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4.)AMT Heme/Coag Quick > AMT Heme Quick > Flashcards

AMT Heme Quick Flashcards

1
Q

Vit K dependent Prothrombin group factors

A

2,7,9,10

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2
Q

Fibrinogen group, thrombin acts on, used up/not in serum

A

1,5,8,13

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3
Q

Intrinsic, factors…

In..it also measures factors..

drug it monitors…
reagents…
NV…

phospholipoprotein inhibitor that prolongs aPTT,not corrected by mixing study…

A

8,9,11,12

In aPTT it also measures 1,2,5,10

heparin
phospholipid+ Ca chloride
30-36sec

lupus like anticoagulant

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4
Q

Common factors…
measured in both…and….

A

1,2,5,10
aPTT,PT

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5
Q

Factors in Contact grp, alternate activation of intrinsic

A

HMWK,PK
11,12

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6
Q

extrinsic factors…

In…also measures factors..
drug names it monitors…
reagent…
NV….
Uses…

A

PT

TF/3, 7

1,2,5,10
warfarin/coumadin
thromboplastin
10-13sec
Uses INR/ISI 2.0-3.5

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7
Q

Prothrombinase complex is in common pathway and acts on prothrombin

consist of these two factors and these two cofactors…

A

5a, 10a
calcium+phospholipid

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8
Q

Protein C degrades…and…
Protein…is cofactor that accelates inhibition

A

C degrades 5,8
S is cofactor

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9
Q

Primary inhibitor of fibrinolytic system..
Principal inhibitor of thrombin/10…

A

fibrinolytic: alpha2 antiplasmin

plasmin is main fibrinolysis agent
-breaks down to x,y,d,e

Inhibitor of thrombin/10: anthrombin 3

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10
Q

Streptokinase
Urokinase
TPA all

A

are clot busters

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11
Q

Labile coag factors…

Severe liver disease coag factors..

A

5,8

1,5
Fibrinogen is made in liver

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12
Q

Names:
1
2
3
4
5
7
8
9
10
11
12
13

A

1 fibrinogen
2 prothrombin
3 Tissue thromboplastin
4 calicium
5 labile
7 stabile
8 AHF A
9 AHF B, christmas factor
10 stuart prower
11 AHF C
12 Hageman
13 fibrin stabilizing

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13
Q

7…
9…two names
10…
12…

A

7: stabile
9: ahf B, Christmas
10: stuart prower
12: hageman

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14
Q

3 PLT disorders with increased BT and normal PLT ct…

3 PLT disorderrs with increased BT and decreased PLT ct…

A

normal PLT:
aspirin, vWD, Glanzmanns

decreased PLT:
May Hegglin, BS, Wiscott
-May hegglin has dohle bodies, lrg PLTs

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15
Q

ITP, TTP, HUS, and DIC all have…PLT cts and …BT

TTP has decreased…

A

decreased PLTs, increased BT

TTP decreased ADAMS13

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16
Q

Two disorders with aggregation issues…
-primary:
-secondary:

Two disorders with adhesion issues…

A

aggregation: G b4 W
-primary: Glanzmann
only agg with ristocetin

-secondary: Wiskott Aldrich

Adhesion:
-vWB, BS

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17
Q

Most common inherited bleeding…
2nd most common…

Most common acquired inhibitor in hereditary def…

Most common PLT disorder…

A

inherited bleeding:
most common vWD,
-decreased 8, vWD, PLT normal
ddavp

second Hemophilia
-A: 8, cryo
-B: 9 ffp

acquired inhibitor in hereditary def: 8

Most common PLT disorder: aspirin

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18
Q

Disorder with no aggregation/flat line with anthing but ristocetin

A

Glansmann

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19
Q

Disorder with abnormal aggregation with most tests, except no aggregation/flat line with collagen

A

aspirin

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20
Q

Two disorders with no aggregation/flat line with ristocetin

A

VWD

BS: diff by VWD with decreaesd,giant plts

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21
Q

Low PLT but normal bleeding/function ok, due to antiplt antibody, destruction of PLTs are virus

A

autoimmune thrombocytopenia
ITP

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22
Q

Test that monitors heparin, FSP, and qual/quant fibrinogen…

test that monitors fragments, D, E…

test that diff factor def from anticoagulant…

test that quantitates factors…

A

Test that monitors heparin, FSP, and qual/quant fibrinogen…thrombin time

test that monitors fragments, D, E…ddimer

test that diff factor def from anticoagulant…
-mixing study

test that quantitates factors…factor assay

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23
Q

Coagulation analyzers used

A

optical photoelectric system

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24
Q

Order of hemotopoesis:

A

yolk sac, liver, spleen, BM

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25
Q

Embryonic hmg chains:
-Gower 1:
-Gower 2:
-Portland:

Newborn hmg and chains:
F- what chains
A1/A2 percent

A

Embryonic hmg chains:
-Gower 1: zeta, epilson
-Gower 2: alpha, epilson
-Portland: zeta, gamma

Newborn hmg and chains:
-F: alpha, gamma

F 50-80
A1 20
A2 1

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26
Q

Adult hmg and chains: made of, %
A1
A2
F

A

Adult hmg, chains, %:
-A1: alpha, beta 97%
-A2: alpha, delta 2%
-F: alpha, gamma 1%

*Embroyonic has zeta, epilson
*Adult has deltaq

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27
Q

Hmg electrophoresis:

Cellulose acetate 8.4:
origin/slowest/cathode/- to fastest/anode+

A

Cellulose acetate 8.4:
*origin-C, S, F, A1
fast(+)

