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Histotechnology > Week 3 > Flashcards

Week 3 Flashcards

1
Q

what do you do when there is a specimen delivered to the lab without a label

A

-dont process
-notify clinician
- record all interactions and next steps with full name
-specimen must be verified in person
-date and time the req
-notify supervisor
-fill out IR

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2
Q

what do you do when the specimen was delivered to the lab without a requisition

A

–dont process
-notify clinician
- record all interactions and next steps with full name
-specimen must be verified in person and bring req to the lab
-notify supervisor
-fill out IR with date and time of incident

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3
Q

What happens when the req doesnt complete patient information

A

-dont process if name, identifiers or source is missing
-notify clinician and specimen with req must be verified in person
- record all interactions and next steps with full name of person taking the message

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4
Q

what if specimen was delivered to the lab in wrong fixative or without fixative

A

-process specimen as per the tests ordered
-if unknown place tissue in refrigerator
-document incident on req with date and time
-file IR
-inform pathologist on case

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5
Q

How is heat damage caused

A

pre fixation issue

-by cauterization
- occurs on margin of the biopsy
-heat will cause the CT fibers to be coagulated due to heat
-causing acidophilia

post fixation it can be caused by prolonged exposure to heat during tissue processing , heated forceps
-during embedding - prolonged heat exposure to after microtomy (hot plate or hot dry over)

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6
Q

what will happen if there is presence of staples and sutures

A

-pre fixation issue

-not pathological
-blade can be damaged during microtomy
-should be removed when visible
-if one is in a block melt the block and re embed for microtomy

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7
Q

what will happen if there is Cellulose contamination

A

pre fixation issue

-plant material in the GI tract
-cellulose from paper, cotton, and cork
-not pathological
-can damage blade during microtomy

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8
Q

what will happen if there is starch contamination

A

pre fixation issue
-when starch from gloves gets transferred on issue during specimen collection

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9
Q

what will happen if there is catheter damage

A

pre fixation issue
-epithelial tissues will be damaged/compressed easily
-if the fixation is prompt the damage stays

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10
Q

what what will happen if there is tattoo pigment present

A

pre fixation issue
-does not react with stain but many obstruct pathological areas

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11
Q

what will happen if there is crush artifact

A

pre fixation issue
-damage to fresh tissue caused by forceps
-mostly on the edge resulting in small blue cell clusters - distorted cell nuclei with intense basophilia

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12
Q

what will happen if there are post mortem changes - autolysis and putrefaction

A

Autolysis - self destruction from enzyme action- Desquamation
Putrefaction - when bacteria acts on tissue especially GI tract

pre-fixation issue
quick in areas with enzymes - gall bladder, pancreas, intestines
Intermediate - liver, kidney , spleen
slow - bones, cartilage, skin.

however there is an impact to tissues surrounding the area- if intestines autolyze quickly so do the structures around it

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13
Q

what will happen if there are specimen marking dyes

A

pre-fixation issue
-dyes are used to mark margins for orientation or cancer monitoring
-can use silver nitrate, india ink, and ink markers
-while it marks the surface it can penetrate

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14
Q

what will happen if there are biopsy pad or sponge artifact

A

pre-fixation issue
-used so small biopsies dont fall out of the cassette
-fixed tissue is placed in between two dry sponges
-can leave a sponge imprint when you try to remove the tissue for embedding seen by flattened nuclei but you can prevent this by pre soaking sponge pads in fixative or using lens paper

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15
Q

what will happen if there is freezing damage

A

pre-fixation issue
-cause frozen-thawed-fixed artifact when ice forms under tissue
-distorts nuclear and cytoplasmic components
-common after frozen sections cut

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16
Q

how to prevent specimen to specimen contamination

A

pre-fixation issue
-place left and right specimen into specific containers
-dont accession sample tissue types one after the other
-use clean scalpel blades, dissection board and other tools between specimen

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17
Q

what are some fixation artifacts

A
  • Formalin pigment
  • Mercuric pigment
  • Streaming artifact
  • Zonal fixation
18
Q

how is formalin pigment formed

A

fixation artifacts

-caused by non buffered formalin
-pigment can be removed using picric acid or NH4OH

19
Q

how is mercuric pigment formed

A

fixation artifacts

-by using mercury based pigment
-can remove with alcoholic iodine, then sodium thiosulphate

20
Q

how is steaming artifact formed

A

fixation artifacts

-caused by precipitation and glycogen displacement due to fixation
-found in formalin fixed liver

21
Q

how is zonal fixation formed

A

-when large specimen with capsules are fixed with slow penetrating fixative
-variable fixation rate

