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MLT Clinical Practicums > Hematology Study Guide > Flashcards

Hematology Study Guide Flashcards

1
Q

Normal value WBC

A

5000-10000

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2
Q

Normal value for RBC

A

m: 4.7 - 6.1 mil/cm3
f: 4.2-5.4 mil/cm3

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3
Q

Normal value for Hgb

A

male 14-18 g/dL

female 12 - 16 g/dL

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4
Q

Normal value for Hct

A

male 42-52%

female 37-47%

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5
Q

Normal value for Platelets

A

150,000 - 400,000

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6
Q

Normal value for Retics

A

0.5-2%

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7
Q

Normal value for ESR

A

male 0-15 mm/hr

female 0-20

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8
Q

What quick quality control calculation can be used to check the accuracy of the RBC parameters as they are obtained from an automated counter?

A

3 x RBC = Hgb

3 x Hgb = Hct

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9
Q

Factors which can increase ESR

A 
anemia
pregnancy
infections
alcoholism
cirrhosis
hepatitis
MM
tilted tube
specimen too warm
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10
Q

Factors which decrease ESR

A 
polycythemia
sickle cell
poik
delay in performing test
spherocytosis
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11
Q

What is the chief use of osmotic fragility test?

A

diagnosis of spherocytosis

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12
Q

What test is best to use to differentiate between homozygous and hetereozygous sickle cell disease?

A

hemoglobin electrophoreisis

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13
Q

How are retics stained?

Which dye is best?

A

New Methylene Blue; separate RNA
Cresyl blue

Wrights Stain - supravital, makes RNA visable

retics seen as polychromatic

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14
Q

What is the use of the retic test to a physician?

A

Helps in diagnosis and monitoring of anemia

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15
Q

In what conditions would one expect to see an increased retic count?

A

Hemorrhage
Hemolysis
Splenectomy
Various, hemolytic, anemias

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16
Q

In what conditions would you see a decreased retic count?

A

BM suppression
Aplastic anemia
Ineffective erythropoeisis (IDA, PA)

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17
Q

What is the proper procedure for a hematocrit?

A

Blood is collected in heparinized capillary tubes. Seal one end. Spin in microhematocrit centrifuge to obtain optimal packed cells. Micromethod for hct determination.

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18
Q

What happens to the value if microhematocrits are spun too long? Not long enough?

A

hemolysis; false decrease

cells will not pack

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19
Q

Red cell morpholgy or classification on anemia based on MCV indice.

A

Size

100 macrocytic

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20
Q

Red cell morpholgy or classification on anemia based on MCHC indice.

A

hgb concentration

degrees of hypochromia

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21
Q

With what conditions are burr cells associated?

A

renal failure

kidney disease

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22
Q

In what condition is basophilic stippling frequently seen?

A

lead poisoning

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23
Q

With what condition are Heinz bodies most closely associated?

A

G6PD deiciency

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24
Q

How are basophilic stippling and reticulum differentiated?

A

Baso - romanowski Wrights stain and new methylene blue

Retic - new methyolene blue only

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25
Q

What is the best specimen to use for blood smears?

A

whole blood from EDTA tube

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26
Q

How can you adjust the color of Wrights stain smear?

A

adjust the pH

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27
Q

What is the most prominent feature of an ABO HDN blood smear?

A

spherocytes

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28
Q

Calculate MCV

A

Hct/RBC

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29
Q

Normal values for MCV

A

male 80-94 fL (femtoliters)

female 81-99 fL

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30
Q

Calculate MCH

A

Hgb/RBC

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31
Q

Normal values for MCH

A

27-31 pg (picograms)

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32
Q

Calculate MCHC

A

(Hgb/Hct) * 100

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33
Q

Normal values for MCHC

A

32-36% g/dL

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34
Q

Suggest diagnosis for Macro/Normo anemia
MCV increased
MCHC normal

A 
liver disease
B12 deficiency
Folate deficiency
PA
alcoholism
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35
Q

Suggest diagnosis for Micro/Hypo anemia
MCV decreased
MCHC decreased

A

IDA
Sideroblastic
Thalassemia
Lead poisioning

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36
Q

Suggest diagnosis for Normo/Normo anemia

A

Aplastic anemia, various others not listed already

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37
Q

What is the appearance of the blood smear in iron deficiency anemia?