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28
Q

Acronym for citrate agar 6.2
slowest/cathod/origin to fastest anode…

citrate can be used if cellulose acetate at 8.6 is abnormal to separate…

A

-FASC+

separate S from D, G

separate E,C

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29
Q

Saponin and sodium dithionite used in this test for …

A

Sickle Dex solubility test for hmg S

saponin lyses, sodium dithionite reduces it to become deoyxgenated/insoluble will precipiate out of phosphate buffer

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30
Q

cyanmethmg diluent…

separate myoglobin from hmg with…

sickle cell reagents, reducer/lyser…

A

cyanmethmg diluent…Drabkins

separate myoglobin from hmg with…
-ammoniun sulfate

sickle cell reagents…
-reducer: sodium dithionite
-lyser: saponin

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31
Q

Cell ct formula…

WBC area of 1 square(usually of 4)…

RBC/PLT of each tiny square…
-RBC usually count 5

-PLT usually count all 25 of middle,
which equals total of…

A

cells x DF/
total square area (#sqsxarea square) x 0.1

WBC 1 square is 1mm, ct 9sqs
-ammonium oxalate

RBC/PLT 1 square is 0.04

PLTs all 25 is 1mm(one center WBC square)
-ammonium oxalate

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32
Q

3 things used to create scatterplots…
1 not used

A

scatter, volume, conductivity

not fluorescence

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33
Q

Retic % cal…

correct retic…

RPI:

A

Retics/10

retic % x HCT/45

RPI: corrected/maturation time factor

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34
Q

WBC correction for NRBCs

A

WBC x 100/NRBC+100

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35
Q

4 things that falsely increase Hmg

A

lipemia, icteric, protein
increased WBC

All cloud reading

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36
Q

Normal MCV, hypochromia due to

A

hyperglycemia

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37
Q

Decreased RBC, HCT

Increased MCV/MCHC due to
MCHC >36

A

cold agg

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38
Q

Decreased RBC, Hmg, HCT…

A

anemia

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39
Q

Anemia is below…

toddler:
female:
male:
neonates:

toddlers have the least, but close to adult females

neonates have the most

A

Anemia is below…

toddler: 12
female: 13
male: 15
neonates: 19

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40
Q

HA…

-size/color anemia…
-RBC/hmg/HCT, haptoglobin…
-indirect bili….

A

HA…

-size/color anemia…normo, normo
-RBC/hmg/HCT/haptoglobin…decreased
-indirect bili….increased

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41
Q

Another name for reticulocyte, NV
no nucleus, reticulum with supravital stain

Stain name

A

polychromatophillic erythrocyte, 0.5-1.5%

still has RNA, basophillic and orange

NMB

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42
Q

2 names for NRBC, last nucleated red cell normally in BM, pyknotic nucleus

A

Metarubricyte

Orthochromatic normoblast
-more orange due to almost being erythrocyte

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43
Q

Alternate name for…
1.)Rubriblast

2.)Prorubricyte
3.)Rubricyte
4.)Metarubricyte

5.)retic
6.)rbc
blast before Pro, Pro before, meta after

A

Alternate name for…
1.)Rubriblast: Pro-normoblast

2.)Prorubricyte: Basophillic normoblast
3.)Rubricyte: Polychormatophilic normoblast
4.)Metarubricyte/nrbc

5.)retic
6.)rbc

Pro 1st, basophillic, polychromatophilic

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44
Q

Stages of WBC:

-Stage with primary nonspecific granules
-Stage with secondary specific granules,
oval nucleus
-Stage with kidney bean nucleus

A

Myeloblast

-Stage with primary nonspecific granules:
Promyelocyte

-Stage with secondary specific granules,
oval nucleus:
Myelocyte

-Stage with kidney bean nucleus: metamyelocyte

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45
Q

Life span…
PLT…
RBC…

PLTs located, %…

A

PLT 8-11 days
RBC 120

PLTs located, %
-blood 70%
-spleen 30%

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46
Q

MCH:
calculation..
NV…

A

MCH: Hmg/RBC x 10 = 28-32 pg
-mean cell hmg/rbc
-wt

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47
Q

Normal values: female versus males
Remember rule of 3, know RBC know the rest, unless anemia
Rbcx3=Hmgx3=HCT

RBC: O2 to tissue, CO2 removal
WBC:
-neu; kill bacteria
-lymph: humoral/cell mediated immunity
-mono;ingest/kill, initiate adaptive
-baso: inflmmatory
-eos: allergic, parasitic

Hmg:
-plasma hmg
HCT:

A

RBC: 4.5-6 million
-females 4.5-5, males 5-6

WBC: 4-11 thousand
-seg 3-5 lobes

Hmg: 12-18, plasma 2-3mg/dL
-females 13-15
-males 14-18

HCT: 35-54
-females 35-49
-males 40-54

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48
Q

WBC NV:

Total WBC:
-absolute is % x total

Segs: bacteria
Lymphs:viral
Monos:TB,syphilis, Malig
Bands

Eos: allergies,parasite
Baso: immediate hypersensitivity

A

total wbc: 4-11 thousand

Segs: 45-70, most

Lymphs: 20-40

Monos: 3-10

Bands: 0-5
Eos: 0-3
Baso: 0-2, least

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49
Q

correct WBC for nrbc

A

wbc x100/nrbc +100

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50
Q

Diluent for WBC/PLT cts

A

ammonium oxalate

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51
Q

2 normal cells seen in CSF

A

arachnoid and choroid

both very large clumps, pink/blue/purple

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52
Q

Normal cell seen in pleural fluid

A

mesothelial (only in serous)

