Hematology PPT Flashcards Unit 4

Hematology PPT Flashcards Unit 4
What is Hemostasis and Thrombosis?
What is hemostasis?
What is thrombosis?
What are four components of hemostasis?
What are three important component of
protein in Hemostasis?
What are several functionally processes are
involved in hemostasis of a small blood
What is the function of Arteries?
What is the function of Veins?
What is the function of capillaries?
What are the characteristics of Arterioles?
How were arterioles operated inside the
How was the microcirculation formed?
What is the function of microcirculation?
What is vasculature physiology role in
The maintenance of circulation hemostasis is
achieved through the process of balancing
bleeding (hemorrhage) and clotting
Prevent from bleeding or hemorrhage
– Vascular system
– Platelets (thrombocytes)
– Blood coagulation factors
– Fibrinolysis and ultimate tissue
 Complement system is a cascade
produced in the liver.
 Kinin systems plays a role in
inflammation, coagulation, sodium
 Protease inhibitors
– Blood vessel spasm
– Formation of a platelet plug
– Contact between damaged blood vessel,
blood platelet, and coagulation proteins
– Development of a blood clot around the
– Fibrinolytic removal of excess hemostatic
material to reestablish vascular integrity
Blood away from heart, arteries have the
thickest walls of the vascular system.
Blood come into the heart, veins are larger and
More irregular lumen than arteries
Gas exchange
Arterioles are the microscopic continuation of
arteries that give off branches called
metarterioles, which in turn join the capillaries.
The walls become thinner as the arterioles
approach the capillaries, with the wall of a very
small arteriole consisting only of an endothelial
lining and some smooth muscle surrounded by a
small amount of connective tissue.
The capillaries, arterioles, and venules constitute
the major vessels of the microcirculation.
As a unit, the microcirculation functions as the
link between the arterial and the venous
• The role of vasoconstriction in
Hematology PPT Flashcards Unit 4
How does the vasoconstriction play a role in
What is the endothelium?
How does endothelium play a role in
What was endothelium role in lysis of fibrin
clots hemostasis?
What is the prostacyclin role in hemostasis?
How was the primary phase hemostasis
activated after disruption of the endothelium?
How was the second phase hemostasis
activated after disruption of the endothelium?
How was the third phase hemostasis activated
after disruption of the endothelium?
How was the final phase hemostasis activated
after disruption of the endothelium?
How many factors are required to maintain of
Vascular Integrity hemostasis?
What are the essential factors of vascular
integrity in hemostasis?
What will be happened if there is lack of
• The role of the endothelium
• Maintenance of vascular integrity
When a smaller vessel, such as an arteriole,
venule, or capillary, is injured, contraction
occurs to control bleeding. This contraction of
the blood vessel wall is called
The endothelium contains connective tissues
such as collagen and elastin.
The endothelium is highly active metabolically
and is involved in the clotting process by
producing or storing clotting components.
It is also rich with plasminogen activator,
which, if appropriately stimulated, is released
and activates plasminogen, which ensures rapid
lysis of fibrin clots.
Additionally, the endothelium elaborates
prostacyclin, which is synthesized by the
endothelium from prostaglandin precursors and
strongly inhibits platelet aggregation and
Initially, rapid vasoconstriction for up to 30
minutes reduces blood flow and promotes
contact activation of platelets and coagulation
In the second phase, platelets adhere
immediately to the exposed subendothelial
connective tissue, particularly collagen. The
aggregated platelets enhance sustained
vasoconstriction by releasing thromboxane A2
and vasoactive amines, including serotonin and
In the third phase, coagulation is initiated
through both the intrinsic and extrinsic
Finally, fibrinolysis occurs following the
release of tissue plasminogen activators (t-PAs)
from the vascular wall. Fibrinolytic removal of
excess hemostatic material is necessary to
reestablish vascular integrity
Vascular integrity or the resistance to vessel
disruption requires three essential factors
Circulating functional platelets
Ascorbic acid
A lack of these factors produces fragility of the
Hematology PPT Flashcards Unit 4
essential factors in vascular integrity
What will be the initial series observation of
megakaryocytic cell?
What will be the second series observation of
megakaryocytic cell?
What is the third series observation of
megakaryocytic cell?
What will be the last series observation of
megakaryocytic cell?
How were the platelets (thrombocytes) role in
hemostasis of megakaryocytic development?
vessels, which makes them prone to disruption.
General characteristics of megakaryocytic
The developmental sequence of platelets
Cellular ultrastructure of a mature platelet
Platelet kinetics, life span, and normal values
Mature platelets (thrombocytes)
(metabolically active cell fragments) are the
second critical component in the maintenance
of hemostasis
Where were the platelets (thrombocytes)
These anuclear cells circulate in the peripheral
blood after being produced from the cytoplasm
of bone marrow megakaryocytes, the largest
cells found in the bone marrow
What are the stages of being formed platelets?
1) Megakaryoblast
2) Promegakaryocyte
3) Megakaryocyte
a. Platelets
Where were the bone marrow
Bone marrow megakaryocytes are derived from
megakaryocytes found?
pluripotential stem cells
How were the platelets formed inside the
The sequence of development from
cytoplasmic membrane?
megakaryocytes to platelets is thought to
progress from the proliferation of progenitors to
polyploidization, that is, nuclear
endoreduplication, and finally to cytoplasmic
maturation and the formation of platelets
Where was the initial process of
Megakaryocytopoiesis proceeds initially
megakaryocytopoiesis take place?
through a phase characterized by mitotic
division of a progenitor cell; Followed by a
wave of nuclear endoreduplication.
What is endoreduplication process of
Endoreduplication is the process in which
chromosomal material (DNA) and the other
events of mitosis occur without subsequent
division of the cytoplasmic membrane into
identical daughter cells
What are two classes of progenitors that have 1) Burst-forming-unit megakaryocyte (BFU-M)
been identified in the early development of
2) Colony-forming-unit megakaryocyte (CFUplatelets?
What is the function of Burst-forming-unit
The BFU-M is the most primitive progenitor
megakaryocyte (BFU-M)?
cell committed to megakaryocyte lineage
What is the second stage of megakaryocyte
The next stage of megakaryocyte development
development of platelets?
is a small, mononuclear marrow cell that
Hematology PPT Flashcards Unit 4
expresses platelet-specific phenotypic markers
but is not morphologically identifiable as a
How well were the mononuclear marrow cells These transitional cells represent 5% of
of platelets visible in cytoplasmic?
marrow megakaryocyte elements.
Have the transitional immature
Some transitional immature megakaryocyte
megakaryocyte cells been undergoing
cells may be capable of cellular division, but
most are nonproliferating while actively
undergoing endomitosis.
Described the final stage of megakaryocyte
The final stage of megakaryocyte development
is the morphologically identifiable
These cells are readily recognizable in the
marrow because of their large size and
lobulated nuclei. These cells are polyploid.
What is the size of a mature platelet?
Platelets have an average diameter of 2 to 4 mm,
with younger platelets being larger than older
Does a platelet have a nucleus?
In contrast to megakaryocytes, platelets have no
What is the characteristic of a platelet?
The cytoplasm is light blue, with evenly
dispersed, fine red-purple granules.
What is the characteristic of an inactive
An inactive or unstimulated platelet circulates as
a thin, smooth-surfaced disc.
What is platelet adhesion?
When vascular injury exposes the endothelial
surface, underlying collagen platelets adhere to
the subendothelial collagen fibers, spread
pseudopods along the surface, and clump
together (aggregate).
How quickly does platelet adhesion to
1-2 minutes after a break in the endothelium.
subendothelial connective tissue, especially
collagen happen?
What’s the best test to use to determine
Platelet aggregation.
platelet function?
What is a thrombus?
When the bridges formed by fibrinogen in the
presence of calcium produce a sticky surface on
platelets, resulting in aggregation and then
reinforced by fibrin is considered a thrombus.
What substances can cause a blockage of a
Prostaglandin E (PG E), adenosine, and
pathway by an aggregation of platelets?
nonsteroidal anti-inflammatory agents (e.g.,
How are permanently anchored platelet plugs
given additional consolidation and
With fibrinogen, under the influence of small
amounts of thrombin. This process involves the
precipitation of polymerized fibrin around each
platelet resulting in a fibrin clot that produces an
Hematology PPT Flashcards Unit 4
Why is a platelet count a fundamental
component in the evaluation of a patient?
What are other fundamental evaluations of
What are blood coagulation factors?
What is blood coagulation a sequential
process of?
What are circulating factors that participate in
the coagulation process designated by?
How are the roman numerals effected if the
enzymatic factor is activated?
What are 3 assays that are conducted by
specialized coagulation laboratories?
What specimen is used for the One-stage
quantitative assay for factors II, V, VII, and
What factors does age serum contain?
What factors does absorbed plasma contain?
Who is the PT for One-stage quantitative
assay for factors II, V, VII, and X conducted?
Why is the percentage of factor activity
For One-stage quantitative assay for factors
VIII, IX, XI, and XII, what procedure is it
based on?
Who are the results expressed in One-stage
quantitative assay for factors VIII, IX, XI,
and XII?
What is the factor VIII antibodies in
irreversible platelet plug.
Examination of the peripheral blood smear for
platelet number and morphology is critical
because many
clinical clues may be obtained from an
evaluation of
platelet quantity and morphology.
