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name in order the blood cell maturation sequence order of RBC colony forming unit
- Rubriblast
- Prorubricyte
- Rubricyte
- Metarubricyte
- Reticulocyte
- Erythrocyte
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what is the iron transport protein
transferrin
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what is the major iron storage form
ferritin
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what is the water insoluable iron storage form(long term)
hemosiderin
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when do excessive formation of porphyrins occur
if any enzymatic step in heme sythesis is blocked
-
What are the heme precursors
- delta-aminolevulinic
- porphobilinogen
- uropophyrinogen
- coprophyrinogen
- protoporphyrin
- hemeglobin
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when there is a shift to left what happens with the oxygen
it not released to tissue adequately
-
when there is a shift to the right what happens with oxygen
Oxygen is released to tissue more easily
-
why is EDTA unavailable to participate in the coagulation cascade
it chelates calcuim
-
what anticoagulant is the anti-thrombin agent
heparin
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what are the sources of error in hemoglobin
- lipemia
- high white count
- extremely icteric sample
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what is the reference range for hemoglobin
- male-16 + or - 2g/dl
- female-14 + or - 2g/dl
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what measures packed cell volume in percent
hematocrit
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what are the sources of error in hematocrit
- failure to seal tube adequately with clay
- incorrect reading due to uneven clay plug
- inappropriate centrifuge time
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what are the reference ranges of hematocrit
- male=45 + or - 5%
- female=42 + or - 5%
-
what is the depth of the chamber in the hemacytometer
0.1
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what is the formula for manual cell counts using the hemacytometer
- # of cells counted x 1 x dilution factor
- total vol.
- (vol. of 1 square=lengthxwidthxdepth )
- total vol=vol. x # of squares counted
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explain how to do the WBC count in hemacytometer
- count all 9 sqaures
- total vol counted=1mm x 1mm x 0.1mm x 9=0.9mm
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what is the reference range of the wbc count using the hemacytometer
150,000-400,000/ul
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solve formula when the wbc count=60 in hemacytometer
- 60 x 1 x 100=6.667mm or 60 x 10%=60 + 6=66 66 x 100=6600mm
- .9
-
solve formula of platelet counted=150
- 150 x 1 x 100=150,000/mm
- .1
- (mutiply # of plts. counted by 1000)
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what is the formula, ref. range, indication of the indice of MCV
- Hct x 10
- Rbc
- 80-100fl
- <80 microcytic anemia
- >100 macrocytic anemia
-
what is the formula, ref. range, and indication of the MCH indices
- HgB x 10
- Rbc
- 28-32
- varies withhemoglobin content and cell size
-
what is the formula, ref. range, and indication of MCHC indices
- HB x 100
- HCT
- 32-36%
- <32 hypochromic >36 hyperchromic(sperocytes), lipemia, HB SS, CC
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what is the formula, ref. range, and indication of RDW indices
- SD of MCV x 100
- mean MCV
- 11.5-14.5%
- >14.5 anisocytosis
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what is the function of rbc
oxygen transport to tissue and carbon dioxide removal from tissue; cell nutrition
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what are the ref ranges for rbc
- female=3.8-5.2
- male=4.5-6.1
-
what is the function of neutrophil
phagocytic response to bacteria
-
what is the ref range for neutrophil
- relative=50-70%
- absolute=2500-7000 ul
-
what is the function of lymphocyte
humoral and cell mediated immunity
-
what is the ref range of lymphocytes
- relative=20-40%
- absolute=1000-4000UL
-
What is the funciton of monocyte
phagocytic response to bacteria
-
what is the ref range of monocytes
- relative 3-10
- absolute 150-1000
-
what is the function of basophil
inflammatory response mediator
-
what is the ref range of basophils
- relative 0-2
- absolute 0-200