nucleated: round to oval, can be multi
large, clumped, more round than synovial

Maintain cytoplasm borders, clear spaces between

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53
Q

normal cell seen in synovial/joint

A

synovial cells, nucleated,
not as uniform as pleural mesothelial

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54
Q

What 4 things increase WBC

A

NRBC, large platelets,
Sickle cell, Cryoglobin

-Based off granularity, size

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55
Q

Schistocytes: affect on RBC, plts

A

RBC decreased because counted as plts

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56
Q

3 things decrease plt
1 thing increase plt

A

Decrease plt:
clumps, satellitosis, giant PLTs

Increase: schistocytes
-counted as plts not rbcs

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57
Q

Platelet estimate:
-# per oil…

Plt ct with sodium citrate DF…

Citrate in Coag tube…
Ratio WB:anticoag

EDTA type anticoag…

A

Platelet estimate 8-20/oil

sodium citrate DF 1.1

Tube 3.2%
WB: anticoag 9:1

EDTA type anticoag…di potassium

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58
Q

PAS stains which blasts…
Chronic or acute…

A

Lymphoblasts
Acute

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59
Q

conditions with target cells…
1 not related to target…

A

Thallesemia, Hmgpathies
IDA, post splenectomy
Liver disease
-Decreased hmg

Not myelofibrosis

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60
Q

Diluent for wbc, plt…

Reagent to diff myoglobin from hmg…

Reducer for sickle cell screen…

A

Diluent for wbc, plt…
ammonium oxalate

Reagent to diff myoglobin from hmg…
Ammonium sulfate

Reducer for sickle cell screen…
Sodium dithionite

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61
Q

Vit K dependent group called

A

Prothrombin group

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62
Q

Citrate agar: 6.2:
Origin/slowest/cathod-
to fastest/anode+

A

Citrate agar: 6.2:
*slow(-) F,A,S,C

other hmg migrate with A

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63
Q

MCV calc, NV

RBC size microm nv
Micro is, macro is

A

MCV: HCT/RBC x 10 = 80-100fL
-In a volume of packed rbc, volume of rbc
-volume: micro <80, macro>80

-RBCs are 6-8 microns,
<6 micro, 9+macro

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64
Q

MCH calc, NV
varries witih

A

Hmg/rbc x 10 28-32pg

varies with hmg content and cell size

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65
Q

MCHC: calc, NV

A

MCHC: Hmg/HCT x 100= 32-36%

-Hmg concentration in volume
-color: hypo <32, hyper >36
-percentage so smaller number on top
->36 spherocytes or cold agg

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66
Q

RDW: NV, indicates

A

RDW: 11-14.5, diff sizes/anisocytosis >15%

SD of MCV x100/mean of MCV

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67
Q

HCT: NV…
Measures…
calculated from these two…

A

HCT: 35-54%
packed cell volume
calculated from MCV and RBC (

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68
Q

The spun microhematocrit method can be done
with either free-flowing capillary blood from a skin
puncture or EDTA-anticoagulated venous blood
(Procedure 12-1). Only a very small amount of
blood is needed. The test uses a high-speed centrifuge with a relatively short centrifugation tim

Capilllary tubes:
These tubes are 1 mm in diameter and 7 cm long.
They can be purchased (1) lined with dried heparin for use with capillary blood or (2) plain (without heparin) for use with previously anticoagulated
venous blood. Some type of seal is needed for one
end of the tube before it can be centrifuged. A special sealing compound (similar to modeling clay)
can be used for this purpose

A

An automated hematocrit result is obtained
when multiparameter instruments are used. This
result is computed from individual red cell volumes (MCV) and the red cell count and is not
affected by the trapped plasma that is left in the
RBC column for the manual methods. Hematocrit
value obtained with the automated instruments is
slightly lower than the value obtained by the centrifugation methods.

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69
Q

rule of 3 only works with normocytic, normochromic

Reason rule of 3 wont work:
clot, cold agg, lipemic/icteric/hemolyzed, hmg s/c, abnormal rbc

A
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70
Q

Retic ct:
-supra vital stain, NMB, monitors erythropoiesis
-increased in HA, blood loss,therapy w/iron/folate/b12

retic nv…
retic % calc…
absolute retic…
corrected retic…
RPI/reticulocyte production index…

A

Retic NV…0.5-1.5%

retic % calc: retics in 1000rbcs/10

absolute retic: retic % x total rbc

corrected retic: Pt HCT x retic%/45

RPI/reticulocyte production index: corrected retic/mat time(2)
->2 adequate BM response to anemia
-<2 inadequate BM response to anemia

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71
Q

Automated Reticulocyte Counts

With the use of an automated procedure (see
Chapter 9), the process of counting reticulocytes
is greatly enhanced. The flow cytometry principle is employed, cells are stained with a fluorochrome dye that preferentially stains RNA, and
the cells are counted by a fluorescent technique.
The RNA-containing reticulocytes will fluoresce
when exposed to ultraviolet light. The instrument
can count thousands of reticulocytes in just a few
seconds with an accuracy of about 0.1%

A
72
Q

Hmg electrophoresis:
nationality, migrates with
D:
E:
G:

A

D: east indian, D-S

E: Southeast asian, E-C

G: Blacks, G-S

73
Q

3 things that have leukopenia and 1 that has increased leukocytes

A

decreased:
leukemia, viral, chemo

increased:
leukemoid rxn

74
Q

M:E ratio:

Myelocyte maturation from youngest to oldest

A

M:E 3-1, 4-1

myeloblast
promyelocyte(pro b4 myelo)
myelocyte
metamyelocyte(meta after myelo)
band

75
Q

6 rbc inclusions

A

HJ bodies
Papemheimer bodies/siderocytes in PB
Baso stippling: RNA
Shuffners dots
Cabot ring

