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118 Cards in this Set
- Front
- Back
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What is plasma?
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fluid portion of blood and makes up 55% of the total blood volume. wbcs and platelets making up only 1% with RBCs making up the remaining portion
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where do blood cells come from?
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formed in bone marrow from a common multipotenntial stem cell.
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What is hematopoiesis?
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continuous formation and development of blood cells
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erythropoisis
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develpment of rbc
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granulopoiesis
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development of granulocytes - neutrophils, eos, basos
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Where do lymophocytes and plasma cells come from?
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common lymphoid progenitor
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What do you need to be concerned iwth making a good wedge slide?
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Ensure that the whole drop of blood is picked up and spread
Too slow a slide push will accentuate poor leukocyte distribution, larger cells are pushed at the end of the slide Maintain an even gentle pressure on the slide Keep the same angle all the way to the end of the smear. |
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What are features of a well made wedge smear?
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Smear is 2/3 or ¾ the entire slide
Smear is finger shaped, very slightly rounded at the feathery edge: widest area of examination Lateral edges of the smear visible Smear is smooth without irregularities, holes or streaks When held up in light: feathery edge should show rainbow appearance Entire whole drop of blood is picked up and spread |
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what is the wrigh-giemsa stain procedure?
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1) air-dry on a level staining rack
2) fix by flooding with methanol 3) flook slide with wright-giemsa stain - 4min 4) without removing slide, add equal vol of phosphate buffer - 7 min 5) rinse with distilled water 6) air dry |
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What are the qualy control procedures for Wright-Giemsa satain?
pH |
pH
RBCs should be pink - if stain is acidic RBCs become red-orange - incufficient staining time - prolonged buffering or washing - acidic or old stain If sain is alkaline RBCs become blue/blue-green - thick blood smears - prolonged staining - inssufficient washing - alkaline stain, buffer or water |
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What are the qualy control procedures for Wright-Giemsa satain?
Contrasts |
Neutrophils should have a deep blue-purplre nucleus, with scytooplasim granules of lilac or violet pink
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What are the qualy control procedures for Wright-Giemsa satain?
Distribution |
Edge of RBCs shold not be touching, WBCs should be evenly distributed
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What is the difference between a band and segmented neutrophil?
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Band - deep blue single uniform thickness band and coarse granular chromatin
Seg – 2-5 distinct nuclear lobs with connecting filament Both – abundant pink cytoplasm with fine lilac or violet pink granules |
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Which two leukocytes are bilobular, with deep purple-blue with coarsely granular chromatin?
How do you tell them apart? |
Eosinophil – pink abundant cytoplasm with red uniform granules
Basophil – pale blue cytoplasm with abundant large purple-black granules that often obscure the nucleus. |
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Which two leukocytes have a 1:1 Nucleus to Cytoplasmic ratio?
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Neurtrophils and Metameyleocytes
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Which leukocyte has a 4:1 nucleus/cytoplasm ratio?
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.lymphocyte
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Which leukocyte has a 2:1 nucleus/cytoplasm ratio?
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monocyte
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Name the components
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The red blood cells here are normal, happy RBC's. They have a zone of central pallor about 1/3 the size of the RBC. The RBC's demonstrate minimal variation in size (anisocytosis) and shape (poikilocytosis). A few small fuzzy blue platelets are seen. In the center of the field are a band neutrophil on the left and a segmented neutrophil on the right.
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Name my components
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A normal mature lymphocyte is seen on the left compared to a segmented PMN on the right. An RBC is seen to be about 2/3 the size of a normal lymphocyte.
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Name my components
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Here is a monocyte. It is slightly larger than a lymphocyte and has a folded nucleus. Monocytes can migrate out of the bloodstream and become tissue macrophages under the influence of cytokines. Note the many small smudgy blue platelets between the RBC's.
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identify
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In the center of the field is an eosinophil with a bilobed nucleus and numerous reddish granules in the cytoplasm. Just underneath it is a small lymphocyte. Eosinophils can increase with allergic reactions and with parasitic infestations.
