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HEMA LAB > Automation > Flashcards

Automation Flashcards

1
Q

Used by most laboratories because results are readily available for a short period of time

A

Automation

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2
Q

How long does automation take?

A

1-2 mins

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3
Q

Provides the Standard Hematology Parameters:

A

Automation

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4
Q

Enumerate the standard hematology parameters

A

RBC Count and Indices, including hemoglobin and hematocrit
WBC Count
Platelet Count
WBC Differential Count

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5
Q

Different Types of Automated Analyzer in Hematology

A

3-part (segmenters, lymphocytes, monocytes)
5-part (Neu, Eos, Baso, Lympho, Mono)
6-part (Neu, Eos, Baso, Lympho, Mono, nRBC)

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6
Q

What are the 3 segmenters

A

3 segmenters: Neutrophils, Eosinophils, Basophils (counted as 1 unit)

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7
Q

T/F: in 6-part, Counting of nRBC is important because it is mistaken as WBC

A

T

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8
Q

Corrected WBC count is performed if there are many nRBCs

A

6-part (Neu, Eos, Baso, Lympho, Mono, nRBC)

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9
Q

Enumerate the different automated machines

A

Electrical Impedance
Radiofrequency
Optical Scatter

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10
Q

aka Low-Voltage Direct Current or Coulter Principle

A

ELECTRICAL IMPEDANCE

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11
Q

Most common principle used in hematology analyzer

A

Electrical Impedance

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12
Q

Electrical impedance is developed by _________________ (________)

A

Coulter Electronics (1950’s)

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13
Q

Coulter Electronics (1950’s) 1st automated hematology analyzer

A

Coulter Cell Counter Model A

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14
Q

Examples of electrical impedance

A

Beckman Coulter (LH series, GEN-S, HmX, A-T)
Sysmex (XE and XT series)
Abbott (Cell-Dyn, 3700, Ruby, Sapphire,.)
ABX (Micros 60, Pentra series)

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15
Q

FIll in the blank:

Principle of Electrical impedance: As a _______ suspension of cells is drawn through the _______, the passage of each individual cell momentarily (increases/decreases) the impedance (resistance) of the electrical path between two submerged electrodes that are located on each side of the aperture.

A

dilute
aperture
increases

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16
Q

Blood cells are suspended primarily in an________ solution.

A

Isotonic solution

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17
Q

The isotonic solution is present in the?

A

aperture bath

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18
Q

Two aperture electrodes:

A

External electrode
Internal electrode

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19
Q

located inside the aperture tubes which contains an aperture

A

Internal electrode

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20
Q

As cell enters the aperture, it will (decrease/increase) impedance (electrical resistance)

A

increase

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21
Q

T/F: Cells are excellent conductors of electricity

A

F: POOR conductors

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22
Q

As the cell passes through the aperture, it ________ the electrical current between the internal and external electrodes causing an __________________

A

disrupts
electrical resistance.

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23
Q

Each electrical resistance causes a pulse which is measured:

A

Number of pulse
Height of pulse

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24
Q

The generated pulse is displayed in a _____________ or _____________

A

oscilloscope or histogram

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25
Q

process for generated pulse

A

cells –> aperture –> resistance –> pulse

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26
Q

Displays the pulses generated by the cells as they interrupt the current

A

Oscilloscope

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27
Q

Oscilloscope

Number of pulses = the number of _____

A

cells

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28
Q

Oscilloscope

Amplitude of impulses = ____/_____ of cells

A

size/volume

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29
Q

height of the pulse

A

Y-axis

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30
Q

allows discrimination of cells of specific volume

A

threshold circuits

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31
Q

Histogram
Principle:

Number of pulses (y axis) = _________

A

Number of cells

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32
Q

Histogram’
Principle

Amplitude of pulse (x-axis) = _____________

A

Cell size/volume

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33
Q

will only identify cell based on its volume range

A

Threshold circuit

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34
Q

usually expressed in femtoliters

A

Threshold circuit

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35
Q

Steps for Electronic Impedance

A

Sample is diluting in an isotonic solution
Dilution is instrument-dependent
RBC and Platelets are simultaneously counted (in one aperture)
WBC counting
Hemoglobin and WBC are simultaneously assessed

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36
Q

Aka RF resistance, high-voltage electromagnetic current

A

Radiofrequency

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37
Q

Used in conjunction with low-voltage direct current (DC) impedance/electrical impedance

A

Radiofrequency

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38
Q

Radiofrequency

Measures ____________

A

conductivity

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39
Q

Radiofrequency measures conductivity which is relative to the:

