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HEMATOLOGY 1
| Question | Answer |
|---|---|
| Total volume of blood in males | 5-6L |
| Total volume of blood in females | 4-5L |
| 3 layers of buffy coat | Uppermost: platelets / middle: Agranulocyte / lower layer: Granulocyte, nRBC |
| Blood pH | 7.35-7.45 (ave. 7.40) |
| Whole blood spe. grav: | 1.045-1.066 |
| Serum spe. Grav: | 1.024-1.028 |
| Plasma SG: | 1.025-1.029 |
| Concentration of solutes dissolved in the blood | Osmolality |
| Ref range for osmolality: | 281-297 milliosmoles/kg |
| Blood makes ____ per body weight. | 7-8% (75-85mL) |
| Most important function of blood: | Respiratory function |
| Optimum conc. of EDTA anticoagulant in blood: | 1.2-1.5 mg/dL |
| EDTA in dry form: | Na²EDTA / K²EDTA |
| EDTA in liquid form: | K³ EDTA |
| Anticoagulant choice in Hematology: | EDTA |
| Disodium salt also known as ______. | Versene 2 |
| Tripotassium salt also known as _____. | Sequestrene 3 |
| EDTA actions to chelate ______. | Calcium |
| _____ are recommended by the International Council for Standardization in Hematology (ISCH) abd CLSI as the anticoag. of choice for BLOOD CELL COUNTING AND SIZING because they produce less shrinkage of RBCs and less of an increase in cell vol in standing. | K² EDTA |
| If conc. of EDTA exceeds 2mg/dL of WB, platelets may ______. | Swell and Fragment (causing false higher account) |
| Platelet Satellitosis is caused by _____. | Using EDTA as anticoag. causing false decrease PLT count. |
| Platelet satellitosis can be fixed by _____. | Using sodium citrate |
| Increase EDTA is caused by _______. | Underfilled / Short draw ( falsely low HCT/ESR) |
| EDTA cannot be used for coag studies because _____. | Factor V is not stable / inhibits fibrinogen - thrombin reaction |
| Sodium Citrate action is to ______. | Bind calcium to form soluble complex. |
| Anticoagulant of choice for coag studies: | Sodium citrate |
| Ratio of blood to anticoagulant is (Na citrate) _____. | 9:1 |
| Sodium citrate should be buffered and use in concentration of ______. | 3.2% or 0.109 M |
| Sodium citrate preserve factors ______. | V and VIII |
| Anticoagulant for Standard Westergren ESR (black top): | Sodium citrate |
| Citrate to blood ratio for Standard Westergren: | 4:1 |
| Sodium citrate conc. for standard Westergren: | 3.8 % |
| Underfilled/short draw of citrated blood can cause _____. | Prolong PT and PTT |
| In polycythemic patient there is hct of >55% which causes excess in citrate thereby prolonging coag test results. What is the remedy? | Reduced the volume of citrate |
| Oxalate concentration: | 1-2mg/dL |
| Oxalate actions to _____. | form insoluble calcium oxalate |
| Forms of oxalate: | Lithium oxalate / sodium oxalate / potassium oxalate / double oxalate |
| Oxalate form which is widely used : | Potassium oxalate |
| Double balance oxalate : | Potassium oxalate ( Paul Heller) causes cell shrinkage / ammonium oxlate (Wintrobe) causes cell swelling |
| Considered as a natural anticoagulant : | Heparin |
| Anticoagulant of choice for most chemistry test | Heparin (Lithium Heparin) |
| Optimal conc. of heparin | 15-20 U/mL or 15-30 U/mL |
| Anticoagulant used for OFT and LAP test: | Heparin |
| Heparin is not used for blood film preparation because: | It produces a bluish background on Romanowsky stained smear |
| Heparin is not used for coag studies because | It inhibits all stages of coagulation cascade specially thrombin |
| Anticoagulant for cardiopulmonary bypass patients | Heparin |
| Used for preserving glucose / inhibitor of glycolysis / can also be used in determination of lactic acid and blood alcohol | Sodium fluoride |