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id
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There is a basophil in the center of the field which has a lobed nucleus (like PMN's) and numerous coarse, dark blue granules in the cytoplasm. They are infrequent in a normal peripheral blood smear, and their significance is uncertain. A band neutrophil is seen on the left, and a large, activated lymphocyte on the right.
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What is wrong with me?
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The RBC's here are smaller than normal and have an increased zone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis (variation in size) and poikilocytosis (variation in shape).
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whats wrong with me
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The most common cause for a hypochromic microcytic anemia is iron deficiency. The most common nutritional deficiency is lack of dietary iron. Thus, iron deficiency anemia is common. Persons most at risk are children and women in reproductive years (from menstrual blood loss and from pregnancy).
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Whats wrong with my numbers
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Here is data from a CBC in a person with iron deficiency anemia. Note the low hemoglobin (HGB). Microcytosis is indicated by the low MCV (mean corpuscular volume). Hypochromia correlates here with the low MCH (mean corpuscular hemoglobin).
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what is wrong with me?
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Here is a hypersegmented neutrophil that is present with megaloblastic anemias. There are 8 lobes instead of the usual 3 or 4. Such anemias can be due to folate or to B12 deficiency. The size of the RBC's is also increased (macrocytosis, which is hard to appreciate in a blood smear).
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What year were officer career fields and enlisted ratings opened to women?
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1978
(E-PME, E5-41) |
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what is wrong with my numbers?
What do I indicate? |
The CBC of a patient with microangiopathic hemolytic anemia (MAHA) demonstrates a markedly increased RDW (red cell distribution width) due to the marked variation in size and shape of the RBC population.
RDW is a measure of the variation in size (degree of aniscytosis) of RBCs. RDW is the measure of the homogeneity of the RBC pop. RDW is increased with a mixture of microcytic and macrocytic RBCs. |
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id
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The WBC's seen here are "atypical" lymphocytes. They are atypical because they are larger (more cytoplasm) and have nucleoli in their nuclei. The cytoplasm tends to be indented by surrounding RBC's. Such atypical lymphocytes are often associated with infectious mononucleosis.
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id
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If most of the neutrophils appear bilobed, this is indicative of an uncommon condition known as Pelger-Huet anomaly, an inherited condition. This is the heterozygous form. The homozygous form is fatal. Just be aware of this condition when you get back a manual differential count with mostly bands, but the WBC count is normal or the patient shows no signs of infection or inflammation.
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what is wrong with me?
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This is sickle cell anemia in sickle cell crisis. The abnormal hemoglobin SS is prone to crystallization when oxygen tension is low, and the RBC's change shape to long, thin sickle forms that sludge in capillaries, further decreasing blood flow and oxygen tension. Persons with sickle cell trait (Hemoglobin AS) are much less likely to have this happen
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what is wrong with me?
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This patient has hemoglobin SC disease, with hemoglobin S and hemoglobin C both present. With SC disease, the RBC's may sickle, but not as commonly as with Hemoglobin SS disease. The hemoglobin C leads to the formation of "target" cells--RBC's that have a central reddish dot. In the center of the field is a rectangular RBC that is indicative of a hemoglobin C crystal, which is also characteristic for hemoglobin C disease.
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ID
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The WBC's seen here are lymphocytes, but they are blasts--very immature cells with larger nuclei that contain nucleoli. Such lymphocytes are indicative of acute lymphocytic leukemia (ALL).
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ID
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lymphocytes
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id
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Here are very large, immature myeloblasts with many nucleoli. A distincitve feature of these blasts is a linear red "Auer rod" composed of crystallized granules. These findings are typical for acute myelogenous leukemia (AML) that is most prevalent in young adults.
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id
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Here is another view of a peripheral blood smear in a patient with CML. Often, the numbers of basophils and eosinophils, as well as bands and more immature myeloid cells (metamyelocytes and myelocytes) are increased. Unlike AML, there are not many blasts with CML.
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id
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Neutrophil band
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id
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Neutrophil Band
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id
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two lymphoblasts and a neutrophil.
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id
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Normally matured segmented and late band neutrophils, shown in panels A and C, have white cytoplasm with pink granules, long and fairly narrow nuclei and tightly condensed chromatin. Segmented and band neutrophils with toxic change (examples shown in panels B and D) have less condensed chromatin than their normal counterparts and bluer cytoplasm due to retention of ribosomal RNA.
