Lecture Notes for Clinical Laboratory Hematology, 2nd Edition

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Instructor’s Resource ManualLinda F. Comeaux, BS, CLS(NCA)Dean, Health, Sciences, and EngineeringArapahoe Community Collegeto AccompanyClinical Laboratory HematologySecond EditionShirlyn B. McKenzie, PhD, CLS(NCA), MT(ASCP)SHDepartment of Clinical Laboratory SciencesUniversity of Texas Health Science Center at San AntonioJ. Lynne Williams, PhD, CLS(NCA), MT(ASCP)Medical Laboratory Sciences ProgramOakland University

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CONTENTSIntroduction11Introduction to Hematology202The Hematopoietic System333The Anemias494Nonmalignant Disorders of Leukocytes825Neoplastic Hematologic Disorders976Body Fluids1177Hemostasis1298Hematology/Hemostasis Procedures147Appendix169Laboratory Worksheet—Differential Worksheet170Laboratory Worksheet—Blood Smear Evaluation171Answers to Practice Questions172iii

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1IntroductionThis Instructor’s Resource Manual is a supplement to theClinical Laboratory Hematologytextbook andis part of the complete teaching and learning package compiled by its authors. Like the textbook, theInstructor’s Resource Manual is created to support instruction and facilitate learning for both CLT/MLTand CLS/MT students.TheClinical Laboratory Hematologytextbook and Instructor’s Resource Manual have been thought-fully prepared to assist the educator in promoting “learner-centered” activities. An ancient Chineseproverb states:“I listen, I forgetI see, I rememberI do, I understand.”TheClinical Laboratory Hematologytextbook has a unique blend of features to enhance student com-prehension and learning. Likewise, the Instructor’s Resource Manual provides guidance and infor-mation to assist the educator and encourage the students’ active participation in the learning process.ORGANIZATION OF THE INSTRUCTOR’S RESOURCE MANUALThis Instructor’s Resource Manual includes active learning and retention tips, teaching strategies, asample syllabus, transition grids, suggested student activities, additional practice questions and casestudies, word searches, and crossword puzzles. It is organized as noted below by the same contentsections as found in theClinical Laboratory Hematologytextbook.ÁÁSection 1Introduction to HematologyChapter 1Introduction to HematologyChapter 2Cellular HomeostasisChapter 3HematopoiesisSection 2The Hematopoietic SystemChapter 4Structure and Function of Hematopoietic OrgansChapter 5The Erythrocyte

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2Instructor’s Resource ManualChapter 6HemoglobinChapter 7The LeukocyteSection 3The AnemiasChapter 8Introduction to AnemiaChapter 9Anemias of Disordered Iron Metabolism and Heme SynthesisChapter 10Hemoglobinopathies: Qualitative DefectsChapter 11ThalassemiaChapter 12Megaloblastic and Nonmegaloblastic Macrocytic AnemiasChapter 13Hypoproliferative AnemiasChapter 14Introduction to Hemolytic AnemiaChapter 15Hemolytic Anemia: Membrane DefectsChapter 16Hemolytic Anemia: Enzyme DeficienciesChapter 17Hemolytic Anemia: Immune AnemiasChapter 18Hemolytic Anemia: Nonimmune DefectsSection 4Nonmalignant Disorders of LeukocytesChapter 19Nonmalignant Granulocyte and Monocyte DisordersChapter 20Nonmalignant Lymphocyte DisordersSection 5Neoplastic Hematologic DisordersChapter 21Introduction to Hematopoietic NeoplasmsChapter 22Myeloproliferative DisordersChapter 23Myelodysplastic SyndromesChapter 24Acute Myeloid LeukemiasChapter 25Acute Lymphoblastic LeukemiasChapter 26Lymphoid Malignancies: Chronic Lymphoid Leukemias, Lymphomas, andPlasma Cell NeoplasmsChapter 27Hematopoietic Stem Cell TransplantationSection 6Body FluidsChapter 28Morphologic Analysis of Body Fluids in the Hematology LaboratorySection 7HemostasisChapter 29Primary HemostasisChapter 30Secondary Hemostasis and FibrinolysisChapter 31Disorders of Primary HemostasisChapter 32Disorders of Secondary HemostasisChapter 33ThrombophiliaSection 8Hematology ProceduresChapter 34Hematology ProceduresChapter 35Bone Marrow ExaminationChapter 36Automation in Hematology and HemostasisChapter 37Flow CytometryChapter 38Chromosome Analysis of Hematopoietic and Lymphoid DisordersChapter 39Molecular Analysis of Hematologic DiseasesChapter 40Laboratory Testing in CoagulationChapter 41Quality Assessment in the Hematology Laboratory

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Introduction3UNIQUE FEATURESEach of the eight sections in the Instructor’s Resource Manual has a number of unique features, whichare described below for both Level I and Level II learners.•Transition GridThe Transition Grid provides the educator with an easy cross-referencebetweenClinical Laboratory Hematologyand other hematology textbooks.•ObjectivesAll chapter objectives, known as checklist items, are listed.•Active LearningA variety of “learner-centered” activities are presented. Detailed informationconcerning implementation of these activities can be found in the Teaching Tips section of theInstructor’s Guide.•Laboratory ActivitiesMost sections include suggested activities to perform in the studentlaboratory. A sample differential and blood smear evaluation worksheet is provided in theInstructor’s Guide appendix.•Practice QuestionsAdditional practice questions and one case study for each level (I and II)are included per section. Three questions from each Taxonomy (recall, application, and analysis)of cognitive learning are integrated throughout the questions. Answers to the practice questionsmay be found in the Instructor’s Guide appendix.•Word Search and Crossword PuzzlesCopy-ready word search and crossword puzzles areprovided at the end of each section. All sections have both a Level I and Level II word searchand crossword puzzle with a correlating answer sheet.SUPPLEMENTAL WEB SITEAn innovative supplement to theClinical Laboratory Hematologytextbook is the Companion Websitefound atwww.pearsonhighered.com/mckenzie. Educators are encouraged to guide their learners to thisadditional teaching and assessment resource. This website is dynamic and will be periodically updated.Educators and learners are provided with additional multiple choice questions at both the Level I andLevel II abilities. To challenge students, there are problem-solving/critical-thinking questions that canbe attempted by students as guided by their instructor. For additional support and information, stu-dents can visit the following websites.Other suggested sites to visit include:http://www.beckman.com/lars/personnel/webinars.asphttp://www.lymphoma.org.ukhttp://dpalm.med.uth.tmc.edu/faculty/bios/nguyen/Webcoag/Webcoag.htmhttp://www.whonamedit.com/http://www.bloodline.netwww.clot-ed.comwww.phd.msu.edu/Education/InteractiveHemostasisAnimations.aspxhttp://ashimagebank.hematologylibrary.org/Active Learning sites to visit:http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/active.htmhttp://trc.ucdavis.edu/TRC/ta/tatips/activelearning.pdfhttp://www.acu.edu/cte/activelearning/whyuseal2.htm

