MLAB 1415 - Hematology

After studying all materials and resources presented in the course, the student will be able to:

1. Chapter 4- Hematopoiesis*
   (1a-i., 1b-iv, 2c-i,ii)
   1. Identify phases and site of origin for cellular development of active hematopoietic tissue in Embryo and fetus:
      1. Mesoblastic phase
      2. hepatic phase (extramedullary)
      3. medullary/myeloid phase.
   1. Define hematopoiesis:
      1. Theory of pluripotent stem cell development
      2. Stem cell kinetics: Generative cell cycle
      3. Regulatory growth factors and inhibitors.
   2. Identify phases and site of origin for cellular development of active hematopoietic tissue in Infant and young child:
      1. All red marrow spaces (all cell lines)
      2. Thymus fully developed (T lymphs)
      3. Secondary lymphoid tissue (T and B lymphs)
   3. Identify phases and site of origin for cellular development of active hematopoietic tissue in Adults:
      1. Red marrow (axial skeleton and proximal ends of long bones)
      2. Primary and secondary lymphoid tissue (T and B lymphs)
   4. Explain the role of other organ systems in hematopoiesis:
      1. Mononuclear phagocyte system
      2. Spleen (structure, blood flow, function)
      3. Liver (structure, blood flow, function)
      4. Lymph nodes (structure, blood flow, function)
      5. Thymus (structure, blood flow, function)
   5. State the physical findings commonly present in hematologic disease:
      1. Splenomegaly
      2. Hypersplenism
      3. Hepatosplenomegaly
      4. Lymphadenopathy
   6. Describe key terms used to assess bone marrow structure and function:
      1. Myeloid to erythroid ratio (M:E)/erythroid to granulocyte ratio (E:G)
      2. Erythropoiesis
      3. Granulopoiesis
      4. Megakaryopoiesis
      5. Non-hematopoietic cells
      6. Cellularity: fat (yellow marrow) to cell (red marrow) ratio
      7. Aplastic marrow
      8. Hypo/Hyperplastic marrow.
   7. Explain mechanisms that regulate and modulate granulopoiesis:
      1. Regulatory growth factors and inhibitors
      2. Kinetics
      3. Life span
      4. Circulation
   8. List nutritional and regulatory factors with associated with erythropoiesis:
      1. Erythropoietin (EPO)
      2. Iron
      3. Vitamins (B12/ folate)
      4. Intrinsic factor
   9. List the maturation sequence of developing erythrocytes
   10. Describe the distinctive features used to characterize developing cells:
       1. Overall cell size
       2. Cell Nucleus Shape
       3. Relative size
       4. Staining reaction
       5. Chromatin pattern
       6. Presence or absence of nucleoli
       7. Staining reaction and size of cytoplasm
   11. List morphologic features used to differentiate developing leukocytes: •
       1. Overall cell size
       2. Nucleus Shape
       3. Nuclear to cytoplasmic ratio (N:C)
       4. Staining reaction
       5. Chromatin pattern
       6. Presence or absence of nucleoli
       7. Relative amount of cytoplasm
       8. Cytoplasmic staining reaction
       9. Presence or absence of granules and staining reaction in cytoplasm
   12. Name and describe the average percentage and cellular characteristics of the six mature leukocytes found in normal peripheral blood.
2. Chapter 5- Erythrocytes: Erythropoiesis, Maturation, Membrane Characteristics, and Metabolic Activities
   (1a-i. 1b-iv. 2c-i,ii,iii)
   1. Identify phases and site of origin for cellular development of active hematopoietic tissue in Infant and young child:
      1. All red marrow spaces (all cell lines)
      2. Thymus fully developed (T lymphs)
      3. Secondary lymphoid tissue (T and B lymphs)
   2. Identify phases and site of origin for cellular development of active hematopoietic tissue in Adults:
      1. Red marrow (axial skeleton and proximal ends of long bones)
      2. Primary and secondary lymphoid tissue (T and B lymphs)
   3. Compare and contrast polycythemia rubra vera, secondary polycythemia, and relative erythrocytosis:
      1. Etiology
      2. Clinical features
      3. Laboratory findings
   4. Describe the purpose of the metabolic pathways used by erythrocytes:
      1. Embden-Meyerhof
      2. Hexose monophosphate shunt
      3. Methemoglobin reductase
   5. Discuss components of the mature red cell that are essential for survival and function:
      1. Membrane composition and function
      2. Lipids/Proteins
      3. Maintain RBC shape, deformability, and permeability
      4. Support system for surface antigens
      5. Transport and exchange of gases and ions (cationic pumps)
   6. Name the basic substances necessary for proper erythropoiesis.
   7. Explain the normal condition that stimulates the production of erythropoietin.
   8. Compare the terms secondary polycythemia and relative polycythemia.
   9. Describe the general characteristics, including the physical properties, of the erythrocyte membrane.
3. Chapter 6- Erythrocytes: Hemoglobin
   (1a-i. 2c-i,ii)
