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Hematolgy > clinical final > Flashcards

clinical final Flashcards

1
Q

WBC parameters?

A

5,000-10,000

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2
Q

RBC parameters?

A

male: 4.6-6.1
female: 4.2-5.4

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3
Q

Hgb parameters?

A

male: 14-18 g/dL
female: 12-16 g/dL

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4
Q

Hct parameters?

A

mele: 42-52%
female: 37-47%

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5
Q

platelet parameters?

A

150,000-400,000

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6
Q

retic parameters?

A

0.5-2%

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7
Q

ESR parameters?

A

male: 0-15 mm/hr
female: 0-20 mm/hr

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8
Q

Factors that increase ESR?

A 
anemia
pregnancy
infections
alchoholism
cirrhosis
hepatitis
MM
tilted tube
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9
Q

Factors that decrease ESR?

A 
polycythemia
sickle cell
anemia
abnormally shaped RBC's
spherocytosis
delay in performing test
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10
Q

what is the cheif use of the osmotic fragility test?

A

diagnosis of spherocytosis

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11
Q

what test is best to use to differentiate between homozygous and heterozygous sickle cell disease?

A

hemoglobin electrophoresis

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12
Q

how are retics stained?

A

new methyl or cresyl blue used to seperate RNA in cells

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13
Q

what stain is used to stain retics?

A

wrights stain (supravital) used to make RNA visible. Retics seen as polychromatophilic green/blue

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14
Q

what is the use of the retic test test to the physician?

A

helps diagonse and monitor anemia

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15
Q

when would you see an increased retic?

A

hemorrhage
splenectomy
various anemias (esp. hemolytic anemia)

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16
Q

when would you see a decreased retic?

A 
bone marrow supression
(chemo, radiation ect...)
aplastic anemia
IDA
PA
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17
Q

what is the proper procedure for a Hct?

A

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

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18
Q

what happens if microhematocrits are spun too long?

A

hemolysis (falsely decreased Hct)

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19
Q

what happens if microhematocrits arent spun long enough?

A

non-packed RBC’s

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20
Q

what does the MCV tell us?

A

RBC size

100 macro

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21
Q

what does the MCHC tell us?

A

degree of polychromasia

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22
Q

what condition are burr cells associated with?

A

renal failure

kidney disease

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23
Q

in what condition is punctate basphilia (baso stippling) frequently seen?

A

lead poisioning

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24
Q

with what conditon are heinz bodies most closely associated with?

A

G-6-P-D deficiency

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25
Q

how are baso stippling and reticulum differentiated in the lab?

A

baso- wrights and new methyl blue

retic new methyl blue only

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26
Q

what is the best specimen to use for blood smears for red blood cell morphology?

A

whole blood for EDTA tube

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27
Q

how can you adjust the color of wrights stained smear?

A

adjust pH

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28
Q

what is the most prominent feature in a blood smear for a patient with ABO HDN?

A

spherocytes

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29
Q

MCV calculation

A

Hct/#RBC’s x 10

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30
Q

MCH calculation

A

Hgb/#RBC’s x 10

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31
Q

MCHC calculation

A

Hgb/Hct x 100

32
Q

if your MCV is increased and MCHC is normal (macro/normal) what diseases can this indicate?

A 
liver disease
B-12 deficiency
folate deficiency
PA
alcholism
33
Q

if your MCV is decreased and MCHC is decreased (micro/hypo) what disease states can this indicate?

A

IDA
sideroblastic
thalassemia
lead poisoning

34
Q

if your MCV and MCHC are both normal what anemia would you expect to see?

A

aplastic anemia

35
Q

what is the appearance of the cells on a patient with IDA?

A

micro(mcv decreased) Hypo (MCHC decreased)

36
Q

what is the appearance of the cells on a patient with folic acid deficiency?

A

Macro (mcv increased) hypo (mchc decreased)

37
Q

what are some causes of aplastic anemia?

A 
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
38
Q

what is the common characteristic of all hemolytic anemias?

A

increased RBC destruction

39
Q

what is an unusual finding that is a means of differentiating AHIA from other hemolytic anemias?

A

+ DAT (direct coombs test)

40
Q

what is panyctopenia?

A

decreased RBC, WBC and Plt.

41
Q

what is the most common WBC in a normal smear?

A

segmented neutro.

42
Q

what information is inclued in a WBC differential?