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4Instructor’s Resource ManualINSTRUCTOR’S RESOURCE DVD-ROMThe Instructor’s Resource DVD-ROM (0-13-513737-3) contains many resources in an electronic format.It includes the complete test bank that allows instructors to design customized quizzes and exams. TheTestGen wizard guides you through the steps to create a simple test with drag-and-drop or point-and-click transfer. You can select test questions either manually or randomly and use online spell-checkingand other tools to quickly polish your test content and presentation. The question formats include mul-tiple choice, fill-in-the-blank, true/false, and essay. You can save your test in a variety of formats bothlocally and on a network, print up to 25 variations of a single test, and publish your tests in an onlinecourse. For more information, please visitwww.pearsonhighered.com/testgen.It also includes aPowerPoint Lecturepackage that contains key discussion points, along with fig-ures and tables for each chapter. This feature provides dynamic, fully designed, integrated lectures thatare ready to use and allows instructors to customize the materials to meet their specific course needs.AnImage Libraryof images and tables in the book is also available to you. We feel this offeringwill help you to be more successful in the classroom as these images can be projected on-screen dur-ing a class lecture or inserted into handouts or quizzes. You have permission from Pearson to copyand paste these images into your PowerPoint lectures, printed documents, and web site, as long asyou have adopted and are usingClinical Laboratory Hematology, 2nd edition,as your course textbook.ABonus Image Library(an instructor’s dream) also is available on the DVD-ROM. This libraryincludes high resolution color microscopic pictures of normal and abnormal hematopoietic cells. It isorganized by chapter and each slide is indexed to help you locate a particular slide quickly. The slidescan be used in digital presentations in the classroom or in on-line courses if you have adopted the bookas your course textbook.Anelectronicversion of this Instructor’s Resource Manual in PDF and Word formats can beaccessed on the Instructor’s Resource DVD-ROM.TEACHING TIPSThis Teaching Tips section provides brief information on writing objectives, test item writing, expla-nations of the suggested activities, and a sample syllabus. This material is intended to assist theclinical laboratory educator at all levels of instruction.Writing ObjectivesObjectives are specific performance or behavioral statements describing what the “student will be ableto do” after completing a particular instructional activity. Learners will be guided and directed by the objec-tives written by the instructor. These instructional objectives should be measurable and consistent withthe instruments designed to assess student learning, that is, exams, laboratory practicals, and so on.Instructional or learning objectives are generally classified into three different domains: cognitive,affective, and psychomotor.• Cognitive domain involves mental operations from recall (lowest level) to evaluation (highestlevel).• Affective domain involves the attitudes, values, or feelings from acquisition (lower level) to actionand internalization (higher level).• Psychomotor domain ranges from simple manipulation to the highest level of creativeperformance.Effective learning objectives should be written within each domain to address and fulfill the fiveareas of developmental needs. Generally, theintellectualneeds are within the cognitive domain, the

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Introduction5physicaldevelopmental needs are found within the psychomotor domain, and thepsychological,social,andmoral/ethicalneeds are within the affective domain. This particular Teaching Tip sectionfocuses on the cognitive domain.Intellectual or cognitive domain objectives are composed according to the complexity of the skills.Benjamin Bloom and associates have created the most widely used and accepted taxonomy (classifi-cation) of cognitive objectives, known as “Bloom’s Taxonomy.” Bloom’s Taxonomy includes the fol-lowing six categories.1.Knowledge(recalling or recognizing information)2.Comprehension(understanding the meaning of information)3.Application(applying or using the information)4.Analysis(comprehending information into its component parts)5.Synthesis(generating new ideas by putting the components together)6.Evaluation(judging the worth of an idea, opinion, or information)This Taxonomy can be further condensed into three categories:•Taxonomy IKnowledge•Taxonomy IIApplication•Taxonomy IIIEvaluationTaxonomy I is the simple recall of information that has been presented. Taxonomy II is the inter-pretation of facts and an application of the information that is given. Taxonomy III involves problemsolving at the highest level of learning. This Instructor’s Guide provides examples of the Taxonomy I,II, and III cognitive process in the practice question sections.Finally, when writing learning objectives the educator should strive to compose a statement withverbs that are measurable or observable. Action verbs such as explain, discuss, or formulate give overtinstructions to the learner. Instructors shouldavoidverbs that are covert or not obviously measurablesuch as understand, realize, learn, know, believe, indicate, comprehend, or appreciate. Direct, mea-surable objectives may include some of the following action verbs.Taxonomy Ichoose, complete, classify, define, describe, explain, express, identify, recall, rec-ognize, state, or summarizeTaxonomy IIapply, analyze, appraise, calculate, compute, demonstrate, develop, diagram,differentiate, distinguish, establish, interpret, perform, provide, relate, solve, submit, or utilizeTaxonomy IIIassess, compile, compare and contrast, create, design, evaluate, formulate, fore-cast, generate, justify, predict, propose, recommend, resolve, revise, synthesize, validateNote:Action verbs may cross over categories depending on the content covered and the question beingasked.Reference:Kellough, R., and Kellough, N.A Guide to Methods and Resources, Planning for Competence.UpperSaddle River, New Jersey: Merrill/Prentice Hall, 1999.Test Item WritingIt is not always difficult to write test questions, however, it is sometimes challenging to compose assess-ment items that are meaningful and effective. Here are a few hints on how to successfully assess yourstudent’s learning while creating exam questions.

