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Hematosis - 2024 > Week 3 > Flashcards

Week 3 Flashcards

1
Q

what is an intrument limitation vs a specimen limitation

A

Instrument
-data suppression or parameter flagging

Specimen
-inherent specimen problems that can cause instrument issues

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2
Q

for Cold agglutinins what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected- low RBC, high MCV and MCHC with grainy appearance

Rationale: Agglutination of RBCs

Instrument indication -Right shift on RBC histogram

Corrective action -Warm specimen to 37°C and rerun

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3
Q

for Hemolysis what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected - low RBC and HCT

Rationale-RBCs lysed and not counted

Instrument indication - rule of three not followed

Corrective action- Recollect new EDTA specimen

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4
Q

for Lipemia or Icterus what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected- High HB and MCH

Rationale-Increased turbidity affects spectrophotometric reading for HB

Instrument indication - Rule of three not followed

Corrective action-Plasma replacement

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5
Q

for Lyse resistant RBCs with abnormal Hb what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected - high WBC and HB

Rationale-RBCs with HB S, C, or F may fail to lyse, will be counted as WBC

Instrument indication -Dense population in Debris (DB) area of Diffplot

Corrective action-Perform manual dilutions, allow incubation time for lysis

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6
Q

for Microcytes or schistocytes what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected - low RBC and High PLT

Rationale-Abnormal population or volume of RBCs at lower RBC threshold /or within PLT threshold

Instrument indication-Left shift on RBC histogram
MCV flagged if outside action limits
Abnormal PLT histogram may be flagged

Corrective action-Review PBS for confirmatory morphology

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7
Q

for NRBCs, Giant PLTs, or micromegakaryoblasts what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected - high WBC

Rationale-NRBCs, Giant PLTs, or micromegakaryoblasts counted as WBCs

Instrument indication -Dense population in Debris (DB) area of Diffplot

Corrective action-Newer instruments eliminate this error

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8
Q

for PLT clumps/aggregates what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected - low pLT and high WBC

Rationale-Large clumps counted as WBCs and not PLTs

Instrument indication -PLT aggregates flag
Dense population in Debris (DB) area of Diffplot

Corrective action-Recollect specimen in sodium citrate and multiple WBC and PLT counts by 1.1 to correct for dilution factor

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9
Q

for Hyperleukocytosis what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected - high HB and RBC , HCT incorrect

Rationale-Increased turbidity affects spectrophotometric reading for HB
WBCs counted with RBC count

Instrument indication -rule of three not followed , WBC count may be about instrument linearity

Corrective action
Manual HCT
Manual HB
Correct RBC count and recalculate indices, if above linearity, dilute for correct WBC count

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10
Q

for Old Specimen what are
Parameters affected
Rationale
Instrument indication
Corrective action

A

Parameters affected - MCV high , and PLT low . utomated DIFF may be incorrect

Rationale-RBCs swell as specimen ages and may hemolyze
PLT swell and degenerate
WBCs affected by prolonged exposure to EDTA (shrinkage and/or swelling

Instrument indication -Abnormal clustering on WBC histogram and Diffplot

Corrective action-Establish stability criteria (retention time) and specimen rejection criteria

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11
Q

what occurs in a TRUE increased RBC count
causes and corrective actions

A

causes: Polycythemia vera (overproduction marrow), low O2, dehydration, kidney disease, or performance enhancing drugs

-there will be increased pulses through the RBC aperture 30-300fL

-linearity will be up to 8.0 x 10^12 and instead of a number on the Act5 report youll have ++++

Corrective actions- dilution or do a manual HCT and Hgb, recalculate the indices and do a PBF

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12
Q

What occurs in a true decrease
causes and corrective action

A

Causes: its variable but mostly due to anemia or RC destruction

-system count lower pulses through RBC apeture

Corrective actions are to do a PBF review for morph

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13
Q

what can cause a falsely high RBC count

A

-high WBC- Leukocytosis
-NRBCS
-large platelets
-platelet clumping
-Cyroglobulins or cyrofibrinogen

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14
Q

what can cause a falsely decreased count

A

-clot - RBC are in the clot and cant be count - reject and recollect

-RBC fragments - too small or micro spherocytes <30fL so they could be counted as PLT causing a falsely high PLT level - do PBF

RBC Agglutination - bunch of RBC counted as one

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15
Q

what will you see if you have microspherocytes or schistocytes

A

RBC↓ PLT↑
Abnormal population or volume of RBCs at lower RBC threshold /or within PLT threshold
Left shift on RBC histogram
MCV flagged if outside action limits
Abnormal PLT histogram may be flagged
Review PBS for confirmatory morphology

