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HEMA 1 LEC > Chapter 7 - SPECIAL HEMATOLOGY PROCEDURES > Flashcards

Chapter 7 - SPECIAL HEMATOLOGY PROCEDURES Flashcards

1
Q

are distorted cells appearing as thin, dense and elongated cells with both ends pointed

A

Sickle cells

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2
Q

is caused by the precipitation of an atypical hemoglobin (commonly hemoglobin S ), which distort the red blood cells into a sickle or crescent shape.

A

Sickling

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3
Q

is fully soluble when oxygenated but becomes insoluble when the oxygen level is decreased.

A

Hemoglobin S

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4
Q

It first polymerizes then forms into crystals which cause the red cell to become rigid

A

Hemoglobin S

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5
Q

Principle: the red blood cells take on a sickle-like shape when oxygen supply to the red cell is decreased (HbS forms insoluble tactoid crystals when exposed to low oxygen tension)

A

Sealed Whole Blood Method (Scriver & Waugh)

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6
Q

Degree of sickling depends on the concentration of Hb S in the RBC

A

Sealed Whole Blood Method (Scriver & Waugh)

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7
Q

Readings are made at an hourly interval for 2 - 3 hrs

A

Sealed Whole Blood Method (Scriver & Waugh)

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8
Q

A positive result is diagnostic but does NOT distinguish between hb S trait and hb S anemia

A

Sealed Whole Blood Method (Scriver & Waugh)

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9
Q

Reagent: 2 % Sodium metabisulfite or sodium bisulfate

A

Sodium Metabisulfite Methods (Daland & Castle)

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10
Q

Principle: A drop of blood is mixed with a drop of 2% sodium metabisulfite (a reducing agent) on a slide, and the mixture is sealed under a coverslip. The hemoglobin inside the RBCs becomes deoxygenated causing polymerization and the resultant sickle cell formation.

A

Sodium Metabisulfite Methods (Daland & Castle)

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11
Q

Reagent: Sodium hydrosulfite (dithionite)

A

Solubility test

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12
Q

Specimen: Whole blood with EDTA, heparin or sodium citrate

A

Solubility test

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13
Q

Principle: Red cells are lysed by saponin allowing Hb to escape. Sodium dithionite binds and removes oxygen from the test environment. HbS polymerizes in the deoxygenated state and forms a precipitate in a high-molarity phosphate buffer solution. The tactoids refract or deflect light and make the solution TURBID.

A

Solubility test

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14
Q

Observe specimen for turbidity by holding the tube 2.5 cm in front of a newsprint or a card reader with thin black lines.

A

Solubility test

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15
Q

TURBIDITY indicates PRESENCE of sickling Hb regardless of any genotype

A

Solubility test

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16
Q

Principle: Hb A & S reagents contain monoclonal antibodies (IgG), which specifically bind to the amino acids at or near the 6th position of the B-chain of hb S and A.

A
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17
Q

will react with the B-chain of HbS. but not with Hb A

A

Hb S monoclonal Ab

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18
Q

will react with the B-chain of HbA, but not with Hb S

A

Hb A monoclonal Ab

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19
Q

are adsorbed to suspended metal sol particles giving the reagent raspberry-like color.

A

Abs

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20
Q

Confirmatory tests:

A

Hemoglobin Electrophoresis; High performance liquid chromatography; Capillary
electrophoresis

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21
Q

are young erythrocytes that are in a discrete, penultimate phase of maturation where the nucleus has been removed, however, some of the extranuclear RNA remains in the cytoplasm.

A

Reticulocytes

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22
Q

The term (?) is derived from the fact that the cell contains a small network of basophilic materials called reticulum which is demonstrable only by supravital stain.

A

reticulocyte

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23
Q

In the peripheral blood they are called as (?).

A

polychromatophilic erythrocytes

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24
Q

Reticulocyte count and its associated corrections can be used to assess

A

bone marrow erythrophoietic activity.

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25
Q

The (?) is stained supravitally. Any non-nucleated RBC that contains 2 or more blue stained particles/granulofilamentous materials, is counted as reticulocyte.

A

ribosomal RNA

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26
Q

: Wet method and Dr Method (schillings method)

A

Methods of Staining

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27
Q

Reticulocytes are enumerated among 1000 RBCs in areas where RBCs are close but not overlapping and reticulocytes appear to be well stained.

A

Light Microscope

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28
Q

Light Microscope Retic % =

A
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29
Q

The calibrated Miller disc appears in the field with 2 squares: a large square and a small square inside the large square which is 1/9 the size of the larger square.

