Hematology

_________________ is about the relationship of bone marrow to the systemic circulation, the realtionship of the plasma environment to the RBC life span, and relationship of the hemoglobin to RBCs

Hematology

A microscope has 4 main components, the ____________, ___________, ___________, and the _________ systems

framework, illumination, magnification, and the focusing

The microscopes ____________ includes the base, arm, stage, and rotating nosepiece

framework

The ___________ system includes the light source, Abbe condensor and iris diaphragm themselves and their adjusters

illumination

The _________ adjusters focus, centers, and directs the beam of light

condenser

The _______ _________ controls the amount of light

Field Diaphragm

____________ are the main magnifiers of the microscope

Objectives

The magnification system as a whole is called the ________ ______

Optical tube

The focusing system includes the ____________ and ______ focusing systems

coarse and fine

Total magnification = ocular magnification x __________ magnification

objective

___ (low power) is used for initial focusing and some cell counts

10x

___ (medium high-dry) is used for scanning and estimating counts

40x

___ (oil immersion) is used for identification and enumeration

100x

___________ reveals fine detail

Resolution

____________ distinguishes object from background

Contrast

The most utilized microscopic technique is ______________ ___________

Bright-field microscopy

Bright-field microscopy makes objects ______ against the bright background

dark

_____________ is the production, development, differentiation, and maturation of all blood cells

Hematopoiesis

The first 2 weeks to 2 months in fetal life is the ________ _______, where erythroblasts and embryonic hemoglobin is produced

mesoblastic period

2-7 months of the fetal life is the _______ _______, where WBCs and megakaryocytes start to appear

hepatic period

Megakaryocytes are the origin of ___________

platelets

The ______ ________ assumes the role of hematopoiesis 7 months post conception

bone marrow

The _______, _______, and _______ ______ can compensate in case of bone marrow damage and/or leukemia

spleen, thymus, and lymph nodes

____________ __________ can be caused by tumors or leukemic cells in the bone marrow

Extramedullary hematopoiesis

The spleen functions as _________, _________, __________ _______, and _________

storage, filtration, immunologic, and hematopoietic function

The spleen stores _____ of platelets and granulocytes

1/3

The spleen also inspects RBCs for damage, provides ________ _______, and produces blood cells

opsonizing antibodies

___________ _____ are capable of differentiation into Myeloid (Non-Lymphoid) or Lymphoid commited precursor cells

Multipotential cells

___________ and ___________ are responsible for controlling replication, maturation, and stem cell growth inhibition

Cytokines and interleukins

The normal Myeloid: Erythroid ratio is ___________ and reflects the production to lifespan ratioof various cell types

3:1 to 4:1

WBC life span is ______ hours

6-10

RBC life span is ______ days

120

______ are produced at a much higher rate than RBCs

WBCs

Bone marrow procedures are prefered to be done at the _______ ______

iliac crest

_________ are areas in a sample richest with cells

Spicules

Stains used for slide preparation are ________ ______ (for iron) and __________ (for everything else)

Prussian blue and Wrights

_______ is the most frequently ordered test in Hematology

CBC

CBC tests are preformed using ________

EDTA

CBC testing measures the amount of __________________________

RBCs, WBCs, PLTs, Hgb, Hct, MCV, MCH, MCHC, and RDW

WBC counts are normal at ___________ for both males and females

4.8-10.8

RBC counts are normal at ________ in males and _______ in females

4.7-6.1; 4.2-5.4

Hgb is normal at _______ in males and _______ in females

14-18; 12-16

MCHC is normal at ________%

32-36

MCV is normal at _________

80-100

PLTs are normal at _________

150-450

With WBCs, _ is considered critically low and __ is considered critically high

3; 25

With Hgb, _ is considered critically low and __ is considered critically high

7; 19

With PLTs, _ is considered critically low and __ is considered critically high

20; 1000

Corelation checks/Rule of threeformulas are _____________________________________

RBC x 3 = Hgb; Hgb x 3 = Hct ∓ 3

Correlation checks/rule of three only applies to ____________/____________ RBCs

normocytic/normochromic

Pluripotent stem cells mature into ____________________

Pronormoblasts

Pronormoblasts are stimulated by EPO and matures into ___ RBCs

16

RBCs have ___ stages of maturation, where the cell decreases in size and decreases in N:C ratio

