UNIT 1 Flashcards
Manual Hematology Methods Microhematocrit ESR Slide Making and Staining Manual Differential Hemocytometer Cell Counts Understand the WBC Scatterplot Instrumentation Flags Correct WBC Count (160 cards)
1
Q
Hematology
A
Study of cellular components of blood
- Cell identification
- Blood forming organs: BM, liver
- Blood related disorders
- Heme lab tests
2
Q
Hemostasis
A
aka Coagulation System
A study of the mechanisms that the body employs to ensure balance & order in the circulatory system.
3
Q
Hematocrit
A
Percentage of packed RBCs in a given volume of centrifuged blood.
4
Q
Manual Differential
A
Count the first 100 WBCs seen on the slide & report the # of each types using 100x with oil.
5
Q
Buffy Coat
A
Makes up < 1%
Made up of WBC & Platelets
6
Q
EDTA
A
A Ca2+ chelating agent that is used as an anticoagulant
7
Q
Na+ Citrate 3.2%
A
Blue tube that chelates Ca2+
Must fill tube 9:1 ratio.
Ideal for platelet clumper patients
8
Q
Rouleaux
A
Penny stacking of RBCs
9
Q
Zeta Potential
A
A negative charge that causes red cells to repel each other. (Aggregation inhibited by the electrical charge on RBCs).
Decreases when inflammatory proteins are increased.
10
Q
Microhematocrit
A
Quick screening for Anemia, uses small volume of blood & spun at high speed.
11
Q
Falsely Increased Microhematocrit
A
Excessive Trapped Plasma
Centrifuge Speed Too Low
Not Centrifuging Long Enough
Poikilocytosis
12
Q
Poikilocytosis
A
Variation of RBCs shape. Thus, RBCs are stacked higher than normal, causing a falsely increased microhematocrit.
13
Q
Falsely Decreased Microhematocrit
A
Tissue Fluids Severe Edema Milking Fingerstick Hemolysis Excessive Anticoagulants Improper Clay Seal Cells Lost During Centrifugation
14
Q
Microhematocrit Procedure
A
Fill 2 capillary tubes 3/4 way full with EDTA or from a finger stick.
Seal 1 end with clay
Put in centrifuge with open end toward the center
Results must be within +/-1% of each other
Report Avg as percent of packed RBCs compared to blood volume
15
Q
ESR
A
Measurement of rate that RBCs sediment in the period of 1 Hr.
A NON-SPECIFIC test for inflammatory processes.
16
Q
Aggregation Phase
A
1 of 3 Phases of ESR.
RBCs come together & form a rouleaux
17
Q
Sedimentation Phase
A
2 of 3 Phases of ESR.
Aggregates fall out of solution
18
Q
Packing Phase
A
3 of 3 Phases of ESR.
Aggregates pack together
19
Q
ESR Procedure
A
- Slowly push pipette through the top of the well.
- Fill pipette to or beyond 0 mark at the top
- Make sure there’s no air bubbles
- Place onto rack & let it sit undisturbed for 1 Hr
- Record mm’s of sedimentation.
DO NOT include Buffy Coat!
20
Q
What causes elevated ESR?
A
Too Warm of Room Temperature
Tilted Tube
Agitation
21
Q
ESR Red Range (male >50)
A
0-20 mm/Hr
22
Q
ESR Ref Range (women <50)
A
0-20 mm/Hr
23
Q
ESR Ref Range (child)
A
0-10 mm/Hr
24
Q
ESR Ref Range (male <50)
A
0-15 mm/Hr
25
ESR Ref Range (woman >50)
0-30 mm/Hr
26
Characteristics of a well-made smear
No lines and holes
Thick & thin areas with gradual transition
Feathered Edge with Rainbow effect
27
What are the components of the Wright Stain?
For Peripheral Smear & Bone Marrow Films, they contain Eosin (Red) & Methylene (Blue)
28
What is the formula for the Platelet Estimate?
Average x 15 = PLT Count/uL
or
Average x 15,000 = PLT Count/uL
29
What is the formula for WBC Estimate?