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16
Q

what is extreme leukocytosis

A

known as hyper leukocytosis - true increase in WBC in leukimia
-turbid sample due to high count
-in HGB bath - this will cause increased scatter falsely increasing HGB - NOTE WBC are not lysed in 1st dilution bath
-so youll see high RBC and Hgb with invalid HCT

Corrective Actions:
manual HCT and HGB, redo RBC count and indices. If WBC is above linearity - aliquot is diluted and rerun

17
Q

what are the causes of a falsely increased WBC count

A
  • lyse resistant RBCs like sickles, NRBCs, PLT aggregates
    -abnormal HGb, NRBCs, PLT clumps or micro megakaryocytes
18
Q

what are the reasons for a falsely low WBC

A

Cell lysis because of
-Prolonged storage
-Smudge (damaged) cells
-Uremia osmotic cell damage
-Immunosuppression
-Fragile leukemic WBCs

Aggregates being counted as single cell- leuk cold agglutinins

True decrease due to disease

CA= manual PBF or morph and a diff

19
Q

what can cause falsely low plt counts and clumps - low PLT and high WBC

A

-improper mixing
-microclots
-excessive heparin
-giant PLTs
–micromegakaryoblasts
-underfilling EDTA
-slow or hard draw
-PLT satellitosis- clumping
-abnormal population on SL/SL1 or Debris area on Diffplot
-extension past 20fL

CA
-rerun on mixed EDTA
-new sample
-use Sodium citrate tube and multiply counts by 1.1

20
Q

What are cold agglutinins and what will we see in a sample that has them

A
  • clumping due to IgM antibodies, but will only agglutinate in cold temperatures
    -macroscopically the sample will grainy

-RBC count decreased
-MCV increased (>130fL)
-HCT decrease
MCHC increase (>400g/L) (HGB/HCT)
MCH also falsely increased (HGB/RBC)
RDW increased
Dual population on RBC Histogram or right shift on RBC histogram

21
Q

what are cryoglobulins

A
  • serum proteins that precipitate out at low temps 4C
    -can dissociate or resuspend at 37- body temp
  • can be associated with myeloma, carcinoma, and leukemia
    -affects the same parameters as cold agglutinins
    -the precipitated proteins can be so large that you might count them as WBC
    -the smear will have a CLOUD LIKE appearance from the stained precipitates

CA- prewarm sample or recollect and maintain sample at 37

22
Q

what will you see in a sample with hemolysis

A
  • rule of 3 not followed
    -red or pink plasma
    -low RBC and HCT because the hemolyzed RBC are not counted and MCHC is falsely increased
    -Hgb is VALID because the RBC are lysed to measure anyways
    -mostly procedural causes but can be hemolytic anemia or liver disease

CA- reject and recollect

23
Q

What is lipemia

A

-interfering substance
-plasma is white and cloudy because of high lipid content
-high turbidity that affects spec reading for HGB (also for icteric samples high HGB breakdown in RBC high bili)
-rule of 3 not followed
-high HGB, HCG MCHC

CA
-replace plasma with saline and rerun

24
Q

what effect does a clotted sample have, causes and CA

A
  • procedural - not mixing properly or hard draw
    -micro clots will have impacts on CBC, PLT WBC because theyll be caught in the clots and wont be counted properly
    -on a PBF youll see fibrous/stringy light purple substance (fibrin) in the tail and body of the smear

CA- reject and recollect

25
Q

What are NRBCs

A
  • occur when the BM is stimulated by EPO causing early release of RBC causing immature RBCs to be seen
    -increase in NRBCs cause false WBC increase
    -all nucleated cells on Act5 are counted as WBC
    -the NRBC will lyse in the baths but their small nuclei will remain and be counted causing left shift in curve on WBC/BASO histogram

CA-recalculated WBC

26
Q

how to correct for NRBC

A

-if 10 or more NRBC per 100 WBC are counted in a WBC diff then its significant and a correction must be made

Automated WBC count = 11.0 x 10^9/L
Manual DIFF- 10 NRBCs counted / 100 WBCs

100 x Automated total WBC count/L
100 + NRBCs /100 WBC

  100 x 11.0 x109/L         = 10.0 x 109/L
        110

Automated WBC count WAS 11.0 x 10^9/L
Automated WBC count NOW 10.0 x 10^9/L

100 x 11.0 x10^9/L /110 = = 10.0 x 10^9/L

When reporting comment
Comment- ‘Corrected’ adjacent to corrected WBC count
Comment- ‘WBC count was corrected for NRBC”
-Then used the corrected WBC and manual diff to calculate the absolute diff and report

Hematosis - 2024 (11 decks)

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