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74 Cards in this Set

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1.1 Define Hematopoiesis

Production and development of blood cells. This occurs in the bone marrow under the influence of hematopoietic growth factors.

1.2 Sites of hematopoiesis in fetal life, children, adult

Fetal life: Embryonic (yolk sac), Hepatic (extramedullary, spleen, liver)

Children: BM

Adult: BM

1.3 Bone marrow location, composition, function

3.4-4.6% of total body weight

Supplies circulating blood cells

Removes senescent and abnormal cells

Red and Yellow marrow

1.4 Bone marrow cellularity; red and yellow marrow

Red: Hematopoietically active cells

Yellow: fatty inactive cells

100-age for cellularity

Hyper: 90/Hypo: 10

At birth 100%

1.5 Stem cells



Stem cells: non-identifiable

GEMM- multipotential cell granulocyte, erythroid, monocyte megakaryocyte

Colony forming unit: the cell which gives rise to the colony

1.6 M/E ratio

The ratio betwee myeloid/erythroid producing cells

Ratio between all granulocytes and nucleated red cell precursors

1.7 M/E ratio


1.8 Conditions that require bone marrow studies




1.9 Define: Growth factors, CSF; applications in the treatment of hematologic disorders

GF: cytokines (CSF, IL-3, G-CSF, GM-CSF, EPO, M-CSF) stimulate hematopoiesis

CSF: colony stimulating factor

1.10 Hematopoiesis: Stem cell, bm, peripheral blood pools

1. Stem cells- morphologcially non-identifiable, pluripotent/Multipotent cells(GEMM 0.4%)

2. Immature and mature cells; morphologically identifiable cells

3. Adult cells

1.11 Stages of hematopoiesis before and after birth

Before: 1. yolk sac, liver, spleen (extramedullary), BM (intramedullary), Lymph nodes

After: BM (Adults: vertebra, sternum rib)(Children- adult sites +femur and tibia), lymph nodes

1.12 Define Extramedullary and Intramedullary hematopoiesis

Sites of hematopoiesis

E: hepatic stage

I: bone marrow

1.14 The function of RBCs and WBCs

RBC: transport O2 excrete CO2

Granulocytes: Fight infection

Mnoncytes: phagocytosis

Lymphocytes: Immune function

Platelet: maintain hemostasis

1.15 Maturation stages of RBC

Pronormoblast, basophilic normoblast, polychromatophilic normoblast, orthochromic normoblast, Polychromatophilic erythrocyte (reticulocyte), RBC

1.16 Morphological characteristics of red cell in different stages of maturation: Cell size, N/C ratio, nucleus cytoplasm

Pronormoblast 14-19um 6:1, 1-3 nucleoli, chromatin fine

Basophilic Normoblast 12-17um, um 4:1, coarser chromatin, indistinct nucleoli

polychromatophilic normoblast 12-15um 2:1 1:1, condense chromatin

orthochromic normoblast 8-12um, 1:1, chromatin very condense

polychromatophilic 7-10 no nucleus, basophilic

RBC:no nucleus 7-8 um pink

1.17 Erythropoietin what does it do, where is it made?

Growth factor secreted by the kidney; influences the formation and maturation of RBCs by stimulating the stem cells in the bone marrow

2.1 Principle and procedure: Hgb, Hct, and sedimentation (Westergren method)

  • Hgb in g/dL: Cyanmethemoglobin (EDTA) spectrophotometric measurement Drabkins reagent, specific gravity copper sulfate soln
  • Hct: microhematocrit (red/blue band tubes) pack RBC vol, automated dervied from MCVXRBC
  • Sed: tube 30cm long predilute with saline 1hr

2.2 Normal values for Hgb, Hct and sed rate in adults and childern

Sed: <20 mm/h

2.3 Results of Hgb, Hct, and sed rate with disorder

Sed: Non-specific response to tissue damage

2.4 Name hemoglobins measured by cyanmethemoglobin method

Potassium ferricyandie (Drabkins)

methemoglobin-----------------> cyanmethemoglobin

2.5 Rule of three in regard to Hgb/Hct

HgbX3=Hct +/-3%

2.6 Type of blood sample used for routine hematology tests

Purple top EDTA

2.7 Sources of error in Hgb, Hct, Sed rates

Hbg: insoluble rbc, abnormal hgb, lipemic, increase WBC

Hct: dehydration, improperly filled tube, read buffy coat, improperly: centrifuged, mixed or sealed, stopping centrifuge

