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Hematology > 3. Peripheral Blood Smear > Flashcards

3. Peripheral Blood Smear Flashcards

1
Q

The patient demonstrates platelet clumping in his blood (lavender top). When CBC was run, the results showed that his PLT count is low (90,000/mm3) and his WBC count is high (15,000/mm3). The phlebotomist recollected his blood using 3.2% Sodium citrate tube and another CBC was run. New results are 115,000/mm3 and 11,000/mm3, respectively. What set of values should finally appear on this patient’s chart?

A

Plt Ct: 126,500/mm3
WBC ct: 12,100/mm3

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2
Q

Sources of specimens for Peripheral blood smear

A

EDTA blood
Anticoagulant-free blood

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3
Q

Blood smears using EDTA spx should be made within ___ after collection

A

2 hours

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4
Q

Advantages of EDTA blood smear (3)

A

Multiple blood smears
Blood smears may be prepared later
Prevents plt clumping

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5
Q

Disadvantages of EDTA blood smear

A

Platelet satellitosis
EDTA-induced platelet clumping

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6
Q

Platelet satellitosis aka

A

Platelet satellitism
Platelet rosette

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7
Q

What CBC parameter is affected by platelet satellitosis

A

PLT Ct: pseudothrombocytopenia

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8
Q

Why is there pseudothrombocytopenia in platelet satellitism

A

When platelets adhere to WBCs’ surface - they are also counted as WBC

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9
Q

In platelet rosette, platelets usually adhere in what type of WBC

A

Neutrophils

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10
Q

How to correct platelet satellitosis and edta-induced platelet clumping

A

recollect using 3.2% sodium citrate; multiply the affected parameters by 1.1

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11
Q

Correction factor when using 3.2% sodium citrate is

A

1.1

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12
Q

Why is there a need for a correction factor when recollecting a specimen using 3.2% sodium citrate

A

There is a need to compensate for the dilution by Na citrate; since there is too much AC

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13
Q

In EDTA-induced platelet clumping, platelets form large clumps and are counted as

A

WBCs

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14
Q

In EDTA-induced platelet clumping, platelets form large clumps and are counted as WBCs, therefore the affected CBC parameters are

A

PLT count: pseudothrombocytopenia
WBC count: pseudoleukocytosis

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15
Q

T/F
There is a need to correct all the CBC parameters using the correction factor after recollecting using the light blue top with 3.2% Na citrate

A

False

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16
Q

Anticoagulant-free blood is rarely used in the hematology section because of (2) disadvantages

A

Platelet clumping
Few films can be made

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17
Q

(2) advantages of using anticoagulant-free blood for PBS

A

made at the patient’s side
some artifacts may be prevented

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18
Q

(3) Methods of blood film preparation

A

Two-glass slide method
Coverslip technique
Automated methods

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19
Q

Two-glass slide method is also known as

A

Manual Wedge Technique

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20
Q

The most frequently used method in the preparation of blood smear

A

Manual Wedge Technique/Two-glass slide method

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21
Q

How many slides are used in manual wedge method?

A

2: pusher slide and film slide

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22
Q

Pusher slide is also known as

A

spreader

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23
Q

The angle between the pusher slide/spreader and the film slide should be

A

30-45 degrees

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24
Q

If the angle of the spreader is too high, the smear is expected to be

A

thicker

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25
Q

If the angle of the spreader is too low, it is expected that the smear is

A

thinner

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26
Q

The distance between the labeled end and the drop of blood should be

A

1 cm

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27
Q

The size of blood on the blood smear should be

A

2-3 mm

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28
Q

If the size of blood in the blood smear is too large, the smear is

A

thicker and longer

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29
Q

If the size of the drop of blood on the smear is too small, the smear is

A

thinner and shorter

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30
Q

When the speed of the spreader is too fast, the blood smear is

A

thicker

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31
Q

When the speed of the spreader is too slow, the smear is thinner with

A

poor WBC distribution

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32
Q

What makes a blood smear thicker?