Heinz bodies
-denaured hmg
-not seen with wright, G6PD
-no Heinz in PK

76
Q

Specific WBC that phagocytizes nucleoprotein in lupus erythematosus

A

Neutrophil

LE cell

can also be macrophage

77
Q

Characteristic findings:

CLL:
CML:
ALL:
AML:
AMML:

Hodgkin:
nonHodgkin name:
Sezary:

myelofibrosis;

A

CLL: smudge cells, sml soccer ball Blymphs

CML: Ph, basophilia, eosinophilia
-decreased LAP

ALL: PAS+, MPO-, Tdt
AML: Auer rod, trans 8:21

AMML: NASDA 3+, NaF 1+

Hodgkin: Reed Sternburg

Nonhodgkin/Burkitt: bcell lymphoma

Sezary: lrg bizarre cerebriform

myelofibrosis;
giant,bizare plts, pancytopenia caused by scarring

78
Q

Cytochemical Staining

Leukocyte alkaline phosphatase (LAP) activity can be used to differentiate a leukemoid reaction from chronic myelogenous leukemia. It is determined by using a cytochemical stain to detect alkaline phosphatase activity in the neutrophils and bands. Normal neutrophils and bands show cytoplasmic alkaline phosphatase activity in the form of dark staining. Patients with leukemoid leukocytosis show very high LAP score due to high cytoplasmic alkaline phosphatase activity. On the other hand, in patients with CML, the neutrophils show a very weak reaction to the alkaline phosphatase staining (low LAP score).

A

The LAP score is derived by counting one hundred neutrophils (and/or bands) and assessing the amount of stain retained in each of these neutrophilic cells. Each cell is assigned a score between 0 (no stain retained) to 4 (very dark staining due to the granules retaining the stain). Once each cell of the 100 neutrophils are scored based on the amount of stain, the numbers are added up. This gives a potential LAP score of 0 to 400.
As shown in Table 1, LAP scores in a patient under normal circumstances would have a LAP score between 13 to 130. In a leukemoid reaction, scores greater than 160 would be expected. In cases of CML, the LAP score is low (less than 13) due to the fact that these cells are not being produced in response to an infection or stress but rather due to the neoplasm.

79
Q

what engulfs what…
LE:
Tart:
Mott:

A

what engulfs what…
LE: neutrophil,macro engults nucleoprotein
-seen in lupus

Tart: mono/macrophage engulfs nuclear

Mott: plasma cell engulfs Ig, russel bodies

80
Q

In reactive leukocytosis, absolute GRANULOCYTES are

A

> 7.0

81
Q

ALL:

-How many classes
-which one has heterogenous?
-which one has vacuolization/abundant cyto?
-which one seen in kids/homogenous?

A

only 3 class, no L4

L1: homogenous, kids
L2: heterogenous, adults

L3: vacuolization, abundant cyto, homo

L1/L2: L is younger than L2, start out homo
L3: odd one with vacuoles

82
Q

AML:
-granules? least to most?
-Auer rod, DIC?
-Mono?
-Erythroblast? Megakaryoblast?

M0:
M1:
M2:
M3:

M4/5:
M6:
M7:

A

AML:

M0: no granules

M1: granules
*M2: few/trace granules

*M3: intense granules, DIC, Auer

M4/5: mono

M6: erythroblast
M7: megakaryoblast

83
Q

Waldenstrom versus Multiple Myeloma:
both have increased…and….

WM Ig…
MM Ig…
MM also has…issues

A

both have extra plasma cells/lymphs and rouleaux

WM Ig M, increased viscosity, normal bone
MM IgG, bence jones in urine, bone issues

84
Q

Condition with
-elevated WBC/segs
-increased ESR/fibrinogen
-decreased iron

A

Hodgkins, Reed Sternberg

85
Q

Tears, giant bizarre plts, increased uric acid most ass with

A

myelofibrosis

86
Q

Least seen wbc

A

Basophil 2%

87
Q

Order of early stem cells etc

A

HSC, MPP, common,
Lymph-myeloid, then CFU

88
Q

PLTs
-NV
-NV in 1000x
-fL

cells youngest to oldest

A

PLTs
140-450,000
8-20
10fL

-Megakaryoblast: BM
-Promegakaryocyte: BM
-Megakaryocyte: BM
-PLT blood

89
Q

Monocytes youngest to oldest….

Lymphocytes youngest to oldest….

A

Monocyte:
-Monoblast
-Promonocyte, more oval nucleus
-Monocyt

Lymphocyte:
-Lymphoblast
-Prolymphocyte: lrg single nuclei
-lymphocyte: scant cyto

90
Q

Hmgpathies..

Hmg S…

HmgC..

A

hmgs: valine replaces glutamic acid, 6th position on beta

hmgc: lysine replaces glutamic acid, 6th position on beta
-washington monument, rod

SC: glove

91
Q

Sudan B:
perioxidase:

PAS:

Oil RedO:

LAP:

TRAP:

NASDA 3+/NaF1+:

A

Sudan B: nonspecific/specific granules, myelogenous granulocytes, AML
-Brown Black
-being replaced by Oil red O neutral lipids

perioxidase: myelos, monos
not lymphs

PAS: periodic acid schiff
acute lymphoblasts,
not chronic
-magenta, glycogen deposits,fungi

Oil RedO: neutral lipids

LAP: Leukomoid, decreased CML

TRAP: hairy cell
-tartrate resistant, acid phosphatase

NASDA 3+/NF1+: AMML
adding Naf makes monos become negative

92
Q

Hmg in reduced state..
-what keeps it reduced…

Hmg in ferric state/oxidized…

Hmg w/carbon monxide, 200 greater affinity to hmg than oxygen…

Hmg with irreversible oxidation, cant carry oxygen, isn’t tested with cyanmethmg…