A

Nuclear:cytoplasmic or N:C ratio,
nuclear density,
cytoplasmic granulation

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40
Q

Radiofrequency is used to detect ____, ____ based on the cellulary desntiy

A

It’s used to detect cell size

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41
Q

Examples of radiofrequency

A

Coulter (LH series, GENfi-S, HmX, A-T)
Sysmex (XE-2100, XT 2000i, HST-N)
Abbott

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42
Q

Principle for radiofrequency

A

Measures two different cell properties (based on the 2 methods):

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43
Q

2 methods in the principle of radiofrequency

A

DC impedance
RF pulse/Conductivity

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44
Q

proportional to cell volume

A

DC Impedance

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45
Q

proportional to intracellular density

A

RF pules/conductivity

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46
Q

Plotted using cytogram or scatterplot

A

Radiofrequency

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47
Q

T/F: Radiofrequency allows 6-part WBC differential

A

5-part WBC differential

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48
Q

Since intracellular density is also identified, the 3 segmenters can now be differentiated as well as ______, and ________

A

monocyte and lymphocyte

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49
Q

Enumerate the errors which may be encountered in automation

A

Instrumental Errors
Nature of Specimen

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50
Q

Enumerate instrumental errors

A

Aperture plugs
Bubbles in the specimen
Extraneous electrical impulses
Excessive lysing of RBCs
Improper setting of aperture current

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51
Q

Which error in instrumental error causes false decrease in RBC count

A

Excessive lysing of RBCs

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52
Q

Which error in instrumental errors

A

may cause (+) or (-) error or either false increase or false decrease

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53
Q

In instrumental errors, all causes false increase in hematology parameter except for _________, and __________

A

Excessive lysing of RBCs
Improper setting of aperture current

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54
Q

Enumerate the errors in nature of specimen

A

Giant platelets/macrothrombocytes
Fragments of WBC cytoplasm
Some abnormal RBCs resist lysis

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55
Q

Which error in nature of specimen is not identified or counted as platelets due to its size

A

Giant platelets/macrothrombocytes

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56
Q

Giant platelets/macrothrombocytes may be counted as:

RBC: false (increase/decrease)
WBC: false (increase/decrease)

A

RBC - false increase
WBC - false increase

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57
Q

Giant platelets/macrothrombocytes causes false (increase/decrease) in platelet

A

decrease

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58
Q

Which error in nature of specimen is counted as ↑platelet, ↑RBC but most of the time as platelet

A

Fragments of WBC cytoplasm

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59
Q

In “some abnormal RBCs resist lysis”, enumerate what may cause false increase in WBC

A

HbS
HbC
HbF

60
Q

What light source is used in optical scatter?

A

laser light (mercury arc)
non-laser light (tungsten halogen lamp)

61
Q

Used to measure light scattering properties of cells

A

Optical scatter

62
Q

T/F: cells can scatter light at a specific angle

A

F; various angles

63
Q

Examples of optical scatter

A

Sysmex
Abbott

64
Q

Principle of optical scatter:

As a single cell passes through the _________ of the flow cell, it scatters the __________

A

sensing zone
focus light

65
Q

Scattered light is detected by a _________

A

photodetector

66
Q

T/F: Photodetector are placed at a different angle so that it can detect light

A

true

67
Q

Each time the photodetector detects a light, it will cause a _______

A

pulse

68
Q

The number of pulses is (directly/indirectly) proportional to the number of cells passing through the sensing zone.

A

Directly

69
Q

Enumerate the angles of light scatter

A

Forward-angle light scatter (0°)
Forward low-angle light scatter (2 to 3°) & Forward high-angle (5 to 15°)
Orthogonal light scatter (90°)

70
Q

cell volume or cell size

A

Forward-angle light scatter (0°)

71
Q

diffracted light by the cell

A

Forward-angle light scatter (0°)

72
Q

as cell passes through it diffracts the light

A

Forward-angle light scatter (0°)

73
Q

can relate to size or volume and allows for description of the refractive index of cellular components

A

Forward low-angle light scatter (2 to 3°) & Forward high-angle (5 to 15°)

74
Q

Forward low-angle light scatter (2 to 3°) & Forward high-angle (5 to 15°)

as cells pass through the focus light:
smaller cell = __________________
bigger cell = ______________

A

smaller angle
bigger angle

75
Q

Orthogonal light scatter (90°) aka _________

A

side scatter

76
Q

correlates w/ degree of internal complexity (granularity and lobularity)

A

Orthogonal light scatter (90°)