   1. Explain the genetic inheritance of hemoglobin.
   2. Summarize the mechanisms by which normal hemoglobin is structured and synthesized in the developing red cell:
      1. Iron transport, uptake, and supply
      2. Protoporphyrin IX (heme) formation
      3. Globin synthesis and genetic control Chromosome 11 and 16
      4. Embryonic hemoglobins (Gower 1, 11, Portland)
      5. Adult hemoglobins (Hb A, Hb A2, Hb F,)
   3. Identify the effect various conditions can have on an oxygen disassociation curve:
      1. pH (Bohr effect)
      2. Temperature
      3. CO2
      4. 2,3-DPG
      5. Hb F and other variants
   4. Describe normal hemoglobin-oxygen function using the oxygen disassociation curve
   5. Discuss the principles of hemoglobin electrophoresis (cellulose acetate, alkaline pH vs. citrate agar, acid pH)
      1. Perform/observe the procedure
      2. Apply appropriate quality control procedures
      3. Correlate results
   6. Discuss the principles of hemoglobin quantification (Hb A, Hb A2, Hb F):
      1. Perform/observe the procedure
      2. Apply appropriate quality control procedures
      3. Correlate results
   7. Explain the mechanism by which red cells are catabolized:
      1. Identify phased (extra/intravascular)
      2. Trace the basic steps associated with each phase
   8. Define terms associated with red cell destruction:
      1. Biliverdin
      2. Bilirubin (conjugated/ unconjugated)
      3. Urobilinogen
      4. Urobilin
      5. Hemoglobin dimers
      6. Haptogloblin
      7. Hemopexin
      8. Hemoglobinemia
      9. Hemoglobinuria
      10. Hemosiderinuria
      11. Methemalbumin
4. Chapter 7- Erythrocytes: Morphology and Inclusions
   (1a-i.1b-ii,iii,iv,v,vi)
   1. Describe methods used to identify and/or confirm the composition of various red blood cell inclusions.
   2. Describe the alterations in color that can be seen in an erythrocyte: polychromatic have hypochromatic
   3. Associate a given red blood cell morphology with routinely encountered conditions:
      1. Hereditary membrane abnormalities (spherocytosis, elliptocytosis, ovalocytosis have etc.)
      2. RBC Enzyme abnormalities (G6PD and PK deficiencies)
      3. Extracorpuscular (immune and non-immune) mediated RBC defects.
   4. Define common words used to describe red cell morphology and identify each on a peripheral smear:
      1. basophilic stippling
      2. Cabot rings
      3. Heinz bodies
      4. Howell-Jolly bodies
      5. Hemoglobin C crystals
      6. Pappenheimer bodies/siderotic granules
      7. Hemoglobin crystals
      8. Poikilocytosis
      9. Rouleaux
      10. agglutination
      11. acanthocyte
      12. codocyte
      13. dacryocyte
      14. drepanocyte
      15. echinocyte
      16. elliptocyte
      17. keratocyte
      18. schistocyte
      19. spherocyte
      20. stomatocyte
      21. malarial parasites
      22. Hemoglobin H
   5. Associate a given red blood cell morphology with routinely encountered conditions: Malaria
   6. Name and describe the variations in the size of a mature erythrocyte.
   7. Correlate at least one clinical condition with each of the erythrocytic size variations: normocytosis, macrocytosis, and microcytosis.
   8. Define the term anisocytosis.
5. Chapter 8- Leukocytes: The Granulocytic and Monocytic Series
   (1a-i.1b-ii,iii,iv,v,vi. 2c-i,ii,iii)
   1. Explain the functions associated with granulocytes:
      1. Phagocytosis and killing
      2. Allergic response (eosinophils and basophils)
      3. Host defense against parasites (eosinophils)
      4. Hypersensitivity mediator (basophils and mast cells)
   2. List the maturation sequence of neutrophils, eosinophils, and basophils
   3. Differentiate band neutrophils, segmented neutrophils, eosinophils, and basophils
   4. Define the terms marginating and circulating pools.
   5. Determine if a granulocyte is mature or immature
   6. Explain the term: shift to the left.
   7. Summarize structural and functional features that characterize monocytes and macrophages,
   8. State absolute monocyte reference values and relative reference values
   9. List the maturation sequence of monocytes and macrophages.
   10. Summarize structural and functional features that characterize monocytes and macrophages
   11. Discuss the length of time the neutrophils, eosinophils, and basophils spend in each marginating and circulating pool.
   12. Describe the nuclear and cytoplasmic characteristics of the neutrophils, eosinophils, and basophils throughout the maturation process.
   13. Explain the appearance and etiology of the various morphological abnormalities encountered in mature granulocytes (i.e. inclusions, hypo- and hyper-segmented).