A

Hmg in reduced state..oxyhmg
-what keeps it reduced…methmg-cytochrome C reductase

Hmg in ferric state,oxidized…methmg can’t bind Oxy

Hmg w/carbon monxide, 200 greater affinity to hmg than oxygen…carboxyhmg smoker, cherry red

Hmg with irreversible oxidation, cant carry oxygen, isn’t tested with cyanmethmg…sulfhmg

93
Q

Hmg principle oxidation of hmg to….
uses these two reagents….
4 sources of error…

A

Hmg principle oxidation of hmg to….methmg
uses these two reagents….cyanide (KCN, KferricCN)
4 sources of error…lipemia, icteric, high WBC, resistant hmg(S,C)

94
Q

Hemiglobincyanide (Cyanmethemoglobin) Method

The HiCN, or cyanmethemoglobin, method uses
a modified Drabkin’s reagent that contains potassium cyanide, potassium ferricyanide, dihydrogen
potassium phosphate (KH2PO4), which shortens
the conversion time to 3 minutes, and a nonionic
detergent that minimizes turbidity and enhances
RBC lysis. When the cyanmethemoglobin reagent
is mixed with the blood specimen, the stable pigment HiCN is formed and can be measured quantitatively in a spectrophotometer.

A

Automated Hemoglobinometry

Various automated and semiautomated techniques measure hemoglobin as well as determine
the white cell count, red cell count, hematocrit,
and red cell indices. Hemoglobin determinations
done by an automated instrument generally use the
cyanmethemoglobin method. The sample is lysed
by using the detergent-modified Drabkin’s reagent,
and light absorbance is measured at 540 nm.

95
Q

PRINCIPLE: HEMOGLOBIN
DETERMINATION: HEMOCUE METHOD

This point-of-care testing assay for hemoglobin
is based on a modified azidemethemoglobin reaction.

Erythrocyte membranes are disintegrated by
sodium deoxycholate, releasing the hemoglobin
from the cells.

Sodium nitrite converts the hemoglobin iron from the ferrous to the ferric state to
form methemoglobin, which then combines with azide to form azidemethemoglobin.
The concentration of azidemethemoglobin is measured optically
to determine the concentration of hemoglobin in
the patient’s blood

A
96
Q

ESR is the rate of fall of rbc thru plasma, NV female/male…

Increased ESR

A

female 0-20 more than men
male 0-15

increased…

-inflammation
-rouleax
-increased proteins: fibrinogen
-MM, WM
-macro
-anemia
-tilting/vibration

97
Q

Decreased ESR

A

decreased:
-microcytes, sperocytes
-sickle, can’t rouleaux
-polycythemia
-edta, cells shrink
-old specimen or decreased temp

98
Q

Optical light scattering is also called

A

laser light scatter, flow cytometry

focuses laser with laminar flow of cells to id granularity/reflectivity

90 side: granularity

Forward: size

99
Q

Fragile WBC causing pseudoleukopenia…

Smudge cells issues with WBC ct…add

Cryoglobin issues with WBC and cold agg issues…

lipemia…

A

Fragile WBC causing pseudoleukopenia…
manual WBC

Smudge cells issues with WBC ct…add 22% albumin to stabilize

Cryoglobin issues with WBC and cold agg issues…warm 37, 15min

lipemia: saline replacement

100
Q

TRAP: hairy cell

A

-tartrate resistant, acid phosphatase

101
Q

IDA:
-iron
-ferritin
-TIBC, transferrin:

Anemia of Chronic:
-iron:
-ferritin:
-TIBC, transferrin:

A

IDA: chronic blood loss
-iron, ferritin: decreased
-TIBC, transferrin: increased

Anemia of Chronic:
-iron: decreased
-ferritin: increased
-TIBC, transferrin: decreased

102
Q

Leptocyte:

Drepanocyte:

Dacrocyte:

Basostilling made of…

A

Leptocyte: codocyte, target

Drepanocyte: sickle

Dacrocyte: tear

Baso stil RNA

103
Q

Macrocytic anemias: MCV>100
decreased PLTs, macros, hyper segmented

Megaloblastic:
-main WBC in BM
-2 def
-type of macrocytes

Nonmegaloblastic:
-2 causes
-type of macrocytes:

A

Macrocytic anemias:

Megaloblastic:
-giant metamyelocytes
-2 def: folate/B12/PA IF
-type of macrocytes: oval

Nonmegaloblastic:
-2 causes: liver disease, alcoholism
-type of macrocytes: round

104
Q

Microcytic anemias:
-5 main

A

IDA, anemia of chronic
sideroblastic
thall
lead

105
Q

3 tests for PNH

1 test for PCH

PNH is a … Defect

A

PNH
-sugar water
-sucrose
-Hams acidified serum

PCH
-Donath landsteiner autoab test, P

Membrane defect

106
Q

most common thallasemia

A

beta thall minor, Cooley’s trait

107
Q

4 neutrophil incusions/anomolies

A

dohle bodies
toxic gran
vacuolition
Pelger Huet

108
Q

TT tests for, reagent ,NV
Monitors 3 things

Fibrinogen test,
Reagent, concentration is….to time, NV

A

TT time it takes thrmobin to convert fibrinogen to fibrin, thrmobin reagent, 10-15 Sec
Monitors: heparin, FSP, fibrinogen levels

Fibrinogen test:
Thrmobin reagent, AMT inversely proportional to time, 200-400

109
Q

Factor with all tests normal except 5M urea solubility, clot dissolves

A

Factor 13

Not involved in coagulation

110
Q

Factor def with no history of bleeding, only abnormal aPTT

A

Factor 12

111
Q

Same and Difference between liver disease and vitK

A

Both decreased 2,7,9,10
Liver disease has increased factor 8

112
Q

Normoblast/erythroblast:

-Pro
-Basophillic
-Polychromatophillic
-Orthochromatic(NRBC)

A

Rubri

-Rubri-blast
-Pro-rubricyte
-Rubricyte
-meta-rubricyte(NRBC)

113
Q

Chediak Higashi: defect of

Alder Riley: defect of

A

Chediak Higashi: defect of large lysosomes/fusion on primary granules

Alder Riley: defect of mucopollysacharrides
A=azurophilic

114
Q

IM:

CMV:

Infectious lymphotosis:

A

All have increased WBC,Lymphs, reactive

IM:
EBV, POS monospot

CMV:
Neg monospot

Infectious lymphotosis:
<5yrs Old, neg monospot

115
Q

Hemo A,B,C all normal

A

PT, 8,9,11 not in extrinsic or common(1,2,5,10)

116
Q

Lupus anticoag

A

PTT not corrected by missing.
PT normal

117
Q

Signs on immature cell

A

Euchromatin, less packed
Dark cytoplasm
Nucleoli
Nonspecific granules

118
Q

Plt, lymph, mono maturation 3 cells

A

Mono/lympho/megakaryo-blast

Pro-mono/lympho/megakaro-cyte

Monocyte, lymphocyte, megakarocyte

119
Q

Factor assay normal range

A

50-150%

120
Q

Romanowsky stain…
Azure is, stains, examples…

Eosin Y is, stains, examples…

A

Romanowsky stain…
Azure is, stains, examples…
-Purple, basic
-stains acidic, nuclei, immature cyto

Eosin Y is, stains, examples…
-is red, acidic
-stains basic, hmg, azure granules

121
Q

Pink or light due to…

Blue or dark due to…

A

Pink or light due to…
-too acidic, not enough stain, long rinse

Blue or dark due to…
-too alkaline, to long stain, not rinsed enough

122
Q

Alpha thall

Alpha thall major:

HmgH:

Alpha thall minor:

Silent carrier:

A

Alpha thall

Alpha thall major:
-hydrops fetalis
-all 4 alpha deleted
-no normal adult hmg
-Barts/Portland

HmgH:
-3/4 deleted
-Heinz bodies
-Barts

Alpha thall minor:
-2/4 deleted
-MICRO/hypo

Silent carrier:
-1/4 deleted

123
Q

Cell with older males, large bizarre cerebriform nuclei

A

Sezary

124
Q

Bone marrow macrophages that are wrinkled/striated cyto w/accumulation of glucocerebrosidease

BM macrophages w/foamy cytoplasm, sea blue histiocytes, disease called

A

Gaucher is wrinkly
G=glucocerebrosidease

Niemann-Pick
foamy, sea blue histocytes, sphingomyelinase

125
Q

Test that tests PLT fnc, affected by #, vascular integrity, less than 10 min NV

A

BT

126
Q

Test that measures PLT fnc, defects plug, closure time/time to occlude aperture;
Depends on count and activity

A

PFA100

127
Q

Thrombocytopenia due to heparin induced ab, heparin/PF4 complex sensitizes PLT and removed from spleen, <50% PLT ct

A

HIT

128
Q

Condition with giant/decreased PLTs/increased BT
abnormal aggregation to Ristocetin, abnormal adhesion

A

Bernard Soulier

129
Q

Condition dohle bodies, giant/decreased PLTs, increased BT due to decreased Plts

A

May hegglin

130
Q

Condition due to adhesion, abnormal aggregation to Ristocetin, normal PLT ct but increased BT

A

VWD

131
Q

Condition with normal PLT ct but increased BT,
only aggregates with Ristocetin/primary agg issue

A

Glannsmann thrombostenia

132
Q

WBC least seen

A

Basophil 2%

133
Q

Sickle cell increase…

Schistocytes increase, decrease…

A

Sickle cell increase…wbc

Schistocytes increase, decrease…
Increase PLTs, decrease rbc

134
Q

What is indicated by a large red cell distribution curve on an automated blood count?

A

Abnormal red cell size variation

The red cell distribution curve will get wider as the red cells vary more in size. A narrow distribution curve indicates limited red cell size variation.

135
Q

What does a manual reticulocyte count do?

A

Uses a vital stain which can be a biological hazard

Manual reticulocyte counts use a vital stain which can be a biological hazard. The reticulocyte count is used to follow therapeutic measures for anemias in which the patient is deficient in, or lacking, one of the substances essential for manufacturing red blood cell.

136
Q

What hematological disease/disorder has an increased number of immature cells?

A

Acute leukemia

Increased numbers of immature cells are seen in acute leukemias, with the predominating cells being myeloblasts and promyelocytes.

137
Q

When evaluating an erythrocyte histogram, a shift to the left of the erythrocyte series should correspond to which type of erythrocytes?

A

Microcytes

A shift to the left of erythrocyte population corresponds to microcytes.

138
Q

When performing the Westergren method, fresh anticoagulated blood collected in sodium citrate is the preferred anticoagulant. What is the ration of blood to sodium citrate?

A

4 vol of blood to 1 vol of sodium citrate

The ratio is 4 vol of blood to 1 vol of sodium citrate. Blood should be at room temperature for testing and should be no more than 2 hours old.

139
Q

Morphologically, what are anemias generally classified as?

A

Normochromic-normocytic, macrocytic, and hypochromic-microcytic

Anemias can be classified according to either the appearance of the RBCs (morphologic classification) or the physiologic cause of the anemia (etiologic or pathogenic classification).

140
Q

Which lymphoproliferative neoplasm is characterized by Reed Sternberg cells?

A

Hodgkin lymphoma, a lymphoproliferative neoplasm, is characterized by Reed Sternberg cells.