77
Q

allows identification of granulocytes

A

Orthogonal light scatter (90°)

78
Q

In the patterns of optical light scatter, enumerate the factors

A

Absorbance
Diffraction
Refraction
Reflection

79
Q

the wavelength of light that is not transmitted

A

Absorbance

80
Q

bending of light around corners with the use of small angles

A

Diffraction

81
Q

bending of light because of a change in speed with the use of intermediate angles

A

Refraction

82
Q

light rays turned back by the surface or an obstruction with the use of large angles

A

Reflection

83
Q

Enumerate the common interferences on automated analyzers

A

COLD AGGLUTININS
LIPEMIA, ICTERUS
HEMOLYSIS

84
Q

In cold agglutinins, blood wherein RBC agglutinates below the body temp. optimally at ______ (grainy appearance)

A

4°C

85
Q

because at a temp. below the body temperature, this cold acting antibodies reacts, causing agglutination of RBC

A

IgM

86
Q

Parameters affected in cold agglutinins

Decreased: ______
Increased: ____, _____

A

RBC
MCV, MCHC

87
Q

T/F: because RBC clumps and or agglutinated (false increase in size), therefore not identified as RBC

A

True

88
Q

What is the correction action for cold agglutinins

A

Warm the sample at 37°C then re-run

89
Q

Lipemia causes __________, while icterus causes ______________________

A

turbidity
abnormal color in blood

90
Q

Lipemia and icterus can affect _____________ reading

A

spectrophotometric

91
Q

Parameters affected in lipemia and icterus

Increased: _____, ______

A

Hgb, MCH

92
Q

principle of automated analyzer in measuring hemoglobin which is why Hgb is affected

A

Cyanmethemoglobin

93
Q

T/F: Hbg value is used to compute for MCH (mean cell hemoglobin), therefore it is also affected

A

True

94
Q

Interferences in automated analyzers due to improper specimen collection

A

Hemolysis

95
Q

Parameters affected in hemolysis

Decreased: ____. _____

A

RBC, Hct

96
Q

T/F: In hemolysis, The RBCs are lysed, but it is still counted as RBC causing false increase

A

F; NOT counted as RBC causing false DECREASE

97
Q

ENUMERATE OTHER PARAMETERS AFFECTED

A
  • Lysis-resistant RBC
  • Microcytosis (small RBCs) and/or Schistocytosis
  • nRBC, megakaryocyte fragments, and
    micromegakaryoblasts
  • Platelet Clumps/macrothrombocytes (giant
    platelets)
  • WBC (>100,000/uL)
  • Leukemia with chemotherapy
  • Old Specimen
98
Q

Lysis-resistant RBC

Increased: ____, _____
Decreased: ______
Others:______

A

Increased: WBC, Hgb
Decreased: None
Others: None

99
Q

Microcytosis (small RBCs) and/or Schistocytosis

Increased: ______
Decreased: ______
Others:______

A

Increased: None
Decreased: RBC
Others: None

100
Q

nRBC, megakaryocyte fragments, and micromegakaryoblasts

Increased: ______
Decreased: ______
Others:______

A

Increased: WBC
Decreased: None
Others: None

101
Q

Platelet Clumps/macrothrombocytes (giant platelets)

Increased: ______
Decreased: ______
Others:______

A

Increased: WBC
Decreased: Platelets
Others: None

102
Q

WBC (>100,000/uL)

Increased: _____, ______
Decreased: ______
Others:______

A

Increased: RBC, Hgb
Decreased: None
Others: Incorrect Hct, Abnormal RBC indices

103
Q

Leukemia with chemotheraphy

Increased: _____
Decreased: ______
Others:______

A

Increased: Platelet
Decreased: WBC
Others: None

104
Q

Old Specimen

Increased: _____, ______
Decreased: ______
Others:______

A

Increased: MCV
Decreased: Platelets
Others: Incorrect WBC differential

105
Q

Increased paraproteins

Increased: _____
Decreased: ______
Others:______

A

Increased: Hgb
Decreased: None
Others: Incorrect RBC Indices (esp. Indices using hemoglobin value MCH, MCHC; MCV value is NOT affected

106
Q

Hyperglycemia

Increased: _____, _______
Decreased: ______
Others:______

A

Increased: MCV, Hct
Decreased: MCHC
Others: None

107
Q

Howell-Jolly Bodies

Increased: _____
Decreased: ______
Others:______

A

Increased: Platelet
Decreased: None
Others: None

108
Q

RBC containing HbS, HbC, HbF

A

Lysis-resistant RBC

109
Q

Microcytosis (small RBCs) and/or Schistocytosis

Most automated hematology analyzers count RBC if the volume is between ___________fL

A

36-360fL.