   14. Define terms associated with an increase and decrease in granulocytes.
   15. Define the term leukocyte surface marker.
   16. Associate the various terms for macrophages depending on their anatomical site.
   17. Describe the general functions of macrophages.
   18. List the relative reference values for neutrophils, eosinophils, basophils and monocytes in normal peripheral blood.
   19. State the (neutrophilic) granulocytic reference range.
   20. Describe the general function of monocytes.
6. Chapter 9- Leukocytes: Lymphocytes and Plasma Cells
   (1a-i.1b-ii,iii,iv,v,vi. 2c-i,ii,iii)
   1. Summarize structural and functional features that characterize lymphocytes
   2. List the sites of formation and production of lymphocytes:
      1. Bone marrow
      2. Thymus
      3. Lymph nodes and secondary lymphoid tissue
      4. Kinetics: Life span/ Migration
   3. Describe lymphocyte function:
      1. Humoral immunity (B lymphs and subsets)
      2. Cell mediated immunity (T lymphs and subsets)
      3. Natural killing and antibody dependent cellular cytotoxicity
   4. State lymphocyte absolute reference values with relative reference values
   5. Define lymphopenia/ lymphocytosis
   6. List the maturation sequence of lymphocytic cells and normal lymphocyte:
      1. Size
      2. Nucleus
      3. Cytoplasm
      4. Heterogeneity
   7. Compare and contrast morphologic features of reactive lymphocyte
   8. Describe the use of monoclonal antibodies to differentiate lymphocytes by CD antigens:
      1. B lymphs and subsets
      2. T lymphs and subsets
      3. Plasma cell (immunoglobulin antibody production)
   9. List the causes of non-neoplastic disorders plasma cells.
   10. Identify key morphologic features for plasma cell.
   11. Describe the role of lymphocytes and plasma cells in the body defense mechanism against disease.
   12. Name and locate the two primary and three secondary lymphoid tissues.
   13. Identify the anatomical sites populated by T cells and B cells.
   14. Compare absolute and relative numbers in lymphocytes.
   15. Calculate the absolute value of a lymphocyte value.
   16. Compare the major types, normal reference value percentages, and quantities of lymphocytes at different ages ranging from birth to adulthood.
   17. Differentiate the functions of the three major categories of lymphocytes.
   18. Describe the appearance and cytoplasmic contents of Russell’s bodies, Mott cells, and flame cells.
7. Chapter 10- Basic Laboratory Assessment of Erythrocytes, Leukocytes, and Platelets
   (1a-i,iii.1b-ii,iii,iv,v,vi. 2c-i,ii,iii)
   1. List the components of a complete blood count (CBC).
   2. Define abbreviations: RBC, WBC, Hgb, Hct, and retic.
   3. Compare and contrast the utility of absolute values with relative values
   4. Discuss the clinical utility of the RBC indices
   5. Use the RBC indices as a quality control mechanism for assessing the validity of the erythrocyte count, hemoglobin, and hematocrit values
   6. Calculate red blood cell indices when provided appropriate data.
   7. Explain sources of error of the red blood cell indices
   8. Correlate automated hemogram parameters with each other and with peripheral smear exam results.
   9. Perform standard reticulocyte assays:
      1. Supravital smear method with Miller disc
      2. Supravital smear method without Miller disc
      3. Automated flow cytometry methods
   10. State reference values that reflect variations in gender and age for the leukocyte counts in peripheral blood:
       1. Total leukocyte count
       2. Absolute lymphocyte count
       3. Absolute neutrophil count
   11. Perform routine methods to assess leukocytes (e.g. manual and automated white blood cell counts and differentials)
   12. List common factors that alter leukocyte values:
       1. Physiologic variation
       2. Cellular abnormalities
   13. Enumerate and/or calculate absolute and relative leukocyte counts:
       1. Relative values
       2. Absolute values
   14. Discuss the clinical utility of the absolute neutrophil count.
   15. Perform calculations associated with reticulocyte assays:
       1. Corrected
       2. Absolute
       3. Production index (RPI)
   16. Perform erythrocyte sedimentation rates:
       1. Wintrobe
       2. Westergren and its modifications
       3. Automated
   17. Determine the appropriate area of a peripheral blood smear to evaluate red blood cell morphology.
   18. Estimate the total white blood count from a smear.
   19. Correct leukocyte counts for the presence of nucleated red cells.
   20. Identify and classify normal white blood cells on a properly stained Romanowsky blood smear.
   21. Describe the measurement of microhematocrit.
   22. Compare RBC, hemoglobin, and hematocrit values using the rules of three.
   23. Define each of the erythrocyte indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC).
   24. Apply the appropriate formulas and calculate the MCV, MCH, and MCHC when give the erythrocyte values.
   25. Classify RBC morphology based on erythrocyte indices.
   26. Name a classic application of the leukocyte alkaline phosphatase (LAP) test.
   27. Explain the purpose of the erythrocyte sedimentation rate (sed rate).
8. Chapter 11- Classification and Laboratory Assessment of Anemias
   (1a-i.1b-ii,iii,iv,v,vi. 2c-i,ii,iii)
