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152 Cards in this Set

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White Blood Cell

4.4-11.0 X 10^3/mm^3

Mean Red Cell Volume (MCV)

*Ref. range and definition

80.0-96.0 fL

Average size of red blood cells

MCV (fL)= (Hematocrit)/(RBC in millions)

Mean Cell Hemoglobin concentration (MCHC)

*Ref. range, def'n, and equation

33.4-35.5 g/dL

MCHC (or mean corpuscular) average amount of red cell volume occupied by Hgb. COLOR indicator (norma, hypo & hyper chromic)

MCHC= (Hemoglobin)/(Hematocrit) *100

Red cell Distribution Width (RDW)

*Ref. range, def'n, and equation


Amount of red cell size variation

"quantitates anisocytosis (%), meaning variation in size"

Platelet Count (PLT)

150-400 X 10^3/mm^3

Neutrophil %


Bands %


Lymphocyte %


Monocyte %


Eosinophil %


Basophil %


Ave. volume of blood in an adult


Differentiate between:



Hematocrit: % of whole blood volume occupied by RBCs

Hemoglobin: Amount of Hgb in a given volume of RBCs (g/dL). The lower the Hgb, the smaller the RBC size

MCV (fL):




Microcytic: <80 fL

Normacytic: 80-100 fL

Macrocytic: >100 fL


What is the mechanism of action?

Tube type?

Complications with using EDTA on some samples?

Chelates calcium, so it can't clot.

Lav. purple top tube with liquid or powdered EDTA

Some people are "EDTA clumpers" either the platelets clump, or the cells do. This falsely increased WBC and decreases platelet count.

Sodium Citrate:

What is the mechanism of action?

Tube type?

Why does the tube need to be full? Correction value for WBC and PLTs?

Binds calcium

light blue top tube

Ratio of citrate to blood needs to be 1:10

Correction value: multiply by 1.1


Used for ______ _______ _______.


When performing a CBC using a heparin blood sample which values should you report?

*Verdict: good or bad for hematology?

Used for osmotic fragility procedure.

Mechanism- inactivates coagulation factors

Report: WBC, RBC, and Hct.

*causes clumping, not a good sample for CBC, doesn't stain well.

True/False: blood with any amount of macroscopic or microscopic clotting is unsatisfactory.

TRUE: clotting activates and consumes clotting factors and binds cells in the fibrin mesh making any hematology results erroneous.

Define the following QA terms







Accuracy: closest to the correct/actual value

Precision: reproducibility of results

Reliability: precise and accurate over time

Linearity: proportional within a range

Sensitivity: ability to detect true positives

Specificity: ability to detect true negatives

As sensitivity increases, specificity ___________.

As sensitivity increases, specificity decreases.

Which blood collection tube is best for doing a peripheral blood smear?

EDTA sample prepared within 2-3 hrs of collection.

When is the preparation of a buffy coat indicated?

When there is a decreased WBC

What are the basic and acidic components of the Wright-Giemsa stain?

BASIC : methylene blue (attracted to acidic structures such as RNA&DNA) Stains 'em blue. Blue=BASOPHILIC

ACIDIC : Eosin, attracted to basic structure (Hgb in RBC) stains it red.

How do you perform a WBC estimate?

40X high dry objective

Ave # of WBCs per field *2000=approx. total WBC/mm3

How do you perform a platelet estimate?

100X oil objective

Ave. # Plts* 20,000=platelets/mm3

NORMAL: 8-20 plts

What can you add to your slide to avoid creating a smudge artifact?

Albumin, it stabilizes the cell membrane

What is going on inside a pyknotic degenerating cell?

apoptosis, the nuclear material is losing its chromatin pattern

Def'n of anemia

a condition in which there is reduced oxygen delivery to the tissues

causes of anemia

increased RBC loss from RBC destruction or excessive blood loss

decreased production of RBC (erythropoiesis)

decreased RBC function

Def'n hematopoiesis

formation, development and specialization of blood cells

What are the three phases (sites) of hematopoiesis in utero?

1. mesoblastic (yolk sac)

2. hepatic (liver)

3. myeloid (medullary = bone marrow)

At birth, where are blood cells primarily made?

Bone marrow in the vertebrae, sternum, ribs, femur and tibia

When you are older, where are blood cells primarily made?