110
Q

T/F: If the RBC size is decreased (in case of microcytosis), it is not counted as RBC. same with schistocytosis

A

True

111
Q

They are counted as WBC

A

nRBC, megakaryocyte fragments, and micromegakaryoblasts

112
Q

nRBC, megakaryocyte fragments, and micromegakaryoblasts

Corrective action: count nRBC, megakaryocyte fragments, and micromegakaryoblasts per ___________ and performed corrected WBC count

A

100 WBCs

113
Q

T/F: Platelets increased in size as they clumps (not counted as WBC)

A

F; COUNTED as WBC

114
Q

Platelet Clumps/macrothrombocytes (giant platelets)

Corrective action: redraw blood using __________ then multiple the result by ____

A

citrate tube
1.1

115
Q

> 100,000/uL of WBC may cause ________ in blood

A

turbidity

116
Q

WBCs are very fragile therefore WBC is decreased.

A

Leukemia with chemotherapy

117
Q

Leukemia with chemotherapy

If the WBC is destroyed, the fragments are counted as platelet causing an (decrease/increase) in platelet

A

increase

118
Q

Old specimen

RBC swells causing an increase in ______

A

MCV.

119
Q

Old Specimen

T/F: Platelets swell and degenerate causing a decrease in amount.

A

True

120
Q

Old Specimen

Prolonged exposure of blood with ______ affects WBC

A

EDTA

121
Q

Old specimen

Corrective action:
–> _____________
–> The laboratory should also established a ____________ (criteria in which the laboratory follows)

A

Recollect sample
Rejection criteria

122
Q

Hyperglycemia causes RBC to (swell/shrink)

A

Swell

123
Q

Hyperglycemia

Hgb conc. is relative to the size of the swollen RBC therefore, _________ is decreased

A

MCHC

124
Q

Nuclear remnants and the size is similar to that of platelet

A

Howell-Jolly Bodies

125
Q

Howell-Jolly Bodies

Corrective action: evaluate ___________ to check if the patient has Howell-Jolly Bodies

A

blood smear

126
Q

Hematocrit CV

A

≤ 21% (0.21)
≥ 65% (0.65)

127
Q

Hemoglobin CV

A

≤ 70 g/L
≥ 200 g/L

128
Q

Reticulocyte CV

A

> 20%

129
Q

WBC count CV

A

< 2,000/uL
> 50,000/uL

130
Q

enumerate blood smear CV

A

Neutrophilic phagocytosis of microorganism
Abnormal Leukemoid Reaction
Schistocytes or RBC fragments
Sickle cells
Blasts/immature cells (if new patient)
Presence of intracellular organisms

131
Q

Blood Smear

presence of systemic infection (sepsis)

A

Neutrophilic phagocytosis of microorganism

132
Q

Blood Smear

indicates hemolytic condition

A

Schistocytes or RBC fragments

133
Q

Blood Smear

Sickle cells indicates

A

hemoglobinopathy or thalassemia

134
Q

Blood smear

indicates that the patient has leukemic condition;

A

Blasts/immature cells

135
Q

Blood smear

only reported immediately on new patients

A

Blast/immature cells

136
Q

Platelets CV

A

< 20,000/uL (if not previously reported)
> 1 million/uL

137
Q

If these values are observed, double check the results by performing the following:

A

–> Rule of three
–> Manual method of the parameter with the critical
value
–> Rerun the sample with control solution

138
Q

Only a way of checking the result of hematology analyzer

A

Rule of three

139
Q

Used for quality control

A

Rule of three

140
Q

Rule of three

Shall only be used if the RBC is:

A

Normocytic (normal MCV)
Normochromic (normal MCHC)

141
Q

In the rule of three, multiple the results by ____

A

3

142
Q

Rule of three

RBC x 3 = _____
Hbg x 3 = ______

A

RBC x 3 = Hbg
Hbg x 3 =Hct (3%)

143
Q

What is the value of RBC?

A

3.62 x 10^12/L

144
Q

What is the value of Hbg?

A

11.1 g/dL

145
Q

What is the value of Hct?

A

32.6%

146
Q

T/F: in rule of three, If the value are close, it means the result of the machine is correct

A

True

147
Q

Manual method of the parameter with the critical value

Example: In hematocrit, ______________ using _______________

A

microhematocrit method
microhematocrit centrifuge

HEMA LAB (1 decks)

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