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Questions and Answers
Which of the following best describes the role of hematopoietic stem cells?
Which of the following best describes the role of hematopoietic stem cells?
- Mature blood cells ready for circulation.
- Specialized cells that directly combat infections.
- Precursors to erythrocytes that enhance the blood's oxygen carrying capacity.
- Undifferentiated cells capable of differentiating into various blood cell lineages. (correct)
A complete blood count (CBC) provides information about the cellular components of blood. Which of the following is NOT a direct measurement reported in a standard CBC?
A complete blood count (CBC) provides information about the cellular components of blood. Which of the following is NOT a direct measurement reported in a standard CBC?
- Red blood cell (RBC) count.
- Hematocrit (Hct).
- Erythrocyte sedimentation rate (ESR). (correct)
- Mean corpuscular volume (MCV).
The peripheral blood smear is useful in identifying cellular abnormalities. What is the primary purpose of examining a peripheral blood smear?
The peripheral blood smear is useful in identifying cellular abnormalities. What is the primary purpose of examining a peripheral blood smear?
- To measure the oxygen-carrying capacity of red blood cells.
- To quantify the levels of various clotting factors.
- To assess the size, shape, and color of blood cells. (correct)
- To determine the exact number of each type of blood cell.
A reticulocyte count can help differentiate between different types of anemia. An elevated reticulocyte count suggests:
A reticulocyte count can help differentiate between different types of anemia. An elevated reticulocyte count suggests:
Which of the following laboratory tests is most useful in assessing polycythemia?
Which of the following laboratory tests is most useful in assessing polycythemia?
Hyper-proliferation, hypo-proliferation, and dilution are terms that describe hematologic diseases. Which condition is most closely associated with hypo-proliferation?
Hyper-proliferation, hypo-proliferation, and dilution are terms that describe hematologic diseases. Which condition is most closely associated with hypo-proliferation?
A patient's red blood cell indices show microcytic/hypochromic cells. Which of the following conditions is most likely?
A patient's red blood cell indices show microcytic/hypochromic cells. Which of the following conditions is most likely?
In the classification of hematopathology based on lineages, which category includes disorders affecting the cells responsible for oxygen transport?
In the classification of hematopathology based on lineages, which category includes disorders affecting the cells responsible for oxygen transport?
During hematopoiesis, a myeloid stem cell can differentiate into several types of blood cells. Which of the following is a product of myeloid stem cell differentiation?
During hematopoiesis, a myeloid stem cell can differentiate into several types of blood cells. Which of the following is a product of myeloid stem cell differentiation?
What is the primary function of erythropoietin (EPO) in the context of hematopoiesis?
What is the primary function of erythropoietin (EPO) in the context of hematopoiesis?
Which of the following etiologies is associated with decreased red blood cell production?
Which of the following etiologies is associated with decreased red blood cell production?
Which of the following conditions is an example of anemia due to blood loss?
Which of the following conditions is an example of anemia due to blood loss?
Which of the following enzyme defects leads to disorders of increased red blood cell destruction?
Which of the following enzyme defects leads to disorders of increased red blood cell destruction?
What is the underlying mechanism of anemia of chronic disease (ACD)?
What is the underlying mechanism of anemia of chronic disease (ACD)?
How does hepcidin contribute to the development of anemia of chronic disease?
How does hepcidin contribute to the development of anemia of chronic disease?
What characterizes 'relative' polycythemia?
What characterizes 'relative' polycythemia?
Which of the following conditions is considered a 'secondary absolute cause' of polycythemia?
Which of the following conditions is considered a 'secondary absolute cause' of polycythemia?
In the context of absolute polycythemia, what is the primary difference between primary and secondary causes?
In the context of absolute polycythemia, what is the primary difference between primary and secondary causes?
If a patient has a normal hemoglobin level but exhibits symptoms of anemia, which RBC index would be most helpful in further evaluating the type of anemia?
If a patient has a normal hemoglobin level but exhibits symptoms of anemia, which RBC index would be most helpful in further evaluating the type of anemia?
In evaluating a CBC, which component is essential for assessing a patient for infection?
In evaluating a CBC, which component is essential for assessing a patient for infection?
What is the primary utility of examining a peripheral blood smear in the context of hematological disorders?
What is the primary utility of examining a peripheral blood smear in the context of hematological disorders?
