MTLE refresher notes Flashcards
(215 cards)
1
Q
Hand-held device that aids in visualization prior to phlebotomy
A
AccuVein
2
Q
Blood to anticoagulant ratio in black-top tubes
A
4:1
3
Q
Blood to anticoagulant ratio in light blue-top tubes
A
9:1
4
Q
Anticoagulant used for trace elements and toxicology determination
A
Sodium heparin
5
Q
Anticoagulant used for fragility testing and Blood Gas Analysis
A
Heparin
6
Q
Disadvantage of using Serum Separator Tubes (SSTs)
A
It interferes with (TDM) Therapeutic Drug Monitoring
7
Q
Clotting time for:
Tubes with activator, with gel separators, and without anticoagulant
A
With gel: 30 mintues
With clot atvator: 5 mins
w/o anticoagulant: 60 mins
8
Q
arterial puncture order of preference
A
- Radial artery 2. Brachial artery 3. Femoral artery
9
Q
Test prior to radial artery puncture
A
Modified Allen Test
10
Q
Amount of anticoagulant for arterial puncture
A
0.05 mL of liquid heparin or 1,000 u/mL
11
Q
Blood Gas Collection for Newborns
A
Indwelling Umbilical Artery Catheter
12
Q
Order of draw for catheter liines
A
- Discard 2-5 mL of blood and discard.
- Blood culture
- Anticoagulated tubes
- Serum tubes
13
Q
Order of draw for capillary puncture
A
- Tubes for blood gas analysis
- Smear/Slide Preparation
- EDTA
- Other anticoagulated tubes
- Serum tubes
14
Q
Order of Draw for Venipuncture
A
- Yellow top
- Light Blue top
- Red top (serum tubes)
- Green top
- Lavender top
- Gray top
15
Q
Size of the drop of blood in wedge smears
A
2-3 mm
16
Q
How to make a thin smear
A
Increased pressure
Decrease the (ASS) Angle, Speed, and Size of blood drop
17
Q
How to make a thick smear
A
Derease the pressure
Increase the (ASS) Angle, Speed, and Size of blood drop
18
Q
Physiological factors that may lead to pre-analytical variations
A
Position - increase values of large molecules
Diurnal variation- increase (WBCs) eosinophils in the afternoon
Stress - increase WBC count
Smoking - Increase WBC hematocrit, RBC count and hemoglobin
Exercise - increase WBC count
Diet- Affects hemoglobin and coagulation tests
19
Q
Prolongged tourniquet application results to?
A
hemoconcentration
20
Q
Light senstitive substances
A
Bilirubin, Vitamin A, Beta-carotene, porphyrins, Iron
21
Q
Samples to be chilled
A
Ammonia, Gastrin, PTH, Lactic Acid
22
Q
Blood films from EDTA should be made within how many hours
A
2-3 hours
23
Q
EDTA-containg tubes
A
Lavender
Pink
Tan
White
Royal Blue
24
Q
Automated smear-making and staining system (wedge type method)
A
Sysmex SP-10
25
Automated staining system (dip-batch staining)
MIDAS III
26
Automated staining (propelled towards two rotating plantars)
HemaTek
27
RBCs with blunt or pointed protrusions that are evenly spaced
Echinocytes
28
Macroscopic appearance of a well-stained smear
Purple/Pink-colored film
29
Macroscopic appearance of a stained film obtained from blood samples with INCREASED PROTEIN LEVELS
Blue color
30
Macroscopic appearance of stained film obtained from blood samples with INCREASED LIPIDS
Has holes
31
Macroscoopic appearance of a stained film obtained from blood samples with INCREASED WBC AND PLATELETS
Bluish lateral edges
32
Macroscopic appearance of a stained film obtained from blood samples with RBC aggregates
Grainy appearance
33
Objective used to estimate bone marrow cellularity
LPO
34
Objective used for WBC estimates
HPO
35
May be confused with plasma cells/plasmablast
Osteoblast
36
May be confused with megakaryocyte
Osteoclast
37
Objective used for WBC differential count, platelet estimates, and cell morphology
OIO
38
RBC per OIO field viewed in the correct are of the film
200-250 RBCs per OIO field
39
Number off WBCs to be differentiated when WBC count is >40 x 109/L
200-cell differential count
40
Number of WBCs to be differentiated when WBC count is >100 x 109/L
300 or 400-cell diifferenntial count
41
Number of WBCs to be differentiated when WBC count is <1 x 109/L
50-cell differential count
42
