spherocytes are red blood cells that are most spherical in shape. They have no area of central pallor like a normal red blood cell. Large spherocytes (macrospherocytes) are seen in hemolytic anemia. Small spherocytes (microspherocytes) are sometimes seen in burn cases.

question

Morphology of Stomatocyte RBC?

answer

Stomatocytes are red blood cells with an oval or rectangular area of central pallor, sometimes referred to as a "mouth." These cells have lost the indentation on one side and may be found in liver disease, electrolyte imbalance, and hereditary stomatocytosis.

question

Morphology of Schistocyte RBC?....possibly....

answer

Red blood cell fragments that result from membrane damage encountered during passage through vessels. They occur in microangiopathic hemolytic anemia, severe burns, uremia, hemolytic anemias caused by physical agents, and in disseminated intravascular coagulation (DIC). They are referred to as "bite cells."

question

Morphology of Dacrocyte (teardrop cell) RBC?

answer

Teardrop shaped red blood cells are found in myelofibrosis and other myeloproliferative disorders, pernicious anemia, thalassemia, myeloid metaplasia, and some hemolytic anemias.

question

What is indicated by Increased Retic Count/ Decreased?

answer

Increased Retic Count could be indicative of various hemolytic anemias such as: 1. Sickle Cell Anemia 2. G-6-PD Deficiency 3. Auto- or Iso- immune antibody formation Decreased Reticulocyte count can be indicative of: 1. Aplastic Anemia 2. Ineffective erythropoiesis a. Thalassemias b. Sideroblastic anemias c. Factor deficiency anemias

question

What is indicated in WBC shift to the left?

answer

Shift to the Left: increase in the number of immature forms of neutrophils in the peripheral blood

question

Normal Ranges for WBC?

answer

d. Normal WBC ranges: 1. Neutrophil: 60-70% 2. Lymphocyte: 20-25% 3. Monocyte: 3-8% 4. Eosinophils: 2-4% 5. Basophils: 0.5-1.0%

question

What is Pelger-Huet anomaly? (WBC)

answer

1. Pelger-Huet anomaly is a congenital autosomal dominant disorder in which granulocyte nuclei fail to segment normally. In the homozygote state, the nucleus is round. In heterozygotes, most granulocytes have biliobed nuclei ("princ-nez" cells) resembling bands. The trait is benign and occurs in 1 in 6,000 people. Cell function is normal.

question

Hypersegmentation of WBC's?

answer

2. Hypersegmentation, the presence of abnormally increased nuclear lobulation, is one of the first hematologic abnormalities seen in megaloblastic anemia. Normal mature circulating neutrophils have an average of 3 lobes and always fewer than 5 lobes. More than 3 cells having 5 lobs or a single cell with 6 lobes found in the course of a 100 cell differential is evidence of hypersegmentation. Hypersegmentation is sometimes referred to as a myeloid "right shift." Hypersegmentation may accompany other disorders in which there is a disturbance of maturation such as iron deficiency.

question

Toxic granulation of WBC?

answer

3. Toxic granulation is found in severe inflammatory states. The toxic granules are azurophilic, usually found in the promyelocyte, metamyelocyte, band, and segmented stages. The toxic granulation is thought to be due to impaired cytoplasmic maturation, in the effort to rapidly generate large numbers of granulocytes

question

What is Giant Platelet syndrome (Bernard-Soulier syndrome) (platelets)

answer

Condition is a primary problem of platelets in which the platelets lack the ability to stick adequately to injured blood vessel walls and as a result of this problem there is abnormal bleeding.

question

What are the Inheritied Platelet Disorders?

answer

I. Von Willebrand disease: associated with decreased production or dysfunction of von Willebrand factor and results in reduced platelet adherence to the injured blood vessel and increased blood loss. II. Glanzmann's thrombathenia: affects platelets ability to aggregate. III. Bernard-Soulier syndrome: characterized by reduced platelet adhesion. IV. Storage pool disease: can affect platelet ability to release substances that promote aggregation.