Average x 2 = WBC Count/uL
or
Average x 2000 = WBC Count/uL
30
Proper peripheral smear technique examination
Scan on 10x, look for unusual distribution of cells
Look for platelet clumps in feathered edge (Redraw if you see any clumps - Blue tube and multiply by 1.1)
Go to 40x, find a "good area" where 1/2 RBCs are overlapping
Do manual WBC estimate if necessary
Go to 100x with oil & perform- Manual WBC Diff, RBC morphology eval, PLT estimation (abnormally shaped)
31
Battlement Pattern
Used to scan for cells during a differential. Following this pattern helps to ensure that we do not count the same cell more than once
Start from the feathered edge
32
Where are the lymphocytes in the Battlement Pattern?
Center
33
Where are the Neutrophils in the Battlent Pattern?
Near the Edge
34
Which WBCs are granulocytes?
N, E, B
Neutrophil
Eosibophil
Basophil
35
Which WBCs are NON-Granulocytes?
Lymphocyte
| Monocyte
36
Characteristics of basophil
Segmented nucleus, abundant dark blue or purple granules
37
Characteristics of neutrophil
Polymorphonuclear and Seg, 2-5 Lobes
38
Characteristics of lymphocyte
Round/Oval shaped nucleus
Nucleus size of RBC.
N:C - Nucleus ratio > Cytoplasm
39
Characteristics of monocyte
Nucleus larger than RBC
Butt/kidney shaped nucleus
Lots of Vacuoles, Pseudopods
40
Hemocytometer Formula
(# Cells Counted)(Dilution Factor) / (# Sq Counted)(Sq Volume) = cells/mm3
41
What is the square volume of WBC?
*Hint: Hemocytometer Cell Count*
0.1 mm^3
42
What is the square volume of RBC?
*Hint: Hemocytometer Cell Count*
0.004 mm^3
43
LEVEY-JENNINGS CHART
A graph used to plot and visualize the results of control over time.
44
What is a "Shift" in Levey-Jennings Chart?
A sudden change in values that remain consistent
45
Which is the correct match of each component of VCS technology with what the WBCs are hit with?
A. Conductivity - Laser Beam, Nuclear Lobularity
Volume - Alternating Current, Measures Nucleus Volume
Light Scatter - Direct Current
B. Volume - Direct Current
Conductivity - Alternating Current, Measures Nucleus Volume
Light Scatter - Laser Beam, Nuclear Lobularity
C. Conductivity - Direct Current
Volume - Laser Beam, Nuclear Lobularity
Light Scatter - Alternating Current, Measures Nucleus Volume
B
Volume - Direct Current
Conductivity - Alternating Current, Measures nucleus volume
Light Scatter - Laser Beam, Nuclear Lobularity
46
What is VCS? What does it stand for?
Volume
Conductivity
Light Scatter
It allows the instrument to analyze WBC immediately (That's a basophil! Thats a neutrophil!) & can be accurately identified. WBCs pass single filed through aperture & hit by (electrical currents, laser beam, radio waves)
47
Delta Check
Automatic check performed by LIS to notify tech of significant difference btwn recent test results
48
What should you do if the LIS notifies you of a Delta Check?
Check sample quality (clots, vole etc)
Check if patient had a tranfusion, surgery, etc
Make sure tube is properly labeled
49
What is QC?
Ensuring test work is done properly
- Controls frequently ran
- Controls have defined value
50
What is QA?
Making sure final results we report are correct (right test on right sample, right result reported on right pt)
- Maintenance
- Validation & Calibration of Instrument
- SOP
- Quality Control
51
How is Hemoglobin measured?
Hgb is directly measured using Cyanmethemoglobin test methodology
52
The _______ is an analyzer's method of measure RBCs, which impede the _______ because they are ______ conductors.
Coulter Principle,
Direct current,
Poor
53
A Hgb molecule is tetrameric (4 Globin molecules placed in a quaternary structure). True or False?
True
54
Where is the iron ion found?
In the Fe2+ Ferrous state
55
Cyanmethemoglobin Method
Considered a Gold Standard.
| Methemoglobin combines with residual cyanide ions to form cyanmethgb.
56
Hemoglobin
A molecule inside RBC that carries O2 & CO2
57
Where is oxyhemoglobin found?
In the ferric (Fe3+) state
58
MCV is directly measured. True or False?
False
| MCV is directly measured
59
MCH, MCHC is Calculated Results. True or False?
True
60
What is the Ferric State of Hgb Formation?
Fe3+
61
What is the Reduced State of Hgb Formation?
Fe2+
62
An adult patient's CBC shows a WBC count of 12.4x10^3 and a relative monocyte count of 8%. What is the absolute monocyte count?
What does it show?
