question

What is the purpose of filtration (in the spleen)?

answer

Remove old RBCs, those with inclusions and remove antibodies from coated RBC

question

What is the purpose of the reservoir in the spleen?

answer

holds 1/3 of platelets and 1/3 of granulocytes

question

What is the purpose of the Immunological role of the spleen?

answer

Serves as largest secondary lymphoid organ

question

The spleen consists of (think colors)?

answer

red pulp - RBC filtration white pulp - lymphocyte processing marginal zone - storage of lymphocytes and platelets

question

Two functions of the bone marrow:

answer

1 central factory for production of all adult hematopoietic cells 2. site of cell maturation

question

Two types of bone marrow:

answer

1. yellow and red marrow

question

After age of 18, where is most of the bone marrow located?

answer

primarily in iliac crest and sternum

question

What is the site of choice to a bone marrow biopsy

answer

iliac crest (take out fiscules and small amount of bloody fluid)

question

Quality checks between the _____ and ____are a significant part of quality assurance

answer

hemoglobin and hematocrit

question

Define anisocytosis

answer

variation in size of a rbc

question

Define poikilocytosis

answer

variation in shape of an rbc

question

What hemoglobin level is considered anemic

answer

Hemoglobin below 7 g/dl

question

Define hematopoiesis

answer

The production, development, differentiation, and maturation of ALL blood cells

question

Where does hematopoisis takes place at different stages of fetal life:

answer

1. Yolk sac ( 2 weeks - 2 months) 2. Spleen and Liver (2 - 7 months fetal life) 3. Thymus, lymph nodes, spleen ( 7 months to birth)

question

Hematopoiesis within the bone marrow is called ______

answer

Intramedullary hematopoiesis

question

Hematopoiesis outside the bone marrow environment is called ______

answer

extramedullary hematopoiesis (takes place in the liver and spleen)

question

The _____ and _____ can function as organs of hematopoiesis if needed in adult life

answer

liver and spleen

question

If extramedullary hematopoiesis develops, the liver and spleen become enlarged in a condition known as:

answer

hepatosplenomegaly (ALWAYS and indicator that hematologic health is compromised)

question

Three functions of spleen

answer

1. Filtration 2. Reservoir 3. Immunologic role 4. Hematopoietic role

question

The filtration function of the spleen involves:

answer

1. Removing old RBCs to include those with inclusions 2. Removes antibodies from coated RBCs

question

Antibody-coated red blood cells have their antibodies removed and usually reappear in the peripheral circulation as ______

answer

spherocytes (smaller and more compact rbc with a shortened life span)

question

As a reservoir, the spleen holds 1/3 of _____ and 1/3 of ______

answer

platelets/ granulocytes

question

What is the immunological role of the spleen

answer

1. Spleen is the largest secondary lymphoid organ 2. It promotes phagocytic activity for encapsulated organisms by providing opsonizing antibodies which strip the capsule from the bacterial surface making them vulnerable to the phagocytic reticuloendothelial system (RES)

question

What is OPSI

answer

overwhelming postsplenectomy infections

question

Functions of bone marrow:

answer

1. Central factory for production of all adult hematopoietic cells 2. Site of cell maturation

question

Anatomy and physiology of bone marrow

answer

1. Consists of yellow and red marrow 2. Under age of 18, marrow is spread throughout major bones 3. After age 18, marrow is located primarily in iliac crest and sternum (marrow is replaced by fatty tissue)

question

Bone marrow contents

answer

1. Myeloids 2. Erythroids 3. Osteoclasts 4. Megakaryocytes 5. Fatty tissue and stoma

question

Myeloid Erythroid (M:E) ratio can predict (or influence) ______

answer

hematological problems that may impair red blood cell life span, inhibit overall production, or cause dramatic increasis in a particular cell linje

question

Anemia stimulates body to produce ______

answer

erythropoeitin (EPO) to increase blood counts (the bone marrow produces elevated nucleated RBCs and reticulocytes (immature RBC)

question

During anemia, the bone marrow produces _______

answer

elevated nucleated red cells and reticulocytes (immature RBCs)

question

What are reticulocytes

answer

Immature RBCs

question

______ are responsible for determining and stimulating colony forming units-spleen (CFU-S) into becoming a specific cell

answer

Cytokines

question

Three cytokines responsible for stimulating or determining lineage of pluripotent cells:

answer

1. EPO (Erythropoeitin) 2. G-CSF (Granulocyte-colony stimulating factor) 3. GM-CSF (granulocyte-macrophage colony stimulating factor

question

GM-CSF functions to:

answer

It is a cell modifier (cytokine) for granulocytes, macrophages, fibroblasts, and endothelial cells

question

EPO (erythropoeitin) functions to:

answer

It is a cell modifer (cytokine) that functions as a targeted erythroid growth factor - It is a hormone produced by the the kidneys - Stimulates red cell production - If body becomes anemic, EPO is released and premature red cells may be released from bone marrow - Available as a pharmaceutical product

question

Uses for pharmaceutical cytokines:

answer

1. Recovery from neutropenia 2. Bone marrow therapy 3. Increase white counts of AIDS patients

question

The iron store is evaluated by the use of the _______ stain

answer

Prussian blue

question

The CBC consists of: (9 components)

answer

1. White blood count (wbc) 2. Red blood count (rbc) 3. Hemoglobin (Hgb) 4. Hematocrit (Hct) 5. Mean corpuscular volume (MCV) 6. Mean corpuscular hemoglobin (MCH) 7. Mean corpuscular hemoglobin content (MCHC) 8. Red cell distribution width (RDW) 9. Platelet count (Plt)

question

Which components of the CBC are read directly?

answer

1. WBC 2. RBC 3. Hemoglobin 4. MCV

question

______ are a calculated parameter

answer

Hematocrits

question

Describe the rule of three:

answer

1. Hgb X 3 = Hct (plus or minus) 3 2. RBC X 3 = Hgb

question

The scatterplot is a pictorial representation of the complete blood count:

answer

Not - Neutrophil Everyone's - Eosinophil Baby - Basophil Loves - Lymphocyte Milk - Monocyte

question

_____ is one of the most stable parameters in the CBC

answer

Mean Corpuscular Volume (MCV)

question

The Mean Corpuscular Volume (MCV) is used to evaluate:

answer

pre-analytical and and analytical specimen integrity

question

Pre-analytical changes in the MCV is caused by:

answer

1. Contamination by drawing through the IV lines or in-dwelling catheters 2. Specimens from hyperglycemic patients 3. Patients on some chemotherapy drugs

question

Analytical changes detected in MCV may be caused by:

answer

1. cold agglutinins 2. transfusion therapy 3. reticulocytosis

question

What is reticulocytosis?

answer

A condition where there is an increase in reticulocytes, (immature red blood cell). It is commonly seen in Anemia.

question

Calculate MCV

answer

MCV = Hematocrit / Red cell count X 10 -Normal value is 80 - 100 fL

question

______ and ______ provide information concerning red cell hemoglobinization

answer

Mean Corpuscular Hemoglobin and Mean Corpuscular Hemoglobin Content

question

How is MCH (Mean Corpuscular Hemoglobin) calculated?

answer

MCH = Hemoglobin / red blood cell count X 10 (The MCH provides information concerning the red cell hemoglobination)

question

How is MCHC (Mean Corpuscular Hemoglobin Content) calculated?

answer

MCHC = Hemoglobin / hematocrit X 10

question

What is MCH (Mean Corpuscular Hemoglobin) and what is the normal value

answer

MCH is the average weight of hemoglobin Normal value is 27 - 31

question

What is MCHC (Mean Corpuscular Hemoglobin Content) and what is the normal value

answer

MCHC is the amount of hemoglobin per red cell Normal value is 32 - 36%

question

RDW (red cell distribution width) gives insight into:

answer

the amount of anisocytosis (variation in size) and poikilocytosis (variation in shape) in a peripheral smear

question

How is RDW (red cell distribution width calculated?

answer

RDW = Standard deviation (sd) of RBC volume / mean MCV X 100

question

What is normal value of the RDW

answer

11.5 - 14.5%

question

Anemia is ___

answer

reduction in hemoglobin

question

(Anemia) Hemoglobin below 7 g/dl may cause:

answer

1. Pallor (paleness) 2. Fatigue 3. Tachycardia (rapid heartbeat) 4. Syncope (fainting)

question

Three morphologic classifications of anemia:

answer

1. Normochromic / normocytic anemia 2. Microcytic / hypchromic anemia 3. Macrocytic / normochromic anemia

question

Normochromic/normocytic anemia values

answer

1. MCV 80 - 100 fL (normal size) 2. MCHC 31 - 36% (normal color)

question

Microcytic / Hypochromic anemia

answer

1. MCV < 80 fL (small size) 2. MCHC < 30% (lacking color) 3. Red cells are microcytic, smaller and lacking hemoglobin

question

Macrocytic / Normochromic Anemia

answer

1. MCV > 100 fL (large size) 2. Normal hemoglobin (normal color)

question

The reticulocyte count is used to _______ or ______ and is an immature un-nucleated cell

answer

assess red cell generation or response to anemia

question

The Reticulocyte count must be stained with supra-vital stains such as ______ or ______

answer

New methylene Blue or Brilliant cresyl blue

question

On Wright's stain, reticulocytes are seen as ______

answer

polychromatophilic macrocytes (large, bluish cells)

question

The reticulocyte rate is _____ in adults and ______ the newborn

answer

.5 to 1.5% in adults and 2.0 to 6.0% in the newborn

question

What is ineffective erythropoiesis

answer

failure to produce reticulocytes during anemic stress

question

The Average life span of a red cell

answer

120 days

question

Four characteristics of red cell maturation

answer

1. cell size is reduced 2. nuclear:cytoplasm ratio decreases 3. nuclear chromatin becomes more condensed 4. cytoplasm color changes due to hemoglobinization

question

How do red cells anucleate?

answer

RBCs begin with nucleus and lose it in the bone marrow through successive cell divisions

question

List 6 stages of red cell development in order according to CAP

answer

Ponies -- Pronormoblast (nucleoli may be present) Bounce -- Basophilic normoblast (cornflower blue) and Play -- Polychromatophilic normoblast (dawn of hemoglobinization) On the -- Orthochromic normoblast (orange-red tinges) Range -- Reticulocyte (dots seen with methylene blue) Everyday -- Erythrocyte (central pallor; disk shaped)

question

List 6 stages of red cell development in order according to ASCP terminology

answer

Racing -- Rubriblast Ponies -- Prorubricyte Run -- Rubricyte My -- Metarubricyte Race -- Reticulocyte Everyday -- Erythrocyte

question

Three component of the red cell membrane and their percentages

answer

1. Protein (50%) 2. Lipid (40%) 3. Cholesterol (10%)

question

Describe integral proteins and their function

answer

Integral proteins start from the cytoskeleton and expand through the membrane to penetrate the outer edge Their function is transport and supporting structure. They also help provide a net negative charge for rbc. Some antigens are located here

question

Transport mechanism for RBC: Which substances can diffuse freely through special channels?

answer

1. water 2. Chloride 3. Bicarbonate

question

Transport mechanism for RBC: which substances are more highly regulated and provide their intra/extracellular ratios:

answer

1. sodium (1:12) 2. potassium (25:1) 3. calcium

question

Define peripheral proteins and their functions

answer

They are confined to the RB membrane cytoskeleton. The cytoskeleton is responsible for RBC deformability (spectrin and ankyrin)

question

The average RBC is _____ wide and must fit through arterioles that are _____ wide

answer

6-9 um 1-3 um

question

Where do mature RBCs derive their energy

answer

glucose

question

RBC adnormalities are quantified by:

answer

Anisocytosis - variation in size Poikilocytosis - variation in shape

question

A normal RBC is ___-shaped, ____ um; MCV is _____fL and the MCHC is ____

answer

disk-shaped 6-9 um MCV 80-100 fL MCHC 32% - 36%

question

A macrocytic RBC is greater than ____ um

answer

9

question

A microcytic RBC is less than ____ um

answer

6

question

Name 4 microcytic anemias:

answer

1. Iron deficiency anemia (IDA) 2. Thalessemia 3. Iron overload disorders 4. Anemia of chronic disorders

question

Two ways that IDA (iron deficient anemia) can develop

answer

1. deficient iron intake 2. defective iron absorption

question

Structure and component of a hemoglobin molecule

answer

1. 2 pairs globin chains (form pocket for heme 2. 2 pairs heme

question

What causes thalassemia

answer

1. Caused by missing or diminished alpha or beta globin chains 2. Results in formation of hypochromic microcytes due to rapid cell divisions searching for iron 3. Normal adult hemoglobin cannot be synthesized

question

Describe iron overload disorders

answer

1. Ex: hereditary hemochromatosis 2. Patients will show dimorphic smear (some microcytes with macrocytes) (some normal hemoglobin and some hypochromic)

