Hematology test 2
Terms
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- P50 value for hemoglobin
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pressure at which 50% of hemoglobin is oxygenated.
P50 for hgb=26 torrs - POâ‚‚for alveolar capillaries
- almost 100 torrs
- pressure effects on oxygen release from hemoglobin
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increase in pressure=higher affinity (more bound)
decrease in pressure=lower affinity (more released) - Bohr Effect
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increased pH=increased hgb-oxygen affinity
decreased pH=decreased hgb-oxygen affinity - shift to the right
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decreased hgb-oxygen affinity
DPG ↑
pH ↓
temp ↑ - shift to the left
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increased hbg-oxygen affinity
DPG ↓
pH ↑
temp ↓ - carboxyhemoglobin
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smokers, smog
reversible over time, slow and unpredictable. occurs when CO (hgb has higher affinity for this) binds instead of oxygen - sulfhemoglobin
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formed during increase in sulfur in blood
caused by taking sulfa drugs or chronic constipation
irreversible--RBCs must be removed from circulation - methemoglobin
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formed when ferrous iron (++) bound to heme is oxidized to (+++). Normal in 1% of circulating blood
reversible with strong reducing agents. - Hemoglobin S
- substitution of valine for glutamate in the 6th position of the beta chain of hemoglobin. Causes sticky patches which lead to deformation of RBC
- Intravascular Hemolysis
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occurs when severely damaged cells lyse in circulation.
components are found in circulation.
hemoglobin bound to haptoglobin and transported to liver
hemoglobinemia, hemoglobinuria, hemosidinuria - Extravascular Hemolysis
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normal processes of removal of old or damaged cells from circulation by spleen or liver.
components are saved and reutilized.
increased serum bilirubin, carboxyhemoglobin, methemoglobin - Disassembly of protoporphyrin
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Alpha carbon exhaled as CO
protoporphyrin ring converted to biliverdin (green) which is then converted to bilirubin (yellow) and carried by albumin to liver then excreted - results of increased intravascular hemolysis
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increased indirect bilirubin
depleted haptoglobin and hemopexin
increased LDH
increased retic count
measurable methemalbumin
hyperplastic bone marrow - role of erythropoeitin in intravascular and extravascular hemolysis
- controls production/destruction balance
- RBC
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4.7-6.1 x 10 6th/μl Male
4.2-5.4 x 10 6tg /μl Female - WBC
- 4.8 – 10.8 x 10 3rd/μl
- Hgb
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14-18 grams/dL Male
12 – 16 grams/dL Female - Hct
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42-52% Male
37-47% Female - MCV
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The average size (volume) of an RBC
Normal values: 80-100 fl. (a femtoliter [fl] = 10-15 liter) - MCH
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the average hemoglobin content of a RBC.
Normal values: 26-34 pg. (a picogram [pg] = 10-12 gram) - MCHC
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the percentage of a RBC's volume which contains hemoglobin.
Normal values: Usually between 31-37%. - RDW
- 11.5-14.5%
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Reticulocyte
(not normal part of CBC) - 0.5 – 1.5%
- PLT
- 150,000 – 450,000/μl
- Neutrophils
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42-75%
1.4-6.5 x 10 3rd/μl - Lymphocytes
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20 – 50%
1.2-3.4 x 10 3rd/μl - Monocytes
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1.7 – 9.3%
0.11-0.59 x 10 3rd/μl - Eosinophils
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0 – 4 %
0-0.5 x 10 3rd/μl - Basophils
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0 – 2 %
0 – 0.2 x 10 3rd/μl - Leukocytosis
- increased number of WBCs
- Leukocytopenia
- decreased number of WBCs
- Pancytopenia
- decreased number of all blood cells
- Normocytic
- RBC's of normal size (Normal MCV)
- Microcytic
- Abnormally small RBC's (corresponds to an MCV < 80)
- Macrocytic
- Abnormally large RBC's (corresponds to a MCV > 100)
- Normochromic
- RBC's that appear to contain normal amounts of hemoglobin on microscopic examination of blood smear
- hypochromic
- RBC's that have decreased amounts of hemoglobin and appear pale, and washed out on smear. (corresponds to a low MCH and low MCHC)
- Anisocytosis
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Variation in RBC size.
The higher the RDW, the greater the amount of anisocytosis - Poikilocytosis
- Variation in RBC shape
- reticulocyte count
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The proportion (%) of RBC's in a specimen of blood that are immature reticulocytes
Normal Range = 0.5% - 1.5% - Rule of Three
- In calculating the RBC indices the RBC count is usually 1/3rd of the Hemoglobin, and the Hemoglobin is usually 1/3rd of the Hematocrit. This gives a MCHC of 33.3 in a normal CBC.
- calculating MCV
- MCV= Hct X 10/RBC
- calculating MCH
- MCH = Hemoglobin X 10/RBC Count
- calculating MCHC
- MCHC = Hemoglobin X 10/Hematocrit
- Calculating absolute values for cells
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total WBC count x % of cell
EX: WBC Count of 8.2 x 10 3rd/μl
73 Neutrophils of 100 cells
so .73 * 8200=5.98 x 10 3rd/μl - Howell Jolly bodies
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spherical granules of 1 to 2 mm--DNA
single granules, occasionally two are present, rarely more
distinctly dark purple with Wrights Stain
Megaloblastic anemia, severe hemolytic anemias, thalassemias and splenectomy - Siderosomes
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Granules or aggregates of ferritin
small clusters near the periphery of normoblasts and less often, reticulocytes
Stained with Prussian Blue (Iron Stain) - Pappenheimer Bodies
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Irregular deposits of iron mature erythrocytes
Wright’s Stain--faint violet or magenta specks
Prussian blue stain-confirm iron - Heinz Bodies
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Spheres of denatured or precipitated hemoglobin
phase contrast microscopy or stained with crystal violet or brilliant cresyl blue
G-6-PD and pyruvate kinase deficiencies, oxidizing drugs, splenectomy - Basophilic Stippling
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Consists of fine, diffuse to course, irregular granules of aggregated ribosomes and polyribosomes
Wright's Stain-dark blue to black
Prominent in fetal and neonatal blood and exposure to lead and other toxic metals