Term
| Identify the smaller cells in the peripheral blood (platelets). Which of the following is the correct description of their development in the BM? |
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Definition
| demarcation and fragmentation of megakaryocyte cytoplasm to produce proplatelets |
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Term
| This is the first stage of the red cell lineage that can be recognized in the BM, what is the cell? |
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Definition
| Proerythroblast (normoblast) - nucleus is immature |
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Term
The synthesis of primary granules occurs in this BM cell. Identify the cell
-what disease states is this imp in? |
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Definition
Promyelocyte
-Granules show up best in this stage
-These granules are imp in two major diseases – AML and bacterial infections (or any reactive condition)
--Acute promyelocytic leukemia with Auer rods – a form of AML
--You WON’T have granules in someone with ALL (acute lymphoblast leukemia)
Histology of promyelocyte – when you see Auer rods, you know it’s AML. You’ll see toxic granulations in neutrophils – these are prominent azurophilic granules in neutrophils |
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Term
| These normal peripheral blood cells leave the blood, migrate, and then differentiate into issue such as the lungs, spleen, and liver. Name the cells. |
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Definition
Monocytes
-They’re in the peripheral blood, have vacuoles in the cytoplasm
-Are called macrophages in the peripheral tissue |
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Term
| See a nRBC in peripheral blood smear. What's the most likely dx? |
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Definition
Severe chronic hemolytic anemia
Bone marrow is stressed |
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Term
| What's the normal life span of a cell with 3-5 lobes? |
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Definition
Neutrophil
6-7 hrs
if it extends beyond acute stage, the chronic inflammatory cells will persist (macrophages, lymphocytes) |
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Term
| This is a BM cell. It is the first cell in the non-mitotic pool for erythroid cells. What is it? |
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Definition
Orthochromatic erythroblast
-It will lose its nucleus to become a reticulocyte, but will still have residual RNA (so a bluish color)
-Will lose its cytoplasm when it goes through the spleen |
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Term
| At what stage do eosinophil granules appear? |
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Definition
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Term
A pt has an inherited chronic hemolytic anemia and these small dense spheroidal red cells in the peripheral blood; polychromasia on the blood smear
-what’s the mechanism?
; and trapped red cells in the spleen. What is the defect in the red cells?
2 possible explanations for spherocytes |
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Definition
i/c production of RBC b/c you have i/c destruction – if you don’t have polychromasia, start looking to see if BM has folate and B12 – hemolytic anemia will have reticulocytes but a deficiency anemia will not!
Acquired: autoimmune disorder. Intrinsic: hereditary spherocytosis
*Cytoskeletal abnormalities involving spectrin* Part of the overall def of hereditary spherocytosis
**spherocytes trapped in the spleen, and the two ways to get spherocytes – inherited (cytoskeletal abnormality) and acquired (autoimmune or something on the surface of the RBC the spleen doesn’t like)** |
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Term
| What is polychromasia associated with? |
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Definition
reticulocytes
hemolytic anemia |
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Term
| In the peripheral blood using routine stains these “large” red cells (colored blue) will show: |
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Definition
Polychromasia
-Large cells, blue reticulated fibers
-A reticulocyte with a special stain
-The spleen will phagocytose this material, and in so doing will take away some of its cytoplasm, cell gets smaller |
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Term
In the WBC diff, what is a metamyelocyte?
What cell precedes the promyelocyte in myeloid maturation? Ddx? |
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Definition
Early myeloid cell
Myeloblast
-has high nuclear/cytoplasmic ratio
-predominate in acute leuk
-will look similar to lymphoblast unless it has granules or rods |
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Term
| What does the myeloid stem cell give rise to? |
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Definition
| basophil, neutrophil, eosinophil, monocyte, megakaryocyte |
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Term
| A patient is asymptomatic and his CBC, Hb electrophoresis, and PBS are normal except for slight hypochromia and microcytosis. He has a normal Hb electrophoresis. He suspects he had Hb Barts at birth, but not now. His diagnosis is? |
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Definition
(remember: Hb Barts is ALPHA THALASSEMIA, d/c alpha chains – in HbF, alpha chains combine with gamma chains – gamma chains will combine to form tetramers)
*Alpha thalassemia*
1, 2, 3, or 4 gene deletion. 1 = silent carrier, 4 = hydrops fatalis
-He has a mild alpha-thalassemia
-Can be confused with iron deficiency
-Will have normal Hb electrophoresis
-Decreased alpha chains so not enough for HbA, A2, and F. So all are decreased
-Hb Barts consists of four gamma chains in alpha thalassemia |
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Term
| What will you see in PBS with bacterial infection? |
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Definition
segmented neutrophils (neutrophilia)
toxic granulations
Dohle bodies |
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Term
| What are Auer rods made of? |
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Definition
| Fused primary (azurophilic) granules |
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Term
Signs of megaloblastic anemia
what is a specific sub-disease? |
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Definition
Hypersegmented neutrophils
Cytopenias
B12, folate deficiency
Macrocytic
Hypercellular BM (d/c fat cells, i/c in all cell lines) - indicating ineffective erythropoiesis
nuclear-cytoplasmic asynchrony
pernicious anemia (no intrinsic factor) |
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Term
| A cell has a very grainy cytoplasm, obscuring the nucleus. What are the major substances in its granules? |
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Definition
Basophilic cell
Histamine, heparin |
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Term
| Why can unconjugated bilirubin deposit in the brains of babies? |
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Definition
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Term
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Definition
denatured Hb
anemias, thalassemias, G6PD deficiency |
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Term
| What do you see initially in PBS after treating pt with iron-def anemia? |
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Definition
| RETICULOCYTES - you don't see polychromasia with iron def anemia initially, but once you give iron you'll see retic initially as BM begins proper production |
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Term
| What do Howell-Jolly bodies indicate? |
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Definition
Spleen is not working properly, or
Spleen can't keep up with production of RBC!
Nuclear fragments, seen in megaloblastic anemia |
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Term
Folate deficiency is associated with:
what's a difference between this condition and thalassemia? |
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Definition
Ineffective erythropoiesis
-hypocellular BM, cells don't develop properly, low retic count
-can be caused by jejunum resection due to Crohn's disease
In thalassemia, you have some ineffective erythropoiesis but some cells get out, so *retic count is still high*f |
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