Hematology Exam 1

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mawilburn
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Hematology Exam 1
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2010-05-14 09:49:58
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  1. What cell types does Myeloperoxidase stain?
    Primary granules containing peroxidase; Promyelocytes, myelocytes, metamyelocytes, PMN/Band
  2. What cell types does Sudan Black stain?
    Primary and Secondary granuls, all granulocyte precursors. Differentation of ALL from AML
  3. What cell types does napthol AS-D Chloroaetate Esterase stain?
    Myeloblast primary granules; to a lesser degree PMN, Basos, and Mast cells; Eos, Monos, and Lymph stain negative.
  4. Alpha-Naphthyl butyrate or Alpha Naphthyl acetate esterase stain which types of cells?
    Monoblasts; monocytes, hisitocytes, macrophages, and megakaryoblasts. Granulocytes stain negative.
  5. TdT or Terminal deoxynucleotidyl transferase stains what cell type?
    • Stem Cells, Immature lymphs in BM, DX Lymphoblastic leukemias
    • Not found in Mature B cells
  6. Acid Phosphatase stains what cell types?
    T-Lymphoblasts
  7. PAS (Periodic Acid-Schiff stains what types of cells?
    Ereythroblasts; glycogen and glycoproteins; DX erthroleukemia
  8. What stains Ereythroblasts?
    PAS, Periodic Acid-Schiff
  9. What stains B- Lymphoblasts?
    TRAP- Acid Phosphatase; good for hairy cell leukemia
  10. What stains B-lymphoblasts?
    TRAP-Tartrate resistant acid phosphatase
  11. What stains T-Lymphoblasts?
    Acid Phosphatase
  12. What stains immature lymphs?
    TdT- Terminal deoxynucleotidyl transferase - DX lymphoblastic leukemias
  13. What stains monoblasts?
    Alpha Napthyl butyrate or Alpha naphthyl acetate esterase, negative for ganulocytes, positive for monoblasts/monocytes/M0/megakaryoblasts
  14. What stain is used for myeloblast primary granules?
    Napthol AS-D Chloroacetate esterase; stainsmyeloblasts, PMN, Basos, and mast cell primary granules; not Eos, Monos, or lymphs
  15. What is used to stain all granulocyte precursors, both primary and secondary granules?
    Sudan Black; differentiates AML from ALL
  16. What stain is used on primary granules that contain peroxidase?
    Myeloperoxidase; MPO, stains promeyelocytes, myelocytes, metamyelocytes and PMN/Band
  17. Hunter's and Hurler's (MPS)
    Mono azurephilic granules, accumulations of vacuoles containing MPS mucopolysaccharides
  18. Tay-Sachs
    Vacuolated lymphocytes; foam cells
  19. Neimann-Pick
    Histiocytes packed with lipids; foam cells and "sea blue histiocytes"
  20. Gaucher's
    Monocyte/M0/Histiocyte have crumpled tissue paper cytoplasm
  21. May-Hegglin anomaly
    Dohle bodies, giant platelets, thrombocytopenia
  22. Chediak-Higashi syndrome
    • Hepatospleenomegaly
    • lymphs and monos have a single red granule
    • Giant gray/green cytoplasmic granules in PMN
  23. Alder's anomaly - Alder-Reilly
    • Coarse dark granules in WBCs (all lines possible)
    • Lipid deposits in cytoplasm
  24. Pelger-Huet anomaly
    • Heterozygoes - dumb-bell nucleus
    • homozygotes - round nucleus
    • "pince nez" cells
  25. M0/Monocyte/Histiocyte have crumpled tissue paper cytoplasm
    Gaucher's
  26. Histiocytes packed with lipids; foam cells present, and can see "sea blue histiocytes"
    Neimann-Pick
  27. Vacuolated lymphocytes; foam cells
    Tay-Sachs
  28. Monos have azurephilic granules and there are MPS accumulations
    Hunter's and Hurler's (MPS)
  29. Pince nez cells
    Pelger-Huet
  30. Coarse dark granules in all WBCs
    Lipid deposits in cytoplasm
    Alder's -Reilly
  31. Giant gray/green cytoplasmic granules
    Lymph and mono have single red granule
    hepatosplenomegaly
    Chediak-Higashi syndrome
  32. Thrombocytopenia
    giant platelets
    dohle bodies in PMN
    May-Hegglin anomaly
  33. If: WBCs too high
    Then dilute, if 3x rule is on, WBCs probably ok
  34. If: Instrument ++++WBCs
    Dilute, rerun, multiply