   1. Define anemia.
   2. Define hypochromic (microcytic) anemia, including the causes.
   3. Compare and contrast laboratory findings in hypochromic anemias:
      1. Serum ferritin
      2. Serum iron
      3. Transferrin/ Total Iron Binding Capacity (TIBC)
      4. Percent transferrin saturation
   4. State the clinical signs and symptoms of anemia:
      1. Hemoglobin
      2. Hematocrit
      3. RBC indices
      4. Peripheral smear
      5. Reticulocyte count
      6. Bone marrow evaluation
      7. Red blood cell distribution width
   5. List the categories used in a morphological classification of the anemias.
   6. Describe the expected laboratory results seen in the various pathophysiologic classifications of anemia:
      1. Decreased red cell production
      2. Increased red cell destruction: Ineffective erythropoiesis/ Hemolytic processes
      3. Loss of red cells
   7. Briefly describe the usual complaints of an anemic patient.
   8. Describe the organization of anemias according to erythrocyte size and explain the limitations of such a system.
   9. Briefly explain the characteristics of categories of anemias using a pathological basis.
9. Chapter 12- Acute and Chronic Blood Loss Anemia and Anemias associated with Systemic Disorders.
   (1a-i.2c-i,ii,iii)
   1. Describe the etiology and physiology of acute blood loss.
   2. List the laboratory findings of acute blood loss
   3. Describe the etiology and physiology of chronic blood loss.
   4. List the clinical symptoms of acute blood loss
   5. Describe the laboratory findings associated with non-hematologic disorders:
      1. Chronic disorders and inflammation
      2. Malignant diseases
      3. Renal disease
      4. Liver disease
      5. Alcoholism
10. Chapter 13- Bone Marrow Failure Syndromes
    (1a-i. 1b-i,ii,iv,v,vi. 2c-i,ii,iii)
    1. Describe bone marrow collection techniques:
       1. Aspiration
       2. Core biopsy
    2. Describe the clinical features of hypoproliferative anemias
    3. Describe the laboratory findings of hypoproliferative anemias:
       1. Peripheral blood changes
       2. Bone Marrow Changes
    4. Define aplastic anemia.
    5. Define pure red cell aplasia:
       1. Describe the clinical features
       2. Describe the laboratory findings
    6. Describe the general characteristics of bone marrow syndromes.
    7. Define pancytopenia.
    8. List three iatrogenic substances that can cause acquired aplastic anemia.
    9. Name 4 viral infections that have been associated with acquired aplastic anemia.
    10. Briefly describe how the immune process causes acquired aplastic anemia.
    11. Discuss the laboratory findings in acquired aplastic anemia (pertaining to ALL cells lines).
    12. Explain the clinical signs and symptoms of Fanconi anemia.
    13. Name one treatment for Fanconi’s anemia.
    14. Describe the characteristics of dyskeratosis congenital.
    15. Name three examples of pure red cell aplasia.
    16. Explain the laboratory findings in congenital dyserythropoietic anemia.
    17. Describe the characteristics of severe congenital neutropenia and cyclic neutropenia.
    18. Explain the characteristics of Shwachman-Diamond syndrome.
    19. Describe characteristics of congenital amegakaryocytic thrombocytopenia.
    20. Compare three types of congenital amegakaryocytic thrombocytopenia.
11. Chapter 14- Disorders of Iron Metabolism and Heme Synthesis.
    (1a-i. 2c-i,ii,iii)
    1. Compare absolute iron deficiency with functional iron deficiency.
    2. Compare primary overload disorders to secondary iron overload disorders.
    3. Name conditions that can contribute to iron deficiency anemia IDA.
    4. Name three of the most common groups vulnerable to IDA.
    5. Describe the physiology of iron metabolism, including the iron needs of children and normal dietary sources.
    6. Describe laboratory findings of IDA.
    7. Define terms: transferrin, hemosiderin, ferritin, total iron-binding capacity (TIBC).
    8. Describe the etiological basis of AOI.
    9. Explain the cause of AOI.
    10. Discuss the laboratory characteristics of AOI.
    11. Compare the characteristics of iron deficiency anemia with AOI.
    12. Explain the laboratory characteristics of sideroblastic anemia.
12. Chapter 15- Macrocytic and Megaloblastic Anemias
    (1a-i. 2c-i,ii,iii)
    1. Name the blood cell morphology associated with Vitamin B12/Folate deficiency.
    2. Discuss tests methods commonly used to assess megaloblastic anemia:
       1. Mean cell volume (MCV)
       2. Blood and bone marrow smear evaluation
       3. Serum B12
       4. Serum folate
       5. Red cell folate
       6. Anti-intrinsic factor antibodies
       7. Anti-parietal cell antibodies
    3. Differentiate nonmegaloblastic macrocytosis from megaloblastic anemia:
       1. Peripheral blood and bone marrow characteristics
       2. Serum vitamin B12 level
       3. Serum folate level
       4. Red cell folate level
    4. Describe clinical features of megaloblastic anemia
    5. Compare and contrast causes and laboratory features of the megaloblastic anemias
    6. State the hematologic abnormalities present in megaloblastic anemia:
       1. Peripheral blood changes
       2. Bone marrow morphology
    7. Discuss the absorption and metabolism of vitamin B12 and folate
    8. Name the two common causes and other less common causes of megaloblastic anemia.
    9. List 4 etiological causes of vitamin B12 deficiency and describe two distinguishing clinical or laboratory characteristics for each.
    10. Explain the etiology and pathophysiology, including the immune nature, of pernicious anemia.
    11. Describe the clinical signs and symptoms of pernicious anemia.
    12. Explain the usual management of and therapy for pernicious anemia.
    13. Name the laboratory assays used to confirm folic acid deficiency and state the results associated with folic acid deficiency.
