Summary

Summary Hematology Study Guide (Year One)

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CSMLS

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This document contains information that first year hematology students at the college level need to know. It is formatted in a way that is easy to comprehend while not leaving anything out. Topics include basic hematology lab procedures, cell morphology, hematopoiesis, diseases relevant to hematolo...

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Uploaded on June 20, 2024
File latest updated on June 20, 2024
Number of pages 82
Written in 2023/2024
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cbc
mlt
mla
hematopoiesis
mla
hema
hematology
nursing
med student
student notes
csmls
cmlto
mlpao
first year notes

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HEMATOLO
YEAR ONE

GY

INTRODUCTION TO HEMATOLOGY. TOPICS INCLUDE CELL MORPHOLOGY,
HEMATOPOIESIS, SLIDE PREP AND EXAMINATION, COMMON TEST QUESTIONS,
AND MORE!

, Page |1

CONTENTS

HOW TO USE THIS DOCUMENT 6

HOW TO CLICK A LINK 6
UPDATING THE TABLE OF CONTENTS 6

HEMATOLOGY OVERVIEW AND CBC PARAMETERS 7

WHAT IS HEMATOLOGY? 7
COMMON TESTS IN HEMATOLOGY 7
SYSMEX CBC TESTING 7
WBC – WHITE BLOOD COUNT 8
WBC TYPES 8
RELATIVE VS. ABSOLUTE COUNTS 8
RBC – RED BLOOD CELLS 10
HGB – HEMOGLOBIN 10
HCT – HEMATOCRIT 10
MCV – MEAN CORPUSCULAR VOLUME 11
MCH – MEAN CORPUSCULAR HEMOGLOBIN 11
MCHC – MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION 11
PLT – PLATELET COUNT 12
RDW – RED CELL DISTRIBUTION WIDTH 12
MPV – MEAN PLATELET VOLUME 13

HEMATOPOIESIS 14

GENERAL BLOOD MORPHOLOGY 14
BLOOD CELL MORPHOLOGY 14
ERYTHROCYTES 14
PLT 14
LEUKOCYTES 14
HEMATOPOIESIS 17
SELF REPLICATION AND PROLIFERATION 18
COMPONENTS OF HEMATOPOIESIS 18
EXTRAMEDULLARY HEMATOPOIESIS 19
THE SPLEEN 20
SPLENECTOMY 20
POOLS 21
HEMATOPOIESIS OF SPECIFIC CELL TYPES 21
MYELOPOIESIS – GRANULOCYTOPOIESIS 21
ERYTHROPOIESIS 21
NEUTROPHIL MATURATION 22
TISSUE EOSINOPHILS AND BASOPHILS 22
MONOPOIESIS 22

, Page |2

LYMPHOPOIESIS 22
MEGAKARYOCYTOPOIESIS 23
BONE-DERIVED CELLS 23
MYELOID: ERYTHROID RATIO 23
FACTORS AFFECTING M:E RATIO 24

BONE MARROW 25

BONE MARROW FUNCTION 25
BONE MARROW STRUCTURE AND COMPONENTS 25
BONE MARROW IRON STORES 25
STEM CELLS IN BONE MARROW 25
HEMATOLOGIC DISEASES 26
INDICATIONS FOR BONE MARROW STUDIES 26
BONE MARROW ANALYSIS 29
GENERAL BONE MARROW EXAMINATION 29
PREPARING SMEARS 29
PARTICLE PREPARATION 29
TOUCH PREP 30
CORE PROCESSING 30
ESTIMATION OF BONE MARROW CELLULARITY 30
BONE MARROW DIFFERENTIAL 30
INTERPRETATION 30

BLOOD CELL MORPHOLOGY 32

MYELOPOIESIS - NEUTROPHILS 32
SEGMENTED NEUTROPHIL 32
BANDED NEUTROPHIL 32
METAMYELOCYTE 33
MYELOCYTE 33
PROMYELOCYTE 34
MYELOBLAST 34
MYELOPOIESIS – EOSINOPHILS 34
EOSINOPHIL GRANULOCYTE 34
ERYTHROBLASTS (NUCLEATED RED BLOOD CELL) 35
MYELOPOIESIS – BASOPHILS 35
BASOPHIL GRANULOCYTE 35
LYMPHOPOIESIS 36
SMALL LYMPHOCYTE 36
LARGE LYMPHOCYTE 36
LYMPHOBLAST 37
MONOPOIESIS 37
MONOCYTE 37
MEGAKARYPOIESIS 37
THROMBOCYTE 38

, Page |3

CELL MORPHOLOGY 39

RED BLOOD CELL MORPHOLOGY - OVERVIEW 39
ASSESSING RBCS 39
GRADING SCALE 40
VARIATIONS IN RBC MORPHOLOGY 40
VARIATIONS IN RBC DISTRIBUTION 40
VARIATIONS IN RBC SIZE 41
HEMOGLOBIN CONTENT IN RBCS 44
NORMOCHROMIC 44
HYPOCHROMIA 44
HYPERCHROMIA 45
POLYCHROMASIA 45
VARIATIONS IN RBC SHAPE 45
POIKILOCYTOSIS 45
TARGET CELLS (CODOCYTES) 46
SPHEROCYTES 47
STOMATOCYTES 47
OVALOCYTES AND ELLIPTOCYTES 47
SICKLE CELLS (DREPANOCYTES) 48
FRAGMENTED CELLS (SCHISTOCYTES/HELMET) 48
TEARDROP CELLS (DACROCYTES) 51
RED CELL INCLUSIONS – LIST 51
BASOPHILIC STIPPLING 52
PAPPENHEIMER BODIES (SIDEROCYTE GRANULES) 52
HEINZ BODIES 53
CABOT RINGS 53
HEMOGLOBIN CC CRYSTALS 54
HEMOGLOBIN SC CRYSTALS 54
PROTOZOAN INCLUSIONS 54
RBC MORPHOLOGY – SPECIAL CIRCUMSTANCES 55
ROULEAUX 55
IRON DEFICIENCY ANEMIA 56
HEMOLYTIC ANEMIA (SPHEROCYTES) 56
PLT MORPHOLOGY - OVERVIEW 56
WBC MORPHOLOGY - OVERVIEW 56
WBC MORPHOLOGY – TOXIC GRANULATION 57
DOHLE BODIES 57
TOXIC VACUOLIZATION 57
WBC MORPHOLOGY – SHIFT TO THE LEFT 57
LEUKOCYTOSIS WITHOUT SHIFT TO THE LEFT 58
LEUKEMOID REACTIONS 58
NEUTROPHIL SEGMENTATION 58