141
Q

What stages does a neutrophil normally mature in the bone marrow from the earliest to the most mature?

A

Myeloblast, promyelocyte, myelocyte, metamyelocyte, band, and segmented neutrophils.

Neutrophils normally mature in the bone marrow in the following stages, from earliest to the most mature:

myeloblast: has a nucleus with fine chromatin and nucleoli and the cytoplasm is agranular

promyelocyte:

myelocyte:

metamyelocyte:

band
segmented neutrophils.

142
Q

Phagocytosis

A

Worn out RBCs are broken down by the mononuclear phagocytic system. These cells are located in the blood sinusoids (tiny blood vessels) in the liver, spleen, and bone marrow and in the lining of the lymph channels in the lymph nodes.

143
Q

When counting platelets using the Unopette System (a manual method), which area is used to count on the Neubauer hemocytometer?

A

Large center square

The Neubauer hemocytometer is broken into nine large squares. The platelet count uses the large center square using the high dry objective.

144
Q

Megaloblastic erythrocytes have an abnormal developmental sequence. As they develop, what are cells of the megaloblastic sequence that have a more open or immature chromatin pattern in the nucleus?

A

Asynchronous maturation, or dyssynchronous development of the nucleus, and cytoplasm are terms used to refer to the megaloblastic sequence of cells that have a more open or immature chromatin pattern in the nucleus.

145
Q

In most infections, there is some increase in the ESR. What are two exceptions?

A

Chorea and undulant fever

ESR is a measure of the presence and severity of pathological processes. In most infections, there is at least some increase in the ESR; chorea and undulant fever are two exceptions.

146
Q

In terms of cell size and cytoplasm, what causes the progressive decrease in both size and in the intensity of the blue color in cell maturation?

A

The intensity of the blue color results from the combination of hemoglobin and RNA in the cytoplasm. The stages are described in terms of the staining reaction of the cytoplasm as it gains in hemoglobin concentration: basophilic cytoplasm is blue, polychromatophilic cytoplasm shows shades of blue and gray as hemoglobin increases, and orthochromic cytoplasm is orange-red.

147
Q

Which compartment is the site of differentiation, proliferation, and maturation during the lifespan of a neutrophil?

A

The bone marrow is the site where neutrophils differentiate, proliferate, and mature. Differentiated neutrophils are then released into systemic circulation.

148
Q

You are working in the coagulation department after service has just finished doing a six-month preventive maintenance (PM) check on the coag analyzer that includes removing all current data in the analyzer. After the PM check, you run quality control (QC) for prothrombin time (PT) and activated partial thromboplastin time (aPTT). The QC for the aPTT is within 2 SD but the PT control is outside of 6 SD. In troubleshooting, what might the problem be?

A

The ISI value that is currently in the instrument was set back to zero after maintenance and needs to be re-entered before patient testing is resumed.

During the preventative maintenance check all current data was removed from the analyzer. If the instrument has the wrong ISI entered, the results will not be accurate and patient testing cannot be performed.

149
Q

What is the appropriate ratio of blood to anticoagulant in a sodium citrate tube drawn for routine coagulation studies?

A

9:1 is the correct ratio of blood to anticoagulant in a sodium citrate tube for routine coagulation studies.

150
Q

What is the process of stopping blood loss through ruptured blood veins, arteries, and capillaries called?

A

Hemostasis is the process of stopping blood loss through ruptured veins, arteries, and capillaries. Hemostasis can be split into primary and secondary hemostasis. Primary hemostasis refers to the initial response to stop bleeding, which is platelet activation and plug formation. Secondary hemostasis is the activation of the coagulation cascade to form a mesh over the injury.

151
Q

The activation of what factor occurs by means of either the extrinsic or intrinsic pathway or a combination of both pathways to form the common pathway?

A

X to Xa

The activation of factor X is the point where the two pathways converge to form the common pathway. Once Xa is formed, another cofactor, V, in the presence of calcium and PF3 converts prothrombin (factor II) to the active enzyme, thrombin.

152
Q

Which test is not beneficial for evaluating a patient with suspected von Willebrand disease?

a.
Multimer test

b.
Platelet count

c.
Ristocetin cofactor

d.
Von Willebrand antigen test

A

Platelet count

Von Willebrand disease is a bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor, a protein involved in the blood clotting process. Diagnostic testing for von Willebrand disease typically includes laboratory tests that evaluate von Willebrand factor activity, such as the ristocetin cofactor assay, multimer test, and von Willebrand antigen test.

153
Q

Which laboratory test measures the concentration and activity of fibrinogen in stage II and monitors coumarin therapy?

A

Thrombin time (TT) measures the concentration and activity of fibrinogen in stage II and monitors coumarin therapy. The purpose of the TT is plasma factors. Fibrinogen is involved in stage I of the blood clotting process, which is the formation of a platelet plug, and in stage II, which is the formation of a stable fibrin clot.

154
Q

What test or panel of tests are used to detect RBCs that have been coated with antibodies?

A

The DAT is used to detect RBCs that have been coated with antibodies. It is one of the most useful procedures for distinguishing immune from nonimmune mechanisms that may underlie hemolytic anemias.

155
Q

Morphologically, what are anemias generally classified as?

A

Normochromic-normocytic
macrocytic
hypochromic-microcytic

Anemias can be classified according to either the appearance of the RBCs (morphologic classification) or the physiologic cause of the anemia (etiologic or pathogenic classification).

156
Q

Which type of anemia is a group of inherited disorders of Hb synthesis, characterized by microcytosis, hypochromasia, and basophilic stippling?

A

Thalassemias

Microcytosis, hypochromasia and basophilic stippling are general observations for thalassemias. Anisocytosis, poikilocytosis, and target cells may be present, as well as decreased osmotic fragility.