Increased number of bands or cells younger than bands in the PBS
Shift to the Left
43
Is the first immature neutrophil normally found in the peripheral blood
Band/Stab/Staff cell
44
SIte for bone marow syntesis in adults and children more than 2 yrs old
Posterior Superior Iliac Crest
45
Site for bone marrow aspirate collection for children less then 2 years old
Tibia
46
Alternative sites for bone marrow aspirate collection in adults
Sternum
spongy bone spicule of vertebrae
Other red marrow containing sites
47
Bone marrow sample management
1. direct smears
2. Anticoagulated smears
3. Crush preparation
4. Touch print technique
5. Concentrated bone aspirate
48
Used for the evaluation of the morphology and distribution of hematopoietic cells (immature)
Bone marrow aspirate
49
Used when patients are suspected of focal lesions
Bone marrow core biopsy
50
Staining technique for bone marrow core biopsy
H & E staining
51
1 ml of bone marrow in heparin is used in
Cytology studies & Flow Cytometry Techniques
52
Most common erythrocytic stages found in the normal marrow
Polychromatophilic & Orthochromatophilic normoblasts or erythroblasts
53
What are the reagents used in Drabkin's solution
1. Potassium ferricyanide - converts hemoglobin to methemoglobin
2. Potassium cyanide - converts methemoglobin to cyanmethemoglobin at 540 nm
3. Sodium carbonate
4. Surfactant
54
Used to assess the erythropoietic activity of the bone marrow
Reticulocyte count
55
What is the relationship of ESR to plasma viscosity?
Inversely proportional
56
What is the relationship of ESR to the RBC mass?
Directly Proportional
57
Passage of more than one cell a time through the aperture
Coincidence
58
Measures the pulse generated by the resistance of the cell as it passes through the current within the aperture
Electrical impedance
59
Measures the rate of conductivity
Radiofrequency
60
The principle in flow cytometers
Optical scatter & Immunofluorescence
61
Principle of Optical scatter
Uses laser beam to differentiate between different blood cell types
62
Principle of Immunofluorescence
Uses immunophenotyping
Uses fluorescent-labeled monoclonal antibodies
63
Combination of forward-low and forward-high scatter. A principle employed by Siemens system
Differential scatter
64
Represents excess signals at the lower threshold region of the WBC histogram
R1
65
Coulter's technology of five-part WBC differential
VCS technology
66
MAPSS technology and three-color fluorescence
Abbott Celldyne Sapphire
67
Peroxidase-staining absorbance and light scatter
Siemens Advia
68
Detection of forward and side scattered light and fluorescence
Sysmex XN-1000
69
RBC in TAILS
(Thalassemia, Anemia of Chronic Disease, Iron deficiency anemia, Lead Poisoning, and Sicke Cell disease)
Microcytic
70
RBC in Vit. B12 deficiency, folate deficiency, and pernicious anemia, Steatorrhea, sprue, D. latum infection
Macrocytic
71
Test involving the formation of Holly Leaf appearance
Sodium Metabisulfate
72
Screening test for hemoglobin S solubility
Sodium dithionate
73
Forward light scatter measures
cell volume
74
Side-angle scatter measures
internal complexity
75
Falsely high ESR
Heat from the back of refrigerator
Vibrations from opening and closing the refrigerator
76
Falsely low ESR
Cool air from refrigerator
77
Decreased ESR is caused by the what
Poikilocytes
Thalassemia
Over-anticoagulation
Bubbles
Delayed reading
78
Increased ESR is caused by what
Multiple myeloma
Waldenstrom's macroglobulinemia
Anemia
Bacterial infection
Carcinoma
Pregnancy
Menstruation
High room temperatures
Tilting
79
A fluid used for the determination of eosinophil count
Pilot's fluid
80
Three components of the Pilot's fluid
1. Phloxine B - stains eosinophil bright red
2. Propylene glycol - lyses RBCs
3. Heparin - prevents leukocyte aggregation
81
Diluting fluids for WBC count
Turk's and HCl
82
The most commonly used RBC count diluting fluid
Formol citrate
83
Color of Wright-stained red cells may be adjusted by?
