MIDTERM - laboratory evaluation part 2 Flashcards
(79 cards)
1
Q
conditions for microcytic
A
- MACROCYTIC ANEMIA
*disorder of iron metabolism
* Iron deficiency anemia
* Anemia of chronic disease
* Congenital hypochromic- microcytic
anemia w/ iron overload
2
Q
Anemia with appropriate BM responses
A
- Acute posthemorrhagic anemia
- Hemolytic anemia
3
Q
Anemia with Impaired Marrow Response
A
- Marrow Hypoplasia
- Aplastic Anemia
- Marrow infiltration
- Infiltration by malignant cells, myelofibrosis
- Decreased Erythropoietin Production
* Kidney and liver disease
* Endocrine deficiencies
* Malnutrition
* Anemia of chronic disease
4
Q
Macrocytic Anemia ( MCV l00-150 fl)
A
- Cobalamin ( B12) Deficiency
- Decreased ingestion
- Competative Parasite
* Fish tapeworm infestation
- Folate Deficiency
* Decreased ingestion
* Lack of vegetable
* alcoholism
5
Q
Measures the average concentration of Hb.
A
Mean Corpuscular Hgb Concentration
MCHC
6
Q
most valuable in monitoring therapy for anemia
A
Mean Corpuscular Hgb Concentration
MCHC
7
Q
Indicates the mean or average volume of a red cell
A
Mean Corpuscular Volume ( MCV
8
Q
- Individual cell size is the best index for classifying anemias.
A
Mean Corpuscular Volume ( MCV
9
Q
Index expresses the volume occupied by a single
erythrocyte and measures in cubic micrometers(
femtoliters) of the mean volume
A
Mean Corpuscular Volume ( MCV
10
Q
Indicates whether the rbc size appears normal
,smaller than normal or larger than normal.
A
Mean Corpuscular Volume ( MCV
11
Q
Decreased __ values signify that a unit volume of
packed RBCs contains less hb than normal
A
MCHC
12
Q
Normal Value for mchc
A
: 32-36 g/dl
13
Q
Hypochromic anemia (MCHC <30)
conditions
A
- Iron deficiency
- Microcytic anemia
- Chronic blood loss anemia
14
Q
Interfering Factors of mch
A
- Hyperlipidemia falsely elevates the MCH
- high heparin concentration falsely elevates
MCH
15
Q
degree of the anisocytosis
A
- Red cell size Distribution Width
(RDW)
16
Q
Explanation of the test : Automated method of
measurement is helpful in investigation of some
hematologic disorders and in monitoring response to
therapy.
A
Red cell size Distribution Width
(RDW)
17
Q
The __ is essentially an indication of the degree of
anisocytosis
A
RDW
18
Q
Helpful in distinguishing uncomplicated
heterozygous thalassemia ( low MCV
A
rdw
19
Q
- use to asses erythropoietic activity of the bone marrow
A
Reticulocyte
Count
20
Q
- whole blood, anticoagulated with EDTA is stained with a
supravital stain such as new methylene blue or brilliant cresyl blue
A
Reticulocyte
Count
21
Q
% Reticulocyte formula
A
of reticulocytes/1000 RBCs observed x 100
22
Q
red cell generation
A
retics count
23
Q
is the actual number of reticulocyte in 1 liter of whole
blood
A
Absolute Reticulocyte Count (ARC)
24
Q
Absolute Reticulocyte Count (ARC) ref range
A
25-75 x 109/L
25
in specimen with a low Hct, the percentage of
reticulocytes maybe falsely elevated because whole
blood contains fewer RBCs.
Corrected Reticulocyte Count
26
A correction factor is used considering the average
normal Hct to be 45%
Corrected Reticulocyte Count
27
Corrected Reticulocyte Count ref range
Reference Range:
2-3%
28
signifies as well if bm will response in anemia
Reticulocyte Production Index
(RPI)
29
Increased Reticulocyte Count conditions
1. Hemolytic anemia
2. Lead poisoning
3. Malaria
4. Parasitic infections
5. Blood intoxication
6. Kala-azar
7. Erythroblastic anemia
8. Sickle cell anemia
9. Relapsing fever
10. Leukemia
11. Splenic tumor
30
Decreased Reticulocyte
Count conditions
1. Aplastic anemia
2. Acute benzol poisoning
3. Chronic infections
4. Anaplastic crisis of hemolytic anemia
31
Physiologic Increase of Reticulocytes
5. Pregnancy
6. At birth
7. Menstruation
32
refers to the speed of fall of the erythrocyte to settle
down from their plasma.
Erythrocyte Sedimentation Rate
33
useful in monitoring the course of an existing
inflammatory disease or differentiating between
similar diseases.