13. Chapter 16- Hemolytic Anemias
    (1a-i.1b-ii,iii,iv,v,vi)
    1. Define the term hemolytic anemia.
    2. Discuss the principle of the Osmotic fragility test:
       1. Perform /observe the procedure
       2. Apply appropriate quality control procedures
       3. Correlate results
    3. Describe the hematologic findings associated with nonimmune hemolytic anemias:
       1. Malaria
       2. Babesiosis
       3. Thermal injury
       4. Disseminated intravascular coagulation
    4. Describe the utility of flow cytometry in assessing red cell membrane defects
    5. Describe the clinical features and laboratory findings of red cell membrane defects:
       1. Hereditary spherocytosis
       2. Hereditary elliptocytosis
       3. Paroxysmal nocturnal hemoglobinuria (PNH)
       4. Hereditary pyropoikilocytosis
    6. Discuss the four mechanisms of drug-induced hemolytic anemias.
    7. Identify mechanisms of immune-mediated hemolytic anemias
    8. Describe the clinical features and laboratory findings of autoimmune:
       1. Warm autoimmune hemolytic anemia (WAIHA)
       2. Cold autoimmune hemolytic anemia idiopathic/secondary
       3. Paroxysmal cold hemoglobinuria
    9. Describe the clinical features and laboratory findings of Alloimmune (isoimmune) hemolytic anemias:
       1. Acute hemolytic transfusion reaction
       2. Delayed hemolytic transfusion reaction
       3. Hemolytic disease of the fetus and newborn (HDFN)
    10. Describe the laboratory features of red cell enzyme abnormalities:
        1. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
        2. Pyruvate kinase (PK) deficiency
    11. Discuss the principles of G6PD assay, pyruvate kinase assay and staining Heinz bodies:
        1. Perform /observe the procedure
        2. Apply appropriate quality control procedures
        3. Correlate results
    12. Name at least three categories of intrinsic versus extrinsic hemolytic anemia.
    13. Name and discuss the five types or varieties of membrane defects.
    14. Name and briefly explain three categories of acquired hemolytic anemia.
    15. Name four mechanisms of drug-induced hemolytic anemias.
    16. Discuss immune mechanism related to acquired hemolytic anemia.
    17. Characterize the etiology of paroxysmal nocturnal hemoglobinuria.
14. Chapter 17- Hemoglobinopathies and Thalassemias
    (1a-i.1b-ii,iii,iv,v,vi. 2c-i,ii,iii )
    1. Describe the common denominator in hemoglobinopathies.
    2. Name the three major categories to classify hemoglobin defects.
    3. Describe the hemoglobin defect in thalassemia
    4. Define hemoglobinopathy
    5. Describe the clinical and laboratory findings of hemoglobinopathies:
       1. Hb SS
       2. Hb AS
       3. Hb CC
       4. Hb SC
    6. State the amino acid substitutions associated with sickle cell anemia and hemoglobin C disease
    7. Outline laboratory findings that are typical of SCD
    8. Discuss the principle of the solubility test for sickling hemoglobin:
       1. Perform /observe the procedure
       2. Apply appropriate quality control procedures
       3. Correlate results
    9. Discuss the principles of hemoglobin quantification (Hb A, Hb A2, Hb F):
       1. Perform/observe the procedure
       2. Apply appropriate quality control procedures
       3. Correlate results
    10. List the characteristic clinical and laboratory findings associated with thalassemia
    11. Identify the electrophoretic patterns when provide appropriate data:
        1. Hb F
        2. Hb A
        3. Hb S
        4. Hb C
        5. Hb A2
    12. Compare the disease state and trait condition of a hemoglobinopathy.
    13. Describe the clinical signs and symptoms of SCD.
    14. Characterize the general signs and symptoms in the categories of pain, pulmonary complications, and stroke associated with SCD.
    15. Identify globin chain defects causing SCD, hemoglobin D disease, and hemoglobin E disease.
    16. Outline laboratory findings that are typical of SCD
    17. Recognize and identify major clinical signs and symptoms and abnormal laboratory tests results including peripheral blood smear pictures that are typically associated with homo and hetero conditions of HbS, HbC, HbD, and HbE and compound heterozygous conditions involving HbS and other variant hemoglobins.
    18. Briefly describe the value of the techniques of hemoglobin electrophoresis and deoxyribonucleic acid (DNA) analysis.
15. Chapter 18- Disorders of Granulocytes and Monocytes
    (1a-i.1b-ii,iii,iv,v,vi. 2c-i,ii,iii)
    1. Associate quantitative and qualitative leukocyte disorders with expected results:
       1. Bone marrow production and release
       2. Rate of entry into peripheral circulating pools
       3. Shifts between circulating and marginating pools
       4. Rate of exit into tissues
    2. Define monocytosis and its causes.
    3. Describe qualitative and quantitative alterations of monocytes.
    4. State common causes of alterations in absolute and relative cell counts for the mature myeloid cells:
       1. Neutrophilia
       2. Neutropenia
       3. Eosinophilia
       4. Eosinopenia
       5. Basophilia
    5. Explain the classification of nonmalignant leukocytic disorders:
       1. Quantitative changes
       2. Qualitative changes
    6. Identify on blood smear morphologic changes in neutrophils that may accompany nonmalignant neutrophilic disorders:
       1. Shift to the left
       2. Toxic granulation
       3. Dohle bodies
       4. Vacuolization
       5. Hyposegmentation
       6. Hypersegmentation
    7. State characteristic abnormalities and clinical features for the qualitative/functional disorders of neutrophils:
       1. Pelger-Huet anomaly
       2. Alder-Reilly anomaly
       3. Chediak-Higashi anomaly
       4. May-Hegglin anomaly
       5. Chronic granulomatous disease (CGD)
       6. Myeloperoxidase deficiency
    8. Define the terms leukocytosis and leukocytopenia.
    9. List examples of general conditions that can cause leukocytosis.
    10. List examples of common conditions that neutropenia.
    11. List at least one representative condition in which a decrease in neutrophils, eosinophils have basophils, or monocytes can be found.