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6Instructor’s Resource ManualMultiple choice questions, a type of “selected response test item,” are some of the more commonitems used in written exams. These items are composed of theitem stem(the question or statement)and possible options to complete or answer the question. Options or choices that are incorrect are calleddistracters.Overall, test items should:• Test one, relevant concept.• Correlate with the learning objectives and Taxonomy level. The action verbs listed above can alsobe used in test item writing. The appropriate action verb will determine the Taxonomy or cogni-tive level required to answer each question.• Be well written in terms of vocabulary, sentence structure, spelling, and grammar.• Avoid unimportant information that will make the question too long or difficult to comprehend.Item stems should:• Be written clearly and concisely so the students know what is being asked—avoid being “tricky.”• Use different phrasing than what is in the textbook.• Not educate or teach concepts within the context of the stem.• Not include unessential information as an introduction.• Not use vague or absolute terms, that is, generally, never, or always.Options/distracters should:• Be consistent with the content of the stem but should not repeat the wording or phrasing.• Avoid the use of “all of the above”—recognizing one wrong option will eliminate this choice.• Include four to five responses (four options seems preferable).• Be listed in alphabetical or chronological order.• Have a consistent length—test-wise students can identify longer options as generally correct.• Be plausible.• Be created in a manner that represents errors in thinking that students might commonly make.Active Learning and Suggested ActivitiesTeaching and learning experts acknowledge that an environment in which students play a role andtake responsibility for their learning and the teacher performs as facilitator rather than lecturer is farmore conducive to learning retention. The “Learning Pyramid” states a learner will retain only 10% ofinformation read and only 20% seen in audiovisual activities. Furthermore, demonstrations provide only30% retention, discussions 50%, hands-on practice retains 75%, and teaching others allows for 90%retention of information.1Every good instructor strives to teach in a way that will optimize student learning. This sectionprovides tools to assist the instructor in creating “learner-centered” activities to enhance student learn-ing. Some educators believe that performing such activities will sacrifice too much time or content.Although it is true a guided activity may take more time, it is also true that the student will developmore critical-thinking skills and comprehend the information much more efficiently.1National Training Laboratories, Bethel, Maine, Average Learning Retention Rates http://www.tcde.tehama.k12.ca.us/pyramid.pdf.

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Introduction7Although the Clinical Laboratory Science profession is composed of many introverted individu-als, it is essential to communicate openly and clearly. Many of the suggested activities in this Guide pro-vide opportunities for the learner to experience and practice conveying a subject or message.Each section of the Instructor’s Resource Manual presents a list of suggested learner-centeredactivities to enhance learning of the content in that section. The following information explains how tocreate and execute each exercise.1.Clear the MudAt the end of any class period, the instructor will pass out index cards to allstudents and ask each of them to write down any topic, current or past, that is still unclear. Thestudents should place their respective index cards into a container on the instructor’s desk. As stu-dents leave, they should randomly pick an index card from the container, research the topic, andprepare an answer or explanation to the “muddy point” written on the card. The instructor canthen have each student present their explanation during the next class period to the whole class.2.Create/ConstructThe “Create” sections are self-explanatory. These exercises are provided toassess the learners “synthesis” cognitive skills. For instance, the instructor may ask the studentsto create a case study for a disease condition that includes laboratory results and patient clinicalpresentation.3.DiagramThe “Diagram” sections are also self-explanatory. These exercises assess the students’ability to “apply” and “analyze” at the Taxonomy II level. Drawing or diagramming a hemoglo-bin molecule or the coagulation cascade can be an effective learning tool.4.Extra, Extra, Read All About ItThis activity will encourage the students’ creativity while assess-ing their comprehension, knowledge, and writing ability. It is simply a fun and different way tohave the learner relate their understanding of the material. For example, section II of this Guidesuggests the following exercise:Have the students write a newspaper or magazine article about their interview with thewell-known celebrity group,“Erythropoietin.”Include in this article where “our stars”are from, what influences them, what affect they have on their environment, and describe“their” most important contribution.5.Group DiscussionWhether teaching in the classroom or on-line, it is invaluable to engage thelearner in an active discussion. Set the ground rules for discussion prior to revealing the topic. Usesuch rules as:• Only professionally delivered comments may be made.• There will be mutual respect for everyone’s opinion—everyone’s opinion is valued.• No name calling or attacking comments may be made. In electronic discussions no inflamma-tory messages may be posted.• Everyone must participate—no person may dominate the discussion.• Establish a time limit for each comment and for the overall discussion.Instructors: Allow students to facilitate the discussion. At the end of the discussion provide asummary of the comments offered. It is invaluable for the learners to know that their opinionshave been heard and are valid.For example, at the end of a discussion on “human cloning” the instructor would summa-rize and say, “I have appreciated everyone’s view on this topic. I heard that some say it wouldbe unacceptable to clone a human for any reason while others thought cloning for medical or re-search purposes could be considered,” and so on.6.Hematology BowlThis activity is also similar to the classic television game show,Jeopardy.The Instructor• Divides the class into three to four small groups (four to five students per group). One stu-dent from each group is to be the contestant.

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8Instructor’s Resource Manual• Creates six to eight categories, that is, RBC, Leukemia, Coagulation, and so on.• Constructs five to seven “answers” per category.°Each answer should be assigned a point value.• Generally, the point value and degree of difficulty increase for each answer in thecategory.Hematology Bowl Rules• A selected student will choose the first category.• The instructor reads the answer.• The contestants “buzz in” or simply raise their hand if they think they know the correct an-swer. The first contestant to do this will have the option to respond and may consult with theother members of their group.• Contestants must formulate their response in the form of a question.• If the contestant provides a correct answer, their group is given the designated point value ofthe answer, and they get to select the next category.°If the contestant does NOT provide a correct answer, the remaining contestants may “buzzin” and attempt a response.Sample Answer• (Under the category “RBC”—response point value equals 100.) Answer: “Stimulates the pro-duction of red blood cells.” Contestant’s response: “What is erythropoietin?”7.Match-Up GameThis learning activity is identical to the Concentration card game (also knownas Memory Match) where a full deck of cards are shuffled and laid face down on a flat surface.The first player turns over two random cards attempting to make a match. If the match is suc-cessful, the player removes the two cards, places them to their side, and takes another turn. If thematch is unsuccessful, the player returns the cards to the facedown position, and the next playertakes their turn.The laboratory Match-Up Game is similar in process; however, the game can be altered byusing clinical laboratory terms and definitions, disease names and conditions/characteristics, ortest parameters and laboratory results, and so on.The instructor can create the Match-Up Game (usually a minimum of 10–15 matches isideal) and have the students “play” it. To further enhance learning, a small group of 2–3 learnerscan “create” the cards themselves.• Divide the class into small groups and assign a particular topic to each group. The stu-dents should use blank/identical index cards and should refrain from making any dis-tinguishable markings on the backside of the cards. After the groups of learners“create” the game, they can exchange cards with another group of learners and “play”the game.8.MappingMapping exercises are effective in identifying the student’s ability to assemble andorganize various pieces of information. The students are instructed to:• Take out a clean piece of paper.• Start at the center of the paper and write down the topic to map.• Draw lines extending from the central topic. At the end of each short line, write another wordthat relates to the central topic. From this extension draw another line and write a word orshort phrase that relates to this extended topic and so on and so on.Here’s a short (incomplete) example of a map on the subject of “leukemia.”

