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Define Hematology - Correct Answer-The science dealing with the morphology of blood and blood forming tissues and their physiology and pathology. State the difference in types of cells found in peripheral blood and bone marrow. - Correct Answer-The peripheral blood contains mature leukocytes, mature erythrocytes, and mature platelets. The bone marrow contains immature precursor cells and matures cells. Identify the 3 types of cellular elements found normally in peripheral blood - Correct Answer-Leukocytes, erythrocytes and platelets Identify the 6 types of white blood cells found normally in peripheral blood. - Correct Answer- Neutrophils, band neutrophils, eosinophils, basophils, lymphocytes, and monocytes. State the function of each cell found on a normal peripheral blood smear. - Correct Answer-Erythrocyte-transport oxygen and carbon dioxide Platelet-blood clotting Leukocyte-immune defense Identify the anticoagulant used most in hematology. - Correct Answer-EDTA Differentiate between serum and plasma. - Correct Answer-Plasma is the medium of blood in vivo. Serum is non-anticoagulated blood. Coagulation factors I, II, V, VIII, and XIII are not present in serum. Describe three methods of preparing peripheral blood smears. - Correct Answer-Wedge smear, coverslip, and spun smear Describe the characteristics of a well-prepared wedge blood smear and recognize inadequately-prepared smears, and how to correct them. - Correct Answer-2/3-3/4 of smear, straight/even feather edge, at least 2.5 cm long, margins narrower than slide, no streak, waves, clumps, or troughs, gradual transition from thick to thin. Identify zone 1-4 on a peripheral blood smear and the cells that can be examined in zone 1, 2, and 3. - Correct Answer-Zone 1: platelets and WBCs Zone 2: RBC inclusion, platelets, and WBCs Zone 3: All cell types
Identify which anticoagulant cannot be used to make blood smears. - Correct Answer- Heparin, because you get a bluish background. Define Romanowsky stain and list two or three specific types of Romanowsky stains useful in hematology. - Correct Answer-A Romanowsky stain is used to visualize cellular components. There are three components: Methylene Blue, Eosin, and Azure B and oxidation products of methylene blue. Two different types of Romanowsky stains are Wright, Wright-Giemsa Jenner. Describe the principles of differential staining of cellular constituents by the various components of Romanowsky dyes - Correct Answer-There are three components: Methylene Blue, which stains acidic components blue Eosin, which stains the basic components red Azure B and oxidation products of methylene blue, which occur when the stain ages. State the color of the following cellular components with Wright/Giemsa stain: RNA, mitochondria, Golgi, eosinophil granules, basophil granules, neutrophil granules, nucleus. - Correct Answer-RNA-blue/purple Mitochondria-no stain Golgi-no stain eosinophil granule-reddish orange basophil granules-purple Neutrophil granules-purple Nucleus-purple Reference interval Neutrophil - Correct Answer-1.8-7.0 x 10^9/L Reference interval band neutrophil - Correct Answer-0-0.7 x 109/L Reference interval lymphocyte - Correct Answer-1.0-4.8 x 10^9/L Reference interval monocyte - Correct Answer-0.1-0.8 x 10^9/L Reference interval eosinophil - Correct Answer-0-0.4 x 10^9/L Reference interval Basophil - Correct Answer-0-0.2 x 10^9/L RBC (erythrocyte) morphologic Characteristics - Correct Answer-7-8 micrometers, no nucleus, biconcave shape, stain red because of presence of hemglobin Platelet morphologic characteristics - Correct Answer-2-4 micrometers, no nuclei, have reddish purple granules Neutrophil morphologic characteristics - Correct Answer-9-15 micrometers, cytoplasm uniformly sized pale pinkish to lavender granules (fine sand, glassy) Nucleus-dark purple color, heavily clumped, 2-5 lobes (3-4 are normal) attached by a fine filament that has length but no breadth.
