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SCHC Hematology III
Inclusion bodies and anomalies
| 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. |
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