Sed: viscosity, sickle cell, spherocytes (decrease), rouleaux, sickle cell increase, fibrinogen, poikilocytosis (increase). 2hr old sample, tilt, bubbles, clotted, significant temp change

2.8-9 RBC indices include formula and calculate

MCH: HgbX10/RBC= Mean corpuscular hemoglobin

MCV: HctX10/RBC= mean corpuscular vol

MCHC: HbgX100/Hct= mean corpuscular hemoglobin concentration

2.10 Values for adults and children RBC indices

Adults Children

MCH: 27-31pg 28-34pg

MCV: 80-100fL 95-118fL

MHCH: 32-36% 30-34%

2.11 RBC indices and morphology with anemias

MCV: normo/micro/macrocytic anemia

MCHC: normochromic/hypochromic anemia

2.12 Reticulocytes

Immature RBC in peripheral blood contain remnant cytoplasmic RNA

Assess bone marrow activity

2.13 Appropriate stain for reticulocyte counts

New methylene blue/supervital stain

2.14 Reticulocyte and stage of bone marrow erythropoiesis

>3 effective bone marrow response

2.15 Normal values of reticulocytes for Adults, children and infants

Adult: 0.5-2.0%

Infant: 2.5-6.5%

Children: 0.5-3.1%

2.16 Clinical application of a retic count

Monitoring anemia

2.17 Significance of an decreased or increased Retic count in anemic patient

Reflects the rate of erythropoiesis during anemia

2.18 calculate reticulocyte using a miller disk and 1000 red cell count method

Manual: count 1000, % retic

Miller disk: count 200 RBC in small box, retic in both box

2.19 calculate absolute retic count and RPI

% reticX HCT/45


Maturation time

>3 effective bone marrow response

2.20 RPI and it's clinical application

Monitoring of anemia

2.2a type of stain used for peripheral smear

Wright stain

Eosin-basic components (Hgb)

Methylene blue- acid components (DNA, RNA)

2.3a pH on a slide

High pH- blue/purple alkaline

Low pH- orange acidic

Brown- hemoglobin

3.1 Structural components of a RBC

Peripheral and Integral protiens


Lipids (Hydrophobic/philic)

3.2 Basic chemical composition of the RBC membrane

Lipids: 40%

Proteins: 52%

Carbohydrates: 8%

3.3 Peripheral and Integral proteins

Integral: glycophorin A, B,C, and D, anion pumps

Peripheral: actin, spectrin, protein 4.11, ankyrin

3.4 Function of integral and peripheral proteins

Integral: sialic acid (60% carbs neg charge), ion exchange, RBC antigens

Peripheral: spectrin 75% shape and flexibility; related to integrity of RBCs

3.5 Lipid component of the RBC membrane

Cholesterol (25%) accumulation acanthocytes



3.6 Structural composition of normal hemoglobin

Heme: Fe + protoporphyrin ring

Globin: 2 sets of polypeptides

3.7 Hemoglobin synthesis

Starts and ends in the mitochondria

Starts with delta- amino levulinic acid

3.8 Types and concentrations of normal adult hemoglobin

Oxyhemoglobin and deoxyhemoglobin

95-97% A1 (alpha and beta)

2-3% A2 (delta and alpha)

1-2% HgbF (alpha and gamma)

3.9-10 Abnormal hemoglobin

Carboxyhemoglobin (smoking, CO)- 5%

Methemoglobin (well water, drugs)-1.5%

Suflhemoglobin (sulfa drugs, irreversible)-0.5%

3.11 Hemoglobin function dissociation curve

The amount of oxygen needed to saturate 50% of hgb; depends on the partial pressure of oxygen (pO2)

26-30mmHg: Normal

Increased P50: shift to the right

Decrease P50: shift to the left

3.12 Shift to the left and right

Due to pressure- Increased O affinity with a left shift, Decreased O afffinity with a right shift

