Hematopathology: Disorders of the Formed Blood Elements, Physiology of Blood Components, Pneumonia & Lung Tumor Pathology, Respiratory Pathology, BRS Pathology ALL QUESTIONS

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What can anemia be associated with?

1. Appearance of abnormal hemoglobin 2. Reduced number of RBCs 3. Structural abnormalities of RBCs

What survivor disorders can lead to anemia?

1. Blood loss - hemorrhage (external or internal) 2. Premature RBC destruction (hemolytic anemia)

What may anemia be a consequence of?

1. Decreased hematopoiesis 2. Abnormal hematopoiesis 3. Increased loss or destruction of RBCs

What production disorders can lead to anemia?

1. Hematopoietic Cell Damage (drugs, radiation, infections, toxins) 2. Factor Deficiency (Iron - Heme synthesis, Vitamin B12 - DNA Synthesis, Folate - DNA Synthesis)

What are the anemias of insufficient red cell production?

1. Iron deficiency anemia 2. Vitamin B12 or folic acid deficiency 3. Anemia of chronic disease 4. Primary marrow failure (aplastic anemia) 5. Bone marrow destruction or replacement

What precursor cells are released from the bone marrow?

1. Reticulocytes 2. Band cells

What is the lifespan of a RBC?

120 days

What percentage of the blood volume is fluid and what percentage is packed cells?

45% is pack cells 55% is fluid

What is the protein composition of the plasma?

5% fibrinogen 15% immunoglobulins (gamma) 20% other globulins (beta) 60% albumin

What percentage of the WBCs in the blood are monocytes, lymphocytes, and granulocytes?

5% monocytes 30% lymphocytes 65% granulocytes

What is the composition of plasma?

7% proteins 92% water 1% other

What percentage of the granulocytes in the blood are neutrophils, eosinophils, and basophils?

97% neutrophils 2% eosinophils 1% basophils

Of the cellular components of blood, what percentage is RBC and what percentage is WBC?

99% is RBC while 1% is WBC

What does anemia mean in practice?

<13 g/dL in males and <11.5 g/dL in females

What is hypersplenism?

A condition that results from splenomegaly. Due to the enlarged spleen, RBCs, WBCs, and platelets become sequestered there and destroyed en masse. The spleen becomes engorged and enlarged and pancytopenia occurs.

What is the lifespan of platelets?

A day or two

What can cause bone marrow destruction?

A bone marrow transplant failing or bone marrow being destroyed by cancer

What is the definition of anemia?

A reduction of hemoglobin in the blood to below-normal levels

What is a "blue" RBC?

A reticulocyte - a precursor to a RBC The nucleus is dissolving but it has a blueish tint because it has not dissolved completely

What is the lifespan of lymphocytes and monocytes?

A week or two

What is the lifespan of granulocytes?

About 4 days

What are the normocytic anemias?

Acute bleeding Aplastic Hemolytic Low erythropoietin Malignancy

What is the role of neutrophils?

Acute inflammatory reactions, phagocytosis, digestion of foreign and inflammatory debris

What is the role of eosinophils?

Allergic and anti-parasitic reactions

What is the role of basophils?

Allergic reactions

What other compounds are found in plasma (other than water and proteins)?

Amino acids Glucose Electrolytes Lipids Hormones Vitamins Wastes

What is the target of erythropoietin?

Bone marrow

What is the pathophysiology of iron deficiency anemia?

Brittle, thin, coarsely ridged, and spoon-shaped nails (koilonychia) A red, sore and painful tongue

What is venipuncture?

Collection of blood from a vein It involves tubes with negative pressure which helps suck the blood into them Different tubes have different additives to check for different things

Why do RBCs have little white circles in them on a slide?

That means that the RBC is laying flat on the smear and the light is able to shine through the biconcave discs The ones that you cannot see through are still normal, they just aren't laying flat on the smear

Is it true that women on their period can become anemic?

That's true, women can lose too much blood and require an increase in their iron intake to avoid anemia

How is hemoglobin measured?

Direct measurement (g/dL)

How can drugs trigger hemolytic anemia?

