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HEMATOLOGY MODULE 1 & 2 > MODULE 2 AUTOMATION > Flashcards

MODULE 2 AUTOMATION Flashcards

(95 cards)

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1
Q

Two basic cell counting principles employed in most hematology analyzers

A

Electrical Impedance
Optical Scatter or Detection

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2
Q

What is Hydraulics

A

aspirating unit, dilutors, dispenser, mixing chambers, aperture baths, flow cells and hemoglobinometer

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3
Q

What is PNEUMATICS

A

Vacuums and pressure for opening valves and moving the sample through the system

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4
Q

What is ELECTRICAL SYSTEMS

A

Electronic analyzers and computing circuity for processing data

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5
Q

What is Electrical Impedance

A

Also know as low-voltage direct current resistance
most commonly methodology used
example are Coulter Counter and Sysmex Counter

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6
Q

Principle of Electrical Impedance

A

Cell passes through the aperture, cells do not conduct current but they change electrical resistance which is counted as voltage pulses.

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7
Q

Size Threshold Ranges in an Electrical Impedance Method

A

`RBCs 36-360 fL
WBCs 45-450 fL
Lymphocytes 45-90 fL
Monocytes 90-160 fL
Granulocytes 160-450 fL
Platelets 2-20 fL

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8
Q

Principle of OPTICAL SCATTER

A

Differentiate and enumerate cell types based on the scattering properties of the cells.
Patterns of scatter are measured in various angles
Uses laser and nonlaser light

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9
Q

What are the Patters of Scatters are measured by various angles

A
  1. Forward angle light source
  2. Side angle light scatter
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10
Q

What is Forward angle light scatter

A

measure cell size

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11
Q

What is Side angle light scatter

A

Measures cell granularity and lobularity

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12
Q

Side angle light scatter consist of

A

a. RBC no nucleus
b. WBC with nucleus

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13
Q

Example of LIGHT used in Optical Scatter

A

a. Tungsten
b. Helium-neon laser

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14
Q

what is Tungsten

A

halogen lamp

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15
Q

Helium-neon Lamp

A

Laser monochrome light

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16
Q

What is a Laser Light

A

most common light source used in flow cytometers because of its properties INTENSITY, STABILITY and MONOCHROMATISM

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17
Q

Principle of FLOW CYTOMETRY

A

Cells suspension is run under high pressure in single, narrow stream of laser, causing excitation of flourescent compounds resulting emission of light energy. Energy is detected by a photomultiplier tube and converted into computerized data, which provide information regarding the number, size and cellular components.

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18
Q

Major components of Flow Cytomers

A

Fluidics
Optics
Electronics

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19
Q

What is FLUIDICS

A

flow chamber for single cell seperation, sheath fluid and hydrodynamic focusing

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20
Q

what is OPTICS

A

excitation of light source includes lasers or lamps.
Light is seperated by dichroic mirror and filters

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21
Q

example of lasers

A

argon
krypton
Helium-neon
helium cadium
diode

(KAHHD)

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22
Q

examples of Lamps

A

Mercury
Xenon-mercury

(MX)

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23
Q

what is Electronics

A

Photomultuplier tube detecs light energy, then converts this to voltage pulses, computers translate pulses into data files.

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24
Q

Benefits of Optical Technology

A

Laser Light can be focused on individual cells
More than 2 measurements can be made and more information can be gathered
Cells are passed in a single file through the flow cells
More realistic results

