Hematology Part 1 Flashcards
(142 cards)
1
Q
Hematology
A
The study of blood and its components.
2
Q
Blood Percentage of Total Body Weight
A
7-8% of total body weight.
3
Q
Average Blood Volume (Male)
A
5-7 liters.
4
Q
Average Blood Volume (Female)
A
4-6 liters.
5
Q
Why Do Females Have Less Blood?
A
Due to smaller average body size and monthly menstruation.
6
Q
Blood Composition
A
55% Plasma, 45% Formed Elements (RBCs, WBCs, Platelets).
7
Q
Plasma
A
The liquid portion of blood containing proteins, nutrients, and waste.
8
Q
Serum
A
Plasma without clotting factors.
9
Q
Formed Elements
A
Red Blood Cells (RBCs), White Blood Cells (WBCs), Platelets.
10
Q
Fibrinogen
A
A plasma protein essential for blood clot formation.
11
Q
Fibrinogen Conversion
A
Converted to fibrin during clot formation.
12
Q
Plasma Water Content
A
90-92% of plasma is water.
13
Q
Albumin Function
A
Maintains oncotic pressure and prevents fluid leakage from blood vessels.
14
Q
Why Blood Volume Matters
A
Important for oxygen transport, heart function, and kidney filtration.
15
Q
Effects of Low Blood Volume
A
Leads to tachycardia, poor circulation, and heart strain.
16
Q
Effects of High Blood Volume
A
Causes hypertension, fluid overload, and kidney strain.
17
Q
Edema
A
Accumulation of water in tissues due to decreased albumin levels.
18
Q
Hemoconcentration
A
Increased blood component concentration due to plasma loss.
19
Q
Role of Kidneys in Blood Volume
A
Filters excess fluid and maintains balance in the body.
20
Q
Nephron
A
Smallest functional unit of the kidney responsible for filtering blood.
21
Q
Effects of Increased Blood Volume on Heart
A
Increases workload, leading to potential heart failure.
22
Q
Transfusion-Associated Circulatory Overload (TACO)
A
A condition caused by excessive blood transfusion leading to fluid overload.
23
Q
Phlebotomy
A
The art and science of collecting blood specimens.
24
Q
Step-by-Step Process
A
A systematic method to ensure correct blood collection.
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Methods of Blood Collection
1. Arterial Puncture, 2. Venipuncture, 3. Skin Puncture.
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Venipuncture Site
Antecubital fossa (inner elbow).
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Preferred Vein for Venipuncture
Median Cubital Vein (well-anchored and does not roll).
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Alternative Veins for Venipuncture
Basilic Vein (inner arm) and Cephalic Vein (outer arm).
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Uses of Skin Puncture
Used for infants, young children, patients with poor veins, and point-of-care testing.
30
Skin Puncture Site for Infants
Medial/Lateral portion of the plantar surface of the foot.
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Most Common Finger for Skin Puncture
Middle Finger.
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Maximum Depth for Skin Puncture
No more than 2.0 mm deep.
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Heel Puncture Age Limit
Only for infants under 1 year old.
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Arterialized Capillary Blood
Capillary blood warmed for arterial gas analysis.
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Warming Time for Arterialized Blood
25 minutes at 42°C.
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Common Sites for Arterialized Capillary Blood
Fingers, Earlobes, Heels.
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Tourniquet Length
18-20 inches long.
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Tourniquet Width
1 inch wide.
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Tourniquet Placement
Should be positioned away from the puncture site.
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Maximum Tourniquet Application Time
No more than one minute.
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What Happens if Tourniquet is Left Too Long?
Remove and reapply after two minutes to prevent hemoconcentration.
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Needle Gauge Number Rule
Higher gauge number = Smaller needle diameter.
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Gauge for Blood Donation
16g.
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Gauge for Blood Transfusion
18g.
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Most Common Gauge for Venipuncture
21g.
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Other Common Venipuncture Gauges
19, 20, 21, 22.
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Preferred Needle Length for Venipuncture
1.0 - 1.5 inches.
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Gauge Number and Needle Hub Color
18g - Pink, 19g - Brown/Yellow, 20g - Yellow, 21g - Green, 22g - Black, 23g - Blue-Green/Blue.
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Red Tube
Non-additive (used for serum collection).
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Light Blue Tube
Sodium Citrate (used for coagulation tests).
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Gray Tube
Sodium Fluoride/Potassium Oxalate (used for glucose testing).
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Green Tube
Lithium Heparin or Sodium Heparin (used for chemistry tests).
