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Hematology > 6. Reticulocytes > Flashcards

6. Reticulocytes Flashcards

1
Q

These are blue-stained, granulomatous materials that are made of residual RNA present in immature non-nucleated RBCs

A

Reticulum

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2
Q

Immature non-nucleated RBCs which contain >2 reticulum after staining with supravital stain

A

Reticulocytes

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3
Q

Last stage in RBC development that still produces hemoglobin

A

Reticulocyte

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4
Q

If Wright stain is used to stain reticulocytes, no reticulum are seen and therefore reticulocytes are called (2)

A

diffusely basophilic erythrocyte
polychromatophilic erythrocyte

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5
Q

Normal maturation time for reticulocytes in blood

A

1 day

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6
Q

usual number of reticulocytes produced per day

A

50 x 10^9/L per day

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7
Q

This is a measure of effective erythropoiesis because it permits effective assessment of RBC production by the bone marrow

A

Reticulocyte count

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8
Q

Normal reference range for Reticulocyte count in adults

A

0.5-1.5%

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9
Q

Normal reference range for Reticulocyte count in newborns

A

1.5-5.8%

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10
Q

The reference age for reticulocyte count in newborns (1-2 weeks of age) are

A

the same as adults

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11
Q

Terms for increased reticulocyte count

A

reticulocytosis
polychromasia
polychromatophilia

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12
Q

This is considered as the first sign of accelerated erythropoiesis

A

Reticulocytosis/Polychromasia/Polychromatophilia

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13
Q

Accelerated RBC production results to polychromasia and is observed in (5)

A

hemolytic anemia
IDA receiving Fe therapy
sideroblastic anemia
thalassemia
chronic and acute blood loss

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14
Q

A term for decreased reticulocyte count

A

Reticulocytopenia

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15
Q

This is observed in aplastic anemia and in conditions in which the bone marrow is not producing RBCs

A

reticulocytopenia

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16
Q

T/F

New Methylene blue is chemically different from Methylene blue.

A

True

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17
Q

Supravital stains used in staining reticulocytes

A

New Methylene Blue
Brilliant Cresyl Blue

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18
Q

2 components of New methylene blue and functions

A

sodium oxalate: prevents coagulation
sodium chloride: provides isotonicity

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19
Q

components of BCB and functions

A

sodium citrate: anticoagulant
sodium chloride: provides isotonicity

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20
Q

The supravital stain that is more preferred in staining reticulocytes

A

new methylene blue

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21
Q

T/F

Medical technologists can still count reticulocytes even without using Miller disk

A

True

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22
Q

What anticoagulant is used in the collecting tube for reticulocyte count spx

A

EDTA

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23
Q

A calibrated disk placed in the ocular of the microscope

A

Miller disk

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24
Q

Large square/Square A is used for

A

counting reticulocytes

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25
Q

Small square/Square B is used for

A

counting RBCs

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26
Q

Square B’s size is _____ of Square A

A

1/9

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27
Q

Minimum number of RBCs that should be counted in Small square (B)

A

112

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28
Q

Square B’s size is 1/9th of Square A and the minimum number of RBCs that should be counted in SB is 112. Therefore, 112 is multiplied by

A

9

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29
Q

112 multiplied by 9 is

A

1008

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30
Q

Methods of counting reticulocytes (3)

A

Routine light microscope method
calibrated miller disk method
flow cytometry

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31
Q

Procedure of routine light microscope method in reticulocyte counting

A
  1. Equal parts blood + supravital stain (2-3 drops/50 uL) in a tube.
  2. Incubate for 3-10 mins at room temp
  3. Remix
  4. Prepare 2 blood smears
  5. Have another MT check the other smear.
  6. Count 1000 RBCs in the field where RBCs are near each other without overlapping. Also count reticulocytes as RBCs (included in the 1000).
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32
Q

In routine light microscope method for reticulocyte count, 2 blood smears are prepared and examined by 2 MTs. The Retic counts should agree within

A

20%

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33
Q

Formula for routine light microscope method for reticulocyte count

A

RC = (# of retics counted/1000) x 100

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34
Q

Formula for routine light microscope method for reticulocyte count

A

RC = (retics counted/1000) x 100

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35
Q

RC formula for calibrated miller disk method

A

RC= (total retics SA / total RBCs in SB x 9) x 100

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36
Q

Most rapid, accurate, and precise method for reticulocyte count

A

flow cytometry

37
Q

In flow cytometry, reticulocytes are counted on the basis of _______ after treatment with fluorescent dyes or nucleic acid stains

A

optical scatter or flourescence

38
Q

In flow cytometry, the test values are reported in

A

absolute and relative terms

39
Q

Example of a machine that uses flow cytometry to count reticulocytes

A

Sysmex-3500

40
Q

Sysmex-3500 uses what supravital fluorescent dye

A

auramine O

41
Q

In flow cytometry, reticulocytes fall into — regions

A

low-, middle-, high-fluorescence

42
Q

In optical scatter, less mature reticulocytes fall into

A

high-fluorescence regions

43
Q

IRF means

A

Immature reticulocyte fraction

44
Q

the sum of the middle-fluorescence and high-fluorescence ratios

A

IRF

45
Q

T/F

IRF is the most sensitive index of bone marrow erythropoietic activity. However, it does not demonstrate an early indication of erythropoiesis.