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25
Principle of histogram
utilizes impedance technology and representation of cell number versus one measured property, usually cell size. Produced by plotting the number on the y axis and cell size on the x axis
26
How many distribution peaks is the Normal WBC Histogram
3 Distribution Peaks
27
First Peak WBC Histogram
45-90 fL: small mononuclear cells (lymphocytes
28
Second Peak WBC Histogram
90-160 fL: minor population of large mononuclear cells (monocytes, reactive lymphocytes, immature WBCs)
29
Third Peak WBC Histogram
160-450 fL: normal mature types of granulocytes
30
WBC categories on Coulter Counter
Small Cells (lymphocytes) Medium Cells (Reactive lymphocytes) Large Cells (Granulocytes)
31
Abnormal WBC Histogram
32
Enumerate Abnormal WBC Histogram
R1: <35 fL indicate nRBCs, giant and clumped platelets R2: 90 fL indicate Reactive lymhocytes or blast cells R3: 160 fL indicate increase in bands, immature neutrophils, eosinophils or basophils R4: >450 fL indicate high granulocyte and multiple region overlap (RM)
33
Enumerate Abnormal WBC Histogram
R1: <35 fL indicate nRBCs, giant and clumped platelets R2: 90 fL indicate Reactive lymhocytes or blast cells R3: 160 fL indicate increase in bands, immature neutrophils, eosinophils or basophils R4: >450 fL indicate high granulocyte and multiple region overlap (RM)
34
Abnormal WBC Histogram
35
Other flags in WBC Histogram
H: parameter value is higher than set normal limit L: parameter value is lower than set normal limit
36
Other flags in WBC Histogram
H: parameter value is higher than set normal limit L: parameter value is lower than set normal limit
36
Abnormal WBC Histogram
37
RBC Histogram
6-360 fL or >36 fL Show single peak at between 70 and 110 fL
38
Abnormal RBC Histogram Interpretation
24-36 fL Reject (RBC Histogram can measure cells as small as 24 fL) Shift to the Right: Macrocytic Shift to the Left: Microcytic Bimodal, 2 Peaks: Cold agglutinin, hemolytic anemia with schistocytes present, anemia with different cell size (when patient present blood transfusion, dimorphic RBC population) Increased Curved Width: Anisocytosis (correlate with increase RDW)
39
WBC Histogram
24-36 fL Reject (RBC Histogram can measure cells as small as 24 fL) Shift to the Right: Macrocytic Shift to the Left: Microcytic Bimodal, 2 Peaks: Cold agglutinin, hemolytic anemia with schistocytes present, anemia with different cell size (when patient present blood transfusion
40
WBC Histogram
24-36 fL Reject (RBC Histogram can measure cells as small as 24 fL) Shift to the Right: Macrocytic Shift to the Left: Microcytic Bimodal, 2 Peaks: Cold agglutinin, hemolytic anemia with schistocytes present, anemia with different cell size (when patient present blood transfusion
41
WBC Histogram
24-36 fL Reject (RBC Histogram can measure cells as small as 24 fL) Shift to the Right: Macrocytic Shift to the Left: Microcytic Bimodal, 2 Peaks: Cold agglutinin, hemolytic anemia with schistocytes present, anemia with different cell size (when patient present blood transfusion
42
Platelet Histogram
2-20 fL
43
Platelet Histogram Interpretation
Lower Region Interference: <2 fL Electrical Impedence Upper Rehion Interference: >20 fL Microcytic RBCs, Schistocytes, Giant or Clumped Platelets
44
Abnormal RBC Histogram Interpretation
45
Scattergram
also called CYTOGRAM OR SCATTERPLOT 2-dimensional representation of 2 or more cell properties or characteristics plotted against each other
46
Scattergram
also called CYTOGRAM OR SCATTERPLOT 2-dimensional representation of 2 or more cell properties or characteristics plotted against each other
47
Scatter plots for WBC
Displayed on a monitor and colored coded for different subpopulations
48
Methodologies of Scattergram
Radiofrequency Fluorescence Cytochemistry
49
Problems Encountered in Automated Methods
Instrumental Errors Nature of the Specimen
50
Example of Instrumental Error
Positive Errors negative Errors Improper Settings of aperture current/threshold
51
What is a Positive Errors
Aperture
52
Examples Positive Errors