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Lavender Tube
EDTA (used for hematology tests).
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Yellow Tube (SPS)
Used for blood culture collection.
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Yellow Tube (ACD)
Contains Acid Citrate Dextrose (used for DNA testing).
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Tubes Containing EDTA
Lavender, Pink, White, Tan.
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Sodium Citrate Tube Cap Colors
Black (3.8%) or Light Blue (3.2%).
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Function of Sodium Citrate
Prevents clotting in coagulation studies by binding calcium.
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Function of EDTA
Prevents clotting by binding calcium, used in hematology tests.
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Function of SPS
Used for blood culture collection.
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Blood Culture Machines
BacT/ALERT, Bactec.
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Why Should Tourniquets Not Be Left for Long?
Prolonged application may cause hemoconcentration and inaccurate test results.
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Why is the Order of Draw Important?
Prevents cross-contamination of additives and ensures accurate test results.
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Front (Term)
Back (Definition)
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D. ORDER OF DRAW FOR EVACUATED TUBES AND SYRINGE (HENRY 22ND ED.)
Young boys should easily learn good nursing
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1. Blood culture bottles
Yellow
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2. Citrate
Blue
68
3. Serum tubes
Red - Non additive tubes - Chem and Sero
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4. Heparin Green
For FOT (Erythrocyte Osmotic Fragility Test)
70
5. EDTA / Lavender
For Hem (CBC) & HBA1C
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6. NaF
Gray - For glucose, anti-glycolytic agent; prevents glycolysis
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E. ORDER OF DRAW FOR SKIN PUNCTURE
1) Blood gases, 2) Slides/Smear, 3) EDTA, 4) Other additive tubes (green/gray), 5) Serum tubes
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Mnemonic
“Busy Si Ed na 05”
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Antiseptics used to clean the venipuncture site
70% Isopropyl alcohol
75
Angle of the needle to the skin during venipuncture
15-30 degrees
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Brachial Arterial Puncture
45-60 degrees
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Femoral Arterial Puncture
90 degrees
78
Bevel position
Bevel of the needle should be facing upward
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Patients with IV lines
IV line should be stopped for 2 minutes
80
Blood collection volume requirement
5 mL of blood should be collected and discarded
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Gentle inversions
Usually at least 8-10 times
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Technologist/student patient attempt rule
A technologist or a student should not stick a patient more than 2 times
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Complications of Phlebotomy
• Ecchymosis (bruise), • Hematoma, • Syncope (fainting), • Edema, • Thrombophlebitis
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Notes on complications
• Do not slap the collection, • Let the site dry, • Apply pressure on the site
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Hyperventilation effect
Increases respiration rate
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How to prevent hyperventilation
Breathe in and out through paper bag
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1. EDTA (ETHYLENEDIAMINETETRAACETIC ACID)
Most commonly used anticoagulant in Hematology
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Types of EDTA
• Spray-dried EDTA = K2 EDTA, • Liquid EDTA = K3 EDTA
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EDTA function
Prevents clotting by chelating calcium ions
90
EDTA concentration
1.5 mg per mL of blood
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Effects of excess EDTA
• RBC shrinkage, • Hct becomes falsely decreased, • ESR becomes falsely decreased
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Timeframe for proper use
Preserves morphology of blood used within 2 HOURS
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Na+ & osmolality | hyper-osmolar | hypertonic
RBCs SHRINK
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Na+ & osmolality | hypo-osmolar | hypotonic
RBCs SWELL
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More common and more preferred EDTA
K3 EDTA (liquid)
96
Heparin
Acid mucopolysaccharide (mucoitin polysulfuric acid)
97
Where Heparin is found
Naturally occurring (anticoagulant) produced by the LIVER (hep)
98
Heparin function
Acts by inhibiting THROMBIN
99
Heparin cofactor
Acts together with the cofactor ANTI-THROMBIN III
100
Concentration
15-20 uM of blood
101
Use in testing
Used for FOT (Erythrocyte Osmolality Fragility Test)
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Why Heparin is NOT used for blood film preparation
Because it causes BLUE coloration of the background of blood films stained with Romanowsky stain
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Heparin is found in
Basophils
104
If Px is undergoing heparin therapy but is unresponsive, what should be requested?
