Exam A Blakes Flashcards
What pertinent facts must be considered when trying to establish normal ranges for any clinical lab?
You must consider your patient’s age and the reference intervals you are measuring.
The age of the population you are dealing with and their gender
What is the main specimen being run on it, such as what anticoagulant is being used?
Time of collection
Venipuncture time and if a tourniquet is used, such as when you measuring lactic acid, make sure you leave the tourniquet off because it can inflate the values.
- Which parameters are measured directly on the automated cell counter in this hematology laboratory and how are they measured?
RBCs, WBC, Hemoglobin,
- Which parameters are calculated values?
MCV, MCH, MCHC, Hct,
- Calculate CBC indices when possible using given information.
MCV= HCT/RBC * 10
Hct= (MCV * RBC)/ 100
MCHC= Hgb/Hct* 100
MCH= Hgb/RBC* 10
- How does electrical impedance work as a means of automated cell counting?
Electrical impedance works by counting the cells by the resistance given off when they cross the cell aperture. A cell with an increase in resistance will have an increase in impedance.
- List 3 sites from which bone marrow aspirates can be obtained. (These sites may differ between adults & children.)
The proximal ends of the long bones
Vertebrae( 3rd)
iliac crest ( 1st preference Adults and children)
Tibia( neonates 4th proximal)
Sternum (2nd only adults)
- Name three findings used to verify that bone marrow has been obtained from an aspirate, rather than peripheral blood
Presence of immature cells
presence of fat
presence of bone spicules
- List the hemogram parameters and the significance of each.
The hemogram includes the RBC count, WBC count, the Plt count, the Hgb count
the MCH, MCHC, and MCV.
The RBC count will be lower in Sideroblastic anemia, IDA, Aplastic anemia, lead poisoning, some leukemias, and in thalassemia.
The WBC count will be low in certain infections and HIV, and burns.
The plt count will be low in splenomegaly conditions, in DIC, in aplastic anemia, in certain bone marrow cancers, in myelopathic anemias,
The MCV will be high in certain leukemias, in megaloblastic anemia, and in B12 and folate deficiencies.
- What action/s should be taken if the linearity on the analyzer were exceeded?
Run a dilution of 1:7
A differential should be run if a value is outside the linearity range for WBCs.
Except if a lymphocyte count is over 50%= albumin smear, differential
for Plts remove the clot and then rerun for distribution errors.
For RBCs= if you have a low RBC count and high hemoglobin, then you should use a heat bath and check for cold agglutinates; if you have an abnormal RBC count and there being counted as plts; then recollect in sodium citrate( blue tube and multiply by 1.1.
- Compare and contrast controls and calibrators, including their definition and proper usage
Calibrator; a material of known value used to standardize any analytical procedure and thereby determine the value of an unknown
used for verifications/ Validations
Controls a stable substance that contains one or more known constituents used to verify the accuracy and precision of a method
- used for runs; are used for lot-lot validations
- Define reference ranges for CBC parameters at your institution.
WBC= 0-400 K/ul
Hct= 0-75.0%
NRBCs=o-600/100nRBCs
Rets=0-30%
RBCs= 0-8.60m/uL
- What is the proper corrective action for: cold agglutinins, lipemia, out of range results?
If you have a low RBC count and high hemoglobin, then you should use a heat bath and check for cold agglutinates; if you have an abnormal RBC count and there being counted as plts, then recollect in sodium citrate( blue tube and multiply by 1.1 also with plt satellitosis.
If you have lipemia, you should automatically rerun with a dilution or you can do plasma replacement( on heme powerpoint)
If you have an out of range results( rerun with a dilution ( a 1:7 dilution)
Pa
- What criteria makes a specimen unacceptable for CBC analysis?
A mislabeled specimen without a request form, wrong tube with anticoagulant, wrong medical records number.
- Compare different cellular morphology and function of WBCs, RBCs, and platelets.
WBCs functions are to stop foreign invades in the body, you have phagocytes such as Macrophages( best) –> neutrophils(2nd)—> dendritic cells—> eosinophils—> basophils.
by mobility–> neutrophil( 1st)–> Macrophage—> then eosinophil—> basophil
- Compare the normal blood cell and hemoglobin proportions for adults, infants, and children.
Segs
% of segs in Newborns= 50-70%
% of segs in Children= 28-45%
% of segs in Adults= 50-70%
Bands%
15-35% in newborns (3-11)
0-5% in children (0-5)
0-5% in adults ( 2-6)
Eosinophils%
newborns: 0-5%
children: 0-8%
Adults: 0-5%
Basos%
newborns, children, and adutls= 0-1%
Lymphs%
lymph: 10-20 newborns, 35-65 children, 20-40 adults
- Explain the purpose of hematological testing, including CBC, ESR, Retic Counts, etc.
CBC is used to find the indices such as RBC, WBC, and hemoglobin that aid in identifying specific disease states.
ESR test
Used to find the inflammatory conditions in the body( RBCs fall because they overcome their repulsion forces called zeta potentials and form rouleaux; this then forces the RBCs to fall fastest down because they have a higher density.
An increase in ESR is caused by increased plasma proteins, an increase in plasma viscosity, and the presence of rouleaux.
A decrease in rouleaux is caused by an increase in whole blood viscosity and a decrease in plasma protein concentrations.