| Venipuncture Order of Draw: ETS or Syringe | YELLOW (SPS) blood culture / BLUE (Sodium Citrate) / RED (serum tubes) with or without activators / GREEN (Heparin) / LAVENDER (EDTA) / WHITE (K² EDTA) / GRAY (Sodium Fluoride) |
| Skin Puncture Order of Draw | Blood gases / SLIDES (unless from EDTA) / EDTA / other anticoagulated microtubes / non aticoagulated microtubes |
| Yellow stopper tubes could be: | SPS (BLOOD CULTURES) first in order / or ACD (last in draw) for blood bank or in lympocytotoxicity testing |
| Depth of skin puncture: | Not more than 2mm |
| Sites for skin puncture: | Lateral (outside) or medial (inside) plantar (bottom) surface of the heel or big toe (INFANTS UNDER 1Y) / distal portion of the third or fourth finger on non dominant hand / earlobes (less pain, fewer nerve endings, less tissue juices) |
| In skin puncture, the phlebotomist should warm the site to a temp. no greater than | 42°C for no longer than 3-5minutes |
| False increase in skin puncture: | WBC count |
| False decrease in skin puncture: | RBC count, Hematocrit, Hemoglobin and platelet counts |
| Most widely used for collecting venous sample | ETS |
| Sterilization for ETS | Gamma irradiation |
| Shelf life for ETS | Atleast 1 year |
| Most preferred veins for venipuncture | Median cubital |
| Least preferred veins for venipuncture | Basilic vein |
| Color of 18g | Pink |
| Color of 21g | Green |
| 22g color | Black |
| 23g color | Blue (children) |
| Standard needle for routine veni accdg to rodaks | 21g |
| Standard needle for routine veni accdg to steinenger | 20g |
| Length of needle | 1-1.5inches |
| Venipuncture angle | 15° or 15-30° |
| Tourniquet application | 7.5 - 10cm (3-4inches) above veni site for 1min |
| Blood pressure cuff as tourniquet | 60mmHg (40-60mmHg) |
| Most convenient and commonly used method for blood film preparation: | Wedge Smear (25/ 30-40°/ 30-45°<) |
| Thick blood smear is used for | Malarial detection |
| Distance from the edge of slide blood film | 0.25mm or 1 inch to 0.5 inches |
| Thin smear | increase pressure / decrease angle, size of blood, speed |
| Thick smear | decrease pressure / increase angle, size of blood, speed |
| Size of drop of blood (blood film) | 2-3mm |
| In polycythemic patients (increased hct), angle of the spreader must be lower to | 25° |
| In anemic patients (decreased hct), angle of the spreader must | be higher |
| In cross sectional counting of cells, blood film is moved to | Side to side (H to T) |
| In longitudinal counting of cells, blood film is moved from | Tail toward the head (T to H) |
| In battlement/track pattern/back and forth or serpentine counting of cells, blood film is moved | to three consecutive horizontal edge field |
| length of film slide | 2/3 to 3/4 |
| Ideal shape for blood film | Finger shape |
| Feather edge of blood film should have | Rainbow appearance |
| A non supravital stain, a polychrome stain that is defined as any stain containing methylene blue or it's products of oxidation and a halogenated fluorescein dye: | Romanowsky stain |
| Fixative used in blood films | Methanol |
| Stain used in blood film | Wright's stain (Methylene blue + Eosin Y) |
| Buffer used in blood film | Aged distilled water or 0.05M sodium phosphate (pH 6.4-6.8) |
| Blood films should be stained after | 2-3 hours after specimen collection |
| Stain used for malarial detection | Giemsa stain |
| Supravital stain used for reticulocytes | New Methylene Blue |
| Supravital stain used for demonstration of Heinz bodies and Hgb H | New Methylene Blue |
| pH of stain used in malarial blood film: | 7.2 |
| pH of stain used in bone marrow blood stain: | 6.8 |
| A continuous regulated processof blood cell production that includes cell renewal, proliferation, differentiation, and maturation. | Hematopoiesis |