Aperture plug- most common problem in cell counting Bubbles in the sample- cause by vigorous mixing Extraneous electrical pulses
53
Example of Negative Errors
Excessive lysing of RBCs
54
Example of Improper setting of aperture current/threshold
cause either + or - errors
55
Example of Nature of specimen error
Giant platelets Fragment of WBC cytoplasm may be counted as RBCs or Platelets Agglutination of RBCs, WBCs and Platelets Platelet Sattelitism
56
Effect of Giant Platelets in Nature of Specimen Errors
57
Effect of Giant Platelets in Nature of Specimen Errors
counted as RBCs or WBCs
57
Effect of Giant Platelets in Nature of Specimen Errors
counted as RBCs or WBCs
58
Effect of Fragment of WBC Cytoplasm in Nature of Specimen Errors
59
Effect of Fragment of WBC Cytoplasm in Nature of Specimen Errors
counted as RBCs or Platelets
60
Effect of Agglutination of RBCs, WBCs and Platelets in Nature of Specimen Errors
False-negative results for each count
61
Effect of Fragment of WBC Cytoplasm in Nature of Specimen Errors
counted as RBCs or Platelets
61
Effect of Agglutination of RBCs, WBCs and Platelets in Nature of Specimen Errors
False-negative results for each count
62
Effect of Platelets Satellitism in Nature of Specimen Errors
Falsely low platelets count
63
Cold agglutinins Parameters Affected
INCREASE: MCV, MCHC DECREASE: RBC Grainy Appearance
64
Corrective action for Cold Agglutinins
warm specimen 37 degree Celsius and RERUN
65
Corrective action for Cold Agglutinins
warm specimen 37 degree Celsius and RERUN
66
Lipemia Icterus Parameters Affected
67
Lipemia Icterus Parameters Affected
INCREASE: Hb, MCH
68
Corrective action for Cold Agglutinins
warm specimen 37 degree Celsius and RERUN
69
Lipemia Icterus Parameters Affected
INCREASE: Hb, MCH
69
Lipemia Icterus Parameters Affected
70
Hemolysis Parameters Affected
DECREASE: RBC, Hct
70
Corrective action Lipemia Icterus
Plasma replacement
71
Corrective action Hemolysis
Request new specimen
72
Lysis-resistant RBCs Parameters Affected
INCREASE: WBC, Hb
73
Corrective action Lysis-resistant RBCs
Perform manual dilution, allow incubation time for lysis
74
Microcytes or Schistocytes Parameters Affected
INCREASE: PLT DECREASE: RBC
75
Corrective action for Microcytes or Schistocytes
review blood film
76
nRCS, Megakaryocytes fragments or Micromegakaryoblasts Parameters Affected
INCREASE: WBC (older specimen)
77
Corrective action for nRCS, Megakaryocytes fragments or Micromegakaryoblasts
Newer instruments Count nRBCs and correct WBC count Count micromegakaryoblasts per 100 WBCs and correct
78
Platelets Clumps Parameters Affected
INCREASE: WBC DECREASE: PLT
79
Corrective action for Platelets Clumps
Redraw specimen in Sodium Citrate, multiply result by 1.1
80
WBC, 100.000/mL Parameters Affected
INCREASE: Hb, RBC, Hct
81
Corrective action for WBC, 100.000/mL
Manual Hct Manual Hb
82
Leukemia, especially with chemotherapy Parameters Affected
INCREASE: PLT DECREASE: WBC
83
Corrective action for Leukemia, especially with chemotherapy
Review film Perform phase platelet count or CD61 count
84
Old Specimen Parameters Affected
INCREASE: MCV, MPV DECREASE: PLT
85
Corrective action for Old Specimen
establish stability and specimen rejection criteria
86
Lyse resistance abnormal RBCs
Sickle Cells Target Cells Hypochromic Cells (STH)
87
Criteria to repeat the analysis if
Rule of 3 failures on a normochromic sample Any results outside linearity limits established by the manufacturer- dilute into linearity range unexplained delta check failures
87
Effect of Agglutination of RBCs, WBCs and Platelets in Nature of Specimen Errors
False-negative results for each count
88
Criteria to repeat the analysis if
Rule of 3 failures on a normochromic sample Any results outside linearity limits established by the manufacturer- dilute into linearity range unexplained delta check failures
88
Effect of Agglutination of RBCs, WBCs and Platelets in Nature of Specimen Errors
False-negative results for each count

HEMATOLOGY MODULE 1 & 2 (3 decks)

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