Drugs can have some affinity for surface proteins on RBCs and attack them (toxins, toxicants, etc.)

What things can cause hematopoietic cell damage?

Drugs, radiation, infections, toxins

What are the classic anemia symptoms?

Fatigue Weakness Dyspnea Pallor

What is the iron storage molecule?

Ferritin

How does absorption of heme iron differ from absorption of non-heme iron?

Heme: ~25% absorbed Non-heme: ~1-2%

What is the active protein of RBCs?

Hemoglobin - it allows them to remain in the bloodstream and move oxygen and carbon dioxide around

What is an example of increased loss or destruction of RBCs?

Hemolytic anemia (type 2 mechanism)

What kind of anemia is caused by cyanide poisoning?

Hyperchromic anemia The RBCs are completely saturated with oxygen because the cyanide uncouples the oxygen phosphorylation which is an electron transport process to get oxygen off hemoglobin The body looks red/pink and you die in the presence of too much oxygen

How are anemias distinguished based on hemoglobin content?

Identified by terms that end in -chromic Normochromic Hypochromic Hyperchromic

How do we classify anemia based on size?

Identified by terms that end in -cytic Macrocytic Normocytic Microcytic

What is the role of lymphocytes?

Immune reactions

Where is the highest concentration of ferririn found?

In the bone marrow and the liver, but it is found in all tissues as well

What is iron primarily absorbed?

In the duodenum

What factor deficiencies can cause anemia?

Iron - Heme Synthesis Vitamin B12 - DNA Synthesis Folate - DNA Synthesis

What are the microcytic anemias?

Iron deficiency Hemoglobinopathy Chronic disease Lead poisoning

How does lead poisoning lead to microcytic anemia?

Lead inhibits an enzyme called ferrochelatase which puts iron in the middle of the heme ring. The body compensates by putting in zinc (iron and zinc both have a 2+ valence). Zinc doesn't have the red color and it is smaller. Lead poisoning is also hypochromic

What is the starting point for hematopoiesis?

Low blood oxygen which is detected by the juxtaglomerular cells of the kidney

What are the macrocytic anemias?

Low vitamin B12 Low folate

What organ is responsible for removing RBCs and WBCs from the circulation?

Lymphoid organs like the spleen

How are lymphocytes formed (steps from lymphoid stem cell to lymphocyte)?

Lymphoid stem cell -> Lymphoblast cell -> Prolymphocyte -> Lymphocyte

What is MCH?

Mean cell hemoglobin (HGB divided by RBC)

What is MCHC?

Mean cell hemoglobin concentration (HGB divided by HCT)

What is MCV?

Mean cell volume (HCT divided by RBC)

Does chronic disease tend to give us macrocytic, normocytic, or microcytic anemia?

Microcytic

What cells are derived from a myeloid stem cell? A lymphoid stem cell?

Myeloid - everything except lymphocytes (monocyte, RBC, platelets, neutrophils, eosinophils, basophils) Lymphoid - lymphocytes

How are RBCs formed (steps from myeloid stem cell to RBC)?

Myeloid stem cell -> Erythroblast -> Normoblast -> Reticulocyte -> RBC

How are platelets formed (steps from myeloid stem cell to platelet)?

Myeloid stem cell -> Megakaryoblast -> Megakaryocyte -> Platelets

How are monocytes formed (steps from myeloid stem cell to RBC)?

Myeloid stem cell -> Monoblast -> Promonocyte -> Monocyte

How are basophils formed (steps from myeloid stem cell to basophil)?

Myeloid stem cell -> Myeloblast -> Myelocyte -> Metamyelocyte -> Band cell -> Basophil

How are eosinophils formed (steps from myeloid stem cell to eosinophil)?

Myeloid stem cell -> Myeloblast -> Myelocyte -> Metamyelocyte -> Band cell -> Eosinophil

How are neutrophils formed (steps from myeloid stem cell to neutrophil)?

Myeloid stem cell -> Myeloblast -> Myelocyte -> Metamyelocyte -> Band cell -> Neutrophil

Are granulocytes active in the vascular system?