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id
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: The two cells are a segmented neutrophil (upper cell) and a band neutrophil (black arrow). Toxic change is evident in both cells - cytoplasmic vacuolation and toxic granulation in the segmented neutrophil and cytoplasmic basophilia in the band neutrophil
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ID
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The picture on the left is a mature neutrophil with 3 lobes. The right picture is of an immature neutrophil (a stab or band cell) in which the nucleus is smoother and more continuous.
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id
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monocyte
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id
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Monocytes are the largest of the white blood cell s and make up about 3 to 8 per cent of the total white cell volume.
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id
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Eosinophil, giemsa stained peripheral blood film
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id
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Blood film showing a monocyte (left) and two neutrophils
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id
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A monocyte is a leukocyte, part of the human body's immune system that protects against blood-borne pathogens and moves quickly (aprox. 8-12 hours) to sites of infection in the tissues. Monocytes are usually identified in stained smears by their large bilobate nucleus.
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id
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myelocyte
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id
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Metamyelocytes (10-18m) are slightly smaller than myelocytes. They have kidney shaped indented nuclei and relatively dense chromatin, especially along the nuclear membrane. The cytoplasm is faintly pink with almost no blue background. Numerous secondary granules (neutro, eos, or baso) clearly outnumber primary granules. Zero to one percent of the peripheral blood white cells may be metamyelocytes
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id
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Bands, slightly smaller than juveniles, are marked by a U-shaped or deeply indented nucleus. Opposite sides or lobes are of roughly equal size or diameter. There is no nuclear constriction > than 1/2 the lobe diameter. The chromatin is heavily clumped and secondary or specific granules either neutrophilic or basophilic predominate.
metamyelocytes (juveniles). |
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id
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Eosinophils The large orange granules of the eosinophil make the eosinophil the most readily recognizable cell in the blood. The eosinophil (12-15u diameter has chromatin similar to that of a neutrophil, but usually fewer (2-3) lobes.
Normally 0-6% eosinophils are found in the peripheral blood. |
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id
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neutrophil
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ID
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eosinophil
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id
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Basophil The purple-black, often large coarse irregularly sized granules of the basophil are chacteristic and may obscure the nucleus of this relatively uncommon cell. The mature nucleus is segmented into 2-3 lobes.
Basophils (12-15u dia) contain heparin and large amounts of histamine. |
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id
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Monocytes are the largest (12-20u dia) cells normally found in the peripheral blood. Monocytes have abundant blue-gray, sometimes very pale pink cytoplasm with small, generally indistinct, granules. One may see fine reddish granules of variable prominence. Occasionally, large azurophilic granules will be seen.
Cytoplasmic vacuoles are often seen. The nucleus is irregular, frequently with delicate folds and often lobulated. The chromatin is fine and lacey, sometimes described as reticular. The mature monocyte has no nucleoli. |
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id
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Compare the chromatin and the size of the monocyte (top) with the lymphocyte.
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id
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Some larger lymphocytes with moderate amounts of cytoplasm and distinct red granules are known as large granular lymphocytes (LGL).
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id
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Some larger lymphocytes with moderate amounts of cytoplasm and distinct red granules are known as large granular lymphocytes (LGL).
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id
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Young or stimulated lymphocytes
Young or stimulated lymphocytes (right panel) are larger and have relatively more cytoplasm and larger nuclei than mature or unstimulated cells |
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id
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mature or unstimulated cells
Young or stimulated lymphocytes (right panel) are larger and have relatively more cytoplasm and larger nuclei than mature or unstimulated cells. |
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id
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Normal peripheral blood showing two neutrophils and a monocyte (arrow). The larger size and irregular shape of the monocyte and its irregular nucleus and grey-blue cytoplasm are typical. Cytoplasmic vacuolation is quite common in monocytes.
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id
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Eosinophil: The eosinophil's nucleus is bilobed, the cytoplasmic granules are usually reddish. It's function is to kill parasitic worms; destroy antigen-antibody complexes; inactivate some inflammatory chemicals of allergy
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id
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Basophil: (This slide was also taken off of the internet, the lab doesn't have any slides of basophils). Basophils have lobed nuclei; large blue-purple cytoplasmic granules. It's function is to release histamines and other mediators of inflammation.
