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Final Exam > Chap 11 > Flashcards

Chap 11 Flashcards

Manual Testing in Hematology

1
Q

What anticoagulant is used in the hematology lab?

A

Ethylenediaminetetraacetic Acid (EDTA)

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2
Q

How long can a CBC be stored at room temp before analysis should be done?

A

6hrs

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3
Q

If we needed to store the sample for 24hrs, what temp should it be stored at?

A

4 degrees Celcius

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4
Q

Within what time frame should PB smears be made?

A

Within 3 hrs of collection

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5
Q

Why do PB smears need to be made w/n 3 hrs?

A

To reduce cell deterioration and morph artifacts.

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6
Q

When looking at the grid of a hemacytometer, which squares are counted for WBCs?

A

The 4 corners, each of the corners has 16 squares.

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7
Q

When looking at the grid of a hemacytometer, which squares are counted for RBCs

A

The 4 corners and middle square of the middle big square. (make it make sense)

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8
Q

What is the dilution fluid used when doing a manual WBC or PLT count?

A

1% buffered Ammonium oxalate or if just counting WBCs, a weak acid solution (3% acetic acid or 1% hydrochloric acid) can be used.

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9
Q

Typical dilution for WBC count?

A

1:20, unless PLTs need counted as well, then 1:100.

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10
Q

What are the parts of dilution for manual WBC count?

A

1 part, 25uL of well-mixed blood to 1part of 475uL of diluting fluid.

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11
Q

How long does a hemacytometer sit after being charged and why?

A

Sets for 10min to allow the cells time to settle.

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12
Q

Cells touching the top and left side lines on a hemacytometer are counted? (T or F)

A

True

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13
Q

Cells touching the bottom and right side lines on a hemacytometer are counted in the box your currently counting? (T or F)

A

False

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14
Q

Typical dilution for a manual PLT count on a hemacytometer? Dilution Fluid?

A

1:100 W/ 1% ammonium oxalate

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15
Q

Where on a hemacytometer do we count PLTs?

A

All 25 squares of the big middle square.

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16
Q

To count RBCs on the hemacytometer, what kind of diluting fluid is used?

A

Isotonic Saline

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17
Q

What is the dilution for a manual RBC count on the hemacytometer?

A

1:100

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18
Q

The ________number of cells on the 2 slides is used to calculate the WBCs.

A

Average

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19
Q

The WBC calculation is?

A

Cells Counted x Dilution Factor/
# of square counted x the depth

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20
Q

WBC Calculation example
Calculate
96 cells, 20 dilution factor (DF), 4 sq counted, and 0.1 depth?

A

96 (cells) x 20 (DF)
Divided by
4 (sq counted) x 0.1 (depth)
96x20x10/4= 4800/mm cubed
4.8x10^3/uL

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21
Q

What is the 1:100 dilution for a PLT count on a hemacytometer?

A

20uL of well-mixed blood into 1980uL of 1% ammonium oxalate.

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22
Q

What makes manual RBC counts so rare?

A

Inaccuracy of the count and questionable necessity.

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23
Q

What power do we count each cell type on?

A

WBCs- 10x (100x W/ ocular and obj.)
RBCs-40x (400x W/ ocular and obj.)
PLTs-40x (400x W/ ocular and obj.)

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24
Q

Principle of the cyanmethhemoglobin assay to determine Hgb?

A

Blood in an alkaline Drabkin solution, (potassium ferricyanide, potassium cyanide, sodium bicarbonate, and a surfactant). Hgb is oxidized to met-Hgb (Fe3+) by the potassium ferricyanide, K3Fe(CN)6. The potassium cyanide (KCN) then converts the met-Hgb to cyanmet-Hgb.

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25
Q

What wavelength should the spectrophotometer be set at for the Cyanmethemoglobin assay?

A

540nm

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26
Q

When performing a microhematocrit, what speed should the centrifuge be set at?

A

10,000-15,000g

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27
Q

Before centrifuging a specimen for a microhematocrit, what must be placed in the end?

A

Non-absorbent clay

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28
Q

When attempting to measure and read the hematocrit using a microhematocrit, what do you avoid?

A

Including the buffy coat

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29
Q

Rule of 3?

A

Hgb x 3 = Hct (+/- 3)
RBC x 3 = Hgb
RBC x 9 = Hct

30
Q

What can cause the rule of 3 to not correlate the data?

A

Red cells are abnormal (not normochromic, normocytic).