| These cells are present in the first few hours after an ovum is fertilized / can develop into any human cell type, including development from embryo into fetus. | Totipotential Stem Cell |
| Cells present in several days after fertilization / they cannot develop into a fetus | Pluripotential Stem Cell |
| Derived from pluripotent stem cells / they are limited to specific types of cells to form tissues (ex bone marrow) | Multipotential Stem Cell |
| Suggests that all blood cells are derived from a single progenitor stem cell called a pluripotent hematopoietic stem cell / most widely accepted theory | Monophyletic theory |
| Suggests that each of the blood cell lineages is derived from its own unique stem cell | Polyphyletic theory |
| An ideal environment of HSC is the allowance for: | Self renewal / Proliferation / Differentiation / Apoptosis |
| Provide protective and nourishing environment to HSCs | Stromal Cells |
| Stromal Cells: | FALREM 🔥 (FIBROBLASTS, ADIPOCYTES, LYMPHOCYTES, RETICULAR CELLS, ENDOTHELIAL CELLS, MONOCYTES) |
| Hematopoietic Development: begins around 19th Day of embryonic development / formation of primitive erythroblast / embryonic hemoglobin | Mesoblastic Stage / yolk sac |
| Phase of hematopoiesis which begins at 5th to 7th week of gestation / production of megakaryocyte / Hgb F is the predominant Hgb | Hepatic Phase |
| Prior to the fifth month of fetal development, hematopoiesis begins at the bone marrow | Medullary (Myeloid Phase) |
| Embryonic Hemoglobins: | Gower I, Gower II, Portland |
| Gower I (Globin Chain Combination) | 2 Epsilon + 2 Zeta |
| Gower II (Globin Chain Combination) | 2 Alpha + 2 Epsilon |
| Portland (Globin Chain Combination) | 2 Zeta + 2 Gamma |
| Fetal Hemoglobin (Globin Chain Combination) | 2 Alpha + 2 Gamma |
| Adult Hemoglobin Hb A/A¹ (Globin Chain Combination) | 2 Alpha + 2 Beta |
| Then adult red marrow is found only in: | RSVP 🔥 (Ribs, Sternum (Shoulder Blade, Skull, (children), Vertebrae, Pelvic Bone (Proximal end of long bones) |
| Principal source of production in adult | Sternum (other flat bones) |
| Hematopoietically active marrow consisting of the developing blood cells and their progenitors | Red/Active marrow |
| Hematopoietically inactive marrow composed primarily of adipocytes (fat cells) with undifferentiated mesenchymal cells | Yellow/Inactive Marrow |
| 80-90% active marrow in | Newborn |
| 50-60% active marrow in | Adult |
| The process of replacing the active marrow by adipocytes (yellow marrow) during development is called | Retrogression |
| Normal myeloid to erythroid ratio: | 2:1 , 3:1, 4:1 |
| Excluded from the ME ratio | Monocytes and Lymphocytes |
| Normocellular marrow has | 30 to 70% HSCs |
| Tissue basophils | Mast cells |
| Bone forming cells (waterbug or comet appearance) | Osteoclasts |
| Bome resorption or destroying cells | Osteoclasts |
| Most commonly used site for bone marrow smear collection | Posterior iliac crest |
| Ocassional used site for bone marrow smear collection | Sternum |
| Site for bone marrow smear for newborns and infants | Upper end of tibial bone |
| Trephine (Core) Biopsy needles: | Trephine biopsy needle / Jamshidi needle / Westerman-Jensen needle |
| Bone Marrow Aspirate needles: | Aspiration needle / University of Illinois Sternal needle |
| Extramedullary hematopoiesis occurs in: | Liver and Spleen |
| A procedure which requires counting atleast 500, and preferably 1000cells be counted for a marrow differential | Bone Marrow Differential |
| Biggest cell in bone marrow: | Megakaryocyte (0.1-3.0%) |
| Most numerous cells in bone marrow: | Metamyelocyte / Juvenile |
| Two most common erythrocytic maturation stages: | Polychromatophilic and Orthochromatic normoblast (fried egg appearance) |
| Largest lymphoid organ | Spleen |
| Spleen stores ____ % of platelets. | 30% |
