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HEMA II LEC > HEMA 2 LAB > Flashcards

HEMA 2 LAB Flashcards

1
Q

His mother experienced 3 weeks of bleeding following a dental
extraction procedure. No remarks made about his father.

A

Look closer to laboratory work out

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2
Q

Laboratory Investigations show:
Hgb - 15 g/dL
Hct - 44%
Platelet count - 245, 000/uL
Bleeding Time - 10 minutes ( Duke Technique) - Abnormal
Protime - 12 seconds
APTT - 55 seconds (Done Twice) - Abnormal

A

Check Platelet Aggregation

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3
Q

He did the platelet aggregation study. The result was abnormal in ADP, EPINEPHRINE and COLLAGEN. ANd it shows there is
abnormal aggregation in RISTOCETIN.

A

Bernard Soulier Syndrome

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4
Q

The automated CBC and platelet reading didn’t display any flags for abnormal cells. Does this mean all the morphology of the cell is normal?

A

I thought it is Bernard-Soulier Dse because of the abnormal platelet aggregation in ristocetin. If this is BSD, the APTT should be normal and there should be flags of large platelets in the automated method, which is not present in this case. Therefore, I conclude that this is Von Willebrand

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5
Q

What is the purpose of Ristocetin aggregation assay?

A

Ristocetin-induced platelet aggregation (RIPA) is used as an in vitro test to determine the presence and integrity of the platelet glycoprotein Ib and von Willebrand factor interaction and is usually performed using platelet-rich plasma (PRP). It can be used to differentiate Glanzmann Thrombasthenia from Bernard-Soulier Dse and VWF Dse.

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6
Q

There are several methods used to test the bleeding time. Between Duke and Ivy Method which one is preferred?

A

I prefer using the ivy method because this is more reliable. The intercapillary pressure is standardized therefore, we can reduce errors and make sure the scouts are screened properly

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7
Q

How can we maintain the intercapillary pressure in Ivy Method?

A

Increase the cuff pressure and hold the pressure exactly 40mmHg for the entire period

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8
Q

Next step is to make separate cuts in the forearm. What is the
recommended depth of the wound?

A
  • 3mm deep will be enough (Adults)
  • 1.6mm (Infants/newborns)
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9
Q

After making the incision what is the next thing to do?

A

Start the timer immediately and wick the blood using filter paper every half minute

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10
Q

How do you record the bleeding time?

A

Count the number of blot multiplied by 30 (seconds)

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11
Q

What is the normal bleeding time (IVY Method)

A

If the bleeding time stops 2-9 minutes

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12
Q

What is the normal bleeding time (Duke’s Method)

A

1-5 minutes (normal range)

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13
Q

Bleeding time assess which parameters?

A

Bleeding time assesses platelet functional integrity and platelet number.

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14
Q

Sasha experiencing weakness and fatigue. She also experienced bleeding gums while brushing her teeth. Her mom experiences nosebleed once a month and her dad experienced prolonged bleeding 3 years ago when he accidentally cut himself with a hunting knife. What laboratory test should we do to diagnose a disorder?

A

APTT, PT, Bleeding Time, Platelet Aggregation, RIPA
and Platelet Count (Best Choice kay all of those methods
assist hemostasis)

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15
Q

Sasha experiencing weakness and fatigue. She also experienced bleeding gums while brushing her teeth. Her mom experiences nosebleed once a month and her dad experienced prolonged bleeding 3 years ago when he accidentally cut himself with a hunting knife. What laboratory test should we do to diagnose a disorder?

A

APTT, PT, Bleeding Time, Platelet Aggregation, RIPA and Platelet Count (Best Choice kay all of those methods assist hemostasis)

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16
Q

Sasha experiencing weakness and fatigue. She also experienced bleeding gums while brushing her teeth. Her mom experiences nosebleed once a month and her dad experienced prolonged bleeding 3 years ago when he accidentally cut himself with a hunting knife. What laboratory test should we do to diagnose a disorder?
Note: If we measure about platelet in Primary hemostasis

A

Bleeding Time and Platelet Count, aggregation and RIPA (ristocetin induced platelet aggregation)

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17
Q

Sasha experiencing weakness and fatigue. She also experienced bleeding gums while brushing her teeth. Her mom experiences nosebleed once a month and her dad experienced prolonged bleeding 3 years ago when he accidentally cut himself with a hunting knife. What laboratory test should we do to diagnose a disorder?
Note: If we want to assess in Secondary

A

Prothrombin Time, APTT

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18
Q

Here are the laboratory results:
APTT- normal
PT- normal
Bleeding time - prolonged
Platelet aggregation - abnormal
RIPA - normal (positive)
Platelet COunt - borderline normal
What can you conclude about these results?

A

This Glanzmann’s Thrombasthenia since her results in RIPA (positive), APTT and PT are all normal but with prolonged bleeding time

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19
Q

To do a Direct Platelet Count using Rees Ecker Method
What is the color of the tube this test requires?