A

too large size of the drop of blood
too fast spreader
too high angle of spreader

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33
Q

What makes a blood smear thinner

A

too small size of the drop of blood
too slow spreader
too low angle of spreader

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34
Q

In Polycythemia vera, the hematocrit is

A

too high

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35
Q

If the HCT is too high, the angle of the spreader and the film slide should be as low as

A

25 degrees

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36
Q

If the HCT is too low i.e. anemia, the angle of the slides should be

A

raised

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37
Q

Scanning method for examining PBS

A

Longitudinal
Battlement

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38
Q

Longitudinal pattern

A

Tail to head

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39
Q

Battlement pattern

A

back-and-forth serpentine

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40
Q

scanning method utilized for manual wedge technique

A

longitudinal

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41
Q

ideal blood smear length

A

2/3 to 3/4 the length of the film slide

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42
Q

Problem encountered in wedge method

A

uneven distribution of wbcs in the slide

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43
Q

when utilizing the wedge method, the feathered edge and side edges contain more

A

monocytes, eosinophils, neutrophils

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44
Q

When utilizing the wedge method, the center part of the film contains more

A

small lymphocytes

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45
Q

(2) types of coverslip technique

A

glass slide-coverslip method
two-coverslip method

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46
Q

glass slide-coverslip method is also known as

A

beacom’s method

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47
Q

two-coverslip method is also known as

A

ehrlich’s method

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48
Q

Beacom’s method and Ehrlich’s method are rarely used. They are sometimes used for

A

bone marrow aspirate smear preparation

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49
Q

There is only one advantage when employing the beacom’s method and ehrlich’s method

A

excellent wbc distribution

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50
Q

4 machines in automated method of blood smear preparation

A

Miniprep
Centrifugal (spinner) type
Coulter LH
Sysmex LP-10

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51
Q

This is a semi-automatic, portable instrument that simulates the manual wedge technique of blood smear preparation.

A

Miniprep

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52
Q

Miniprep simulates what type of staining method

A

manual wedge technique

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53
Q

This type of machine uses approximately 0.2 mL of well-mixed anticoagulated blood

A

Centrifugal (spinner) type

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54
Q

Centrifugal (spinner) type makes use of ______ of well-mixed anticoagulated blood

A

0.2 mL

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55
Q

What type of automated machine for blood smear preparation is helpful for medical technologists working on field

A

Miniprep

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56
Q

What type of automated machine for blood smear preparation is useful for conditions like CLL

A

Centrifugal (spinner) type

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57
Q

In centrifugal (spinner) type, there is a monolayer of evenly distributed cells; and fewer ______ in patients with chronic lymphocytic leukemia

A

smudge cells

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58
Q

These cells are nuclear remnants of lymphocytes

A

smudge cells

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59
Q

smudge cells are often mistaken as

A

debris

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60
Q

These machines are considered as both slide makers and slide stainers

A

Coulter LH
Sysmex SP-10

61
Q

Sysmex SP-10 and Coulter LH are both

A

slide makers
slide stainers

62
Q

Purpose of blood smear staining

A

for evaluation of cellular morphology

63
Q

fixative used in blood smear staining

A

methanol

64
Q

stain used in blood smear

A

wright or wright-giemsa

65
Q

a chemical that maintains the pH within a particular range

A

buffer

66
Q

buffer used in blood smear preparation

A

0.05 M sodium phosphate

67
Q

alternative buffer if there is no 0.05 M sodium phosphate

A

aged distilled water placed in a glass water bottle for at least 24 hours, with pH 6.4-6.8

68
Q

pH of 0.05 M sodium phosphate

A

6.4

69
Q

the correct pH for blood smear preparation

A

6.4-6.8

70
Q

Defined as any stain which contains methylene blue (and/or its products of oxidation) and a halogenated fluorescein dye (commonly eosin b or eosin y)

