AMT Heme Quick Flashcards
Vit K dependent Prothrombin group factors
2,7,9,10
Fibrinogen group, thrombin acts on, used up/not in serum
1,5,8,13
Intrinsic, factors…
In..it also measures factors..
drug it monitors…
reagents…
NV…
phospholipoprotein inhibitor that prolongs aPTT,not corrected by mixing study…
8,9,11,12
In aPTT it also measures 1,2,5,10
heparin
phospholipid+ Ca chloride
30-36sec
lupus like anticoagulant
Common factors…
measured in both…and….
1,2,5,10
aPTT,PT
Factors in Contact grp, alternate activation of intrinsic
HMWK,PK
11,12
extrinsic factors…
In…also measures factors..
drug names it monitors…
reagent…
NV….
Uses…
PT
TF/3, 7
1,2,5,10
warfarin/coumadin
thromboplastin
10-13sec
Uses INR/ISI 2.0-3.5
Prothrombinase complex is in common pathway and acts on prothrombin
consist of these two factors and these two cofactors…
5a, 10a
calcium+phospholipid
Protein C degrades…and…
Protein…is cofactor that accelates inhibition
C degrades 5,8
S is cofactor
Primary inhibitor of fibrinolytic system..
Principal inhibitor of thrombin/10…
fibrinolytic: alpha2 antiplasmin
plasmin is main fibrinolysis agent
-breaks down to x,y,d,e
Inhibitor of thrombin/10: anthrombin 3
Streptokinase
Urokinase
TPA all
are clot busters
Labile coag factors…
Severe liver disease coag factors..
5,8
1,5
Fibrinogen is made in liver
Names:
1
2
3
4
5
7
8
9
10
11
12
13
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
7…
9…two names
10…
12…
7: stabile
9: ahf B, Christmas
10: stuart prower
12: hageman
3 PLT disorders with increased BT and normal PLT ct…
3 PLT disorderrs with increased BT and decreased PLT ct…
normal PLT:
aspirin, vWD, Glanzmanns
decreased PLT:
May Hegglin, BS, Wiscott
-May hegglin has dohle bodies, lrg PLTs
ITP, TTP, HUS, and DIC all have…PLT cts and …BT
TTP has decreased…
decreased PLTs, increased BT
TTP decreased ADAMS13
Two disorders with aggregation issues…
-primary:
-secondary:
Two disorders with adhesion issues…
aggregation: G b4 W
-primary: Glanzmann
only agg with ristocetin
-secondary: Wiskott Aldrich
Adhesion:
-vWB, BS
Most common inherited bleeding…
2nd most common…
Most common acquired inhibitor in hereditary def…
Most common PLT disorder…
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
Disorder with no aggregation/flat line with anthing but ristocetin
Glansmann
Disorder with abnormal aggregation with most tests, except no aggregation/flat line with collagen
aspirin
Two disorders with no aggregation/flat line with ristocetin
VWD
BS: diff by VWD with decreaesd,giant plts
Low PLT but normal bleeding/function ok, due to antiplt antibody, destruction of PLTs are virus
autoimmune thrombocytopenia
ITP
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…
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
Coagulation analyzers used
optical photoelectric system
Order of hemotopoesis:
yolk sac, liver, spleen, BM
Embryonic hmg chains:
-Gower 1:
-Gower 2:
-Portland:
Newborn hmg and chains:
F- what chains
A1/A2 percent
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
Adult hmg and chains: made of, %
A1
A2
F
Adult hmg, chains, %:
-A1: alpha, beta 97%
-A2: alpha, delta 2%
-F: alpha, gamma 1%
*Embroyonic has zeta, epilson
*Adult has deltaq
Hmg electrophoresis:
Cellulose acetate 8.4:
origin/slowest/cathode/- to fastest/anode+
Cellulose acetate 8.4:
*origin-C, S, F, A1
fast(+)
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…
-FASC+
separate S from D, G
separate E,C
Saponin and sodium dithionite used in this test for …
Sickle Dex solubility test for hmg S
saponin lyses, sodium dithionite reduces it to become deoyxgenated/insoluble will precipiate out of phosphate buffer
cyanmethmg diluent…
separate myoglobin from hmg with…
sickle cell reagents, reducer/lyser…
cyanmethmg diluent…Drabkins
separate myoglobin from hmg with…
-ammoniun sulfate
sickle cell reagents…
-reducer: sodium dithionite
-lyser: saponin
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…
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
3 things used to create scatterplots…
1 not used
scatter, volume, conductivity
not fluorescence
Retic % cal…
correct retic…
RPI:
Retics/10
retic % x HCT/45
RPI: corrected/maturation time factor
WBC correction for NRBCs
WBC x 100/NRBC+100
4 things that falsely increase Hmg
lipemia, icteric, protein
increased WBC
All cloud reading
Normal MCV, hypochromia due to
hyperglycemia
Decreased RBC, HCT
Increased MCV/MCHC due to
MCHC >36
cold agg
Decreased RBC, Hmg, HCT…
anemia
Anemia is below…
toddler:
female:
male:
neonates:
toddlers have the least, but close to adult females
neonates have the most
Anemia is below…
toddler: 12
female: 13
male: 15
neonates: 19
HA…
-size/color anemia…
-RBC/hmg/HCT, haptoglobin…
-indirect bili….