A

Miller Disc Method

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30
Q

Reticulocytes are counted in the large square while RBCs are counted in the small square in successive fields on the film until a total of 500 RBCs have been counted

A

Miller Disc Method

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31
Q

Miller Disc Method Retic % =

A
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32
Q

Reference Value:
Adults:
Newborn:

A

Adults: 0.5 - 1.5 %
Newborn: 2.5 - 6.5 %

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33
Q

Inclusions confused with Reticulocytes:

A

Pappenheimer bodies; Howell-Jolly bodies; Heinz bodies; Artifact

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34
Q

: actual number of Reticulocytes in 1 Liter of whole blood.

A

Absolute Reticulocyte Count

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35
Q

ARC =

Reference Value:

A

25.000 - 75,000 /uL

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36
Q

this corrects the Reticulocte count to a normal Hct to allow correction for the degree of patient anemia.

A

Corrected Retic count / Reticulocyte Index

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37
Q

The percentage of reticuloctes may appear increased because of early release into the circulation or because of a decrease in the number of mature RBCs in the circulation.

A

Corrected Retic count / Reticulocyte Index

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38
Q

CRC =

Reference value:

A

1% (depends on the degree of anemia)

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39
Q

: Index calculated to correct for the presence of shift reticulocytes that otherwise may falsely elevate the visual reticulocyte count.

A

Reticulocyte Production Index/Shift Correction (RPI)

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40
Q

RPI =

Reference value:

A

1 if hct is 0.45

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41
Q

Clinical Significance of Reticulocytes:

A

Increased in hemolytic & hemorrhagic anemias

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42
Q

40 - 45
35 - 39
25 - 34
15 - 24
< 15

A

40 - 45 1.0
35 - 39 1.5
25 - 34 2.0
15 - 24 2.5
< 15 3

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43
Q

measures the ability of the RBCs to take in fluid without lysing.

A

OFT

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44
Q

It Reflects RBC shape and size (surface area-to-volume ratio).

A

OFT

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45
Q

This is used to detect spherocytosis, because spherocytes rupture in saline concentrations near the normal level.

A

OFT

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46
Q

It may also detect target cells, which, owing to their reduced hemoglobin content, are able to withstand osmotic stress and rupture only at very dilute saline concentrations.

A

OFT

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47
Q

Importance: Diagnosis of (?) and other hemolytic anemias associated with spherocytes.

A

Hereditary Spherocytosis (HS)

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48
Q

Affected by: shape of the RBC, which in turns depends on the (?).

A

volume, surface area and functional state of the cell membrane

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49
Q

Specimen: (?); Blood sample should be obtained with minimum trauma and stasis

A

Heparinized blood or defibrinated blood

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50
Q

Normal Result:
Incomplete hemolysis:
Complete hemolysis:

A

0.45 %

0.35 %

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51
Q

whole blood is pipetted to each of a series of hypotonic saline solutions of graduated concentration.

A

Sanford Method

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52
Q

Uses hypotonic saline buffered with PO4 at ph 7.4

A

Dace Med

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53
Q

Hemolysis is determined spectrophotometrically at 540 nm

A

Dace Med

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54
Q

: sterile incubation at 37OC for 18 24 hrs to detect mild forms of hereditary spherocytosis.

A

Incubated OFT

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55
Q

Clinical Significance of OFT:
Increased OFT:

A

Hereditary spherocytosis; red cells with abnormal membrane; severe G-6-PDH deficiency; Pyruvate kinase deficiency; hemolytic anemias

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56
Q

Clinical Significance of OFT:
Decreased OFT:

A

Sickle cell anemia, severe Iron deficiency anemia, Thalassemia

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57
Q

Measures the degree of settling of erythrocytes in plasma in an anticoagulated whole-blood during a specified period of time.

A

ERYTHROCYTE SEDIMENTATION RATE

58
Q

Importance:
1. An non-specific measure of (?).
2. It is a good index for the presence of a (?)
3. It measures the (?) of the RBCs
4. It measures the (?) of fibrinogen and globulin

A

inflammation

hidden but active disease

suspension ability

abnormal concentration

59
Q

Stages of ESR:

A
  1. Lag phase/Initial rouleaux occurs during the first 10 minutes.
  2. Decantation phase/ Period of rapid settling occurs within 40 minutes.
  3. Final settling/packing occurs during the last 10 minutes.
60
Q

occurs during the first 10 minutes.

A
  1. Lag phase/Initial rouleaux
61
Q

Period of rapid settling occurs within 40 minutes.

