Hematology 1 - Preliminary Examination

Hematology 1 - Preliminary Examination

• Safety Practices (Q1):

  • Sterilizing lancets for reuse is NOT an appropriate safety practice.
  • Keep specimens separate from food.
  • Dispose of needles in biohazard, puncture-proof containers.
  • Frequent handwashing is essential.

• Standard Precautions (Q2):

  • Prevent healthcare workers from bloodborne pathogens like HIV and HBV.

• Gloves (Q3):

  • Can be sterile or nonsterile.
  • Latex or vinyl.
  • Used only once.
  • Appropriate for nonintact skin, mucous membranes, and parenteral exposures.

• Plasma vs Serum (Q4):

  • Preventing blood coagulation using anticoagulants separates cellular elements from plasma (straw-colored fluid).

• Anticoagulant K3 EDTA (Q5):

  • Commonly used anticoagulant in hematology.
  • Placed in lavender-stoppered tubes.
  • Removes Ca²⁺ from whole blood (chelation).
  • Used for routine coagulation studies.

• Blood Smear Length (Q6):

  • Too long a smear can be fixed by decreasing the angle of the pusher slide.

• Erythrocyte Maturation (Q7):

  • The maturation sequence involves steps like rubriblast, prorubricyte, rubricyte, metarubricyte, reticulocyte, and mature erythrocyte.
  • Also involves steps like pronormoblast, basophilic normoblast, polychromatophilic normoblast, orthochromic normoblast, reticulocyte, and mature erythrocyte.

• Reticulocyte Stage Duration (Q8):

  • With normal diet, a reticulocyte remains in circulation for ~2.5 days.

• Reticulocyte Appearance (Q9):

  • Reticulocytes on a Wright-stained peripheral blood film appear blue (polychromatophilia).

• Iron Transport Protein (Q10):

  • Transferrin is the protein responsible for iron transport in hemoglobin synthesis.

• Embden-Meyerhof Pathway (Q11):

  • Utilizes ~90% of the erythrocyte's total glucose.

• Oxidative Pathway Defect (Q12):

  • A defect in the hexose monophosphate shunt leads to insufficient reduced glutathione.
  • Potential for denaturation of globin and precipitation of Heinz bodies.

• Polychromatophilia (Q13):

  • A blue-colored erythrocyte on Wright stain.
  • Caused by diffusely distributed RNA in the cytoplasm.
  • Equivalent to a reticulocyte on supravital staining.

• Rouleaux Formation (Q14):

  • Erythrocytes resembling a stack of coins on a blood smear.

• Anemia Symptoms (Q15):

  • Anemia symptoms stem from reduced oxygen delivery to tissues and low hemoglobin.

• Kidney-Derived Growth Factor (Q16):

  • Erythropoietin (EPO) is produced in the kidneys and treats anemia related to kidney disease.

• Mature Normoblast (Q17):

  • Orthochromic normoblast is the most mature normoblast.

• RBC Production Stimulation (Q18):

  • Hypoxia stimulates the kidney to increase erythropoietin (EPO) production.

• RBC Peroxide Detoxification (Q19):

  • NADPH and reduced glutathione are responsible for peroxide detoxification in red blood cells.

• RBC Shape Maintenance (Q20):

  • Cytoskeletal proteins play a key role in maintaining red blood cell shape.

• Hemoglobin Composition (Q21):

  • A hemoglobin molecule consists of four heme molecules and four globin chains.

• Newborn Hemoglobin (Q22):

  • The predominant hemoglobin in a healthy newborn is fetal hemoglobin (HbF).

• Adult Hemoglobin Distribution (Q23):

  • Normal adult hemoglobin distribution: Approximately 97% Hb A, 2-3% Hb A2, and less than 2% Hb F.

• Wright's Stain Buffer Effect (Q24):

  • Buffer at pH 6.0 results in red cells staining too pink.

• Normal Hemoglobin (Q25):

  • Deoxyhemoglobin is considered a normal hemoglobin form.

• Oxyhemoglobin Dissociation Curve Shift (Q26):

  • Acidosis shifts the oxyhemoglobin dissociation curve to the right.

• Spleen Function (Q27):

  • The spleen removes imperfect and aging red blood cells.

• Acceptable Blood Collection Tubes (Q28):

  • Lavender (EDTA) for hematologic testing; green (heparin) isn't ideal for coagulation but can be acceptable for hematologic tests.

• Microscope Focus (Q29):

  • Parfocal microscopes maintain focus when switching objectives.

• RBC Lifespan Limitation (Q30):

  • Loss of mitochondria is a crucial factor in red blood cell lifespan limitation.

• Hematopoietic Growth Factors (Q31):

  • Hematopoietic growth factors bind to receptors, exhibit lineage-restricted action, promote/suppress cell death, and stimulate/inhibit cell proliferation.

• Primary Hematopoiesis Site (Q32):

  • Primary site of hematopoiesis in the third month of gestation is the liver.

• Tissue Oxygen Level Information (Q33): The kidney relays information about tissue oxygen levels to erythropoietin-producing sites.