HA…
-size/color anemia…normo, normo
-RBC/hmg/HCT/haptoglobin…decreased
-indirect bili….increased
Another name for reticulocyte, NV
no nucleus, reticulum with supravital stain
Stain name
polychromatophillic erythrocyte, 0.5-1.5%
still has RNA, basophillic and orange
NMB
2 names for NRBC, last nucleated red cell normally in BM, pyknotic nucleus
Metarubricyte
Orthochromatic normoblast
-more orange due to almost being erythrocyte
Alternate name for…
1.)Rubriblast
2.)Prorubricyte
3.)Rubricyte
4.)Metarubricyte
5.)retic
6.)rbc
blast before Pro, Pro before, meta after
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
Stages of WBC:
-Stage with primary nonspecific granules
-Stage with secondary specific granules,
oval nucleus
-Stage with kidney bean nucleus
Myeloblast
-Stage with primary nonspecific granules:
Promyelocyte
-Stage with secondary specific granules,
oval nucleus:
Myelocyte
-Stage with kidney bean nucleus: metamyelocyte
Life span…
PLT…
RBC…
PLTs located, %…
PLT 8-11 days
RBC 120
PLTs located, %
-blood 70%
-spleen 30%
MCH:
calculation..
NV…
MCH: Hmg/RBC x 10 = 28-32 pg
-mean cell hmg/rbc
-wt
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:
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
WBC NV:
Total WBC:
-absolute is % x total
Segs: bacteria
Lymphs:viral
Monos:TB,syphilis, Malig
Bands
Eos: allergies,parasite
Baso: immediate hypersensitivity
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
correct WBC for nrbc
wbc x100/nrbc +100
Diluent for WBC/PLT cts
ammonium oxalate
2 normal cells seen in CSF
arachnoid and choroid
both very large clumps, pink/blue/purple
Normal cell seen in pleural fluid
mesothelial (only in serous)
nucleated: round to oval, can be multi
large, clumped, more round than synovial
Maintain cytoplasm borders, clear spaces between
normal cell seen in synovial/joint
synovial cells, nucleated,
not as uniform as pleural mesothelial
What 4 things increase WBC
NRBC, large platelets,
Sickle cell, Cryoglobin
-Based off granularity, size
Schistocytes: affect on RBC, plts
RBC decreased because counted as plts
3 things decrease plt
1 thing increase plt
Decrease plt:
clumps, satellitosis, giant PLTs
Increase: schistocytes
-counted as plts not rbcs
Platelet estimate:
-# per oil…
Plt ct with sodium citrate DF…
Citrate in Coag tube…
Ratio WB:anticoag
EDTA type anticoag…
Platelet estimate 8-20/oil
sodium citrate DF 1.1
Tube 3.2%
WB: anticoag 9:1
EDTA type anticoag…di potassium
PAS stains which blasts…
Chronic or acute…
Lymphoblasts
Acute
conditions with target cells…
1 not related to target…
Thallesemia, Hmgpathies
IDA, post splenectomy
Liver disease
-Decreased hmg
Not myelofibrosis
Diluent for wbc, plt…
Reagent to diff myoglobin from hmg…
Reducer for sickle cell screen…
Diluent for wbc, plt…
ammonium oxalate
Reagent to diff myoglobin from hmg…
Ammonium sulfate
Reducer for sickle cell screen…
Sodium dithionite
Vit K dependent group called
Prothrombin group
Citrate agar: 6.2:
Origin/slowest/cathod-
to fastest/anode+
Citrate agar: 6.2:
*slow(-) F,A,S,C
other hmg migrate with A
MCV calc, NV
RBC size microm nv
Micro is, macro is
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
MCH calc, NV
varries witih
Hmg/rbc x 10 28-32pg
varies with hmg content and cell size
MCHC: calc, NV
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
RDW: NV, indicates
RDW: 11-14.5, diff sizes/anisocytosis >15%
SD of MCV x100/mean of MCV
HCT: NV…
Measures…
calculated from these two…
HCT: 35-54%
packed cell volume
calculated from MCV and RBC (
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
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.
