Unit 1 Flashcards
(169 cards)
1
Q
hematology
A
The study of cellular components of the blood
2
Q
The study of Hematology includes
A
Cell Identification, blood forming organs, blood related disorders and lab tests
3
Q
hemostasis
A
The study of the mechanisms that ensures the balance and order in the circulatory system
4
Q
composition of whole blood
A
55% plasma, 45% cells
5
Q
Name three anticoagulants used in hematology testing
A
EDTA
Sodium Citrate
Lithium Heparin
6
Q
EDTA tube
A
Powdered anticoagulant that deactivates metal dependent enzymes, binds Ca++ to prevent clumping
7
Q
sodium citrate tube
A
liquid anticoagulant, binds calcium, exact volume is important
8
Q
blue tops have a ___:___
A
1:9
9
Q
Microhematocrit (aka hematocrit)
A
The percentage of packed RBCs in a given volume of centrifuge blood
10
Q
a quick screening test for anemia
A
microhematocrit
11
Q
microhematocrit procedure
A
Fill 2 capillary tubes 3/4 full with EDTA whole blood or from fingerstick, seal one end with clay, place in centrifuge open end toward the center, interpret results with microhematocrit card, report the average as a percentage
12
Q
What can cause a falsely increased microhematocrit result?
A
centrifuge speed too low
centrifuge spin time too short
poikilocytosis
13
Q
what can cause a falsely decreased microhematocrit result?
A
tissue, severe edema, hemolysis, excessive anticoagulant, improper clay seal, cells are lost during centrifugation, excessively milking a fingerstick.
14
Q
Reference range
A
A range considered include 95% of the normal population
15
Q
critical range
A
lab tests that reflects a life-threatening situation
16
Q
normal range for RBC in male
A
4.5 - 5.5
17
Q
normal range for RBC in females
A
4.0 - 5.0
18
Q
normal range for RBCs in newborns
A
3.9-5.9
19
Q
RBC critical range
A
no critical range
20
Q
Normal range for WBC in adults
A
4.5 - 11.0
21
Q
normal WBC range for newborns
A
9.0-30.0
22
Q
critical high WBC
A
more than 50.0
23
Q
PLT’s are necessary for maintaining ____ in the circulatory system
A
hemostasis
24
Q
PLT normal range
A
150-400
25
critical low PLT
less than 20
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critical high PLT
More than 1,000
27
Normal HCT range for males
42%-52%
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HCT normal range for females
36-46%
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Critically Low HCT
< 20%
30
Critically high HCT
more than 60%
31
ESR
One hour measurement of the rate that RBCs settle from the plasma, used to demonstrate presence of inflammation
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three phase of sedimentation
1.) aggregation phase
2.) sedimentation phase
3.) packing phase
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aggregation phase
RBCs are allowed to come together and from rouleaux
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sedimentation phase
aggregates fall out of solution
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Packing Phase
RBCs aggregate pack closely together at the bottom of the tube
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Rate of RBC settling in an ESR depends on:
increase levels of plasma proteins
protein composition of the plasma
decrease in zeta potential
size and shape of RBCs
RBC concentration
37
Macrocytes tend to settle____
faster
38
Microcytes tend to settle ______
Slowers
39
Poikilocytes are unable to form rouleaux and settle _______.
slower
40
A Higher RBC concentration results in a _________ ESR
Decreased
41
Causes of an elevated ESR
almost anything that causes inflammation (Infections, autoimmune diseases, pelvic inflammatory disease and pregnancy)
anemia, leukemias, Waldenstrom macroglobulinemia, multiple myeloma
42
ESR normal range for males
<50
>50
<50: 0-15 mm/hr
>50: 0-20 mm/hr
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ESR normal range for females
<50
>50
<50: 0-20 mm/hr
>50: 0-30 mm/hr
44
what can falsely increase an ESR?
(meaning a higher number like 100 mm/hr)
Room temp is too warm
tilted tube
agitation
45
Which two stains are commonly used for PBS and BM stains?
Wright and Wright Giemsa stains
46
What can falsely decrease an ESR?
(like a result of 3mm/hr)
Room temp too cold
excessive anticoagulant
clotted sample
old sample
47
A wright stain is also know as?
