SCHC Hematology III

Description:	Inclusion bodies and anomalies
Category:	Laboratory Science
Created by:	Jeannie Moore on 2009-10-04

Question	Answer
How do you do a corrected WBC count?	wbc counted x (100/100+NRBC count)
What does an NRBC look like?	approc 7-12um, pinkish cytoplasm, a uniform pyknotic nucleus.
Why is it important to note the presence of NRBCs?	B/c with electronic cell counters the nrbcs are counted at wbcs. If there are more than 10 on a smear then the wbc count needs to be corrected.
What is the inclusion body composed of in the retic?	residual rRNA.
WHat is the specific stain used to visualize retics?	New Methylene blue
When are you likely to see retics?	When a person is being treated for anemia and hemolytic anemias.
What are Howell-Jolley bodies composed of?	they are small fragments of non-functional dna
What organ usually removes them and why would it cease to do this function?	The spleen usually removes them but due to erythroid stress the spleen cannot keep up with removal of the inclusions
What disease processes could result in this howell-jolly inclusions?	Thalassemia, hemolytic anemia, megaloblastic anemia, and splenectomy.
What is the most common cause of basophilic stippling?	Lead poisoning.
What is the inclusion body in basophilic stippling composed of? Which stain can it be visualized under?	Spontaneous aggregation of ribosomal RNA; Wright's stain
What does a retic look like under a Wright's stain?	bluish compared to regular RBCs and also slightly larger
What are siderotic granules composed of?	Iron
What stain confirms presence of siderotic granules?	Prussian blue
What are pappenheimer bodies composed of?	Iron
When these iron granules are seen in a rbc under Wright's stain what are they called?	Pappenheimer bodies
What conditions are associate with siderotic granules?	Hemoglobinopathies, hemolytic anemias, sideroblastic anema, post-splenectomy
What are heinz bodies composed of? How does it effect the rbc?	Heinz bodies are composed of denatured hb. They are large and rigid and cause distortion of the RBC
What diseases can cause Heinz bodies?	G6PD, alpha-thalassemia, and other unstable hb syndromes
What stain shows the heinz bodies?	Supravital stains such as crystal violet or brilliant cresyl blue
What do the heinz bodies look like under a wright's stain?	they look like funny shaped rbcs...almost like unevenly distributed burr cells.
Cabot rings look like what under the wright's stain?	A figure eight with stippling. Cell is elongated.
What are the cabot ring's composed of?	Arginine rich histones and non-hgb iron.
What conditions are associated with Cabot rings? What causes Cabot rings?	homozygous thalassemia, megaloblastic anemias, post-splenectomy; the cause of their formation is unknown.
What stain is used to visualize malaria? And what is this considered for malaria diagnosis?	Giemsa; it's considered the gold standard.
If vacuoles are present in a neutrophil what does that indicate?	A serious bacterial infection. Vacuoles are not usually seen in neutrophils.
When you see toxic granules and Dohle bodies in the neutrophils what does that indicate?	Bacterial infection, burns, cancer, toxic or inflammatory states, chemotherapy.
Toxic granules and Dohle bodies are considered?	Non-specific reactive changes in morphology
In a differential is toxic granulation counted in the results?	Yes and they're graded.
What condition would cause toxic vacuolization?	Septicemia
What is a Dohle body composed of?	glycogen and rER.
What conditions are associated with Dohle bodies?	Severe burns, severe infection, pregnancy, and chemotoxic drug ingestion
Define leukocytosis.	Occurs when a pt's wbc count is 10,000 greater than their baseline.
What could cause a white cell count from 10,000 to 50,000?	Bacterial infections
What causes a white cell count from 50k to 100k?	Leukamoid reaction.
What causes a white cell count greater than 100,000?	Leukemia
What distinguishes between the Leukamoid rxn and Leukemia?	The white cell count as well as the amount of immaturity. In leukemia there is a shift to the left and immature cells are seen within the bloodstream. Also leukamoid rxn is transient and will disappear once the stimulus is removed.
What can cause physiological leukocytosis?	Vigorous exercise, temp increase, labor/delivery, intense emotional distress.
What types of patients would be susceptible to fungal infections that are intracellular?	HIV+ pt's
Define hypersegmented. What causes them?	It is when there a greater than 6 lobes on a granulocyte; a defect in DNA production which causes the maturation process prolonged
What diseases/conditions are associated with hypersegmentation?	Megaloblastic anemia, pernicious anemia, folic acid deficiency
What are Auer rods composed of?	Azurophilic granular materials
What do Auer rods look like? What disease is associated with them?	A reddish rod found in myeloid blasts; AML
What is Pyknotic or karyopyknosis?	it is the irreversible condensation of chromatin in the nucleus undergoing cell death or apoptosis.
What disease is most likely to cause reactive lymphs?	Mononucleosis.
Viral infections have what affect on lymphocytes?	Increased count plus reactive lymphs
What disease can cause reactive lymphs?	Treponema pallidium, Epstein-Barr Virus, CMV, Toxoplasmosis, S. agalactiae, Hep C, Hantavirus
What type of leukemia is associated with Hairy cell leukemia? Which lymphocyte is affected?	Chronic lymphoid leukemia; the b-cell (it's a mature B-cell neoplasm)
Ehrlichia is transmitted by? What does it look like on a smear?	Lone star tick; blue inclusion bodies in the cytoplasm of monos and neutros.