Bone marrow in the vertebrae

The lymphoid progenitor cells gives rise to:

NK cell, B and T lymphocytes

A normal adult bone marrow displays ____% tissue and _____% fat.

50% tissue

50% fat

What is the largest lymphoid organ


What immunoglobulin is synthesized in the spleen?

What is stored in the spleen?


platelets are stored in the spleen

what is extra-medullary hematopoiesis?

It is blood cell development that happens outside the bone marrow, when the spleen does this it is not normal

What is splenomegaly

enlargement of the spleen

what treatment is advisd when there is an increased RBC destruction and or decreased plts?


What are the liver tissue macrophages called

Kupffer cells- they remove cellular debris

Liver & hematopoietic roles:




the liver

synthesizes proteins and coag factors

stores vitamins and minerals

conjugates and transports bilirubin

hemolytic anemia and RBC dysplasia is characterized by:

increased conjugation of bilirubin

increased storage of iron

enzymatic deficiency that results in accummulation of intermediate products of heme production


problem w/liver, you can't make enzymes

enzymatic deficiency that results in the accumulation of lipids in macrophages

lipid storage disease

liver problem

what is diff about lymph (compared to blood)

lower protein and no RBCs

what are the three main functions of lymph nodes

1. filter particulate matter, debris and bacteria

2. process specific immunoglobulins

3. proliferation of lymphocytes

what organ has the following two jobs?

1. promotes differentiation of progenitor lymphoid cells into T cells

2. holding site for T cells (and also B cells, eosinophils, neutrophils and myeloid cells)


what is the clinical manifestation of not having a thymus develop gestationally

no T cell formation

True/False: adults with thymus disturbance (like an accident) no longer make mature T cells

False, adults maintain a pool of T cells for life

2 types of stem cells:

1. noncommitted or undifferentiated stem cell (pluripotent stem cell)

2. multi potential and committed progenitor cells (lineage specific precursor)

when a monocyte enters a tissue what is it then called?


which cells are capable of self renewal

stem cells, duh.




colony forming units

CFU-L: lymphoid

CFU-GEMM: granulocyte, erthrocyte, monocyte, megakaryocyte (committed to anything BUT a lymph)

which hematopoietic cytokine promotes mast cell (tissue basophil) proliferation?

Kit ligand (KL) or Stem Cell factor (SCF)

which hematopoietic cytokine is particularly effective at very low concentrations?

interleukins (IL)

how is apoptosis initiated

cells don't receive cytokines necessary to PREVENT cell death

what is the first part of the cell to degrade during apoptosis


chromatin condensation


EPO is __________, which induces __________ synthesis and stimulates CFU-E to produce RBCs.

erythropoietin induces hemoglobin synthesis

depends on your kidneys ability to detect hypoxia

EPO also inhibits RBC apoptosis

which cells produced EPO

renal tubular epithelial cells

how are nucleated RBCs formed??

nRBCs are formed from the early release of RBCs from the bone marrow after promotion from EPO... they essentially get kicked out before they were ready

every single one is clinically significant

TPO is ________________, which is a key factor in __________ production.

Where is TPO made?

TPO is thrombopoietin, important for platelet production.

Produced by the liver and kidney

What is the name of the cell type that is right before (lineage) platelet production?


What is the process of hematopoiesis when hypoxia is detected?

hypoxia (due to decreased RBC, decreased O2 in blood or increased tissue O2 needs) detected, kidneys release erythropoietin, EPO stimulates red bone marrow, RBC numbers increase.

If you need more platelets, __________ will prevent the megakaryocytes from dying.


What is the name of the differential cell counter we use?

Clay Adams

What is the most numerous and most common WBC? What is it primarily used for?

neutrophil -> phagocytic cell used for defense against bacteria

increased in #s during bacterial infection, depleted in viral infection

PMN, "poly", "seg":


N/C ratio:

# lobes:

color of cytoplasm:


n/c ratio: 1:1

2-5 distinct nuclear lobes

pink cytoplasm with deep blue-purple chromatin

no nucleoli (RNA, proteins)

What is the name of a slightly immature poly?

Band cell

singular lobe, no segment or filament connections

Which cell type serves to mediate immediate hypersensitivity reactions and destroy helminth larvae and other parasites?




what are nucleoli?