Polychrome stain
48
Methylene blue - basic
Stains acidic Cellular components Like RNA (blue)
49
RBCs stain
Pink to salmon
50
In hematology the condenser is
All the way up
51
A good area is
1.) Monolayer of RBC's
2.) Even distribution of RBC's
3.) less than half of the RBCs are overlapping
52
WBC estimation procedure
find the average number of WBCs in 10 fields
multiply by 2,000
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Normal RBC Morphology
Normocytic, normochromic
NC/NC
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100x Peripheral blood Smear is for
1.) RBC morphology
2.) PLT estimation
3.) Manual WBC differential
55
RBC Morphology procedure
Done at the 100x objective and just looking at the general appearance of the RBC
56
PLT Estimation procedure
*Cannot be done when platelets are clumped*
Find the average number of platelets seen in 10 fields
multiply by 15,000
57
Manual WBC Differential
Microscopically differentiate the WBCs and note using the 100x objective and note any abnormalities
58
hypersegmented nuclei can be caused by
B12 or folate
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WBC are involved in counteracting _______ & __________.
Foreign substances and disease
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Adult WBC Count
4.5-11.0
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WBC count >11.0 x10^ 3 is termed
Leukocytosis
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WBC count <4.5 x 10 ^ 3 is termed
leukopenia
63
Newborn WBC count
9.0-30
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Critical low WBC
<1.5
65
Critical High WBC
>50.0
66
Critically high WBC is indicative of
fatal infection
67
critically low WBC indicates
leukemia
68
Granulocytes
neutrophils, eosinophils, and basophils
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Agranulocytes
Lymphocytes and monocytes
70
The differential is used to determine
the different types of WBC present
if each cells type is present in normal proportions
if each cell type numbers are normal, increased or decreased
the presences of abnormal and/or immature WBCs
71
Variation in the number of leukocytes occur with
infections
inflammation
hematologic and neoplastic disease
age
giving birth
72
important numbers to consider in WBC diff
Total WBC count
relative differential (%) for all 5 cell types
Absolute count (#) for all 5 cell types
73
define Relative %
Measure the percentage of each type of WBC out of 100 cells reviewed on a peripheral blood smear
74
Formula for absolute #
Total WBC count x relative %of a cell counted
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Relative percentage of Neutrophils
40-80%
76
absolute count of neutrophils
1.8-7
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Increased relative neutrophilia is defined by what %
>80%
78
absolute neutrophilia is indicated by a #
> 7
79
<40% relative neutrophil is considered
relative neutropenia
80
<1.8 x10^3/ul neutrophil is considered
absolute neutropenia
81
relative % of neutrophils in newborns
50-60%
82
Other names for Neutrophil
Polymorphonuclear (PMN)
segmented neutrophil
83
Relative % of neutrophils in 4-6 months old
30%
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at what age does the WBC count gradually increase at
6 years old
85
neutrophil physical characteristics
neutral blue or pink cytoplasm
2-5 lobes connected by a thin filament
86
relative percentage for band neutrophil
0-5%
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absolute count for band neutrophil
0-0.7
88
An increased absolute count for bands is termed
Bandemia
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physical characteristics of bands are
neutral blue/pink cytoplasm
C, S or J shaped
no individual lobes
90
Relative percentage for a eosinophil
0-5%
91
absolute count for eosinophil is
0.0- 0.4
92
A decreased absolute count for an eosinophil is termed
eosinocytopenia
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an increased absolute count for an eosinophil is termed
Eosinophilia
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Eosinophil physical characteristics
pink cytoplasm
segmented nucleus
red to orange granules
95
relative percentage for a basophil
0-1
96
absolute count for a basophil
0.0-0.2
97
an increased absolute count for basophils is termed
basophilia
98
a decreased absolute count for basophils is termed
basocytopenia
99
basophils physical characteristics
light purple to colorless cytoplasm
segmented nucleus
abundant dark blue to purple granules
100
give the relative percentage for lymphocytes
25-35%
101
give the absolute count for lymphocytes
1.0-4.8
102
an increased absolute count for lymphocytes is termed
lymphocytosis
103
A decreased absolute count for lymphocytes is termed
Absolute lymphopenia
104
Lymphocytes physical characteristics
deep blue cytoplasm
small round or oval shaped nucleus
dense clumped purple chromatin in the nucleus
nucleus is roughly the size of a RBC
can have some small vacuoles
small granules are sometimes present
105
Reactive lymphocytes characteristics
increased size
decreased N:C ratio
nucleus can vary in shape
cytoplasm frequently show small granules
106
give the relative percentage of monocytes
2- 10
107
give the absolute count for monocytes
0.1- 0.8
108
an increased absolute count for monocytes is termed
monocytosis
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A decreased absolute count for monocytes is termed
monocytopenia
110
physical characteristics of monocytes
nucleus is much larger than RBCs
variable shaped nucleus
blue-gray cytoplasm
vacuolated
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Platelets
A tiny, disc shaped piece of cell that is found in the bone marrow and spleen
they help form blood clots to slow or stop bleeding and to help wounds heel
112
Platelets are pieces of very large cells in the bone marrow called
Megakaryocytes
113
PLT critical low
less than 20
114
PLT critical High
more than 1,000
115
Platelets physical characteristics
anucleate fragments of cytoplasm
116
PLT circulate in peripheral blood for
7-10 days
117
What are the two principles of cell counting currently used
1.) The coulter principle or impedance
2.) Optical light scatter
118
The coulter principle
cells are suspended in an electrically conductive fluid, cells are pulled through a small aperture by a vacuum
119
Describe how the the coulter principle works
Cells pass through the aperture and interrupt the electrical current because cells are poor conductors, this electrical resistance is measurable
120
the number of pulses is proportional to the __________
number of cells counted
121
Size of the pulse is proportional to the ___________
the size of the cell
122
Optical light scatter
As a single blood cell passes through a beam of light the light will scatter
123
Describe how the optical light scatter works
A single cell is struck by a focused laser beam, light scatter in all direction this light scatter patterns provides information about the cell structure, shape and complexity.