THE RED CELL 59

RBC SURVIVAL AND FUNCTION 59

, Page |4

RBC MEMBRANE 59
INNER MEMBRANE 59
PROTEINS OF RED CELL MEMBRANE 60
LIPIDS OF RED CELL MEMBRANE 60
OSMOTIC FRAGILITY 60
CLINICAL SIGNIFICANCE 60
HGB STRUCTURE AND FUNCTION 61
HGB PRODUCTION 61
HGB FORMATION 62
HGB FUNCTION 62
CHANGES TO SHAPE OF HGB 62
ABNORMAL HGB OF CLINICAL IMPORTANCE 63
CARBOXYHEMOGLOBIN 63
METHEMOGLOBIN 63
SULFHEMOGLOBIN 63
RBC SENESCENCE AND HEMOLYSIS 63
THE SPLEEN 64
RISKS OF INFECTION 64
EXTRAVASCULAR HEMOLYSIS 64
ROLE OF THE LIVER 64
INTRAVASCULAR HEMOLYSIS 65
HEMOGLOBINURIA 65
FREE HGB 65
INTRAVASCULAR HEMOLYSIS AND SENESCENCE 65

EXAMINING A PERIPHERAL BLOOD SMEAR 66

BENEFITS OF AUTOMATION 66
BENEFITS OF SLIDE REVIEWS 66
WHEN TO DO A SMEAR 66
HOW TO PERFORM A SMEAR 66
ABNORMALITIES 67

HEMATOLOGY STAINS 69

WRIGHT GIEMSA STAIN 69
USES 69
PRINCIPLE 69
GIEMSA STAIN 69
DYES 69
ROMANOWSKY DYES 70
STAINS AND THE STAINING PROCESS 70
BUFFER 70
TYPES OF STAINS 70
METHOD 71
STAIN RESULTS 71

, Page |5

SOURCES OF ERROR 72
TROUBLESHOOTING STAIN PROBLEMS 73
LEUKOCYTE ALKALINE PHOSPHATE METHOD (LAP) 74
PRINCIPLE 74
SPECIMENS 75
LAP SCORING 75

HEMOLYSIS 77

EXTRAVASCULAR 77
SYMPTOMS 77
INTRAVASCULAR 77
LABORATORY EVIDENCE OF HEMOLYSIS 78
PERIPHERAL SMEAR CLUES 79
CLASSIFICATIONS RELEVANT TO THE HEMOLYTIC ANEMIAS 79

, Page |6

HOW TO USE THIS DOCUMENT

When trying to find a specific section, refer to the table of contents. Many links are
clickable within the document, including the table of contents. Some content repeats and thus,
one section may refer to another section (via the link) to cut down on the space within the
document.
This document was created to be a (mostly) point form note system that provides ALL
relevant information for first-year hematology students. It is especially useful for students in
the Medical Laboratory Technology field when they’re preparing for national exams and
certifications.

HOW TO CLICK A LINK

Links in this document were set up using Windows through Microsoft Word. Controls for Apple
products may differ.

To use links in this document, press CTRL on your keyboard and then click the link. The
document will auto-scroll to the section you’ve requested. To click an in-text link you can follow
the same process.

UPDATING THE TABLE OF CONTENTS

If changes are made to this document (for example, if you add your own notes to it), don’t
forget to update the table of contents!

To update, click anywhere on the table without pressing the CTRL key. There should now be a
tab attached to the top left of the table with a red exclamation point that says, “update table.”
Click on it. In the pop-up window, click “update entire table” and you’re all set!

, Page |7

HEMATOLOGY OVERVIEW AND CBC PARAMETERS
WHAT IS HEMATOLOGY?

Hematology is the study of blood and blood disorders.

Examples:
• Anemias
• Leukemias
• Lymphomas
• Enzyme deficiencies (G6PD deficiency)
• Hemophilia and coagulation disorders (DVT, VW)
• Polycythemia
• Myeloid Disorders

COMMON TESTS IN HEMATOLOGY

• CBC (Complete Blood Count)
• Differential
• ESR (Erythrocyte Sedimentation rate)
• Coagulation tests
o INR
o PT
o APTT
o Fibrinogen
• D-Dimer
• Semen analysis
• Bone marrow

SYSMEX CBC TESTING
The Sysmex is a widely used instrument that analysts can use for complete blood counts.
The information the instrument gives is not only the count values and whether or not the
sample is within a set reference range, but also histograms that represent a more complete
picture of patient health.
On the image below, each dot on the first histogram represents a white blood cell.
Clumps can indicate monocytes, neutrophils, etc.

NOTE: reference ranges that are given by the Sysmex instrument in the example photo are not
set ranges for each lab and each patient. Ranges may differ for a given demographic and should
be taken into account when analyzing a Sysmex data sheet.

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