16. Chapter 19- Disorders of Lymphocytes
    (1a-i.1b-v. 2c-i,ii,iii)
    1. Differentiate between reactive and resting lymphocytes on Romanowsky stained smears
    2. Identify causes of non-neoplastic disorders of lymphocytes.
    3. List the causes of reactive lymphocytosis.
    4. State the normal relative value reference range for lymphocytes in an adult.
    5. State the absolute number of lymphocytes using the total leukocyte count and the relative number of lymphocytes.
    6. Explain the difference between absolute lymphocyte count and a relative lymphocyte count.
    7. Describe the etiology, epidemiology, clinical signs and symptoms, and laboratory data for infectious mononucleosis.
    8. Describe and recognize the appearance of lymphocytes associated with infectious mononucleosis.
    9. Name major immune deficiencies associated with T cells or B cells.
17. Chapter 20- Characteristics of Leukemias, Lymphomas, and Myelomas
    (1a-i.1b-ii,iii,iv,v,vi)
    1. Observe and/or perform procedures, apply appropriate quality control procedures, and interpret laboratory findings for laboratory procedures used in the identification, classification and differentiation of neoplastic disorders:
       1. Complete blood count
       2. Hemograms
       3. Scatterplots and histograms
    2. Correlate diagnostic blood and bone marrow findings to various sub-types of acute myeloid leukemia.
    3. Define and differentiate the terms neoplasm and malignant.
    4. Define and list categories associated with Neoplastic Disorders of Leukocytes:
       1. Leukemias
       2. Myelodysplastic syndromes
       3. Myeloproliferative disorders
       4. Lymphoproliferative disorders
    5. Describe general criteria to classify leukemias:
       1. Cell maturity (Acute/Chronic)
       2. Cell lineage (Myeloid /nonlymphoid)
       3. Lymphoid
    6. Describe the use of various diagnostic techniques used to assess neoplastic disorders of blood and bone marrow cells:
       1. Cytochemical Stains
       2. Immunophenotyping
       3. Cytogenetics
       4. Molecular genetics
    7. List major systems used to classify neoplastic disorders of leukocytes:
       1. French, American-British (FAB) Cooperative Group
       2. World Health Organization (WHO)
    8. Compare the characteristics of leukemia, lymphoma, and myeloma.
    9. Define and compare acute and chronic leukemia.
    10. Differentiate between acute and chronic myeloid (AML and CML) and lymphoid leukemias (ALL and CLL) based on clinical and hematologic findings.
    11. List the traditional forms and the major types of leukemia
    12. Explain the significance of the discovery of the human T-cell leukemia virus (HTLV) family and describe associated disorders.
18. Chapter 21- Acute Leukemias
    (1a-i.1b-ii,iii,iv,v,vi. 2c-i,ii,iii)