| Spleen: contains lymphocytes, macrophage, and dendritic cells (antigen dependent lymphocytosis) | White pulp |
| Cord of billroth, contains specialized macrophages for removal of the senescent RBCs | Red pulp |
| Removal of mature RBC through phagocytosis that leads to eventual degradation of cell organelles / removal of aged/senescent RBCs | Culling |
| Removal of cell inclusions | Pitting |
| Hypersplenism leads to ________. | Pancytopenia (false decrease) |
| Necrosis of spleen due to entrapment of sickled RBCs such as in case of sickle cell anemia | Autosplenectomy |
| The absence of of splenic function (due to either surgical removal or radiation exposure) | Asplenia |
| Splenectomy or Asplenia causes ______. | Pancytosis (false increase) |
| Hematopoeitic stem cell marker (lymphoid and myeloid precursor) | CD 34 |
| Pre CALLA marker | CD 10 |
| Most reliable way to differentiate immature from a mature cell | Chromatin pattern |
| Erythropoietin is manufactured in _____. | Liver and Kidney |
| Erythropoietin is mainly produced in | Peritubular cells of the kidney |
| First morphologically identifiable RBC precursor | Pronormoblast |
| Erythropoietin major stimulant: | Hypoxia |
| NC ratio is 8:1 / earliest recognizable precursor | Pronormoblast / Rubriblast |
| Intense basophilic cytoplasm / NC ratio is 6:1 / nucleoli are usually not visible | Basophilic normoblast / Prorubricyte |
| Last stage capable of mitosis / first stage of hemoglobin synthesis / 3rd precursor stage | Polychromatophilic normoblast / rubricyte |
| Pyknotic nucleus (homogeneous blue black mass) / LAST NUCLEATED STAGE | Orthochromic normoblast / metarubricyte |
| Enveloped extruded nucleus found in metarubricyte | Pyrenocyte |
| Last stage capable of hemoglobin production / fine basophilic reticulum of RNA | Reticulocyte/ Polychromatic erythrocyte or macrocyte/diffusely basophilic erythrocyte |
| Are recognizable on wrightstained blood smears by their larger size and increased blue tint / found on reticulocyte stage | Stress reticulocytes |
| 6-8 um / biconcave disc / 120 +- 20 days | Mature Erythrocytes / Discocytes |
| Rubricyte nucleus pattern | Checkered |
| Rubricyte cytoplasm pattern | Muddy gray |
| Lymphocyte nucleus pattern | Crushed velvet |
| Lymphocyte cytoplasm pattern | Robin's blue |
| Up to ____ erythrocyte produced from a single rubriblast | 16 |
| _____ erythrocytes are produced from a single rubriblast (rodaks) | 8-32 |
| Vit B12 or folic deficiency is seen in _____. | Pernicious anemia (megaloblastic) |
| Nucleus lags behind cytoplasm in maturation | Megaloblastic anemia |
| Cytoplasm lags behind nucleus in maturation | IDA |
| Oval macrocytes are seen in | Pernicious anemia |
| Microcytic, hypochromic RBC are seen in | IDA |
| Macrophages provides iron directly to the normoblast for hemoglobin synthesis | Suckling pig phenomenon |
| RBCs are biconcave and average ____ in volume | 90fl |
| Average surface area of RBC | 140um |
| A normal RBC has increase deformability | TRUE |
| Peripheral/Cytoskeletal protein responsible for increase deformability | Spectrin |
| Decrease in spectrin leads to | having spherocytes/bronze cells |
| Enzyme found in the lipid portion of RBCs: | LCAT |
| 90% anaerobic glycolysis / major energy provider | Embden Meyerhof Pathway |
| Glucose enters the RBC without energy expenditure via the transmembrane protein _____. | GLUT-1 |
| Most common enzyme deficiency in Embden Meyerholf Pathway | Pyruvate Kinase |
| 10% Glycolysis (anaerobic) / provides reduced glutathione (GSH) to prevent oxidative denaturation of hemoglobin | Hexose monophoshate Shunt/ Pentose Phosphate pathway |
| Most common inherited enzyme deficiency and associated with Heinz bodies in Hexose monophosphate pathway | G6PD |
