Automation Flashcards
(147 cards)
1
Q
Used by most laboratories because results are readily available for a short period of time
A
Automation
2
Q
How long does automation take?
A
1-2 mins
3
Q
Provides the Standard Hematology Parameters:
A
Automation
4
Q
Enumerate the standard hematology parameters
A
RBC Count and Indices, including hemoglobin and hematocrit
WBC Count
Platelet Count
WBC Differential Count
5
Q
Different Types of Automated Analyzer in Hematology
A
3-part (segmenters, lymphocytes, monocytes)
5-part (Neu, Eos, Baso, Lympho, Mono)
6-part (Neu, Eos, Baso, Lympho, Mono, nRBC)
6
Q
What are the 3 segmenters
A
3 segmenters: Neutrophils, Eosinophils, Basophils (counted as 1 unit)
7
Q
T/F: in 6-part, Counting of nRBC is important because it is mistaken as WBC
A
T
8
Q
Corrected WBC count is performed if there are many nRBCs
A
6-part (Neu, Eos, Baso, Lympho, Mono, nRBC)
9
Q
Enumerate the different automated machines
A
Electrical Impedance
Radiofrequency
Optical Scatter
10
Q
aka Low-Voltage Direct Current or Coulter Principle
A
ELECTRICAL IMPEDANCE
11
Q
Most common principle used in hematology analyzer
A
Electrical Impedance
12
Q
Electrical impedance is developed by _________________ (________)
A
Coulter Electronics (1950’s)
13
Q
Coulter Electronics (1950’s) 1st automated hematology analyzer
A
Coulter Cell Counter Model A
14
Q
Examples of electrical impedance
A
Beckman Coulter (LH series, GEN-S, HmX, A-T)
Sysmex (XE and XT series)
Abbott (Cell-Dyn, 3700, Ruby, Sapphire,.)
ABX (Micros 60, Pentra series)
15
Q
FIll in the blank:
Principle of Electrical impedance: As a _______ suspension of cells is drawn through the _______, the passage of each individual cell momentarily (increases/decreases) the impedance (resistance) of the electrical path between two submerged electrodes that are located on each side of the aperture.
A
dilute
aperture
increases
16
Q
Blood cells are suspended primarily in an________ solution.
A
Isotonic solution
17
Q
The isotonic solution is present in the?
A
aperture bath
18
Q
Two aperture electrodes:
A
External electrode
Internal electrode
19
Q
located inside the aperture tubes which contains an aperture
A
Internal electrode
20
Q
As cell enters the aperture, it will (decrease/increase) impedance (electrical resistance)
A
increase
21
Q
T/F: Cells are excellent conductors of electricity
A
F: POOR conductors
22
Q
As the cell passes through the aperture, it ________ the electrical current between the internal and external electrodes causing an __________________
A
disrupts
electrical resistance.
23
Q
Each electrical resistance causes a pulse which is measured:
A
Number of pulse
Height of pulse
24
Q
The generated pulse is displayed in a _____________ or _____________
A
oscilloscope or histogram
25
process for generated pulse
cells --> aperture --> resistance --> pulse
26
Displays the pulses generated by the cells as they interrupt the current
Oscilloscope
27
Oscilloscope
Number of pulses = the number of _____
cells
28
Oscilloscope
Amplitude of impulses = ____/_____ of cells
size/volume
29
height of the pulse
Y-axis
30
allows discrimination of cells of specific volume
threshold circuits
31
Histogram
Principle:
Number of pulses (y axis) = _________
Number of cells
32
Histogram'
Principle
Amplitude of pulse (x-axis) = _____________
Cell size/volume
33
will only identify cell based on its volume range
Threshold circuit
34
usually expressed in femtoliters
Threshold circuit
35
Steps for Electronic Impedance
Sample is diluting in an isotonic solution