A
  1. Decantation phase
62
Q

occurs during the last 10 minutes.

A
  1. Final settling/packing
63
Q

Erythrocyte factors

A

RBC size or mass: directly proportional to ESR
Number of RBC: inversely proportional
Presence of Anisocytes & Poikilocytes: slower settling

64
Q

Plasma factors

A

Plasma viscosity

Plasma composition

65
Q

: inversely proportional to ESR

A

Plasma viscosity

66
Q

fibrinogen, -1 globulin, -2 globulin

A

= increase ESR

67
Q

: decreases ESR

A

albumin & lecitihin

68
Q

: should be exactly vertical.

A

Position of the tube

69
Q

: should be free from any movement or vibration

A

Incubation environment

70
Q

: should be at room temperature

A

Incubation temperature

71
Q

of the tube

A

Length and Diameter

72
Q

: should not be over-anticoagulated

A

Anticoagulant

73
Q

of setting up

A

Time

74
Q

Erythrocyte factors

A
75
Q

Plasma factors

A
76
Q

Mechanical/Technical factors

A
77
Q

Factors affecting settling of RBC

A
78
Q

Anticoagulant = Ammonium-Potassium Oxalate

A

Wintrobe & Landsberg Method (Wintrobe tube)

79
Q

Westergren Method (Westergren tube)

A

Anticogulant: Original Westergren = 3.8% sodium citrate

80
Q

Modified Method =

A

2 ml of EDTA-anticoagulated blood with 0.5 ml NSS or 3.8% sodium citrate

81
Q

Less than 50 y/o:

A

0 - 15 mm/hr
0 - 20 mm/hr

82
Q

More than 50 y/o:

A

0 - 20 mm/hr
0 - 30 mm/hr

83
Q

More than 85 y/o:

A

0 - 30 mm/hr
0 - 42 mm/hr

84
Q

Children:

A

0 - 10 mm/hr

85
Q

Inflammations; acute & chronic infections, tuberculosis, multiple myeloma

A

Increased ESR

86
Q

Rheumatic fever, rheumatoid arthritis, myocardial infarction, nephrosis

A

Increased ESR

87
Q

SBE, Waldenstroms macroglobulinemia, hepatitis, menstruation, pregnanc

A

Increased ESR

88
Q

Polycythemia, spherocytosis, conditions associated with Hb S & Hb C disease

A

Decreased or Normal ESR

89
Q

: uses 3.8% sodium citrate and Cutler tube

A

Graphic-Cutler Method

90
Q

: uses 3.8% sodium citrate and Linzenmeier tube

A
  1. Linzenmeier Method
91
Q

: uses 5 % sodium citrate

A
  1. Micro-Landau Method
92
Q

: uses 5 % sodium citrate

A
  1. Smith Micro Method
93
Q

: uses heparin

A
  1. Roarke-Ernstene Method
94
Q

: 1.3% sodium oalate

A
  1. Bras Method
95
Q

Automated Erythrocyte Sedimentation Rate

A

Ves-Matic system
Sedimat 15
ESR STAT PLUS system - based on centrifugation.

96
Q

Uses (?) (applies controlled centrifugation of blood, producing alternating compaction and dispersion of erythrocytes to measure how closely the erythrocytes approach one another under a specific standardized gravitational force.

A

zetafuge

97
Q

Also uses a special capillary tube, (?) in length with an internal diameter of (?

A

75 mm

2 mm

98
Q

After centrifugation, (?) is determined at the knee of curve.

A

Zetacrit%

99
Q

ZSR (%) =

A
100
Q

Reference value: (ZSR) :

A
101
Q

Advantages of ZSR:
It requires a (? of blood
It is not affected by (?) and is faster than other methods
Reference range is the same for (?)

A

smaller amount

anemia

both sexes

102
Q

Absolute Eosinophil Count:

Specimen:

A

EDTA or heparinized or capillary BLOOD

103
Q

Absolute Eosinophil Count:

Equipment:

A

WBC pipet / Unopette

Fuchs 􏰂 Rosenthal or Speirs 􏰂 Levy Counting chamber

104
Q

Absolute Eosinophil Count:

Diluting fluid (1:10 dilution)

A

􏰃 Phloxine
􏰃 Propylene glycol
􏰃 Heparin
􏰃 Na Carbonate
􏰃 Alternative stains: Pilot􏰄s solution; Randolph􏰄s stain

105
Q

(Test for adrenocortical functions)

A

Thorn test

106
Q

Thorn test

Perform (?) (fasting simple)
Introduce (?)
After (?)., draw second specimen for absolute eosinophil count

A

direct absolute eosinophil count

ACTH

4 hrs

107
Q

uses Cooper and Cruickshank stain (neutral red)

A

Absolute Basophil Count:

108
Q

Absolute Basophil Count:

Counting chamber:

A

Speirs 􏰂 Levy or Fuchs-Rosenthal

109
Q

Thorn test

Normal = 2nd count should at least be (?) lower than initial count

A

50%

110
Q

is a neutrophil or macrophage that has phagocytized (engulfed) the denatured nuclear material of another cell.

