MLS 310 with Ismail El-Amouri
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| Define Iron Deficiency Anemia. | Deficiency of iron due to malabsorption, malnutrition, or blood loss.
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| Define Anemia of Chronic Disease. | Iron will not leave the ferritin stores and cannot get to the RBC precursors. There is a defect in the hepcedin.
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| Define Sideroblastic Anemia. | Iron can leave the ferritin stores but cannot be inserted into the porphyrin ring.
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| Where does the iron accumulate during SA? | In the mitochondria, forming ringed sideroblasts.
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| What is the difference between a sideroblast and a siderocyte? | A sideroblast has a nucleus whereas a siderocyte does not.
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| What are the iron deposits on the ringed sideroblasts called? | Pappenheimer bodies
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| Which stain can stain the iron? | Prussian blue
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| What is the first stage of IDA? | Iron store depletion (exhaustion of iron stores)
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| What are the lab results with stage one IDA? | Normal serum iron
Low serum ferritin
N-sl high TIBC
Normal saturation
NO anemia
RDW elevated
Hgb normal
normocytic, normochromic
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| What is the second stage of IDA? | Iron deficient erythropoiesis (insufficient iron to be inserted into protoporphyrin ring)
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| What are the lab results with stage two IDA? | Low serum iron
Increased TIBC
Low transferrin saturation
No anemia yet
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| What is stage three of IDA? | Iron deficient Anemia
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| What are the lab results of stage three of IDA? | Low Hgb and Hct
Low MCV and MCHC
High RDW
Anemia and hypochromia
Microcytic, hypochromic
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| What is ferritin? | The iron stores
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| What is serum iron? | The amount of iron circulating in the blood
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| What is TIBC? | The amount of iron that is bound to transferrin
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| What is % saturation? | How much iron is saturated on the receptors
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| What is primary megaloblastic anemia? | Nutritional deficiency of B12 or folate
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| How does primary megaloblastic anemia affect DNA? | Leads to impaired DNA synthesis which impairs the nuclear maturation and cell division.
ONLY AFFECTS DNA, NOT RNA
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| What is secondary megaloblastic anemia? | Due to malabsorption conditions such as pernicious anemia.
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| What is pernicious anemia? | Defect in HCL secretion and intrinsic factor.
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| Which cell types does megaloblastic anemia affect? | RBCs, WBCs, and PLTs (pancytopenia)
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| What is nuclear cytoplasm ansynchrony? | Young nucleus, old cytoplasm
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| What is non megaloblastic anemia? | Unrelated to nutritional deficiency. Due to liver disease, alcoholism...etc...
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| What does the intrinsic factor (IF) do? | Absorbs the B12
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| What are some lab findings withe megaloblastic anemia? | Pancytopenia
Macrocytic normochromic
Macro ovalocytes and anisocytosis
HJ bodies
Hypersegmented neutrophils
RPI <2
N:C ansynchrony
Low serum folate/B12
High MMA and homocysteine
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| Why is MMA and homocysteine high in megaloblastic anemia? | Because B12 cannot convert them
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| Why is red cell folate a better indicator of MA? | Because RBCs survive for 120 days
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| What are some lab findings of nonmegaloblastic anemia? | Macrocytes round, not oval
No hypersegmented neutrophils
Normal WBC and PLT count
Normal levels of B12
Normal levels of MMA and homocysteine
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| What are the two types of hemolytic anemia and which one is most common? | Intravascular (within blood vessels) and Extravascular (in the spleen, most common)
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| What are the lab findings with intravascular HA? | Low Hgb, Hct, and RBC count
Schistocytes
High serum bilirubin
High LDH
Low serum haptoglobin
Hemoglobinemia
Hemoglobinuria
Hemosiderinuria
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| What does the serum haptoglobin do? | Carries bilirubin
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| What does hemosiderin do? | Breakdowns the porphyrin ring
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| What are some lab findings with extravascular HA? | Low Hgb, Hct, and RBC count
Spherocytes
High Serum bilirubin
High LDH
Hepatosplenomegaly
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| What is DAT used for? | To seperate HA's into immune mediated (inherited) and non immune mediated (aquired)
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| What membrane proteins are defected with HA? | HS (ankryin and Spectrin)
HE (protein 4.1 and Spectrin)
Hereditary Stomatocytosis
PNH (CD55 and CD59)
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| What enzyme defects are associated with HA? | G6PD and PK
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| What Hgb defects are associated with HA? | Hemoglobinapathies
Thalassemias
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| What is hereditary spherocytosis? | Vertical protein defect. Blood film shows spherocytes and MCHC is high whereas MCV is normal.