Platelet aggregation, platelet adhesion, and
antiplatelet antibody assays. Blood coagulation
factors are one of the most important of the
Basic concepts of blood coagulation, common
characteristics of coagulation factors,
characteristics of individual factors, the
mechanism of coagulation, fibrin formation,
laboratory assessment of blood coagulation
factors, and assays for fibrin formation.
Chemical reactions, involving plasma proteins,
phospholipids, and calcium ions.
Roman numerals.
It’s a roman numeral followed by the suffix –a
and the inactive enzymatic factor, zymogens are
the roman numeral alone.
1) One-stage quantitative assay for factors II, V,
VII, and X.
2) One-stage quantitative assay for factors VIII,
IX, XI, and XII.
3) Factor VIII antibodies in hemophiliacs.
Aged serum and absorbed plasma in the PT.
Factors VII, IX, X, IX, and XII.
Factors V, VIII, XI, and XIII
Using specific factor-deficient plasma with
specific dilutions of patient plasma.
To construct an activity curve.
 The APTT assay.
And it is based on the results of patient plasma
to correct specific factor-deficient plasma.
In percent activity on an activity curve.
An ELISA technique that uses the binding of
Hematology PPT Flashcards Unit 4
hemophiliacs assay?
What is Warfarin?
Why do Warfarin drugs cause incomplete
Biological activity is significantly1)______
(decreased or increased) as revealed by the
The onset of action of most warfarin
derivatives is between how many hours?
The maximum affect occurs in approximately
how many hours?
What is the duration of action of Warfain?
What is the mainstay of immediate therapy
for acute PE.
How does Heparin acts as an anticoagulant?
Why is Heparin termed an antithrombin?
What can Heparin cause?
Before initiating heparin, what should
patients be screened for?
What should the baseline laboratory
evaluation include?
When is Heparin anticoagulation used?
What are 2 other Antithrombin-Dependent
What 2 new types of drugs are direct
thrombin inhibitors?
What are the new types of thromboplastins
for measuring the PT?
What are Fibrinogen assays useful for?
antibodies in the plasma to solid phase antigen,
which is subsequently detected by a human
polyclonal IgG labeled with the alkaline
phosphatase-p-nitrophenyl phosphate substrate
The traditional oral anticoagulant (Coumadin).
Warfarin drugs are vitamin K antagonists that
interfere with the normal synthesis of factors II,
VII, IX, and X as well as proteins C and S.
Because they lack calcium-binding sites and
cannot form enzyme substrate complexes.
Thus, these factors are unable to function as
procoagulants or anticoagulants.
8 and 12 hours
36 hours
Approximately 72 hours.
Heparin anticoagulation
Heparin has no anticoagulant activity of its own
but acts as an anticoagulant by accelerating the
binding of antithrombin to target enzymes (e.g.,
thrombin and factor Xa).
Because it helps prevent new thrombus
formation and buys time for endogenous
fibrinolytic mechanisms to lyse the clot.
Bleeding, thrombocytopenia, and osteopenia.
Clinical evidence of active bleeding
CBC, platelets, PTT, PT, stool analysis for
occult blood, and urine dipstick for hematuria.
During percutaneous transluminal coronary
angioplasty (PTCA) and cardiopulmonary
bypass (CPB) to prevent clot formation.
1) Danaparoid (Orgaran)
– 2) Fondaparinux (Arixtra)
1) Hirudin, lepirudin (Refludan)
2) Argatroban
Mixtures of phospholipids and recombinantly
derived human tissue factor.
Detecting deficiencies of fibrinogen and
alterations in the conversion of fibrinogen to
Hematology PPT Flashcards Unit 4
The normal value of 200 to 400 mg/dL may
be decreased in?
What is the normal titer of fibrinogen?
What does the thrombin time test determines?
What is the normal value of thrombin?
What is the Reptilase time assay similar to?
What is the D-Dimer?
What are the 3 major hemostatic stages that
must be functioning in order for D-dimers to
All 3 of these stages require adequate
formation of?
What are 4 normal protective mechanisms
against Thrombosis?
In the blood circulation, the predisposition to
thrombosis depends on?
Several important biological activities
normally protect the body against thrombosis.
What are these activities?
What does the normal flow of blood prevent?
This mechanism reduces the chance of?
What is another normal mechanism against
inappropriate thrombosis?
What does this process, along with the
naturally occurring inhibitors do?
Why is the removal of particulate material by
the cells of the mononuclear phagocytic
system also important?
Liver disease or the consumption of fibrinogen
owing to accelerated intravascular clotting
1:128 to 1:256.
The rate of thrombin-induced cleavage of
fibrinogen to fibrin monomers and the
subsequent polymerization of hydrogen-bonded
fibrin polymers to form an insoluble fibrin clot.
The normal value is less than 20 seconds.
The thrombin time assay.
Is a specific fragment generated from two crosslinked fibrin molecules after a clot has formed.
1) Coagulation to form the clot
2) Covalent cross-linking of fibrin by activated
factor XIII
3) Fibrinolysis to dissolve the fibrin clot into
smaller fragment
1) Normal blood flow
2) Removal of activated clotting factors and
particulate material
3) The natural anticoagulant systems
4) Cellular regulators
The balance between procoagulant and
anticoagulant factors.
-The normal flow of blood
-The removal of activated clotting factors and
particulate material
-Natural anticoagulant systems known to be
operative in vivo:
* Antithrombin III (AT-III)
* Heparin cofactor II (HC-II)
* Protein C and its cofactor, protein S
-Cellular regulators
The accumulation of procoagulant material.
Local fibrin formation.
The removal of activated clotting factors by
hepatocytes from the blood.
Limits intravascular clotting and fibrinolysis by
inactivation of such factors as XIa, IXa, Xa, and
It prevents the initiation of coagulation.
Hematology PPT Flashcards Unit 4
Why is the in vivo existence of natural
anticoagulant systems essential?
What are the natural anticoagulant systems?
What are AT-III and HC-II?
When activated, protein C is capable of
degrading which activated factors?
What is considered the major inhibitor of
What are the serpin superfamily of serine
proteinase inhibitors?
To prevent thrombosis.
Antithrombin III, heparin cofactor II, and
protein C and its cofactor, protein S
Serine-protease inhibitors.
V (Va) and VIII (VIIIa) in the presence of the
cofactor protein S.
Antithrombin III (AT-III)
III (AT-III), alpha-1 antitrypsin, C1 inhibitor,
alpha-2 antiplasmin, heparin cofactor II, and
plasminogen activator inhibitor.
Heparin is produced endogenously by?
Mass cells.
Heparin-like molecules are found in the?
What are the two heparin-dependent thrombin AT-III heparin cofactor and heparin cofactor II,
inhibitors present in human plasma?
previously referred to as heparin cofactor A.
The inhibitory activity of heparin cofactor II
is accelerated by?
What does the inhibition of thrombin by
The activity of thrombin or fibrinogen; also
heparin cofactor II not limited to?
inhibited are thrombin-induced platelet
aggregation and release.
In addition to thrombin, heparin cofactor II
also inhibits?
Heparin cofactor II does not significantly
Blood coagulation factors IXa, Xa, and XIa or
What 2 proteins are involved in one of the
Protein C and S
major natural anticoagulation systems in the
Deficiency and/or alteration in either protein Predisposition to thrombosis.
(C and/or S) have been clearly associated
What does Protein C (A vitamin K–dependent A natural anticoagulant formed in response to
plasma protein synthesized in the liver)
thrombin generation.
What is APC resistance (A hypercoagulable
A point mutation in the factor V gene [factor V
condition discovered in 1993) is associated
What does the mutation results in?
The replacement of Arg506 with Gln(Q) in the
factor V protein.
This mutation slows the inactivation of what
Factor Va by APC
factor causing a hypercoagulable state?
What is the most common cause of The
Inherited thrombophilia.
presence of factor V (Leiden)?
It accounts for ____? % to _____? % of the
20% to 50%
Protein S is another vitamin K–dependent
APC to express an anticoagulant effect.
Hematology PPT Flashcards Unit 4
plasma protein that is an essential cofactor
Protein S does not require 1) ____?
modification to function, but it can be
regulated by 2) ____?
What is becoming recognized as essential to
the maintenance of hemostasis and
What are 2 powerful mechanisms to limit the
formation or spread of clotting and the
reliquefication of clots?
What have been demonstrated to be the major
pathway for activation of coagulation?
What has also been discovered about
What is the key enzyme in the conversion of
soluble fibrinogen into fibrin
What is required for the activation of the
protein C system, which downregulates
What is required for the activation of
thrombin-activatable fibrinolysis inhibitor
(TAFI), which is involved in the
downregulation of the fibrinolytic process?
What has led to the development of
alternative schematic representations of the
pathways that better represent the normal in
vivo process of coagulation?
What may cause abnormal bleeding?
What is purpura?
Purpura is characterized by?
Purpura may be produced by a variety of
vascular abnormalities such as?
1) Proteolytic
2) proteolysis.
Cellular activities related to thrombosis
Plasma possesses, and plasmin
Tissue factor and factor VIIa in the extrinsic
That it has a far more important role as an
activator and an inhibitor.
The cumulative result of new discoveries in
coagulation has led.
Disorders of the microcirculation, platelets, or
plasma proteins.
Abnormal bleeding involving the loss of red
blood cells from the microcirculation.
Hemorrhages into the skin, mucous membranes,
and internal organs.