The largest structure in the nucleus of eukaryotic cells, where it primarily serves as the site of ribosome synthesis and assembly.

which type of granulocyte generates histamine and other mediator of the inflammatory response?


which cell has a lot of the same features as a poly, except that it has coarse purple-black non-uniform specific granules?



which cell is the bodies' primary defense adjacent viral infection but are necessary as mediators for virtually EVERY immune response?


B-lymphs- synthesis and excretion of Ab


Cant differentiate on a Wright-stained specimen

which cell often has a smudged nuclear chromatin?



whats the name of an activated T lymph

reactive lymphocyte

features: wandering or ballerina skirt cytoplasm, bluer periphery, coarse nuclear cytoplasm or smudged. 

reactive lymphocyte

features: wandering or ballerina skirt cytoplasm, bluer periphery, coarse nuclear cytoplasm or smudged.

T/F: nRBCs are included in the 100 cell diff


If you count more than 5 nrbcs you must correct the automated WBC. whats the equation?

100*uncorrected WBC/100+nRBC

RBC morphology is always done on what objective


in infants birth to 12 mos of age, what is the primary type of WBC? What is it in adults?

Lyphocyte- up to 61%, their immune systems are still developing. In adults, the most abundant are PMNs.

calculation for absolute value of cell type

Abs value= relative value % * WBC/mm3

N/C ratio:



N/C ratio:

Rubriblast (Pronormoblast)

14-19um, N/C ratio- 4:1

Red-purple finely stippled,granular chromatin, finelace-like

N/C ratio



N/C ratio

Prorubricyte (Basophilic normoblast)

12-15um, N/C ratio - 3:1

Increased granularity ofnuclear chromatin (moredistinct parachromatin)

N/C ratio



N/C ratio

Rubricyte (Polychromatic normoblast(polychromatophilic))

10-15um, N/C ratio - 2:1

Smaller nucleus with increasedcondensation of chromatin,very coarse chromatinpattern(distinct parachromatin)

N/C ratio



N/C ratio

Metarubricyte (Orthochromic normoblast)

8-12um, N/C ratio - 1:1

Smaller nucleus with pyknoticdegeneration, condensedchromatin, no discernibleparachromatin (nucleus is solid)

Lavender/pink cytoplasm

N/C ratio



N/C ratio


7-10um, no nucleus

Clear lavender - pink cytoplasm(polychromatophilic). Lackscentral pallor






Clear pink cytoplasm, centralpallor 1/3 of cell diameter

WBC Variant: The stimulation of granulocytic cells results infewer mitotic divisions. Prevents normaldilution of nonspecific granules.

Leads to ___________ in _____ and _______ cells.

Toxic granulation in PMNs and bands (granulocytes)

Pale blue translucent bodies in the cytoplasm of granulocytes and monocytes:

Dohle bodies

What are Dohle bodies made of?

Remnant RNA (often seen along with toxic granulation/vacuoles and shift to the left.

How many lobes is considered hypersegmented (in neutrophils)?

Segmented neutrophils with six or more nuclear lobes. Cells are often larger than normal. Congenital or megaloblastic change.

What is the opposite of hyper segmentation?

Pelger-Huet anomaly, ALL PMNs will have <3 lobes.

Typically benign, just note it in the diff.

What does pince-nez and Stodtmeister cell refer to?

Pince-nez are two lobed PMNs

Stodtmeister cells are one lobed PMNs

Name for an activated B lymph

Plasmacytoid lymph

Plasmacytoid lymph, with ecentric nucleus that is being pushed to one side by the golgi (which is not visible)

What is this?

What is this?

Neutrophil with a Barr body

Which is an extra X-chromosome

ID the arrow 

ID the arrow

This cell is undergoing apoptosis.. Pyknotic degeneration (necrobiotic)

What kind of protein spans the lipid bilayer (transmembranous)?

example in RBC:


ex: sialic acid - rbc neg chg

What kind of protein may interact with lipids at the membrane surface, but don't penetrate the bilayer?

example in RBC:

Peripheral proteins

ex: spectrin - cytoskeleton (which modulates shape and deformability)

RBC Metabolic Pathway that utilizes Pyruvate kinase (PK) in anaerobic glycolysis.

Embden-Meyerhof pathway

EM path. Net gain of 2 ATP.... glucose metabolism

RBC Metabolic Pathway that utilizes Glucose-6-phosphatedehydrogenase (G6PD) as the major enzyme in aerobic glycolysis.

Hexose Monophosphate Pathway.