6

As RBCs age, the color changes from blue to _______

salmon

__________ RBCs are large, blue and has a nucleus

Immature

__________ RBCs are small, salmon, and have no nucleus

Mature

Pronormoblasts (1) has a N:C ratio of _____

6:1

Pronormoblasts (1) have a nucleus with __________ packed chromagin

densely

Basophilic Normoblasts (2) have a N:C ratio of _____

6:1

Basophilic Normoblasts have a round nucleus with _______ ______ appearance

Crystalline Chromatin

Polychromatophilic Normoblasts (3) have a N:C ratio of ______

4:1

Polychromatophilic Normoblasts (3) have a condensed, moderately compacted nucleus with no _______

Nucleoli

____________________________ ____________________ is where hemoglobin is first appears

Polychromatophilic Normoblasts

3

Orthochronic Normoblasts (4) have a N:C ratio of _____

1:1

Orthochronic Normoblasts (4) has a ________, velvet nucleus

Dense

_________________ has no nucleus or N:C ratio, also has remnants of RNA in the cytoplasm

Reticulocytes

________ _____ are disc shaped and have no nucleus

Mature RBCs

Matuer RBCs are found in ____________ __________

peripheral blood

Polychromasia and nucleated RBCs are observed with ___________ ____________

Effective Erythropoiesis

Precursor cells hemolyzing before their maturation is complete is seen with ____________ ___________

Ineffective erythropoiesis

__________ ____ are RBCs in stages 1-4 of the maturation cycle

Precursor cells

The outer layer of the RBC membrane contains _____________ and ____________

glycoprotein and glycolipids

The central layer of the RBC membrane contains ______________ and ______________

cholesterol and phospholipids

The inner layer of the RBC membrane is the ______________

cytoskeleton

RBC membranes protein matrix is supported by ___________ and ___________ proteins

Integral and peripheral

The cytoskeletons gives the RBCs there elasticity and is made up of the proteins ___________ and ___________

Spectrin and Ankyrin

RBC metabolism has 3 pathways, the ______________________________________________________

Embden-Meyerhof, pentose phosphogluconate, and methemoglobin reductase pathway

The embden meyerhof pathway provides _____ of ATP required to run the Na/k pumpand generates NADH

90%

The pentose phosphogluconate pathway generates ___________ and 5-10% of ATP

NADPH

The methemoglobin reductase pathway keeps hemoglobin in the ____________ state

ferrous

_______ is the average volume of one RBC

MCV

MCV = (Htc/RBCs) x ___

10

______ is the average weight per RBC

MCH

MCH = (_________) x 10

Hgb/Htc

_______ is hemoglobin concentration

MCHC

MCHC = (Hgb/Htc) x ____

100

MCV has a valuable role in monitoring _______________ and _____________ properties

preanalytical and analytical

______________ is variation in the size of RBCs

Anisocytosis

_____________ are <6 microns in diameter and <80 MCV

microcytes

_____________ are >8 microns in diameter and >100 MCV

Macrocytes

______________ is the absence or reduced production of globin chains

Thalassemia

____________________ is the high presence of abnormal RBCs

Poikilocytosis

__________________ lack biconcave shape and have an increased hemoglobin content

Spherocytes

Spherocytes are associated with diseases such as ___________________________

Hereditary spherocytosis, Hemolytic anemia, and post transfusion

Ovalo/elliptocytes are associated with diseases such as ________________________________________

Thalassemia and Megaloblastic anemia/ Hereditary elliptocytosis and Iron deficiency anemia

Echinocytes (Burr) are associated with diseases such as ___________________________-

hypernatreamia, Renal disease, and Severe burns

Acanthocytes are associated with _______________________________________

liver disease, alcoholism, post-splenectomy, and Vit E deficiency

Schistocytes (fragments) are associated with __________________________________________

disseminated Intravascular coagulation, hemolytic anemia, and Artificial heart valves

Drepanocytes are associated with ______________________

Sickle cell anemia

Codocytes (Target) are hallmark indicators of _________ _________, also indicates Hgb C disease, post splenectomy, and iron deficiency anemia

liver disease

Dacrocytes (Tear drop) is associated with diseases such as ____________ and ____ ____________

thalassemia and iron deficiency

Keratocytes (helmet) is associated with ___________________________________

G6PD deficiency, pulmonary embolism, and disseminated intravascular coagulation

Stomatocytes are associated with _____________________________________________

chronic liver disease (alcoholism), hereditary stomatocytosis, and hereditary spherocytosis

Howell-Jolly bodies are seen after spleen removal and _________ ________

megaloblastic anemia

Pappenheimer bodies are associated with ___________________________

Hereditary hemochromatosis, iron loading anemias, thalassemia, and following splenectomy