State the criteria used for differentiation of a band and segmented neutrophil. - Correct Answer-Seg: filaments visible, nucleus lobed Band: Nucleus is one continuous body Identify and describe two artifacts (torocytes and necrobiotic cells) seen in peripheral smears and the cause for those artifacts. - Correct Answer-Torocyte: punched-out pallor cell caused by too slow drying time. Necrobiotic cells: dead neutrophils caused by old blood that sat in EDTA too long. Hematpoiesis - Correct Answer-formation and development of blood cells. Trabeculae - Correct Answer-bony spicules, pink in color Cords - Correct Answer-Composed of developing blood cells Marrow Sinus - Correct Answer-large thin-walled veins lined with endothelial cells abluminal - Correct Answer-away from the lumen hyperplasia - Correct Answer-increase in the number of cells/proliferation of cells. Adipocyte - Correct Answer-fat cell Stroma - Correct Answer-... Erythroblastic island - Correct Answer-specialized microenvironment compartments within which definitive mammalian erythroblasts proliferate and differentiate list the sites of blood cell production in the developing fetus - Correct Answer-MKsBL2T Mononuclear phagocyte system Kidneys(?) Spleen Bone Marrow Liver Lymph nodes Thymus What is the function of bone marrow? - Correct Answer-Blood cell production in adults Medullary hematopoiesis - Correct Answer-blood cell production in the bone marrow after birth. Normal extramedullary hematopoiesis - Correct Answer-blood cell production in hematopoietic tissue other than bone marrow, which is abnormal
Reference interval ratio of cells to fat in bone marrow in adults - Correct Answer-50/ cells/fat in normal adults composition of red and yellow marrow - Correct Answer-yellow marrow is 100% fat red marrow contains red cell, white cell (myeloid) and platelet precursors Hematopoietic microenvironment - Correct Answer-Environment for the optimal growth, orderly maturation and release of blood cells from the marrow. Conditioning by the spleen - Correct Answer-usually new red cells coming out of bone marrow have too much surface area (target cell), need some of the surface area removed (conditioning) Culling - Correct Answer-senescent or damaged RBCs removed from circulation Pitting - Correct Answer-inclusions or particles within the cell are removed and stay behind without destroying the cells What percentage of platelets are stored in the spleen? - Correct Answer-33% List four red cell changes that occur following post-splenectomy. - Correct Answer- Acanthocytes-RBCs with "club-like" projections. Target cells/codocytes Howell-Jolly bodies (DNA remnants) Pappenheimer Bodies (Iron + protein remneants in mitochondria) Nucleated RBCs Explain the functions of lymph nodes, thymus, and liver as related to blood cell production and/or destruction - Correct Answer-Lymph nodes-Produce T and B lymphocytes after response to antigen Thymus-compartment of maturation of T lymphocytes Liver-filters damaged cells Identify the four cell types found in the mononuclear phagocyte system. - Correct Answer-Monoblasts, promonocytes, monocytes (go into peripheral blood and become macrophages), and macrophages (aid in culling). Explain the methodology and significance of the experiments of till and McCulloch. - Correct Answer-Provided evidence for stem cell existence. Destroy all hematopoietic cells in mice, then inject bone marrow from a healthy mouse. In 8-10 days, colonies of bone marrow cells on spleen. Most only had one cell type. At 14 days, usually more than one cell type. Experiments showed that cells produced in the bone marrow were all derived from the same stem cell (CFU-S).
GM-CSF - Correct Answer-acts on early progenitor cells that can become many different cell lines. Also has actions on mature cells. EARLY-ACTING G-CSF - Correct Answer-in cultures results in granulocyte colonies among other actions. LATER-ACTING M-CSF - Correct Answer-action is primarily to stimulate monocyte/macrophage growth. LATER-ACTING Erythropoietin (EPO) - Correct Answer-acts to produce red cells. LATER-ACTING Thrombopoietin (TPO) - Correct Answer-acts to produce platelets. LATER-ACTING Identify 5 stromal cells that produce the cytokines/growth factors and interleukins. - Correct Answer-macrophages, endothelial cells, fibroblasts, T lymphocytes, adipocytes List 3 examples of negative regulators or hematopoiesis. - Correct Answer-Interferons, TGF-beta (Transforming growth factor), TNF (Tumor necrosis factor)
