Lab Exam 2 Flashcards

1
Q

What equipment is needed for a safe venipuncture?

A

Gloves, sterile needles, blood collection tubes, needle holder, tourniquet

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2
Q

Veins for venipuncture procedure

A

medial cubital, cephalic (lateral), basillic (medial)

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3
Q

Identify additives, their functions, their volume, and specimen considerations for the color coded tubes

A

LIght blue top:
- sodium citrate
- coagulation
- 2.7 ml

Red top:
- No additives, used for serum separation
- 5-10 ml

Green top:
- Heparin
- 4-8 ml
- electrolytes

Gray top:
- sodium fluoride
- 2-4 ml
- glucose

Lavender top:
- EDTA
- 3-5 ml
- used for CBC

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4
Q

What is the order for drawing proper specimen collection?

A

coagulation, heparin, complete blood count (CBC)

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5
Q

What areas should you avoid when performing venipuncture and why?

A

visible veins, previous IV sites, areas close to major arteries or nerves

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6
Q

Given a set of “out of control” values, calculate the dilution necessary to obtain a value within the analyte assay range and calculate the final result

A

Dilution factor = initial concentration / desired target concentration

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7
Q

What are the parts of a hemocytometer?

A

2 counting chambers

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8
Q

Identify the parts of the 3 dimensions of the counting chamber

A
  1. Length = 1 dimension
    in mm
  2. Area = 2 dimensions in
    mm (L x W = mm2)
  3. Volume = 3 dimensions
    in mm
    (L x W x H = mm3)
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9
Q

Serpentine pattern

A

Allows for continuity

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10
Q

Which border lines count when cells are touching them?

A

top or left. never bottom or right

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11
Q

Proper counting pattern for WBC

A

left, right, down, left

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12
Q

Proper counting pattern for RBC

A

left, right, down, left, middle

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13
Q

How to calculate a WBC and RBC count using the universal formula

A

cells/mm3 = (Average # of cells x depth factor x dilution factor) / area (mm2)

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14
Q

Normal ranges for Manual WBC count

A

Adult - 5.0-10.0 x 10^3 / mm^3
Children - 4.5-12.0 x 10^3/mm^3
Newborn - 9.0-30.0 x 10^3 / mm^3

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15
Q

Name the diluting fluid for WBC count

A

Ammonium oxalate with 100 dilution factor

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16
Q

Normal ranges for manual RBC count

A

Adult male :
4.5-6.0 x 10^12 / L
Adult female:
4.0-5.5 x 10^12/L
Newborn:
5.0-6.3 x 10^6/mm^3

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17
Q

Diluting fluid for RBC count

A

Isotonic saline with 200 dilution factor

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18
Q

Components of hemoglobin molecule

A

Heme (iron containing portion)
Globin (the protein portion)

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19
Q

What do hemoglobin variants contain?

A

Amino acid chains: alpha, beta, gamma, and delta

Alpha chain has 141 amino acids
Beta chain has 146 amino acids

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20
Q

Normal HbA and HbA2 Variants

A

HbA has 2 alpha and 2 beta chains

HbA2 has alpha chains that are paired with 2 delta polypeptide chains

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21
Q

Normal HbF Variant

A

2 alpha chains are paired with 2 gamma chains

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22
Q

Abnormal variants

A

Hb C & S because both of them have amino acid substituions in the beta chain

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23
Q

Hemoglobin derivatives

A

Carboxyhemoglobin (usually bc of smokers), methemoglobin (unable to bind with O2) sulfhemoglobin (from ingesting oxidizing drugs)

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24
Q

Cyanmethemoglobin method for hemoglobin measurement

A

mixing Drabkin’s reagent to a sample of blood forming cyanmethemoglobin. This oxidized blood is read in a
spectrophotometer