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Introduction9Each open line represents an area where additional information can be attached. First,have the students create a map without the assistance of textbooks or notes. This will assesstheir current level of comprehension. Instructors may or may not choose to then allow the stu-dents to complete the map using the text.9.Mystery BoxThe Mystery Box activity allows the students to assemble or arrange separate“pieces of information” into one.• Divide the class into small groups of two to four students.• A decorated or cardboard box may be used.• For each box place all of the necessary information on separate pieces of paper.• Have the students empty the box and combine, arrange, or assemble the information accord-ing to the activity instructions given in each section.For example: Section I of the Instructor’s Guide has the following Mystery Box activity.Create a Mystery Box with the different components and reference ranges. Be sure toinclude at least:• Leukocytes• Erythrocytes• Thrombocytes• Plasma• Whole blood•••• 55% of blood volume150–450*109/L4.0–5.5*1012/L4.0–11.0*109/LFAB ClassificationCLLChronicleukemiasLeukemiaSeen in childrenALLProliferation oflymphoid cellsAcuteleukemiasmay see Auer rodsGreater than 30% blast seenAMLFABClassificationCMLM1-withoutmaturationM2-withmaturation

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10Instructor’s Resource Manual• 5–6 liters in adults• And so onThe instructor places each of the above components or reference ranges on a separate pieceof paper and places all pieces in the Mystery Box. The students will empty the box and matchthe component with its appropriate reference range.Additional Notes1. The instructor should decide if textbooks or other reference materials may be used duringthis exercise.2. The student may be directed to read a section of the textbook and, without additional in-struction, perform the Mystery Box activity.3. A time limit for completing this activity may be implemented.4. Students may perform these exercises individually or in teams.5. As an alternate activity, the students may be asked to create their own Mystery Box, thengive it to another student or group to solve.10.One Minute ParagraphThe one minute paragraph activity is used to assess students’ under-standing of a particular topic. It may be used several times during the course. Students arerequested to write all that they know about a particular subject for exactly one minute without anyassistance from textbooks or notes. Instructors should read the students’ work, evaluate theirlevel of comprehension on the topic, and provide feedback.The one minute paragraph may be performed at any time during the class. Composing theone minute paragraph at the end of a class period, however, gives the instructor guidance onhow well the students have grasped the information presented that day. The instructor may ormay not choose to give advanced notice of this activity.11.Mnemonic DeviceLearners need some process or technique to assist their information reten-tion and memory. Mnemonic devices are one example of such a technique. An example of amnemonic device is Princess Brown’s Pet Ox Ran Everywhere.In this case the first letter of eachword in the phrase represents the first letter of each cell in the erythrocyte maturation series, start-ing with the most immature, Pronormoblast, Basophilic normoblast, and so on.Instructors should allow the students to create their own mnemonic device. Instructorsmay choose to select a particular phrase that the whole class will utilize.12.Pyramid GameThis exercise is similar to the game show,$25,000 Pyramid,and promotes afun/enjoyable environment for learning.Activity Preparation• A pyramid of boxes or index cards are created (any number of cards may be used dependingon how long the activity will proceed).• The index cards are placed face down in a pyramid shape.• On the back side of the card is a category.• The cards are turned over, starting with the lower left side of the pyramid and proceeding inthe following manner.654123

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Introduction11Pyramid Game Rules• One student provides the clues (Student A). The other student provides the answers (Student B).• Student A turns over the first card and looks at the category. Student A then begins to listwords or characteristics included in the category without using any of the words listed onthe card.• Student B tries to name the category as soon as it is recognized.• If Student B is successful, Student A moves to the next card. Student A has the option to passon a category but must eventually return to it in order to complete the pyramid.• A specific time limit should be set for each pyramid, that is, one to two minutes.• The instructor and fellow classmates should act as time keepers and monitor for giving ap-propriate clues.• Each team of students (Students A andteam) can record their time, and the team com-pleting the pyramid in the shortest amount of time would be considered the winner.Sample category and cluesB=a654Neutrophilmaturation23Category:Clues:Myeloblast. . .promyelocyte. . .myelocyte. . .metamyelocyte. . .band. . .seg(The word “neutrophil” cannot be used as a clue.)13.Short StoryThis activity is similar to the “Extra, Extra, Read All About It” exercise. Creating a“Short Story” will encourage the students’ creativity while learning the subject content. Forinstance, Section I of the Instructor’s Guide invites the learner to create a story entitled “The Lifeand Development of a Cell.” This exercise asks the learner to personify a cell and discuss its jour-ney of development.Instructors may choose to give this exercise as an in-class activity, as a group assignment,or even as a take-home exercise.14.Small Group TeachingOften learners cannot appreciate the amount of time and work neededto prepare a lecture. This activity gives the student an opportunity to experience the depth andattention to detail needed in order to produce an effective presentation.Each student group should be given this assignment with adequate time to research andprepare. The instructor may act as facilitator for this exercise and should provide direction onwhat topics need to be included. The instructor may also give direction or hints on how to ad-dress an audience.The instructor may consider planning which lectures throughout the course will betaught by a small group of learners. Each student should have the opportunity to participate inthis activity.

