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Mercy CLS 6: Hematology > Lab Exam 1 > Flashcards

Lab Exam 1 Flashcards

1
Q

hemacytometer use

A

manual WBC, RBC, platelet counts and body fluid cell counts

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2
Q

depth and depth factor of hemocytometer

A

0.1 mm
10

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3
Q

area of each large square (9 total)

A

1 mm^2

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4
Q

area of each small square (25 in one large)

A

0.04 mm^2

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5
Q

counting area for WBCs

A

4 large corner squares
4 mm^2

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6
Q

counting area for RBCs

A

5 small squares in the center square
0.2 mm^2

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7
Q

counting area for PLTs

A

large center square (1 mm^2)
or 5 small squares if count in large square is >40

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8
Q

boundary line rules

A
  • double line —count cells touching innermost top and innermost left side lines
  • triple line—count cells touching innermost lines, and cells touching middle top and middle left side lines
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9
Q

WBC count dilution

A

1:20 with acetic acid
1.9 mL diluent. + 0.1 mL sample

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10
Q

RBC count dilution

A

1:200 with 0.9% saline

first, make 1:10 with 0.1 mL sample + 0.9 mL saline
then, make 1:20 dilution with 0.1 mL previous + 1.9 mL saline

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11
Q

PLT count dilution

A

1:100 with ammonium oxalate

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12
Q

the higher the dilution…

A

the more statistical error inherent in the procedure

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13
Q

formula for calculating cell counts

A

(# cells)(depth factor)(dilution factor)/counting area = cells/μ

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14
Q

when diluting for WBCs or PLTs, let sample sit for —- mins before charging hemocytometer to…

A

10 min
lyse RBCs

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15
Q

let cells sit in hemocytometer for —– min to…

A

10
let them settle into same plane

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16
Q

sources of error in manual count

A
  • clumped/clotted/rouleaux
  • chipped or scratched coverslip
  • improper filling
  • not mixing sample
  • tech error when counting
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17
Q

normal RBC, WBC levels for an adult

A

RBC female: 3.8-5.2 x 10^6 cells/μL
RBC male: 4.5-5.9 x 10^6 cells/μL
WBC: 4.0-11.0 x 10^3 cells/μL

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18
Q

principle of manual hgb test

A

lysis of RBCs and conversion of hgb to methemoglobin, which is read on the spec

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19
Q

reagent, dilution, and wavelength of manual hemoglobin

A

SLS (sodium laurel sulfate)
1:250
540 nm

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20
Q

3 functions of Hgb reagent

A
  • lysis RBCs
  • dilutes blood
  • converts hemoglobin to methemoglobin
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21
Q

Beer’s law equation for finding Hgb concentration

A

(ABS unk/ABS std)(std conc) = unk conc

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22
Q

Hgb sample dilution procedure

A

5 mL SLS
remove 20 μL
add 20 μL sample

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23
Q

manual Hgb interferences

A

icterus
lipemia
high WBC ct
high plasma proteins
failure to lyse cells
failure to detect abnormal Hgb

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24
Q

hematocrit

A

proportion of blood that is RBCs

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25
Q

spun crit centrifuge must be standardized every ——

A

6 months

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26
Q

degree to RBC packing during spun crit depends on…

A
  • speed
  • time
  • radius of centrifuge
  • fullness of tube (3/4)
  • trapped plasma
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27
Q

advantages of spun crit

A
  • uses small amt of blood
  • only takes 3 mins
  • allows us to look at supernatant
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28
Q

disadvantages of spun crit

A
  • trapped plasma
  • somewhat subjective
  • incomplete separation of RBCs and buffy coat
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29
Q

causes of increased hematocrit

A

pregnancy
hemoconcentration
polycythemia/polycythemia vera
hypoxia → EPO → erythropoiesis

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30
Q

causes of decreased hematocrit

A

anemias
excessive fluids
many more

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31
Q

rule of 3s

A

Hct = 3(Hbg) ± 3

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32
Q

sources of error for spun crits

A
  • hemolysis
  • not sealed well
  • IV contamination
  • measuring buffy coat
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33
Q

optimum spin time

A

time at which maximum packing occurs

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34
Q

MCV
definition
RR
terminology
calculation

A

average size of RBCs
80-100 fL
normocytic, microcytic, macrocytic
MCV = 10(Hct/RBC)

