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74 Cards in this Set
- Front
- Back
1.1 Define Hematopoiesis |
Production and development of blood cells. This occurs in the bone marrow under the influence of hematopoietic growth factors. |
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1.2 Sites of hematopoiesis in fetal life, children, adult |
Fetal life: Embryonic (yolk sac), Hepatic (extramedullary, spleen, liver) Children: BM Adult: BM |
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1.3 Bone marrow location, composition, function |
3.4-4.6% of total body weight Supplies circulating blood cells Removes senescent and abnormal cells Red and Yellow marrow
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1.4 Bone marrow cellularity; red and yellow marrow |
Red: Hematopoietically active cells Yellow: fatty inactive cells 100-age for cellularity Hyper: 90/Hypo: 10 At birth 100% |
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1.5 Stem cells GEMM CFU |
Stem cells: non-identifiable GEMM- multipotential cell granulocyte, erythroid, monocyte megakaryocyte Colony forming unit: the cell which gives rise to the colony
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1.6 M/E ratio |
The ratio betwee myeloid/erythroid producing cells
Ratio between all granulocytes and nucleated red cell precursors |
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1.7 M/E ratio |
3/1 |
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1.8 Conditions that require bone marrow studies |
Leukopenia/Leukocytosis Anemia Thrombocytopenia/thrombocytosis |
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1.9 Define: Growth factors, CSF; applications in the treatment of hematologic disorders |
GF: cytokines (CSF, IL-3, G-CSF, GM-CSF, EPO, M-CSF) stimulate hematopoiesis CSF: colony stimulating factor |
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1.10 Hematopoiesis: Stem cell, bm, peripheral blood pools |
1. Stem cells- morphologcially non-identifiable, pluripotent/Multipotent cells(GEMM 0.4%) 2. Immature and mature cells; morphologically identifiable cells 3. Adult cells |
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1.11 Stages of hematopoiesis before and after birth |
Before: 1. yolk sac, liver, spleen (extramedullary), BM (intramedullary), Lymph nodes After: BM (Adults: vertebra, sternum rib)(Children- adult sites +femur and tibia), lymph nodes |
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1.12 Define Extramedullary and Intramedullary hematopoiesis |
Sites of hematopoiesis E: hepatic stage I: bone marrow |
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1.14 The function of RBCs and WBCs |
RBC: transport O2 excrete CO2 Granulocytes: Fight infection Mnoncytes: phagocytosis Lymphocytes: Immune function Platelet: maintain hemostasis
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1.15 Maturation stages of RBC |
Pronormoblast, basophilic normoblast, polychromatophilic normoblast, orthochromic normoblast, Polychromatophilic erythrocyte (reticulocyte), RBC |
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1.16 Morphological characteristics of red cell in different stages of maturation: Cell size, N/C ratio, nucleus cytoplasm |
Pronormoblast 14-19um 6:1, 1-3 nucleoli, chromatin fine Basophilic Normoblast 12-17um, um 4:1, coarser chromatin, indistinct nucleoli polychromatophilic normoblast 12-15um 2:1 1:1, condense chromatin orthochromic normoblast 8-12um, 1:1, chromatin very condense polychromatophilic 7-10 no nucleus, basophilic RBC:no nucleus 7-8 um pink |
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1.17 Erythropoietin what does it do, where is it made? |
Growth factor secreted by the kidney; influences the formation and maturation of RBCs by stimulating the stem cells in the bone marrow |
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2.1 Principle and procedure: Hgb, Hct, and sedimentation (Westergren method) |
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2.2 Normal values for Hgb, Hct and sed rate in adults and childern |
Sed: <20 mm/h |
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2.3 Results of Hgb, Hct, and sed rate with disorder |
Sed: Non-specific response to tissue damage |
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2.4 Name hemoglobins measured by cyanmethemoglobin method |
Potassium ferricyandie (Drabkins) methemoglobin-----------------> cyanmethemoglobin |
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2.5 Rule of three in regard to Hgb/Hct |
HgbX3=Hct +/-3% |
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2.6 Type of blood sample used for routine hematology tests |
Purple top EDTA |
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2.7 Sources of error in Hgb, Hct, Sed rates |