OXIDATIVE. Combats oxidative injury to RBC.

RBC Metabolic Pathway that utilizes 2,3-biphosphoglycerate( 2,3-BPG ) as the enzyme for regulating oxygen delivery to tissues...

Rapoport-Luebering Pathway

RBC Metabolic Pathway that utilizes Methemoglobin reductase as the enzyme..

Methemoglobin Reductase pathway.

Maintains hemoglobinin its functionally reduced state ( Fe +2 )

Methemoglobinemia (Fe+3) results in ___________. This condition is often caused by....

Cyanosis because the Met-Hgb can't carry O2, caused by Hereditary Enzyme Defic., toxic substance exposure (oxidizes Hgb) OR Hgb M Disease.

Another name for protoporphyrin IX is ________.

Pyrole ring. 

Heme - ring of carbon, hydrogen and nitrogen
atoms called protoporphyrin IX (or pyrole ring)
with an atom of ferrous (Fe+2) iron inserted.

Pyrole ring.

Heme - ring of carbon, hydrogen and nitrogenatoms called protoporphyrin IX (or pyrole ring)with an atom of ferrous (Fe+2) iron inserted.

Each hemoglobin molecule has _____(#) hemes.

Each hemoglobin molecule has 4 hemes.

Eachhemoglobin moleculehas _______(#) pairs ofpolypeptide chains.Each chain is made upof 141-146 amino acids.

Eachhemoglobin moleculehas two pairs ofpolypeptide chains.Each chain is made upof 141-146 amino acids.

Alpha and beta pairs.

How soon after birth does the ratio of Hgb F and Hgb A slowly reverse to the adult ratio>

6 most of age

What are the three intrauterine Hgb?

Gower 1, Gower 2, and Portland

What molecule is critical for regulating oxygen delivery to tissues?


Controls Hgb affinity for oxygen

What happens when 2,3-BPG binds to oxygenated-hemoglobin?

The hemoglobin unloads its oxygen and is now "deoxygemoglobin"

What happens to the salt bridges in Hgb when it becomes oxygenated?

Salt bridges are broken, beta chains pull together and 2,3-BPG is expelled.

What percentage of oxygen in the Hgb is released to the tissues?


In lungs - pO2 is ~ 100 mm Hg andHgb is almost 100%saturated with O2

(A) As rbc travels totissues the pO2 dropsto ~ 40mm Hg andthe Hgb saturationdrops to ~ 75%.

p50 value is the pO2 at which Hgb is50% saturated withO2 under standard in vitro conditionsof temperature and pH•

Reference range:

P50 = 26-30 mm Hg

What is a shift to the right?

What it is mediated by?

This is a compensatory mechanism (ex. in response to hypoxia). Increases the p50 value = more efficient RBC.

Mediated by increased 2,3-BPG - which decreasesHgb affinity for O2 and increases O2 deliveredto tissues

What is a shift to the left?

This is when the RBC are less efficient at delivering oxygen to tissues, and the p50 value decreases.

Results in increasedO2 affinity anddecreased O2released to tissues

In a shift to the right, how do the following change?


BPG levels


p50 value

pH decreases

BPG, temp and p50 all increase

In a shift to the left, how do the following change?


BPG levels

p50 value

pH increases

BPG, temp and p50 value all decrease

What is oxidized iron?

If you lack Met-Hgb reductase, what does this lead to?

Iron in the ferric (+3) state


Hgb molecule changes and O2
affinity of other heme groups increases resulting
in Shift to the Left.

Iron in the ferric (+3) state

Hgb molecule changes and O2affinity of other heme groups increases resultingin Shift to the Left.

Hgb modified by irreversible oxidation by certaindrugs or chemicals such as sulfonamides.


Ineffective for O2 transport– (100 x less affinity for oxygen)

The binding of carbon monoxide to heme iron results in what modified hemoglobin??

This Hgb has _____x more affinity for CO than 02


Hgb has 200x more affinity for CO than 02

The blood is bright, cherry red

__________ __________ is the Normal Catabolism of Senescent RBCs

Extravascular Hemolysis

Abnormal amount ofvariation in rbc size


Name the associated morphology: Rbc <7um or MCV < 80 fL.

This is an indicator of what kind of problem?

Microcytosis, often accompanied by hypochromasia. Indicator of Hgb production problem.