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12Instructor’s Resource Manual15.Think-Pair-ShareThink-Pair-Share is an in-class type of activity. A subject or topic is introduced,and the students are asked to discuss their understanding of the subject with one other student.Selected pairs of students may be asked to share their discussion and information. The instructorshould designate a particular amount of time for this activity, that is, one to five minutes.This activity may also be used as anIce Breakerexercise on the first day of a new class.Students are asked to pair with another student. Students share with each other a small amountof information about themselves. After a designated amount of time, each student shares withthe class information they learned about their partner. Generally, it appears to be easier to talkabout someone else instead of yourself, especially on the first day of class. This activity is a gen-tle and effective way of getting to know the students in class.16.Thumbs Up/Thumbs DownTo get immediate feedback on any topic during the class period theinstructor can quickly ask for a “Thumbs Up or Thumbs Down” so students can indicate if theycomprehend the information presented. As the instructor presents topics that are potentially dif-ficult he or she can stop momentarily and ask students to show either a thumbs up, indicating theyunderstand the information, or thumbs down, meaning more explanation or clarification is needed.17.Tic-Tac-ToeThis activity is constructed just like the television game show. Arrange your stu-dents in the following manner.• Two contestants—one is “X”; one is “O.”• Seat nine students in chairs to form a square—three rows of three chairs each.• Each student should have two fairly large cards—one marked with an “X” and the othermarked with an “O.”• The instructor or a designated student is the “host.”Proceed with the following activities:• The instructor creates a series of questions prior to the activity.• The contestant (usually “X” goes first) is asked to pick a particular student in the square.• The host reads the first question to the contestant and the selected student in the square. Forexample, “Auer rods are found in what type of leukemia?”• The student in the square provides an answer. The contestant decides to either agree or dis-agree with this answer.• If the contestant makes a correct decision, then their symbol (X or O) is placed in the square.If the contestant makes an incorrect decision, then the opponent’s symbol is placed in thesquare (the student in that square should now hold up the appropriate symbol).• Play continues in the same manner for the other contestant.• The object of the game is to create a tic-tac-toe. The first contestant to do this wins the round.**Rotate students as contestants and square participants.18.Web SearchIn addition to the distinctive Web site feature of theClinical Hematology Textbook,instructors may encourage students to conduct their own Web search on a selected topic. Theactivity of researching and discovering information is an invaluable learning tool. To make thestudents accountable, the instructor may also request a short report on their findings.

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Introduction13SAMPLE SYLLABUSEach course should include a syllabus. This document acts as a stated agreement between the instruc-tor and learner and provides valuable information to guide and direct the student to success.Basic information in a course syllabus includes:1. Course title, number, and credits2. Instructor contact information3. Course description4. Prerequisite requirements5. Textbook or materials required6. Course or program policies and procedure7. Grading scales and policies8. Course objectivesEach component of the course syllabus should be thoughtfully and accurately written. Courseobjectives, in particular, are vital to guide the students’ learning. These objectives should be written toaddress the affective, psychomotor, and cognitive domains. Suitable action verbs are included in eachobjective to address the appropriate skill or cognitive level (see the “Writing Objectives” section of thisTeaching Tips document).Note:To assist instructors in the development of course objectives, Level I and Level II Objectives foundin each chapter of Clinical Laboratory Hematology may be utilized.SampleCLT 131—Introduction to HematologyHi!—Welcome to the 2-credit on-line hybrid course of an “Introduction to Hematology” (the study ofblood).A calendar with assignments, tests, and due dates is listed under the “Assignments” link. Coursematerials are found under “Course Documents,” and a student manual that describes how to use theon-line features is found under the “Tools” button.This CLT 131 syllabus includes the following information:• Course description• Participation• Corequisite• Laboratory makeup policy• Course technology requirement• Due dates• Textbooks/required materials• Academic integrity policy• Instructor contact information• Withdrawal policy

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14Instructor’s Resource Manual• Learner expectations• Disability services• Classroom environment• Grading• Attendance• Course objectivesCourse DescriptionCLT 131—Introduction to Hematology is designed for anyone interested in the laboratory sciences. Itis especially offered for learners interested in the Clinical Assistant Certificate and/or the Clinical Lab-oratory Technology degree.This course will cover the topics of:1. Laboratory safety2. OSHA (Occupational Safety and Health Administration) standards3. An introduction to phlebotomy (blood drawing)4. Basic hematology test theory and procedures such as:• Hemoglobin and hematocrit determinations• White blood cell (WBC) and red blood cell (RBC) structure and function• Manual hematocrit test procedures• Peripheral slide preparationCorequisiteThere are no “required” prerequisites; however, completion of or current enrollment in Biology 201and/or Biology 202 (Anatomy and Physiology) is recommended. Contact the CLT Program Director formore information about general education and CLT courses needed to complete the AAS degree.Course Technology RequirementsA basic working knowledge of the following will be necessary to succeed in this on-line course.• Completing Internet browsing• Operating a word processor program (i.e., Microsoft Word)• Sending and receiving e-mail with attachments• Participating in chat room discussions• Accessing, reading, and posting to bulletin boardsTextbooks/Required Materials1. **Textbook:Clinical Laboratory Hematology, 2/e,Shirlyn B. McKenzie and J. Lynne Williams,Pearson publisher, copyright 2010, ISBN 0-13-513732-22. **CLT 131 Laboratory Manual**All of the above books are required and can be purchased from the college bookstore.

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Introduction153. Lab coat (for student laboratory sessions)4. Black sharpie marker5. Computer with Internet access and an Internet browser that is 4.0 or higher. You may also ac-cess the college’s open computer lab at no additional cost.Contact InformationInstructor:Name###-###-#### (phone)###-###-#### (fax)e-mail address College, hospital, or UniversityAddressCity, State zipTechnical Support:Name###-###-#### (phone)###-###-#### (fax)e-mail addressLearner ExpectationsTo be successful in this on-line hybrid course, you will need to set aside at least six to eight hours perweek in order to complete reading assignments, course documents, answer unit questions, participatein on-line activities and discussions, and take quizzes. You are strongly encouraged to designate a spe-cific block of time each week to work on these materials. Although your activities and participation areasynchronous (not at the same time), it is essential that you stay current with the pace of the course offer-ings. When attending scheduled laboratory sessions, you are expected to have reviewed and com-pleted all required assignments. Doing this will promote a successful learning experience.Additionally, all learners are expected to adhere to the following terms throughout this course.Please send the instructor an e-mail at“e-mail address”by “month, date, year”with your acceptance ofthese terms of agreement.When e-mailing, please always putCLT 131in the subject line in order to identify your messageas part of the Introduction to Hematology course. The instructor will respond to e-mails and phone mes-sages within 24 hours (excluding weekends and holidays).Terms of AgreementClassroom EnvironmentIt is crucial that the on-line classroom be an atmosphere that is stimulating and safe for learning. Eachlearner is encouraged and welcomed to offer their thoughts and opinions. In the on-line environment,each learner should expect trust and mutual respect that celebrates diversity of thought, culture, andintellect. The instructor and classmates will work constructively while maintaining a professionaldemeanor and consideration for everyone.