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25
Cyanmethemoglobin Method Procedure
1. Pipet 5mL of Drabkin’s 2. Add 20uL of whole blood 3. Cover the test tube with parafilm, invert and allow to stand at RT for 10 minutes 4. Turn on the spec and set the λ to 540 5. Set the blank curvette that only has Drabkin's to read 0 abs 100%T. 6. Read the absorbance of the prepared standards, then the patients and control
26
Cyanmethemoglobin Reaction
RBCs are lysed; the Fe2+ of the released HgB is oxidized to Fe3+ to form methemoglobin. This reacts with the cyanide of K+ cyanide to form cyanmethemoglobin, read by spec at 540λ
27
What does Drabkin's reagent contain?
iron,potassium, cyanide and sodium bicarbonate (this is a corrosive reagent)
28
How to find concentration of Hb?
Conc = amount / vol g/dl
29
Hgb Concentration reference ranges
Adult males: 13-18 g/dL Adult females: 11-16 g/dL Infant :10-14 g/dL
30
Formula for Hct
Volume of RBC / Volume of blood
31
Reference ranges for Hct
Adult males: 40-54% Adult females: 37-47%
32
Give 3 reasons for erroneous (wrong) hemoglobin values due to patient considerations
Hemodilution: if pt has IV Dehydration: concentration changes Hemolysis: shaking tube
33
Extruded
being released from the cell
34
What are some factors that can affect hemoglobin levels?
Age, altitude, gender, and diet
35
Preparation of a Standard curve
x axis - concentration of Hb (g/dL) y axis - Aborsbance hgb values straight line
36
Hemoglobin absorbance values in men
14.0-17.5 g/dL
37
Hemoglobin absorbance values in women
12.3-15.3g/dL
38
Hemoglobin absorbance values in children
16.5 g/dL - 14.0 g/dL
39
Hematocrit definition
a measure for the volume % of RBCs in WB commonly used as an indirect method to assess packed cell volume (PCV) = hematocrit value. PCV refers to the volume occupied by packed red blood cells in a given volume of blood after centrifugation.
40
What is the hematocrit's role in assessing packed cell volume?
It provides important information about the concentration of RBCs in the blood and aids in the diagnosis and monitoring of various hematological conditions.
41
What is shown in a microhematocrit tube after centrifugation?
Plasma, buffy coat (WBC and platelets) , RBCs, sealant
42
What could low hematocrit values mean?
- Anemia * Bleeding/Hemorrhage * Cancer/Leukemia * Chronic illness * Increased RBC destruction * Not enough folate, iron, B6 and B12 in diet * Bone marrow problems
43
What could high hematocrit values mean?
- Polycythemia vera * Heart Disease * High altitude * Hemochromatosis
44
Hematocrit Normal Values
Reference Values * - Adult male 40 - 54% * - Adult female 37 - 47% * - Newborn 41 – 61% * - Infant 32 – 42%
45
Micro-pipetting technique
1. Mix the EDTA tube 2. Micro-pipette 2 tubes with 3/4 of the blood sample 3. seal the tube with crip-o-seal 4. Unscrew top of micro-hematocrit centrifuge 5. load micros to centrifuge, screw the top back on tight and set for 5 minutes
46
How to measure microhematocrit tube post-centrifuged?
Load micro on reader with blood facing center, set bottom wheel to 100, move top wheel until curve hits top of plasma. Move both wheels until curve hits intersection of blood and plasma, read results of both tubes The results should range +/-2% and the average is reported
47
Sources of error in hemoglobin testing
Improper pipetting, dirty or scratched curvettes, Drabkin's solution deterioration (must be kept in dark bottle to prevent exposure to light)
48
Sources of error due to condition of pt and how
Lipemic samples: high lipids are cloudy, interfering with light absorption Increased WBC levels: interfere with light absorption Presence of HgB C or HgB S: resistant to cyanide lysing of the RBCs, causing decreased HgB levels Increased protein levels: Light absorption issues
49
Sources of error in hematocrit testing
Incorrect Centrifugation Speed or Time, Overfilling or Underfilling of Hematocrit Tubes, Air Bubbles, Equipment Calibration
