PART # 1 HEMATOLOGY a) What is meant by M:E ratio? b) What is a

PART # 1 HEMATOLOGY a) What is meant by M:E ratio? b) What is a normal M:E ratio? c) Apply the information above and explain why a normal M:E ratio is what it is. d) CFU Differentiation: CFU-GEMM gives rise to multiple cell types, while CFU-Eos and CFU-Bas produce only eosinophils and basophils, respectively. Why is it important for the bone marrow to regulate differentiation through interleukins and growth factors? e) Why is the development of secondary granules important for determining the final role of a granulocyte? f) Why do T lymphocytes need to go through a selection process in the thymus before entering circulation, while B lymphocytes fully mature in the bone marrow? g) How do secondary lymphoid organs like the spleen and lymph nodes enhance immune surveillance and response compared to lymphocytes circulating in the blood? h) B cells require cytokines like IL-1 and IL-6 to fully activate. Why is this additional signaling step necessary, and how does it prevent unwanted immune responses? i) Unlike B cells, T cells specialize in cell-mediated immunity rather than antibody production. Why is this distinction important for fighting viral infections and cancer cells? J) NK cells function as part of the innate immune system but can recognize and destroy virus-infected and cancerous cells. How does this differ from the specific antigen recognition of T cells, and why is this important for immune defense? k) bsolute and Relative Counts W B C count = 5.0 multiplied by 10⁹/liter W B C Differential Segs = 40% Bands = 3% Lymphs = 55% Monos = 2% Relative Value of Lymphs Lymphs = 55% Absolute Value of Lymphs W B C count multiplied by relative percentage of lymphs 5,000 multiplied by 0.55 = 2,750 12 Questions: A patient has a WBC count of 4.0 × 10⁹/L, with 80% lymphocytes. Another patient has a WBC count of 12.0 × 10⁹/L, with 40% lymphocytes. Which patient has a higher absolute lymphocyte count, and why? A patient’s CBC shows an elevated relative neutrophil percentage but a normal absolute neutrophil count. What does this indicate, and why might this occur? Why are absolute cell counts more reliable than relative percentages when evaluating changes in a patient’s WBC count over time? PART #2 URINALYSIS Metabolic Diseases Case Studies A) – A 46 year old man presented to the emergency room with hematuria and pain. He reported a history of kidney stones, going back to his teen years, and said he had told he had a metabolic disorder. A urinalysis gave the following results: Color Yellow Appearance Hazy Specific gravity 1.012 pH 6.0 Protein ++ Glucose Negative Ketone Negative Bilirubin Negative Blood +++ Urobilinogen 1.0 mg/dL Leukocyte esterase + WBCs 5-10/hpf RBCs >100/hpf Bacteria ++ Casts 5-10/LPF mixed Crystals Many 1. What metabolic disorder does this patient most likely have? 2. Are these typical findings for kidney stones? 3. What causes this disorder? 4. Name a disorder with which this may be confused. 5. Name two major differences between these two disorders. 6. What further tests should be done? B) A 5-month old infant was brought to the emergency department because of vomiting and diarrhea. The physical examination revealed an enlarged liver and spleen. Urinalysis testing gave the following results. Color Yellow Appearance Cloudy Specific Gravity 1.009 pH 7.0 Protein + Glucose Trace Ketone Neg Bilirubin Neg Blood Neg Urobilinogen 0.2 mg/ dL Nitrite Neg Leukocyte Esterase Neg WBCs 0-5/hpf RBCs – Bacteria – Casts Rare hyaline Crystals Moderate 1. The symptoms and urine findings shown by this infant may indicate which diagnosis? 2. What is the most common form of this disorder and what is the cause? 3. What additional test would be helpful in establishing a diagnosis and what are the expected results? C) C- A 9-month old boy is admitted to the pediatric unit and diagnosed with of failure to thrive. The mother states that she has observed setbacks in her son’s motor skills development as well as noticing occasional diapers with a substance resembling orange sand in them. Urinalysis results are as follows: Color Yellow Appearance Hazy Specific Gravity 1.024 pH 5.0 Protein Neg Glucose Neg Ketones Neg Blood Neg Bilirubin Neg Urobilinogen Normal Nitrite Neg Leukocyte Neg Microscopic: Many uric acid crystals 1. Is there any correlation between the urinalysis results and the substance observed in the child’s diapers? Explain your answer. 2. What disorder do the patient’s history and urinalysis results indicate? 3. Is the fact that this is a male patient of any significance? Explain your answer. 4. Name the enzyme that is missing

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