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what is the function of eosinophil
allergic responsed regulator
-
what is the ref ranges for eosinophil
- relative 0-3%
- absolute 0-300
-
what is the function of platelets
clotting
-
what is the ref range for platelets
absolute 150,000-400,000
-
what are neutrophils increased in 50-70%
bacterial infections
-
what are lymphocytes increased in 20-40%
viral infections
-
what are monocytes increased in 3-10%
TB syphillis malignancies
-
what are eosinophils increased in 0-3%
allergies parasites CML
-
what are basophils increased in 0-2%
immediate hypersensivity CML
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Name what is associated with this cell morphology:
hypersegmented neutrophil
hyposegmented neutrophil
toxic granulation/vacuoles
dohle bodies
atypical lymphs(increased size and basaphilla)
- pernicious anemia
- pelger huet anomaly pseudo-Pelger huet(AML AIDS)
- bacterial infections burns may-hegglin
- infections mono ( epstein-barr virus) other viral infections
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what is the ref range for platelets
8-20 per oil immersion field
-
what is the formula for corrected wbc count
- wbc count x 100 100 + #nrbcs
-
what does anisocytosis mean
variation in size
-
what does polychromasia mean
blue color in rbc ( if stained with reticuloctyes stain it would be reticulocytes)
-
define poikilocytosis
variation in shape
-
what inclusion is indicative of thalassemia and lead poisoning
basophillic stippling
-
what is the indication of heniz body inclusion
- G6PD Deficiency
- Thalassemia
-
what inclusion is megaloblastic anemia indicated of
cabot ring
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if rule of three the correlation of Hb, Hct, and rbc what should you consider
- clotted specimen
- cold agglutinin(warm sample and rerun)
- lipemic or icteric sample
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what is associated with cold agglutinin disease;warm sample & rerun
increase in MCV and MCHC and decrease in red cell count
-
what is the priniciple of erythrocyte sedimentation rate (westergren-ESR)
measures rate of fall of red cells through plasma
-
what is the reference ranges of ESR
- female=0-20mm/hr
- male=0-15mm/hr
-
what is the clinical correleation of ESR
increase seen in presence of abnormal plasma proteins(inflammatory conditions)
-
what are the sources of error in ESR
- increase-tilting tube standing too long increase temp. excess EDTA
- decrease-QNS specimen decrease temp
-
what stains are used in reticulocyte stain
- a supra vital stain which stains red cells in living state
- a. new methylene blue
- b. brilliant cresyl blue
-
what do reticulocyte monitor
erythropoiesois
-
formula for reticuloctyes
-
formula for absolute retics
# RBCs x % retics
-
formula for corrected retic count
-
what is the ref. ranges for retics
0.5-1.5%
-
what is the reticulocyte production index formula
- corrected retic countmaturation time usually use 2
-
what position is hemoglobin S on the beta chain
6th position of valine for glutamic acid
-
what position is hemoglobin C on the beta chain
6th posiition of lysine for glutamic acid
-
the perpherial blood is composed of
rbc, wbc, platelets,plasma(water, electrolytes, and protein)
-
what is hematopoeisis
the production and maturartion of peripheral blood cells
-
where do cellular elements of the perpheral blood arise from
precursor cells in the bone marrow
-
why it is good for rbc to deform in shape
it aids to the passage through very small capaillaries
-
what happens to rbc as they mature
increase in hemoglobin and content and decreasre in size
-
what happens to rbc nucleus during maturation
decreases in size until it is extruded
-
what happens to rbc cytoplasm during maturation
increases in amount relative to the nucleus
-
name the six stages of rbc maturation for morphologic identification
pronormoblast basophillic normoblast polychromatophilic normoblast orthochromic normoblast polychromatophilic red cell erythrocyte
-
define normochromic rbcs
rbc with central pallor no more than one third the diameter of the cell
-
define hypochromic
rbc with central pallor greater than 1/3 the diameter of the cell
-
when do you see hypochromic rbcs
in iron deficiency anemia
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define anisocytosis
variation in reb blood cell size
-
when do you see anisocytosis
in iron deficiency megaloblastic anemia and burn pts.
