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Normal values: WBC, RBC, Hgb, HCT, MVC, MCH, MCHC, plt
- WBC: ~5-11x10^3/uL
- RBC: ~4.5-6x10^3/uL (f is decr)
- Hgb: ~14-18 g/dL (F is decr)
- HCT: 42-52% (F is decr)
- MVC: 80-94 fL (F is incr)
- MCH: 27-31pg
- MCHC: 32-36%
- Plt: 150-450x10^3/uL
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Heme synthesis (pneumonic)
- Delta-aminolevulenic acid -> porphobilinogen -> uroporphyrinogen -> coproporphyrinogen -> protoporphyrinogen -> heme
- In the DELTA POUR UR COP, PROnTO, a cup of HEME
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Hemoglobins and their chain composition.
- A: α2β2 (normal)
- A2: α2δ2 (normal)
- F: α2Υ2 (normal)
- H: β4 (path)
- Bart's: Υ4 (path)
- S, C, E are β mutations (a2β*2)
- Sexy Valentine
-
Hemoglobin genes on chr11, chr16?
- 11: α (x2), ζ, θ, μ
- 16: β, δ, Υ (x2), ε
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oxygen diss curve left right (simple/area of body)
- left: lungs (increased O2 affinity)
- right: tissues (decreased O2 affinity)
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Large platelet disease
- Bernard Soulier
- May Hegglin (also has Dohle-like bodies)
- myeloproliferative disorders
- "stress plts"
-
nRBC correction fomula
#WBC x100/ 100+#nRBC
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What is the most likely cause of acanthocytes, helmet cells, schistocytes, teardrop cells?
- acanthocytes: abetalipoproteinemia (can't abs fat)
- helmet: hemolysis
- schistocyte: DIC/hemolysis
- teardrop: extramedullary
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What are the inclusions in Howell-Jolly, basophilic stippling, pappenheimer bodies, heinz bodies, cabot rings
- HJ: DNA
- Bas: RNA
- Pappenheimer: iron
- Heinz: denatured hgb (only seen in supravital)
- cabot: mitotic spindle
-
Examining a bone marrow?
- ME ratio: (~3:1)
- Aspirate:
- Romanowsky stain:
- Ratio of cells to fat: (50/50)
- Overall cellularity:
- WBC distribution:
-
Electrophoresis of Hgbs EVERYTHING (Cellulose acetate, Citrate Agar)
- Cellulose Acetate: pH 8.4 / -*CSFA+
- Crawl Slow Fast Accelerate
- A2 C E Of Clubs / Sad Dog Gets Love
- Citrate Agar: pH 6.2 / -FA*SC+
Most migrate with A
-
microcytic, normocytic, and macrocytic anemias
- microcytic: Hypochromic
- heme issues - iron def, sideroblastic, chronic disease
- globin issues - Thalassemia, Hgb E
- normocytic: normochromic
- Ab destruction - HDFN, PCH
- RBC memb defect - sphero, PNH, etc
- enzyme def - G6PD, PK
- decr product - aplastic anemia, liver issue, etc
- Hgb S, C
- external actions - trauma, chemicals, etc
- macrocytic:
- megaloblastic issues - B12, folate, myeloprolif, neoplasms
- liver disease
-
Likely cold agglutinins (2)
- IgM anti-I
- IgG anti-P (PCH, Donath Landsteiner biphasic)
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How do the cells appear and act? Alder Reilly, Chediak Higashi, May Hegglin, Pelger Huet
- AR: large azurophilic granules (PMNs like basos)
- CH: large lysosymes (non fx PMNs)
- MH: Dohle bodies, lg plts (decreased number, same fx)
- PH: hyposeg PMNs (same fx)
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Myelodysplastic vs Myeloproliferative disorders
- myelodysplastic: cytopenia
- refractile anemia
- myeloproliferative: increased cells
- CML, PV, thrombocythemia
-
Phili chrom and PV mutation
- Phili: 9;22
- PV: Jak 2
- Poly loves Jak
-
AML - WHO vs FAB distinction
- WHO: >20% blasts
- FAB: >30% blasts
-
FAB AML classifications major acute cell
- M0-M2: myeloblast
- M3: promyelocyte
- M4: myeloblast/monoblast
- M5: monoblast
- M6: erythrocytic
- M7: megakaryocyte
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Stain purpose - TRAP, Prussian Blue, LAP, Peroxidase, Sudan Black, Specific Esterase, Nonspecific Esterase
- TRAP: Hairy Cell (TRAP the HAIRY beast)
- Prussian: Iron
- LAP: leukamoid rxn (NOT CML)
- Perox/S Black: Myeloid precursors+
- Sp Est: Granulocyte precursors+
- NonSp Est: Monocyte precursors+
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