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| How do you diagnose HS? | Osmotic fragility test (will be increased) and DAT (will be neg)
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| What is hereditary elliptocytosis? | Horizontal protein defect
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| What is hereditary pyropoikilocytosis? | Severe form of HE
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| Explain the overhydrated form of Hereditary stomatocytosis. | More Na+ in than K+ out. Water rushes in. Uncompensated HA
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| Explain the dehyrdrated form of Hereditary stomatocytosis. | More K+ out than Na+ in. Water rushes out. Well compensated HA.
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| What is PNH? | defect in the GPI anchor for CD55 and CD59 proteins.
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| How do you diagnose PNH? | Sucrose hemolysis test (sugar water)
Ham's test (acid serum test which will activate C')
Flow analysis
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| What is the role of G6PD? | Catalyzes the formation of NADPH that is need to keep glutathione in the reduced state (GSH) to prevent oxidative damage to Hgb
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| What does G6PD deficiency cause? | Impaired generation of GSH -> cellular oxidants accumulate -> Hgb is oxidized to methemoglobin -> Heinz bodies formed and are removed by macrophages of spleen
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| In G6PD, what does the blood film and enzyme assay look like? | Blood film has bite cells, blister cells, and Heinz bodies. Enzyme assay has decreased flourescence.
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| Explain warm antibodies (Warm AIHA). | Mostly extravascular hemolysis via the spleen. Blood film shows spherocytes with a pos DAT
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| Explain cold antibodies (Cold AIHA). | Mostly intravascular hemolysis via C'. Blood film shows red cell agglutination
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| DAT can help you differentiate between which two conditions? | Heriditary spherocytosis (neg DAT) and Warm AIHA (pos DAT)
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| What does DAT and IAT look for? | DAT looks for antibodies whereas IAT looks for alloantibodies
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| What is the substitution for Hgb S? | B6 glu->val
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| What is the substitution for Hgb C? | B6 glu->lys
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| What is the substitution for Hgb E? | B26 glu->lys (microcytic, hypochromic anemia)
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| What is sickle cell trait? | The heterozygous state (SA). Mostly asymptomatic
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| What is sickle cell anemia? | The homozygous state (SS). Symptoms range from mild to severe
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| What causes the cells to sickle? | When oxygen tension decreases (deoxygenated) because Hgb S is soluble.
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| What is vaso-occlusive crisis? | The hallmark of sickle cell anemia. Very intense pain (body biting)
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| Recurrent vaso-occlusive crisis can lead to what? | Organ damage causing autosplenectomy
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| What type of anemia is sickle cell? | Normocytic Normochromic
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| What does the peripheal blood smear show in the homozygous and heterozygous sickle cell. | Hetero is mostly normal with some possible target cells
Homo has target cells, sickled cells, nRBCs, polychromasia and possible HJ bodies and basophilic stippling from autosplenectomy
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| How is sickle cell diagnosed? | Solubility testing and Hgb electrophoresis.
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| What is the downfall to solubility testing? | It is just a screening test, it does not differentiate between trait and disease.
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| What is the reagent used in solubility testing and what does it do? | Sodium dithionite. Removes the O2
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| What is thalassemia? | Inherited disorder caused by a mutation of one or more globin genes leading to decreased or absent synthesis of a structurally normal globin chain.
