Hematology Final Review
4 heme molecules and 4 globin chains
A hemoglobin molecule is composed of:
A newborn
A hemoglobin of 19 g/dL is normal which patient?
5% * (25% / 45) = 2.78%
A patient sample had a retic count of 5%. The patient's hematocrit was 25%. Normal hematocrit is 45%. What is the corrected reticulocyte count?
Embden-Meyerhof-Parnas Pathway
ATP is generated in RBC by:
Iron Deficiency
All of the following disorders can lead to macrocytic anemia EXCEPT: Alcoholism Liver disease Hypothyroidism Iron Deficiency
Bone marrow response to anemia
An elevated immature reticulocyte fraction is associated with:
A shift to the left
An increase in metamyelocyte, and promyelocytes can be referred to as:
spectrophotometry
Analysis of hemoglobin concentration is performed via:
Increased in hepcidin
Anemia of chronic inflammation is characterized by:
IgG
Associated class of immunoglobulin is:
Folate acid/Vitamin B12
CBC results on a pregant patient indicate an MCV of 112 fl. What is the next test that needs to be ordered to confirm this MCV value?
Acute leukemia, either myeloid or lymphoblastic
Chronic myelogenous leukemia often progresses to:
IgM, usually anti-I
Cold type AIHA
Chemical messengers that facilitate cross talk between blood cells
Cytokines
Nuclear cytoplasmic asynchrony
Deficiencies in folic acid lead to what condition?
Heinz bodies
Denatured and precipitated hemoglobin, as a result of failure by hexose monophosphate pathway to yield glutathione, causes these RBC inclusions:
7-8 um biconcave disc that lives for 120 days
Describe the general morphology of RBCs and their lifespan
Porphyria
Diseases associated with the production of heme, excluding Fe issues, are called:
Liver
During midfetal life, the primary source of blood cells is the:
Formation, development, and maturation of red blood cells
Erythropoiesis
Cell-mediated phagocytosis of IgM or IgG coated RBCs
Extravascular hemolysis
Splenic macrophages ingest senescent or old cells
Extravascular hemolysis occurs where?
A child
For which patient is a hemoglobin of 10.5 g/dL normal?
Intravascular
Haptoglobin is depleted in which type of hemolysis?
The study of all blood cells, development and maturation, as well as pathologies
Hematology
Development and maturation of blood cells
Hematopoiesis
Protopophyrin IX
Heme is composed of iron and:
An overabundance of oval-shaped red cells
Hereditary Elliptocytosis
A subgroup of common hereditary elliptocytosis seen primarily in blacks, MCV 55-74 fL, many microspherocytes and RBC fragments
Hereditary Pyropoikilocytosis
Can be seen in the genetic hgb defect, thalassemia
Hereditary Stomatocytosis
A permeability disorder, more intracellular sodium, cells dehyrate, MCHC increase
Hereditary Xerocytosis
Defect in the interaction between cell membrane skeleton and the phospholipids bilayer, MCV is normal or slightly decreased, MCH is normal, but MCHC >36%
Hereditary spherocytosis
4
How many molecules of oxygen can one molecule of hemoglobin carry?
stimulating EPO production by the kidney
Hypoxia stimulates RBC production by:
Agglunitaed or clumped up RBCs
If a MCHC result of 40g/dL is discovered in a patient, what is a possible cause?
0.5 - 1.5%
In a non anemic adult, what is the normal range for peripheral blood reticulocytes?
Normocytic, normochromic
In aplastic anemia, red blood cells are usually:
MCV decreased MCH decreased MCHC normal
In iron deficiency anemia, the erythrocytic indices are typically
Lyse RBC in circulation by activation of complement IgM or IgG
Intravascular hemolysis
Hepcidin
Iron intake and distribution is primarily regulated by:
Ferrous
Iron is incorporated into the heme molecule in what forms?
Transferrin
Iron is transported in the plasma via:
usually occurs in newborn infants
Isoimmune hemolytic anemia
anemia of chronic inflammation
Lack of accessible iron is the mechanism for iron deficiency in what disease?
Formation, development, and maturation of white blood cells
Leukopoiesis
Macrocytic non-megaloblastic anemia
Liver disease can cause:
Sezary cells
Mature T cells with cerebriform, clefted nuclei found in the skin and peripheral blood describe:
Left
Methemoglobin will cause a shift of oxygen dissociation curve to the:
Citrate agar electrophoresis
Methods used to separate the variant hemoglobins from normal hemoglobin types include electrophoresis at acidic pH is called:
Potassium is in higher concentration inside the RBC than in the plasma, and sodium is in lower concentration inside the RBC plasma.
