Principles of Hematology.pdf

Principles of Hematology Study online at https://quizlet.com/_efj8u6 1. Lab Tests/Studies Most appropriate to order on a patient with suspected hematologic disorder 1. CBC - complete blood count 2. PBS - peripheral blood smear 3. Differential WBC count (WBC Diff) 4. Corrected reticulocyte count (CRC...

Principles of Hematology Study online at https://quizlet.com/_efj8u6 1. Lab Tests/Studies Most appropriate to order on a patient with suspected hematologic disorder 1. CBC - complete blood count 2. PBS - peripheral blood smear 3. Differential WBC count (WBC Diff) 4. Corrected reticulocyte count (CRC) 5. Other lab tests depend upon results of above tests - hemoglobin electrophoresis - iron panel -serum B12 and folate levels (B9) 6. Bone marrow examination, if indicated 2. HemoScreen CBC Analyzer - put drop of patients blood in machine 3. hemoglobin - best indicator of oxygen-carrying capacity of blood - accurate and preferable to hematocrit for diagnosis of anemia 4. mean cell volume - the most important blood index for classifying anemia (MCV) 5. red cell distribu- - reflects variation in RBC size (anisocytosis) tion width (RDW) 6. platelet count - we are cautious about lower level of platelets - anything less than 100,000 is a problem 7. PBS and Nikon Microscope 8. PBS:Principles of Evaluation RBC WBC Platelets any abnormal cells/structures 9. red blood cells size, shape, hemoglobin concentration, inclusion bodies evaluated by PBS 1/8 Principles of Hematology Study online at https://quizlet.com/_efj8u6 10. WBC evaluated by PBS differential count, abnormal cell morphology 11. platelets evaluat- presence/absence, number, size ed by PBS 12. abnormal cells/structures by PBS - immature cells:erythroblasts, myeloblasts, lymphoblasts (immature bone marrow) -atypical lymphocytes - megathrombocytes: very large platelets - parasites: malaria, babesia, filaria, etc. 13. Normal Adult PBS should contain: -red blood cells - white blood cells (2 neutrophils and 1 monocyte) - platelets **gimsa wright stain** 14. Another variation - red blood cells of normal adult - white blood cells (4 segmented neutrophils) PBS - platelets **larger microscope power** 15. Classification of - related to mean cellular volume anemias based on RBC SIZE 1. Normocyte (ANISOCYTOSIS) 2. Microcytic 3. Macrocytic 16. Normocytic ex. sickle cell anemia rbcs are normal size 17. Microcytic ex. iron-deficiency anemia and thalassemia 18. Macrocytic - megaloblastic (B12 and folate deficiency) anemia 2/8 Principles of Hematology Study online at https://quizlet.com/_efj8u6 19. anisocytosis related to red blood cell size mean cellular volume (MCV) 20. Variation in RBC - related to MCH and MCHC Color Intensity - "chromia" - color intensity 21. normochromic ex. sickle cell anemia 22. hypochromic with iron-deficiency and thalassemias as major causes 23. central palor faded out whiteish appearance in center of cell corresponds to 1/3 of whole red blood cell diameter 24. is there hyperno chromic anemia? 25. Spherocytes - sphere-shaped red blood cells with normal MCV, MCH,and MCHC, aka spherocytes are normocytic and normochromic rbc's -because of the shape, the spherocytes look smaller and hyperchromic - they are seen in hereditary spherocytosis and immune hemolytic anemia 26. Hematopoiesis formation of blood cells 27. Variaation in - activation of erythropoiesis --> early release of immature RBC color - how RBC's from the bone marrow it occurs - if PBS is stained with wright-giemsa (grayish-blue) , immature red blood cells are identified as polychromatophilic or orthochromic macrocytes (polychromasia/polychromatophilia) - the color is determined by presence of RNA in the cytoplasm - if PBS is stained with supra-vital stains, ex. cresyl violet 3/8 Principles of Hematology Study online at https://quizlet.com/_efj8u6 or new methylene blue, and presence of RNA molecules is identified the cells are named as reticulocytes 28. Polychromasia vs Reticulocytosis first you use a wright-giemsa stain and then supravital new methylene blue stain 29. supravital new methylene blue stain used to be 100% sure that the cells are reticulocytes 30. reticulocytes immature red blood cells 31. Reticulocyte Counts (RC) - a marker of erythropoietic activity - % of RC count is falsely increased in anemia because of destruction of mature red blood cells in the spleen, for example, correction in RC is required. 