What is the principle of electronic impedence?

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What is the principle of optical scatter?

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What is the principle of flow cytometry?

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Cells in single file are moved through a "flow cell" and past a laser.  Optical signals are generated and different populations of cells are seen and separated.

What tests in a CBC are affected by a cold agglutinin and how are they affected?

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RBC count is decreased

MCV is increased

MCHC is increased

What do you do when you have a cold agglutinin and you need to run a CBC?

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Warm the sample to 37º C and repeat the test

What tests are affected by lipemic specimens and how are they affected?

Hemoglobin is increased

MCH is increased

MCHC is increased

What do you do if you have a lipemic specimen and you need to run a CBC?

Perform a saline replacement and repeat

What test would giant platelets or platelet clumps interfere with on automated cell counters?

Would increase the white blood cell count due to the analyzer confusing platelets with WBCs.  Platelet clumps would also decrease automated platelet count.

A platelet estimate was performed on a blood smear and 150 platelets were counted on 10 fields.  What is the platelet estimate?

300 x 10^9/L

Calculation: 150/10= 15

15 x 20,000= 300,000

What cell is this and what is its associated disease state(s)?

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Target cell or codocyte

Most often seen in iron deficiency anemia but also seen in obstructive liver disease, thalassemia, sickle-cell disease and Hemoglobin SC disease.

What cell is this and what is its associated disease state(s)?

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Spherocytes

Caused by RBC membrane defect.

These cells are seen in Hereditary spherocytosis and hemolytic anemias.

What cell is this and what is its associated disease state(s)?

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Sickle cell

Seen in sickle cell anemia and Hgb SC disease

What cell is this and what is its associated disease state(s)?

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Ovalocyte or elliptocyte

This cell is seen in hereditary elliptocytosis, iron deficiency, megaloblastic anemia, and thalassemia

What cell is this and what is its associated disease state(s)?

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Macrocyte

Large cells- MCV >100 fL

Severe anemia, liver disease, megaloblastic anemia, B12 or folate deficiency, and hemolytic anemia.

What cell is this and what is its associated disease state(s)?

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Helmet cells or keratocytes

Seen in TTP, DIC, HUS and MAHA

What cell is this and what is its associated disease state(s)?

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Teardrop cell or dacryocytes

These cells are seen in myelofibrosis, myelopthisic anemia and megaloblastic anemia.

What cell is this and what is its associated disease state(s)?

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Stomatocytes

These cells are seen in hereditary stomatocytosis, obstructive liver disease, alcoholism and cirrhosis

What cell is this and what is its associated disease state(s)?

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Schistocyte

RBC fragment

This cell is seen in TTP, DIC, HUS, MAHA, carcinoma, severe burns or March hemoglobinuria

Name that cell:

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Myeloblast

Name that cell:

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Atypical Lymphocyte

Name that cell:

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Basophil

Name that cell:

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Plasma cell

Name these cells:

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Erythroblasts

(note the size next to the mature RBC)

Name that cell:

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Metamyelocyte

Name that cell:

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Nucleated Red Blood Cell

Name that cell:

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Myelocyte

Name this inclusion:

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Dohle Bodies

Name that inclusion and the disease(s) associated with it:

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Howell-Jolly bodies

Seen in Megaloblastic anemia

Name that inclusion and the disease(s) associated with it:

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Heinz bodies

Seen in G6PD deficiency and other hereditary hemolytic anemias

Name that inclusion and the disease(s) associated with it:

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Cabot ring

Seen in pernicious anemia, lead intoxication and Hb H disease

Name that inclusion and the disease(s) associated with it:

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Pappenheimer bodies - siderotic granules

Seen in sideroblastic anemia, hemolytic anemia and sickle cell disease.

Name that inclusion and the disease(s) associated with it:

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Hemoglobin C Crystal

Seen in hemoglobin C disease

This is an autosomal dominant disorder that presents with Dohle bodies in neutrophils, giant platelets with decreased function and shortened life span and usually thrombocytopenia.