An increased reticulocyte count is associated with increased red blood cell production, and with certain types of anemia. Which of the following conditions would most likely present with an elevated reticulocyte count?
An increased reticulocyte count is associated with increased red blood cell production, and with certain types of anemia. Which of the following conditions would most likely present with an elevated reticulocyte count?
In the context of iron studies, what does the serum ferritin level primarily indicate?
In the context of iron studies, what does the serum ferritin level primarily indicate?
In iron studies, which of the following results indicates iron deficiency anemia?
In iron studies, which of the following results indicates iron deficiency anemia?
In hemoglobin electrophoresis, which hemoglobin variant migrates to the greatest extent from cathode to anode?
In hemoglobin electrophoresis, which hemoglobin variant migrates to the greatest extent from cathode to anode?
What characteristic of red blood cells defines hypochromic anemia?
What characteristic of red blood cells defines hypochromic anemia?
What is a typical finding in the peripheral blood smear of a patient with Glucose-6-Phosphate Dehydrogenase Deficiency?
What is a typical finding in the peripheral blood smear of a patient with Glucose-6-Phosphate Dehydrogenase Deficiency?
What laboratory finding is expected in a patient with macrocytic anemia due to Vitamin B12 deficiency?
What laboratory finding is expected in a patient with macrocytic anemia due to Vitamin B12 deficiency?
Which of the following anemias is usually classified as normocytic and normochromic?
Which of the following anemias is usually classified as normocytic and normochromic?
What is the main reason for anemia in a patient with chronic kidney disease?
What is the main reason for anemia in a patient with chronic kidney disease?
During an initial evaluation of anemia, after taking a history and performing a physical exam, which of the following is the next most appropriate step?
During an initial evaluation of anemia, after taking a history and performing a physical exam, which of the following is the next most appropriate step?
What is the role of physical examination in determining the causes for anemia?
What is the role of physical examination in determining the causes for anemia?
After initial assessment with a CBC, which lab test helps determine if anemia is caused by increased destruction of red blood cells?
After initial assessment with a CBC, which lab test helps determine if anemia is caused by increased destruction of red blood cells?
When evaluating macrocytic anemia, why is it important to assess both Vitamin B12 and folate levels?
When evaluating macrocytic anemia, why is it important to assess both Vitamin B12 and folate levels?
What is the clinical implication of a bone marrow aspiration in the workup of anemia?
What is the clinical implication of a bone marrow aspiration in the workup of anemia?
Which of the following accurately describes the role and production of myeloid and lymphoid stem cells?
Which of the following accurately describes the role and production of myeloid and lymphoid stem cells?
When analyzing a CBC, which diagnostic insight can be derived from evaluating the red blood cell (RBC) indices?
When analyzing a CBC, which diagnostic insight can be derived from evaluating the red blood cell (RBC) indices?
In the evaluation of anemia, what are the distinct characteristics of sideroblastic anemia?
In the evaluation of anemia, what are the distinct characteristics of sideroblastic anemia?
When observing a peripheral blood smear, which abnormal finding suggests hereditary spherocytosis?
When observing a peripheral blood smear, which abnormal finding suggests hereditary spherocytosis?
Flashcards
Hematopathology Organization
Hematopathology Organization
The overall structure of hematopathology including erythrocyte lineage disorders.
Complete Blood Count (CBC)
Complete Blood Count (CBC)
Complete blood count-evaluates cells circulating in blood
What is complete blood count(CBC)?
What is complete blood count(CBC)?
A blood test evaluating cells that circulate in blood.
What are CBC components?
What are CBC components?
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H/H
H/H
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What are RBC indices?
What are RBC indices?
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Peripheral Blood Smear
Peripheral Blood Smear
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What are Reticulocytes?
What are Reticulocytes?
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High Reticulocyte Count
High Reticulocyte Count
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Ferritin
Ferritin
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Transferrin
Transferrin
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TIBC
TIBC
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What is Ferritin?
What is Ferritin?