Dilution is instrument-dependent
RBC and Platelets are simultaneously counted (in one aperture)
WBC counting
Hemoglobin and WBC are simultaneously assessed
36
Aka RF resistance, high-voltage electromagnetic current
Radiofrequency
37
Used in conjunction with low-voltage direct current (DC) impedance/electrical impedance
Radiofrequency
38
Radiofrequency
Measures ____________
conductivity
39
Radiofrequency measures conductivity which is relative to the:
Nuclear:cytoplasmic or N:C ratio,
nuclear density,
cytoplasmic granulation
40
Radiofrequency is used to detect ____, ____ based on the cellulary desntiy
It’s used to detect cell size
41
Examples of radiofrequency
Coulter (LH series, GENfi-S, HmX, A-T)
Sysmex (XE-2100, XT 2000i, HST-N)
Abbott
42
Principle for radiofrequency
Measures two different cell properties (based on the 2 methods):
43
2 methods in the principle of radiofrequency
DC impedance
RF pulse/Conductivity
44
proportional to cell volume
DC Impedance
45
proportional to intracellular density
RF pules/conductivity
46
Plotted using cytogram or scatterplot
Radiofrequency
47
T/F: Radiofrequency allows 6-part WBC differential
5-part WBC differential
48
Since intracellular density is also identified, the 3 segmenters can now be differentiated as well as ______, and ________
monocyte and lymphocyte
49
Enumerate the errors which may be encountered in automation
Instrumental Errors
Nature of Specimen
50
Enumerate instrumental errors
Aperture plugs
Bubbles in the specimen
Extraneous electrical impulses
Excessive lysing of RBCs
Improper setting of aperture current
51
Which error in instrumental error causes false decrease in RBC count
Excessive lysing of RBCs
52
Which error in instrumental errors
may cause (+) or (-) error or either false increase or false decrease
53
In instrumental errors, all causes false increase in hematology parameter except for _________, and __________
Excessive lysing of RBCs
Improper setting of aperture current
54
Enumerate the errors in nature of specimen
Giant platelets/macrothrombocytes
Fragments of WBC cytoplasm
Some abnormal RBCs resist lysis
55
Which error in nature of specimen is not identified or counted as platelets due to its size
Giant platelets/macrothrombocytes
56
Giant platelets/macrothrombocytes may be counted as:
RBC: false (increase/decrease)
WBC: false (increase/decrease)
RBC - false increase
WBC - false increase
57
Giant platelets/macrothrombocytes causes false (increase/decrease) in platelet
decrease
58
Which error in nature of specimen is counted as ↑platelet, ↑RBC but most of the time as platelet
Fragments of WBC cytoplasm
59
In "some abnormal RBCs resist lysis", enumerate what may cause false increase in WBC
HbS
HbC
HbF
60
What light source is used in optical scatter?
laser light (mercury arc)
non-laser light (tungsten halogen lamp)
61
Used to measure light scattering properties of cells
Optical scatter
62
T/F: cells can scatter light at a specific angle
F; various angles
63
Examples of optical scatter
Sysmex
Abbott
64
Principle of optical scatter:
As a single cell passes through the _________ of the flow cell, it scatters the __________
sensing zone
focus light
65
Scattered light is detected by a _________
photodetector
66
T/F: Photodetector are placed at a different angle so that it can detect light
true
67
Each time the photodetector detects a light, it will cause a _______
pulse
68
The number of pulses is (directly/indirectly) proportional to the number of cells passing through the sensing zone.