  35. If: Ictirus/Lipemia
    • Hgb, MCH, MCHC increased and RBC low
    • Then: look at slides, replace plasma with saline and/or notify physisian
  36. If: MCHC, MCH, and Hgb high, and RBC low
    Then: Ictirus or Lipemia
  37. If: Cold Agglutenin
    • Then: Low RBC, High MCV, MCHC
    • Warm to 37 and rerun
  38. If Low RBC, High MCV and MCHC
    Then: Cold agglutenin
  39. If: increased WBC count, and low platelet count
    Then: could be satellite platelets; look at slide, redraw in blue top and multiply result by 1.1 for the 10% dilution
  40. Spleen Functions
    • 1. Hematopoiesis 2-7mo fetal
    • 2. Granulocyte and platelet storage
    • 3. Culling fo old WBCs
    • 4. Processing of Blood Borne pathogens
    • 5. Part of the RES and a lymph organ
  41. MCV
    • Mean Corpuscular Volume
    • 80-100fL, HCT/RBC x10
  42. MCH
    • Mean Corpuscular Hgb
    • 27-31pg
    • Hgb/RBC x10
  43. MCHC
    • Mean Corpuscular Hgb Concentration
    • 32-36%
    • Hgb/HTC x100
  44. RDW
    • RedCell Distribution Width
    • 11.5-14.5%
    • Anisocytosis
  45. Hgb
    • 14-18 Males
    • 12-16 Females
    • g/dL
  46. HCT
    • 42-52% Males
    • 37-47% Females
  47. WBC Normal Numbers
    4-11 x10^9g/L
  48. WBC Diff
    • Segs -50-70
    • Band- 2-6
    • Lymph - 20-44
    • Mono 2-9
    • Eos 0-4
    • Besos 0-2
  49. RBC
    • 4.7-6.1 Males
    • 4.2-5.4 Females
    • x10^12/L
  50. Anemic Color Classification
    • MCHC
    • Normochromic- 32-36%
    • Hypochromic- <32%
  51. Anemic Size Classification
    • MCV
    • Microcytic- <80fL
    • Normocytic- 80-100fL
    • Macrocytic- >100fL
  52. Platelet Count
    • Oil
    • 4-5 Fields
    • x15,000
  53. WBC Diff Count
    • 10x Low
    • Average 5 fields x1000 /4
  54. nRBC Count Adjustment
    • >=10
    • WBC/#nRBCx100
  55. LAP (Leukocyte alkaline phosphatase) Stain
    • Chronic Myeloproliferative Disorders (CMPDs)
    • ---not high in CML
  56. Stain for CMPDs
    LAP (Leukocyte alkaline phosphatase) Stain
  57. CML
    • Phidelphia chromosome; 9:22 translocation
    • Clonal myeloproliferative disorders - Granulocytes
    • Myeloid Leukocytosis- all stages of development
  58. 3 Phases of CML
    • Chronic- huge increased WBC count
    • Accelerated- 6-18mo long
    • Blast Crisis- looks like myelogenous or acute lymphoblastic leukemia
  59. Polycythemia Vera
    • Old people
    • Hypercellular BM
    • Overproduction of mature RBCs and Platelets
    • JAK 2 mutation
    • More sensitive to EPO
  60. PV RBC description
    • Microcytic hypochromic, exhausting of Fe
    • Blood EPO levels are low
  61. PV Diagnosis
    • JAK2 mutation, or other
    • Thromobocytosis > 400,000/uL, WBC>12,000/uL
    • Low serum EPO
    • Treatment: Phlebotomy
  62. AML causes
    Chromosomal translocation
  63. M1
    Myeloblastic -without differentation
  64. M0
    Myeloblastic - minimally differentiated
  65. M2
    Myeloblastic with maturation
  66. M3
    Promyelocytic leukemia
  67. M4
    Myelomonocytic
  68. M5
    Monoblastic
  69. M6
    Erythroleukemia
  70. M7
    Megakaryoblastic
  71. WHO AML Classification
    • I - Cytogenic abnormalities
    • II - Multilineage dysplasia
    • III - Myelodysplastic syndromes (therapy)
    • IV - Not categorized
  72. ALL
    • Acute lymphoblastic leukemia- CD10 abd TdT positive, >100 x 10^9/L
    • Anemia
    • Thrombocytopenia
    • Neutropenia
    • Overpopulation of lymphoblasts - often clefting
  73. Mononucleosis, Cytomegalovirus, Acute Viral Hepatitis
    Increased WBC, Decreased PMN, Increased lymphs, Reactive lymphs on smear
  74. Mononucleosis
    • Reactive T-cells react to infected B-cells
    • EBV infected cells can have thrombocytopenia or anemia due to Ab (IgG IgM)
    • >10% reactive lymphs
  75. CMV
    • Similar to EBV
    • IgG and IgM Ab to CMV Ag
    • Reactive lymphocytes with negative heterophil antibody
  76. Acute Viral Hepatitis
    • Hepatitis Ab findings diagnostic
    • Absolute lymphocytosis and reactive lymphs

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