Hbg: insoluble rbc, abnormal hgb, lipemic, increase WBC Hct: dehydration, improperly filled tube, read buffy coat, improperly: centrifuged, mixed or sealed, stopping centrifuge Sed: viscosity, sickle cell, spherocytes (decrease), rouleaux, sickle cell increase, fibrinogen, poikilocytosis (increase). 2hr old sample, tilt, bubbles, clotted, significant temp change |
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2.8-9 RBC indices include formula and calculate |
MCH: HgbX10/RBC= Mean corpuscular hemoglobin MCV: HctX10/RBC= mean corpuscular vol MCHC: HbgX100/Hct= mean corpuscular hemoglobin concentration |
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2.10 Values for adults and children RBC indices |
Adults Children MCH: 27-31pg 28-34pg MCV: 80-100fL 95-118fL MHCH: 32-36% 30-34%
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2.11 RBC indices and morphology with anemias |
MCV: normo/micro/macrocytic anemia MCHC: normochromic/hypochromic anemia
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2.12 Reticulocytes |
Immature RBC in peripheral blood contain remnant cytoplasmic RNA
Assess bone marrow activity |
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2.13 Appropriate stain for reticulocyte counts |
New methylene blue/supervital stain |
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2.14 Reticulocyte and stage of bone marrow erythropoiesis |
>3 effective bone marrow response |
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2.15 Normal values of reticulocytes for Adults, children and infants |
Adult: 0.5-2.0% Infant: 2.5-6.5% Children: 0.5-3.1% |
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2.16 Clinical application of a retic count |
Monitoring anemia |
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2.17 Significance of an decreased or increased Retic count in anemic patient |
Reflects the rate of erythropoiesis during anemia |
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2.18 calculate reticulocyte using a miller disk and 1000 red cell count method |
Manual: count 1000, % retic Miller disk: count 200 RBC in small box, retic in both box |
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2.19 calculate absolute retic count and RPI |
% reticX HCT/45 _________________ Maturation time
>3 effective bone marrow response |
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2.20 RPI and it's clinical application |
Monitoring of anemia |
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2.2a type of stain used for peripheral smear |
Wright stain Eosin-basic components (Hgb) Methylene blue- acid components (DNA, RNA) |
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2.3a pH on a slide |
High pH- blue/purple alkaline Low pH- orange acidic Brown- hemoglobin |
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3.1 Structural components of a RBC |
Peripheral and Integral protiens Carbohydrates Lipids (Hydrophobic/philic) |
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3.2 Basic chemical composition of the RBC membrane |
Lipids: 40% Proteins: 52% Carbohydrates: 8% |
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3.3 Peripheral and Integral proteins |
Integral: glycophorin A, B,C, and D, anion pumps Peripheral: actin, spectrin, protein 4.11, ankyrin |
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3.4 Function of integral and peripheral proteins |
Integral: sialic acid (60% carbs neg charge), ion exchange, RBC antigens Peripheral: spectrin 75% shape and flexibility; related to integrity of RBCs |
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3.5 Lipid component of the RBC membrane |
Cholesterol (25%) accumulation acanthocytes Phospholipids Glycolipids |
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3.6 Structural composition of normal hemoglobin |
Heme: Fe + protoporphyrin ring Globin: 2 sets of polypeptides |
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3.7 Hemoglobin synthesis |
Starts and ends in the mitochondria
Starts with delta- amino levulinic acid |
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3.8 Types and concentrations of normal adult hemoglobin |
Oxyhemoglobin and deoxyhemoglobin 95-97% A1 (alpha and beta) 2-3% A2 (delta and alpha) 1-2% HgbF (alpha and gamma) |
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3.9-10 Abnormal hemoglobin |
Carboxyhemoglobin (smoking, CO)- 5% Methemoglobin (well water, drugs)-1.5% Suflhemoglobin (sulfa drugs, irreversible)-0.5% |
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3.11 Hemoglobin function dissociation curve |
The amount of oxygen needed to saturate 50% of hgb; depends on the partial pressure of oxygen (pO2)
26-30mmHg: Normal Increased P50: shift to the right Decrease P50: shift to the left
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3.12 Shift to the left and right |