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16Instructor’s Resource ManualAttendanceStudents are appreciated for the time and effort they give to participating in the on-line activities andattending all on campus laboratory class sessions. Five points/hour for each laboratory session will beoffered to students that are present. Attendance points will be used in the final grade calculations.Please be courteous and notify the CLT Program Director and/or Instructor if your attendance is pro-hibited by an emergency. (CLT office ###-###-####)ParticipationInteraction and participation in on-line and laboratory sections is essential for a successful learningexperience. A portion of your evaluation and grade is based upon your participation and thoughtfulcontributions to class discussions and activities. Ten points will be given for each discussion activitybased upon the depth and quality of your response posted by the assigned due date. Likewise, 5–20points/unit will be offered for successful completion of unit questions by the assigned due date.Laboratory Makeup PolicyOn campus, laboratory classes will NOT be repeated. Open laboratory times will be available duringthe semester for student practice. Missed laboratory practical exams cannot be made up.Due DatesAccess the course “Assignments” navigational button for a listing of course assignments and a calen-dar of due dates. There are established deadlines for assignments, group work, unit questions, andtests. The instructor will be flexible with the due dates for unit questions and assignments if notifiedin advance. However, out of respect for each participant, extensions cannot be provided for group proj-ects, discussion activities, or quizzes. It is truly in your best interest to stay current with the materialsas they are presented. If you are having difficulties, please contact the instructor as soon as possible,and arrangement for tutorial sessions can be made.Academic IntegrityYou demonstrate academic integrity when you submit your own work or properly acknowledge thework of others. Violating this principle constitutes academic dishonesty and may result in disciplinaryaction. The College’s Student Handbook determines academic misconduct and dishonesty as: “Cheatingor knowingly assisting another student in committing an act of cheating or other forms of academic dis-honesty. Cheating includes but is not limited to: 1) use of any unauthorized assistance in taking quizzes,tests, or examinations; 2) dependence upon the aid of sources authorized by the instructor in writingpapers, preparing reports, solving problems, or carrying out other assignments; or acquisition, withoutpermission, of tests or other academic material belonging to a member of the college faculty or staff.”Plagiarism or knowingly assisting another student in committing an act of plagiarism.Plagiarism includes, but is not limited to the useof the published or unpublished work ofanother person without full and clear acknowledgment. It also includes submitting examinations,themes, reports, drawings, laboratory notes, undocumented quotations, or other material as one’s ownwork when such work has been prepared by another person or copied from another person. Unau-thorized possession of examinations, answer keys, reserve library materials, computer software, com-puter codes, or laboratory materials is unacceptable behavior.Á

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Introduction17Please refer to the College Student Handbook for more information on Code of Conduct and Stu-dents Rights and Responsibilities. (The CLT Program Guide and College Student Handbook will bemailed to you the first week of class.)Withdrawal PolicyStudents are responsible for meeting the deadline dates and for initiating a withdrawal either throughthe college Web site or calling the Office of Admissions and Records (###-###-####). The deadline forreceiving a refund is before the first 15 percent of the course is completed. After the first 15 percent ofthe class and before 80 percent of the class is complete, students may still withdraw. However, norefund will be granted.• Last day to drop this course and receive a refund:month date, year• Last day to withdraw from this course and receive a “W” with NO refund:month date, yearDisability ServicesSupport services are available to students with disabilities who have a documentable need for accom-modation in accordance with the Americans with Disabilities Act and the Rehabilitation Act of 1973,Section 504. To access services at the College, contact The Center for Academic Resources in Room ####or call ###-###-####/tty.GradingRequired Projects and/or Papers2–3 On-line Journal Entries2 Discussion Activities1–2 Group Projects/Cooperative Learning ExercisesSubmission of Laboratory Manual Unit questions each weekNumber of ExaminationsLECTURE: 3–4 ON-LINE EXAMS(On-line): 1 FINAL WRITTEN EXAMLABORATORY: 2–3 PRACTICAL EXAMS(On Campus): LABORATORY COMPETENCIES1 Final Practical ExamScale665%=F65%–74%=D75%–84%=C85%–92%=B93%–100%=A

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18Instructor’s Resource ManualGrade DeterminationsSTUDENTS MUST RECEIVE AT LEAST 75 PERCENT IN BOTH THE LECTURE AND LABORATORYSECTIONS IN ORDER TO SUCCESSFULLY COMPLETE THIS COURSE.ObjectivesEach individual unit of instruction in the Laboratory Manual has specific objectives to guide the learner.The following are overall course objectives for the CLT 131—Introduction to Hematology course.After successful completion of this course the learner should be able toOn-line Sections1. Discuss OSHA safety regulations for blood-borne pathogens.2. Discuss fire, chemical, electrical, and radiation safety, as well as laboratory safety rules.3. Evaluate Medical Ethics scenarios.4. Describe the microscope parts and functions.5. Explain the proper venipuncture technique and describe all appropriate phlebotomy equipment.6. Calculate basic metric system problems.7. Compare and contrast the morphology and function of whole blood cellular elements.8. Describe all parameters of the complete blood count (CBC).9. Explain hemoglobin and hematocrit test procedures and results.10. Classify the criteria for making a quality peripheral blood smear.On Campus Laboratory Sections1. Demonstrate compliance with OSHA safety regulations for blood-borne pathogens.2. Properly utilize fire, chemical, electrical, radiation, and laboratory safety guidelines.3. Demonstrate proper use of personal protective equipment.4. Demonstrate acquired responsibility by:a. Arriving on time to lab and setting up equipment or supplies as listed.b. Being ready to listen attentively to the instructor’s directions.c. Cleaning and turning off equipment as instructed.d. Disinfecting bench tops before and after the lab period.e. Returning and storing all equipment (i.e., microscopes), supplies, and reagents to specifiedarea in a correct and orderly fashion.5. Practice proper venipuncture and finger stick procedures and evaluate fellow classmates’technique.Lab final practical=15%Competencies=20%Laboratory practicals=15%Lecture final exam=15%Class participation/Assignments=15%Lecture exams=20%

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Introduction196. Determine suitability of hematology specimens and dispose of them in the appropriate biohazardcontainers.7. Correctly identify and date each specimen and reagent to minimize the chance of misunderstanding.8. Properly store, clean, and operate the laboratory microscopes.9. Determine hematocrit values on whole blood samples.10. Prepare acceptable peripheral blood smears and view for slide and staining quality.11. Apply and adhere to quality control standards for all student laboratory testing.12. Recognize technical testing errors for all laboratory tests and suggest possible reasons for andsolutions to errors.Laboratory CompetenciesComplete and document 100 percent of the following tasks with a minimum competency of 75 percent.1. Complete all laboratory assignments.2. Prepare 10 acceptable peripheral blood smears.3. Perform and read five manual hematocrits.4. Obtain three successful venipunctures.5. Obtain two successful finger sticks.ReferencesKellough, R., and N. Kellough.A Guide to Methods and Resources, Planning for Competence.UpperSaddle River, New Jersey: Merrill Prentice Hall, 1999.National Credentialing Agency (NCA) Test Item Writing Review.Test Item Writing athttp://www.jmu.edu/assessment/itemformats.htm.Frary, R. “More Multiple-Choice Item Writing Do’s and Don’ts.” ERIC Digest athttp://www.ed.gov, 1995.