124
A WBC count is generated through _________
VCS technology
125
The V in VCS stands for
volume
126
the C in VCS stands for
Conductivity
127
the S in VCS stands for
light Scatter
128
Using VCS technology a WBC passes through an aperture and are hit by (3):
Electrical current
Radio waves
Laser beams
129
Electrical current (DC)
cell volume and cell number
130
Radio waves (AC)
conductivity and nucleus volume
131
laser beam
Light scatter or complexity
132
Routine hematology testing for EDTA
CBC, manual HCT, PBS, ESR, retic count, immunophenotyping by flow cytometry
133
Routine testing for light blue top tubes (sodium citrate)
Platelet function, protime, partial thromboplastin time, anti-factor Xa, Coagulation factor studies
134
Green top tubes routine hematology testing
Not appropriate for hematology testing
135
define conductivity
A high frequency alternating current in the radio frequency range, Measures the volume of the nucleus
136
what is the formula for correcting WBC count?`
(uncorrected WBC count) (100) / (# of nRBCs +100)
137
In what case would we correct WBC?
When nRBCs are seen in high numbers the WBC count may be falsely increased
138
Hematocrit is a calculated value from _____ and _____
MCV and RBC count
139
How is hemoglobin measured?
Hemoglobin is directly measured
140
What two methods are used to measure hemoglobin?
Cyanmethemoglobin
Sodium lauryl sulfate (SLS)
141
What is considered the gold standard for measuring hemoglobin
Cyanmethemoglobin
142
Explain how Cyanmethemoglobin measures hemoglobin
RBCs are lysed by diluting lytic reagent to release HGB
potassium ferricyanide is added: Potassium ferricyanide oxidizes all Fe2+ (ferrous) to Fe3+ (ferric) methemoglobin
*MORE INFO CAUSE I DON'T UNDERSTAND*
143
define MCV
A measurement of the average RBC size
Mean corpuscular volume
144
MCV formula
(HCT/RBC) X 10
145
MCV normal range
80-100 fL
146
A MCV value of <80 is termed
microcytosis
147
A MCV value of >100 fL is termed
Macrocytosis
148
Define MCH
A calculation showing the average weight of hemoglobin in each RBC
Mean corpuscular hemoglobin
149
MCH formula
(HGB/RBC) x 10
150
MCH normal range
28-34 pg
151
A MCH value of <27 is termed
hypochromic
152
Is there high values for MCH
No, because the RBC can only up to 40-45% of its volume
153
Define MCHC
compares the weight of the hemoglobin to the volume of the cell
mean corpuscular hemoglobin concentration
154
MCHC formula
(HGB/HCT) x 100
155
normal MCHC values, termed
32-36 g/dL, normochromic
156
hypochromic is represented by a value
<32 g/dL
157
MCHC of >37
check the sample integrity
158
RDW normal range
12.0-14.6%
159
RDW is a measurement of how _______ or ______ the RBC are in size
homogenous ; heterogeneous
160
Anisocytosis
Variation in size of RBCs
161
RDW-CV
measure the deviation of the width of the curve on the RBC histogram
162
erroneous causes of a high MCHC
RBC agglutination, hemolysis, lipemia
163
erroneous causes of low MCHC
old sample, extremely high WBC count
164
The Rules of 3
HGB x 3 = HCT +-3
RBC count x 3 = HGB +/-3
165
How is a PLT count derived automated
any particle between 2-20 fL is counted as a platelet and plotted into a histogram
166
Define MPV
Mean Platelet volume, similar to the MCV
167
MPV normal range
8-12 fL
168
Lipemic samples can falsely elevate
HGB measurement and associated indices
169
how to troubleshoot lipemic samples
Saline replacement and plasma blank