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Hypochromic
Hypochromic
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Microcytic
Microcytic
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Normochromic
Normochromic
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Normocytic
Normocytic
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Macrocytic
Macrocytic
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Study Notes
- Hematologic Concepts 1, Winter 2025
- Presenter: Jeanette Rodríguez, D.O., Assistant Professor of Family Medicine at Nova Southeastern University
Student Learning Objectives
- Describe the organization of hematopathology and identify erythrocyte lineage disorders
- Briefly discuss the role of stem cells in hematopoietic and lymphoreticular diseases
- List the components and clinical applications of the complete blood count (CBC)
- Discuss the value of the peripheral blood smear in diagnosing hematologic and other disorders
- Define reticulocyte and discuss the clinical implication of the reticulocyte count
- Identify lab tests used to assess anemia and polycythemia
- Define hematologic diseases characterized by hyper-proliferation, hypo-proliferation, and dilution
- Describe diseases associated with normocytic/normochromic, microcytic/hypochromic, and macrocytic RBC indices
Classification of Hematopathology Based on Lineages
- Hematopathology includes erythrocyte disorders, WBC disorders, plasma cell disorders and platelet disorders
- This lecture focuses on erythrocyte disorders
Hematopoiesis: Blood Cell Differentiation and Lineages
- Blood cell differentiation and lineages originate from hematopoietic stem cells
- These differentiate into myeloid and lymphoid stem cells
- Myeloid stem cells differentiate into: Erythrocytes, Megakaryoblasts, Monoblasts
- Lymphoid stem cells differentiate into: Lymphoblasts
Hematopathology: Classification of Disorders of RBC
- Classification of disorders of red blood cells includes anemia (too few cells) and erythrocytosis/polycythemia (too many cells)
Anemia: Etiology
- Anemia is caused by: blood loss (hemorrhage), decreased production, and increased destruction
Anemia: Blood Loss
- Acute etiologies include acute trauma, acute hemorrhage including postpartum hemorrhage, GYN, GI, urologic etiologies
- Chronic etiologies include GI lesions, malignancies, other causes such as angiodysplasia, hemorrhoids, colon cancer, bleeding peptic ulcer
- Chronic etiologies also include GYN lesions, malignancies, other causes such as menorrhagia, fibroids, and adenomyosis
Anemia: Disorders of Increased Destruction
- Enzyme defects: Glucose-6-Phosphate Dehydrogenase Deficiency, Pyruvate Kinase Deficiency
- Disorders of Hemoglobin Synthesis: Sickle Cell Anemia, Thalassemia
- Membrane Defects: Hereditary Spherocytosis, Elliptocytosis
- Acquired disorders include Paroxysmal Nocturnal Hemoglobinuria
- Immune Mediated disorders: Rh disease of the newborn, Systemic Lupus Erythematosus
- Infections: Malaria and other parasitic infections
Anemia: Disorders of Decreased Production
- Lack of raw materials like iron deficiency anemia, anemia of chronic disease, folate deficiency anemia, and vitamin B12 (cobalamin) deficiency anemia can cause decreased production
- Problems with bone marrow like myelophthisic anemia (marrow infiltration), aplastic anemia, and pure red cell dysplasia
- Other causes include chronic inflammation and chronic diseases like diabetes mellitus, rheumatologic conditions, hypertension, coronary artery disease, and congestive heart failure
Anemia of Chronic Disease (ACD) / Anemia of Inflammation (AI)/ Anemia of Chronic Inflammation (ACI)
- Secondary iron metabolism issues are caused by inflammation
- Hepcidin regulates iron metabolism and is an inhibitor
Polycythemia (Erythrocytosis): Etiology
- Polycythemia (Erythrocytosis) etiologies include relative and absolute causes
Polycythemia (Erythrocytosis): Relative Causes
- Reduction of plasma volume leads to hemoconcentration
- Examples include vomiting, diarrhea and polyuria
Polycythemia (Erythrocytosis): Absolute Causes
- Primary causes: abnormal proliferation of myeloid stem cells with normal or low EPO levels, Ex: Polycythemia Vera
- Secondary causes: Proliferation of myeloid stem cells in the setting of elevated EPO levels
What are some causes of elevated EPO (i.e. secondary absolute causes)?
