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PHRM 3520: Hematology Exam Study Guide
direct precursor of red blood cells - ANSWER reticulocyte lifespan of RBCs - ANSWER 120 days RBC count - ANSWER number of red corpuscles/volume Hgb - ANSWER hemoglobin - amount of metalloporphyrin-protein/volume direct indication of O2 transport capacity Hct - ANSWER hematocrit - % volume of blood composed of erythrocytes (packed cell volume) ~3x value of Hgb MCV - ANSWER mean corpuscular volume - average volume of RBC 80-96 fL/cell MCH - ANSWER mean corpuscular hemoglobin - average weight of Hgb in RBC (O carrying capacity) 27-33 pg/cell MCHC - ANSWER average concentration of Hgb in RBC volume (Hgb/volume); direct index of O2 carrying capacity of blood 33.4-35.5g/dL Which test categorizes RBCs by volume and classifies anemias? - ANSWER MCV normocytic - ANSWER normal sized cells MCV 80-100 fL microcytic - ANSWER smaller than normal cells MCV <80 fL macrocytic - ANSWER larger than normal cells MCV >100 fL
RDW - ANSWER RBC distribution width anisocytosis - RBCs with different sizes hyperchromic - ANSWER too much hemoglobin in RBC MCH >31 pg/cell normochromic - ANSWER normal amount of hemoglobin in RBC MCH 27-31 pg/cell hypochromic - ANSWER too little hemoglobin in RBC MCH <27 pg/cell microcytic hypochromic anemia - ANSWER small RBC, large central pallor, decreased hemoglobin decreased MCHC macrocytic normochromic anemia - ANSWER large RBCs, normal central pallor, normal Hgb normal MCHC microcytic hyperchromic anemia - ANSWER small RBCs, abnormal/no central pallor, increased Hgb increased MCHC reticulocyte count - ANSWER reflects bone marrow production of immature, non nucleated RBCs released in peripheral blood from bone marrow increased with blood loss of hemolysis effective measure of erythropoietic activity ESR - ANSWER erythrocyte sedimentation rate high sensitivity and low specificity male: 1-15 mm/hr female: 1-20 mm/hr
weakness hyperreflexia ataxia poor coordination neuropsychiatric changes accumulation of methylmalonic acid (MMA) takes years to develop homocysteine accumulation megaloblast - ANSWER immature RBC with large nuclei folic acid - ANSWER 50 mcg/day from green, leafy vegetables (20%) and GI microbes (80%) used for DNA synthesis aka pteroylglutamic acid, vitamin B folic acid deficiency causes - ANSWER increased requirements decreased intake/absorption loss during hemodialysis drugs interfering with metabolism genetic disorders folic acid deficiency symptoms - ANSWER macrocytic megaloblastic anemia weakness, fatigue, pallor, malnutrition develops over weeks to months
homocysteine accumulation How do you differentiate between vitamin B12 and folate deficiency when one or both are borderline low? - ANSWER check MMA and homocysteine both normal - exclude deficiencies increased MMA and homocysteine - B12 deficiency normal MMA, increased homocysteine - folate deficiency microcytic anemia causes - ANSWER iron deficiency (sometimes chronic disease or thalassemia) iron requirements - ANSWER 20-25 mg/day for erythropoiesis mostly obtained via recycling metabolized Hgb 5% absorbed via fecal/urinary excretion, sweat, desquamated skin causes of iron deficiency - ANSWER pregnancy blood loss peptic ulcer disease gastritis inflammatory bowel disease lead poisoning symptoms of iron deficiency - ANSWER microcytic hypochromic anemia weakness
hemolytic anemia labs - ANSWER increased lactate dehydrogenase (LDH) decreased haptoglobin hemolytic anemia causes - ANSWER metabolic disorders (G6PD deficiency) Hgb abnormalities (sickle cell, thalassemia) membrane abnormalities (spherocytosis) acquired from immunological, chemical, or physical damage to RBC (autoimmune hemolytic anemia) can lead to poikilocytosis poikilocytosis - ANSWER irregularly shaped blood cells can result from hemolytic anemia normal Hgb structure - ANSWER 2 alpha subunits 2 beta subunits sickle cell Hgb structure - ANSWER valine is substituted for glutamine on beta chain if one beta mutated - sickle cell trait if both betas mutated - sickle cell disease thalassemia - ANSWER deficiency in Hgb subunits cause of microcytic and hemolytic anemias
cells involved in innate immunity - ANSWER basophil neutrophil eosinophil monocyte cells involved in adaptive immunity - ANSWER natural killer cells T lymphocytes B lymphocytes 5 types of mature WBCs - ANSWER granular: neutrophil, eosinophil, basophil granular: monocyte, lymphocyte WBC count - ANSWER total number of white blood cells 4.4-11.3 x 10^3 cells/microliter PMN count - ANSWER 1800-7800 per micoliter 45-73% of WBC count band neutrophil count - ANSWER 0-700 per microliter 3-5% of WBC count lymphocyte count - ANSWER 1000-4800 per microliter 20-40% of WBC count
"left shift" - ANSWER leukocytosis secondary to neutrophilic especially with increase in bands (immature neutrophils with crescent nuclei) eosinophil - ANSWER phagocyte best for parasites present in intestinal mucosa and lungs When do eosinophils increase? - ANSWER parasitic infections allergies asthma medications (ACE inhibitors, antimicrobials) When do eosinophils decrease? - ANSWER acute infection basophil - ANSWER most long lasting granulocyte (14 days) contain heparin, histamine, leukotriene involved in hypersensitivity reactions When do basophils increase? - ANSWER chronic inflammation leukemia monocytes - ANSWER circulate for 16-36h then enter tissues and become macrophages attack foreign cells, destroy old RBCs, proteins, and lipids become APCs (dendritic cells) to direct lymphocytes
When do monocytes increase? - ANSWER autoimmune diseases chronic bacterial infections protozoal infections leukemia lymphocytes - ANSWER B cells, T cells, and NK cells less granular, more specific When do lymphocytes increase? - ANSWER most bacterial and viral infections malignancies (multiple myeloma) When do lymphocytes decrease? - ANSWER burns trauma HIV malignancies (lymphoma) corticosteroids aplastic anemia CD4 - ANSWER helper T cells secrete cytokines to regulate other immune cells HIV binds to CD4 receptor and destroys helper T cells CD8 - ANSWER cytotoxic T cells
heat conservation (vasoconstriction) and heat production (shivering, thermogenesis) causes of fever - ANSWER pyrogens pyrogenic drugs autoimmune and auto inflammatory disease drug fever impaired in older adults