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
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…
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
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%
Hmg electrophoresis:
nationality, migrates with
D:
E:
G:
D: east indian, D-S
E: Southeast asian, E-C
G: Blacks, G-S
3 things that have leukopenia and 1 that has increased leukocytes
decreased:
leukemia, viral, chemo
increased:
leukemoid rxn
M:E ratio:
Myelocyte maturation from youngest to oldest
M:E 3-1, 4-1
myeloblast
promyelocyte(pro b4 myelo)
myelocyte
metamyelocyte(meta after myelo)
band
6 rbc inclusions
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
Specific WBC that phagocytizes nucleoprotein in lupus erythematosus
Neutrophil
LE cell
can also be macrophage
Characteristic findings:
CLL:
CML:
ALL:
AML:
AMML:
Hodgkin:
nonHodgkin name:
Sezary:
myelofibrosis;
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
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).
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.
what engulfs what…
LE:
Tart:
Mott:
what engulfs what…
LE: neutrophil,macro engults nucleoprotein
-seen in lupus
Tart: mono/macrophage engulfs nuclear
Mott: plasma cell engulfs Ig, russel bodies
In reactive leukocytosis, absolute GRANULOCYTES are
> 7.0
ALL:
-How many classes
-which one has heterogenous?
-which one has vacuolization/abundant cyto?
-which one seen in kids/homogenous?
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
AML:
-granules? least to most?
-Auer rod, DIC?
-Mono?
-Erythroblast? Megakaryoblast?
M0:
M1:
M2:
M3:
M4/5:
M6:
M7:
AML:
M0: no granules
M1: granules
*M2: few/trace granules
*M3: intense granules, DIC, Auer
M4/5: mono
M6: erythroblast
M7: megakaryoblast
Waldenstrom versus Multiple Myeloma:
both have increased…and….
WM Ig…
MM Ig…
MM also has…issues
both have extra plasma cells/lymphs and rouleaux
WM Ig M, increased viscosity, normal bone
MM IgG, bence jones in urine, bone issues
Condition with
-elevated WBC/segs
-increased ESR/fibrinogen
-decreased iron
Hodgkins, Reed Sternberg
Tears, giant bizarre plts, increased uric acid most ass with
myelofibrosis
Least seen wbc
Basophil 2%
Order of early stem cells etc
HSC, MPP, common,
Lymph-myeloid, then CFU
PLTs
-NV
-NV in 1000x
-fL
cells youngest to oldest
PLTs
140-450,000
8-20
10fL
-Megakaryoblast: BM
-Promegakaryocyte: BM
-Megakaryocyte: BM
-PLT blood
Monocytes youngest to oldest….
Lymphocytes youngest to oldest….
Monocyte:
-Monoblast
-Promonocyte, more oval nucleus
-Monocyt
Lymphocyte:
-Lymphoblast
-Prolymphocyte: lrg single nuclei
-lymphocyte: scant cyto
Hmgpathies..
Hmg S…
HmgC..
hmgs: valine replaces glutamic acid, 6th position on beta
hmgc: lysine replaces glutamic acid, 6th position on beta
-washington monument, rod
SC: glove
Sudan B:
perioxidase:
PAS:
Oil RedO:
LAP:
TRAP:
NASDA 3+/NaF1+:
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
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…
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
Hmg principle oxidation of hmg to….
uses these two reagents….
4 sources of error…
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)
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.
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.