Name the associated morphology: Rbc >8um or MCV >100 fL.

This is an indicator of what kind of problem?

Macrocytosis, indicates a DNA synthesis problem. Fewer mitotic divisions in mitosis.

Hypochromasia is due to what?

Hypo chromatic cells are also often _____, with an MCHC < ________.

RBCs that lack the normal amount of Hgb. (iron deficiency, thalassemia)

Often microcytic. Often the MCHC <32.

What does the supra vital stain do?

It is useful for viewing and counting reticulocytes.

polychromasia.... diffuse pale blue/gray or lavender (due to remnant RNA) and it picks up more methylene blue stain.

often macrocytic and lack central pallor

variation in RBC shape is called:

Poikilocytosis (POIK)


Caused by:

ovalocytes or elliptocytes (cigar or egghead shaped) Rounded ends.

DUE TO: hereditary, IDA, megaloblastic anemias, thalassemias, myelodyplastic syndromes...


Caused by:

Target cells (codocytes)

increased membrane lipid resulting in increased surface area or decreased Hgb.

Also: liver disease, anemias, IDA, any Hgb abnormalities

This is due to the presence of what?


This is due to the presence of what?

Sickle cells (Drepanocytes) pointed ends "oat shaped"

Due to presence of abnormal Hgb S in decreased O2, tension cells will take a crescent or sickle form.

Crystal Cells form due to....

Crystal Cells form due to....

Due to the condensation of abnormal Hgb C ... often into "washington monument" shaped formations



Due to...

BURR cells (echinocytes)

small, blunt evenly spaced projections.

Due to the change in the tonicity of intravascular fluid.

Also: Uremia, liver disease, burns, anemias, MAHA


Due to:

Acanthocytes, long irregular, spiny uneven projections.

Due to Abnormal membrane lipids, liver disease, abetalipoproteinemia


Schistocytes - fragmented RBCs

Due to DIC, TTP, HUS, Hemolysis, MAHA, AproL (M3)


Due to:

Tear drop (Dacryocytes)

Due to formation from inclusion containing RBCs, myelofibrosis


Due to:


Due to defect in or loss of cell membrane

Usually microcytic, MCHC may be >36 (b/c they are so small, it gives a really high MCHC)


Due to:

Stomatocytes. Central pallor is slit or mouth shaped.

Due to artifact, hereditary (Na/K pumps OR Rh def. syndrome) or liver disease

What is this called, how can you reduce this?

Disease associations...

What is this called, how can you reduce this?

Disease associations...

Rouleax- increased plasma proteins or Igs. Reduce this by using the saline replacement technique.

Multiple myeloma, Waldenstrom's macroglobulinemia.


What is it made of?

Due to:

Howell-Jolly Body. Busy bone marrow,


Due to: hemolytic & megaloblastic anemias, thalassemias, splenectomy


What are they made of?

Due to...

Basophilic stippling of remnant precipitated RNA, reticulocyte (Slightly immature).

Due to: bodies attempt to compensate for blood loss/hemolysis

Course stippling attributed to lead poisoning.


Made of...

Due to...

Pappenheimer bodies. Clustured near periphery, made of granules of iron, ineffective utilization or excess iron.

Due to: sideroblastic anemias, hemochromatosis, hemoglobinopathies, thalassemias


Made of...

Due to...

Cabot ring

No DNA, just the remnant nuclear membrane.


Made of...

Due to...

Heinz bodies. These are not visible with Wright stain. Requires supra vital stain

The bodies are precipitated, denatured Hgb due to oxidative injury.

Due to G6PD deficiency! (think Hexose Monophosphate Pathway)

State the hemoglobins normally found in an adult, the approximate percentage, and globin chain composition of each.

Hgb A: alpha 2, beta 2 (>95%)

Hgb A2: alpha 2, delta 2 (~2%)

Hgb F: alpha 2, gamma 2 (1-2%)

State the predominant hemoglobin in newborns and give its globin chain composition.

Hgb F: alpha 2, gamma 2 (60-90%)

Methemoglobin is....

Iron in the ferric state (Fe+3) can’t bind O2

Seen in presence of oxidants such as nitrites, decreased activity of methemoglobin reductase, or inherited HbM disease (abnormal globin structure)

which RBC inclusion is only visible when stained with a supra vital stain?

Heinz bodies

1. State the length of normal rbc survival incirculation.

120 d