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| What are the differences between thalassemias and hemoglobinopathies? | Both the same except thalassemia has structurally normal globin chains whereas Hemogloblinopathy has structurally abnormal. Thalassemia is microcytic hypochromic and hemoglobinopathy is normochromic normocytic
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| What is Intermedia alpha thalassemia? | Hgb H disease. No Hgb A, only four beta chains. Pitted golf ball inclusions. --/-a
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| What is Major alpha thalassemia? | Hgb Barts/Hydrops Fetalis. No Hgb A only four gamma chains. Incompatible with life. --/--
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| What is major beta thalassemia? | Homozygous, severe form of HA. Cooley's or Mediterranean anemia. Little or no beta chain sythesis (No Hgb A), mostly are Hgb F
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| What are the differences between Thalassemia and IDA? | Thalassemia has basophilic stippling, IDA does not
IDA has anisocytosis, Thalassemia does not
IDA has abnormal iron studies, Thalassemia does not
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| What is aplastic anemia and give an example? | Stem cell defect. Pancytopenia and hypocellular BM.
EX: Fanconi Anemia
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| What is Pure Red Cell Aplasia and give an example? | Progenitor Cell Defect. Failure to produce erythroid and progenitor cells while leukocytes and platelets are normal.
EX: Diamond Blackfan Syndrome
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| What is myelophthisic anemia? | From a bone marrow replacement
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| List the stages of leukocyte maturation. | Myeloblast: earlist recongnizable form of GM
Promyelocyte: first recognizable of granulocyte
Myelocyte: first commited to three types
Metamyelocyte: first not capable of divison
Band
Seg
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| What is in the mitotic pool? | Myeloblasts, Promyelocytes, and Myelocytes
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| What is in the post mitotic pool? | Metamyelocytes, Bands, and Segs
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| What is in the circulating and marginal neutrophil pools? | 1/2 neutrophils in circulating, 1/2 neutrophils in marginal
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| Neutrophils move into the tissues from which pool? | Marginal
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| What is blastogenesis? | When B and T cells are activated and make fighter/end cells.
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| What are some fighter/end cells? | Reactive lymphs, large granular lymphs, and plasma cells
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| What are dohle bodies and what anomaly is often confused with it? | Laminar precipitates of rough ER (RNA). Confused with May-Hegglin
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| What is toxic granulation and what is often confused with? | Enhanced lysosome enzyme production. Confused with Alder-Reiley
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| What is Chediak Higashi Syndrome? | Defective chemotaxis and phagocytosis causing recurrent infections in children and even death
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| What kind of shape does Pelger-Huet form? | Dumbbell
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| How can you tell when it's just an artifact and not toxic neutrophils? | All cells will be effected
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| What can cause an artifact? | Delay in EDTA or poor staining
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| How do you calculate and absolute count? | Relative count (decimal) x WBC count
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| What is leukomoid reaction? | Benign leukocyte proliferation characterized by high WBC count with many circulating immature WBC precursors (left shift)
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| What is a proto-oncongene? | Good gene
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| What is an oncongene? | Malignant cell
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| What happens if you lose a tumor suppressor gene? | Cell becomes malignant
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| What morphologies could indicate malignancy? | Clustering
Prominent Nucleoli
Multiple Nucleoli
Auer rods (myeloid only)
Clonal morphology
Cytoplasmic fragmentation
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| What is the major difference between acute and chronic leukemias? | Acute has more immature cells whereas chronic has more mature cells
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| What is the biggest difference between the FAB and WHO classification systems of Acute leukemias? | FAB says >30% blasts
WHO says >20% blasts
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| Give the name of M0 | Acute myeloblastic Leukemia without differentiation
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| Give the name of M1 | Acute myeloblastic Leukemia with minimal differentiation
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| How do you differentiate between M0 and M1? | Flow analysis
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| Give the name and translocation of M2. | Acute myeloblastic leukemia with maturation
t(8;21)
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| Give the name and translocation of M3. | Acute promyelocytic leukemia
t(15;17)
DIC and Auer rods
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| Give the name and translocation of M4. | Acute myelomonocytic leukemia.