• Incapable Hemoglobins (Q34):

  • Carboxyhemoglobin and methemoglobin are unable to transport oxygen.

• Accelerated Erythropoiesis Sign (Q35):

  • Signs of accelerated erythropoiesis include nucleated red cells and a hypercellular bone marrow with reduced red cell precursors.

• EDTA-Induced Platelet Satellitosis (Q36):

  • Pseudothrombocytopenia is caused by platelet satellitosis in EDTA-treated blood.

• Blood Smear Stains (Q37):

  • Too acidic a buffer can cause excessively blue staining in blood smears.

• Pan-myeloid Growth Factor (Q38):

  • Granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulates the production of erythroid, granulocyte, monocyte, megakaryocyte, and eosinophil progenitors.

• Red Blood Cell Maturation Pathways (Q39):

  • The key pathways in red blood cell maturation include the Embden-Meyerhof pathway, methemoglobin reductase pathway, and the Rapoport-Luebering pathway.

• Blood Leakage Swelling (Q40):

  • Hematoma is a swelling of body tissue due to blood leakage.

• Neutrophil Precursor (Q41):

  • Myeloblast is the precursor of neutrophil.

• Stromal Cells (Q42):

  • Endothelial, adipose, and hematopoietic cells are parts of the stroma.

• Mitosis in Erythropoiesis (Q43):

  • Mitosis ends at the rubricyte stage in erythropoiesis.

• Early Embryo Hemoglobins (Q44):

  • Gower 1, Gower 2, and Portland are hemoglobins produced during early embryogenesis.

• Anticoagulant-to-Blood Ratio (Q45):

  • The recommended ratio of anticoagulant to blood for coagulation studies is 1:9.

• Cytokines (Q46):

  • Examples of cytokines include chemokines, interleukins, and colony-stimulating factors.

• Platelet Satellitosis (Q47):

  • Platelet satellitosis (platelets surrounding PMNs) can occur in citrated samples, and is remedied by using EDTA.

• Skin Puncture Considerations (Q48):

  • Avoid using povidone-iodine for skin punctures due to its potential interference with potassium/phosphorus/uric acid measurements. Punctures should not be deeper than 4mm. Lateral/medial plantar heel is the preferred infant site. Avoid over-warming the site.

• Packed Red Blood Cells Volume (Q49):

  • Hematocrit is the volume percentage of red blood cells in whole blood.

• Red Blood Cell Energy Source (Q50):

  • The Embden-Meyerhof pathway is the primary source of energy for red blood cells.

• Adult Hemoglobin Chains (Q51):

  • Hemoglobin A (HbA) in adults is comprised of two alpha and two beta chains.

• Oxyhemoglobin Dissociation Curve Shift (Q52):

  • A shift to the right in the oxyhemoglobin dissociation curve occurs with decreased pH, increase in CO2, increase in temperature, and decrease in 2,3-DPG.

• Physiological Errors in Hemoglobin Measurement (Q53):

  • Patient plasma can correct errors from extremely high white blood cell counts, lipemia, and abnormal plasma proteins. The plasma acts as a blank.

• EDTA Concentration (Q54):

  • 1.5 mg/mL EDTA is a recommended concentration for complete anticoagulation without cell alteration.

• Sex-Linked Enzyme Deficiency (Q55):

  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common sex-linked enzyme deficiency in the hexose monophosphate shunt.

• Environmental Factors Affecting ETS (Q56):

  • Sunlight exposure is NOT a known environmental factor that affects the ETS.

• Extramedullary Hematopoiesis (Q57):

  • Extramedullary hematopoiesis can occur in scenarios like bone marrow dysfunction, inability to meet hematopoietic demands (e.g., hemolytic anemias), and myeloproliferative conditions.

• Extravacular Hemolysis (Q58):

  • Extravacular or macrophage-mediated hemolysis increases total serum bilirubin and is a key factor in RBC destruction.

• Cyanmethemoglobin Measurement (Q59):

  • The Cyanmethemoglobin method measures certain hemoglobin types.

• Blood Color (Q60):

  • Mauve-lavender colored blood may indicate specific conditions affecting blood components.

• Methemoglobin Treatment (Q61):

  • Intravenous methylene blue is administered for methemoglobin levels exceeding 30%.

• Heme Synthesis Defect (Q62):

  • Variegate porphyria is a result of a defect in heme synthesis.

• Heme Synthesis (Q63):

  • Heme synthesis takes place in the ribosomes of normoblasts, and globin synthesis occurs in the cytoplasm.

• Hemoglobin and Heme Composition (Q64):

  • One molecule of hemoglobin binds four moles of oxygen, and a heme molecule consists of four pyrrole rings and one ferrous iron.

• Extravascular Hemolysis (Q65):

  • Extravascular hemolysis occurs within the reticuloendothelial system (RES) and is responsible for about 90% of RBC destruction.

• Oxyhemoglobin Dissociation Curve Shift (Q66):

  • A shift to the right on the oxygen dissociation curve can be due to decreased pH, increased CO2 and temperature, and decreased 2,3-DPG.

