Hematolgy Review
Hematolgy Review
Hematolgy Review
Know reference ranges for WBC, RBC, Platelet, MCH, MCV, MCHC
a. What determines microcytic/macrocytic/normocytic
2. Calculations
a. RBC indices
b. Retic count
i. Retics/10= X%
c. Corrected retic count
i. Retics% x Hct / 45
d. Corrected WBC count (due to presence of nRBCs)
i. WBC count*100 / (NRBCS+100)
3. Know which are measured vs calculated
a. Measured - WBC, RBC,Hgb, Hct
b. Calculated - MCH, MCV, MCHC. RDW,
4. Which anemia does/does not have marked retic (increased/decreased) - not sure
a. Increased - caused by acute blood loss or hyperprolferative bone marrow
b. Decreased - defective red cells (hemoglobinopathies or thalassemias) or
accelerated hemolysis (hemolytic anemias); also caused by bone marrow failure
5. What is the most probable abnormality if RDW and MCV is increased
a. Megaloblastic anemia ie Folate def, B12 def. Non-megalobalstic anemia caused
by alcoholism or liver disease should also be correct.
6. Electrophoresis in cellulose acetate and citrate agar
a. Know the order of migration
b. Know which is farthest towards the anode
c. Know which other Hgb is with A2
d. Cellulose acetate - ACE OF CLUBS; Sad Dogs Get Love
i. Crawl Slow Fast Accelerate
e. Citrate Agar
i. Cathode (-) F A < Origin > S C Anode (+)
7. PCH (paroxysmal cold hemoglobinuria)
a. Donath Landsteiner anti-P
8. PNH (paroxysmal nocturnal hemoglobinuria)
a. Dark urine caused by? Answers: Red cells, haptoglobin, hemoglobin (I think it’s
red cells)
b. +Pancytopenia, low LAP score
c. Ham’s and sugar water test used in diagnosis in olden days. Now flow cytometry
is used to detect CD55 and CD59
9. RBC metabolic pathway responsible for 2,3 DPG metabolic pathway→
a. Leubering - Rapoport shunt
10. LAP score principle
a. 13-130 is normal range.
b. Purpose - used to differentiate a CML from a leukemoid reaction.
i. A high LAP score like 150 is a true leukemoid reaction caused by an
infection. You would observe a left shift, high LAP, no Ph’ (Philadelphia
chromosome), high WBC count
ii. Normal LAP score along w a positive Ph’, left shift, high WBC count can
indicate CML
c. Know the theory on LAP Stain
11. Cytochemical stains
a. MPO, SBB, Esterase, LAP, TRAP and what they differentiate
b. Which one differentiates AML vs ALL →
i. Myeloperoxidase (MPO)/Sudan Black B (SBB)
c. Esterase
i. Myeloid vs monocytic cells
d. LAP
i. Leukemoid vs CML
e. TRAP
i. Hairy cell leukemia
12. Which inclusions show on Supravital stain but not Wright stain →
a. Heinz bodies
13. Know the different type of anemias, and what they would demonstrate in a patient;
normocytic, microcytic, macrocytic...etc
14. Leading cause of anemia in an alcoholic -
a. I think it’s folate deficiency. Other options were B12… non-megaloblastic not an
option
b.
15. Megaloblastic/macrocytic anemias
a. Vitamin B12 (cobalmin) deficiency
b. Folate/folic acid deficiency
c. Non-megaloblastic anemia = alcoholism
16. Thalassemia
a. Quantitative genetic disorder. Cannot produce alpha or beta globin chain.
b. Microcytic anemia
17. Chediak- Higashi causes
a. Albinism and photosensitivity
18. What cause skin lesions and neurological complications →
a. lead poisoning
b. I believe it also causes basophilic stippling (RNA inclusions in RED cells)
19. Presence of predominantly mature malignant cells are classified as →
a. chronic
20. AML
21. CML vs Leukemoid rxn
a. CML = positive for Ph (philadelphia) chromosome, negative for LAP, left shift with
some blasts, eos, and baso
b. Leukemoid rxn = negative for Ph chromosome, positive for LAP, left shift with NO
blasts with toxic granularity and
22. ALL
a. Which pre-B cell marker is used exclusively in the work up of acute leukemia in
studying B lineage ALL – I THINK answer is mu heavy chain? (other answers
shown are delta, epsilon, gamma heavy chain) CORRECT
23. Know the different leukemia molecular tests to differentiate them
a.
24. TdT - Terminal deoxynucleotidyl transferase
a. It is the DNA polymerase expressed in immature lymphoid cells (Tcells and
Bcells)
b. In acute lymphocytic leukemia (ALL), TdT is VERY HIGH. Therefore, TdT is a
good marker to test patients for ALL.
i. Note: Since TdT is mainly expressed in lymphoid cells, if a patient has
cancer, lymphoid cells increase, therefore TdT increases. Direct
correlation.
25. Idiopathic Myelofibrosis - what are the clinical indications?
a. Anemia with < 10g/dL Hb
b. Ineffective erythropoiesis
c. CD34+ cells
26. Polycythemia vera, secondary polycythemia
a. Polycythemia vera = increased JAK/STAT pathway within the bone marrow, I
think it should be normal erythropoietin levels
b. Secondary polycythemia = increase in erythropoietin
27. How long can a sample be kept in RT before a differential smear is made →
a. 3 hours
28. Infectious mononucleosis → variant lymphs (increased size and basophilia). Observed in
viral infections. Is it increased, decreased, or normal lymph count? Increased
29. Hgb C (what RBC morph does it have →
a. target cells
30. Hairy cell leukemia, TRAP
31. RBC inclusions
a. What are Dohle bodies (in granulocytes) consist of = ribosomes / RNA
b. Heinz bodies (and that it is associated with G6PD deficiency) - RBC inclusions
made of denatured hemoglobin caused by lack of G6PD. Free radicals are free
to denature hemoglobin without glutathione neutralizing them.
32. Order/principle of cyanmethomoglobin method for hemoglobin
a. Purpose - to measure amount of hemoglobin in specimen
b. Principle -
i. Lyse all red cells → free hemoglobin → convert to methemoglobin →
convert to cyanmethemoglobin by adding potassium cyanide (turns it
purple color) → interpret unknown mass of hemoglobin in specimen
based on absorbance
33. FSC (x-axis, size) and SSC (y-axis, granularity) - forward scatter and side scatter with
respect to flow cytometry; used to perform autodiff; Kaiser uses Sysmex machine
a. Where is lymphocyte located compared to mono/neutrophils on the graph
→lower
b.