clinical final Flashcards
WBC parameters?
5,000-10,000
RBC parameters?
male: 4.6-6.1
female: 4.2-5.4
Hgb parameters?
male: 14-18 g/dL
female: 12-16 g/dL
Hct parameters?
mele: 42-52%
female: 37-47%
platelet parameters?
150,000-400,000
retic parameters?
0.5-2%
ESR parameters?
male: 0-15 mm/hr
female: 0-20 mm/hr
Factors that increase ESR?
anemia pregnancy infections alchoholism cirrhosis hepatitis MM tilted tube
Factors that decrease ESR?
polycythemia sickle cell anemia abnormally shaped RBC's spherocytosis delay in performing test
what is the cheif use of the osmotic fragility test?
diagnosis of spherocytosis
what test is best to use to differentiate between homozygous and heterozygous sickle cell disease?
hemoglobin electrophoresis
how are retics stained?
new methyl or cresyl blue used to seperate RNA in cells
what stain is used to stain retics?
wrights stain (supravital) used to make RNA visible. Retics seen as polychromatophilic green/blue
what is the use of the retic test test to the physician?
helps diagonse and monitor anemia
when would you see an increased retic?
hemorrhage
splenectomy
various anemias (esp. hemolytic anemia)
when would you see a decreased retic?
bone marrow supression (chemo, radiation ect...) aplastic anemia IDA PA
what is the proper procedure for a Hct?
blood is collected in hepranized red capillary tubes. Seal one end and spin in microhematocrit centrifuge to obtain packed RBC’s. Macro of wintrobe and micro (non-hepranized blue-top) for Hct determination
what happens if microhematocrits are spun too long?
hemolysis (falsely decreased Hct)
what happens if microhematocrits arent spun long enough?
non-packed RBC’s
what does the MCV tell us?
RBC size
100 macro
what does the MCHC tell us?
degree of polychromasia
what condition are burr cells associated with?
renal failure
kidney disease
in what condition is punctate basphilia (baso stippling) frequently seen?
lead poisioning
with what conditon are heinz bodies most closely associated with?
G-6-P-D deficiency
how are baso stippling and reticulum differentiated in the lab?
baso- wrights and new methyl blue
retic new methyl blue only
what is the best specimen to use for blood smears for red blood cell morphology?
whole blood for EDTA tube
how can you adjust the color of wrights stained smear?
adjust pH
what is the most prominent feature in a blood smear for a patient with ABO HDN?
spherocytes
MCV calculation
Hct/#RBC’s x 10
MCH calculation
Hgb/#RBC’s x 10
MCHC calculation
Hgb/Hct x 100
if your MCV is increased and MCHC is normal (macro/normal) what diseases can this indicate?
liver disease B-12 deficiency folate deficiency PA alcholism
if your MCV is decreased and MCHC is decreased (micro/hypo) what disease states can this indicate?
IDA
sideroblastic
thalassemia
lead poisoning
if your MCV and MCHC are both normal what anemia would you expect to see?
aplastic anemia
what is the appearance of the cells on a patient with IDA?
micro(mcv decreased) Hypo (MCHC decreased)
what is the appearance of the cells on a patient with folic acid deficiency?
Macro (mcv increased) hypo (mchc decreased)
what are some causes of aplastic anemia?
bone marrow supression failure or replacement chemical or radiation exposure -blood pic: WBC, RBC, Plt., retics decreased -normo/normo -no increased RBC formation -decreased bone marrow
what is the common characteristic of all hemolytic anemias?
increased RBC destruction
what is an unusual finding that is a means of differentiating AHIA from other hemolytic anemias?