question

What causes anemia of chronic disorders

answer

1. arises from renal failure or thyroid dysfunction 2. Iron delivery to the reticuloendothelial system is impaired

question

Conditions that cause macrocytes:

answer

1. liver disease of alcoholism 2. megaloblastic anemia Formed due to lack of vitamin B12 or folic acid

question

Describe appearance of Spherocytes

answer

They are dense, dark red and small Elevated MCHC with lifelong moderate anemia shorted life span Hereditary spherocytosis Ab-coated RBC formed from immune response Spleen cleans off Ab's and remove part of RBC membrane

question

Sickle cells

answer

1. crescent shape 2. Patients possess hemoglobin S 3. As cell moves through spleen and kidney the cells are less elastic and unable to squeeze through 4. Causes cell deformation (10% irreversible)

question

Ovalocytes

answer

1. egg shaped 2. Thalassemia (normochromic ovalocytes) 3. Megaloblastic anemia (macroovalocytes)

question

Elliptocytes

answer

1. elliptical shaped 2. hereditary elliptocytosis 3. iron deficiency anemia 4. idiopathic myelofibrosis

question

Target cells

answer

1. bullseye 2. formed as artifact 3. decreased hemoglobin 4. increased red cell surface membrance caused by increased plasma cholesterol

question

Describe cell inclusions

answer

1. Siderotic (prussian blue stain) 2. Pappenheimer (wright stain) Sen in iron overload conditionars around periphery of RBC

question

Howell Jolly bodies

answer

1. Remnant of DNA; eccentrically located

question

Basophilic stippling

answer

1. RNA and mitochondrial remnants 2. diffuse basophlic granules 3. seen in lead poisoning

question

Heinz bodies

answer

1. denatured hemoglobin 2. seen on periphery of RBC 3. cannot be seen in Wright stain

question

What are the three major parts of a hemoglobin molecule

answer

1. Heme 2. Globin 3. 2,3 diphosphoglycerate (2,3-DPG)

question

How may molecules of iron per heme?

answer

4 iron atoms (Fe2+)

question

Name the three types of synthesized hemoglobin

answer

1. embryonic hemoglobin 2. fetal hemoglobin 3. adult hemoglobin

question

Name the thee types of adult hemoglobin and its percentages

answer

Hemoglobin A (95 - 98%) Hemoglobin A2 (3 - 5%) Hemoglobin F (<2%)

question

Main function of hemoglobin

answer

Principal purpose is oxygen delivery Additional functions: Pull CO2 away from the tissues and keeping the blood in a balanced pH

question

Explain Oxygen dissociation curve

answer

1. S-shaped 2. Shows how the hgb molecules and oxygen respond to normal and abnormal physiologies 3. In high levels of O2, molecule is fully saturated and more willing to give to tissues

question

In lungs if PO2 is 100 mm Hg then hemoglobin will be ___ % saturation

answer

97

question

In venous circulation if PO2 is 40 mm Hg then hemoglobin saturation is ___ saturation

answer

75%

question

Shift to right

answer

more likely to release oxygen to tissue H+ increase P-CO2 increase temp increase Lower affinity (less attraction) - Anemia - Acidosis - Increased 2,3-DPG

question

Shift to left

answer

Less likely to release oxygen to tissue Higher affinity (more attraction) H+ decrease P-CO2 decrease temp decrease - Decreased body temp - abnormal hemoglobin - alkalosis - Decreased 2,3-DPG

question

Name the three types of abnormal hemoglobin

answer

These are often formed by accidental or intentional ingestion or they can be inherited defects 1. Methemoglobin - iron oxidized for Fe 3+ state instead of Fe2+ - > 10% person become cyanotic 2. Sulfhemoglobin -exposure to sulfonamide or sulfa drugs 3. carboxyhemoglobin - increased in smokers and some industrial workers - high infinity for carbon monoxide (200 times greater) no oxygen delivery to tissue - formed during carbon monoxide poisoning

question

Two types of hemolysis

answer

1. extravasular 2. intravascular

question

Extravascular hemolysis

answer

red blood cells are lysed in organs

question

Intravascular hemolysis

answer

red blood cells are lysed directly into the blood 10% of hemolysis Lysis takes place directly inside vessel and hemoglobin released into plasma Hemoglobinemia - red tinged blood in plasma hemoglobinuria - free hemoglobin in urine

Hematology Test 1 – Chapter 1 – 4 – Flashcards

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