Due to pressure- Increased O affinity with a left shift, Decreased O afffinity with a right shift |
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3.13 Conditions with a left and right shift |
Right: hypoxia, acidosis, anemia, high temps, increase 2,3-DPG, decreased Hgb O2 affinity; increased erythropoiesis, cardiac output Left: old blood, alkalosis, low body temp, abnormal hemoglobin, increase O2 affinity, decrease 2,3-DPG |
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3.14. The role of 2,3-DPG in O2 delivery |
Helps regulate hemoglobins affinity for oxygen |
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3.15 Function of normal hemoglobin |
transport O2 to tissue Remove CO2 from tissue |
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3.16-17 RBC metaboloic pathways |
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3.18 RBC life span |
120 days Travel 200-300 miles |
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3.19 RBC production and destruction rates and sites |
Destruction 1% a day in BM 5-10 Intravascular |
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4.1 Applications of hemocytometer |
Platelet and WBC counts |
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4.2 Steps of using a hemocytometer |
Dilute, Load, count, calculate, interpret |
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4.3 Unopette system: reservoir pipet dilution: WBC Platelet |
precalibrated pipet: 20ul/1.98mL diluent 1:100 dilution |
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4.4 Diluent used in unopette |
ammonium oxolate |
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4.7 Normal WBC, RBC, and platelets in adults and children |
WBC adult: 4,800-10,800 mm^3 RBC adult:4.7-6.1X10^6/4.2-5.4X10^6 Platelet adult: 150,000-400,000/uL
Children RBC: 3.8-5.5X10^6 mm^3 |
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5.1 Three essential parts of examining a peripheral smear |
Est of WBC WBC diff Morphological evaluation of RBC, WBC, platelets |
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5.6 WBC estimate, diff count, plt est, evaluation of WBC and RBC morphology |
WBC/hpf: 2-4 (4.0-7.0), 4-6 (7-10), 6-10 (10-13), 10-20 (12-18) Plt est: avg 10 fieldsX 20,000 WBC est: avg 10 fieldsX 2000 Corrected WBC: uncorr. WBC X100/100+nRBC |
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5.7 The normal values for WBCs In adults, infants and children |
Seg N: 50-70% Band: 2-6% Eos: 0-4% Baso: 0-2% Lymph: 20-44% Mono: 2-9% |
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5.8-9 Relative vs. absolute value of WBC type |
Relative: % value of various cell types in peripheral blood Absolute: Based on total WBC of 10.0X10^3mm^3 |
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5.10 What is the criteria for counting more than 100 WBC |
Leukemia High WBC |
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5.12 Indicate what is examined at 10X, 40x, 100X |
10x: overall staining quality 40x: est WBC count 100x: platelet est, WBC diff, RBC and WBC morphology |
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6.1 Define anemia |
decrease competence of blood to carry oxygen to tissue, causing hypoxia; decrease in hemoglobin |
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6.2 Three physiological causes of anemia |
Blood loss Decrease production or ineffective RBC Increased RBC destruction
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6.3 Body's physiological response to anemia |
Increase 2,3-DPG, EPO, cardiac output |
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6.4 3 morphological classifications of anemia |
N/N M/N M/H |
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6.5 Clinical signs and symptoms associated with anemia |
Bleeding, Splenic enlargement, lymphadenopathy, organ dysfunction, pallor, dyspnea, lethargy, headache, nausea, decreased appetite, tachycardia, angina pectoris |
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6.6 RBC indicies and anemia |
MCV: cytic MCHC: chromic
Mod Anemia Hgb 8-10, Hct 24-30% Severe: Hgb <7, Hct <22 |
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6.8 Routine lab tests and results for anemia |
CBC: hgb, hct, indices Retic BM smear |
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6.10-11 M/H, M/N, N/N and indices |
M/H: IDA, SA, Thalassemias MCV<80fl MCHC <32% M/N: B12 def, folic acid def, liver disease, malignancies, alcoholism, drugs MCV>100fl MCHC 32-36% N/N: Intracorpuscular inherited defects/Extracorpuscular acquired immune hemolytic, infections MCV 80-100fL, MCHC 32-36% |
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Hgb Hct
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Adult: 14-18/12-16 g/dL 37-47% Children: 11-16 g/dL 30-43% |