157
Q

What is the name of nucleated red blood cells or reticulocytes in the peripheral blood?

A

Shift cells

Shift cells are nucleated red blood cells or polychromatic macrocytes (reticulocytes) in the peripheral blood.

158
Q

Which lymphoproliferative neoplasm is characterized by Reed Sternberg cells?

A

Hodgkin lymphoma

Hodgkin lymphoma, a lymphoproliferative neoplasm, is characterized by Reed Sternberg cells.

159
Q

Which coagulation test monitors unfractionated heparin therapy and screens for intrinsic and common pathway deficiencies?

A

Which coagulation test monitors unfractionated heparin therapy and screens for intrinsic and common pathway deficiencies?

160
Q

The aPTT measures factors XII, XI, IX, VIII, V, II, and

A

fibrinogen.

A laboratory test that monitors the intrinsic pathway leading to fibrin clot formation is the aPTT. The aPTT measures factors XII, XI, IX, VIII, V, II, and fibrinogen (I).

161
Q

Cellulose acetate ph8.4
fastest(-) to slowest(+)

A

Cellulose acetate ph 8.4
fastest(-) to slowest(+)

fast(-) A,F, S,C (+)slow

162
Q

Heinz body prep nonspecific screen for hemolysis due to drugs/toxins, enzyme deficiencies, thall, and unstable hmg, stain/prep these two conditions

A

G6PD def
HmgH

163
Q

Bone Marrow Preps:

Megakaryocytes/10x:
M:E ratio:

Aspirate from:

Stain;

Cell:Fat ratio:

A

Bone Marrow:

Megakaryocytes/10x: 5

M:E ratio: 3:1-4:1
-dry tap; aplastic, myelofibrosis

Aspirate from: sternum/hip iliac crest

Stain;: wrights/romanowsky

Cell:Fat ratio: 50%/50%

*use biopsy for overall eval of celluarity

*WBC diff to determine leukemia

164
Q
A
165
Q

ESR
1.)Rouleaux, stage of aggregation, 10min
2.) sedimentation, settling 40min
3.) Packing 10min

A

Basophilic stippling: RNA
a red blood cell inclusion, is composed of ribonucleic acid. Additionally, it is indicative of thalassemia or lead poisoning.

166
Q

ESR
1.)Rouleaux, stage of aggregation, 10min
2.) sedimentation, settling 40min
3.) Packing 10min

A

Basophilic stippling: RNA
a red blood cell inclusion, is composed of ribonucleic acid. Additionally, it is indicative of thalassemia or lead poisoning.

167
Q

A patient was screened for HIV which resulted in a positive test. The patient would like to conduct a second test to confirm these findings. What would be a more confirmatory test for HIV?
Question 127Answer

a.
ELISA

b.
Immunofluorescent assay

c.
Microarray

d.
Western blot

A

The standard current test for confirming a positive HIV test uses the Western blot technology.

168
Q

A patient was screened for HIV which resulted in a positive test. The patient would like to conduct a second test to confirm these findings. What would be a more confirmatory test for HIV?
Question 127Answer

a.
ELISA

b.
Immunofluorescent assay

c.
Microarray

d.
Western blot

A

The standard current test for confirming a positive HIV test uses the Western blot technology.

169
Q

What is a technique in which proteins are separated electrophoretically, transferred to membranes, and identified using labeled antibodies specific for the protein of interest?
Question 130Answer

a.
Eastern blot

b.
Northern blot

c.
Southern blot

d.
Western blot

A

Western blot is used to detect antibodies of specific epitopes. Specific assays using the Western blot technology are used to detect antibodies to human immunodeficiency virus (HIV), the causative agent of AIDS.

170
Q

What is a technique in which proteins are separated electrophoretically, transferred to membranes, and identified using labeled antibodies specific for the protein of interest?
Question 130Answer

a.
Eastern blot

b.
Northern blot: rna

c.
Southern blot: dna

d.
Western blot

A

Western blot is used to detect antibodies of specific epitopes. Specific assays using the Western blot technology are used to detect antibodies to human immunodeficiency virus (HIV), the causative agent of AIDS.

171
Q

Ethylene diamine tettracetic acid

Edta

A
172
Q

Bone marrow

A

No heparin for slide and clot
-2 finger stick smears

Direct smears and unit preps with aspirate: glass rod, unit preps are squashed to spread out

Touch prep from bone marrow core: if dry tap, roll between two slides and 5 pairs cover slips
May need to be decalcifying

Sample tubes: lavender, yellow, green, formalin container

Clot

173
Q

D dimer
Fibrin clot degradation, monoclonal antibodies against ddimer, x linked not FSP/FDP

Mixing: 50-100%, normal plasma correct rosner index, dilute plasma, buffer, Appt,PT

Plt function: adhesion/aggregation pfa 100: collagen, epi, adp, closure time, occlusion of aperture

A

Heparin: anti Xa unfractitonated heparin. Chromogenic, inactivation of Xa is amount of heparin, OD/time

HITT: igG abb after heparin, decreased plts Elisa, heparin ab

174
Q

Heme
Iron, protopotphyrin

While I’m Delta, Por, UR, Cop, pronto, heme

A

…

175
Q

Heme
Iron, protopotphyrin

While I’m Delta, Por, UR, Cop, pronto, heme

A

…

176
Q

Hemoglobinopathy: structural mutation, amino change

Thalassemia: decreased production of alpha or beta
-micro hypo

A

Hmgpathy
S-valine 6th beta
C-lysine 6th beta

D- indian, S
G-black, S

E-asian,C

4.)AMT Heme/Coag Quick (1 decks)

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