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Questions and Answers
What does an increase in haptoglobin indicate during a haemolysis screen?
Which lab test results can indicate iron deficiency?
What characteristic is typical of neutrophilia in a blood film?
Which is NOT a primary component measured in a full blood count (FBC)?
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What primarily drives the production of ferritin in the body?
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What does flow cytometry determine in lab tests?
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Which blood film finding is associated with hyposplenism?
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What is typically observed in a leucoerythroblastic blood film?
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What happens to transferrin levels when iron decreases in the body?
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Which component of a Full Blood Count (FBC) is a measure of the total proportion of blood made up of red blood cells?
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What is primarily assessed in a haemolysis screen alongside an increase in bilirubin?
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Which of the following findings would be indicative of bacterial infection in a blood film?
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How is flow cytometry utilized in lab tests?
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What do Howell-Jolly bodies indicate in a blood film?
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Which parameter serves as a marker for the storage of iron in the body?
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What is a typical finding in a blood film when assessing for leucoerythroblastic changes?
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What does an increase in serum ferritin primarily indicate in relation to iron levels?
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Which of the following cell types would most likely show morphological changes indicative of a bacterial infection in a blood film?
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In a haemolysis screen, which laboratory finding is associated with increased free hemoglobin in circulation?
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What does a decreased level of haptoglobin indicate in the context of a haemolysis screen?
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Which term describes the condition where target cells and Howell-Jolly bodies can be observed in a blood film?
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What is the primary purpose of using flow cytometry in laboratory testing?
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What changes would indicate a left shift in neutrophils during a blood film analysis?
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When transferrin saturation decreases, which of the following occurs in relation to transferrin levels?
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Study Notes
Full Blood Count (FBC)
- Ordered for almost all patients
- Hematocrit (Hct): percentage of blood composed of red blood cells (RBCs)
- Mean Corpuscular Volume (MCV): average volume of a single RBC
Iron Studies
- Serum Iron: level of iron in plasma
- Serum Ferritin: measures iron storage primarily in the liver and bone marrow
- Serum ferritin is proportional to the body's iron stores
- Interleukin-6 (IL-6) stimulates ferritin production
- Transferrin: protein responsible for iron transport
- Transferrin Saturation: percentage of transferrin bound to iron
- When iron decreases, serum iron and ferritin decrease
- Less iron is bound to transferrin in the blood, leading to a decrease in transferrin saturation and an increase in free transferrin
Flow Cytometry
- Determines the immunophenotype (number of cells of each type)
- Cells stained with fluorescent monoclonal antibodies are passed through a flow cytometer
Haemolysis Screen
- Ordered if FBC shows anemia
- Components:
- Increased unconjugated bilirubin
- Elevated Lactate dehydrogenase
- Decreased haptoglobin (protein that binds free hemoglobin)
- Direct Coombs test
- Increased reticulocyte count (immature red blood cells)
- Blood Film: normocytic or showing specific reasons for anemia
Red Blood Cell (RBC) Morphology on Blood Film
- Target Cells: small, centrally stained RBCs with a pale area around the center (resembling a target)
- Howell-Jolly Bodies: small, round, darkly stained inclusions within RBCs
- Acanthocytes: RBCs with irregular, spiky projections
- Spherocytes: smaller, rounder, more dense RBCs than normal
Bacterial Infection
- Neutrophilia: increased neutrophil count
- Left Shift: presence of immature neutrophils (bands)
-
Morphological Changes in Neutrophils:
- Toxic granulation: abnormally large, dark granules in the cytoplasm
- Dohle bodies: light-blue, oval inclusions near the periphery of the cytoplasm
- Vacuolation: presence of vacuoles within the cytoplasm
- Intracellular/extracellular bacteria
Leucoerythroblastic Blood Film
- Presence of immature RBCs and WBCs in the peripheral blood
- Suggests bone marrow abnormalities
Hyposplenism
- Indicates impaired function of the spleen
- Target cells
- Howell-Jolly bodies
- Acanthocytes
- Spherocytes
Full Blood Count (FBC)
- Ordered for many conditions
- Hct: Percentage of red blood cells (RBC) in the blood
- MCV: Average volume of a single RBC
Iron Studies
- Serum Fe: Measures iron levels in plasma
- Serum ferritin: Reflects the amount of iron stored in the body