- Chronic lung disease
- Cyanotic heart disease
- High-altitude living
- Intake of EPO (athletes)
- EPO secreting tumors (renal cell carcinoma, hepatoma, cerebellar hemangioblastoma)
Into to the World of Lab Tests
- Complete Blood Count is a blood test performed with peripheral blood drawn that evaluates cells that circulate in the blood
Complete Blood Count (CBC)
- Components: White Blood Cell (WBC) count with or without a differential; Red Blood Cell (RBC) count, Hemoglobin (Hgb or Hb) and Hematocrit (Hct), RBC indices; Platelet count with or without Mean Platelet Volume (MPV) and/or Platelet Distribution Width (PDW)
- Hgb/Hct are sometimes referred to together as H/H
Complete Blood Count (CBC): RBC Indices
- RBC Count: # of red blood cells per cc of blood
- Hemoglobin: Measure of amount of O2 carrying protein in RBCs
- Hematocrit (HCT): Measures volume percentage of RBC in blood
- MCH: Measure of the amount of Hgb per cell
- MCHC: Measure of the concentration of Hgb in each RBC
- MCV: Measure of RBC size
- MCHC descriptors: normochromic, hypochromic, hyperchromic
- MCV descriptors: normocytic, microcytic, macrocytic
Complete Blood Count (CBC) usage:
- Evaluate infection, anemia, malignancy, heritable conditions, conditions of altered bone marrow production of cells
Peripheral Smear (normal)
- Evaluates morphology
Peripheral Smear Findings
- Peripheral Smear: Sickle cell shows sickle cells
- Peripheral Smear: G6PD Deficiency shows Heinz bodies, bite cells
Reticulocytes
- Reticulocytes = large immature RBC
- Reticulocyte counts indicate significant blood loss anemia or hemolytic anemia
Iron Studies
- Iron Panel Tests: Ferritin, Transferrin, TIBC and Iron
Iron Studies: Definitions
- Ferritin: Protein that stores iron
- Transferrin: Protein that transports iron in the blood
- TIBC: Total Iron Binding Capacity; how much Fe can be bound to transferrin
Iron Studies: Disease
- Iron Deficiency: ↓ Serum Iron, ↓ Serum Ferritin, ↑ TIBC, ↓ Iron Saturation %
- Anemia of Chronic Disease: ↓ Serum Iron, NL or ↑ Serum Ferritin, ↓ or NL TIBC, NL or ↓ Iron Saturation %
- Thalassemia: ↑ Serum Iron, ↑ Serum Ferritin, ↓ TIBC, ↑ Iron Saturation %
- Sideroblastic: ↑ Serum Iron, ↑ Serum Ferritin, ↓ TIBC, ↑ Iron Saturation %
- Transferrin is reflected by TIBC in labs
Hemoglobin Electrophoresis
- Separates hemoglobins based on charge from cathode to anode on a electrophoretic gel
- Hemoglobin migrates from the negatively charged cathode to the positively charged anode
- HbA migrates the farthest, followed by HBF, HbS, and HbC.
- Missense mutations in HbS and HBC replace glutamic acid with valine (neutral) and lysine (making HbC and HbS more positively charged than НЬА).
Anemia Characterization Based on Morphology
- Based on RBC indices
Hypochromic and Microcytic
- Hypochromic: less than normal amount of hemoglobin; Look at MCHC
- Microcytic: cells are smaller than usual, look at MCV (MCV Range: < 80 fL)
- Hemoglobin problem
- Common Etiologies: Iron Deficiency Anemia and Thalassemia
Normocytic Normochromic
- Normochromic: normal hemoglobin concentration. Look at MCHC (MCHC Range: 30-34)
- Normocytic: cells are normal sized. Look at MCV (MCV Range: 80-100 fL)
- Not enough cells
- Common Etiologies: Hereditary Spherocytosis, Sickle Cell Disease, Acute blood loss, Myelofibrosis, Anemia of chronic disease (*usually), Renal disease
Macrocytic
- Macrocytic: cells are larger than usual. Look at MCV (MCV range: >100 fL)
- DNA problem
- Common Etiologies: B12 Deficiency Anemia such as Pernicious anemia, strict vegetarians and Folate Deficiency Anemia
Anemia Comparison Chart
- Microcytic anemia results from a hemoglobin problem and has MCV < 80 fL
- Normocytic anemia results from not enough cells having MCV 80-100 fL
- Macrocytic anemia results from defective DNA Synthesis, and has MCV >100 fL
Initial Evaluation of Anemia
- History
- Physical Exam
- CBC with interpretation of indices
- Reticulocyte count
Additional Anemia Work-up (as needed)
- Blood smear
- Iron/TIBC
- B12 level
- Folic acid level
- Bilirubin
- Hemoglobin electrophoresis
- Osmotic fragility test
- Bone marrow aspiration
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