    1. List the clinical findings and laboratory results for acute leukemia
    2. Contrast the FAB with the WHO acute myeloid leukemia subgroups:
       1. FAB classification
          1. M0--acute myeloid leukemia with minimal differentiation
          2. M1--acute myeloid leukemia without maturation
          3. M2--acute myeloid leukemia with maturation
          4. M3--acute promyelocytic leukemia
          5. M4--acute myelomonocytic
          6. leukemia M5--acute monoblastic leukemia
          7. M6--acute erythroleukemia
          8. M7--acute megakaryoblastic leukemia
       2. WHO classification
          1. AML with recurrent genetic abnormalities
          2. AML with myelodysplasia-related changes
          3. Therapy-related myeloid neoplasms
          4. AML, not otherwise specified
    3. List the WHO acute lymphocytic leukemia subgroups:
       1. B lymphoblastic leukemia/lymphoma, not otherwise specified
       2. T lymphoblastic leukemia/lymphoma
    4. Compare and contrast the principles of various cytochemical stains and the cell lineages they react with:
       1. Myeloperoxidase
       2. Tartrate resistant acid phosphatase (TRAP)
       3. Iron staining (Sudan Black)
    5. Describe the fundamental characteristics of blood and bone marrow cell in acute leukemias.
    6. Coordinate factors related to epidemiology and long-term survival of AML patients.
    7. Discuss factors associated with the prognosis in AML.
    8. Discuss the purpose, advantages, and concerns related to allogeneic hematopoietic-cell transplantation.
    9. Discuss the epidemiology of acute lymphoblastic leukemia (ALL) in the United State.
    10. Summarize the pathogenesis of ALL.
    11. Name and briefly describe the FAB classification of ALL.
    12. Name and describe five life-threatening emergencies.
19. Chapter 22- Lymphoid and Plasma Cell Neoplasms
    (1a-i.1b-v. 2c-i,ii,iii)
    1. List diagnostic features of PLL:
       1. Median age of onset and gender
       2. Clinical finding of severe splenomegaly
       3. Blood and bone marrow findings of PLL
       4. markedly elevated white count with absolute lymphocytosis
       5. white cell differential predominantly of prolymphocytes
       6. immunophenotypic profile
       7. Survival rates
    2. Discuss classification based on proliferation of plasma cells and abnormal production of immunoglobulins:
       1. Multiple myeloma
       2. Waldenstrom’s macroglobulinemia
       3. Plasma cell leukemia (PCL)
       4. Heavy-chain disease
       5. Monoclonal gammopathy of undetermined significance (MGUS)
    3. Classify the chronic lymphoid leukemias by T and B cell lineage:
       1. Chronic lymphocytic leukemia (CLL)
       2. Prolymphocytic leukemia (PLL)
       3. Hairy cell leukemia (HCL)
    4. List diagnostic features CLL:
       1. Median age of onset
       2. Symptoms and clinical findings
       3. Blood and bone marrow findings of CLL
       4. Peripheral blood absolute lymphocytosis
       5. Leukemic cell line of mature, small lymphocytes with monotonous Morphology and smudge/basket cells
       6. Bone marrow lymphocytosis
    5. List diagnostic features of Adult T-cell leukemia:
       1. Human T-cell lymphotropic virus-1 (HTLV-1)
       2. Endemic areas
       3. blood and bone marrow findings of Adult T-cell leukemia
       4. Lymphoid cell line of small to large cells with cloverleaf/knotty nucleus
    6. List diagnostic features of HCL:
       1. Median age of onset and gender
       2. Clinical finding of severe splenomegaly
       3. Review blood and bone marrow findings of HCL
       4. Pancytopenia
       5. Leukemic cell line of “hairy” cells
       6. Tartrate resistant acid phosphatase (TRAP) stain reaction
       7. “Dry “tap; marrow fibrosis and infiltrates
    7. Define lymphoma and generally classify using key terminology:
       1. Hodgkin
       2. Reed-Sternberg cells
       3. Rye modified cells
       4. Non-Hodgkin
    8. Recognize lymphoma cells
    9. Outline the laboratory tests used to diagnose and stage Hodgkin’s lymphoma:
       1. Complete blood count (CBC)
       2. Liver function tests
       3. Renal function tests
    10. Review blood and bone marrow findings of Hodgkin’s lymphoma:
        1. Radiologic studies
        2. Physical examination
        3. Lymph node biopsy
    11. Name disorders based on the proliferation of plasma cells and abnormal production of immunoglobulins
    12. Compare the clinical findings and laboratory features of various plasma cell disorders
    13. Compare the characteristics of leukemia and lymphoma.
    14. Describe the general characteristics and laboratory data in multiple myeloma.
20. Chapter 23- Myeloproliferative Neoplasms
    (1a-i.1b-ii,iii,iv,v,vi. 2c-i,ii,iii)