1) Purpura associated with direct endothelial
cell damage. Endothelial damage may result from physical
or chemical injury to the tissue caused by microbial agents such
as in rickettsial disease or immunological antibody-mediated
injury. Bacterial toxins produce deendothelialization induced by
an endotoxin. Antibody vascular injury, vasculitis, may be
induced by drug reactions, insect bites, or the activation of
2) Purpura associated with an inherited
disease of the connective tissue. Alterations of the
vascular supportive framework can occur in disorders such as
3) Purpura associated with decreased
mechanical strength of the microcirculation.
Hematology PPT Flashcards Unit 4
Decreased strength can be seen in conditions such as scurvy and
4) Purpura associated with mechanical
disruption of small venules. The principal cause of
this type of purpura is increased intraluminal pressure. This
condition can be observed around the ankles with prolonged
standing and may be caused by the presence of abnormal
proteins in macroglobulinemias or hyperviscosity disorders.
5) Purpura associated with microthrombi
(small clots). This type of disorder is associated with
abnormal intravascular coagulation conditions.
6) Purpura associated with vascular
malignancy. Purpura of this origin is observed in Kaposi
sarcoma and vascular tumors.
What are the disorders of platelet size?
What is Wiskott-Aldrich syndrome?
What is May-Hegglin anomaly?
What is Alport syndrome?
What is Bernard-Soulier syndrome?
1) Wiskott-Aldrich syndrome
2) May-Hegglin anomaly
3) Alport syndrome
4) Bernard-Soulier syndrome
Is the smallest platelets seen.
It is characterized by the presence of large
platelets and the presence of Döhle-like bodies
in the granulocytic leukocytes.
Exhibits giant platelets and thrombocytopenia
Is the largest platelets seen and is also referred
to as giant platelet syndrome.
150 x 109/L to 450 x 109/L
What is the normal range of circulating
When the quantity of platelets decreases to
levels below 150 x 109/L to 450 x 109/L a
condition known as _____? exists.
Is the quantity of platelets increases then what Thrombocytosis
is the result?
Disorders of platelets can be classified as?
Quantitative (thrombocytopenia or
thrombocytosis) or qualitative
If platelets are absent or severely decreased
The presence of petechiae or purpura.
below 100 x 109/L, what clinical symptoms
are usually seen?
What is Petechiae?
Small purplish hemorrhagic spots on the skin or
mucous membranes.
What is Purpura?
It is characterized by extensive areas of red or
dark-purple discoloration.
Most thrombocytopenic conditions can be
1) Disorders of production of platelets may be
classified into major categories such as?
caused by hypoproliferation of the
megakaryocytic cell line or ineffective
thrombopoiesis caused by acquired conditions
Hematology PPT Flashcards Unit 4
What is the most drug-induced
What are the predominant clinical symptoms
of HI?
What are the two types of HIT that exist?
What replace the term idiopathic
thrombocytopenic purpura?
What is immune thrombocytopenia (ITP)?
What can contribute to the increased
utilization of platelets?
What rapidly consumes platelets?
What are some examples of disorders that can
trigger the accelerated consumption of
What can contribute to the
Why do vascular injuries (vasculitis) causes a
decrease in platelets?
What is thrombotic thrombocytopenic
purpura (TTP)?
What are the diagnostic of the diseases TTP?
In TTP, coagulation testing will demonstrate
1) ____ prothrombin and 2) _____ partial
thromboplastin time but 3) ______D-dimer
and fibrinogen levels.
TTP is in contrast to DIC, which
demonstrates 1) _____ prothrombin time and
2) _____ partial thromboplastin time.
What 3 types of TTP have been identified?
or hereditary factors.
2) Disorders of destruction, including decreased
megakaryocytopoiesis and ineffective platelet
production, and disorders of utilization. It may
result from a number of mechanisms—drugs,
bacterial sepsis, etc.
3) Disorders of platelet distribution and dilution
Heparin-Induced Thrombocytopenia (HIT)
Thrombocytopenia and thrombosis
1) Nonimmune HIT: Type I
2) Immune HIT: Type II
New standard nomenclature, immune
thrombocytopenia (ITP)
ITP is an acquired immune-mediated disorder
characterized by isolated thrombocytopenia
(platelet count <100 x 109/L) and the absence of
any obvious initiating and/or underlying cause
of the thrombocytopenia.
Intravascular coagulation, vascular injury or
occlusion, and tissue injury.
DIC (disseminated intravascular coagulation)
Trauma, obstetrical complications, and
microbial sepsis.
In the case of bacterial sepsis, thrombin-induced
platelet aggregation in vivo contributes to
Because of the direct consumption of platelets at
the sites of endothelial loss without appreciable
depletion of clotting factors such as fibrinogen.
Is a clinical syndrome with a high mortality rate
that is characterized by formation of
microthrombi in the microvasculature.
The hematological findings of
thrombocytopenia and red blood cell
1) Normal
2) Activated
3) Elevated
1) Abnormal
2) Activated
1) Idiopathic
Hematology PPT Flashcards Unit 4
A platelet distribution disorder can result
This type of thrombocytopenia develops
Disorders that may produce splenomegaly
with resultant splenic pooling or delayed
intrasplenic transit include?
2) Secondary
3) Inherited (Upshaw-Shculman)
A pooling of platelets in the spleen, which is
frequent if splenomegaly is present.
More than a double or triple increase in platelet
production is required to maintain the normal
quantity of circulating platelets.
Alcoholic or posthepatic cirrhosis with portal
hypertension, lymphomas, and leukemias and
lipid disorders, for example, Gaucher disease.
Generally defined as a substantial increase in
circulating platelets over the normal upper
limit of 450 x109/L. Thrombocytosis can be
classified into three major categories which
1) Hereditary or familial thrombocytosis
associated with germline mutations of the
thrombopoietin (THPO) gene in the
thrombopoietin receptor (MPL) gene
2) Thrombocytosis associated with
myeloproliferative neoplasms and/or
myelodysplastic disorders (clonal
thrombocytosis associated with somatic
mutations of JAK2 [V617F], MPL, and
additional currently unknown genes)
3) Reactive (secondary thrombocytosis)
If platelets are normal in number but fail to
perform effectively then….?
In addition to both individual and family
medical histories, laboratory tests are critical
What do Laboratory tests of platelet function
A platelet dysfunction exists.
Three separate categories of platelet
dysfunction can be identified based on?
Hyperactive platelets associated with
hypercoagulability and thrombosis make up
an additional category of what?
Examples of inherited disorders include?
Determining a platelet dysfunctional diagnosis.
bleeding time, clot retraction, platelet
aggregation, platelet adhesiveness, and
antiplatelet antibody assay.
Etiology- the more common acquired causes
and the less frequent hereditary causes.
Abnormal platelet function.
Bernard-Soulier syndrome and Glanzmann
Vascular response and platelet plug formation.
What is responsible for the initial phases of
Subsequent to these activities what is initiated The clotting factors
to form the fibrin clot?
Fibrin formation can occur if ?
The activity of various factors is at least 30% to
Hematology PPT Flashcards Unit 4
40% of normal.
A coagulation factor
Bleeding and defective fibrin clot formation
are frequently related to what?
Disorders of the blood coagulation factors can 1) Defective production may be related to a
be grouped into three categories, which are?
deficiency of vitamin K. Classic hemophilia
(hemophilia A) and von Willebrand disease are
examples of hereditary disorders that represent
functionally inactive factor VIII.
2) Excessive destruction
3) Pathological inhibition
What is hemophilia ?
When a clotting factor is either missing or is not
working to its full ability causing for a greater
chance of prolonged bleeding as well as the
blood taking longer to clot
Is there a cure for hemophilia
No cure is a life long disease but can be treated
and managed
What causes hemophilia ?
It is an X-linked autosomal recessive disease
this means that the women are the carries and
the men are affected
What is hemophilia A?
Clotting factor 8 is either deficient or not present
What is hemophilia B?
Clotting factor 9 is deficient or not present
What is Von willebrand Disease ?
This is when vonon willebrand clotting
factor is not present this can affect both
men and women
What is mild severity of hemophilia?
What are manifestation of hemophilia ?
What types of tests are done to diagnose
True or false ? von willebrand disease may be
an acquired or inherited disorder ?
What distinguish von willebrand disease from
classic factor V111: C ?
Von wildebrand’s disease occurs in ____of
_________is a major relatory mechanism of
Pts who have herediatary protein Cor S
6%-50% of the clotting factor is active
Hemarthrosis- bledding in the joint
Hematuria- blood in the urine
Partial thromboplastin time (ptt)
Typically prolonged
Prothrombin time (pt)
Bleeding time
Fibrinogen level
Platelet count
Factor 8,9 and van willebrand assay
Genetic testing
A deficiency of factor V111 procoagulant
Protein C (PC)
Skin necrosis
Hematology PPT Flashcards Unit 4
deficiency have of what if take Coumadin?
Is homozygous antithrombin deficiency
compatible with life?
What is DIC ?
What include triggering events that may
predispose patients to DIC ?
What are some examples of clinical situations
in which tissue thromboplastin can activate
coagulation ?
Through what 4 ways does the body stop the
clotting process ?
How does Heparin help inhibit the clotting
process ?
How does TFPI (Tissue Factor Pathway
Inhibitor) work ?
How does fibrinolysis happen ?
What is disseminated intravascular
What are some characteristics of DIC
What is DIC caused by?
Is DIC a primary or secondary?