Whole blood collected in 0.5 mg/ml EDTA is specimen of choice
westergren reference ranges: males: 0-15mm/hr
females: 0-20mm/hr
What conditions are present with a decrease In ESR
Hypofibrinogenemia, CHF, polycythemia, RBC morphological abnormalities such as anisocytosis, pokilo, spherocytes, and MM/ WM.
Retic counts
are done when the cell is alive and uses a supravital stain called new methylene blue.
count retics in 1000 cell and then divide by 10
uses a miller disk to count
- Which CBC values are useful in predicting the peripheral blood picture and how are they interpreted?
The CBC values are useful in predicting the Peripheral blood picture are the Retic value, the MCV, then the MCH and MCHC.
- What is the proper action taken when the following are found in specimens?
a. Platelet clumping
b. nRBCs
c. clotted specimen
The appropriate action to take when there is platelet clumping is to get fibrin sticks look for a clot, and then rerun the specimen. If this doesn’t work then you can collect in sodium citrate and multiply by 1.1
For nRBCs do a differential and then if greater than 5 are present use this formula (WBCs * 100/ nRBC + 100)
Clotted specimen : do a automatic rerun and use fibrin sticks to get clot out.
- Explain what is meant by an M:E ratio. Describe a normal M:E ratio and explain how it differs between adults and children.
The M: E ratio states the amount of myeloid to erythroid cells in the bone marrow.
Children/ infant have a M to R ration of 5:1- 6:1
- Identify the purpose of forward angle and side angle light scatter measurements in automation.
Forward scatter indicates cell volume ( wider image device
Side scatter indicates the granularity and internal components s
- List the cytochemical tests and stains that can be performed on bone marrow specimens, and correlate results with their corresponding disease states.
Myeloperoxidase= is a stain that can stain immature granulocytes
Sudan Black B is a more specific stain that can stain immature granulocytes
Both MPO and SSB can be used for mono but the stain will only be 1+
- Correlate typical bone marrow findings and clinical presentation with each of the following conditions. Be sure to include mention of the new drugs, Gleevec, ATRA, Aredia, & Velcade, where applicable:
a. ALL b. AML c. aplastic anemia d. multiple myeloma
- Evaluate the principle, special features, normal and abnormal cellular reactions to the following bone marrow stains:
a. Myeloperoxidase/peroxidase b. Sudan Black B e. Prussian blue
c. Specific Esterase d. Periodic Acid-Schiff
- Explain the principle of the osmotic fragility test and correlate an increased or a decreased osmotic fragility result with the appropriate clinical conditions.
- Diagram the physiologic mechanism of Heinz body formation, and the clinical conditions in which they would occur.
- Compare and contrast Ham’s Test and the Sucrose Hemolysis Test, including the clinical significance of each.
- Explain the principle and possible sources of error of the erythrocyte sedimentation rate (ESR).
- Examine the reference range for ESRs, and the clinical conditions associated with an increased and a decreased ESR.
- What criteria make a Hematology specimen unacceptable for an ESR?
- Explain the principle of the screening test for sickle cell disease, including the phenotypes with a positive test result.
- Evaluate the components and trouble-shoot reactions of the Wright Stain.
- Assess the migration patterns for both cellulose acetate & citrate agar hemoglobin electrophoresis.
- Describe the condition of PCH; include its etiology, pathophysiology (including specific antibody produced), and characteristic lab results
- Which esterase stain is specific, & which cell type does it stain? Which esterase is stain is
nonspecific, & which cell type does it stain? Why do you add fluoride to the nonspecific esterase stain?
- The Tartrate-Resistant Acid Phosphatase (TRAP) stain is positive in what disease?
- Assess the purpose of the following laboratory test with the proper clinical disease state:
a. Osmotic fragility c. Hemoglobin electrophoresis e. Ham’s test
b. Fluorescent spot test d. Reticulocyte count
Amorphous such as amorphous phosphates and urates
is a type of salt and is non crystalline
Amorphous phosphates are soluble in acetic acid, and amorphous urates are not; alkaline urates are present in acidic urine.
amorphous urates are present in acidic conditions and are composed of sodium, potassium, magnesium, and calcium
and they are soluble in alkaline conditions
both have no clinical significance and no defined shape
Anisotropic
materials with different properties
Are composed of ( cholesterol esters) and have a distinct maltose cross appearance under polarizing microscopy but will not stain with a fat stain.
Anuria
The presence of no urine secretion usually indicates renal failure.
Cylindroiduria
Urine sediment that resembles casts but has one end that tapers out like a strand of mucus.
Cystitis
Inflammation of the bladder
Diurnal
Changes of concentration based on the time of day
. Diuresis
An increase in the production of urine
. Ehrlich Unit
Up to 1 mg/dl/2h or Ehrlich unit of urobilinogen is present in normal urine. 2-4 mg/dl are present every 24 hours
Glomerulonephritis
Glomerulonephritis is a sterile inflammatory condition that causes proteins, blood and casts in the urine.
Hyposthenuria
abnormally low osmolality of the urine (abnormally low specific gravity) 1.007 or less
. Isothenuria
The kidney is unable to regulate urine concentration, the urine has a similar specific gravity to protein-free plasma.
Book definition- the urine stays at a constant specific gravity of 1.010 and usually occurs because of renal tubular reabsorption issues.
. Isotropic
the substance maintains the same properties no matter what methods of examination or measurement
Ketoacidosis
Occurs in type two diabetes and is where glucose cant enter the cell, therefore ketone production will increase.
Nephritis
Inflammation of the nephrons and the urine has blood in it.
Nebula
A cloudy appearance in the urine as it cools