What has PAS-positive vacuoles and what condition is associated with it?	Sezary cell; Sezary syndrome
What are five factors associated with acquired neutropenia?	Viral infections, medications, alloantibody formation, autoantibody formation, and secondary conditions (i.e. bone cancer or aplastic anemia)
What is characteristic of aplastic anemia?	Fatty bone marrow
Name the defect classifications of qualitative neutrophil disorders.	cytoplasmic granules, disturbance of respiratory burst, chemotaxis, combination of defects.
Why is Chediak-Higashi syndrome so severe? What are the symptoms?	Because the neutrophils and lymphocytes lose the ability to kill because the granules are large, fused, and unable to release lysosomal enzymes; Symptoms are pancytopenia, organomegally, systemic infections, and neurologic complications
What causes CGD?	The inability to activate a respiratory burst that results in reduced or no superoxide production.
What are the symptoms of CGD?	Neutrophilia, granuloma formation, eczematoid rashes, lymphadenitis, organomegaly, osteomyelitis.
How can CGD be diagnosed?	nitroblue tetrazolium test (NTB) or by measuring the resp. burst activity via flow cytometry
What is characteristic of Pelger-Huet anomaly? Is this condition severe?	Dumb-bell shaped nucleus in neutrophils; no, it's benign.
What is an Alder-Reilly inclusion body? What is it associated with?	It causes dark cytoplasmic granules (azurophilic) in the leukocytes; it's associated with mucopolysaccharidosis like in Hurler's syndrome.
What is a May-Heglin body composed of? How can it be differentiated from a Dohle body?	MH is composed of RNA from the rough endoplasmic reticulum; the May-Heglin is larger and more prominent than the Dohle bodies and also enlarged plts can be present.
What causes sea-blue histiocytosis syndrome? What is a prominent symptom? What stain can be used to visualize it?	An inborn error involving apolipoprotein E which leads to abnormal lipid metabolism. It causes an accumulation of glycosphingolipids in the histiocytes. It can be visualized by using May Grunwald staining (bm or spleen aspirations).
What is a major symptom of Gaucher's disease?	Distended abdomen, enlarged liver and spleen, brownish tint to skin, anemia
What is the cause of Gaucher's disease?	It is an inherited disease which causes a deficiency in an acid called beta-glucosidase which makes the marcophages unable to breakdown the lipids they ingest from phagocytosis.
Niemann-Pick disease is caused by what? How is it diagnosed?	Caused by a missing enzyme: sphingomyelinase which normally breaks down lipids. It causes foamy macrophages which are easy under the microscope.
What are the symptoms of Niemann-Pick disease?	splenomegaly then thrombocytopenia, accumulation of sphingomyelin in the CNS, altered speech, dysphagia.
What is an easy way to tell if lymphocytes are part of a malignant disorder or reacting to viral infection?	If the lymphocytes are uniform in size then they are most likely malignant. Lymphocytes usually vary in size naturally.
How do you test for infectious mononucleosis?	Mono heterophile antibodies
Toxoplasmosis is caused by what organism? How do you test for it? Why is it such a big concern? How do you get it?	Toxoplasma gondii; serological antibody tests; It can cause problems for the fetus (hydrocephalic); can get infected by cat feces or undercooked meat.
What conditions cause increased lymphocytes?	CLL, ALL, CMV, infectious lymphocytosis, Bordetella pertussis, lymphocytic leukamoid rxn.
What are possible causes of lymphocytopenia?	AIDS, SCIDS, Digeorge syndrome, Sex-linked agammaglobulinemia
Symptoms of plasmacytosis. Where are they found in this condition?	skin disease, cirrhosis of the liver, collagen disorders, sarcoidosis, multiple myeloma, and plasma cell leukemia; plasma cells are in the peripheral blood
What is basophilia associated with?	Hypersensitivity reactions, myeloproliferative disorders, and chronic granulocytic leukemia
WHat is monocytosis associated with?	malaria, rickettsial infections, syphilis, TB, rocky mtn spotted fever, and infectious mononucleosis.
What can neutropenia be caused by?	Overwhelming bacterial infections, radiation, drugs, acute leukemia, megaloblastic leukemia, splenomegaly, aplastic anemia, Lupus,
What is agranulocytosis caused by and what is the count like?	It is a severe neutropenia caused by infection, decreased bone marrow production, drug interactions; count is less than 0.5.
WHen is leukoerythroblastic reaction occur?	cancer, leukemia, myelofibrosis, or most importantly HDN.
What does a person with myeloperoxidase deficiency lose the ability to do?	unable to create bleach, but not that severe b/c they still have respiratory burst.
MPO deficiency is commonly seen is people with?	AML, myelodysplastic syndromes, and lead posioning.
How can you tell the difference between an acute and chronic leukemia based on the blood smear?	Chronic leukemias have mostly mature cells and a shift to the right. Acute leukemias have a shift to the left and has a lot more immaturity.