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35
Q

MCH
definition
RR
calculation

A

average weight of Hgb in RBCs
28-34 pg
MCH = 10(Hgb/RBC)

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36
Q

baby MCV

A

up to 105

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37
Q

MCHC
definition
RR
terminology
calculation

A

hemoglobin concentration in average RBC
32-36 g/dL
normochromic, hypochromic, spherocyte
MCHC = 100(Hgb/Hct)

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38
Q

causes of falsely elevated MCHC

A
  • lipemia
  • icterus
  • hemolysis
  • high WBC
  • high protein
  • cold agglutinins
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39
Q

causes of falsely decreased MCHC

A
  • hyperglycemic osmotic effect
  • IV contamination
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40
Q

RDW
definition
obtained from…
RR
unable to report when…

A

RBC distribution width
obtained from RBC histogram
12-15 (CV)
unable to report with dimorphic RBC population

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41
Q

anisocytosis
associated with which index?

A

variation in cell size
RDW

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42
Q

should always be used to check the indices

A

appearance of cells on smear

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43
Q

H+H mismatch
MCHC <32

A

check glucose/Na/K
or contaminated specimen

recollect or spun Hct and report

44
Q

H+H mismatch
MCHC >36, <40
MCV low/normal

A

spherocytes
check smear
report

45
Q

H+H mismatch
MCHC >36
MCV normal

A

lipemia, icterus, high WBC count
saline replace

46
Q

H+H mismatch
MCHC >36
MCV high

A

cold agglutinin

warm, or saline replace and warm

47
Q

smear should be made when?

A

as soon as possible after collection
refrigeration makes cells more fragile

48
Q

criteria of a good smear

A
  • thick area makes gradual transition to thin area
  • blood does not extend to end of slide; goes 3/4 way
  • smooth with no ridges, spikes, holes
  • rainbow effect on feathered edge
49
Q

factors which affect thickness of smear

A
  • angle of spreader
  • speed of spreading
  • size of drop
50
Q

common causes of poor smear

A
  • drop too large
  • spreader pushed with jerky motion
  • spreading too slow
51
Q

3 purposes of diff

A
  • screning
  • diagnosis
  • monitoring
52
Q

Wright’s stain is a type of… (2)

A

polychrome stain
Romanowski stain

53
Q

ingredients of wright stain and purpose

A
  • methanol: fixative; no longer infectious
  • eosin: acid dye, dyes basic components pink
  • methylene blue: basic dye, dyes acid components blue/purple
54
Q

eosinophilic
basophilic
neutrophilic

A

take up eosin
take up methylene blue
take up both

55
Q

examples of eosinophilic substances

A
  • Hgb
  • granules of eosinophils
56
Q

examples of basophilic substances

A

DNA
RNA
platelet granules
WBC nuclei
basophilic granules

57
Q

pH of Wright stain

A

6.8-7.2

58
Q

Wright stain excessively blue

A

pH too ↑

59
Q

Wright stain excessively pink

A

pH too ↓

60
Q

look for on feathered edge first

A
  • WBC distribution
  • platelet clumps
  • fibrin strands
61
Q

smudge cell procedure

A

if ≥9 are seen, do an albumin slide (1 drop albumin + 10 drops blood)

62
Q

describe segs

A
  • 10-15 microns
  • clumped chromatin
  • 2-4 lobes
  • pink/tan granules
63
Q

describe bands

A
  • 1 lobed nucleus, usually indented
  • chromatin through entire lobe
64
Q

describe eos

A
  • large orange circular granules
  • 2-3 lobes
65
Q

describe basos

A
  • dark purple water-soluble granules
  • light, smeared nucleus
66
Q

describe lymphs

A
  • round at rest
  • large dense oval nucleus
  • small blue cytoplasm
  • countable granules
67
Q

describe monos

A
  • up to 20 microns
  • more, blue-gray cytoplasm
  • lacy chromatin
  • folded nucleus
  • vacuolated
68
Q