Directly
69
Enumerate the angles of light scatter
Forward-angle light scatter (0°)
Forward low-angle light scatter (2 to 3°) & Forward high-angle (5 to 15°)
Orthogonal light scatter (90°)
70
cell volume or cell size
Forward-angle light scatter (0°)
71
diffracted light by the cell
Forward-angle light scatter (0°)
72
as cell passes through it diffracts the light
Forward-angle light scatter (0°)
73
can relate to size or volume and allows for description of the refractive index of cellular components
Forward low-angle light scatter (2 to 3°) & Forward high-angle (5 to 15°)
74
Forward low-angle light scatter (2 to 3°) & Forward high-angle (5 to 15°)
as cells pass through the focus light:
smaller cell = __________________
bigger cell = ______________
smaller angle
bigger angle
75
Orthogonal light scatter (90°) aka _________
side scatter
76
correlates w/ degree of internal complexity (granularity and lobularity)
Orthogonal light scatter (90°)
77
allows identification of granulocytes
Orthogonal light scatter (90°)
78
In the patterns of optical light scatter, enumerate the factors
Absorbance
Diffraction
Refraction
Reflection
79
the wavelength of light that is not transmitted
Absorbance
80
bending of light around corners with the use of small angles
Diffraction
81
bending of light because of a change in speed with the use of intermediate angles
Refraction
82
light rays turned back by the surface or an obstruction with the use of large angles
Reflection
83
Enumerate the common interferences on automated analyzers
COLD AGGLUTININS
LIPEMIA, ICTERUS
HEMOLYSIS
84
In cold agglutinins, blood wherein RBC agglutinates below the body temp. optimally at ______ (grainy appearance)
4°C
85
because at a temp. below the body temperature, this cold acting antibodies reacts, causing agglutination of RBC
IgM
86
Parameters affected in cold agglutinins
Decreased: ______
Increased: ____, _____
RBC
MCV, MCHC
87
T/F: because RBC clumps and or agglutinated (false increase in size), therefore not identified as RBC
True
88
What is the correction action for cold agglutinins
Warm the sample at 37°C then re-run
89
Lipemia causes __________, while icterus causes ______________________
turbidity
abnormal color in blood
90
Lipemia and icterus can affect _____________ reading
spectrophotometric
91
Parameters affected in lipemia and icterus
Increased: _____, ______
Hgb, MCH
92
principle of automated analyzer in measuring hemoglobin which is why Hgb is affected
Cyanmethemoglobin
93
T/F: Hbg value is used to compute for MCH (mean cell hemoglobin), therefore it is also affected
True
94
Interferences in automated analyzers due to improper specimen collection
Hemolysis
95
Parameters affected in hemolysis
Decreased: ____. _____
RBC, Hct
96
T/F: In hemolysis, The RBCs are lysed, but it is still counted as RBC causing false increase
F; NOT counted as RBC causing false DECREASE
97
ENUMERATE OTHER PARAMETERS AFFECTED
- Lysis-resistant RBC
- Microcytosis (small RBCs) and/or Schistocytosis
- nRBC, megakaryocyte fragments, and
micromegakaryoblasts
- Platelet Clumps/macrothrombocytes (giant
platelets)
- WBC (>100,000/uL)
- Leukemia with chemotherapy
- Old Specimen
98
Lysis-resistant RBC
Increased: ____, _____
Decreased: ______
Others:______
Increased: WBC, Hgb
Decreased: None
Others: None
99
Microcytosis (small RBCs) and/or Schistocytosis
Increased: ______
Decreased: ______
Others:______
Increased: None
Decreased: RBC
Others: None
100
nRBC, megakaryocyte fragments, and micromegakaryoblasts
Increased: ______
Decreased: ______
Others:______
Increased: WBC
Decreased: None
Others: None
101
Platelet Clumps/macrothrombocytes (giant platelets)
Increased: ______
Decreased: ______
Others:______
Increased: WBC
Decreased: Platelets
Others: None
102
WBC (>100,000/uL)
Increased: _____, ______
Decreased: ______
Others:______
Increased: RBC, Hgb
Decreased: None
Others: Incorrect Hct, Abnormal RBC indices
103
Leukemia with chemotheraphy
Increased: _____
Decreased: ______
Others:______
Increased: Platelet
Decreased: WBC
Others: None
104
Old Specimen
Increased: _____, ______
Decreased: ______
Others:______
Increased: MCV
Decreased: Platelets
Others: Incorrect WBC differential
105
Increased paraproteins
Increased: _____
Decreased: ______
Others:______
Increased: Hgb
Decreased: None
Others: Incorrect RBC Indices (esp. Indices using hemoglobin value MCH, MCHC; MCV value is NOT affected
106
Hyperglycemia
Increased: _____, _______
Decreased: ______
Others:______
Increased: MCV, Hct
Decreased: MCHC
Others: None
107
Howell-Jolly Bodies
Increased: _____
Decreased: ______
Others:______
Increased: Platelet
Decreased: None
Others: None
108
RBC containing HbS, HbC, HbF
Lysis-resistant RBC
109
Microcytosis (small RBCs) and/or Schistocytosis
Most automated hematology analyzers count RBC if the volume is between ___________fL
36-360fL.