DIC is a complication or intermediary phase of
many diseases and does not constitute a disorder
in itself
Alterations in the endothelium direct activation
of fibrinogen release of thromboplastin-like
substances and erythrocyte or platelet
Extravascular trauma abruption placentae
advanced malignancy leukemia and retained
fetal synf=rome
antithrombin III
Protein C / Protein S /
catalyzes antithrombin III's inactivation of IX,
X, XI, and thrombin
complexes with factors VIIa, TF, and Xa, and
inactivates Xa
TPA (Tissue Plasminogen Activator), which is
on the surface of endothelial cells, converts
plasminogen--> plasmin. Plasmin is a general
protease that loves blasting proteins w/lysine
residues. Fibrin has a lot of lysine residues, so it
looks particularly sexy to plasmin (high
affinity). It turns what was once a cold-hearted
insoluble clot all soluble and easygoing, and Ddimers float around.
A life-threatening uncontrolled activation of the
coagulation system
1. Widespread small vessel thrombosis
2. Consumption of platelets and factors
3. Uncontrolled bleeding due to depletion of
platelets and coagulation factors
4. organ failure
Various clinical conditions that activate clotting
Septic shock
DIC is never a primary condition. It is always
secondary to another problem (ex: a person
in septic shock would have DIC as a
Hematology PPT Flashcards Unit 4
Describe the onset and end result of DIC
Why is DIC considered a consumptive
colaguopathy ?
What does consumption of coagulation
factors and platelets result in?
Why does hemorrhage occur?
What occurs in all preestablished clots?
How type of cycle is DIC?
Stimulation of clottiing --> Thrombosis emboli
formation --> Vascular occlusion -->
Organ/tissue ischemia --> Infarction -->
Because there's a primary stimulus that
stimulates the body to think that it has a major
issue where it needs to form clots (may be true
in some cases for a trauma patient that is
actively bleeding)
As the small clots
consume coagulation proteins and platelets,
normal coagulation is disrupted and abnormal
bleeding occurs from the skin
Because platelets and coagulation factors are no
longer present
Clot is programmed to break down and
Fibrinolysis starts
Vicious cycle of clotting and bleeding
What are two abnormal coagulation
profiles that decrease?
Thrombocytopenia (decrease in
Decreased clotting factors
(any Roman numeral, fibrinogen, or thrombin)
What are two abnormal coagulation
profiles that increase?
What are some treatments for DIC?
Increased clotting measurements/ amount of
time (Prothrombin time, Partial prothrombin
time, bleeding times)
Increased Fibrin
Degradation Products (FDPs) or Fibrin Split
Products (FSPs)
-->D-Dimer is specifically
measurable with FDP to indicate Fibrinolysis
Monitor CBC for evolving and worsening
*The anemia will normally be
Normocyctic normochromic from acute
hemorrhage situation
What are some treatments for DIC?
What is responsibility of hematology
Remove percipitating primary) problem
(because DIC is secondary
Restore balance between
coagulation and fibrinolysis
Maintain organ
viability Administer anti- coagulants
Gross physical examination, total cell count,
How should DIC be evaluated?
Hematology PPT Flashcards Unit 4
technicians and technologists?
microscopic examination, and other special tests
Where are chemical analyses and
microbial and cytological examinations?
Examinations are generally performed in the
chemistry, microbiology, and cytology
departments, respectively
Where sterile body fluid can be found?
It found in various body cavities under normal
conditions. In diverse disorders and disease
processes, the quantity of these fluids can
increase significantly. Fluid specimens aspirated
from different anatomical sites and examined for
the total number of cells, differentiation of cell
types, chemical composition, and microbial
How all body fluids are should be
handled with caution?
Standard precautions must be practiced.
What are the type of examination
performed on the body fluid depends
the body fluid depends on the source of the
specimen. However, a portion of the
examination of cerebrospinal fluid (CSF);
serous fluids from the pleural, pericardial, and
peritoneal cavities; synovial fluid; and seminal
fluid is frequently performed in the hematology
What the most is commonly analyzed body
Cerebrospinal Fluid
How cerebrospinal fluids (CSF) are acts?
CSF acts as a shock absorber for the brain and
spinal cord, circulates nutrients, lubricates the
central nervous system (CNS), and may also
contribute to the nourishment of brain tissue.
Where cerebrospinal fluids (CSF) are
circulates through?
The CSF circulates through the ventricles and
subarachnoid space that surrounds both the brain
and the spinal cord. The ventricles consist of
four hollow, fluid-filled spaces inside the brain.
Hematology PPT Flashcards Unit 4
What CSF is production?
What the plexus is composed of two layers?
What make constitute the anatomical
structure of the blood-brain barrier?
Where CSF is found?
How many the total maximum volume of
CSF in adults is?
How to measure CSF?
How a specimen of CSF is examined?
A lateral ventricle lies inside each hemisphere of
the cerebrum
Primarily a function of the choroid plexus, with
a smaller proportion being derived from the
ependymal lining and perivascular spaces
The ependyma (the lining epithelium of the
ventricle) and the pia mater. The plexuses in the
lateral ventricles are the largest and produce
most of the CSF.
The choroid plexus epithelium and the
endothelium of capillaries in contact with CSF.
Inside all the ventricles, in the central canal of
the spinal cord, and in the subarachnoid space
around both the brain and the spinal cord.
About 150 mL. The maximum volume in
neonates is approximately 60 mL.
Introducing a needle into the subarachnoid space
makes it possible to measure CSF pressure and
to obtain fluid for analysis.
A specimen of CSF is examined visually and
The total number of cells can be enumerated,
and the types of cells can be morphologically
.Gross physical examination
What normal CSF is contains?
How many WBC count are low or high?
A few mononuclear cells (lymphocytes and
monocytes) and rare ependymal cells. Very few
leukocytes should be seen in normal CSF. The
generally accepted total number of WBCs in the
CSF ranges from 0 to 5 cells/mL or 0 to 5 ×
106/L. A value of up to 20 x106/L can be
considered within the range of normal for
children and adults. Neonates have a higher
normal range, 0 to 30 cells × 106/L.
Occasionally, the WBC count may be very low
(0 to 20 × 106/L), but the CSF is turbid because
of a high concentration of bacteria. In acute,
untreated bacterial meningitis, the CSF
leukocyte count usually ranges from 100 to
10,000 cells × 106/L. Very high WBC counts
Hematology PPT Flashcards Unit 4
Cells Unique to the Cerebrospinal Fluid
Body fluids that are analyzed in the
hematology laboratory.
What is an effusion?
What transudates generally?
What exudates are?
What is pleural fluid?
How difference color between transudates
and exudates?
Erythrocyte and leukocyte counts
How WBC count are effect transudates and
Cell types that can be encountered in the
examination of a Wright-Giemsa–stained
specimen include the following:
(greater than 50,000 × 106/L) are unusual and
suggest intraventricular rupture of a brain
Ependymal cells
Choroidal cells
Pleural, Peritoneal, and Pericardial Fluids
An effusion is an abnormal accumulation of
fluid in a particular space of the body. Effusions
in the pleural, pericardial, and peritoneal cavities
are divided into transudates and exudates.
Fluid has accumulated because of the presence
of a systemic disease.
Associated with disorders such as inflammation,
infection, and malignant conditions involving
the cells that line the surfaces of organs (e.g.,
lung or abdominal organs).
normally produced by the parietal pleura and
absorbed by the visceral pleura as a continuous
process. Although healthy individuals form 600
to 800 mL of fluid daily, the normal volume of
fluid in each pleural space is estimated at less
than 10 mL.
Aspiration of pleural fluid is referred to as
Transudates are usually clear, are pale yellow,
and do not clot. In comparison, exudates can
display a range of colors depending on the
associated disorder.
They are of limited value in the differential
diagnosis of pleural effusions. A massively
bloody (hemorrhagic) effusion in the absence of
trauma almost always suggests malignancy, or
occasionally pulmonary infarct.
Extremely elevated total leukocyte (WBC)
counts of 50.0 × 109/L or higher are consistent
with a diagnosis of empyema. In general, WBC
counts less than 1.0 × 109/L are associated with
transudates, and WBC counts greater than 1,000
× 109/L are associated with exudates.
Neutrophils (PMNs)
Plasma cells
Mononuclear phagocytes (monocytes,
Hematology PPT Flashcards Unit 4
What is peritoneal Fluid?
How about an abnormal amount of fluid (an
What are result of the collection of fluid in
the peritoneal cavity, ascites?
What are causes of Peritoneal Effusions?
How can effusions that may conform with the
definition of transudates?
What the laboratory are criteria for
distinguishing transudates from exudates?
How difference baboratory Analysis of
transudates and exudates?
What includes of an evaluation of ascitic fluid
What is total WBC count higher than 0.3 ×
histiocytes, and macrophages)
Mesothelial cells (normal, reactive, atypical,
and malignant)
Metastatic tumor (malignant) cells
A body fluid that is analyzed in the hematology
It can accumulate in the peritoneal cavity if the
balance between fluid formation and
reabsorption is altered by a disease process.
Results from increased hydrostatic pressure in
the systemic circulation, increased peritoneal
capillary permeability, decreased plasma
oncotic pressure, or decreased fluid
reabsorption by the lymphatic system.
The causes of peritoneal effusions range from
disorders and diseases that directly represent
involvement of the peritoneum, such as
bacterial peritonitis, to abdominal conditions
that do not directly involve the peritoneum,
such as hepatic cirrhosis, cirrhosis, congestive
heart failure, Budd-Chiari syndrome,
hypoalbuminemia (caused by nephrotic
syndrome or protein-losing enteropathy
malnutrition), and miscellaneous disorders
such as myxedema, ovarian diseases,
pancreatic disease, and chylous ascites.