0.9 Absolute Monocytosis
63
An adult patient's CBC result shows a WBC count of 15.7x10^3 and the automated diff shows 30% Neutrophils. To describe this patient's result, you would say this patient has ______ and ______.
Absolute Leukocytosis and Relative Neutropenia
64
You walk into a lab where a tech is performing an ESR. Upon closer examination, you realize the testing is being performed directly adjacent to a centrifuge. You tell the tech this may cause a _____ test result.
A. Falsely Decreased
B. Falsely Increased
C. Normal
D. None of the above
B. Falsely Increased
65
Select what criteria from a CBC printout would lead you to believe a patient has a Cold Agglutinin.
```
A. High MCHC (>36)
B. Polymodal Peak in RBC histogram
C. Low MCHC (<36)
D. R flag on RDW
E. High Hemoglobin
```
A. High MCHC (>36)
B. Polymodal Peak in RBC histogram
D. R flag on RDW
66
What does the conductivity component of VCS technology measure?
Volume of the Nucleus
67
++++++
Result exceeds instrument linearity
68
A CBC gives you a +++++ flag saying the result exceed the instrument linearity. What should you do?
Make a dilution and rerun
69
---------
| Why does this flag occur?
"Total Voteout"
Cell counts occur in triplicate. Voteout occurs when 2 of the 3 counts disagree.
Caused by: Dirty apertures, Clotted spec, Not enough spec
70
You are asked to perform an estimated WBC count. After counting 10 fields, the average number of WBCs seen per field is 3. What is the estimated WBC count (in WBC countx10^3/uL)?
Average x 2000 = WBC Count/uL
3 x 2000 = 6000 or 6.0 x 10^3/uL
71
What is the Rule of 3?
Helps identify testing abnormalities.
Results follow rules of 3 when RBCs completely normal.
RBC x 3 = Hgb +/-3
Hgb x 3 = Hct +/-3
72
According to the rule of 3, if a patient's hemoglobin is 15.0g/dL, what range should their hematocrit fall in?
15 x 3 = 45
| So +/- 3 is 42~48.
73
A patient's MCH is 40pg. You look at their cells under the microscope and would report them as hyperchromic. True or False?
False! RBC cannot hold more Hgb than its size allows.
Low value indicate hypochromic. But there is NO such thing as hyperchromic.
74
Which of the RBC indices is directly measured?
MCV (Mean Corpuscular Volume)
75
You perform a manual differential on an infant. The CBC gave you a WBC count of 41.0 x10^3. When performing the differential, you counted 212 nRBC among 100 WBCs. What is the corrected WBC count?
(Uncorrected WBC count)(100)/(# of nRBCs + 100) = Corrected WBC Count
Answer: 13.1
76
The analyzer does not measure hematocrit. True or False?
True. The MLS directly measure the Hct.
77
Neutrophil Reference Range
Absolute Count - 1.8 ~ 7.0x10^3/uL
Relative % - 40-80%
"In New England, the most start working at 18 and hope to retire at 70. But most find their second careers at 40 and retire at 80 instead"
78
Lymphocyte Reference Range
Absolute Count - 1.0 ~ 4.8x10^3/uL
Relative % - 25~35%
79
Monocyte Reference Range
Absolute Count 0.1~0.8x10^3/uL
Relative % - 2~10%
"MOnsters, change legal drinking at from 18 to 21.
80
Eosinophil Reference Range
Absolute Count - 0.0 ~ 0.4x10^3/uL
Relative % - 0~5%
"Oklahoma area code 4-oh-5"
81
Basophil Reference Range
Absolute Count - 0.0~0.2x10^3/uL
Relative % - 0~1%
82
Bands Reference Range
Absolute Count - 0.0~0.7x10^3/uL
Relative % - 0~5%
"James BAnd agent triple-O-7 only had at most 0-5% luck with the ladies"
83
If the WBC Count is high, this is called?
Absolute Leukocytosis
84
If the Absolute Monocyte count is high, this is called?
Absolute Monocytosis
85
If the Relative Monocyte Count is high, this is called?
Relative Monocytosis
86
You are asked to perform an estimated PLT count. You count 10 fields, and on average see 25 platelets per field. What is the estimated platelet count?
Average x 15 = PLT Count
25 x 15 = 375 x 10^3/uL
87
If the hematocrit is out of range, what are the possible causes?
