Manual Test Methods

Question 1

What are characteristics of a good smear

Answer 1

smoot even film with feathered ends
minimum of 3cm in length
blood should not spill over the end or sides

Question 2

What causes a smear to be too short

Answer 2

spreading the blood too quickly, angle of spreading slide greater than 30 degrees

Question 3

What causes a smear to be too long

Answer 3

spreading the blood too slowly, angle of spreader is less than 30 degrees

Question 4

What causes a smear to be too thin

Answer 4

drop of blood too small, patient has low HGB

Question 5

What causes a smear to be too thick

Answer 5

drop of blood too large, patient abnormalities with viscous blood

Question 6

What causes chattering or streaking in a smear

Answer 6

clots/clumps/debris on slide, blood drying out, glass edge not smooth

Question 7

What does malaria protocol need

Answer 7

4 thin smears (2 stained, 2 unstained) and 4 thick smears

Question 8

When is a buffy coat smear made

Answer 8

when the white blood cell count is too low for analysis on a routine smear or when bacteria/parasites are present

Question 9

What is a buffy coat smear used for

Answer 9

to evaluate WBC morphology

Question 10

When is a cytospin smear used

Answer 10

whenever a fluid has a WBC count above 5x10^6/L

Question 11

What types of smears are used for bone marrows

Answer 11

push smears, squash smears and touch-prep smears

Question 12

What are the components of a wright-giemsa stain

Answer 12

methylene blue, purified azure blue B, eosin

Question 13

What fixative is used for the wright-giemsa stain

Answer 13

methanol

Question 14

What is the pH of the wright-giemsa stain

Answer 14

6.8

Question 15

What components are stained by the methylene blue and azure B in wright-giemsa

Answer 15

nucleic acids, RNA, DNA, neutrophil granules

Question 16

What components are stained by the eosin in wright-giemsa

Answer 16

hemoglobin, eosinophil, neutrophil granules

Question 17

What are the components of a May-Grunwald stain

Answer 17

eosin, methylene blue

Question 18

What is the pH of a may-grunwald-giemsa stain

Answer 18

6.8

Question 19

What does the May-grunwald component of the may-grunwald-giemsa stain

Answer 19

cytoplasm

Question 20

What does the giemsa component of the may-grunwald-giemsa stain

Answer 20

nuclear and inclusions

Question 21

What are the components of giemsa stain for malaria

Answer 21

eosin, purified azure B, methylene blue

Question 22

What are common supervital stains

Answer 22

new methylene blue, brilliant cresyl blue, methyl violet, crystal violet, brilliant green

Question 23

What is the principle of supervital stains

Answer 23

used to stain living and unfixed cells in vitro to demonstrate heinz bodies and reticulocytes

Question 24

What are the components of the prussian blue iron stain

Answer 24

0.2N HCl, Potassium ferrocyanide

Question 25

What is the principle of the prussian blue iron stain

Answer 25

HCl splits ferric iron from hemosiderin and then the iron combines with potassium ferricyanide to form a blue complex

Question 26

What are considerations when viewing an iron stain slide

Answer 26

iron must be inside cells, extracellular iron is considered artifact

Question 27

What can cause increased iron stores

Answer 27

megaloblastic anemia, hemolytic anemia, sideroblastic anemia, anemia of chronic disease, lead poisoning, hemosiderosis

Question 28

What can cause decreased iron stores

Answer 28

iron deficiency anemia, polycythemia vera

Question 29

What is myeloperoxidase stain used for

Answer 29

stains primary granules in monocytes and myeloid lineage

Question 30

What is sudan black stain used for

Answer 30

stains primary and secondary myeloid granule lipids, weakly stains granules in monocytes

Question 31

What is periodic acd-schiff stain used for

Answer 31

stains glycogen compounds commonly found in lymphoid lineage cells

Question 32

What is non-specific esterase stain used for

Answer 32

stains non-specific esterase compounds in monocytes

Question 33

What is the Leukocyte Alkaline Phosphatase stain used for

Answer 33

cells are scored based on intensity of staining, higher intensity is seen in mature neutrophils or band cells

Question 34

What causes increased LAP scores

Answer 34

leukemoid reaction, multiple myeloma, hodgkins disease, myeloproliferative disorders, aplastic anemia

Question 35

What causes decreased LAP scores

Answer 35

chronic myelogenous leukemia, paroxysmal nocturnal hemoglobinuria. sickle cell anemia, myelodysplastic syndromes

Question 36

How does high pH effect staining

Answer 36

increased dissociation of methylene blue cause dark blue colour RBC stain green/blue neutrophils can appear toxic

Question 37

How does low pH effect staining

Answer 37

increased dissociation of eosin causing dark pink colour RBC stain red/orange WBC nuclei will be pale eosin granules will be bright orange

Question 38

How does short stain time effect staining

Answer 38

pale slides

Question 39

How does long staining time effect staining

Answer 39

dark/overstained slides

Question 40

What are common artifacts in slides

Answer 40

debris, stain precipitate, water, thick smears, no blood smear left

Question 41

What is done under the 10x objective during smear analysis

Answer 41

check cell distribution and stain WBC estimate smear scan for rouleaux, smudge cells, fibrin strands, platelet clumps, large/abnormal cells, parasites

Question 42

What is done under the 50x objective during smear analysis

Answer 42

WBC differential and morphologies Overview of RBC morph

Question 43

What is done under the 100x objective during smear analysis

Answer 43

PLT estimate and morphology RBC morphology

Question 44

What is the calculation for % parasitemia or %retic

Answer 44

(square A/Square B) x (100/9)

Question 45

What is the calculation for corrected WBC

Answer 45

WBC count/(1+(nRBC/100))

Question 46

How many cells should be counted using a miller-occular

Answer 46

111 cells in square B

Question 47

What does transudate mean

Answer 47

an accumulation of fluid caused by a non-inflammatory circulation disturbance

Question 48

What are examples of disorders tha cause transudates

Answer 48

congestive heart failure, liver disease, renal disease, obstructive tumors

Question 49

What does exudate mean

Answer 49

an accumulation of fluid caused by an inflammatory condition

Question 50

What is done to a fluid once it is recieved in the lab

Answer 50

gross examination, WBC count, RBC count if requested, cytospin differential if indicated, crystals if requested

Question 51

What is done to a CSF once it is recieved in the lab

Answer 51

gross examination, cell count, cytospin differential if indicated

Question 52

What can cause cloudy and colourless CSF

Answer 52

high WBC count, presence of microorganisms

Question 53

What can cause coloured CSF

Answer 53

hemoglobin/RBC, increased proteins, bilirubin

Question 54

What is an ESR

Answer 54

a nonspecific test used as a marker for tissue damage or inflammation

Question 55

What causes increased ESRs

Answer 55

infection, rheumatoid arthritis, TB, cancer

Question 56

What is the principle of the ESR

Answer 56

when more acute phase reactants are present the zeta potenetial is reduced and RBC fall quicker than normal

Question 57

What can cause falsely increased ESR testing

Answer 57

increased rouleaux formation, decreased numbers of red cells, macrocytes, increased albumin

Question 58

What can cause falsely decreased ESR testing

Answer 58

abnormally shaped red cells, increased numbers of red/white cells, microcytes, increased fibrinogen, increased immunoglobulin