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201Introduction to HematologyA.TRANSITION GRIDInformation concerning Chapter 1, “Introduction; ” Chapter 2, “Cellular Homeostasis;” and Chapter3, “Hematopoiesis” may also be referenced in the following hematology textbooks.Clinical Laboratory HematologyChapter 1Chapter 2Chapter 3McKenzie, 1st editionChapter 1Chapter 2Chapter 2Harmening, 5th editionn/an/aChapter 1Rodak, 3rd editionn/aChapter 6Chapter 7Turgeon, 4th editionn/aChapter 3Chapter 4B.OBJECTIVESChapter 1 – IntroductionLevels I and II1. Compare the reference intervals for hemoglobin, hematocrit, erythrocytes, and leukocytes in in-fants, children, and adults.2. Identify the function of erythrocytes, leukocytes, and platelets.3. Describe the composition of blood.4. Explain the causes of change in the steady state of blood components.5. Describe clinical pathway, critical pathway, reflex testing, and disease management and identifythe laboratory’s role in developing these models.6. Compare capitated payment, prospective payment, and fee-for-service and describe the impactof capitation on the laboratory.

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1Introduction to Hematology21Chapter 2 – Cellular HomeostasisLevel I1. Describe the location, morphology, and function of subcellular organelles of a cell.2. Describe the lipid asymmetry found in the plasma membrane of most hematopoietic cells.3. Differentiate the parts of the mammalian cell cycle.4. Define R (restriction point) and its role in cell cycle regulation.5. Defineapoptosisand explain its role in normal human physiology.6. Classify and give examples of the major categories of initiators and inhibitors of apoptosis.7. List the major events regulated by apoptosis in hematopoiesis.Level II1. Explain the significance of SNPs, introns, exons, UTRs, post-translational protein modifications.2. List the components and explain the function of the Ubiquitin-Proteosome system.3. DefinecyclinsandCdksand their role in cell cycle regulation; describe the associated Cdk partnersand function of cyclins D, E, A, and B.4. DefineCAK(Cdk-activating kinase) and the two major classes of CKIs (cyclin-dependent kinaseinhibitors) and describe their function.5. Compare the function of cell-cycle checkpoints in cell-cycle regulation.6. Describe/illustrate the roles of p53 and pRb in cell-cycle regulation.7. Propose how abnormalities of cell-cycle regulatory mechanisms can lead to malignancy.8. Definecaspasesand explain their role in apoptosis.9. Differentiate the extrinsic and intrinsic pathways of cellular apoptosis.10. Define and contrast the roles of proapoptotic and antiapoptotic members of the Bcl-2 family ofproteins.11. Describe apoptotic regulatory mechanisms.12. Give examples of diseases associated with increased apoptosis and inhibited (decreased)apoptosis.13. Define, and give examples of, epigenetics, oncogenes and tumor suppressor genes and theirroles in cell biology.14. Differentiate using morphologic observations, the processes of necrotic cell death and apoptoticcell death.Chapter 3 – HematopoiesisLevel I1. Describe the basic concepts of cell differentiation and maturation.2. Compare and contrast the categories of hematopoietic precursor cells: hematopoietic stem cells,hematopoietic progenitor cells, and maturing cells, including proliferation and differentiationpotential, morphology, and population size.3. Describe the hierarchy of hematopoietic precursor cells and the relationships of the variousblood cell lineages to each other (including the concept of colony-forming units/CFUs).

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22Instructor’s Resource Manual4. Discuss the general characteristics of growth factors and identify the major examples of earlyacting (multilineage), later acting (lineage restricted), and indirect acting growth factors.5. Differentiate between paracrine, autocrine, and juxtacrine regulation.6. List examples of negative regulators of hematopoiesis.7. Definehematopoietic microenvironment.Level II1. Identify the phenotypic characteristics differentiating the hematopoietic stem cells and progenitorcells.2. Identify the key cytokines required for lineage-specific regulation.3. Describe the structure and role of growth factor receptors.4. Summarize the concept of signal transduction pathways.5. Discuss the roles of transcription factors in the regulation of hematopoiesis and differentiation.6. Outline current clinical uses of cytokines.7. Describe the cellular and extracellular components of the hematopoietic microenvironment.8. Discuss the proposed mechanisms used to regulate hematopoietic stem/progenitor cellproliferation/differentiation.Note:Statements in parts C, D, & E identified with asterisks suggest Level II competenciesC.ACTIVE LEARNING SUGGESTED ACTIVITIES{Background information on each suggested activity is provided in theIntroduction/Teaching Tipssection atthe beginning of this Instructor’s Resource Manual.}1.Clear the MudAt the end of class, pass out index cards to all students and ask each of them towrite down any topic, current or past, that is still unclear. Have students place their respectiveindex cards into a container on the instructor’s desk. As students leaves, they should randomlypick an index card from the container, research the topic, and prepare an answer or explanationto the “muddy point” written on the card. The instructor may choose to ask a few students topresent their explanation during the next class period.2.Diagramsa. Using the information provided in Chapter 2, have the learners create their own explicit dia-gram of the:• Cell structure• Stages of the cell cycle•Hematopoietic precursor cell model3.Group Discussiona. Create a group discussion on the topic of the Medical Ethics concerning stem cell transplants.4.Mystery Boxa. Create a Mystery Box with the different blood components and corresponding referenceranges. Be sure to include at least• Leukocytes• Erythrocytes**

