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Lab, Qualitative change- WBC., Cytoplasmic abnormalities:, Chediak…
Lab
Microscopic: 10x assess overall quality of the smear. Will be reject: snow plow effect and fibrin strands.
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Qualitative change- WBC.
Alder-Reilly anomaly - dense azurophilic
granules, mucopolysaccharoidoses. Heavy, coarse, blue-black granules in neutrophils -- Hurler's syndrome and Hunter's syndrome
Pelger Huet anomaly – failure of normal segmentation of nucleus, bi-lobed nucleus or stab forms only, “pince-nez nucleus”
May-Hegglin anomaly - Giant platelets, Dohle-bodies like inclusions seen even in monocytes.
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Siderocytes: like papp, but iron cannot into hgb. Side of cell has bright blue graunle. RBC is pale
Cabot rings
Heniz bodies: denatured Hgb. (light blue and granules dark blue maybe cental or side.) oxidative stress damage Hgb.
Basophilic stippling: RNA and mitochondrial remnants. Rbcs have multiple blue/purple granules and RBC is tear shape
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Reddish blue threadlike rings, remnants of the nuclear membrane.
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Pencil cells
Sickle cell
Target cells
Acanthocytes
Tear drop cells
schistocytes
Crenated red cells
Burr cells
Ovalocytes
Spherocytes
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oval and less elliptical in shape, IDA, megaloblstic anemia.
Echinocytes. Uraemia, pyruvate kinase deficiency, aucte blood loss
Echinocytes or crenated cells w/ evenly distributed blunt spicules of uniform size on their surface. Few is normal.
fragmented red blood cells .severe burns, drugs, toxins, DIC, uraemia
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hypochromic red cells w/ central spot of Hb. HbC and HbD disease, thalassemia syndromes, sickle cell disease
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Leukocytes
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Agranulocyes, nonsegmented
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Basophil, neutrophil, eosinophil
Band
Metamyelocyte
Myelocytes
Promyelocyte
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Large oval nucleus. First recognizable cell in granulopoiesis. Azurophilic (primary) granules in cytoplasm and Produced only at this stage.
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M2: clearly divide lines. Few hundred specific granules present in the cytoplasm but > azurophlic granules. Nucleus: Heterochromatic (silenced). Indentation deepens to form horse shoe shape
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voilet brown is nutrophilic, Orange red is eosionophilic, dark blue is basophilic. of granules
except: spherocytosis, lipemic, icterus elevated MCHC.
How to exam RBCs: 1. count RBCs. 2. examine Hb, Hct (can decided anemia or polycythemia). If morphology is normal (aniso and poiki), then use rule of three: Hct (%) ≈ 3 × Hgb (g/dL). 3. MCV: correlated to morpholic apperance. 4. MCHC: meaning how well the cells are filled with Hb. Hypochromic and normochromic.
RBCs: anisocytosis: unequal sizes. micro and macrocytic). Poikilocytosis: Shape different. like oval, teardrop-shaped, sickle-shaped, or irregularly shaped.
How to know the optimal assessment area: RBCs are uniformly and singly distributed. Few Rbcs touching or overlapping, 200-250RMC per OIO
Decreases: neutropenia, lymphopenia, monocytopenia
Increase: neutrophilia , eosinophilia, basophilia, lymphocytosis, monocytosis.
How to exam WBCs: 1. Total WBC counter per (WBC x 109/L). Increase: leukocytosis. decrease is leukopenia. 2. WBC differential counts are percentages. 3. WBC differential count values expressed as actual number of each type of cell. 4. WBC morphology
100 WBCs are counters. If WBC >40 x 109/L, WBCs need 200.
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CFU-erythroid, rubriblast, prorubricyte, rubricyte, metarubricyte, reticulocyte, erythrocyte
Mature RBCs: disk shaped, have an area of central pallor is pale stained. Noted the size is smaller than eosinophil and neutrophil
Polychromatic macrocyte: is reticulocyte. Large bluish in wright's stain. Have some RNA in cytoplasm
Orthochromtic normoblast: N/C=1. plasm increased with orange red tinges, slight blue
Polychromatophilic normoblast: N/C: 4:1. plasm: blue layered w/ tinges of organe red d/t Hgb synthesis 2/3
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RBCs metabolism: 1. Embden Meyerhof pathway: provides 90% ATP. 2. phosphogluconate pathway: 5%-10 ATP. 3. Methemoglobin reducatase pathway: maintain iron 2+ (ferrous state).
Peripheral proteins: is cytoskeleton that for deformability and elasticity of the RBCs. Spectrin and ankyrin.
Integral proteins: transport and antigens: glycophorin A,B,C
RBCs outer glycolipids and glycoproteins. Inner is cytoskeleton. Central is cholesterol and phospholipids.
Spectrin abnormality: sperocytes. or autoimmune disease: antibody coated cells. osmotically fragile. Can formed Elliptocytes
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Wright stain: after dry, use methanol to adheres the cellular proteins to the slide. Eosin is red and Thiazin is blue.
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Normal RBC: 6-8 micrometers, MCV: 80-100,MCHC: 32% -36%.
RBCs: Normocytic is normal size. Normochromic is red orange appearance on wright stained smears. so the central pallor no larger than 3 microns in diameter.
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Granules: histamin, heparin
IgE receptors, allergy, circulrating is mast cells
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Main regulator of (*)production is the hormone thrombopoietin (TPO), which is synthesized in the liver.