| Converts back methemoglobin back to normal hemoglobin using methemoglobin reductase enzyme (corrective mechanism) / cytochrome B5 reductase / methemogbin reductase pathway | Methemoglobin reductase pathway |
| Involved for reducing ferric iron into ferrous state | Cytochrome B5 reductase / methemoglobin reductase |
| Generates 2,3 DPG that decreases hemoglobin affinity to oxygen | Rapoport Leubering Pathway |
| ODC has ____ shape. | Sigmoid |
| Arterial blood 95% has ______ mmHg. | 95 |
| Venous blood 70% has _____ mmHg. | 40 |
| p50: 26.6mmHg | Demonstration of the relationship between blood pH and oxygen affinity of Hb / presence of Hgb F (increase) and increase in myoglobin |
| Bohr Effect | 90% |
| 90% of RBC Destruction / also known as the macrophage mediated hemolysis | Extravascular Hemolysis |
| ____ mg of urobilinogen are excreted in urine/day | 1-4mg |
| Converts uncojugated bili to conjugated: | UDP-G |
| 10% of RBC destruction / 3H's (Hemoglobinuria,Hemoglobinemia,Hemosiderinuria) | Intravascular hemolysis |
| One gram of hemoglobin can carry ____ of oxygen. | 1.34mL |
| One gram of hemoglobin can carry ____ of Iron. | 3.47mg |
| Adult hemoglobin has _____ dimer of beta chains. | 2 |
| Hgb concentration in children: | 12-15g/dL |
| Hgb concentration in adult male: | 14-18g/dL |
| Hgb concentration in adult female: | 12 to 15g/dL |
| Ferrous iron to pyrole rings ratio: | 4:1 |
| Alpha and Zeta Hgb is found on chromosome | 16 (the rest are found on chromosome 11) |
| 65% hemoglobin synthesis occurs in ______. | immature nRBCs |
| 35% hemoglobin synthesis occurs in ______. | Reticulocytes |
| The most abundant transition metal in the body. | |
| Iron | |
| Normal daily diet contains _____ iron. | 15mg |
| ______ of iron is absorbed in the duodenum and upper jejunum. | 1-2mg |
| Ferrous iron and taken up from the the intestinal lumen into the enterocytes by the iron transport protein _____. | Divalent monotransporter 1 (DMT) |
| Iron maybe stored as ferritin in the enterocytes or exported into the circulation by another iron transport protein, ________. | Ferroportin |
| Major iron transport protein | Transferrin |
| Master regulatory hormone of systemic iron metabolism | Hepcidin |
| Major storage form of iron | Ferritin (soluble) |
| Minor storage form of iron | Hemosiderin (insoluble) |
| Hb A normal reference range | 95-97% |
| Hgb F ref range | 1% |
| Hgb A² ref range | 2% |
| Hemoglobin which has 200x more affinity for CO² | Carboxyhemoglobin |
| Light sensitive and imparts a typical brilliant CHERRY RED COLOR | Carboxyhemoglobin |
| Hemoglobin with ferric iron / chocolate brown discoloration | Methemoglobin / Hemiglobin |
| Irreversible Hgb / green flurochrome / blood is mauve lavender / C. perfringens infection | Sulfhemoglobin |
| Reference method for Hgb | Cyanmethemoglobin / Hemiglobincyanide (HiCN) Method |
| Cyanmeth Hgb rgt: | Modified Drabkin's rgt |
| Cyanmethemoglobin is measured at ______. | 540nm |
| All hemoglobin can be measured except: | Sulfhemoglobin |
| Turbidity of sample in Cyanmethemoglobin det.can cause: | False elevated results |
| Dihydrogen potassium phosphate / allows the solution to be read after | 3 mins |
| Original Drabkin's reagent contains _____. | Sodium Bicarbonate (10-15mins) |
| Converts methemoglobin to cyanmethemoglobin | Potassium cyanide |
| Converts Hgb (w/ferrous iron) to methemoglobin | Potassium ferricyanide |
| Improves lysis of RBCs and decrease turbidity | Non ionic detergent |
| Dilution used for cyanmethemoglobin det. using capillary whole blood: | 1:251 |
| How do you obtain a 1:251 dilution for cyanmethemoglobin det. using capillary blood: | adding 0.2mL (20mL) of blood to 5mL of cyanmethemoglobin rgt |