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1Introduction to Hematology23• Thrombocytes• Plasma• Whole blood•••• 55 percent of blood volume• 5 – 6 liters in adults• And so on5.One-Minute ParagraphHave learners submit a one minute paragraph on the:a. Composition of bloodb.Abnormal tissue homeostasis and cancer6.Short StoryHave the learners, individually or as a group, write:a. The story of “The Life and Development of a Cell”b. A “Murder Mystery” of a Cell7.Think-Pair-Sharea.Discuss the value and need for “clinical” and “critical” pathways.b.Discuss Necrosis versus Apoptosis.8.Thumbs Up/Thumbs DownRemember to get immediate feedback on any topic during theclass period, call for a quick “Thumbs Up or Thumbs Down.” Ask students to indicate if theycomprehend the information presented by showing either a thumbs up, indicating they un-derstand the information, or thumbs down, meaning more explanation or clarification isneeded.D.LABORATORY ACTIVITIES1.Perform WBC and RBC counts on each learner in the class, and create a “class reference range”for WBC and RBC. You might want to have students read the section “Reference Interval Deter-mination” in Chapter 41 if you include this activity.E.PRACTICE QUESTIONS1. List the components of whole blood and state the reference range for each. [Taxonomy 1]2.Explain why “reflex testing protocols” are designed. [Taxonomy 1].3. A patient experiencing a viral infection is likely to demonstrate an increase in which of the fol-lowing? [Taxonomy 1]a. Erythrocytesb. Hematocritc. Leukocytesd. Thrombocytes4. Patient Aaron had an RBC count ofExplain why a hospital in Alabama might con-sider this value “normal,” whereas a facility in Utah may recognize Aaron’s RBC as “below”normal. [Taxonomy 2]5.In the textClinical Laboratory Hematology,differentiate “precursor cells” from “maturing cells.”[Taxonomy 2]**4.0*1012/L.**********150-450*109/L4.5-5.5*1012/L4.5-11.0*109/L

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24Instructor’s Resource ManualWhich set of results demonstrates aa. Leukocytosisb. Erythrocytopeniac. Thrombocytopeniad. Critically decreased H & He. Leukopeniaf. Thrombocytosis7.Compare and contrast a “fee-for-service” reimbursement system to a “capitated payment” plan.[Taxonomy 3]8. Compare and contrast the processes of cell “self-renewal” versus “cell differentiation.” [Taxonomy 3]9. Evaluate the following patient results and conclude which body function (mechanism) will beadversely affected. Explain why. [Taxonomy 3]10. A 26-year-old male, Type I diabetes mellitus patient is seen in the emergency department. Thepatient’s blood chemistry results confirm the need for renal dialysis. Explain the etiology for thispatient’s hematology results. [Taxonomy 3]Plt=321*109/LHct=27.6%Hgb=9.5 g/dLRBC=3.2*1012/LWBC=11.8*109/LPlt=222*109/LHct=25.1%Hgb=8.2 g/dLRBC=2.5*1012/LWBC=0.8*109/L**A.B.C.WBC=18.6*109/LWBC=0.6*109/LWBC=6.5*109/LRBC=3.50*1012/LRBC=2.12*1012/LRBC=4.79*1012/LHgb=10.2 g/dLHgb=7.5 g/dLHgb=16.4 g/dLHct=31.1%Hct=24.3%Hct=49.6%Plt=202*109/LPlt=89*109/LPlt=543*109/L6. Analyze each set of results and answer the following questions. [Taxonomy 2]

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1Introduction to Hematology25VHEHNJNHDTRFNEMMNLPSCTDTSSSZTXESOYYREYLTEEMYSNMIIHRGYDENNHCNUMBSTRECYMEIKOBKEMROAPVMCGKPBLNLLNATRRHEOOGMAQBNCMNPEZLCTSOSWIXTUMEOFLNYLRTPQRDLNHWPIOCTHEMATOLOGYTALQTTXPLZSXQLCWMMOKKYZTVRDIXYVWFLRDGGGLVTNPSMRWYVPQLFEUCHROMATINDRNNRMKCNALBUMINCLSISEIOPOTAMEHMWIntroduction to Hematology—Level I• cell division—repeated reproduction• another term for hematopoietic growth factor• study of formed cellular blood elements• process of forming a blood clot• outer boundary of a cell• the earliest morphologically recognizable cell of each blood cell lineage• the process of blood cell formation• how a blood cell passes through vessel walls• part of cell that contains the genetic material• genes that induce tumor formation• main constituent of plasma• programmed cell death• platelet• lightly stained portions of chromatin• undifferentiated, pleuripotential hematopoietic cell (2 words)Figure out what words the clues represent. Then find the words in the grid. Words can go horizontally, vertically, anddiagonally in all eight directions.

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26Instructor’s Resource ManualVHEHNJNHDTRFNEMMNLPSCTDTSSSZTXESOYYREYLTEEMYSNMIIHRGYDENNHCNUMBSTRECYMEIKOBKEMROAPVMCGKPBLNLLNATRRHEOOGMAQBNCMNPEZLCTSOSWIXTUMEOFLNYLRTPQRDLNHWPIOCTHEMATOLOGYTALQTTXPLZSXQLCWMMOKKYZTVRDIXYVWFLRDGGGLVTNPSMRWYVPQLFEUCHROMATINDRNNRMKCNALBUMINCLSISEIOPOTAMEHMWIntroduction to Hematology—Level I• cell division—repeated reproduction (proliferation)• another term for hematopoietic growth factor (cytokines)• study of formed cellular blood elements (hematology)• process of forming a blood clot (hemostasis)• outer boundary of a cell (membrane)• the earliest morphologically recognizable cell of each blood cell lineage (blast)• the process of blood cell formation (hematopoiesis)• how a blood cell passes through vessel walls (diapedese)• part of cell that contains the genetic material (nucleus)• genes that induce tumor formation (oncogenes)• main constituent of plasma (albumin)• programmed cell death (apoptosis)• platelet (thrombocyte)• lightly stained portions of chromatin (euchromatin)• undifferentiated, pleuripotential hematopoietic cell (2 words) (stem cell)

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1Introduction to Hematology27123456789101112131415ACROSS1Growth and development of lymphoid cells4Stage during which microtubular spindles alignduring mitosis7Cells that defend against foreign antigens8Where the metabolic activities of the cell takesplace12Alternate copies (alleles) of a gene13Type of cell that differentiates into mature,functional cells15Cell murderDOWN2Outside of cell3Study of the entire genome of an organism5Arrest of bleeding6Study of the formed cellular blood elements9Vital protein inside erythrocytes10Organelles that assemble amino acids intoprotein11Group of proteins responsible for apoptotic celldeath14Complete blood count (abrv)Introduction to Hematology—Level I

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28Instructor’s Resource ManualLPOIOMYHPSESIGXEMSAEATHPHHNRLUEETSOKYCOAMMMCOAIESTYPOCCALMSHTOSLEALRUMSOICLOIGBAAGYLOMOPMSPRIHLSPOEGINPORAOTRBCMSIBEEENRCSOSISSIntroduction to Hematology—Level I

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