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
ESR is the rate of fall of rbc thru plasma, NV female/male…
Increased ESR
female 0-20 more than men
male 0-15
increased…
-inflammation
-rouleax
-increased proteins: fibrinogen
-MM, WM
-macro
-anemia
-tilting/vibration
Decreased ESR
decreased:
-microcytes, sperocytes
-sickle, can’t rouleaux
-polycythemia
-edta, cells shrink
-old specimen or decreased temp
Optical light scattering is also called
laser light scatter, flow cytometry
focuses laser with laminar flow of cells to id granularity/reflectivity
90 side: granularity
Forward: size
Fragile WBC causing pseudoleukopenia…
Smudge cells issues with WBC ct…add
Cryoglobin issues with WBC and cold agg issues…
lipemia…
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
TRAP: hairy cell
-tartrate resistant, acid phosphatase
IDA:
-iron
-ferritin
-TIBC, transferrin:
Anemia of Chronic:
-iron:
-ferritin:
-TIBC, transferrin:
IDA: chronic blood loss
-iron, ferritin: decreased
-TIBC, transferrin: increased
Anemia of Chronic:
-iron: decreased
-ferritin: increased
-TIBC, transferrin: decreased
Leptocyte:
Drepanocyte:
Dacrocyte:
Basostilling made of…
Leptocyte: codocyte, target
Drepanocyte: sickle
Dacrocyte: tear
Baso stil RNA
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:
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
Microcytic anemias:
-5 main
IDA, anemia of chronic
sideroblastic
thall
lead
3 tests for PNH
1 test for PCH
PNH is a … Defect
PNH
-sugar water
-sucrose
-Hams acidified serum
PCH
-Donath landsteiner autoab test, P
Membrane defect
most common thallasemia
beta thall minor, Cooley’s trait
4 neutrophil incusions/anomolies
dohle bodies
toxic gran
vacuolition
Pelger Huet
TT tests for, reagent ,NV
Monitors 3 things
Fibrinogen test,
Reagent, concentration is….to time, NV
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
Factor with all tests normal except 5M urea solubility, clot dissolves
Factor 13
Not involved in coagulation
Factor def with no history of bleeding, only abnormal aPTT
Factor 12
Same and Difference between liver disease and vitK
Both decreased 2,7,9,10
Liver disease has increased factor 8
Normoblast/erythroblast:
-Pro
-Basophillic
-Polychromatophillic
-Orthochromatic(NRBC)
Rubri
-Rubri-blast
-Pro-rubricyte
-Rubricyte
-meta-rubricyte(NRBC)
Chediak Higashi: defect of
Alder Riley: defect of
Chediak Higashi: defect of large lysosomes/fusion on primary granules
Alder Riley: defect of mucopollysacharrides
A=azurophilic
IM:
CMV:
Infectious lymphotosis:
All have increased WBC,Lymphs, reactive
IM:
EBV, POS monospot
CMV:
Neg monospot
Infectious lymphotosis:
<5yrs Old, neg monospot
Hemo A,B,C all normal
PT, 8,9,11 not in extrinsic or common(1,2,5,10)
Lupus anticoag
PTT not corrected by missing.
PT normal
Signs on immature cell
Euchromatin, less packed
Dark cytoplasm
Nucleoli
Nonspecific granules
Plt, lymph, mono maturation 3 cells
Mono/lympho/megakaryo-blast
Pro-mono/lympho/megakaro-cyte
Monocyte, lymphocyte, megakarocyte
Factor assay normal range
50-150%
Romanowsky stain…
Azure is, stains, examples…
Eosin Y is, stains, examples…
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
Pink or light due to…
Blue or dark due to…
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
Alpha thall
Alpha thall major:
HmgH:
Alpha thall minor:
Silent carrier:
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
Cell with older males, large bizarre cerebriform nuclei
Sezary
Bone marrow macrophages that are wrinkled/striated cyto w/accumulation of glucocerebrosidease
BM macrophages w/foamy cytoplasm, sea blue histiocytes, disease called
Gaucher is wrinkly
G=glucocerebrosidease
Niemann-Pick
foamy, sea blue histocytes, sphingomyelinase
Test that tests PLT fnc, affected by #, vascular integrity, less than 10 min NV
BT
Test that measures PLT fnc, defects plug, closure time/time to occlude aperture;
Depends on count and activity
PFA100
Thrombocytopenia due to heparin induced ab, heparin/PF4 complex sensitizes PLT and removed from spleen, <50% PLT ct
HIT
Condition with giant/decreased PLTs/increased BT
abnormal aggregation to Ristocetin, abnormal adhesion
Bernard Soulier
Condition dohle bodies, giant/decreased PLTs, increased BT due to decreased Plts
May hegglin
Condition due to adhesion, abnormal aggregation to Ristocetin, normal PLT ct but increased BT
VWD
Condition with normal PLT ct but increased BT,
only aggregates with Ristocetin/primary agg issue
Glannsmann thrombostenia
WBC least seen
Basophil 2%
Sickle cell increase…
Schistocytes increase, decrease…
Sickle cell increase…wbc
Schistocytes increase, decrease…
Increase PLTs, decrease rbc
What is indicated by a large red cell distribution curve on an automated blood count?