May-Hegglin Anomaly

This is a disorder, primarily of children, with the sudden onset of bruising, petechiae, thrombocytopenia and sometimes mucosal bleeding in previously healthy children.  Symptoms follow a viral infection or live vaccine injection.

Immune Thrombocytopenic Purpura (ITP)

This immunologic disorder is characterized by thrombocytopenia caused by the ingestion of certain drugs such as quinidine and sulfonamide derivatives.

Immunologic Drug-Induced Thrombocytopenia

What disorder  develops when a mother lacks a platelet-specific antigen that her fetus has inherited from the father?  The mother develops antibodies against the fetus platelets resulting in thrombocytopenia.

Neonatal Alloimmune Thrombocytopenia

This disorder is predominantly in children but can also occur in adults.  Thrombocytopenia and anemia follow a Shigella or E. Coli O157:H7 infection.  Can result in permanent kidney damage.

Hemolytic Uremic Syndrome (HUS)

This disorder is a common destructive thrombocytopenia.  The coagulation cascade is activated for different reasons and platelets and coagulation factors go into overdrive and are consumed.  PT and PTT are prolonged.  FDP and D-dimer are found in the blood stream. 

Disseminated Intravascular Coagulation (DIC)

This disorder is characterized by thrombocytosis with platelet counts higher than 1 million/uL and uncontrolled proliferation of megakaryoctes.

Essential Thrombocythemia (ET)

This rare platelet adhesion disorder begins in infancy or childhood that is characterized by giant platelets, thrombocytopenia, prolonged bleeding time, and decreased platelet survival. 

Bernard -Soulier (Giant Platelet) Syndrome

This disorder is extremely rare in which the platelets lack glycoprotein IIb/IIIa. No fibrinogen bridging can occur, and bleeding time is significantly prolonged.

Glanzmann's Thrombasthenia

Von Willebrand disease

This genetic X-linked disorder is also known as Factor VIII deficiency that is characterized by internal or external bleeding episodes that are prolonged.  PTT is increased, PT and thrombin time are normal. 

Hemophilia A

This is a X-linked genetic disorder also known as factor IX deficiency or Christmas disease.  Symptoms include deep internal bleeding or external bleeding episodes that are prolonged.  PTT is increased, PT is normal.

Autosomal dominant neutrophil disorder characterized by skeletal abnormalities such as short stature and short upper limbs.  The neutrophils present with the characteristic hyposegmentation with "pince-nez" formation.

Pelger-Huet Anomaly

This is a rare autosomal recessive disorder that arises from a microtubule polymerization defect which leads to a decrease in phagocytosis.  Decrease in phagocytosis results in partial albinism and peripheral neuropathy.  WBCs and platelets have very large granules.

Chediak-Higashi Syndrome

t(9;22)(q34;q11.2) on genes BCR/ABL1

Chronic Myelocytic Leukemia (CML)

What is a Myelodysplastic Syndrome?

Primary neoplastic stem cell disorder characterized by dysplasia or abnormal development of 2 or more cell lines.  Usually develops into a leukemia.

What describes the WHO classification of refractory anemia? (RA)

<1% Blasts in Peripheral Blood

<5% Blasts in Bone Marrow

<15% Ringed sideroblasts

What describes the WHO classification of refractory anemia with ringed sideroblasts?

<1% Blasts in peripheral blood

<5% Blasts in bone marrow

> or = 15% Ringed sideroblasts

What describes the WHO classification of Refractory cytopenia with multilineage dysplasia?

<1% Blasts in PB, no auer rods

<5% Blasts in BM, no auer rods

<15% Ringed sideroblasts

Bi or pancytopenia

Dysplasia in > or = 10% of cells in 2 or more cell lines

What describes the WHO classification of Refractory cytopenia with multilineage dysplasia and ringed sideroblasts?