A

count and classification of leukocytes
Plt. count
RBC morphology

43
Q

what is the most common WBC in children under one year of age?

A

lymph

44
Q

what is the least common WBC in a normal smear?

A

baso

45
Q

what is the largest WBC in a smear?

A

mono

46
Q

which immature RBC’s are classified as NRBC’s in a differential?

A

blast cells, prorubricytes, rubricytes, metarubricytes

47
Q

what is the apperance of a plasma cell?

A

eccentric nucleus w/ clumped chromatin, basophilic cytoplasm w/ a clear reinuclear halo (hof.)

48
Q

is plasma cell likely to found in the peripheral blood?

A

no ( normally

49
Q

what is the meaning of a left shift?

A

increased immature grans (blast, pro, myelo, meta, band)

50
Q

what is the meaing of a right shift?

A

increased mature cells (segs and hypersegs)

51
Q

how is a diagnosis of heridiatry spherocytosis made?

A

at lease 25% elliptical/oval shaped cells in perpherial blood smear

  • osmotic fragility testing
  • autohemolysis test
  • direct protein test by gel electro.
52
Q

what are the characteristics of Hodgkin’s disease?

A
  1. slow relentless progression
  2. leukemoid rxn. w/ increased EOS
  3. Reed-Sternberg cells
53
Q

what are the normal features of a smear from a newborn that might be considered abnormal in an adult?

A

NRBC’s, polychromasia, young WBC’s

54
Q

describe a Downey type atypical lymphocyte as it appears on a Wrights stained smear?

A

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.

55
Q

at what stage of development does differentiation of the granules of a graulocyte take place?

A

myelocyte

56
Q

how is the metamyelocyte differentiated from the myelocyte?

A

myelo-round to oval nucleus (nuclear hof)

meta- nucleus kidney been shaped

57
Q

procedure for perfoming a EOS count

A

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

58
Q

what conditions are EOS associated with?

A

allergic rxns

parasites

59
Q

normal values for CSF fluid?

A

adults; 0-5 mononuclear cells, 0 RBC’s

neonate: 0-30 mononuclear cells, 0 RBC’s

60
Q

what test is the best to meausre the erythroid activity of the bone marrow?

A

retic count

61
Q

what conditions can’t be diagnosed without bone marrow aspirate?

A 
myeloproliferative disorders
aplastic anemia
lymphoma
tumors
lukemia
PA
62
Q

what is the cheif use of the LAP?

A

differentiate lukemoid rxn increase from CML decrease

63
Q

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?

A

false increase in WBC count

WBC x 100/ 100 + #NRBC’s

64
Q

what age group is ALL common in?

A

children

65
Q

what age group is CML most common in?

A

middle age

66
Q

what age group is CLL most common in?

A

older patients

67
Q

what is the typical picture in the peripheral blood smear in acute leukemia?

A

decreased RBC
decreased Plts (thrombocytopenia)
increased immature WBC’s

68
Q

at the time of diagnosis, which leukemia frequently presents with a greatly increased Plt. count?

A

CML (chronic myelocytic anemia)

69
Q

how do you do an plt estimate?

A 
count platelets in 8 squares
# Plts. / 8 x 10
70
Q

how do you report the amount of plts.?

A

decreased, adequate, increased

71
Q

how are PNH and PCH diagnosed in the lab and how do these conditions differ?

A

PCH: extrinsic, D-L antibody, extracorpuscular defect (Donath-Landsteiner test)
PNH: intrinsic, acquired, sensitive to complement.
(Hams test or sugar water test)

72
Q

which layer of blood is used for making an L.E. prep?

A

buffy coat

73
Q

which group of disorders is classified by using the F.A.B. system of classification?

A

acute leukemias

74
Q

what is the use of the Kleinhauer-Betke technique or the Fetaldex stain?

A

meausres fetal Hgb transferred from the fetal blood stream to the mothers blood stream used for D neg. mothers

75
Q

which age group has the highest values for the RBC parameters?

A

newborns

76
Q

what is the coulter (impedence) principle for cell counting?

A

interruption of light source as it passes through a flow cell (flow cytometry)

77
Q

how would you obtain a blood specimen from a patient who has IV solutions in both arms?

A

choose a vein dital from the IV site (below) or ask a nurse to turn off 1 IV 15 mins before draw.

Hematolgy (7 decks)

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