- Primarily stored in the liver and bone marrow, but also leaks out of cells
- Serum ferritin is proportional to total body iron
- Increased production of ferritin is driven by interleukin-6 (IL-6)
- Transferrin: Protein responsible for iron transport in the blood
- Transferrin saturation: Percentage of transferrin that is bound to iron
- When iron decreases, serum iron and ferritin decrease
- Less iron is bound in the blood leading to decreased transferrin saturation
- Free transferrin levels increase
Flow Cytometry
- Determines the immunophenotype (number of cells of each type)
- Cells are stained with fluorescent monoclonal antibodies and passed through a flow cytometer
Haemolysis Screen
- Ordered when FBC shows anaemia
- Increased unconjugated bilirubin
- Increased lactate dehydrogenase
- Decreased haptoglobin (binds free hemoglobin)
- Direct Coombs test performed
- Increased reticulocyte count
- Blood film examined to assess RBC morphology and identify the cause of anaemia
Blood Film
- Used to examine RBCs, platelets, neutrophils, and other white blood cells (WBCs)
-
RBC morphology
- Target cells: Have a central dark spot
- Howell-Jolly bodies: Black dots within RBCs
- Acanthocytes: Spiky RBCs
- Spherocytes: Round RBCs
-
Hyposplenism
- Characterized by the presence of the above RBC morphology
-
Bacterial Infection
- Neutrophilia (increased neutrophil count)
- Left shift (increased number of immature neutrophils)
- Morphological changes in neutrophils: Toxic granulation, Dohle bodies, vacuolation, intracellular, and extracellular bacteria
-
Leucoerythroblastic blood film:
- Characterized by the presence of immature WBCs and RBCs in the peripheral blood
Other Blood Film findings
- Platelets: Can be assessed for size, shape, and number
- Neutrophils: Can show signs of activation, including increased granulation, nuclear lobes, and cytoplasmic vacuoles
- Other WBCs: Can be examined for abnormalities in morphology and number
Full Blood Count (FBC)
- Ordered for most investigations
- Hematocrit (Hct): Percentage of blood volume composed of red blood cells (RBCs)
- Mean Corpuscular Volume (MCV): Average volume of a single red blood cell
Iron Studies
- Serum Iron: Measures iron levels in the plasma (the liquid portion of blood)
- Serum Ferritin: Reflects the body's iron storage, primarily in the liver and bone marrow. Serum ferritin levels are proportional to the amount of iron stored in the body
- Interleukin-6 (IL-6) stimulates ferritin production
- Transferrin: The protein responsible for iron transport in the blood
- Transferrin Saturation: Percentage of transferrin that is bound to iron.
Iron Deficiency
- Decreases in serum iron and ferritin
- Less iron is bound in the blood, leading to a decrease in transferrin saturation, but an increase in free transferrin
Flow Cytometry
- Determines the immunophenotype: The relative number of cells of each type in a sample.
- Uses fluorescent monoclonal antibodies that bind to specific cell surface markers to identify different cell types.
- Cells are then passed through a flow cytometer which identifies and quantifies the different cell populations.
Cytogenics and Molecular Studies
- Cytogenics examines chromosomes
- Molecular studies analyze DNA
Haemolysis Screen
- Ordered when red blood cells are breaking down (hemolysis)
- FBC: Anemia may be present
- Bilirubin: Increased unconjugated bilirubin (a breakdown product of heme)
- Lactate Dehydrogenase: Increased levels (an enzyme released from damaged red blood cells)
- Haptoglobin: Decreased due to haptoglobin's role in binding free hemoglobin
- Direct Coombs test: Detects antibodies attached to red blood cells (can indicate autoimmune hemolytic anemia)
- Reticulocyte Count: Increased reticulocytes (immature red blood cells) indicate the body is trying to compensate for red blood cell loss.
- Blood Film: Can show if the red blood cells are abnormally sized or shaped, providing clues as to why they are breaking down.
Blood Film - RBC
- Contains information about the size and shape of red blood cells.
Blood Film - Platelets
- Provides information about platelets, small cell fragments essential for blood clotting
Blood Film - Neutrophils
- Shows neutrophil morphology (the shape and appearance of neutrophils)
Blood Film - Other WBC
- Demonstrates features of other white blood cells (WBCs) such as lymphocytes and monocytes
Blood Film - Hyposplenism
- Hyposplenism is a condition in which the spleen is not functioning properly
- Target cells: Red blood cells with a central area of pallor surrounded by a dark ring (indicates abnormal hemoglobin synthesis)
- Howell-Jolly bodies: Small inclusions within red blood cells (usually removed by the spleen)
- Acanthocytes: Red blood cells with thorny projections
- Spherocytes: Spherical red blood cells (lacking central pallor)
Blood Film - Bacterial Infection
- Neutrophilia: Increased number of neutrophils in the blood
- Left Shift: Increase in the number of immature neutrophils (suggests the body is responding to infection)
-
Morphological Changes in Neutrophils:
- Toxic Granulation: Coarse, dark granules within neutrophils
- Döhle Bodies: Pale, blue-gray inclusions in neutrophils
- Vacuolation: The presence of holes or vacuoles within neutrophils
- Intracellular/Extracellular Bacteria: Bacteria may be present within or outside neutrophils
Blood Film - Leucoerythroblastic
- Indicates the presence of immature red blood cells and white blood cells in the blood
- Often seen in conditions affecting the bone marrow, such as myelofibrosis or other myeloproliferative disorders
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