110
T/F: If the RBC size is decreased (in case of microcytosis), it is not counted as RBC. same with schistocytosis
True
111
They are counted as WBC
nRBC, megakaryocyte fragments, and micromegakaryoblasts
112
nRBC, megakaryocyte fragments, and micromegakaryoblasts
Corrective action: count nRBC, megakaryocyte fragments, and micromegakaryoblasts per ___________ and performed corrected WBC count
100 WBCs
113
T/F: Platelets increased in size as they clumps (not counted as WBC)
F; COUNTED as WBC
114
Platelet Clumps/macrothrombocytes (giant platelets)
Corrective action: redraw blood using __________ then multiple the result by ____
citrate tube
1.1
115
>100,000/uL of WBC may cause ________ in blood
turbidity
116
WBCs are very fragile therefore WBC is decreased.
Leukemia with chemotherapy
117
Leukemia with chemotherapy
If the WBC is destroyed, the fragments are counted as platelet causing an (decrease/increase) in platelet
increase
118
Old specimen
RBC swells causing an increase in ______
MCV.
119
Old Specimen
T/F: Platelets swell and degenerate causing a decrease in amount.
True
120
Old Specimen
Prolonged exposure of blood with ______ affects WBC
EDTA
121
Old specimen
Corrective action:
--> _____________
--> The laboratory should also established a ____________ (criteria in which the laboratory follows)
Recollect sample
Rejection criteria
122
Hyperglycemia causes RBC to (swell/shrink)
Swell
123
Hyperglycemia
Hgb conc. is relative to the size of the swollen RBC therefore, _________ is decreased
MCHC
124
Nuclear remnants and the size is similar to that of platelet
Howell-Jolly Bodies
125
Howell-Jolly Bodies
Corrective action: evaluate ___________ to check if the patient has Howell-Jolly Bodies
blood smear
126
Hematocrit CV
≤ 21% (0.21)
≥ 65% (0.65)
127
Hemoglobin CV
≤ 70 g/L
≥ 200 g/L
128
Reticulocyte CV
> 20%
129
WBC count CV
< 2,000/uL
> 50,000/uL
130
enumerate blood smear CV
Neutrophilic phagocytosis of microorganism
Abnormal Leukemoid Reaction
Schistocytes or RBC fragments
Sickle cells
Blasts/immature cells (if new patient)
Presence of intracellular organisms
131
Blood Smear
presence of systemic infection (sepsis)
Neutrophilic phagocytosis of microorganism
132
Blood Smear
indicates hemolytic condition
Schistocytes or RBC fragments
133
Blood Smear
Sickle cells indicates
hemoglobinopathy or thalassemia
134
Blood smear
indicates that the patient has leukemic condition;
Blasts/immature cells
135
Blood smear
only reported immediately on new patients
Blast/immature cells
136
Platelets CV
< 20,000/uL (if not previously reported)
> 1 million/uL
137
If these values are observed, double check the results by performing the following:
--> Rule of three
--> Manual method of the parameter with the critical
value
--> Rerun the sample with control solution
138
Only a way of checking the result of hematology analyzer
Rule of three
139
Used for quality control
Rule of three
140
Rule of three
Shall only be used if the RBC is:
Normocytic (normal MCV)
Normochromic (normal MCHC)
141
In the rule of three, multiple the results by ____
3
142
Rule of three
RBC x 3 = _____
Hbg x 3 = ______
RBC x 3 = Hbg
Hbg x 3 =Hct (3%)
143
What is the value of RBC?
3.62 x 10^12/L
144
What is the value of Hbg?
11.1 g/dL
145
What is the value of Hct?
32.6%
146
T/F: in rule of three, If the value are close, it means the result of the machine is correct
True
147
Manual method of the parameter with the critical value
Example: In hematocrit, ______________ using _______________
microhematocrit method
microhematocrit centrifuge