Basophilic stippiling is associated with _______________________

lead poisoning or Thalassemia

A cobots ring is rarely seen with _____ ___________

lead poisoning

Heinz Bodies are associated with diseases such as ________________________

G6PD deficiency and Alpha Thalassemia

PSS/ Parasites are associated with _________

malaria

______________________ ________ (polychromasia) are immature RBCs caused by anemic stress, iron deficiency anemia, thalassemia, and Sickle cell anemia

Polychromatic RBCs

Heme is composed of _____ and a ___________________ _____

Fe2+ and a Protoporphyrin ring

Heme synthesis occurs in the _____________ and __________

mitochondria and cytoplasm

Hemoglobin contains _ heme and _ unalike globin chains (a A-globin and a G/D-globin)

4; 2

The a-globin and the B/G/D chain bind to form heterodimers, and 2 heterodimers combine to form a ________ __________ ________

tetramer hemoglobin molecule

The polychromatophilic normoblast phase (3) begins _______ synthesis

Hgb

The Reticulocyte phase ends ______ synthesis

Hgb

Adults have _______% hemoglobin A, _____% hemoglobin A2, and <__% hemoglobin F

95-98; 3-5; 2

____________ ___ contains A chain globins

Chromosome 16

___________ ____ contains B chain globins

Chromosome 11

Embryonic Hgb is present __ months post-conception

3

Hgb ___ has a high O2 affinity

F

Hgb F is dominant untis baby is ~__ months old

6

__________________ is formed by irreversible hemoglobin oxidation by drugs or chemicals

Sulfhemoglobin

Sulfhemoglobin has an O2 affinity _____x lower than normal Hgb

100

Old RBCs are phagocytized by _____________

macrophages

______________ is premature RBC destruction

Hemolysis

_________ ____________ may indicate hemolysis in the bone marrow

Erythroid Hyperplasia

More _____________ and _______________ indicate hemolysis in peripheral smears

polychromasia and spherocytes

Low _______________ and increased _____________ and _______ indicate hemolysis in the blood plasma

Haptoglobin; bilirubin and LDH

Haptoglobin carries free ______________

hemoglobin

______________ hemolysis accounts for 90% of all hemolysis

Extravascular

With extravascular hemolysis, destruction usually occurs by ________________ outside of the blood vessels (spleen, liver, bone marrow, lymph nodes)

macrophages

With extravascular hemolysis __________________________ may be seen

hepatosplenomegaly

With intravascular Hemolysis, _______________ and ______________ may be seen

Hemoglobinemia and Hemoglobinuria

for both Extra and Intravascular hemolysis, Hgb, Hct, and RBCs are all decreased and serum bilirubin, reticulocytes, and LDH are all elevated, however decreased ____________ is the hallmark symptom of hemolysis

Haptoglobin

Intrinsic RBC defects refers to _________ ______

inherited defects

Intrinsic RBC defects include __________, _____ ____, and _________ defects

membrane, stem cell, and enzyme

Extrinsic RBC defects are _________________________________________

Autoimmune hemolytic anemia, Parasitic infections. microangiopathic hemolytic anemia, and environmental agents

The ________________ method drops 1 blood drop into a beaker of water and if it falls to the bottom within 15 seconds it has a Hgb concentration of atleast 12.5

Gravimetric

The Photometric method is based on Hgbs ability to combine with ___________ __________, which oxidizes Hgb to methemoglobin which becomes cyanmethemoglobin pigment which can be measured spectrophotometrically at 540 nm

Drabkins Reagent

Decreased Hgb indicates _________________

anemia

Increased Hgb indicates ______________ (erythrocytosis)

polycythemia

Hemoglobin picks up oxygen and facilitates cellular respiration by ______________ __________ to O2

reversibly binding

Hemoglobin also binds to wast products such as _______ and ____

2,3-DPG and Acid

In the _______, Hgb releases CO2, binds to O2, and releases 2,3-DPG; it then enters its relaxed from (oxygenated)

lungs

In the ______, Hgb binds CO2, releases O2, and binds 2,3-DPG; then enters its tense state (deoxygenated)

tissues

O2 binding and release from hemoglobin is defined by the _____ __________

OD curve

In the lungs PO2 is ____ mm (97%)

100

In Circulation, PO2 is ___ mm (75%)

40

With the OD curve, a _____ shift is more likely to release O2, so less O2 and more of everything else

right

With the OD curve, a _____ shift is less likely to release O2, so more O2 and less of everything else

left

With __________________, the iron is oxidized (Ferric) so it is incapable of binding O2; irreversable

methemoglobin

With ___________________, CO is bound to heme, leaving a reversible bond that is 200x harder to break

carboxyhemoglobin