22
Q

what types of issues can occur in tissue processing

A
  • Precipitate in the chamber and in the tubing
  • Poor processing
  • Under-processed
  • Over-dehydration
  • Accidental desiccation
23
Q

what causes Precipitate in the processor chamber and in the tubing

A

tissue processing issues

-caused by using phosphate buffered formalin as a fixative and starting dehydration at >70% alcohol

-caused when zinc-buffered formalin pH >7.0 - the pH must be below 7

–if the precipitate is in the tubing then rinse the chamber and tubing with 5-10 acetic acid

24
Q

what are the causes and prevention techniques for poor processing

A

tissue processing issues

Causes:
-under fixation
-water remains in tissue (incomplete dehydration) leading to poor clearing and infiltration
-improper QC of tissue processor
-paraffin is contaminated by clearing agent
-too much heat during processing

Prevention
-proper fixation
-make sure the absolute alcohol hasnt absorbed water or become diluted
-use heat only for infiltration
-ensure PM is performed

25
Q

what are the causes for Under-processed – tissue mushy, soft and shrunken

A

Incomplete hydration, clearing or infiltration
-not in fixative long enough
-faulty reagents

Evaporation of solvent that was not displaced by wax
-retraction when the tissue shrinks back into the embedded block

Troubleshoot
-re-process tissue

26
Q

what are the causes for Over-dehydration – tissue dry and brittle

A

long time in dehydrating solutions
-causes micro chatter, parched earth , cracking and cell shrinkage

Prevention
-seperate small tissues from larger ones
-mindful of dehydration time
-decrease time in dehydration solution

27
Q

what are the causes for Tissue accidentally desiccated

A

-caused by open processor - not used anymore in labs

-tissue can be rehydrated in water, alcohol and sodium carbonate overnight and then processed

28
Q

what is floating- causes and prevention

A

Embedding fault

caused by:
-if tissue isnt pressed down during embedding
-need uniform surface along the base

prevention
-press down
-dont let the wax solidify at different rates

29
Q

what happens when the mold is large or small

A

large- wax compression
small - tissue compression

prevent- get the proper mold size

30
Q

what is stratification-causes and prevention

A

cause
uneven wax cooling
block can fall apart and cause tissue damage due to loss of support

prevention
-re embed
-fill wax properly and quickly

31
Q

what will happen if Block removed from mold before it solidified

A

cassette will not be filled properly

-re embed and make sure block is completely cooled before you move it

32
Q

what will happen if block is Underfilled -Poor support for the block

A

-it could detach from cassette and you could lose pt ID

cause- not enough wax

prevention - re embed and fill with appropriate amount of wax

33
Q

how can transcription errors occur

A

-if the cassette number doesnt match the worklist

caused by
rushing
not double checking

prevention
double check
investigate
file IT

34
Q

why will cracking happen on a block and how to prevent

A

cause:
-cold plate too cold
-wax on specimen has solidified before it could be positioned
-tissue was moved after the wax was solidifying

prevention
-check the temperature of the cold plate
-only re embed if microtomy is hard

35
Q

what causes a bubble underneath the cassette - how can it be prevented

A

cause
-when air is trapped during embedding

prevention
-re-embed
-decrease rate of paraffin flow
-fill on an angle and then decrease the angle to displace the air before placing on cold plate

36
Q

what will be caused by poor or incorrect orientation

A

-place tissue diagonally not parallel to mold edges
-place tissue in center
-tissues with walls (gall bladder, GIT) are embedded on edge
-tubular structures are embedded on end
-tissues with collegenous capsule must be embedded so the blade hits hard parts last - if its but first the tear can go through the sample
-multiple pieces should be placed in a diagonal line with each piece on a angle, if parallel they can cause tissue compression

37
Q

if your orientation is incorrect from the gross what will it cause and how can you prevent it

A

cause
-wrong side was inked

prevention
-embed correct side
-complete checklist properly
-open GI tract layers before grossing to avoid rolling because that makes it hard to see layers

38
Q

how is soft mushy tissue caused and how do you prevent it

A

cause
tissue grossed too thick
tissue was under processed

CA
reprocess
gross the tissue thinly

39
Q

what causes tissue carryover and how to prevent

A

cause
fragmented tissues that contaminate the next sample
-forceps metastasis

CA
-clean your forceps between cassettes
-one cassette at a time

40
Q

what causes pieces/tissues to be missing from the cassette and how to prevent

A

Cause
-lost during processing
-small pieces were not put in filter paper and were missed

CA
-note the number of pieces during grossing
-check back of cassette before discarding
- check bottom of tissue processor
-open filter paper or biopsy bags slowly
-notify supervisor and file IR if anything is out of place
-if you cannot find the tissue embed the empty cassette and notify the pathologist

Histotechnology (13 decks)

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