<1% Blasts in PB, no auer rods

<5% Blasts in BM, no auer rods

> or =15% Ringed sideroblasts

Bi or pancytopenia

Dysplasia in > or = 10% of cells in 2 or more cell lines 

What describes the WHO classification of Refractory anemia with excess blasts, Type 1?

<5% Blasts in PB, no auer rods

5-9% Blasts in BM, no auer rods

Variable ringed sideroblasts

What describes the WHO classification of Refractory anemia with excess blasts, Type 2?

5-19% Blasts in PB, occasional auer rods

10-19% Blasts in BM, occasional auer rods

Variable ringed sideroblasts

What describes the WHO classification of Myelodysplastic syndrome associated with isolated del(5q)?

<1% Blasts in PB

<5% Blasts in BM

Platelet count= normal to increased

Normal to increased megakaryocytes with hypolobulated nuclei and isolated del(5q)in BM

WHO Leukemia Classification

M0 Characteristics

M0- AML Minimally Differentiated

<5% of AMLs

Absence of visible granules in blasts

Neg cytochemical stains

MPO positive

WHO Leukemia Classification

M1 Characteristics

M1- AML without maturation

No maturation beyond blast

Auer rods present in at least 50% cells

Strongly positive specific esterase

WHO Leukemia Classification

M2 Characteristics

M2- AML with maturation

Maturation seen from promyelocyte

Myeloblasts are 30-90% in BM

MPO and specific esterase positive

Many have t(8;21)

WHO Leukemia Classification

M3 Characteristics

M3- Acute Promyelocytic Leukemia

• 10% of all AMLs
• Greater than 80% have intense azurophilic granules
• >90% are t(15;17)
• 30-90% of marrow cells are promyelocytes
• DIC seen often in these patients

WHO Leukemia Classification

M4 Characteristics

M4- Acute Myelomonocytic Leukemia

• 15% of AMLs
• >30% BM cells are myelo and monoblasts
• Separated by special stains
• Auer rods may be present
• Increased monocytes in PB
• Chromosomal abnormalities

WHO Leukemia Classification

M5 Characteristics

M5- Acute Monocytic Leukemia 

• 5-15% AMLs
• Seen in young adults and children
• Chromosome abnormalities-    t(9;11) and t(11;15)
• Gingival hypertrophy seen

WHO Leukemia Classification

M6 Characteristics

M6- Erythroleukemia or Di Guglielmo's Syndrome

• >50% Erythroblasts in BM
• 30% or more of non-erythrocytes are myeloblasts
• Gradual myeloblast dominance- may convert to AML
• Anemia and thrombocytopenia
• NRBCs present

WHO Leukemia Classification

M7 Characteristics

M7- Megakaryoblastic Leukemia

• Marrow fibrosis (dry tap)
• Blast cells present that resemble lymphoblasts
• Megakaryocytes have agranular cytoplasm and shedding ofcytoplasmic blebs
• MPO and specific esterase negative
• PAS positive
• Platelet peroxidase positive
• Platelet receptors pos (CD42, 41 and 61)

Hypersegmented neutrophils are seen in which disease?

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Megaloblastic Anemia

Red blood cells production and destruction is dependent on the presence and amount of what glycoprotein hormone?

Erythropoeitin

What functions does erythropoetin have?

Increases RBCs

Increases permeability of bone marrow sinuses

Increases iron transfer to precursor cells

What protein is found inside the RBC and is responsible for support, deformability and stability?

Spectrin

Which pathway in RBC production is responsible for converting hemoglobin unable to transport oxygen into hemoglobin that is capable of transporting oxygen?

Methemoglobin Reductase Pathway

What are normal hemoglobin levels in males and females?

Males: 14-18 g/dL

Females: 12-16 g/dL

Group of genetic disorders in which there is an absence or decrease in the production of globin chains due to genetic mutation

Thalassemia