A

romanowsky-type stain

71
Q

methylene blue is a basic dye and colors the ____ blue or purple

A

nucleus and some cytoplasmic structures

72
Q

eosin stains acidophilic cytoplasmic structures an _____ color

A

orange-red

73
Q

the most commonly used type of stain in the hematology laboratory

A

romanowsky-type stain

74
Q

Wright stain, wright-giemsa, and May-Grunwald are examples of what type of stain

A

romanowsky

75
Q

(3) techniques of staining

A

manual
automated
quick

76
Q

Manual staining takes _____ mins

A

1-3 minutes

77
Q

Automated staining takes _____ to stain a batch of slides

A

5-10 minutes

78
Q

4 machines employed for automated staining

A

Midas III
Hema-tek
Coulter LH
Sysmex SP-10

79
Q

Quick staining takes _____ minute/s

A

1 min

80
Q

Quick staining uses _____ filtered into a staining dish/coplin jar

A

modified wright or wright-giemsa stain

81
Q

What type of buffer is used in quick staining

A

aged distilled water

82
Q

ideal macroscopic characteristic of a blood smear

A

color: pink to purple

83
Q

Color of RBCs

A

orange to salmon-pink

84
Q

color of wbc nuclei

A

purple to blue

85
Q

color of neutrophil cytoplasm

A

pink to tan (with violet to blue granules)

86
Q

color of eosinophil granules

A

bright orange

87
Q

the most common cause of wbcs appearing dark and the rbcs & eosinophil granules appearing gray

A

stain/buffer is too basic

88
Q

T/F
Inadequate rinsing leads to wbcs appearing too pale.

A

False

89
Q

T/F
Heparin is an ideal anticoagulant in the hematology lab since it does not cause any problems during the staining process.

A

False

90
Q

Heparinized blood causes the eosinophil granules to appear

A

gray

91
Q

The possible reasons for rbcs appearing too pale or red and barely visible wbcs include:

A

too acidic stain/buffer
underbuffering
over-rinsing

92
Q

Probable reason for a blood smear appearing bluer than normal

A

patient has increased blood proteins

93
Q

Old name of plasma cell myeloma

A

multiple myeloma

94
Q

Multiple myeloma is a condition where a patient excretes bence jones proteins in the urine. In this condition, the PBS of the patient is expected to appear

A

bluer than normal

95
Q

A grainy blood smear is probably due to

A

RBC agglutination

96
Q

Cold hemagglutinin diseases can cause the blood film to appear

A

grainy

97
Q

A patient with increased lipid levels will probably have a blood film that has

A

holes all over the film

98
Q

Blue specks at the feathered edge of the blood film indicates that the patient has

A

increased WBC count
increased PLT count

99
Q

10x objective is used to (6)

A

assess overall film quality, color, distribution of cells
locate rare abnormal cells
detect snowplow effect
detect fibrin strands
recognize rouleaux formation
detect parasites

100
Q

This refers to the presence of >4x the number of WBCs per field at the feathered edge compared with the monolayer area.

A

Snowplow effect

101
Q

If fibrin strands are present, the specimen should be rejected since it indicates that

A

the specimen has already clotted

102
Q

What area of the blood film should be examined microscopically

A

the are between the thick part and the feathered edge

103
Q

There is a need to avoid the feathered edge of the smear when examining since the

A

RBCs appear macrocytic
WBCs appear distorted

104
Q

There is a need to avoid the thick part of the blood film since the

A

RBCs appear microcytic
RBCs seem to form rouleaux

105
Q

Signs that the area being examined in the blood film is the correct one

A

RBCs have central pallor, near each other, never overlapping
cells are appropriately stained

106
Q

This magnification is employed to estimate the total WBC count

A

40x High-Dry/50x OIO

107
Q

WBC count estimate formula (40x High-Dry)

A

average # of wbcs (10 fields) x 2000

108
Q

WBC count estimate formula (50x OIO)

A

average # of wbcs counted (10 fields) x 3000

109
Q

Calculate the estimated wbc count if the average number of white blood cells counted is 5 (40x High-Dry)

A

10,000/uL

110
Q

Calculate the estimated wbc count if the average number of white blood cells counted is 5 (50x OIO)