No, they are inert and not active until you have some type of inflammation. They can become active during septicemia because there are bacteria in the vasculature (maybe activated by PAMP receptors)

Are bones dry?

No, they are very well vascularized so anything in the blood can affect the RBC production

What is the most difficult anemia to distinguish?

Normocytic anemia The slide tells you nothing about what is going on because the RBCs are all completely normal

What would a blood smear look like in a patient with hypersplenism?

Normocytic, normochromic All of the RBCs are fine but they are trapped in the spleen

What are the types of iron deficiency anemia?

Nutritional iron deficiency - not eating enough iron Metabolic or functional deficiency - like lead poisoning where the ability to insert iron is inhibited, or genetic deficiencies

When do we use MCHC?

Only used in weird blood disorders Tells us the relationship between hemoglobin and hematocrit

How do you measure hematocrit (Hct)?

Packed RBC volume (PV) - manual "spun" hematocrit (%) Automated counters calculate based on RBC number and size

What is the role of monocytes?

Phagocytosis, immune reactions

What is the physiologic manifestation of anemia?

Reduced oxygen carrying capacity

What is an example of abnormal hematopoiesis?

Sickle cell anemia, thalassemia

What is koilonychia?

Spoon shaped nails often seen in iron-deficiency anemia

Why is there usually a backup or RBCs in the bone marrow?

The RBCs exist for quite some time so we don't always need to be releasing a ton from the bone marrow

Why is tachycardia a compensation mechanism of anemia?

The heart races because the heart thinks that it isn't getting the RBCs to the tissues fast enough so it speeds up to try to fix the problem.

What happens to your RBCs if you have to have your spleen removed?

The liver will take over its job of removing old RBCs and WBCs from circulation. The hepatocytes are very busy cells and they can manage if they need to do an additional task

What is a RBC count?

The number of RBCs per uL of blood

What is hematocrit?

The percentage of blood volume taken up by pack RBCs

If a person has a high WBC count, what does that mean?

The person might have a bacterial infection

What does MCV tell us?

The size of the RBC Whether they are normal, too big, or too little

Does most of hematopoiesis happen in the soft bones or the long bones?

The soft bones

Are blood samples usually venous blood or arterial blood?

They are usually venous blood. We don't really test arteriole blood anymore because we can just get oxygenation information from skin tests now

Why are most things absorbed in the first 2-3 meters of the intestines?

This is where the highest concentration gradient is located because everything has just left the stomach

What is the iron transport protein?

Transferrin

What is the role of albumin?

Transport, plasma osmotic pressure

What is the role of beta globulins?

Transport, reactant proteins

What does the top of venipuncture tubes tell you?

What additives are inside of the tube Ex. Lavender - EDTA Green - heparin

Which is bigger: WBCs or RBCs?

WBCs are always bigger than RBCs

What are you looking for with a healthy bone marrow sample?

We want to see lots of cells growing in the sample. They should be purple/blue because there is a lot of basophilia - nuclei in the precursor cells. Pink fragments are just bone pieces - that is normal

What is an internal hemorrhage?

When you are bleeding inside your body. You can't see the blood but blood is still escaping your vasculature and getting to where it shouldn't be

Do immature RBCs have nuclei?

Yes, the precursor cells (erythroblasts, normoblasts) DO Have a nuclei so that can be affected by pathophysiology that impacts the ability of cells to divide

Why is tachypnea a compensation mechanism of anemia?

You aren't getting enough oxygen to the tissues and the body doesn't know it is because of the reduced RBCs so it thinks that you aren't breathing enough. You start breathing shorter and faster to compensation

Why wouldn't you want to use a venipuncture tube with sodium fluoride if you were checking the sodium levels in your patient?

You wouldn't be able to tell if the sodium came from the tube or from the blood

What is hematopoiesis?

formation of blood cells (RBC and WBC)

What is the most common type of anemia?

iron deficiency anemia

What WBCs are granulocytes?

neutrophils, eosinophils, basophils

What is erythropoiesis?

production of RBCs

What is TIBC?

total iron binding capacity fully saturated transferrin

How much iron does your body lose per day?

~1-2 mg/day due to epithelial cell shedding


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