39 Questions
What is the primary purpose of a bone marrow aspirate and biopsy?
To diagnose and stage various blood and bone marrow disorders
What is the typical procedure for obtaining a bone marrow aspirate and biopsy?
Insertion of a needle into the sternum to extract bone marrow samples
What can a hypercellular bone marrow indicate?
Acute Megakaryoblastic Leukemia
What do the results of a bone marrow aspirate and biopsy help determine?
The treatment plan for blood and bone marrow disorders
Which laboratory test is most appropriate to order for a patient with a suspected hematologic disorder to identify blood cell characteristics?
Peripheral blood smear (PBS)
What is the primary purpose of ordering a complete blood count (CBC) for a patient with a suspected hematologic disorder?
To identify the components of a CBC
In a patient suspected of having a hematologic disorder, which laboratory test would help in identifying anemia morphology and underlying mechanisms?
Peripheral blood smear (PBS)
What would be the most appropriate test to order to determine if a patient with suspected hematologic disorder has intravascular or extravascular hemolysis?
Hemoglobin electrophoresis
If indicated, which test would be essential to explain the indications for bone marrow aspirate and biopsy?
Bone marrow examination
Which lab test would be most useful in identifying the cause for each type of given anemia in a patient with suspected hematologic disorder?
Iron panel
Which laboratory test is the best indicator of oxygen-carrying capacity of blood?
Hemoglobin, Hb (g/dL)
What is the average volume of red blood cells (RBCs) known as?
Mean cell volume (MCV)
Which condition is indicated by MCV < 80 µm³?
Microcytic anemia
What does the term 'hyperchromic' refer to in relation to red blood cells?
Increased MCH concentration
In which condition is the red cell distribution width (RDW) normal?
Thalassemias
What does an increase in segmented neutrophils (%) indicate?
(Acute) inflammatory response
Which condition is associated with increased eosinophils (%)?
(Acute) allergic reactions
What does a decrease in platelet count indicate?
(Acute) inflammatory response
'Immature cells' such as erythroblasts and myeloblasts can be observed in which type of PBS evaluation?
Differential count of WBCs
'Megathrombocytes', which are very large platelets, can be observed in which type of PBS evaluation?
Assessment of presence/absence of platelets
What can be assessed by evaluating RBCs in a peripheral blood smear (PBS)?
Shape and hemoglobin concentration of RBCs
What is the relevance of assessing WBCs in a peripheral blood smear (PBS)?
Analyzing abnormal cell morphology in WBCs
Which condition is characterized by normocytic and normochromic RBCs?
Sickle-cell anemia
What condition is associated with microcytic and hypochromic RBCs?
Iron-deficiency anemia
Which disease can result in the presence of spherocytes in the blood smear?
Hereditary spherocytosis
What is the characteristic RBC size in megaloblastic (B12- and folate-deficiency) anemia?
Macrocytic
What is the color of immature RBCs identified as polychromatophilic or orthochromic macrocytes on a Wright-Giemsa stained blood smear?
Gray
What is the marker of erythropoietic activity that is a result of early release of immature RBCs from the bone marrow?
Reticulocyte count (RC)
Which mechanism involves the phagocytosis of RBCs by macrophages in the spleen, liver, and lymph nodes?
Extravascular hemolysis
What is the end product of bilirubin metabolism that gives stool its characteristic dark brown color?
Urobilin
'Hyperchromic' and 'microcytic' spherocytes seen in a PBS would be counted as which type of cells by a CBC analyzer?
'Normochromic' and 'normocytic'
'Polychromasia' on a blood smear indicates what about the cells?
They have increased RNA in the cytoplasm.
Which site is NOT involved in metabolic transformation during extravascular hemolysis?
Kidneys
In intravascular hemolysis, which of the following is a clinical feature?
Blood vessel lumen
What is the main site of hemolysis in extravascular hemolysis?
Spleen, liver, and lymph node macrophages
Which laboratory finding is characteristic of intravascular hemolysis?
No free hemoglobin
What is the mechanism of metabolic transformation in intravascular hemolysis?
Immune destruction by C5b-9
Which enzyme is typically elevated in extravascular hemolysis?
Lactate dehydrogenase (LDH)
Which condition is associated with increased urobilinogen in urinary samples?
Extravascular hemolysis
Study Notes
- The text is from an educational resource titled "Principles of Hematology" by Michael M. Yakubovskyy.
- The text covers various topics related to hematology, including laboratory tests for suspected hematological disorders, components of a complete blood count (CBC), peripheral blood smear analysis, and anemia classification.
- Laboratory tests for suspected hematological disorders include a complete blood count (CBC), peripheral blood smear (PBS), differential white blood cell (WBC Diff) count, corrected reticulocyte count (CRC), hemoglobin electrophoresis, iron panel, serum B12 and folate levels, and bone marrow examination.
- CBC includes RBC indices (red cell count, hemoglobin, hematocrit, mean cell volume, mean cell hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width), WBC count and differential count, and platelet count.
- The components of a CBC and their relevance to blood cell characteristics are important for diagnosing and understanding various blood disorders. For instance, microcytic anemia is characterized by an MCV below 80 fL, while normocytic anemia has an MCV between 80 and 100 fL.
- Peripheral blood smear (PBS) analysis is essential for recognizing and interpreting various abnormalities, such as immature cells, atypical lymphocytes, megathrombocytes, parasites, and other abnormal cells or structures.
- Normal adult PBS typically includes RBCs, WBCs, and platelets, with variations in size, shape, hemoglobin concentration, and inclusion bodies.
- Anemia classification can be based on RBC size (normocytic, microcytic, and macrocytic) and color intensity (normochromic, hypochromic, and hyperchromic). For example, iron-deficiency anemia is hypochromic and microcytic, while sickle-cell anemia is normochromic and normocytic.
- Spherocytes, which are sphere-shaped RBCs with normal MCV, MCH, and MCHC, are seen in hereditary spherocytosis and immune hemolytic anemia.
- Nucleated RBCs are produced during erythropoiesis and can be seen in a peripheral blood smear.
Test your knowledge in recognizing and interpreting the characteristics evaluated in a peripheral blood smear (PBS), including variation in RBC size (Anisocytosis, related to MCV), normocytic and normochromic RBCs, microcytic and hypochromic RBCs, and macrocytic RBCs.
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