• Oxygen Dissociation Curve Right Shift (Q67):

  • Factors that induce a rightward shift include decreased pH, increased CO2, increased temperature.

• Red Blood Cell Protection (Q68):

  • The hexose monophosphate shunt produces reduced glutathione, which protects against oxidative denaturation of hemoglobin.

• Red Blood Cell Membrane Proteins (Q69):

  • Spectrin, ankyrin, band 3, and aquaporin 1 are integral/transmembrane proteins in the red blood cell membrane.

• Red Blood Cell Maturation Stages (Q70):

  • Rubriblast, prorubricyte, rubricyte, metarubricyte, reticulocyte are the nucleated stages of red blood cell maturation.

• Erythroblast Stage (Q71):

  • The metarubricyte is the last nucleated erythrocyte, shortly before the nucleus is expelled.

• Hemoglobin Production Stages (Q72):

  • The orthochromic erythrocyte produces the final hemoglobin.

• Erythropoietin's Effects (Q73):

  • Erythropoietin promotes reticulocyte release and prevents apoptosis, increasing the time required for cell maturation in the bone marrow.

• Earliest RBC Colony (Q74):

  • Burst-forming unit erythroid (BFU-E) is the earliest identifiable colony of red blood cells, stemming from CFU-GEMM progenitor.

• Red Blood Cell Degradation (Q75):

  • Pitting and culling are processes in the spleen that removes old/damaged red blood cells.

• Red Blood Cell Graveyard (Q76):

  • The spleen is a primary site for damaged red blood cell removal.

• Hematopoiesis Types (Q77):

  • Medullary hematopoiesis is the primary site of red blood cell production in an adult, often occurring during periods of high blood cell demand (e.g., in anemia)..

• Hematopoiesis Timeline (Q78):

  • Hematopoiesis begins in the yolk sac, later shifts to the liver and, finally, to the bone marrow.

• Blood Cell Origin Theory (Q79):

  • All blood cells originate from a single pluripotent stem cell (monophyletic theory).

• White Blood Cell Counting (Q80):

  • Longitudinal method counts WBCs in consecutive fields.

• Ideal Blood Smear Characteristics (Q81):

  • An ideal blood smear shows gradual transitions from thin to thick portions, has a ~2/3-4 length (relative to the slide), and lacks irregularities causing gaps or holes.

• Thin Blood Smear Causes (Q82):

  • Thin blood smears are caused by slow smearing speed and a low (not high) angle of the slide.

• Blood Smear Drop Placement (Q83):

  • The drop placement distance on a slide for peripheral blood smears is 0.5 inches (or 1cm).

• Bone Marrow Sample Method (Q84):

  • The wedge method is used for bone marrow sampling.

• Needle Color (Q85):

  • Different colored needles can indicate different collection procedures.

• EDTA Tube Uses (Q86):

  • EDTA tubes are used for complete blood counts (CBC), peripheral blood smears (PBS), and other hematologic tests.

• RBC Maturation Trends (Q87):

  • As red blood cells age, the nucleus is expelled, the N:C ratio increases, diameter decreases, and membrane flexibility declines.

• Polychromatophilia Stage Name (Q88):

  • Reticulocytes (and rubricytes) are called polychromatophilic due to the presence of multiple colors.

• Erythroblast Chromatin (Q89):

  • Prorubricytes exhibit a wheel-like or reticulated chromatin pattern.

• Hemoglobin Appearance Stage (Q90):

  • Hemoglobin first appears in rubricytes, which marks a later stage of maturation.

• Critical Phlebotomy Step (Q91):

  • Patient identification is a critical first step in phlebotomy.

• Fetal Blood Cell Production (Q92):

  • The liver acts as a primary site for blood cell production during the second trimester of development.

• Hemoglobin Oxygen Affinity (Q93):

  • Tense hemoglobin has a lower affinity for oxygen.

• Oxygen Dissociation Curve pH Effect (Q94):

  • Decreased pH shifts the oxyhemoglobin dissociation curve to the right, decreasing oxygen affinity.

• Nucleoli (Q95):

  • Nucleoli are present in immature red blood cells, but not in all young cells.

• Hemoglobin Molecule Grouping (Q96):

  • A hemoglobin molecule has four heme subunits.

• Red Blood Cell Aging (Q97):

  • Aging red cells have less membrane flexibility, decreased glycolysis, and less hemoglobin.

• Hemoglobin Chains (Q98):

  • Hb A1 consists of two α and two β chains; Hb F consists of two α and two γ chains.

• Drabkin's Reagent Composition (Q99):

  • Drabkin's reagent is a solution containing potassium ferricyanide, potassium cyanide, a nonionic detergent, and dihydrogen potassium phosphate.

• Phlebotomy Issues (Q100):

  • Problems in phlebotomy include improper anticoagulants, patient misidentification and needle placement within blood vessels.

Test your knowledge on safety practices, standard precautions, and essential concepts in hematology. This quiz covers topics such as the use of anticoagulants, blood components, and key safety procedures in a laboratory setting.