3.13 Conditions with a left and right shift

Right: hypoxia, acidosis, anemia, high temps, increase 2,3-DPG, decreased Hgb O2 affinity; increased erythropoiesis, cardiac output

Left: old blood, alkalosis, low body temp, abnormal hemoglobin, increase O2 affinity, decrease 2,3-DPG

3.14. The role of 2,3-DPG in O2 delivery

Helps regulate hemoglobins affinity for oxygen

3.15 Function of normal hemoglobin

transport O2 to tissue

Remove CO2 from tissue

3.16-17 RBC metaboloic pathways

  • Embden-Meyerhoff Anaerobinc pathway- 90% ATP
  • Hexose monophosphate shunt: 10% glu metabolized, reduced glutatfhione, can have G-6-PD deficiency in this pathway
  • Methemoglobin Reductase pathway- reduces methemoglobin
  • Luebering-Rapoport pathway- 2,3-DPG

3.18 RBC life span

120 days

Travel 200-300 miles

3.19 RBC production and destruction rates and sites

Destruction 1% a day in BM

5-10 Intravascular

4.1 Applications of hemocytometer

Platelet and WBC counts

4.2 Steps of using a hemocytometer

Dilute, Load, count, calculate, interpret

4.3 Unopette system: reservoir pipet dilution: WBC Platelet

precalibrated pipet: 20ul/1.98mL diluent 1:100 dilution

4.4 Diluent used in unopette

ammonium oxolate

4.7 Normal WBC, RBC, and platelets in adults and children

WBC adult: 4,800-10,800 mm^3

RBC adult:4.7-6.1X10^6/4.2-5.4X10^6

Platelet adult: 150,000-400,000/uL


RBC: 3.8-5.5X10^6 mm^3

5.1 Three essential parts of examining a peripheral smear

Est of WBC

WBC diff

Morphological evaluation of RBC, WBC, platelets

5.6 WBC estimate, diff count, plt est, evaluation of WBC and RBC morphology

WBC/hpf: 2-4 (4.0-7.0), 4-6 (7-10), 6-10 (10-13), 10-20 (12-18)

Plt est: avg 10 fieldsX 20,000

WBC est: avg 10 fieldsX 2000

Corrected WBC: uncorr. WBC X100/100+nRBC

5.7 The normal values for WBCs In adults, infants and children

Seg N: 50-70%

Band: 2-6%

Eos: 0-4%

Baso: 0-2%

Lymph: 20-44%

Mono: 2-9%

5.8-9 Relative vs. absolute value of WBC type

Relative: % value of various cell types in peripheral blood

Absolute: Based on total WBC of 10.0X10^3mm^3

5.10 What is the criteria for counting more than 100 WBC


High WBC

5.12 Indicate what is examined at 10X, 40x, 100X

10x: overall staining quality

40x: est WBC count

100x: platelet est, WBC diff, RBC and WBC morphology

6.1 Define anemia

decrease competence of blood to carry oxygen to tissue, causing hypoxia; decrease in hemoglobin

6.2 Three physiological causes of anemia

Blood loss

Decrease production or ineffective RBC

Increased RBC destruction

6.3 Body's physiological response to anemia

Increase 2,3-DPG, EPO, cardiac output

6.4 3 morphological classifications of anemia




6.5 Clinical signs and symptoms associated with anemia

Bleeding, Splenic enlargement, lymphadenopathy, organ dysfunction, pallor, dyspnea, lethargy, headache, nausea, decreased appetite, tachycardia, angina pectoris

6.6 RBC indicies and anemia

MCV: cytic

MCHC: chromic

Mod Anemia Hgb 8-10, Hct 24-30%

Severe: Hgb <7, Hct <22

6.8 Routine lab tests and results for anemia

CBC: hgb, hct, indices


BM smear

6.10-11 M/H, M/N, N/N and indices

M/H: IDA, SA, Thalassemias MCV<80fl MCHC <32%

M/N: B12 def, folic acid def, liver disease, malignancies, alcoholism, drugs MCV>100fl MCHC 32-36%

N/N: Intracorpuscular inherited defects/Extracorpuscular acquired immune hemolytic, infections MCV 80-100fL, MCHC 32-36%




14-18/12-16 g/dL



11-16 g/dL