32. corrected reticu- actual HCT/45 x RC locyte count 45 = normal HCT 33. In cases of RBC polychromasia two phenomena are observed 1. early release of premature red blood cells in the peripheral blood 2. early maturation of reticulocytes (RNA expulsion) in the peripheral blood - need to do reticulocyte production index 34. reticulocyte pro- RPI = CRC/2 duction index (RPI0 35. Variation in RBC - spherocytes - round/spheroid in shape Shape (Poikilocy- - in PBS, spherocytes are smaller than ordinary RBC'S tosis) and hyperchromic (loss of central pallor due to accumulation Hb in the central area of RBC cytoplasm) - osmotically fragile - seen in hereditary spherocytosis and immune hemolytic anemia 4/8 Principles of Hematology Study online at https://quizlet.com/_efj8u6 36. Sickle cells (drepanocytes) seen in sickle cell anemia 37. Teardrop cell (dacrocytes) seen in myelofibrosis, marrow infiltration, etc. 38. shistocytes (hel- seen in anemias resulting from trauma to red blood cells met cells) 39. Target Cells aka codocytes 40. Target cells have - too much cell membrane or too little cell volume --> what? accumulation of Hb in the central area of red blood cells -cells are osmotically resistant - seen in hemoglobinopathies 41. RBC inclusions 1. howell-holly bodies 2. basophilic stippling 3. heinz bodies 4. cabot rings 42. Howell-Jolly bod- - nuclear remnants visualized with wright-giemsa stain ies - normally taken from the reticulocytes during their transit through splenic sinuses - major causes: splenectomy, hyposplenism 43. Basophilic stippling ribsomal aggregates that stain deep blue with wright-giemsa stain - supravital stains will reveal "reticulum" similar to observed in reticulocytes major causes: lead intoxication, thalassemia 44. Heinz bodies aggregates of denatured proteins, primary Hb -heinz bodies are eliminated as red blood cells traverse the endothelial slits of the splenic sinuses 5/8 Principles of Hematology Study online at https://quizlet.com/_efj8u6 - not seen in wright-giemsa - identified with supravital-stains only major cause: G6PD deficiency anemia 45. Cabot rings the ringlike or figure of eight structures probably originating from mitotic spindle major cause: megaloblastic anemia 46. hemolysis - premature destruction of RBC's - compensatory erythropoiesis: increased elevated EPO and reticulocytosis 47. anemia is the re- insufficiency in compensatory erythropoiesis sult of what 48. retention of the protoporphyrin ring = unconjugated hyperbilirubinemia products of degraded red cells iron = hemosiderosis (stored in ferritin) 49. Sites of hemoly- 1. extravascular sis 2. intravascular 50. extravacular he- within the macrophages of the spleen, liver, and lymph molysis nodes 51. intravascular he- within the bloodstream molysis **Hg falls out into the bloodstream** 52. Steps in extravascular hemolysis 1. antibody-coated or irregular red blood cell 2. phagocytosis 3. degradation in lysosome 4. intracellular hemoglobin 5. billiverdin 6/8 Principles of Hematology Study online at https://quizlet.com/_efj8u6 6. (in liver) - bilirubin - glucosylated 7. bile 53. Intravascular He- 1. red blood cell in circulation molysis 2. direct lysis: shear stress, toxins, complement 3. intravascular free hemoglobin 4. bound to haptoglobin ----> hepatic clearance OR if haptoglobin capacity exceeded, 5. renal tubular excretion (hemoglobinuria) 54. haptoglobin Binds free hemoglobin after RBC lysis to be destroyed by spleen, decreased levels in sickle cell, thalessemia, lead poisoning,etc. 55. Cola Colored urine 56. "Hair on end" -or- "crew cut" appearance on X-ray seen in conditions such as sickle cell anemia, thalassemia, and other hemolytic anemias where there is an increased demand for red blood cell production, leading to expansion and changes in the bone marrow. 57. Bone Marrow as- to aspirate the tissue fluid piration 58. BM (trephine) biopsy to get a piece ("column") of tissue 59. 7/8 Principles of Hematology Study online at https://quizlet.com/_efj8u6 indications of - evaluation of unexplained CBC results bone marrow ex- - confirm/rule out the diagnosis of malignancy (cancer) amination - evaluation of iron stores 60. primary BM can- leukemia and myeloma cers 61. secondary BM cancers metastatic tumors 62. evaluation of iron - evaluation of disseminated infection: tuberculosis, fungal stores disease -BM donor harvesting (aspiration) 63. Sites for BM Aspiration and Biopsy technique sternum anterior iliac crest posterior iliac crest **safest** 64. position of pt prone, or on the contralateral to biopsy site during bm biopsy/aspiration 65. surface anatom- iliac crest identified by palpation ic landmarks present in bm biop- biopsy site marked with indelible ink sy/aspiration 66. preparation of BM aspiration/biopsy informed, written, and signed consent -aseptic technique -local anesthesia 8/8