Can be associated with congestive heart failure,
hepatic cirrhosis, and hypoproteinemia.
less clearly defined for peritoneal (ascitic) fluid
than for pleural fluid.
Transudates are usually clear and pale yellow.
Exudates are cloudy or turbid because of an
increased concentration of leukocytes, elevated
protein levels, and occasionally
microorganisms. Exudates may be seen in
peritonitis, cases of perforated or infarcted
intestine, and pancreatitis.
gross inspection, total cell count, microscopic
examination of sediment for cell
differentiation, cytological studies, chemical
analysis for constituents such as total protein
and lactic dehydrogenase, and microbial
Total WBC counts are of limited value in
differential diagnosis, but a total WBC count
higher than 0.3 × 109/L is considered to be
Hematology PPT Flashcards Unit 4
What is A wide variation in the peritoneal
WBC count?
An abnormal accumulation of fluid in the
cavity, a ?, is most frequently caused by
damage to the lining of the cavity and
increased capillary permeability.
In addition, in acute pericarditis, interference
with ? venous and lymphatic drainage
predisposes the patient to effusion
A wide variety of diseases and disorders can
produce ? effusion.
Normal fluid is 1 and 2. Hemorrhagic
(bloody) effusions may result from a variety
of abnormal conditions or from aspiration of
intracardiac blood into the specimen.
On visible examination, a hemorrhagic
effusion should not form clots in a plain
(nonanticoagulant) tube, but aspirated blood
usually exhibits clotting. A milky-appearing
effusion may be a true or ? fluid.
Erythrocyte and leukocyte cell counts are of
limited value in the differential diagnosis of a
A ? is a body fluid that is analyzed in the
hematology laboratory.
Seminal fluid (semen) is examined 1 and 2.
Semen analysis is the primary test for the
evaluation of male infertility. Sperm
concentration, motility, and morphology can
be used to classify men as what other 3
? also can be analyzed for a variety of
reasons, including artificial insemination
protocols, postvasectomy assessment, and
evaluation of probable sexual assault.
A fresh specimen is needed. It is mandatory
that the specimen be kept at ?°C and
examined within 1 hour of collection. After
60 minutes of storage in a plastic container,
sperm motility is significantly reduced.
Is the following macroscopic or microscopic?
A fresh specimen should be examined for
It seen in patients with chronic liver disease
because of extracellular shifts in fluid
associated with ascites formation or resolution.
pericardial effusion
1. Transparent
2. pale yellow
pericardial effusion
Seminal fluid
1. macroscopically
2. microscopically
subfertile, of indeterminate fertility, or fertile.
Hematology PPT Flashcards Unit 4
coagulum formation, color, pH, volume, and
Is the following macroscopic or microscopic? microscopic
Enumeration of the number of sperms and
examination of the morphological
characteristics of the cells are routinely
performed procedures. Other microscopic
procedures include motility, viability, and
agglutination studies.
What type fluid is a transparent, viscous fluid Synovial (joint)
secreted by the synovial membrane. This fluid
is found in joint cavities, bursae, and tendon
Arthrocentesis constitutes a liquid biopsy
of the ?.
Disorders such as gout, calcium
pyrophosphate dihydrate (CPPD) deposition
disease, and septic arthritis can be diagnosed
definitively by synovial fluid analysis and
may allow for consideration or exclusion of
rheumatoid arthritis and ?
Synovial fluid is readily obtained by ? from
most joints. Frequent sites of ? include the
knee, shoulder, elbow, wrist, interphalangeal
joints, hip, and ankle.
Routine analysis of synovial fluid should
include microscopic examination of a wet
preparation, crystals, Gram stain, and ?
If the fluid is very turbid, or if septic arthritis
is considered for other reasons, the specimen
should be sent for 1. And 2.?
True or False? A Gram stain is needed if a
high likelihood of infection exists.
Other observations or procedures can include
volume and appearance, viscosity, mucin test,
chemical analysis for protein, and glucose.
This is what type of examination?
Normal, noninflammed joints have small
quantities of clear or transparent fluid. This
fluid is viscous and slightly alkaline and, if
normal, does not clot. This describes what?
The best use of the ? test is to distinguish the
anatomical origin of bloody or other fluids.
The presence of a mucin clot implies that it is
systemic lupus erythematosus (SLE).
1. Gram stain
2. culture
mucin clot
Hematology PPT Flashcards Unit 4
synovial fluid.
A differential cell count on a body fluid
– hemocytometer
should be performed on stained smears
prepared from a concentrated preparation—
not in a ?. Some of the techniques of sediment
preparation and staining are different for body
fluids than for blood.
Morphological descriptions of cells
1. Wright
encountered in body fluids reflect their
2. Wright-Giemsa stain.
microscopic appearance with 1. or 2?
The coloration of cells with Papanicolaou
• Cytological
stain is somewhat different. Papanicolaou
stain is a commonly used what type of stain?
The following describe what type of
CLSI Pricedural Format
• Procedure title and specific method
• Test principle including type of
reaction and the clinical reasons for
the test
• Specimen collection and preparation
• Reagents, supplies, and equipment
• Calibration of a standard curve
• Quality control
• Procedure
• Calculations
• Reporting results (normal values)
• Procedure notes including sources of
error, clinical applications, and
limitations of the procedure
• References
T or F? All specimens should be treated
with caution. All blood, tissues, and blood
derivatives should be considered
potentially infectious.
A stained smear is examined to determine
the percentage of each type of leukocyte
present and assess the erythrocyte and
platelet ?.
Increases in any of the normal leukocyte
types and the presence of immature
leukocytes or erythrocytes in peripheral
blood are important diagnostically in a
wide variety of inflammatory disorders
and ?
Erythrocyte abnormalities are clinically
Hematology PPT Flashcards Unit 4
important in various ?.
Platelet size irregularities are suggestive
of particular what type of disorders?
Disorders associated with increases or
decrease in normal leukocyte types?
• Neutrophils
Bacterial infections, inflammation, stress,
and chronic leukemia
• Lymphocytes
Viral infections, whooping cough, and
chronic leukemia
• Monocytes
Tuberculosis, rheumatoid arthritis, and
fever of unknown origin
• Eosinophils
Active allergies and invasive parasites
• Basophils
Ulcerative colitis and hyperlipidemia
The packed cell volume (PCV) is a
measurement of the ratio of the volume
occupied by the RBCs to the volume of whole
blood in a sample of ?.
Following centrifugation, this ? is measured
and expressed as a percentage or decimal
The ? is used to calculate the mean
corpuscular volume (MCV) and the mean
corpuscular hemoglobin concentration
True or False? The PCV is used to detect
anemia, polycythemia, hemodilution, or
capillary or venous blood
Name the 11 elements that the CLSI
Procedural Format must have.
Procedure title and specific method
Test principle
Specimen collection and preparation
Reagents, supplies, and equipment
Calibration of a standard curve
Quality control
Reporting results (normal values)
Procedure notes
Hematology PPT Flashcards Unit 4
What must be included in Test Principle?
What must be included in the Procedure
How must all specimens be treated?
Type of reaction and Clinical reasons for the
Sources of error, clinical applications, and
limitations of the procedure.
With Caution
What specimens should be considered
potentially infectious?
What are the 5 basic procedures in
All blood, tissues, and blood derivatives.
What is the principle of Leukocyte
Differential Count?
Increases in any of the normal leukocyte
types and the presence of immature
leukocytes or erythrocytes in peripheral blood
are important diagnostically in what?
What are erythrocyte abnormalities are
clinically important in?
Platelet size irregularities are suggestive of
Disorders associated with Neutrophils are?
Disorders associated with Lymphocytes are?
Disorders associated with Monocytes are?
Disorders associated with Eosinophils are?
Disorders associated with Basophils are?
How to you read a slide when doing a
differential count?
What is packed cell volume (PCV)?
How is the ratio is measured and expressed?
What does the PCV calculate?
What are the PCV Reference values?
What is the PCV is used to detect?
What are the 3 calculations of RBC Indices?
• Leukocyte differential count
• Packed cell volume of whole blood
• Red blood cell indices
• Reticulocyte count
• Sedimentation rate of erythrocytes
To determine the percentage of each type of
leukocyte present and assess the erythrocyte
and platelet morphology
A wide variety of inflammatory disorders and
Various anemias
Thrombocyte disorders
Bacterial infections, inflammation, stress, and
chronic leukemia
Viral infections, whooping cough, and chronic
Tuberculosis, rheumatoid arthritis, and fever of
unknown origin
Active allergies and invasive parasites
Ulcerative colitis and hyperlipidemia
Up, Across, Down, Across
A measurement of the ratio of the volume
occupied by the RBCs to the volume of whole
blood in a sample of capillary or venous blood
As a percentage or decimal fraction.
The mean corpuscular volume (MCV) and the
mean corpuscular hemoglobin concentration
Males, 0.47 L/L ± 0.07
Females, 0.42 L/L ± 0.05
Anemia, polycythemia, hemodilution, or
Mean corpuscular volume
Hematology PPT Flashcards Unit 4
What does Mean Corpuscular Volume
(MCV) do?
What is the MCV Reference value?
What does Mean Corpuscular Hemoglobin
(MCH) do?
What is MCH directly proportional to?
What is the MCH Reference value?
What does Mean Corpuscular Hemoglobin
Concentration (MCHC) do?
What does the MCHC defined as the ratio of?