Inv (16)
M4eo: with eosinophils
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| Give the name and translocation of M5. | Acute monocytic leukemia
t(9;11)
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| Give the name M6. | Acute erythroblastic leukemia
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| Give the name and translocation of M7. | Acute megakaryblastic leukemia
t(1;22)
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| At what age is there a good prognosis for ALL? | 2-8 years
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| What is L1? | Homogenous blasts
Children 2-10
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| What is L2? | Heterogenous blasts
Adolescence and adults
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| What is L3? | Homogenous Large blasts
Children and Adults
AKA: Burkitts type leukemia
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| What are the differences between a lymphoblast and myeloblast? | Lymphoblast is smaller and has scant cytoplasm, dense chromatin, indistinct nucleoli, and NO auer rods
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| What is the importance of immunophenotyping? | To determine whether the leukemia is B or T cell origin. Very important in prgonosis.
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| Which malignancies are normally more agressive: T cell, NK cell, or B cell? | T cells and NK cells are more aggressive than B cells
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| What is the Philadelphia chromosome? | t(9;22)
Associated with CML
Leads to the formation of BCR-ABL fusion gene->P210 protein->increase tyrosine kinase->increase proliferation and apoptosis
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| What is blast crisis? | Nearly all myeloid cells are Ph'+
Patients usually die
Most blast crisis' resemble AML
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| What are the main differences between CML and Leukomoid reaction? | CML has low LAP, RXN has high LAP
CML has eosos and basos, RXN doesn't
CML has Ph' and RXN doesn't
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| What is Polycythemia Vera (PV)? | Have the JAK2 mutation
Overproduction of RBCs, WBCs, and PLT
High Hgb, Hct, RCM
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| What is relative polycythemia? | Low plasma volume due to vomiting or dehydration
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| What is seondary polycythemia? | Increased EPO from renal disease, tissue hypoxia, pulmonary disease, or high O2 affinity Hgb
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| How do you differentiate primary and secondary polycythemia? | Primary has normal O2 and EPO
Secondary has abnormal O2 and EPO
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| What is CLL? | A disease in the elderly. Has a high lymphocyte count with non functional lymphocytes. Mostly a B cell abnormality
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| What is the key morphology with CLL? | Smudge Cells
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| What is Prolymphocytic leukemia (PLL)? | A severe form of CLL
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| Which test is positive in Hairy Cell leukemia? | TRAP positive. Uses tartrate which HCL is resistant to
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| What is the difference between a leukemia and a lymphoma? | Lymphoma is in the tissues and leukemia is in the blood.
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| How do you diagnose Hodgkin Lymphoma? | Presence of Reed Sternberg cells (owl eye cells)
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| What is the translocation in Burkitt's lymphoma (Non hodgkin)? | t(8;14) C-MYC gene rearrangement
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| What are some characteristics of multiple myeloma? | Presence of rouleaux
Bence jones proteinuria (light chains in urine)
M spike in serum electrophoresis
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| What is Sudan Black B? | Stains cellular components containing lipids. Pos for AML, negative for ALL. Differentiates myeloid from lymphoid.
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| What is myeloperoxidase (MPO)? | Sensitive and specific for granulocytes. Differentiates blast of AML (pos) and ALL (neg). Faster than SBB but reagent is carcinogenic
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| What reagent is used in Specific esterase? | Chloroacetate esterase (M4 and M5 pos)
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| What reagent is used in Non Specific esterase? | Alpha-naphthyl esterase (M4 pos)
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| What is Periodic Acid Schiff (PAS)? | Glycogen causes a pos PAS which makes ALL postive and AML negative.
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| What is Terminal deoxynucleotidyl transferase? | Recognized as a marker for B and T primitive lymphs. ALL pos, AML neg (usually)
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