A

LE cell

111
Q

Its formation is characterized by the production of a number of autoantibodies

A

LE cell

112
Q

The most important of these are the (?) which occur in the serum of patients with some autoimmune disorders including systemic lupus erythematosus (SLE).

A

antinuclear antibodies

113
Q

Demonstration of LE cells therefore suggests the presence of these antinuclear antibodies also termed as the (?).

A

LE factor

114
Q

causes nuclear lysis (lysed nucleus becomes a homogenous amorphous mass) and this material is then phagocytized by a neutrophil.

A

LE factor

115
Q

The neutrophil which has phagocytized the lysed nucleus is now called an.

A

L.E. cell

116
Q

(seen on a buffy coat smear)

A

L.E. cell

117
Q

is NOT considered positive.

A

Rosette formation

118
Q

Other Anti-Nuclear Antibody Test:

A

Fluorescent test

119
Q

(has replaced the LE test)

A

Fluorescent test

120
Q

Uses fluorescein-conjugated antihuman IgG

A

Fluorescent test

121
Q

BONE MARROW STUDY:
Collection of specimen:
Adults =
Children =

A

Adults = posterior iliac crest
Children = tibia

122
Q

This is taken before aspiration biopsy to avoid any disruption of marrow architecture.

A

Trephine Biopsy/Core

123
Q

Imprint biopsy is prepared by touching the specimen on a slide.

A

Trephine Biopsy/Core

124
Q

Fixative: Zenker fluid

A

Trephine Biopsy/Core

125
Q

Processed within 1hr.

A

Aspiration

126
Q

Bone marrow smear preparations:

A
  1. Particle smear
  2. Buffy coat (concentrate) smear
  3. Histologic section (Cell block)
127
Q

compensates for hypocellular marrow and allows for examination of large numbers of nucleated cells without interference from fat or RBCs

A

Buffy coat (concentrate) smear

128
Q

Fixative: 10% formalin, Zenker glacial acetic acid, or B5 fixative

A

Histologic section (Cell block)

129
Q

Bone marrow smear preparation Stains:

A

Romanowsky; iron stain; H and E

130
Q

Normal Marrow cells

A
  1. Hematopoietic cells
  2. Lymphoblasts
  3. Monocytic cells
  4. Myelocytic cell
  5. Erythrocytic precurosrs
  6. Macrophages/ Histiocyte
  7. Mast Cells / Tissue Basophil
  8. Osteoblasts
  9. Osteoclasts
131
Q

Marrow fat : hematopoietic cell =

A

1 : 2 (adults)

132
Q

Myeloid:Erythroid(M:E)ratio =

A

2:1 - 4:1

133
Q

include all nucleated hematopoietic cells EXCEPT megakaryocytes & macrophages

A

Marrow differential

134
Q

at least 500 cells are counted preferably 1000 cells, 500/slide (2 slides )

A

Marrow differential:

135
Q

SMEAR PREPARATION FOR MALARIA EXAMINATION:

Specimen:

A

EDTA-anticoagulated blood or fresh capillary blood collected before the initiation of treatment

136
Q

SMEAR PREPARATION FOR MALARIA EXAMINATION: At least (?) should be made.

A

two thick and two thin peripheral blood films

137
Q

For morphologic examination and species identification and determination of Percent arasitemia.

A

Thin blood smear

138
Q

Thin blood smear Preparation:

A

same as wedge method

139
Q
  • For screening purposes
A

Thick blood smear

140
Q

Thick blood smear Preparation: place (?) of blood close together near one end of the slide. With one
corner of a clean slide, stir the blood for about (?) to mix the three drops over an area approximately (?) in diameter

A

3 small drops

30 seconds

1 to 2 cm

141
Q

First dehemoglobinized; air-dried then stained

A

Thick blood smear

142
Q

Stains for malarial blood smear:

A

Wright􏰄s; Giemsa

HEMA 1 LEC (15 decks)

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