Adjusting the buffer
84
Causes of excessively pink smears
Thin smears
Acidic buffer
Prolonged washing
Insufficient staining time
Old fixative
85
Causes of excessively blue smears
Think smears
prolonged staining
Insufficient washing
Alkaline buffer
Heparinized sample
86
Characterized by increased Osmotic Fragility Testing
Shperocytes
87
Characterized by decreases OFT
Target cells
88
Test for the identification of Factor XIII deficiency
Ducker's test
89
Type of lymphocyte seen in Infectious Mononucleosis
Type II Reactive Lymphocyte/IM Lymphocyte
90
What cells are infected by the causative agent of IM
B cells
91
A reactive lymphocyte also known as "Turk's Irritation Lymphocyte"
Type I
92
The causative agent of Infectious Mononucleosis
Epstein-Barr Virus
93
Mode of transmission of EBV
Kissing
Blood transfusion
Organ transplant
sexual contact
94
Which cells are infected by EBV
CD21/B cells
95
A congenital form of Red Cell Aplasia
Diamond-Blackfan Anemia
96
A congenital form of Aplastic Anemia
Fanconi Syndrome
97
The classic drug associated with bone marrow aplasia
Chloramphenicol - an antibacterial drug
98
An inherited form of Aplastic Anemia
Fanconi syndrome and Idiopathic Aplastic anemia
99
Acquired Aplastic Anemia is caused by what
Chronic exposure to certain drugs and chemicals,
Chronic exposure to radiation,
Abnormal Immune Mechanisms,
Miscellaneous (PNH, Non-A, Non-B hepatitis)
100
Drugs Associated with Aplastic Anemia
Anti-bacterial= Chloramphenicol & sulfonamides
Anti-inflammatory = Phenylbutazone, Oxyphenobutazone, Gold salts, Indomethacin
Anti-convulsants = Phenytoin, methoin
diuretics = Chlorothiazide
Anti-thyroid = Propyl/Methylthiouracil, Carbimazole, Thiocyanate, Potassium perchlorate
Oral hypoglycemic = Chlorpropamide
Anti-malarial = Amodaquine, Chloroquine, mepacrine
101
Diagnostic Criteria for Aplastic Anemia
Bone marrow cellularity
WBC count <500/uL
Plt count <20,000/uL
Anemia with <1% reticulocytes
102
A blood and bone marrow cancer characterized by pancytopenia with an unknown cause
Acute Lymphoblastic Leukemia (ALL)
103
Common childhood ALL
L1
104
Common adulthood ALL
L2
105
Burkitt type leukemia
L3
106
An antigen present on the leukemic cells of 70% of ALL patients
CALLA (Common Acute Lymphoblastic Leukemia)
107
ALL Cytochemical stain rxn
MPO & SBB (-)
ACP (+)
NSE - (+)
TdT- Terminal deoxyribonucleotide transferase(+)
108
Presence of TdT and HLA-DR only
uALL (uncategorized ALL)
109
Presence of CALLA, TdT, and HLA-DR
cALL (common ALL)
110
Has a T cell antigen but lacks sheep erythrocyte receptor (CD2)
Pre-T ALL
111
Has cytoplasmic immunoglobulin but no surface immunoglobulins (no IgG & IgM)
Pre-B ALL
112
Presence of T antigens and sheep erythrocyte receptor
T ALL
113
Presence of B antigens and surface immunoglobulins
B ALL
114
A rare type of leukemia characterized by splenomegaly and mononuclear cells with hair-like or ruffled projections
Hairy Cell leukemia
115
Which enzyme is positive in Hairy cell leukemia
Tartrate Resistant Alkaline Phosphatase
116
Most common malignant disease of plasma cells
Multiple Myeloma
117
Have the same characteristics as multiple myeloma but is not a malignant condition
Benign Monoclonal Gammopathy
118
Russell bodies accumulation exhibits what
Grape cell/Mott celllMorula cell
119
What are the cellular inclusions in Multiple Myeloma
Dutcher Intranuclear bodies
120
A type of cell that exhibits blue color and mottled appearance
Plasmablast
121
Crew-cut appearance on skull X-ray is found in
Beta-Thalassemia major
122
is a structural variant and rare type of δbeta-thalassemia caused by a fusion of δbeta-globin genes
Hemoglobin Lepore
123
The first type of cell in a developing embryo
RBCs
124
The most abundant hemoglobin in newborn
HbF
125
The most abundant hemoglobin in adults
HbA1
126
first identifiable RBC stage under the light microscope
rubriblast
127
Last stage of mitosis of RBC presursor
rubricyte
128
Last nucleated stage in RBC precursor
Metarubricyte
129
Last stage capable of hemoglobin synthesis in RBC precursor
Reticulocyte
130
Last erythropoietic stage with a nucleus present
Most common nucleated RBC that interferes with RBC counting
metarubricyte
131
Last erythropoietic stage where mitosis occurs
Hemoglobin component of RBCs are first detected
rubricyte
132
Pica is commonly associated with?