-
what cell are normal rbc the same size of
the nucleus of small lymphocytes
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what are microcytic cells smaller than
the nucleus of small lymphocytes
-
when are microcytes seen
in thalasssemia and iron deficiency anemia
-
describe macrocytes
rbc that are larger than the nucleus of small lymphocytes
-
when are macrocytes seen
in anemia due to folate and vitamin B12 deficiency
-
define poikiolocytosis
variation in rbc shape
-
when are poikilocytosis seen
sickle cell anemia severe iron anemia burn pts
-
when are spherocytes seen
in hereditary spherocytosis and immune hemolytic anemia
-
when are teardrops seen(dacrocytes)
result from marrow replacement by fibrosis or malignancy
-
when are stomocytes seen
in acute alcoholism and liver disease
-
when may you schisotocytes(keratocytes)
in disseminated intravascular coagulation or thrombotic thromobocytopenic purpura
-
when are target cells seen(codacytes)
in liver disease and thalassemia
-
list all the inclusions
- basophillic stippling
- heniz body
- howell jolly body
- pappenheimer body
-
when are basophillic stippling seen
lead poisioning thalasemia and sideroblastic anemia
-
describe howell jolly bodies
are nuclear fragments often seen in rbc seen from pts who have their spleen removed
-
what is heniz bodies associated with
G6PD deficiency and composed o denatured hemoglobin
-
give the sequence for the granulocytic maturation
- myeloblast
- promyelocyte
- myelocyte
- metamyelocyte
- band
- neutrophil
-
what can bacterial infections cause to neutrophils
toxic changes
-
when are hyposegmented neutrophils
in pts with Pelger-Huet anomaly or myelodysplastic syndrome
-
describe hypersegmented neutrophils
neurtrophil with six or more nucleur segments
-
what are hypesegmented neutrophils associated wih
pts with anemia due to vit. b12 and folate deficiency
-
when are toxic granules seen
in pts with bacterial infection
-
where do lymphocyte maturation primarily occur
in thymus and bone marrow
-
where the majority of lymphocyhtes reside
in lymph nodes spleen and other extravacular sites
-
reactive lymphocytes(atypical) may be associated with
viral infections
-
what are lymphcytes with a cleaved(cut in half) nucleus associated with
whooping cough(pertussis) in children
-
where the majority of monocytes reside
in tissues and called macrophages
-
another name for platelets
thrombocytes
-
primary site of platelet production
Bone marrow
-
where do platelets arise from
large precursor cell called megakarocyte
-
when are smudge cells seen
in chronic lymphocytic leukemia
-
what is infectious mononucleosis
viral disease caused by by the Epstein-Barr virus
-
what is May-Hegglin anomaly
rare dominant trait
-
what is Cheediak-Higashi syndrome
rare autosomal recessive trait resulting in abnormal neutrophil function and frequent bacterial infection
-
how is chronic myelogenous leukemia chacterized
large increase in granulocyte production and the presence of the Philadelphia chromosome,t(9,22)
-
What do acute leukemias result from
clonal proliferation in the bone marrow of immature cells having little or no maturation(blasts)
-
what is the criteria for diagnosis of acute leukemia
presence of 30% of blasts in perpherial blood and/or bone marrow
-
describe acute lymphoblastic leukemia
proliferation of blasts having lymphoid characteristics and is more common in children
-
describe chronic lymphocytic leukemia
increased small lymphocytes with coarsely clumped chromatin, smudge(basket) cells, most common form, seen in prevalent in adults
-
what is mutiple myeloma
clonal proliferation of plasma cells usually in the bone marrow
-
what is rouleaux formation
four or more rbcs lined up resembling a stack of coins
-
what is lymphoma
a clonal proliferation of lymphocytes occurring in tissue
-
what is the presence of poikilocytosis and red cell fragments (shistocytes) a characteristic of
mechanical trauma(artificial heart valve)
-
what condition is seen if numerous reactive atypical lymphocytes seen
infectious mononucleosis
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