A

Micro/Hypo
target, burr, oval, tailed rbc
serum iron decrease
TIBC increase

38
Q

What are the causes of aplastic anemias?

A 
BM suppresion, failure or replacement
pancytopenia
Normo/Normo anemia
no rbc increase
low retic
decreased BM
39
Q

What is a common characteristic of all hemolytic anemias?

A

increased RBC destruction

40
Q

What is an unusual finding that also differentiates AIHA from other hemolytic anemias?

A

+ DAT

41
Q

What is pancytopenia?

A

decreased RBC, WBC and Plt

42
Q

What information is included in a WBC diff?

A

WBC count and classification
plt count
rbc morphology

43
Q

Most common WBC in a diff

A

neutrophil

44
Q

Most common WBC in a normal smear

A

neutrophil

45
Q

Most common WBC in chilred under age 1

A

lymphocyte

46
Q

Lest common WBC in a normal smear

A

basophil

47
Q

Largest WBC in a normal smear

A

monocyte

48
Q

Which immature RBC are classified as Nrbc in a diff?

A

blast cells
prorubricytes
rubricytes
metarubricytes

49
Q

What is the appearance of a plasma cell?

A

eccentric nucleus with clumped chromatin

basophilic cytoplasm with a clear perinuclear halo (hof)

50
Q

Is a plasma cell likely to be seen in the peripheral blood?

A

No. approx 1% of nucleated cells in BM

51
Q

Shift to the left

A

increase of immature granulocytes

52
Q

Shift to the right

A

increase of mature granulocytes

53
Q

How is diagnosis of Hereditary Elliptocytosis made?

A 
at least 25% of rbc's or ellip/oval
OF testing
autohemolysis test
Direct protein assays
gel electrophoreisis
54
Q

What are the distinguishing characteristics of Hodgkin’s disease?

A

slow relentless progression
leukemoid rxn with eos’
Reed-Sternberg cells

55
Q

What features of a blood smear are normal in a newborn but not an adult?

A

NRBCs
Polychromasia
young WBCs

56
Q

describe a Downy atyipcal lymph from a Wright stain smear

A 
eccentric nucleus
dense chromatin
may have open spaces
abundant smooth cytoplasm, shades of blue near edges which may be scalloped
may have azurophilic granules
confused with a mono
57
Q

What stage of development differentiates the granules of a granulocyte

A

myelocyte

58
Q

How is a myelocyte differed from a metamyelocyte?

A

meta have kidney bean shaped nucleus

59
Q

Procedure for performing a total eosinophil count

A

must be done to count a larger volume, either by using special counter or both sides of hemacytometer. Whole blood is diluted with staining solution. Use max light, count entire ruled area on both sides on low power. Calc: total # of cells x 10(dilution) / 1.8 mm3

60
Q

Normal value for CSF cell count

A

adults 0-5, 8 mononuclear cells

neonates 0-30 mononuclear cells

61
Q

What test is the best test for measure of erythroid activity in the BM?

A

reticulocyte count

62
Q

What conditions can not be absolutely diagnosed without a BM aspirate?

A 
Myeloproliferative disorders
Leukemia
PA
Lymphoma
Tumors
Aplastic anemia
63
Q

What is the main use of LAP

A

differentiate leukemoid rxn (increased) from CML (decreased)

64
Q

Why correct WBC count if more than 5 nrbc present and how do you calculate for correction?

A

causes a false increase in WBC

#WBC * 100)/(#nrbc per 100 wbc

65
Q

Incidence of leukemia in various age groups

A

ALL - most common in children
CML - middle age
CLL - older pts (>55)

66
Q

What is the typical blood picture in acute leukemia?

A

N/N anemias
decreased RBC
thrombocytopenia
increased immature cells

67
Q

At the time of diagnosis, which leukemia frequently presents with a greatly increased platelet count?