IDA
133
Release by the liver in response to high iron levels
Neutralizes ferroportin
Hepcidin
134
Aplastic anemia is characterized by ?
Normocytic, normochromic anemia
135
Other conditions assoc with normocytic, normochromic anemia
Hemolytic anemia
Aplastic anemia
Anemia of chronic blood loss
Myelophthisic anemia
Stem cell related anemia
136
Abnormal cell seen in uremia
Burr cell
137
an enzyme that converts phosphoenolpyruvate to pyruvate generating two molecules of adenosine triphosphate; essential for aerobic anaerobic glycolysis
Pyruvate kinase
138
dark blue granules and filaments in cytoplasm (seen in reticulocytes)
Diffuse basophilia
139
Dark blue-purple, fine or coarse punctuate granules distributed throughout the cytoplasm
Basophilic stippling
140
Dark blue-purple dense, round granule; usually one per cell; occasionally multiple
Howell-Jolly bodies
141
Round, dark blue-purple granule attached to inner RBC membrane
Heinz bodies
142
Irregular clusters of small, light to dark blue granules, often near periphery of the cell
Pappenheimer bodies
143
Rings of figure-eights
Cabot rings
144
Fine, evenly dispersed, dark blue granules; imparts "golf ball" appearance to RBCs
Hb H
145
Associated conditions with Howell-Jolly bodies
Hyposplenism
Postsplenectomy
Megaloblastic anemia
Hemolytic anemia
Thalassemia
Myelodysplastic syndromes
146
Associated conditions with Heinz bodies
G6PD deficiency
Unstable Hemoglobins
Oxidant drugs/chemicals
147
Associated conditions with Basophilic stippling
Lead poisoning
Thalassemias
Hemoglobinopathies
Megaloblastic anemia
Myelodysplastic syndrome
148
Associated conditions with Pappenheimer bodies
Sideroblastic anemia
Hemoglobinopathies
Thalassemias
Megaloblastic anemia
Myelodysplastic syndromes
Hyposplenism
Postsplenectomy
149
aka Pentose Phosphate shunt
Hexose Monophosphate Shunt
150
Pathway that converts ferric iron to reduced ferrous iron
EMB pathway
151
Nucleus is elongated, curved or sausage-shaped with rounded ends and areas of dense clumping at each pole
band cell/stab cell/ staff cell
152
Stool containing dark red or black color
Melena
153
Stool containing fresh blood
Hemotochezia
154
Blood leakage into the joint cavity
Hemarthrosis
155
Expectoration of blood
Hemoptysis
156
Vomiting of blood
Hematemesis
157
Excessive menstrual bleeding
Mennorhagia
158
Uterine bleeding not related to menstruation
Metrorrhagia
159
Platelet Distribution Width (PDW) & Mean Platelet Volume is derived from where
Platelet Histogram
160
RDW & MCV are derived from where
RBC histogram
161
The first factor affected by Coumarin therapy
Factor VII
162
Coagulation factor deficiency that is commonly found in Ashkenazi Jews
Factor XI
163
What is the effect of microcytosis in PLT count using automated counters?
Falsely elevated PLT count
164
Most common problem in cell counting causing an increase in current
Positive error
165
What causes Negative error?