. Identify components and the functions of stromal cells. - Correct Answer-Stromal cells: Adipocytes, fibroblasts, endothelial cells, T cells and macrophages: Expression of homing receptors, expression of soluble growth and differentiation factors, production of integral membrane proteins that function as juxtacrine regulators (SCF, FL), production of ECM components. Identify extracellular matrix components of the hematopoietic microenvironment. - Correct Answer-Soluble factors (cytokines and growth factors), extracellular matrix (ECM) collagen, glycosaminoglycans (heparan, chondroitin, dermatan-sulfate), cytoadhesion molecules: regulation of hematopoietic stem/progenitor cell differentiation and expansion, structural support, cell-to-cell interactions; localization of growth factors, adhesion of hematopoietic precursors to ECM proteins Define apoptosis and explain its role in human physiology. - Correct Answer-Apoptosis is programmed cell death. It is important in keeping homeostasis. Explain the cell cycle. Explain the processes occurring in each stage. - Correct Answer- G1- Cells increase in size in Gap 1. The G1 checkpoint control mechanism ensures that everything is ready for DNA synthesis. S-DNA replication G2- Cells increase in size in Gap 1. The G1 checkpoint control mechanism ensures that everything is ready for DNA synthesis. M- Cell growth stops at this stage and cellular energy is focused on the orderly division into two daughter cells. A checkpoint in the middle of mitosis (Metaphase Checkpoint) ensures that the cell is ready to complete cell division
State the approximate time spent in each stage of the cell cycle. - Correct Answer-G1- 9hrs S-6hrs G2-3hrs M-1 hr State the DNA ploidy level at each stage of the cell cycle. - Correct Answer-G1-2N S-4N G2-4N M-2N Explain the general morphologic changes that occur in blood cells as they mature in the bone marrow. - Correct Answer-Stem cells differentiating to progenitor cells to maturing cells. Multiplication by mitotic division. Maturation. Release into peripheral blood Define maturation as it applies to cells in bone marrow. - Correct Answer-Immature cells of a cell line are in the bone marrow, whereas mature cells are in the peripheral blood. State the accepted nomenclature for the maturation series of all blood cells. - Correct Answer-Myeloblast, promyelocyte, myelocyte, metamyelocyte Describe 5 general morphologic changes that occur as cells mature from the blast stage to a mature cell. - Correct Answer-Total cell size decreases Nuclear size decreases Chromatin condenses Nucleoli disappear Cytoplasmic volume increases Cytoplasmic color develops Membrane receptors change Erythropoiesis - Correct Answer-Entire process by which erythrocytes are produced in the bone marrow. BFU-E - Correct Answer-Burst-forming unit-erythrocyte; more primitive than the CFU-E, differentiates into CFU-E. colonies develop (14 days), only few EPO receptors so need a lot of EPO. CFU-E - Correct Answer-Colony forming unit-Erythrocyte; more mature than the BFU-E, colonies develop 8 days after BFU-E colony. Many EPO receptors so only need small amount of EPO
Explain the process of release of newly developed erythrocytes from the bone marrow - Correct Answer-They lose their receptors for stromal cells and make their way through the pores in sinuses. Define erythron, state its components and significance and explain its regulation. - Correct Answer-The total mass of circulating red blood cells, their precursors, and the tissues that produce them. Stimulated by hypoxia, regulated by erythropoietin State the average time period for maturation of red cells in the bone marrow and in the peripheral blood - Correct Answer-The reticulocyte matures in the marrow for 2 days and in the peripheral blood for 1 day. State the life span of a mature erythrocyte in the peripheral circulation - Correct Answer- Approximately 100-120 days State the major energy source of the mature red cell - Correct Answer-ATP State the major metabolic pathway by which the mature red cell generates its energy. What are the beginning and end products of this pathway? - Correct Answer-The glycolytic pathway, which begins with glucose and ATP and ends with lactate and ATP
. Name and describe the function of three ancillary pathways associated with the major metabolic pathway of the erythrocyte - Correct Answer-Methemoglobin reductase pathway-keeps hemoglobin in reduced state Rapoport-Leubering pathway-produces 2,3-BPG, which helps hemoglobin release O2 in tissues Hexose monophosphate shunt-produces NADPH shunt. Describe the principle of the methods for measuring the hemoglobin level and hematocrit - Correct Answer-Hemoglobin: Cyanmethemoglobin method: bood + potassium ferricyanide and potassium cyanide=cyanomethemoglobin=color change, measured with spectrophotometer Hematocrit: Blood spun down to separate cells and plasma. Cells packed with as small a volume as possible. Reference intervals for hemoglobin in peripheral blood. - Correct Answer-Male: 14-17. g/dL Female: 12-16 g/dL Reference intervals for hematocrit in peripheral blood - Correct Answer-Male: 0.42-0. L/L Female: 0.36-0.46 L/L Reference intervals for RBC count in peripheral blood - Correct Answer-RBC count