A

F

46
Q

IRC is used together with ____ to distinguish types of anemias

A

absolute reticulocyte count

47
Q

IRF indicates the ratio of immature reticulocytes to —- in a blood sample

A

total reticulocytes

48
Q

BCB also stains reticulocytes. State the disadvantage of BCB in staining retics

A

Shows too much unpredictability in staining for routine use

49
Q

If a px is very anemic or polycythemic, the proportion of dye to blood should be adjusted. How?

A

anemic/low Hct: larger portion of blood to dye
polycythemic/high Hct: smaller amount of blood to dye

50
Q

T/F

The time allowed for staining of the reticulocyte is critical. It should not be more than 10 minutes.

A

First statement is false. Second statement is true.

51
Q

2 factors that can cause the reticulocytes to appear pale

A

use of heparin as anticoagulant
increased blood glucose

52
Q

2 factors that can cause the reticulocytes to appear pale

A

use of heparin as anticoagulant
increased blood glucose

53
Q

The blood and the stain should be mixed well prior to smearing. Why?

A

reticulocytes have lower SG compared to RBCs, therefore they settle on top of RBCs in the mixture

54
Q

Color of Howell-Jolly bodies when using NMB

A

deep purple

55
Q

color of heinz bodies when using NMB

A

light blue green

56
Q

color of pappenheimer bodies when using NMB

A

purple

57
Q

color of hemoglobin H bodies when using NMB

A

greenish-blue

58
Q

Other RBC inclusions stained by NMB (4)

A

howell-jolly bodies
heinz bodies
pappenheimer bodies
hemoglobin h bodies

59
Q

This RBC inclusion still has nuclear fragments (DNA) present

A

howell-jolly bodies

60
Q

rbc inclusion that is usually present at the peripheral edge of the red cell, and contains denatured and precipitated hemoglobin

A

heinz bodies

61
Q

Generally appear as several granules in a small cluster. Hemosiderin in mitochondria.

A

Pappenheimer bodies

62
Q

Stains used to confirm the presence of pappenheimer bodies

A

wright stain
prussian blue

63
Q

multiple dots in rbc

A

hemoglobin h

64
Q

hemoglobin h is seen in what condition

A

alpha thalassemia

65
Q

3 methods of reporting reticulocyte count

A

absolute reticulocyte count
corrected reticulocyte count
reticulocyte production index

66
Q

This is the actual number of reticulocytes in 1 liter of whole blood

A

ARC

67
Q

ARC formula

A

ARC= [retic (%) x rbc count (x10^12) / 100] x 1000

68
Q

Reference range for ARC

A

25-75x10^9/L

69
Q

ARC and IRF of px with hemolytic anemia

A

both increased

70
Q

ARC and IRF of px with hemorrhage

A

both increased

71
Q

ARC and IRF of px with chronic renal disease

A

both decreased

72
Q

ARC and IRF of px with chronic renal disease are both decreased. why?

A

damaged kidneys cannot produce EPO to stimulate erythropoiesis in the BM

73
Q

ARC of px’s early response to tx in nutritional anemias. why?

A

normal to low;
ARC is not a sensitive index

74
Q

IRF of px’s early response to tx in nutritional anemias

A

increased

75
Q

3 other terms for CRC

A

Reticulocyte Index
Hematocrit Correction
Poor Man’s Bone Marrow Aspirate

76
Q

There is a need for CRC since the percentage of retics may falsely increase due to (2)

A

early release of reticulocytes into the bloodstream
the number of mature rbcs in the circulation is decreased

77
Q

The CRC corrects the observed retic count to a normal Hct of _____ to allow correction for the degree of the px’s anemia

A

0.45 L/L

78
Q

the average normal Hct for both male and female

A

0.45 L/L or 45%

79
Q

CRC formula

A

CRC= Retic (%) x (px Hct / 0.45 L/L)

80
Q

Reticulocyte production index is also known as

A

shift correction

81
Q

Provides a further refinement of the CRC

A

RPI

82
Q

A general indicator of the rate of rbc production increase above normal in anemias

A

shift correction

83
Q

RPI formula

A

RPI= CRC/maturation time in peripheral blood

84
Q

maturation time for px with Hct of 40-45%

A

1.0 day

85
Q

Hct (%); Maturation time (days)
40-45 ; 1.0
35-39; —–
——–; 2.0
15-24: —–
——-; 3.0

A

1.5
25-34
2.5
<15

86
Q

If RPI is >3,

A

adequate BM response

87
Q

If RPI <2,

A

inadequate BM response

88
Q

Case:

29/M px
Hct: 28%
RC: 5.0%

Calculate CRC and RPI

A

CRC: 3.11%
RPI: 1.6 –> inadequate BM response

Hematology (7 decks)

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