31
Q

MCV

A

Hct x 10/ RBC = (fL)

32
Q

MCH

A

Hgb x 10/RBC = (pg)

33
Q

MCHC

A

Hgb x 100/Hct = (%)

34
Q

MCV reference range

A

80.0-100.0 fL

35
Q

Newborn MCV reference range

A

95.0-125.0 fL

36
Q

Children MCV reference range

A

76.0-92.0 fL

37
Q

MCH Reference Range

A

26.0-34.0 pg

38
Q

MCHC reference range

A

32.0-36.0% (or g/dL)

39
Q

RDW reference range

A

11.5-14.5%

40
Q

MCV<80fL, MCHC<32, Microcytic, Hypochromic?

A

IDA, Anemia of Inflammation, Thalassemias, Hb E Disease and trait, SA

41
Q

MCV 80-100, MCHC 32-36, Normocytic, Normochromic?

A

Hemolytic Anemia, Myelophthisic Anemia, BM failure, Chronic Renal Disease

42
Q

MCV >100, MCHC 32-36, Macrocytic, Normochromic?

A

Megaloblastic Anemia, Chronic liver disease (CLD), BM failure, Myelodysplastic Syndrome

43
Q

Principle of manual Retic count?

A

Any NRBCs W/ 2 or more particles of blue granulofilamentous material after supravital stain new methylene blue are retics.

44
Q

What stain do we use to stain retics?

A

Supravital stain New methylene blue(SPS and NMB)

45
Q

How many drops of blood to how much NMB for a retic stain?

A

Equal parts

46
Q

How long should the tube sit after blood and NMB have been added?

A

3-10 minutes (Closer to 10)

47
Q

What should be done to improve Retic counts?

A

Have another laboratorian count the other film made and the counts should be within 20%.

48
Q

How many wedge smears are made for a retic count?

A

2

49
Q

Retic % calculation

A

of retics x 100/ 1000 RBCs counted

50
Q

Retic % calculation Example:
15 (Retics) x 100/ 1000 (RBCs)

A

15 x 100/ 1000=
150/1000= 1.5%

51
Q

Absolute Retic Calculation (ARC)

A

Retic % x RBC Count/ 100

52
Q

ARC Example
Calculate
4.0% Retics in 1000 RBCs, 3.01 million RBCs

A

4.0 x 3,010,000/ 100=
12,040,000/100= 120,400 or 120.0x10^3/uL

53
Q

What can cause an increased Retic count %?

A

Low Hematocrit

54
Q

Corrected Retic Count (CRC) Calculation

A

CRC= Retic % x PT Hct %/ 45 (Normal Hct)

55
Q

CRC Example
Calculate
Retic %- 5.5%, PT Hct- 24%

A

5.5% x 0.24/45=
1.32/45= 0.029 CRC %

56
Q

Retic reference range

A

0.5-2.5% (Relative)
or
20,000-115,000/uL or 20-115x10^3/uL (Absolute)

57
Q

Shift Retics

A

Retics that are released from the BM prematurely.

58
Q

What can cause shift retics?

A

Anemia or RBC morph W/ polychromasia.

59
Q

Retic Production Index (RPI)

A

Indicates the BM’s response

60
Q

RPI Calculation

A

RPI= Retic % x (Hct %/45)/ Mature Time
or
RPI= CRC/Mature time
(When Retics have been corrected)

61
Q

RPI Example
Calculate
7.8% Retics, Hct 30%, W/ polychromasia
Maturation time 2 days.

A

7.8%x(0.3/0.45)/ 2=
7.8x0.67/2= 2.613
RPI=2.6

62
Q

RPI greater than 3 indicates?

A

Adequate BM response

63
Q

RPI less than 2 indicates?

A

Inadequate Erythropoietic response

64
Q

Erythrocyte Sedimentation Rate (ESR)

A

Ordered W/ other tests to detect and monitor course of Imflammatory conditions (I.E. RA, Infections, certain malignancies).

65
Q

ESR is useful in diagnosing RA, but what other 2 arthritis diseases is it also helpful with?

A

Temporal Arteritis and Polymyalgia Rheumatica.

66
Q

(T or F): ESR is a specific test for inflammatory diseases?

A

False, the ESR is elevated in many other conditions (I.E. Plasma cell myeloma, Pregnancy, Anemia, older age).

67
Q

What test for inflammation may be more predictable and reliable than ESR?

A

C-reactive protein

68
Q

ESR is?

A

the distance in mm that RBCs fall in 1 hr.

69
Q

Male ESR reference range and males over 50?

A

0-15mm/hr
0-20mm/hr (>50)

70
Q

Female ESR reference range and females over 50?

A

0-20mm/hr
0-30mm/hr (>50)

Final Exam (27 decks)

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