What is the MCHC Reference value?
How do you calculate MCHC?
What is a reticulocyte?
What is Renumeration of reticulocytes
important in?
What type of stain is new methylene blue N?
What does new methylene blue N cause?
What is Reticulum?
What is the Reference value of Reticulocytes
in methyl blue?
Name 2 disorders associated with abnormal
reticulocyte results.
What does Sedimentation rate measures?
What does Sedimentation rate depend on?
What is the clinical value of this procedure?
What are 2 other names for Sedimentation
Rate of Erythrocytes?
What is ESR directly proportional to?
Which sediments more slowly, microctytes or
Mean corpuscular hemoglobin
Mean corpuscular hemoglobin concentration
It expresses the average volume (size) of an
80 to 96 fL
It expresses the average weight (content) of
hemoglobin in an average erythrocyte.
The amount of hemoglobin and the size of the
27 to 32 pg
It expresses the average concentration of
hemoglobin per unit volume of erythrocytes.
The weight of hemoglobin to the volume of
32% to 36%
Hemoglobin (g / dL)
 g / dL
PCV or hematocrit (L / L)
An erythrocyte still possessing RNA
Assessing the status of erythrocyte production
in the bone marrow (erythropoiesis).
Supravital stains
Ribosomal and residual RNA to co-precipitate
with the few remaining mitochondria and
ferritin masses in living young erythrocytes to
form microscopically visible dark-blue clusters
and filaments.
Clusters and filaments.
0.5% to 1.5%; neonates, 2.5% to 6.5%
Decreased reticulocytes - Aplastic anemia
Increased reticulocytes - Acute blood loss
The rate of settling of erythrocytes in diluted
human plasma
An interrelationship of variables, such as the
plasma protein composition, the concentration
of erythrocytes, and the shape of the
It is in the diagnosis and monitoring of
inflammatory or infectious states.
ESR and Sedrate
The weight of the cell aggregate and inversely
proportional to the surface area.
Hematology PPT Flashcards Unit 4
Name 3 factors that contribute to decrease in
Name 3 irregular erythrocyte shapes.
When is an increased ESR value seen
What are some clinical conditions associated
with increased ESR values?
Give an example of tissue necrosis.
Name 10 Specialized hematology procedures.
What test is Acid serum lysis called?
How do you test for hemolysis?
Weak acid is used in specific serum cell
mixtures to maximize what?
The presence of hemolysis may be observed
in cases such as?
How is a marrow examined histologically?
Who preforms a bone marrow aspiration?
What does the physician examine in the bone
What Stain(s) is used on bone marrow
What is bone marrow examination?
Give an example of a bone marrow
 The removal of fibrinogen by defibrination
 Erythrocytes with abnormalities
o Erythrocytes with irregular shapes
 Sickle cells
 Spherocytes
 Hinder rouleaux
various abnormal blood conditions: rouleaux,
increased fibrinogen levels, a relative increase
of plasma globulins caused by the loss of plasma
albumin, and an absolute increase of plasma
a) Anemia, infections, inflammation, tissue
necrosis, pregnancy, and some types of
hemolytic anemia
b) Myocardial infarction.
• Acidified serum lysis test
• Bone marrow examination
• Donath-Landsteiner screening test
• Glucose-6-phosphate dehydrogenase activity
in erythrocytes
• Hemoglobin electrophoresis
• Hemoglobin S screening test
• Malarial smears
• Monospot test
• Osmotic fragility of erythrocytes
• Sucrose hemolysis test
HAM test
Erythrocytes are incubated with fresh and heated
Hemolytic activity.
Antibody-sensitized coated erythrocytes,
spherocytes, or paroxysmal nocturnal
hemoglobinuria (PNH).
By using a hematoxylin-eosin (H&E) stain.
A physician
Cellular activities of the marrow
Wright-Giemsa stain
Prussian blue and cytochemical stains
Is valuable in the diagnosis of disorders and in
the study of leukemia’s and some types of
anemia specifically involving the marrow
Multiple myeloma.
Hematology PPT Flashcards Unit 4
What's the normal distribution of bone
marrow cells in an adult?
What is the myeloid:erythroid ratio?
The Donath-Landsteiner screening antibody
test requires?
A positive result shows?
True or False: The observed rate of
appearance of bright fluorescence is
proportional to the blood G6PD activity.
What is one of the most prevalent hereditary
erythrocyte enzyme deficiencies?
A deficiency of G6PD can produce?
The movement of charged particles on
various media under the influence of an
electric current is called?
True or False: Particles move at the same
speeds because of their weight and electric
How is hemoglobin electrophoresis useful?
A hemolysate prepared from intact
erythrocytes is placed on which medium?
What describes a biphasic system with an
upper organic phase of toulene and a lower
aqueous phase of phosphate buffer, saponin,
and reducing agents?
How are erythrocytes lysed?
The released hemoglobin is reduced by?
The resulting colors of the aqueous phase and
the interface phase allow for the
differentiation of which hemoglobin types?
True or False: Detection of the abnormal Hb
S is diagnostic of sickle cell disease.
The detection of this heterozygous state is
important to which individuals?
Thick and thin blood smears are prepared,
stained and examined microscopically for
which malaria types?
What is the diagnosis of malaria based on?
What is based on agglutination of horse
erythrocytes by heterophile antibody in
Rubricytes, neutrophils, lymphocytes,
monocytes, megakaryocytes, reticulum cells,
plasma cells, myeloid, erythroid
M/E ratio 2.5:1
Cold incubation to exhibit hemolysis in the
patient's serum.
Paroxysmal cold hemoglobinuria(PCH), the
rarest form of autoimmune hemolytic anemia
Glucose-6-Phosphate Dehydrogenase (G6PD)
Drug or stress induced hemolytic anemia
To identify and quantify hemoglobin variants
and abnormal quantities of hemoglobin fractions
Cellulose acetate
Hemoglobin S Screening Test
By toluene and saponin
Sodium hydrosulfite
AA, AS, and SS
Long distance runners, test pilots
Plasmodium malariae, P. vivax, P. falciparum,
P. ovale
The demonstration of the Plasmodium species in
Monospot Test
Hematology PPT Flashcards Unit 4
infectious mononucleosis?
How is the specific heterophile antibody
distinguished from the Forssman type?
Serum or plasma is absorbed with?
What does Guinea pig kidney absorb?
What does beef erythrocytes absorb?
A positive reaction for heterophile antibody
occurs when?
Agglutination of horse RBCS by the absorbed
patient specimen indicates____ for
heterophile antibody
Guinea pig kidney contains only the ___ and
beef erythrocytes contain only the __
Whole blood is added to varying
concentrations of sodium chloride solution
and allowed to incubate at room temperature
in the ____ test?
How is the amount of hemolysis determined?
The main factor in this procedure is?
The shape of the erythrocyte depends on?
True or False: The fragility of erythrocytes is
increased when the rate of hemolysis is
True or False: If the rate of hemolysis is
increased, the erythrocytic fragility is
Which test demonstrates the sensitivity of
erythrocytes to the protein complement?
When do erythrocytes in PNH lyse?
Which cells are tartrate resistant?
Most of the acid phosphatase isoenzyme is
inhibited by?
Where are peripheral blood or bone marrow
smears fixed and incubated?
True or False: Lymphocytes display more
activity than other leukocytes.
Leukocyte alkaline phosphatase(LAP)
activity is often used to distinguish?
In a variety of conditions LAP activity can be
By differential absorption of the patient's serum
Both guinea pig kidney and beef erythrocyte
Only heterophile antibodies of the Forssman
Only the heterophile antibody of infectious
Agglutination of horse RBCs by the absorbed
patient specimen happens
A positive reaction
Forssman antigen, antigen associated with
infectious mononucleosis
Osmotic fragility test
By examining the supernatant fluid either
visually or with a spectrophotometer
The shape of the erythrocyte
The volume, surface area, functional state of the
erythrocytic membrane
Sucrose Hemolysis Test
When exposed to serum solutions of low ionic
strength containing complement
Hairy cell leukemia, Sezary syndrome, some Tcell acute lymphoblastic leukemias
L-tartaric acid
In a solution of naphthol As-BI phosphoric acid
and fast garnet GBC salt
Leukemoid reactions and chronic granulocytic
(myelogenous) leukemia
Increased, normal, or decreased
Hematology PPT Flashcards Unit 4
What is the leukocyte alkaline phosphatase
(LAP) procedure often used to distinguish?
Which best describes esterases?
This method distinguishes what?
How are positive reacting cells differentiated
from monocytes?
In the alpha- naphthyl acetate esterase
procedure, which is incubated with naphthol
AS-D chloroacetate?
Naphthol compounds are coupled with what?
Which represent unstable types of
hemoglobin, denatured by dyes and appear as
intraerythrocytic stained bodies?
How are Heinz bodies formed?
What is the significance of increased numbers
of Heinz bodies?
What happens shortly after birth to the
amount of fetal hemoglobin (Hb F)?
Increased amounts of Hb F are found in
which conditions?
What happens when leukocytes are treated
with Periodic Acid–Schiff (PAS)?
How is Myeloperoxidase (MP) detected?
Leukemoid reactions and chronic granulocytic
(myelogenous) leukemia
Ubiquitous in nature and encompass a variety of
different enzymes acting on selective substrates
Cells of the granulocytic series from cells of the
monocytic series, useful in differentiation of
Sodium fluoride is incorporated with the
incubation system.