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id
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eosinophil
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id
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Eosinophil
-Contain bright orange-red spherical granules. -Granules are of the same size, are usually evenly distributed and rarely overlie the nucleus. -The earliest recognizable phase of eosinophil is the myelocyte. -Cell size, shape and nuclear maturation mimic the neutrophils. -The eosinophilic granules are larger than granules in neutrophils and this aids in the idenfication when stain quality is questionable. |
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id
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Basophil
-The cells mimic the netrophils in size shape and nuclear maturation. -Characterized by small to moderate number of coarse, densely stained granules of different sizes and shapes. -The color of the granules is bluish-black but some may stain purple or purple-red. -The granules are unevenly distributed and frequently overlie the nucleus. |
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id
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Lymphocyte
-Round or oval cells but may be notched or slightly indented. -Nuclear details include dense chromatin without nucleoli. Some may show a perinuclear clear zone. -Sparse to moderate, light blue cytoplasm which may contain a few unevenly distributed, pink azurophilic granules. -The N:C ratio is 5:1 to 2:1. |
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id
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Metamyelocyte
-Slightly smaller than myelocytes -Nucleus may be central of eccentric but is usually indented (by definition, to less than half of the distance to the farthest nuclear margin). This gives the nucleus the kidney bean shape. Occasionally the nucleus is flattened. -The N:C ratio is 1.5:1 to 1:1. -There are few primary granules and many secondary granules. |
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id
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Reactive Lymphocyte
-Have variable cell size and shape and variable nuclear size and shape. Cells may be round, oval or irregular. Nuclei may be round, oval, notched, indented, folded or lobulated. -Different types of reactive lymphs may be found in the same viral illness. -Cytoplasm is abundant but varies from gray, through pale blue to deep blue. -The N:C ratio is 2:1 to 1:2. -The cytoplasm is sometimes indented by adjacent RBCs. |
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id
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White Blood Cell, specifically, an eosinophil
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id
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basophil
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id
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basophils
Uncommon in perypheral blood. Many cytoplasmic dark granules containing heparin and histamine. |
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id
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Similar to neutrophils but cytoplasmic granules are coarser and redder. Rarely more than three nuclear lobes. Role in allergic response, defence against parasites and removing fibrin formed during inflamation.
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id
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basophil
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id
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Basophils (human). Wright's stain. 1800x
Note: 1. These are 8-14 um in diameter and <1% of WBCs in an blood smear; 2. the cytoplasmic granules are of variable size that stain intensely with methylene blue. Ross, et al. p. 212 Plate 26. Fig. 6 & 7. |
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id
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Eosinophils (human). Wright's stain. 1800x
Note: 1. These are 10-14 um in diameter, 1-6% of WBCs in a blood smear; 2. they have a bilobed nucleus (like spectacles); 3. granules are relatively uniform in size, 0.6 um in diameter and are refractile. Ross, et al. p. 212 Plate 26 Fig. 1 & 2. |
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id
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Blood film at 1000X magnification shows a promyelocyte, an eosinophil, and 3 basophils. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
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id
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Blood film at 1000X magnification demonstrates the whole granulocytic lineage, including an eosinophil and a basophil. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland.
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id
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Basophilic metamyelocyte: Derived from basophilic myelocyte, which is not represented in this figure. Basophilic myelocytes are scarce and may not be seen in a single marrow smear preparation. It is believed that their granules are water soluble. This cell is no longer capable of cell division. The nucleus is oval to kidney-shaped. Cytoplasm has basophilic granules.
Basophilic band: An immature basophil with a horseshoe-shaped nucleus. There are basophilic granules in the cytoplasm. BONE MARROW Developing basophils Neutrophilic band: See Plate 58. Note the difference in cytoplasmic granularity between the neutrophilic band and the basophilic band. Segmented neutrophil: See Plate 58. |
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manual cbc count - how do you do it?
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1 - choose a portion where there is no overlapping RBCs.