A

15,000/uL

111
Q

40x High-Dry/50x OIO is used to get the

A

estimated total wbc count

112
Q

range of RBCs per 100x OIF in a normal person

A

200-250 RBCS per 100x OIF

113
Q

100x OIO is used to

A

examine the nuclear details of WBCs
tabulate the actual WBC differential count
platelet count estimate

114
Q

Formula for platelet estimate (normal)

A

average # of platelets/OIF (10 Fields) x 20,000 = estimated plt ct/uL

115
Q

Formula for platelet estimate (anemia, erythrocytosis)

A

average # plts per field x total RBC count
________________________________
200 RBCs per field

116
Q

The average number of RBCs per OIF in the optimal assessment area

A

200

117
Q

Parasites that may appear in the blood film

A

Malaria
Filaria
Trypanosomes

118
Q

Species that can cause malaria in humans

A

P falciparum
P vivax
P ovale
P malariae
P knowlesi

119
Q

Most pathologic plasmodium spp

A

Plasmodium falciparum

120
Q

most prevalent plasmodium spp

A

plasmodium vivax

121
Q

people with ______ seem to be resistant to plasmodium falciparum infections

A

sickle cell trait

122
Q

sickle cell trait persons are resistant to

A

plasmodium falciparum infections

123
Q

Malarial parasites metabolize this protein to make a malaria pigment.

A

hemoglobin

124
Q

Malarial parasites metabolize hemoglobin to produce this malarial pigment

A

hemozoin

125
Q

How many blood films should be made to check for malarial parasites ASAP after blood collection

A

2 thick films
2 thin films

126
Q

T/F
Blood films can also be directly made from capillary puncture

A

True

127
Q

For the visualization of malarial parasites, this type of stain is used

A

Wright-Giemsa stain

128
Q

This type of blood film is ideal for the initial screening of blood

A

thick film

129
Q

Thick blood film is used to view more parasites. It is stained with water-based Wright-Giemsa stain to

A

lyse the red cells

130
Q

The water-based Wright-Giemsa stain done in thick blood films for malarial parasite is done without

A

methanol fixation

131
Q

Thin blood films are used for

A

parasite identification
determination of percent of parasitemia

132
Q

Thin blood films are stained after

A

methanol fixation

133
Q

Degree of parasitemia is determined by counting the number of parasitized RBCs (asexual stages) among — RBCs on a thin blood film and converting it to a percentage

A

500-2000

134
Q

Before a negative malaria result is released, how many fields of thick and thin films should be examined

A

at least 300 (100x OIO)

135
Q

Microscopy can detect _____ per microliter of blood

A

5-20 parasites

136
Q

Microscopy can detect 5 to 20 parasites per uL of blood or

A

0.0001% parasitemia

137
Q

T/F
A negative result for a single set of thick and thin PBS rules out a diagnosis of malaria

A

False

138
Q

This may be confused with a malarial parasite by an inexperienced observer

A

platelet lying on top of an RBC

139
Q

How to prepare thick blood film

A

3 drops of blood close together
stir for 30 seconds using a clean slide to mix
the drop should be 1-2 cm
Dry
Stain with water-based wright-giemsa

140
Q

Filaria spp

A

Wuchereria bancrofti
Brugia malayi
Loa loa

141
Q

Species that can cause elephantiasis

A

Brugia malayi
Wuchereria bancrofti

142
Q

Loa loa can cause

A

calabar swelling

143
Q

Trypanosomal spp that infect humans

A

Trypanosoma brucei rhodesiense
Trypanosoma brucei gambiense
Trypanosoma cruzi

144
Q

African sleeping sickness vector

A

Tsetse fly

145
Q

East African Sleeping Sickness

A

Trypanosoma brucei rhodesiense

146
Q

Trypanosoma brucei gambiense is also known as

A

West African Sleeping sickness

147
Q

Trypanosoma cruzi can cause

A

Chagas disease

148
Q

The feces of this triatomine bug can cause chagas disease

A

Reduviid bug

149
Q

Blood smear slides can be stored for at least _____ before disposal

A

7 days

Hematology (7 decks)

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