Blood or bone marrow smears
Diazonium salt, forming highly colored deposits
at the sites of enzyme activity
Heinz bodies
When the glycolytic enzymes in the erythrocytes
are unable to prevent the oxidation of
Unstable forms of hemoglobin in hemolytic
disorders such as G6PD.
It decreases to low levels
Sickle cell anemia, thalassemias, and hereditary
persistence of fetal hemoglobin
When treated with periodic acid, glycols are
oxidized to aldehydes. After reaction with
Schiff’s reagent (a mixture of pararosaniline and
sodium metabisulfite) a pararosaniline adduct is
released that stains the glyco-containing cellular
elements. Clinically, the PAS stain is helpful in
recognizing some cases of erythroleukemia and
acute lymphoblastic leukemia.
Myeloperoxidase (MP) is detected by means of
the enzyme’s interaction with diaminobenzidine
(DAB), a benzidine substitute. The brown
reaction product is first intensified with copper
salts followed by Gill’s modified Papanicolaou
stain, which results in intense gray-black
granules at sites of neutrophil and monocyte
myeloperoxidase activity.
This procedure differentiates cells of lymphoid
origin from granulocytes and their precursors
and monocytes.
Hematology PPT Flashcards Unit 4
What is the Prussian blue reaction?
What is a sideroblast ?
When does a ring sideroblast occurs?
When is a Sudan Black B Stain performed?
What is a Terminal Deoxynucleotidyl
Transferase Test and where is it found?
What is a Specimen quality procedure?
What is a Special collection techniques?
The Prussian blue reaction precipitates free iron
into small blue or blue-green granules in
erythrocytes. Free iron is not identifiable on
Wright-stained or Wright-Giemsa–stained blood
A sideroblast or siderocyte is an immature or
mature erythrocyte containing free iron.
Increased numbers of siderocytes are seen in
disorders such as thalassemia major or in
patients after a splenectomy.
If the iron granules encircle the nucleus of the
erythrocyte, it is referred to as a ring sideroblast.
Although alcoholism is the most common cause
of ring sideroblasts, they may also be seen in
cases of lead poisoning or anemia.
Following fixation, blood or bone marrow films
are immersed in a buffered Sudan black B
solution. After rinsing, slides are counterstained
with Mayer hematoxylin. Cells are examined
microscopically for the presence of blue-black
discrete granulation.
Cells committed to the lymphoid pathway
display negative staining reactions, whereas
myeloid and monocytoid forms display
characteristic positive reactions. The Sudan
black B staining pattern usually parallels the
myeloperoxidase stain and is useful in the
identification of myelogenous and
myelomonocytic leukemias.
Terminal deoxynucleotidyl transferase (TdT) is
a non–template-directed DNA polymerase that
catalyzes the irreversible addition of
deoxynucleotides to the 3-hydroxy groups on
the end of DNA. The primary methods of
detection are immunofluorescence and
immunoperoxidase using a monoclonal
TdT is a cell marker found on immature and
neoplastic cells frequently seen in leukemic
All coagulation testing critically depends on the
quality of the specimen. Minimum tissue trauma
and the avoidance of hemolysis are essential.
Proper phlebotomy techniques must be strictly
To reduce the possibility of introducing tissue
Hematology PPT Flashcards Unit 4
What are some general sources of error?
How is quality control maintained?
List some of the Coagulation Procedures
Describe the principle of the Activated Partial
Thromboplastin Time procedure
How is the aPTT used?
How are the aPTT results reported?
What are the Clinical applications of the
thromboplastin into a whole blood sample and
the subsequent utilization of certain factors with
clot formation, certain techniques should be
All procedural directions must be strictly
followed because variations in pH, reagent
concentration, and temperature are major
sources of error.
Water baths and heat blocks must be monitored
continually for accurate temperatures.
Refrigerators and freezers should also be
monitored to ensure the stability of specimens
and test reagents.
Reagents must not be beyond their stated
expiration date. Procedural technique must be
consistent and appropriate.
Activated partial thromboplastin time,
Antithrombin III, Bleeding time, Circulating
anticoagulants, D-dimer assay, Euglobulin lysis
time, Substitution studies and factor
assays,Fibrin split products, Fibrinogen assay
The aPTT procedure measures the time required
to generate thrombin and fibrin polymers via the
intrinsic pathway. Although a partial
thromboplastin time test can be performed,
contact factors can be activated more thoroughly
by the addition of substances such as kaolin in
the activated form of this assay.
In the aPTT, calcium ions and phospholipids
that substitute for platelet phospholipids are
added to blood plasma. The generation of fibrin
is the end point.
–Clinically, the aPTT is used to identify and
quantitate deficiencies in the intrinsic clotting
system and to control anticoagulant therapy.
Reference values are dependent on the activator
and phospholipid reagents used; however, 20 to
35 seconds is typically normal. In some
laboratories, ranges may be from 28 to 42
seconds, with 42 to 46 seconds being marginal.
The aPTT is widely advocated as the test of
choice for the control of heparin therapy. It is
also important in the screening profile of
prekallikrein; high-molecular-weight kininogen;
factors XII, XI, IX, VIII, X, V, II, and I; and
Hematology PPT Flashcards Unit 4
Describe the principle of the Antithrombin
What is the advantage of the Bleeding Time
What is a circulating anticoagulant?
How can a circulating anticoagulant be
How can a circulating anticoagulant be
What are some of the anticoagulants that may
interfere with coagulation?
inhibitors against these factors.
In the presence of heparin, thrombin is
neutralized at a rate that is proportional to the
antithrombin (AT III) concentration. Following
defibrination, plasma is assayed in a two-stage
procedure that utilizes standardized amounts of
heparin, fibrinogen, and thrombin. The resulting
clotting time is interpreted using a calibration
Clinically, the AT III assay is useful prior to and
subsequent to treatment with heparin in cases of
disseminated intravascular coagulation (DIC).
The bleeding time test is an in vivo
measurement of platelet adhesion and
aggregation on locally injured vascular
subendothelium. This test provides an estimate
of the integrity of the platelet plug and thereby
measures the interaction between the capillaries
and the platelets.
Clinically, the bleeding time is prolonged in
thrombocytopenia, qualitative platelet disorders
such as von Willebrand disease, aspirin
ingestion, or the presence of vascular problems
When coagulation deficiencies are caused by
inhibitors to specific factors rather than the lack
of a factor, these inhibitors are sometimes
referred to as circulating anticoagulants .
To detect a circulating anticoagulant, the aPTT
and the PT that were originally abnormal are
repeated using various dilutions of patient
plasma and normal plasma.
The detection of an inhibitor may show up
immediately or may require incubation of the
normal plasma in the presence of the inhibitor.
Differentiation between a coagulation factor
deficiency and a circulating anticoagulant is
If the abnormality is that of a deficiency, a
normal plasma sample will correct the assay
results to a reference value.
If the abnormality is caused by a circulating
anticoagulant (inhibitor), a greater correction is
demonstrated as the ratio of normal plasma
increases in the mixture.
Various types of anticoagulants may interfere
with coagulation at different stages, especially
Hematology PPT Flashcards Unit 4
What is principle of the D-dimer assay?
Explain the principle of the Euglobulin Lysis
Describe Substitution studies Assay and how
they can be performed
What is the principle of Specific factor
When conducting a Fibrin Split Products
(FSP) test, what is the purpose of adding
thrombin as well as soy bean enzyme
inhibitors to the whole blood sample?
What is demonstrated from FSP elevated
factor VIII, heparin-like activity, and
antithromboplastins. Most acquired
anticoagulants are autoantibodies (usually IgG,
sometimes IgM) directed against specific
coagulation factors.
The fundamental principle of the D-dimer assay
has remained largely unchanged: recognition of
the unique neoepitope in D-dimer by specific
antisera. D-dimer contains a neoepitope that is
formed following the cross-linking of adjacent
D domains by factor XIIIa. It is this epitope that
is recognized by specific antisera used in
clinical assays.
The euglobulin fraction of plasma contains
plasminogen, fibrinogen, and activators with the
potential for transforming plasminogen to
plasmin. This fraction is precipitated with 1%
acetic acid and resuspended in a borate solution.
The euglobulins are then clotted by the addition
of thrombin. The clot is incubated and the time
of lysis is reported. Clinically, the euglobulin
lysis test is a screening procedure for
fibrinolytic activity.
Substitution studies and factor assays can be
used to identify specific coagulation factor
Substitution studies may be performed using
adsorbed plasma and aged serum with the aPTT
to identify deficiencies of blood coagulation.
Substitution studies may also be performed
using adsorbed plasma with the PT to identify a
factor VII deficiency.
Factor assays are based on the ability of the
plasma in question to correct a factor-deficient
substrate, such as factor VIII. The actual assay is
the same as the aPTT with the exception of the
factor-deficient substrate. Identification of
specific factor deficiencies is valuable in both
the diagnosis and the treatment of patients.
Thrombin is added to ensure complete clotting
of the sample, and the soy bean enzyme
inhibitors are added to prevent any breakdown
of fibrin.
Elevated results demonstrate that the activation
of plasmin has occurred or is occurring, such as
in primary fibrinolysis and DIC with secondary
Hematology PPT Flashcards Unit 4
What is the principle behind a fibrinogen
What is the use of the simple protein,
What is the indication of a positive result
from a Protamine Sulfate Assay?
What is being measured when conducting a
prothrombin time?
What are some situations in which
prothrombin time test is used?
What is indicated from prolonged results in a
prothrombin time?