Trapped Plasma
Hemolysis
Lipemia
Cold Agglutinin
88
MCV NORMAL RANGE
80~100fL
89
MCV Formula
(Hct/RBC) x 10 = MCV
90
What is MCH (Mean Corpuscular Hgb)?
A CALCULATION showing the average amount or weight of hemoglobin in each RBC.
91
What is the unit for MCH?
pg (picogram)
92
MCH NORMAL RANGE
23~34 pg
93
A ____ MCH would be accompanied by an ____ MCV.
A. High, Increased
B. Low, Decreased
C. High, Decreased
D. Low, Increased
A. High, Increased
94
MCH FORMULA
(Hgb/RBC) x10 = MCH
95
What would the RBC look like if the MCH was low?
Hypochromic. There would be increased central pallor
96
What is MCHC (Mean Corpuscular Hgb Concentration)?
A CALCULATION showing the concentration of Hgb in each RBC
97
MCHC NORMAL RANGE
32~36 g/dL
*Sometimes reported as %*
98
MCHC FORMULA
(Hgb/Hct) x 100 = MCHC
or
(MCH/MCV) x 100 = MCHC
99
Which specimen criteria increases or decreases with its effect on the MCHC?
```
Hemolyzed Sample - ?
Old Sample - ?
Extreme Leukocytosis - ?
Lipemic Sample - ?
Clotted Sample - ?
Cold Agglutinin - ?
```
```
Hemolyzed Sample - Increased
Old Sample - Decreased
Extreme Leukocytosis - Decreased
Lipemic Sample - Increased
Clotted Sample - Increased
Cold Agglutinin - Increased
```
100
What is RBC Agglutination?
Caused by cold agglutinin, an antibody that makes RBCs stick together.
101
What should you do if you see some agglutination in patient's specimen?
Incubate the sample at 37 degree Celsius for 15 mins
102
What is the measurement of anisocytosis called?
RDW (Red Cell Distribution Width)
103
What is Anisocytosis?
Variation in size of RBCs
104
What is the unit of measure for MCV?
fL (femtoliters)
105
If RDW is what tells us the variation in the size of the RBCs, then what does MCV give?
MCV only gives the AVERAGE SIZE
106
RDW NORMAL RANGE
12. 0~14.6%
| * The actual result is a statistical value known as a Coefficient of Variation (CV)*
107
What does a normal RBC histogram look like?
Unimodal, one-peak and follows a Gaussian ( bell shaped) curve
108
What does a unimodal abnormal RDW look like?
| What does it indicate?
Wider, it indicates Anisocytosis
109
When would you see a polymodal histogram in a person?
Polymodal histogram indicates multiple distinct cell sizes. It is seen in someone who has received a tranfusion
110
R-Flag (Review Flag)
Indicates a potentially erroneous result
111
```
Which of the following causes a R Flag?
A. RBC Agglutination or fragmentation
B. Miscounted PLT as RBCs
C. Transfusion
D. All of the above
E. A and C
```
D - All of the above
112
How are RBCs read as they are moved through the aperture? What technology is this called?
The Coulter Principle
113
WBC NORMAL RANGE (ADULT)
4.5~11.0 x 10^3/uL
114
WBC NORMAL RANGE (NEWBORN)
9. 0~30.0 x 10^3/uL
| * Higher for newborn to fight the infections b/c their acquired immune system has not been developed like adults.*
115
WBC CRITICAL VALUE
Critically High > 50.0 x 10^3/uL
| Critically Low < 1.5 x 10^3/uL
116
What is an ABSOLUTE COUNT?
The actual number of a certain type of cell
117
RELATIVE (%)
The percentage of a certain type of cell as compared to the total
118
What does -cytosis and -philia suffixes indicate?
An elevated value
```
Leukocytosis
Monocytosis
Neutrophilia
Lymphocytosis
Basophilia
```
119
An adult CBC shows the following results...
WBC: 30.9 x 10^3/uL
Monocyte: 4.2 x 10^3/uL
What is the Relative Monocyte Count?
(Absolute Count)(100) / (Total WBC Count) = Relative Count %
(4.2)(100) / (30) = 14 %
120
Absolute Count vs Relative Count Formula
(Absolute Count)(100) / (Total WBC Count) = Relative Count
121
An adult CBC shows the following results...
WBC: 10.0 x 10^3/uL
NE %: 76%
What is the Absolute Neutrophil Count?