basophil function

A

hypersensitivity rxn
IgE receptors
release histamine

69
Q

WBC count frequently used by oncologists during patient chemo

A

ANC, absolute neutrophil count

70
Q

-cytosis

A

increased
granulocytes, lymphs, monos

71
Q

-cytopenia

A

decreased
granulocytes, lymphs, monos

72
Q

-philia

A

increased
granulocytes

73
Q

-penia

A

decreased
neutrophils

74
Q

WBC estimate performed when…

A

analyzer’s WBC count is questionable
ie platelet clumps

75
Q

WBC estimate procedure

A
  1. scan on 10X; find monolayer
  2. count WBCs in 1/4 field; do this for several, find avg
  3. average # is WBC count (x 10^3)
  4. if analyzer does not match w/i 20%, do a manual WBC ct
76
Q

when is corrected WBC count for nRBCs done?

A

more than 5 nRBCs present per 100 WBCs

77
Q

corrected WBC count for nRBCs

A

WBC(100)/nRBC + 100 = corrected WBC

78
Q

platelet description

A
  • small
  • nonnucleated
  • mainly consist of granules
79
Q

younger platelets
report if you see many

A

giant platelets

80
Q

RBC RR
WBC RR
platelet RR

A

female 3.8-5.2 x 10^6/μL
male 4.5-5.9 x 10^6/μL

4.0-11.0 x 10^3/μL

150-400 x 10^3/μL

81
Q

platelet estimate performed when…

A
  • platelet count critical (<30) for first time
  • schistocytes present
  • analyzer gives platelet population or platelet clump flags
82
Q

platelet clumps may be due to…

A

EDTA sensitivity
not mixing when drawn

83
Q

platelet estimate procedure

A
  1. on 100X, look at several fields on the feathered edge; check for clumps/clots (determines need for estimate)
  2. count number of platelets in at least 5 fields, and determine average
  3. multiply average by 15 and 20 to get estimated range
  4. if analyzer’s result is not within range, perform manual platelet ct
84
Q

name and fix

A

giant platelet

“platelet F” method on analyzer
detects platelet organelles

85
Q

name and fix

A

agranular platelets

“platelet F” method on analyzer
detects platelet organelles
report presence

86
Q

name and fix

A

platelet clumps
recurs on same patient each day
EDTA sensitivity

draw in Na citrate

87
Q

extra step when platelet count is done from Na citrate

A

multiply by 1.1 to account for additive volume difference

88
Q

name and fix

A

platelet satellitism
EDTA sensitivity

draw in Na citrate

89
Q

name and fix

A

fibrin strands

recollect

90
Q

name and description

A

left shift
immature neutros in PB
infection response

91
Q

name and description

A

toxic granulation
darker granules
toxic reaction to bacterial infection

92
Q

name and description

A

dohle bodies
light blue areas in cytoplasm
leftover RNA
toxic change to neutro from infection

93
Q

name and description

A

vacuolization
response to infection
result of phagocytosis

94
Q

name and description

A

hypersegmentation
B12/folate deficiency

report if ≥5 cells with ≥5 lobes

95
Q

name and description

A

agranular neutrophils
clear or blue cytoplasm
report

96
Q

name and description

A

virally reactive lymphs
cytoplasm expands, wraps around RBCs
edges darker blue

97
Q

name and description

A

plasmtacytoid cell
B-cell
eccentric nucleus
dark blue cytoplasm
if many are present, pathology follows up

98
Q

name and description

A

large granular lymph
countable granules
NK cells or reactive T-cells

99
Q

name and description

A

pediatric lymphocytes
appear younger
not abnormal

100
Q

name and description

A

Pelger-Huet anomaly
genetic condition
bilobed (pince-nez shaped) nucleus
no effect on function

101
Q

name and description

A

May-Hegglin anomaly
dohle-body like inclusions in granulocytes
large platelets and thrombocytopenia
genetic condition

102
Q

name and description

A

Chediak-Higashi anomaly
giant granules in lymphs and neutros
fusion of granules
genetic

103
Q

name and description

A

Alder-Reilly anomaly
large purple/red granules, very full
in almost all neutros
lysosomal storage disease (Hunter’s or Hurler’s)

104
Q

name and description

A

smudge cells
broken cells
usually lymphs, especially in CLL

105
Q

name and description

A

pyknotic cells
degenerated nucleus
solid mass

might be an old sample

Mercy CLS 6: Hematology (25 decks)

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