    1. Name the four diseases classified as myeloproliferative neoplasms (MPNs)
    2. List the clinical and laboratory findings commonly found in MPD:
       1. CML/CGL
       2. Leukocytosis with absolute neutrophilia and left shift maturation
       3. Absolute basophilia and eosinophilia
       4. Thrombocytosis
       5. Bone marrow hypercellularity with granulocytic proliferation
       6. Leukocyte alkaline phosphatase (LAP) activity
       7. Philadelphia chromosome
       8. Cytogenetic (karyotype)
       9. Molecular (DNA) techniques
       10. PV
       11. Increased red blood cell (RBC) mass
       12. Leukocytosis with mild left shift maturation and basophilia
       13. Thrombocytosis
       14. Bone marrow hypercellularity with all cell lines increased
       15. LAP activity
       16. Red cell morphology (initial phase/ “spent” phase)
       17. ET
       18. Marked thrombocytosis with platelet aggregates and abnormal forms
       19. Megakaryocytic hyperplasia of bone marrow
       20. LAP activity
       21. AMM
       22. Leukoerythroblastosis with teardrop-shaped red cells
       23. Leukocytosis with left shift maturation to occasional immature myeloid cell
       24. Bone marrow fibrosis and relationship to megakaryocytic hyperplasia
       25. LAP activity
    3. Define polycythemia
    4. Describe changes in the bone marrow and peripheral blood with polycythemia
    5. Differentiate between absolute polycythemia and relative polycythemia
    6. Report the general prognostic features of MPNs.
    7. Name the subtypes of chronic myelogenous leukemia (CML)
    8. Describe the epidemiology of CML.
    9. Explain the use of leukocyte alkaline phosphatase (LAP) in the diagnosis of CML compared to a leukemoid reaction.
    10. Characterize modes of treatment and prognostic features in CML.
    11. State other names that might be used to refer to polycythemia rubra vera (PRV).
    12. Describe the etiology of polycythemia rubra vera (PRV).
    13. Name the most striking feature of PRV.
    14. Describe the clinical signs and symptoms of PRV.
    15. List the criteria for establishing a diagnosis of PRV.
    16. State the other name for primary myelofibrosis.
21. Chapter 24- Myelodysplastic Syndromes and Myelodysplastic/Myeloproliferative Neoplasms
    (1a-i.1b-ii,iii,iv,v,vi. 2c-i,ii,iii)
    1. Discuss and compare features commonly shared by Chronic Myeloproliferative Neoplasms:
       1. Clinical manifestations
       2. Pathophysiologic mechanisms
       3. Blood and bone marrow findings
       4. Transitional forms between stages
       5. Disease evolution with potential for blastic transformation
    2. List subgroups recognized by the World Health Organization (WHO) Cooperative Groups for the MDS classification
    3. List the Chronic Myeloproliferative Neoplasms by cell type:
       1. Granulocytes--Chronic myelogenous/granulocytic leukemia (CML/CGL)
       2. Erythrocytes-- polycythemia vera (PV)
       3. Megakaryocytes--essential thrombocythemia (ET)
    4. Define and describe cellular features that characterize the MDS:
       1. Dyserythropoiesis
       2. Dysgranulopoiesis
       3. Dysmegakaryocytopoiesis
22. Instrumentation in Hematology
    1. Identify basic concepts of electrical impedance, optical detection, radio frequency, and of light scatter plus cytochemical stain systems
       1. Discuss the principle
       2. List components
       3. Describe operation
    2. Identify basic concepts of quality assurance for automated hematology cell counting systems
       1. Describe acceptable practices
       2. Perform basic quality assurance
       3. Assess data to ensure quality
       4. Monitor quality assurance program
       5. Describe the limitations and list interfering substances
    3. Identify and describe hemogram parameters
       1. Evaluate patient data
       2. Describe the flagging system
       3. Correlate scatter plots, histograms and data plots with the peripheral smear
       4. Describe the mathematical calculations used to monitor instruments
       5. Recognize unexpected results
    4. Discuss the principle of Automated reticulocyte counting
       1. Describe acceptable practices
       2. Perform basic quality assurance
       3. Assess data to ensure quality
       4. Monitor quality assurance program
       5. Describe the limitations and list interfering substances
    5.  
23. Lab #1:
    (1a-i.1b-ii,iii,iv,v,vi,2a-i.2b-i,ii,v,vi.2c-i,ii,iii.2e-i,ii,iii)
    1. Practice staining smears using Romanowsky dyes and/or Wright stain.
    2. Practice staining techniques according to established procedures:
       1. Manual
       2. Automated
    3. Investigate staining problems using the troubleshooting process.
    4. Demonstrate the appropriate area of a peripheral blood smear to evaluate red blood cell morphology
    5. Differentiate between normal and abnormal RBC morphology
    6. Distinguish between normal and abnormal hematopoietic elements found within the peripheral blood
    7. Identify a normal red blood cell (RBC) on a stained slide. Describe (in words) the characteristics of a normal red blood cell.
    8. Explain the FUNCTION of the red blood cell in the body.
    9. Identify cells that are white blood cells (WBC) on a stained smear (not required to differentiate until next lab).
    10. Identify normal platelets on a stained slide.
    11. Understand the meanings and uses of the MCV, MCH, and MCHC on a Hematology analyzer report
    12. Define normochromic and normocytic as it pertains to red blood cells.
    13. Discuss the automated hemogram parameters used for erythrocyte evaluation:
        1. Hemoglobin
        2. Hematocrit
        3. mean cell volume (MCV)
        4. Mean cell hemoglobin (MCH)
        5. Mean cell hemoglobin concentration (MCHC)
        6. Red cell distribution width (RDW)
    14. Categorize red cells:
        1. Shape
        2. Color
        3. Inclusions
        4. Distribution patterns
    15. Identify common RBC morphologies: hypochromia, polychromia, anisocytosis, poikilocytosis have acanthocytes, burr cells, sickle cells (drepanocytes), target cells, tear drop cells (dacryocytes) have stomatocytes, schistocytes, microcytosis, macrocytosis.)
24. Lab #2
    (1a-i.1b-ii,iii,iv,v,vi,2a-i.2b-i,ii,v,vi.2c-i,ii,iii.2e-i,ii,iii)
    1. List and define components of commonly used stains.
    2. Judge the acceptability of blood smears through microscopic evaluation and established criteria:
       1. Determine specimen acceptability
       2. List appropriate anticoagulants
       3. Identify acceptable ratio of anticoagulant to blood for specimens obtained from venipuncture and skin puncture
       4. List reasons for rejecting specimens
    3. List red blood cell count and indices reference values that account for variations in gender and age.
    4. Correlate automated hemogram parameters with each other and with peripheral smear exam results
    5. Differentiate band neutrophils, segmented neutrophils, eosinophils, and basophils
    6. List morphologic features used to differentiate developing leukocytes
    7. Practice performing differential cell count on normal specimens
    8. Define lymphocytopenia.
    9. List approximate normal ranges for WBC, RBC, Hgb, Hct, Platelet.
    10. Read a CBC printout/report and interpret results. Given the reference ranges, determine if the patient's results are high, low, or normal.
    11. Identify RBCs, WBCs, and platelets on a slide.
    12. Differentiate the different WBCs on a slide: segmented neutrophils (segs), band neutrophils (bands), lymphocytes (lymphs), monocytes (monos), basophils (basos), and eosinophils (eos).
    13. Define leukocyte.
    14. Be able to describe (in words) the appearance/characteristics of the different WBCs (seg have band, lymph, mono, baso, eos).
    15. Define the requirements of a WBC differential.
    16. Perform a WBC differential on unknown slides and match the instructor within a given margin of error.
25. Lab #3
    (1a-i.1b-ii,iii,iv,v,vi,2a-i.2b-i,ii,v,vi.2c-i,ii,iii.2e-i,ii,iii)
    1. Independently read 3-5 slide differentials, matching the technologist within stated percentage.