2. estimate the total wbc by count the number of wbcs in 5 high dry fields, take the average 2 - counting 100 wbcs - avoiding the densely packed or thinly packed areas. 3 - chart on modified WHO chart. record 10 cells in each row 5 - report results |
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what is a left shift?
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increased number of immature granulocytes - band neutrophils
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what is a right shift?
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increase in hyper-seg neutrophils (>8lobulations)
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what is an absolute value (cells/mL)
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Relative value (%) * Total WVBC count (cells/mL)
multiplying the differential percentages by the total WBC count |
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Total WBC count - normal adult average?
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5,000 to 10,000 WBCs per mL
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what is an elevated wbc count?
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over 10,000 - leukocytosis
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what is a decreased wbc count
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leukopenia below 5000
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what causes leukocytosis?
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bone marrow suppression, infection, medication, radiation, B12 adn folate deficiencies
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what do you calculate a wbc with when manual?
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hemocytometer
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hemocytometer procedure
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1 - flood the counting chamber by loading the solution in the v groove and allowing cap reaction
2 - leave in chamber undisturbed for 2 min 3 - under 10x with a high condensor focus on wbcs that appear as small black dots on the grid 4 - count the number of wbcs observed in the four feilds Counting formula: 1)count up all the wbcs in the four counting chambers 2 - divide by 2 3 - divide the number by 10 4 - express as cells x10 to the 4th power per mm cubed |
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wbc count example
you count 102 wbcs in the four squares |
divide 102/2 = 51
divide 51/10 = 5.1 wbc count 5.1x10 to the fourth mm cubed |
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what is a normal platelet count?
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one per 15-20 RBCs
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what is a decreased platelet count?
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<1 per 15-20 RBCs
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what is an increased platelet count?
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>1 per 15-20 RBCs
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Hemoglobin concentration is a measure of what?
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the amount of hemoglobin in whole blood
the absolute number of thrombocytes per liter of whole blood |
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what is hemoglobin
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the iron containing protein that RBCs use to transport oxygen
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what is a normal Hb?
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12-15 g/dL in circ
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what is hemocrit?
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the fraction of whole blood that is comprised of RBCs
ratio of RBC volume to the volume of whole blood |
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what is a normal Hct?
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men 40-54%
women 37-47% generally 3x Hb |
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MCV?
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mean cell volume - average vol of a single rbc used to classify anemia
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microcytic anemia?
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decrease in the size of rbc
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macrocytic anemia?
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increase in the size of rbc
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calculte mcv?
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Hct/RBC count
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MCH?
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Mean cell hemoglobin
avearge amount of Hb in a single rbc |
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hypochromic anemia?
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decreased MCH
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normochromic and hypochromic anemia
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increased MCH
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calculate mch
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Hb/RBC count
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RDW
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Read Cell Distribution Width = measure the variation in size (degree of aniscytois) of rbc
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increased rdw
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mixture of microcytic and macrocytic rbcs
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calculate rdw
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standard deviation of red cell vol/mean cell vol
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Poikilocytosis
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irreg shaped rbcs - burr, target, sickle cells
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anisocytosis
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irreg size rbcs - macrocytic and microctyic
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normocytic
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normal rbc 7-8 microns
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normochromic
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stain pink and have a small pallor no more than 1/3 of the cell
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reticulocytes
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immature rbcs that usually comprise 0.5-1% of rbcs in circ
basophil bodies in rbc |
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what do you use to identify reticulocytes?
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brillant cresyl-blue or methylen blue stain
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Retic count formula
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CalculationReticulocyte Production Index is calculated as follows:
1. Retic index = retic count*(Hct/Normal Hct) A value of 45 is usually used as a normal hematocrit.[3] Calculation Using the Manual Method Calculate the percent of reticulocytes as follows: %Reticulocytes= # retics in 1000 RBCs/10 EXAMPLE: Retics counted = 47 in 953 erythrocytes % Retics = 47/10 = 4.7% |
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Correct Retic count
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(Retic count*Hct) / (Normal Hct for age and sex)
i.e. adult female has a retic count of 1.8%, Hct 31, normally an adult female would be 40 corrected count - 1.8*31/40 = 1.4% |