Na+, K+ ATPase maintains a concentration of ions in which:
Leukoerythroblastic
Neutrophilia accompanied by immature granulocytes and nucleated red cells is what kind of reaction?
Alpha and Beta
Normal adult hemoglobin A contains which polypeptide chains?
Chediak higashi
Nuclear hyposegmentation and denser than normal chromatin clumping are features of
Sleep
Paroxysmal nocturnal hemoglobinuria episodes are usually associated with:
Complement
Paroxysmal nocturnal hemoglobinuria exhibits sensitivity of one population of red blood cells to:
Anti-vitamin B12 antibodies
Perniscious anemia is a disorder characterized by:
Reticulocytes
Polychromatophilia or polychromasia is a term used to describe the presence of:
Howell Jolly bodies
Remnants of DNA inside an RBC produce which type of inclusion?
A failure to incorporate iron into protoporphyrin IX
Sideroblastic anemia are anemia that results from:
Extravascular
Spherocytes are observed in which type of hemolysis?
Concentrated acids
Standard precautions apply to all of the follwing EXCEPT: Blood CSF Concentrated acids Semen
Acute myeloid leukemia from lymphoblastic leukemia
Sudan black is used to distinguish which types of leukemia?
Permits the accumulation of 2,3 DPG
The Luebering-rapport pathway
NADPH and reduced glutathione
The activity of the hexose monophosphate pathway increases the RBC source of:
Bilirubin
The breakdown products of heme go through several biochemical degradation to form:
Mitochondria
The initial condensation reaction in the synthesis of porphyrin preceding heme formation takes place in the:
Rubriblast - prorubricyte - rubricyte - metarubricyte-reticulocyte
The maturational sequences of an erythrocytes are:
37 C
The optimal temperature of reacticity is:
4 C
The optimal temperature of reactivity for cold AIHA is:
Segmented polymorphonuclear neutrophil
The predominant cell type found in the maturation storage compartment is:
Hemoglobin F
The predominant hemoglobin found in new born is:
An increase in the reticulocyte
The presence of polychromatophilic RBCs on a blood film suggest that there will be:
Yolk sac - liver and spleen - red bone marrow
The progression of erythropoiesis from prenatal life to adulthood is"
0-20%
The reference range of PMN neutrophil count in adult is:
Pluripotential stem cell
The term for the earliest hematopoietic cell is the:
Bacterial infection
Toxic granulation, Dohle bodies, and vacuolization in neutrophils are often found together in:
True
True or False A characteristic associated with Anemia of Chronic Inflammation is impaired release or mobilization of iron.
False
True or False A characteristic of Anemia of Chronic Inflammation is inadequate production of EPO in response to anemia.
False
True or False All blood cells except monocytes arise from the common Myeloid Progenitor cells.
True
True or False Intervascular hemolysis is the result of trauma to RBCs while in the circulation.
False
True or False Mature RBCs are able to synthesize or make lipids.
True.
True or False The reticulum of reticulocytes can only be visualize using supravital stain, such as new methylene blue.
Dohle body like inclusions and thrombocytopenia
What abnormal findings are found in May-Hegglin anomaly?
EDTA in the lavender top
What anticoagulant agent is used most often in the hematology laboratory?
mucopolysaccharide lipids that disrupt cell functions
What are the abnormal cytoplasmic inclusion of chediak higashi?
IgM
What associated class of immunoglobulin is in cold AIHA?
Presence or absence of blood cell inclusions
What can be evaluated only through the microscopic examination of a stained blood film?
Serum is severly decreased and the TIBC is increased
What can be said about serum iron and TIBC in Iron Deficiency Anemia?
Macrophage
What cell is capable of phagocytosis and antigen processing?
t(9;22)
What chromosomal translocation is associated with Chronic myeloid leukemia?
Splenomegaly
What clinical findings specifically suggests extravascular hemolysis?
Colony stimulating cytokines such as interleukins
What directs the mitosis and maturation action of progenitor neutrophil cells in the bone marrow?
Auer rods
What does the myeloperoxidase stain best demonstrate?
Characterized by selective failure of red blood cell production
What is Diamond-Blackfan anemia?
Congenital form of aplastic anemia, low birth weight, skin hyperpigmentation, renal malformations, mental retardation
What is Fanconi anemia?
Anemia = absent MCV = decreased Ferritin = normal
What is characterized by stage 1 iron deficiency?