50
Reference range for MCH
27-33 pg
51
MCH
Mean Corpuscular Hbg (pg) = Hgb concentration / RBC count x 10
52
MCV
Mean Corpuscular Volume (fL) = Hct/RBC count x 10
53
MCHC
Mean Corpuscular Hemoglobin Concentration (g/dL) = Hgb concentration / HCT (RBC volume) x 10
54
Reference range in normal adults for MCV
80-96 fL
55
RBC Indices and how they classify anemias
1. Normochrmoic- normocytic 2. Macrocytic 3. Hypochromis- microcytic
56
Anisocytosis
variation in size of RBC
57
ESR
the rate at which RBCs in anticoagulated whole blood descend in a standardized tube over a period of one hour
58
Hematopoiesis
overall blood cell maturation and function that equates to blood cell production
59
Hemoglobinopathies
Disorder in which structurally abnormal Hb is considered to play an important role pathologically Structurally abnormal Hb has an amino acid subsitution Usually from B chain abnormalities
60
Oxyhemoglobin
Hb carrying O2
61
Reduced Hb
Hb returning to the lungs with CO2 from the tissues
62
Megakaryocytes
These cells turn into platelets
63
Mononuclear phagocytic system
This is how worn out RBCs are removed from blood
64
Poikilocytes
an increase in abnormal red blood cells
65
Polychromasia
more immature red blood cells than what's considered normal
66
Polychromatophilia
how red blood cells look under a microscope when the cells are stained with special dyes. It means there is more staining than normal with certain dyes. The extra staining is due to an increased number of immature red blood cells (RBCs)
67
What do reticulocytes % indicate and what do they look like?
The percentage of reticulocytes in the blood stream tells us the degree of RBC production from the bone marrow; has RNA in them
68
Supravital stains
This stain shows us the RNA in the reticulocytes and by using cresyl blue or methylene blue
69
Another name for platelets
thrombocytes
70
What do myeloid progenitors differentiate into?
Erythrocytes, platelets, neutrophils and monocytes
71
Stages of maturation
Rubriblas, prorubricyte, rubricyte, metarubricyte, reticulocyte, erythrocyte
72
Oxygen Dissocation Curve
Trend that shows oxygen leaving the Hb to the tissues making the Hb from OxyHb to Reduced Hb
73
Factors that change when there is a shift in an O2 curve
Temp, 2-3 DPG (a chemical), pH, Hb,
74
Normal Leukocytes
Polymorphonuclear neutrophils, band neutrophils, lymphocytes, monocytes, eosinophils, basophils
75
What do band neutrophils look like?
They look like an embryo and egg lol
76
What do monocytes look like?
Deformed globs
77
What do lymphocytes look like?
giant yolk in an egg
78
What do basophils look like?
purple splotch with blue black granules
79
What do eosinophils look like?
orange granules with distinct lobes
80
What do polymorphonuclear neutrophils look like?
3 or 4 distinct lobes
81
How to clean hemacytometer
70% alcohol with lens paper and clean before and after each use
82
The Hemacytometer
Heavy glass slide with precise measurements as defined by the National Bureau of Standards (NBS)
83
Hemacytometer Counting Area
WBC counting area - 4mm RBC counting area - 0.2 mm Depth of counting area - 10 mm Total area - 9mm3
84
Charging the hemacytometer
Use a micropipette to fill each chamber and then let it stand for 5 minutes
85
Counting WBCs
Count both sides of hemacytometer, find the average, multiply by 10 (depth factor) and 10 dilution factor and divide by 9 (the area) sides must agree +/- 20 cells
86
Counting RBCs
count both sides of hemacytometer, find the average, multiply by 10 (depth) and dilution factor the sides must agree +/- 20 cells
87
Leuk-o-tic Procedure
1. Open eppendorf tube 2. Aspirate 20uL of WB 3. Wipe excess blood from tip 4. Add WB to the tube and rinse/mix 5. close tube and invert 10x 6. Let sample sit for at least a minute 7. Mix the tub several times 8. Load 10uL to a clean and dry hemacytometer 9. perform count
88