question

What is the Erythrocyte sedimentation Rate used for?

answer

Nonspecific test used to detect conditions associated with acute and chronic inflammation, including infections, cancers, and autoimmune diseases. It is nonspecific because increased results do not indicate where inflammation is in the body or what is causing it. ESR is used in conjunction with other tests. ESR is helpful in diagnosing two specific inflammatory diseases, temporal arteritis and polymyalgia rheumatic. A high ESR is one of the main test results used to support the diagnosis. It is also used to monitor disease activity and response to therapy in both of these diseases.

question

What does the Glucose-6-Phosphate Dehydrogenase test for?

answer

Tests detect decreased G-6-PD activity. Reference range: screening methods report "normal" or "deficient" enzyme activity. Specimen: whole blood anticoagulated with EDTA or heparin. Older RBCs are more affected. Enzyme activity degrades over time. After a hemolytic episode a "deficient" patient may appear "normal" because older RBCs have been removed by hemolysis. Caused by sex-linked genetic abnormalities which cause decreased G-6-PD activity. Exposure of RBCs in affected person to oxidizing drugs (e.g. antimalarial drugs primaquine, quinidine, and quinine, also sulfonamides, and nitrofurantoin) causes RBCs to lyse.

question

Yay! What are unsuitable specimens?

answer

Clotted Specimens: 1. Cells are trapped in clot. 2. Results in falsely low cell count Hemolyzed: 1. RBCs no longer intact 2. May be acceptable sample if evaluating underlying condition of intravascular hemolysis.

question

What are bone marrow studies used for?

answer

1. Polycythemia vera 2. Acuted and chronic leukemias (myelogenous, lymphocytic, monocytic) 3. Myelodysplastic syndromes (pre-leukemic state) 4. Aplastic anemia

question

How does one classify anemias?

answer

1. Size and hemoglobin content of RBC 2. Mechanism of its production

question

What are the common results in anemia labs?

answer

1. Decrease in Hgb. Less than 13 gm/dL in men and 12 gm/dL in women 2. Decrease in RBC 3. Decrease in Hct

question

What are the symptoms for anemias?

answer

1. Reduction of oxygen transportation: fatigue, dyspnea, synescope, angina pectoris 2. Reduction in blood volume: pallor, hypotension 3. Increased cardiac output: palpitations, hemic murmurs, congestive heart failure.

question

What are the classifications according to size for anemias?

answer

Macrocytic normochromic: pernicious anemia, folic acid deficiency and chronic liver disease Normochromic normocytic: acute blood loss and hemolytic anemias Microcytic normochromic: neoplastic Microcytic hypochromic: Iron deficiency, thalassemia, siderblastic anemias.

question

What are the classifications according to mechanisms for anemias?

answer

1. Blood loss acute and chronic 2. Excessive destruction of RBCs 3. Decreased production of RBCs 4. Bone Marrow Failure

question

Examples of Acute/Chronic Anemia?

answer

Acute I. External: trauma, nosebleeds, OB complications II. Internal: GI bleeding, (ulcers, diverticules, varies) Chronic I. GI II. Vaginal III. Nosocomial IV. Fetal and postnatal

question

Examples of Excessive destruction of RBCs Anemia...

answer

I. Hereditary: Spherocytosis, elliptocytosis, HbS, etc. II. Aquired: alloantibodies, (ex. incompatible blood transfusion) - autoantibodies, paroxysmal cold hemoglobinuria; drug induced antibodies, penicillin; infections, malaria

question

Examples of Decreased production of RBCs Anemia...

answer

I. Nutritional deficiency (inadequate intake) II. Defective adsorption: lack of intrinsic factor to adsorb vitamin B12 III. Increased demand: pregnancy

question

Examples of Bone Marrow Failure Anemia...

answer

I. Chemicals: drugs, radiation II. Idiopathic: aplastic anemia III. Endocrine: adrenal, pituitary IV. Myelophthistic: leukemia, lymphoma, myelofibrosis

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