Male: 4.5-5.5 x 10^12/L Female: 4.0-5.0 x 10^12/L List four functions of hemoglobin - Correct Answer-Carries O Carries CO Carries Nitric oxide Buffer for blood pH List the three basic components of hemoglobin - Correct Answer-4 globin chains, 4 heme molecules, 4 Fe 2+ atoms State the number of amino acids in each of the alpha and beta chains of hemoglobin and describe the basic structure of each, including the site at which heme is attached. - Correct Answer-Alpha chains: 141 Beta, gamma, and delta: 146 Heme is attached to Histidine in position 8 in the F segment. Each hemoglobin molecule has 2 pairs of 2 kinds of globin, held together by non- covalent bonds. Unlike chains are closely associated into dimers Describe the pathway of heme synthesis, including the names of first and last enzymes, 1 cofactor and the compounds in steps 1, 2 and the last step - Correct Answer-First step: Glycine + succinyl CoA=Delta-aminolevulinic acid (ALA) Last step: protoporphyrin + iron=heme Enzymes: Delta-aminolevulinic acide synthase (delta ALAS2) and ferrochelatase Coenzyme: pyridoxal phosphate Differentiate the steps in heme synthesis that occur in the mitochondria and the cytoplasm. - Correct Answer-The beginning and the end happen in the mitochondria. The middle part happens in the cytoplasm The final assembly of hemoglobin depends on what? - Correct Answer-adequate iron supply and delivery to erythrocyte precursors in the bone marrow, adequate synthesis of precursors of heme (the porphyrins), adequate globin synthesis. State the chromosomes on which the globin genes are located. - Correct Answer- Chromosome 11 and 16 List in order each of the genes located in the alpha and beta gene clusters. - Correct Answer-Alpha gene cluster chromosome 16: 4 functional alpha genes Beta gene cluster chromosome 11: 2 gamma genes, 1 delta gene, 1 beta gene Identify the types of globin chains present in hemoglobins A, A2, and F. Write the formula for each in shorthand notation. - Correct Answer-A-2 alpha, 2 beta A2-2 alpha, 2 delta F-2 alpha, 2 gamma
List growth factors needed for granulocyte development and identify their sources in general terms - Correct Answer-IL-3, SCF, CSF-G, CSF-GM Myeloblast morphology - Correct Answer-14-20 micrometers in diameter, ~0.9% bone marrow diff, very little cytoplasm, moderate blue, no granules, nucleus-round or slightly oval, occupies most of cell (high N:C) fine chromatin pattern, reddish purple in color, about 2-5 nucleoli promyelocyte morphology - Correct Answer-15-21 micrometers, ~3.3% bone marrow diff. More cytoplasm than myeloblast, pale blue, primary, azurphilic (purple staining) granules. Nucleus-occupies half or more of the cell, oval or round shape, fine chromatin, nucleoli visible. neutrophilic myelocyte morphology - Correct Answer-12-18 micrometers, ~12.7% bone marrow diff. moderate amount of cytoplasm, specific (secondary) granules stain pinkish, nonspecific granules still visible. Nucleus-oval or round, coarser chromatin pattern, no nucleoli in later forms, last stage capable of mitosis Neutrophilic metamyelocyte - Correct Answer-10-18 micrometers in diameter, ~15.9% normal bone marrow diff. cytoplasm moderate to abundant, lots of secondary (pink) granules. Nucleus-indented or kidney-shaped, chromatin pattern is coarse and clumped, no nucleoli. Name two types of neutrophil granules. Name significant components of each type of granule. - Correct Answer-Primary granule: lysosome-myeloperoxidase, muramidase, defensins. Secondary granule-lactoferrin State the significance of neutrophil (leukocyte) alkaline phosphatase - Correct Answer- Used to differentiate chronic myelocytic leukemia from infection or inflammation Name three bone marrow compartments (pools) of granulocyte development. List the stages of development in each compartment - Correct Answer-Stem and progenitor pool Mitotic pool-blast, promyelocyte, myelocyte Post-mitotic pool-maturation and storage compartment-marrow reserve of metamyelocytes, bands and segs Name two pools (compartments) of neutrophils in peripheral blood and state the ratio of numbers of cells in each. - Correct Answer-Circulating and marginating pools and there are the same number of neutrophils in each pool. State the function of neutrophils - Correct Answer-Fight infections
Identify the components of the monocyte stem cell compartment - Correct Answer-the bone marrow Monocyte morphology - Correct Answer-12-20 micrometers, no nucleoli present, clumped chromatin Macrophage morphology - Correct Answer-15-80 micrometers. Nucleus-round, reticular. Cytoplasm-very frayed edges, can have debris in it What are the main functions of monocytes and macrophages? - Correct Answer- phagocytosis inhibit growth of intracellular microorganisms attach to tumor cells and kill them by direct cytolytic effect scavengers ingest activated coagulation proteins ingest antigen/antibody complexes remove toxic substances from blood, macrophages in spleen remove old RBCs initiate and regulate immune response secrete interleukin- release many other substances. Name 6-8 different types of macrophages in the body - Correct Answer-Kupffer cells Microglial cells Langerhans Aveola Spleen macrophages Epitheliod cells Osteoclasts Multinucleated giant cells Name the stem cell for the lymphocyte development - Correct Answer-HSC Describe the maturation sequences of T and B lymphocytes - Correct Answer- Lymphoblast->pro T->pre T->immunoblast->activated T lymphocyte Lymphoblast->pro B->pre B->mature B->plasmacytoid B->plasma cell List the primary lymphoid organs; the secondary lymphoid organs - Correct Answer- Primary-bone marrow and thymus Secondary-lymph nodes, spleen, Gut associated lymphoid tissue (GALT) List and describe 4 morphologic variations of antigen-dependent lymphocytes. - Correct Answer-Immunoblast Reactive lymphocyte Plasma cell Effector T & B cells