(?)(100) / 10.0 = 76%
? = 7.6 x 10^3/uL
122
An adult CBC shows the following results...
NE #: 5.5 x 10^3/uL
NE%: 30%
What is the Total WBC Count?
(5.5)(100) / ? = 30%
WBC: 18.3 x 10^3/uL
Absolute Lekocytosis
Relative Neutropenia
123
Volume - The Coulter Principle
What current is used for total cell volume measurement?
Direct Current
124
Conductivity - VCS
This produces an ALTERNATING ELECTRICAL CURRENT.
It measures the VOLUME OF THE NUCLEUS
125
How does Light Scatter occur? What hits the cell?
A LASER BEAM!
Light scatters in all directions.
126
What information is provided by the Light Scatter patterns?
Nuclear Lobularity
Structure
Shape
Granularity
127
WBC Scatterplot
L, M, N, O (old/dying), E
*Watch the Unit 1 Lecture 5 for photos*
Quickly and easily identify abnormalities
128
On the WBC Histogram, what anormalities may have caused R Flag?
Small WBCs
Lyse Resistant RBCs
PLT Clump
129
Red Cells supposed to be nucleated in the peripheral blood. True or False?
False!
*Only exception is newborns*
130
nRBCs can be miscounted as WBCs. You need to correct this by doing a manual differential. What is the formula?
(Uncorrected WBC)(100) / (# of nRBCs + 100) = Correct WBC Count
131
You ran the CBC & got a WBC count of 37.0 x 10^3/uL. While doing the manual differential you counted 126 nRBCs among 100 white cells. What is the correct WBCs?
(37)(100) / (126 + 100) = 16.4 x10^3
132
PLT Count also uses the Coulter Principle. What type of current are we using?
Direct Current
133
Any particle between ______fL is counted as a platelet & plotted onto a histogram.
2~20 fL
134
Platelet Normal Range
150 ~ 450x10^3/uL
135
If the particle count does not agree with the curve and is above 20fL, an R Flag is generated on the Platelet Histogram. True or Flase?
True
136
What causes R Flag on Platelet Histogram?
Small/fragmented RBCs
Giant/Clumped PLTs
PLT size variation
137
What should you do if you get an R Flag on PLT Histogram?
1. Verify the results through smear review & manual PLT estimate
2. PLT count & estimate cannot be reported if PLT clumping or PLT satellism is seen
3. Have the specimen recollected/redrawn
138
Platelet Satellism
All of these platelets have the tendency to surround the granular sites, specifically the neutrophils. So specimen has to be recollected
139
An EDTA tube is best ran in _____ Hrs.
24
140
When looking at a dry specimen under the microscope, you will move the condenser ______.
Up
141
When looking at a wet specimen under the microscope, you will move the condenser ______.
Down
142
Hematocrit percentage for males
45%
143
Hematocrit percentage for females
35%
144
If the blood in the ESR (drops below/rises above) the normal range, then the patient has an inflammatory issue.
Drops below
145
Aggregation is promoted by _____ _____ _____.
| CRP, Fibrinogen
Acute Phase Proteins
146
The charge on the red blood cell is?
Negative
147
The further the red blood cells drop during the Westergren ESR procedure, the _______ the ESR (inflammation).
higher
148
Polychrome
Many colored granules
149
Wright Stain
A type of stain most labs use for routine staining.
150
Wright Giemsa Stain
A higher quality stain. Frequently used to stain bone marrow slides.
151
Scan for platelet clumping in the feathered edge on _____x.
10x
152
Perform a manual WBC estimation in _____x.
40x
153
The further a ESR "falls" the _____ result.
Higher
154
Romanowsky
Prototype polychrome stain
155
Perform manual diff, RBC morphology, and platelet estimation in this field.
100x
156
The ______ ion (Fe2+) is oxidized to the _____ state (Fe3+).
Ferrous
| Ferric
157
The deoxyhemoglobin ion is in the reduced ferrous (Fe2+) state. True or False?
True
158
When K+ ferricyanide is added to Hgb, oxidizing all the ferrous ions (Fe2+) to ferric ions (Fe3+), the Fe3+ ions are known as
Methemoglobin
159
_______ is found in the ferric (Fe3+) state. It has an oxygen molecule attached to the hemoglobin.
Oxyhemoglobin
160
Cyanmethemoglobin is measured by __________. The amount of light absorbed is proportional to the amount of hemoglobin in the sample.
Spectrophotometry