Lysis
166
Hemoglobin that is insoluble under lowered oxygen tension
Hb S
167
Oxygen saturation which causes sickling in homozygotes
<85%
168
Hemoglobin that is resistant to alkali denaturation
Hb F
169
Conditions associated with increased HbF
Infancy
Hemoglobinopathies
Doubly heterozygous conditions
Thalassemia
Aplastic anemia
Leukemia
Pregnancy
170
What is the principle of Alkali Denaturation Test
Principle: Hemoglobin is denatured once exposed to an alkali environment
Hb F resists denaturation
171
Hereditary hypersegmentation of PMNs
Undritz Anomaly
172
Functional iron
Hemoglobin - blood
Myoglobin - muscles
Peroxidase, catalase, cytochromes, riboflavin enzymes in all cells
173
Storage form of iron
Ferritin - macrophages
Hemosiderin - hepatocytes
174
Transport iron
Transferrin
175
Length of Wintrobe tube
115 mm
176
Length of Westergren tube
300 mm
177
Graduation lines of Wintrobe and Westergren
Wintrobe = 100
Westergren = 200
178
Zetafuge and special capillary tubes are used for?
Zeta Sedimentation Rate
179
What is M4 called
Naegeli Monocytic Leukemia
180
What is the FAB and WHO classification of Schilling's Leukemia
FAB: Cute Monocytic Leukemia
WHO: t9:11
181
M6
FAB classification: Erythroblastic Leukemia
DiGuglielmo's Syndrome
182
Poikilocyte in McLeod phenotype
Acanthocytes
183
Infectious crisis is the common cause of death in ------
Sickle Cell Disease
184
A rare disease characterized by impaired oxidative metabolism caused by decreased ability of neutrophils to undergo a respiratory burst after phagocytosis of foreign organisms.
Chronic Granulomatous Disease
185
What tests are performed to diagnose CGD/
(1) Nitroblue tetrazolium test
(2) Chemiluminescence test
186
A test that detects Prekallikrein
Activated Partial Thromboplastin time (aPTT)
187
Hemoglobin that is bound carbon monoxide, which prevents normal oxygen exchange.
carboxyhemoglobin
188
Irreversible hemoglobin variant
Sulfhemoglobin
189
Abnormal form of hemoglobin in which the ferrous ion is oxidized to the ferric state; cannot carry oxygen.
Methemoglobin
190
RBC inclusion: clamshell or bar of gold appearance
Hexagonal crystals with blunt ends that stains deeply
Found within RBC membrane
Hb CC crystal
191
RBC inclusion: Washington monument appearnace
Hb-SC crystal
192
What is the FAB Classification of M3
Acute Promyelocytic Leukemia
193
Most fragile blood cell associated with Chronic Lymphocytic Leukemia
Smudge cells/Basket cell
194
A taste of primary platelet function
Bleeding time
195
What is the normal range for platelet
200,000 - 400,000/uL
196
Platelet aggregometer measures_____?
Change in light transmission
197
Platelet factor 3 is associated to the activated platelet's____?
Phospholipid
198
Stimulates aggregation
Platelet factor 4
199
Estimated platelets per OIO field
8-20 plts
200
The outermost zone of platelets
Consists of glycoproteins and surface receptors for coagulation factors
Contains pores for communication between the intracellular and extracellular compartments of PLTs
Glycocalyx
201
Glycoprotein that binds with vWF
Glycoprotein Ib
202
Binds with fibrinogen
Glycoprotein IIb-IIIa
203
Binds with thrombin
Glycoprotein V
204
Site of prostaglandin and arachidonic acid synthesis
Dense Tubular System
205
Inhibits platelet activation by increasing cAMP levels
Prostacyclin (PGI2)
206
Its deficiency results to a normal platelet aggregation with decreased platelet adhesion
12-HETE (hydroxyeicosatetraenoic acid)
207
An endothelia cell derived chemorepellent which inhibits platelet adhesion
13-HODE (hydroxyoctadecadienoic acid)
208
Converts plasminogen to plasmin
tPA
209
Binds and inactivates thrombin
enhances protein C action
Thrombomodulin
210
Weakly enhances anti-thrombin III activity
Heparan Sulfate
211
A substance that stimulates vasodilation
Adenosine
212
A disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13.
Regulates the size of circulating von Willebrand factor by cleaving ultralong VWF multimers into shorter segments that have less hemostatic potential
ADAMTS-13
213
Recommended for detecting intrinsic and common factor deficiencies and monitoring heparin therapy
aPTT
214
Normal value of aPTT
20-45 seconds
215
Used to rule out heparin as the cause of increased thrombin clotting time (TCT). Reverses the effects of heparin.
Protamine Sulfate