Erythrocyte Sedimentation Rate
34
2 ways of measurement of esr
1. Measuring the length of fall from the top of the column of RBC in a specified period of time
2. Determining the time required for the red cells to reach a specified point
35
Phases or Stages in ESR
Agglomeration Phase
Phase of Fast Settling
Final Phase of Packing
36
the agglomerates sink rapidly
- the rate of fall depends on size-
takes place for about 40 minutes
Phase of Fast Settling
37
initial rouleau formation
few cells sink under gravity but the majority from agglomerates of various sizes
takes place during firsrt 10 mns
agglomeration phase
38
Macromethods in esr
1. Wintrobe-Landsberg Method
2. Westergren Method
3. Graphic and Cutler Method
4. Linzenmeir Method
39
Micromethods
1. Micro Landau Method
2. Smith Method
3. Hellige-Volmer Method or Crista Method
40
. plasma factors increasing esr
a. increased fibrinogen concentration
b. increased globulin concentration
c. cholesterol
41
Red cell factors increasing esr
a. macrocytes
b. anemia
c. hemolysis
42
. Plasma Factors decreasing esr
a. increased albumin
b. increased lecithin
c. defibrination
43
red cell factors decreasing esr
a. microcytosis
b. more red cells
c. spherocytosis
d. increased sickle cells and poikilocytes
44
extrinsic factors affecting esr
1. long standing of blood since rbc tends to be spherical
2. excess dry anticoagulant
3. temperature below 20°C
4. short sedimentation tube
5. small bore of sedimentation tube
6. more blood specimen
7. presence of blood clots
8. dirty glass wares
45
Westergren’s Method's ref range
* Women : 0 – 20 mm/hr
Men : 0 – 15 mm / hr
* Children : 0 – 10 mm /hr
46
Increased ESR conditions
* All collagen disease , SLE
* Infection , pneumonia
* Inflammatory disease
* Carcinoma , lymphoma
* Toxemia
* anemia
47
Methods of Preparation of Blood Smears
Manual Method
-- Wedge/Push/2-Glass Slide Method- the simplest and most commonly used
48
the simplest and most commonly used manual method of smearing
Wedge/Push/2-Glass Slide Method
49
Advantages of manual method
a.slides are not easily broken
b.easy to prepare
c.easy to label and transport
d.allows storages, even without cover slip
e.abnormal cells can easily be foun
50
Characteristics of a Good Smear
1. There should be a transition from thick to thin area.
2. Smear should occupy ¾ of the length of the slide.
3. Most have a smooth even surface, free from waves,
ridges and holes.
4. White blood cells should not be bunched at the end
or edge of smear.
5. It should have a feathery edge or tail.
51
Uses of Thin Smears
1. WBC differential count
2. Stained red cell examination
3. Platelet count (indirect method)
4. Reticulocyte count
5. Siderocyte count
6. Malarial parasite examination
7. Thorough study of morphology of blood cells
52
Requirements to Produce a Proper Blood Films
1. Use of a chemically clean glass slides
and cover glass.
2. Use of not too large nor too small drop
of blood.
3. Work is done quickly before coagulation
of the blood.
4. Proper angle and pressure of the
spreader.
53
Methods of Drying the Blood Films
1. Air drying
2. Heating in the oven for a low flame
3. Chemical drying in ethyl alcohol
Fixatives
for Blood Films
Factors Affecting Thickness/Thinness of Smear
Factors
1. Size of the drop of blood used
a. large drop
b. small drop
4. Methanol
5. Absolute Ethyl Alcohol
6. Absolute Ethyl Alcohol and Ether
7. 1% solution of HgCl₂
8. 1% Formali
54
proper angle smear of smearing
35-45°
55
Pressure exerted when pushing the
spreader against the stationary slide
heavy pressure
thin smear
56
Speed of the spreader slide
too fast
thick smear
57
preferred for bone marrow preparation
Cover Glass/Ehrlich’s Method
58
even distribution of blood cells especially leukocytes is observed
Cover Glass/Ehrlich’s Method
59
Disadvantages of cover glass method
a. cover glasses are easily broken
b. require chemically clean coverglass
c. difficult to prepare
d. difficult to label, stain and transport
60
there is even distribution of cells but
yields limited blood smear.
Beacom’s Method/Cover Glass and Slide Method
61
Automated Method for smearing
Spun Smear
Smear Prepared in Miniprep
62
prepared in hemaspinner
Spun Smear
63
Staining of Blood Smears
Wright’s Stain
2.giemsa stain
3. May-Grunwald’s stain
4. Leishman’s stain
5. Jenner’s stain
6. Panoptic stain
7. supravital stain
64
combination of Romanowsky stain and another
stain
Panoptic stain
65
considered polychrome stain
Wright’s Stain
66
Wright’s Stain component
methylene blue
eosin
67
– basic dye and stains
acidic cellular components
methylene blue
68
acid dye and stains basic
(eosinophilic) cellular components
eosin
69
- buffer added to the stain
- must have a pH of 6.
Sodium Phosphate
70
it is the enumeration and determination of
relative proportion or percentage (%) of
each type of leukocyte in the peripheral or
venous blood.
Leukocyte Differential Count
71
Steps in Leukocyte Differential Count
1. Preparation of blood smear
2. Staining of blood smear
3. Differentiation of leukocytes
4. Reporting of results
72
Ways of Scanning Smears for Differential Count
1. Strip or Horizontal Method
2. Crenellation Method- cells are counted fro
3. Exaggerated Battlement Method
4. Two Field Meander Method
5. Four Field Meander Method
73
all the cells in a longitudinal strip from
head to end or tail of the cells are
counted.
Strip or Horizontal Method
74
cells are counted from the upper part
of the smear, the lower part, then
sideways, then to the upper part until
100 cells are differentiated.
Crenellation Method
75
Shift to the left
- the presence of an increase in younger
forms of leukocytes
76
Shift to the left
seen in pyogenic infections
77
Shift to the right
-the presence of an increase in older forms
of leukocytes
78
Shift to the right
seen in megaloblastic anemia, pernicious
anemia, and in convalescence
79