What is determined from a thrombin time
What might cause the abnormal result of a
thrombin time test?
How is cell size and quantity determined
based on the use of an electrical impedance
Which method of cell counting uses a laser
How does the diluted blood specimen interact
with the laser light during optical detection?
 When plasma is diluted and clotted with
excess thrombin, the fibrinogen
concentration is inversely proportional to
the clotting time
Fibrinogen assays are useful in detecting
deficiencies of fibrinogen and in detecting an
alteration in the conversion of fibrinogen to
– Protamine is used to neutralize the
effects of heparin.
– Inappropriate presence of intravascular
fibrin monomers
– Length of time required to form a fibrin
clot (measured in seconds)
 to monitor oral anticoagulant therapy
 as a screening test in the diagnosis of
coagulation deficiencies
– as a component of a liver profile
Deficiency of one or more factors in the
extrinsic pathway: factors VII, X, and V and
factor II or I. The presence of an inhibitor will
also produce prolonged values.
Determines the rate of thrombin-induced
cleavage of fibrinogen to fibrin monomers and
the subsequent polymerization of hydrogenbonded fibrin polymers
 Extremely low fibrinogen levels
 Abnormal fibrinogen thrombin inhibitors
 High concentrations of immunoglobulin
(e.g., myeloma proteins)
 Presence of heparin
High concentrations of fibrin-fibrinogen
degradation products
Cell counting and sizing are based on the
detection and measurement of changes in
electrical impedance (resistance) produced by a
particle as it passes through a small aperture.
Optical Detection method
A diluted blood specimen passes in a steady
stream through which a beam of laser light is
As each cell passes through the sensing zone of
Hematology PPT Flashcards Unit 4
the flow cell, it scatters the focused light.
Scattered light is detected by a photodetector
and converted to an electrical pulse.
What is represented by the number of
The number of pulses generated is directly
electrical pulses detected in an optical
proportional to the number of cells passing
detection method?
through the sensing zone in a specific period.
What are the three operational processes of
 Diffraction and the bending of light
light amplification generated by emission of
around corners with the use of small
 Refraction and the bending of light
because of a change in speed with the
use of intermediate angles
Reflection and light rays turned back by the
surface or an obstruction with the use of large
How is Radio Frequency (RF) used to detect
– High-voltage electromagnetic current is
cell size?
used to detect cell size, based on the
cellular density.
Why is laser light the most common light
– Because of the properties of intensity,
source used in flow cytometers?
stability, and monochromatism.
What is flow cytometry?
– The simultaneous measurement of
multiple physical characteristics of a
single cell, as the cell flows in
suspension through a measuring device.
How can flow cytometry rapidly classify
– Flow cytometry combines the
groups of cells?
technologies of fluid dynamics, optics,
lasers, computers, and fluorochromeconjugated monoclonal antibodies that
rapidly classify groups of cells with
heterogeneous mixtures.
In flow cytometry, what intrinsic properties of
– Forward- and right-angle light scatter,
a cell are detected?
which correlate with size and granularity
of a cell, respectively.
Regarding scattered light, what is a forward
– Light scattered along the axis of the laser
Regarding scattered light, what is a side/
– Light scattered perpendicular to the axis
orthogonal scatter?
Forward scatter is proportional to?
– Cell size
Side scatter is proportional to?
– Cytoplasmic granularity
Define parameter:
– Statistical term that refers to any
numerical value that describes an entire
Major types of automation are representations Representative of the ways that blood cells can
of what?
be counted, leukocytes differentiated, and other
components (e.g., MCH and MCHC) calculated
How does hemoglobin being measured?
Measured by the traditional cyanmethemoglobin
Hematology PPT Flashcards Unit 4
flow-cell method at 525 and 546 nm, depending
on the instrument manufacturer
What are histograms?
Histograms are graphic representations of cell
frequencies versus sizes.
In a homogeneous cell population, the curve
A symmetrical bell-shaped or gaussian
assumes what shape or distribution?
In a histogram, a wide or more flattened curve A wide or more flattened curve is seen when the
is seen in what?
standard deviation from the mean is increased.
True or false.
Histograms not only provide information
about erythrocyte, leukocyte, and platelet
frequency and their distribution about the
mean but also depict the presence of
True or False
Histograms provide a means of comparing the
sizes of a patient’s cells with normal
True or False.
In a histogram, shifts in one direction or the
other can be of diagnostic importance.
Tue or False
False (x-axis represents the size)
In the Coulter system, the size (volume in
femtoliters) is represented on the y-axis.
In analysis of instrumental data output
The erythrocyte histogram
includes what?
Quantitative descriptors of erythrocytes
The leukocyte histograms
Platelet histograms
Derived platelet parameters
What does an erythrocyte histogram reflects? The erythrocyte histogram reflects the native
size of erythrocytes or any other particles in the
erythrocyte size range.
The erythrocyte histogram in the Coulter
1) 24 fL
system displays cells as small as __(1)___fL., 2) 36 fL
but only those greater than ___(2)___fL are
counted as erythrocytes.
In a erythrocyte histogram, what is the
It allows for the detection of erythrocyte
advantage of the extension of the lower end
fragments, leukocyte fragments, and large
of the scale from 36 to 24 fL?
An expression of erythrocyte size is the
_______ in the Coulter series. This term
refers to variation in erythrocyte size.
Correlations between the _______ and the
RDW and the MCV
_________exist for various types of anemia.
What does size-referenced leukocyte
The classification of leukocytes according to
histograms displays?
size following lysis. It does not display the
Hematology PPT Flashcards Unit 4
What does a platelet histogram reflects?
What is the measure of the average volume of
platelets in a sample?
True or False
The MPV is analogous to the erythrocytic
True or False
Mean platelet volume calculation is derived
from the same data as the platelet count.
True or False
In healthy patients, there is an inverse
relationship between platelet count and size.
What are the three steps in a laser
RBC/platelet channel uses a laser-based
optical assembly that is shared with what
Where is the platelet histogram derived?
What is the mode of the measured platelet
Most flow-cell instruments can
simultaneously analyze multiple parameters
at what rate?
In flow cytometry, the cellular analysis yields
what properties of individual cells?
Major advances in this technology are owing
to several factors, what are these factors?
native cell size
Platelet counting and sizing in both the electrical
impedance and the optical systems reflect the
native cell size.
Cytochemical reactions prepare the blood cells
for analysis.
A cytometer measures specific cell properties.
Algorithms convert these measurements into
familiar results for cell classification, cell count,
cell size, and hemoglobinization.
The basophil/lobularity channel.
The platelet histogram is derived from
measurements made with the high-angle
at the rate of 5,000 to 10,000 cells/sec.
The cellular analysis yields quantitative data
about the chemical and physical properties of
individual cells.
 The ability to produce monoclonal
antibodies resulted in the subsequent
development of specific surface markers
for various subpopulations of cells.
 The development of new fluorescent
probes for DNA, RNA, and other
cellular components increased the
variety of possible applications at the
molecular and cellular levels.
The expansion of computer applications has
improved the instrumentation technology,
Hematology PPT Flashcards Unit 4
In hematology, automated differentials can be
based on a variety of principles which
includes what?
Because single-cell suspensions of peripheral
blood and bone marrow are easy to obtain,
most clinical applications of flow cytometry
are in the specialties of __________ and
Reticulocytes Enumeration by flow cytometry
is more ____________.
Platelet counts can provide an estimate of
young, reticulated platelets by counting
platelets that stain with what kind of dye?
What kind of typing identified by a cluster
designation (CD), are used in most flow
cytometry immunophenotyping.
A cellular application that has become an
important tool in the diagnosis and
classification of hematologic neoplasia by
immunophenotyping. This techniques with
bone marrow cells are applicable to DNA cell
cycle analysis.What is this technique?
What kind of new technology that referred to
as automated digital cell morphology,
provides an unprecedented level of efficiency
and consistency. In its simplest form,
automated digital cell morphology is a
process where blood cells are automatically
located and preclassified into categories of
blood cell?
This is the earliest instruments to detect blood
clotting. This uses a methodology to measure
the conduction or impedance of an electrical
current by the formation of fibrin. What kind
of instrumental methodology is this?
This principle/methodology measures is the
change in light transmission as optical density
(absorbance) versus time can be used to
quantitatively determine the activity of
various coagulation stages or factors.
_______ is defined as the resistance that a
material has to a change in its form.
making it easier to operate and more practical
for use in clinical as well as research
– Determination of cell volume by
electrical impedance or forward light
scatter, cytochemistry or peroxidase
staining, and VCS technology.
– hematology and immunology
accurate, precise, and cost-effective.
with an RNA dye.
Immunophenotyping monoclonal
Flow Cytometry
Digital Technology
Electromechanical methods
Photo-optical Method
Hematology PPT Flashcards Unit 4
This principle usesthe natural thickening
(viscosity) and monitored by the motion
(amplitude of an oscillating steel ball in a
specially designed cuvette), as a change in
form takes place.
What type of platelet agglutination method
measures the ability of a patient’s plasma to
agglutinate formalin-fixed platelets in the
presence of ristocetin?
The principle of the test is that platelet-rich
plasma is treated with a known aggregating
agent. What is this test?
A new type of automated system that
incorporates a high shear flow system to
simulate the in vivo hemodynamic conditions
of platelet adhesion and aggregation as
encountered at a vascular lesion.
Viscosity-Based Detection System
ristocetin cofactor assay
Platelet Aggregation
Siemens PFA-100