• A anti-thrombin III assay
105
Romanowsky stain
Family of stains; composed of alkaline stain and acid stain
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Alkaline stain
Methylene blue
107
Acid stain
Eosin
108
Sodium Citrate
Anticoagulant of choice for COAGULATION STUDIES
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Sodium citrate function
Inhibits calcium by forming soluble complexes
110
Potassium oxalate function
Inhibits calcium by forming insoluble complexes
111
Sodium Citrate Concentrations
• Light blue tube = 3.2%, • Black tube = 3.8%
112
Uses of Sodium Citrate
Coagulation studies, ESR
113
Effect of underfilled tubes
Leads to FALSELY PROLONGED PT and aPTT
114
Adjustment in Polycythemia
In patients with PCV, PT and aPTT are FALSELY PROLONGED
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Formula
Hct = 595 - Hct x mL of blood / 595
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Methods of ESR
Westergren vs Wintrobe
117
Types of Westergren Method
• Original, • Modified
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Original Westergren Method
Black tube = used original Westergren method
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Modified Westergren Method
Lavender tube = used modified Westergren method
120
PCV (Hct) Modification
Tube too much RBC → Plasma vol ↓ → (Hct > 0.55L) → ↓ Sodium Citrate
121
Errors in Venipuncture Preparation (Before)
• Improper patient identification, • Failure to check patient adherence to dietary restrictions, • Failure to calm patient prior to blood collection, • Use of improper equipment and supplies, • Inappropriate method of collection
122
Errors in Venipuncture Procedure (During)
• Failure to dry the site completely after cleaning with alcohol, • Inserting the needle bevel side down, • Use of needle that is too small, causing hemolysis of specimen, • Venipuncture in an unacceptable area, • Prolonged tourniquet application, • Wrong order of tube draw, • Failure to mix blood collected in additive-containing tubes, • Pulling back on syringe plunger too forcefully, • Failure to release tourniquet prior to needle withdrawal
123
Antiseptic vs Disinfectant
• Antiseptic = Animate (humans, animals), • Disinfectant = Inanimate objects
124
Question,Answer
125
Errors after Venipuncture Completion (After),"Failure to apply pressure immediately to venipuncture site
Agitating/shaking an anti-coagulated blood specimen
126
SPECIMEN FOR DIFFERENT LABORATORY TESTS - EDTA Whole Blood,CBC
Platelet count
127
SPECIMEN FOR DIFFERENT LABORATORY TESTS - Heparinized Whole Blood,EOPI
Solubility test
128
SPECIMEN FOR DIFFERENT LABORATORY TESTS - Air dried blood or bone marrow smears,Prussian blue stain (Periodic Acid Schiff Sudan Black B
Acid phosphatase stain (with tartrate resistance) Non-specific esterase stain
129
SPECIMEN FOR DIFFERENT LABORATORY TESTS - Citrated Whole Blood,Original Westergren method of ESR
Solubility test
130
SPECIMEN FOR DIFFERENT LABORATORY TESTS - Platelet-poor Citrated Plasma,Prothrombin time
Activated Partial Thromboplastin time
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SPECIMEN FOR DIFFERENT LABORATORY TESTS - Serum,Haptoglobin
Viscosity test
132
SPECIMEN FOR DIFFERENT LABORATORY TESTS - Defibrinated Blood,EOPI
Autohemolysis test for hereditary spherocytosis
133
SPECIMEN FOR DIFFERENT LABORATORY TESTS - Capillary Blood,LAP stain
Peroxidase stain
134
HEMOCYTOMETRY - RBC Diluting Fluids,Hayem's fluid
Gower's fluid
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HEMOCYTOMETRY - WBC Diluting Fluids,2-3% glacial acetic acid with Gentian violet
1% hydrochloric acid
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HEMOCYTOMETRY - Platelet Diluting Fluids,"Tocantin’s method: 1% ammonium oxalate
Rees & Ecker’s method: Uses crystal violet, sodium citrate, and formalin"
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Notes on Hemocytometry Diluting Fluids,Characteristic of diluting fluids for RBCs: Should be ISOTONIC to preserve the RBCs
Characteristic of diluting fluids for RBCs: Should be CAPABLE OF LYSING RBCs for light microscopy
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HEMOCYTOMETRY - Counting Chambers,1. Neubauer Counting Chamber
2. Speirs-Levy Counting Chamber
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Neubauer Counting Chamber - Dimensions,Total area: 9mm² (3mm x 3mm)
Depth: 0.1mm (1/10 mm)
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Speirs-Levy Counting Chamber - Dimensions,Total Area: 10mm² (2mm x 5mm)
Depth: 0.2mm
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Fuchs-Rosenthal Counting Chamber - Dimensions,Total Area: 16mm² (4mm x 4mm)
Depth: 0.2mm
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