MCH
What is elevated in megaloblastic anemia?
Decreased WBC count and vitamin B12 levels
What is found in megaloblastic macrocytosis and not in nonmegaloblastic macrocytosis?
Increased serum haptoglobin
What is not associated with hemolytic anemia?
Acute myeloid leukemia
What is not included in chronic myeloproliferative disorders?
Decreased hemoglobin, hematocrit, and red cell count compared with healthy people in the same demographic
What is the best definition of anemia?
Reed sternberg cell
What is the diagnostic cell, found in involved lymph nodes, for hodgkin lymphoma?
>95% Hb A <3.5% Hb A2 1-2% Hb F
What is the distribution of normal hemoglobins in adults?
Inherent problems leading to occasional spurious results
What is the greatest limitation of automated cell counters?
Myelocyte
What is the last granulocyte in the maturation sequence able to undergo mitosis?
myeloblast, promyelocyte, myelocyte, metamyelocyte, band, segmented
What is the maturation sequence for granulocytes starting with the least mature:
chronic blood loss
What is the most common cause of iron deficiency in adult males and postmenopausal females?
acute lymphoblastic
What is the most common leukemia in children between the ages of 2 and 5?
Low WBC with immature neutrophils and toxic changes
What is the prognostic sign for a patient with a bacterial infection?
Low MCV Low MCH Low MCHC
What is the result typical in stage 3 iron deficiency anemia?
Intravascular
What is the site of hemolysis for cold AIHA?
Saline replacement of the lipemic plasma
What is the troubleshooting procedure for lipemic samples that require hemoglobin testing in hematology?
It decreases in repsonse to increased ferritin
What is true about hepcidin?
It enhances the release of oxygen from hemoglobin
What is true for both 2,3 BPG or DPG?
Has a lower affinity for oxygen
What is true of hemoglobin if the oxygen dissociation curve shifts to the right?
Increased osmotic fragility Increased in serum bilirubin Increased reticulocyte count
What laboratory procedures would relfect a typical hemolytic anemia?
WBCs deteriorate and RBCs swell
What occurs if testing is not performed within 24 hours of specimen collection?
B lymphocytes
What particular leukocyte is affected in patients with infectious mononucelosis?
Microcytic hypochromic
What red blood cell morphologies are observed in blood smears of patients with severe iron deficiency anemia?
Basophilic stippling
What red cell inclusions is composed of RNA and stained by wright-giemsa stain and is often found in lead poisoning?
Increased flexibility of the cell membrane
What single feature of the normal RBCs is most responsible for limiting their lifespan?
Hydrodynamic focusing
What technology minimizes the problem of rigid aperture, including protein buildup, coincidence, and a single cell being counted twice?
RDW
What test is used along with the MCV to morphogically classify anemia?
20% blasts in the peripheral blood
What would be an unexpected finding in chronic myelogenous leukemia?
High transferrin
What would point to Iron deficiency anemia as opposed to the anemia of chronic inflammation?
Variation in the shape of RBCs
When anisocytosis is present, what is true about their shape?
Are larger and bluer on wright stain from remnant RNA
When compared with mature erythrocytes, reticulocytes:
As the nucleus to cytoplasmic ratio decrease, the cell is more mature
When trying to determine the maturity of a cell by using the nuclear-cytoplasmic ratio, what is true about the nucleus?
kidney
Where is EPO synthesized?
Red blood cell precursors in the bone marrow
Where is heme produced?
attached to hemoglobin in RBCs
Where is most of the iron found in the body?
OSHA
Which agency is responsible for ensuring safe and healthful working conditions for every US worker?
Lymphocytes
Which cells are normally produced in multiple sites including the bone marrow, thymus, and spleen?
acute myeloid leukemia t(15;17)(q22;q12)
Which form of acute myeloid leukemia is most often associated with disseminated intravascular coagulation (DIC)?
infants and childrens
Which group of patients is most likely to develop iron deficiency from increased needs?
CFU-E
Which of the following is an erythrocyte Progenitor? Pronormoblast Reticulocyte CFU-E Orthochromic normoblast
Neutropenia and suppressed normal immunoglobulin
Why are patients with plasma cell myeloma susceptible to infection?
Total leukocyte count * relative Lymphocytes
absolute lymphocyte count
Rh antibodies are the most frequent cause
warm type autoimmune hemolytic anemia (AIHA)
only cells freely circulating
what pools of leukocytes are included in the typical wbc count?