| Let stand for __ at room temp to allow full conversion of Hgb to cyanmethHgb | 10minutes |
| In standard hemoglobin curve, x axis (abscissa) correlates _____. | Hgb value (g/dL |
| In Standard Hgb curve, Y axis or ordinate correlates _____. | Optical density (absorbance) |
| CuSO4 spe. grav. should be _____. | 1.053 to 1.055 |
| In copper sulfate method, distance between drop of blood and solution is ___. | 1 cm |
| In copper sulfate method, acceptable drop of blood will sink in solution within _____. | 15 seconds if Hgb conc. is > or equal to 12.5 g/dL |
| Copper sulfate method is also known as | Specific Gravity Method |
| Gasometric method is also known as | Van Slyke Oxygen Capacity Method |
| Chemical method is also known as | Kennedy's Wong's |
| Variation of cell size | Anisocytosis |
| Assess anisocytosis | RDW |
| Normal MCV | 80-100fL |
| Normal RBC size | 6-8um |
| RV for RDW | 11.5% to 14.5% |
| Microcytic criteria | RBC size: <6um / MCV: <80fL |
| Macrocytic criteria | size: >8um / MCV: >100fL |
| variation in hemoglobin content | Anisochromia |
| Normal RBCs have central pallor of approx. 1/3 in diameter | Normochromic |
| MCHC NV | 32-36% |
| Variation in rbc shape | Poikilocytosis |
| Polychromasia or polychromatophilic cells are indicative of | Immature/young RBCs / Severe Anemia |
| Seen in abetalipoproteinemia / McLeod Syndrome | Acanthocytes / Spur Cells / Thorn Cells |
| Seen in having exposure to hypertonic solution / anemia associated with renal insuffieciency (uremia) | Echinocyte / Crenated cells / Sea urchin cell / Burr cells |
| Seen in hemoglobinopathies, Thalassemia | Target cell / Codocyte / Mexican Hat Cell |
| Seen in Rh null disease | Stomatocytes / mouth cells |
| Seen in Hereditary elliptocytosis (Leach phenotype) / megaloblastic bone marrow | Elliptocyte / Ovalocytes |
| Schistocytes with hornlike projections | Keratocytes |
| Seen in DIC, microangiopathic hemolytic anemia, TTP | Dacryocytes |
| RBCs fragment at 45°C (normally at 49°C) / severe burns | Pyropoikilocytes |
| Seen in ptx having malaria | Semilunar bodies/ half moon |
| Seen in Sickle cell anemia | Drepanocytes / Sickle cell |
| Holly leaf formation | SC disease |
| Pich cells / triangular shape with 2 central pallor associated in DIC / microangipathia | Knizocytes |
| A thinner variant of codocyte | Leptocyte |
| Remnants of DNA / positive in fuelgen reaction / seen in Megaloblastic anemia | Howell Jolly bodies |
| Blue berry bagel appearance / dark blue granules / precipitation of ribosomes and RNA / seen in Lead Poisoning | Basophilic stipplings / punctuate basophilia |
| Figure of eight / microtubules of mitotic spindle | Cabot Rings |
| Precipitated or denatured Hb / a pitted golf ball / napthalene balls / moth balls / G6PD deficiency | Heinz bodies |
| Resembles basophilic stipplings / unused iron deposits / stains with Perl's Prussian Blue / sideroblastic anemia | Pappenheimer bodies / siderotic granules |
| Requires Brilliant Cresyl blue as a supravital stain | Hgb H |
| Barr of Gold / Clam shell appearance | Hb CC crystal |
| Crystalline fingerlike / quartzlike crystal / washington monument crystal | Hb SC crystals |
| Nucleated RBC that contains non heme iron particles / excessive iron overload / sideroblastic anemia | Ringed Sideroblast |
| Maltese cross appearance | Babesia spp |
| causative agent of Nantucket fever | Babesia microtii |
| Stack of coin pattern of RBC / seen in Multiple Myeloma / Waldenstrom macroglobulinemia / Hyperproteinemia | Primary Atypical pneumonia is also known as |
| Walking pneumonia | causative agent for Primary Atypical pneumonia |
| M. pneumoniae | Clumping of RBC with no pattern / seen in Cold agglutinin disease / primary atypical pneumonia |
Created by:
oddreann
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