A

CML

case study

68
Q

AML blood picture

A 
60-90% blasts
scattered segs but no intermediate cells
severe N/N anemia
polychromasia
nRBC
thrombocytopenia w/ large or abnormal plt
possible auer rods
69
Q

ALL blood picture

A

> 60% lymphoblasts
severe N/N anemia
thrombocytopenia
case study

70
Q

CML blood picture

A

marked leukocytosis
increase wbc, shift to right, eos, basos, plt(at first, then they decrease)
N/N anemia, incl nrbc’s

71
Q

CLL blood picture

A

lymphocytosis, 60-95% small lymphs
smudge cells, eos
all stages of granulocytes
N/N anemia

72
Q

Hodgkin’s blood picture

A 
not terribly abnormal or specific
mild anemia
thrombocytopenia
leukocytosis, grans espec. eos
leukemoid rxn with eosinophilia
decreased lymphs
73
Q

Blood picture after splenectomy

A 
Pappenheimer bodies
HJB
target cells
Aniso&Poik (tear drop, bite, frags)
increased platelets
74
Q

Megaloblastic anemia blood picture

A 
pancytopenia
hypersegs
oval macrocytes
aniso&poik (schis, sphero, td, target, giant plt)
shift to the right
75
Q

Polycythemia Vera blood picture

A 
N/N  but may become Micro/Hypo
increased rbc
occasional nrbc
ig's - myelo, metas
increased eos and/or baso
normal or increased plt, giant/bizarre
76
Q

Myelfibrosis blood picture

A 
moderate N/N anemia
polychromasia
nrbc's
aniso & poik
WBC normal to increased
plt increase at first, then decreases - giant plts
ig shift to the left
77
Q

DIC blood picture

disseminated intravascular coagulation

A 
thrombocytopenia
microplatelets
leukocytosis
schis
decreased retic
78
Q

AIHA blood picture

A 
N/N anemia
Sphero
macrocytic Polychromasia
nRBC
schisto, burr
erythrophagocytosis by monos
WBC increase, slight shift to the left
79
Q

Thal Major blood picture

A 
marked aniso & poik( td, burr, schisto...)
many nRBC
severe micro/hypo
polychromasia
HJB, baso-stipp
increased WBC, shift to the left
*case study*
80
Q

Thal Minor blood picture

A 
mild Micro/Hypo
target
baso-stipp
polychromasia
usually normal WBC
occasional nrbc
81
Q

Multiple Myeloma blood picture

A 
rouleaux
N/N anemia
wbc normal to increased
rare circulating plasma cell
increase lymph, eos, immature grans
decreased neutrophils
82
Q

IM blood picture

A

slight leukocytosis
atypical lymphs, Downey cells
rare immature lymphs
plt & rbc normal

83
Q

how do you do an indirect platelet count and how do you report out platelets in reference to your estimation?

A

count platelets in 5 fields of high power at the feathered edge of smear, multiply by 4.
report as decreased, increased or adequate

84
Q

How are PNH and PCH diagnosed in the lab and how do they differ?

A

PCH: extrinsic, D-L antibody, extracorpuscular defect. Diagnose with D-L test

PNH: intrinsic, acquired, sensitive to complement, Diagnosed by Ham’s test or sugar water test

85
Q

Which layer of blood is used for LE prep?

A

buffy coat

86
Q

Which group of disorders is classified using the FAB system?

A

acute leukemias

87
Q

What is the use of the Kleihauer-Betke technique or the Fetaldexx stain?

A

measures the amount of fetal Hgb transferred from fetal blood to maternal blood; used for D neg mothers; aids in correct dosage for RhoGam

88
Q

Which age group has the highest values for RBC parameters?

A

newborns

89
Q

What is the Coulter principle for cell counting

A

Flow cytometry; interruption of a light source as it passes through a flow cell

90
Q

How would you obtain a blood specimen from a pt who has IV solutions running into both arms?

A

Draw below the IV site or ask nurse to turn off IV for 15 minutes before draw.

91
Q

What is the appearance of folic aid deficiency?

A

Macro/Hypo

PA, no neurological symptoms

92
Q

With what conditions are an increased eos count associated?

A 
allergic disease
skin disorders
parasitic infections
blood diseases
splenectomy

MLT Clinical Practicums (12 decks)

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