+ DAT (direct coombs test)
what is panyctopenia?
decreased RBC, WBC and Plt.
what is the most common WBC in a normal smear?
segmented neutro.
what information is inclued in a WBC differential?
count and classification of leukocytes
Plt. count
RBC morphology
what is the most common WBC in children under one year of age?
lymph
what is the least common WBC in a normal smear?
baso
what is the largest WBC in a smear?
mono
which immature RBC’s are classified as NRBC’s in a differential?
blast cells, prorubricytes, rubricytes, metarubricytes
what is the apperance of a plasma cell?
eccentric nucleus w/ clumped chromatin, basophilic cytoplasm w/ a clear reinuclear halo (hof.)
is plasma cell likely to found in the peripheral blood?
no ( normally
what is the meaning of a left shift?
increased immature grans (blast, pro, myelo, meta, band)
what is the meaing of a right shift?
increased mature cells (segs and hypersegs)
how is a diagnosis of heridiatry spherocytosis made?
at lease 25% elliptical/oval shaped cells in perpherial blood smear
- osmotic fragility testing
- autohemolysis test
- direct protein test by gel electro.
what are the characteristics of Hodgkin’s disease?
- slow relentless progression
- leukemoid rxn. w/ increased EOS
- Reed-Sternberg cells
what are the normal features of a smear from a newborn that might be considered abnormal in an adult?
NRBC’s, polychromasia, young WBC’s
describe a Downey type atypical lymphocyte as it appears on a Wrights stained smear?
Eccentric nucleus w/dense chromatin, may have open spaces. Smooth cytoplasm that is near pale nucleus, various shade of blue towards periphary and scallops surrounding the WBC. Easily confused with monos.
at what stage of development does differentiation of the granules of a graulocyte take place?
myelocyte
how is the metamyelocyte differentiated from the myelocyte?
myelo-round to oval nucleus (nuclear hof)
meta- nucleus kidney been shaped
procedure for perfoming a EOS count
whole blood diluted w/ stain solution. used maximu light on microscope, count entire ruled area on both sides on low power
calculation: total # cells/1.8 x 10
what conditions are EOS associated with?
allergic rxns
parasites
normal values for CSF fluid?
adults; 0-5 mononuclear cells, 0 RBC’s
neonate: 0-30 mononuclear cells, 0 RBC’s
what test is the best to meausre the erythroid activity of the bone marrow?
retic count
what conditions can’t be diagnosed without bone marrow aspirate?
myeloproliferative disorders aplastic anemia lymphoma tumors lukemia PA
what is the cheif use of the LAP?
differentiate lukemoid rxn increase from CML decrease
why is it necessary to correct a WBC cout if more than 5 NRBC’s are present on a peripheral blood smear and how is he correction made?
false increase in WBC count
WBC x 100/ 100 + #NRBC’s
what age group is ALL common in?
children
what age group is CML most common in?
middle age
what age group is CLL most common in?
older patients
what is the typical picture in the peripheral blood smear in acute leukemia?
decreased RBC
decreased Plts (thrombocytopenia)
increased immature WBC’s
at the time of diagnosis, which leukemia frequently presents with a greatly increased Plt. count?
CML (chronic myelocytic anemia)
how do you do an plt estimate?
count platelets in 8 squares # Plts. / 8 x 10
how do you report the amount of plts.?
decreased, adequate, increased
how are PNH and PCH diagnosed in the lab and how do these conditions differ?
PCH: extrinsic, D-L antibody, extracorpuscular defect (Donath-Landsteiner test)
PNH: intrinsic, acquired, sensitive to complement.
(Hams test or sugar water test)
which layer of blood is used for making an L.E. prep?
buffy coat
which group of disorders is classified by using the F.A.B. system of classification?
acute leukemias
what is the use of the Kleinhauer-Betke technique or the Fetaldex stain?
meausres fetal Hgb transferred from the fetal blood stream to the mothers blood stream used for D neg. mothers
which age group has the highest values for the RBC parameters?
newborns
what is the coulter (impedence) principle for cell counting?
interruption of light source as it passes through a flow cell (flow cytometry)
how would you obtain a blood specimen from a patient who has IV solutions in both arms?
choose a vein dital from the IV site (below) or ask a nurse to turn off 1 IV 15 mins before draw.