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.
What does a manual reticulocyte count do?
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.
What hematological disease/disorder has an increased number of immature cells?
Acute leukemia
Increased numbers of immature cells are seen in acute leukemias, with the predominating cells being myeloblasts and promyelocytes.
When evaluating an erythrocyte histogram, a shift to the left of the erythrocyte series should correspond to which type of erythrocytes?
Microcytes
A shift to the left of erythrocyte population corresponds to microcytes.
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?
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.
Morphologically, what are anemias generally classified as?
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).
Which lymphoproliferative neoplasm is characterized by Reed Sternberg cells?
Hodgkin lymphoma, a lymphoproliferative neoplasm, is characterized by Reed Sternberg cells.
What stages does a neutrophil normally mature in the bone marrow from the earliest to the most mature?
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.
Phagocytosis
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.
When counting platelets using the Unopette System (a manual method), which area is used to count on the Neubauer hemocytometer?
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.
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?
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.
In most infections, there is some increase in the ESR. What are two exceptions?
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.
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?
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.
Which compartment is the site of differentiation, proliferation, and maturation during the lifespan of a neutrophil?
The bone marrow is the site where neutrophils differentiate, proliferate, and mature. Differentiated neutrophils are then released into systemic circulation.
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?
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.
What is the appropriate ratio of blood to anticoagulant in a sodium citrate tube drawn for routine coagulation studies?
9:1 is the correct ratio of blood to anticoagulant in a sodium citrate tube for routine coagulation studies.
What is the process of stopping blood loss through ruptured blood veins, arteries, and capillaries called?
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.
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?
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.
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
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.
Which laboratory test measures the concentration and activity of fibrinogen in stage II and monitors coumarin therapy?
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.
What test or panel of tests are used to detect RBCs that have been coated with antibodies?
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.
Morphologically, what are anemias generally classified as?
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).
Which type of anemia is a group of inherited disorders of Hb synthesis, characterized by microcytosis, hypochromasia, and basophilic stippling?
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.
What is the name of nucleated red blood cells or reticulocytes in the peripheral blood?
Shift cells
Shift cells are nucleated red blood cells or polychromatic macrocytes (reticulocytes) in the peripheral blood.
Which lymphoproliferative neoplasm is characterized by Reed Sternberg cells?
Hodgkin lymphoma
Hodgkin lymphoma, a lymphoproliferative neoplasm, is characterized by Reed Sternberg cells.
Which coagulation test monitors unfractionated heparin therapy and screens for intrinsic and common pathway deficiencies?
Which coagulation test monitors unfractionated heparin therapy and screens for intrinsic and common pathway deficiencies?
The aPTT measures factors XII, XI, IX, VIII, V, II, and
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).
Cellulose acetate ph8.4
fastest(-) to slowest(+)
Cellulose acetate ph 8.4
fastest(-) to slowest(+)
fast(-) A,F, S,C (+)slow
Heinz body prep nonspecific screen for hemolysis due to drugs/toxins, enzyme deficiencies, thall, and unstable hmg, stain/prep these two conditions
G6PD def
HmgH
Bone Marrow Preps:
Megakaryocytes/10x:
M:E ratio:
Aspirate from:
Stain;
Cell:Fat ratio:
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
ESR
1.)Rouleaux, stage of aggregation, 10min
2.) sedimentation, settling 40min
3.) Packing 10min
Basophilic stippling: RNA
a red blood cell inclusion, is composed of ribonucleic acid. Additionally, it is indicative of thalassemia or lead poisoning.
ESR
1.)Rouleaux, stage of aggregation, 10min
2.) sedimentation, settling 40min
3.) Packing 10min
Basophilic stippling: RNA
a red blood cell inclusion, is composed of ribonucleic acid. Additionally, it is indicative of thalassemia or lead poisoning.
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
The standard current test for confirming a positive HIV test uses the Western blot technology.
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
The standard current test for confirming a positive HIV test uses the Western blot technology.
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
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.
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
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.
Ethylene diamine tettracetic acid
Edta
Bone marrow
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
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
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
Heme
Iron, protopotphyrin
While I’m Delta, Por, UR, Cop, pronto, heme
…
Heme
Iron, protopotphyrin
While I’m Delta, Por, UR, Cop, pronto, heme
…
Hemoglobinopathy: structural mutation, amino change
Thalassemia: decreased production of alpha or beta
-micro hypo
Hmgpathy
S-valine 6th beta
C-lysine 6th beta
D- indian, S
G-black, S
E-asian,C