A

EDTA (purple top) for platelet counting

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20
Q

What is the best site for extraction of blood?

A

Median Cubital Vein

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21
Q

What pipette do we use in the Rees Ecker Method?

A

RBC Pipette

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22
Q

In routine where do we aspirate nga mark?

A

1 mark and 101 diluting fluid

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23
Q

In what instances can we lower aspiration of the sample?

A

When the platelet is increased

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24
Q

At what level of platelet concentration count can we use the WBC
pipette?

A

Less than 50, 000/mL

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25
Q

What is the purpose of rinsing the RBC pipette with Reese Ecker
diluting fluid?

A

Aside from being diluent, this fluid stains the platelet so we can count them easily in the Light Microscope

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26
Q

What is the purpose of rinsing the RBC pipette with Reese Ecker
diluting fluid? ( answer: Aside from being diluent, this fluid stains the platelet so we can count them easily in the Light Microscope)

What if we use a Phase contrast microscope? What method is being
used?

A

Brecher-conkrite method Diluting fluid of Brecher-Conkrite- ammonium oxalate (no stain)

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27
Q

What mark can we draw blood?

A

Draw until 0.5 mark and use 200 as the dilution factor

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28
Q

How many minutes are we going to put this on the pipet shaker?

A

5-10 minutes

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29
Q

We count platelets using 40x magnification on which area?

A

Central Large Square containing 25 smaller squares

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30
Q

On the first square. I counted a total of 237 platelets and on the
other square I counted a total of 210. Is this alright?

A

Not acceptable. Do it Again (27 difference)

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31
Q

Here’s my new platelet count 227 and 215

A

Since the difference is less than 10% those values are
acceptable.
Formula:
Platelets/uL
(227+215) 𝑥 200 / 0.1

32
Q

442, 000 platelets/uL

A

Slight increase

33
Q

What is the component present in cell that’s why ga positive in
Periodic acid-schiff (PAS)?

A

Carbohydrate

34
Q

If we inhibit the non-specific esterase may sodium fluoride

A

Nd ma stain

35
Q

Other name for eosinophil depression test

A

Thorn’s Test

36
Q

Reagent used to lysed WBC except eosinophil

A

Sodium Carbonate

37
Q

Basophil will distinguish from other cells using

A

Toluidine Blue Stain under Toluidine Blue method/Cooper and Cruickshank Method

38
Q

Important stain for eosinophil count

A

Phloxine

39
Q

Important stain in Basophil count

A

Toluidine blue (appear metachromatic purplish red/reddish purple)

40
Q

Complete Component

A

Pilot Solution (phloxine, propylene glycol, sodium carbonate, heparin)

41
Q

What is this substance to lyse the RBC but the basophilic granules
become insoluble?

A

Cetylpyridinium chloride

42
Q

Terminal deoxynucleotidyl transferase (TDT) uses to stain

A

Polymerase found in lymphoblast nuclei

43
Q

What is the relationship between Eosinophil count and level of
corticosteroids

A
  • In hyperadrenalism cushing’s disease eosinophil will decreased while hypoadrenalism eosinophil will increased
  • INVERSELY PROPORTIONAL
44
Q

In Nitroblue Tetrazolium Test (NBT) colorless

A

Stain Neutrophil (when mixed in neutrophil it becomes blue-black formazan precipitate) especially the granules

45
Q

In Other cytochemical staining what enzyme is present?

A

Isoenzyme 5 of acid phosphatase (that is why hairy cells are TRAP positive)

46
Q

Isoenzyme 5 acid phosphatase

A

Tartrate resistance present in hairy cells

47
Q

LAP SCORE

A
  • Increased LAP - Leukemoid Reaction
  • Decreased LAP - CGL/CML
48
Q

With regards to cytochemical stains. What are the 3 cytochemical
stains that are positive in AML but negative in ALL

A
  • MPO
  • SBB
  • Specific Esterase
49
Q

How many platelets are seen per 100 RBC

A

3-10

50
Q

How many platelets are seen per OIO?

A

7-21

51
Q

Percent of Platelet:

A

Circulation- ⅔ 75%
Spleen - ⅓ 25%

52
Q

How many platelets are produced per megakaryocyte?

A

2000-4000

53
Q

Approximately in healthy adult women. What is the platelet
concentration? (total blood volume)

A

1 trillion

54
Q

Per cu/mL kabilogan nga blood volume

A

250 million

55
Q

Indirect method of platelet counting. What factor used?

A

2, 000

56
Q

In an automated analyzer. What are the situations that can falsely
increase/elevated platelet count?

A
  • Fragmented RBC/schistocytes
  • Cytoplasmic fragments of WBC
57
Q

In an automated analyzer. What are the situations that can falsely
decrease platelet count?

A
  • Old specimen
  • Giant platelets
  • Satellitism
  • Clumping/aggregates of platelet
58
Q

(Module 3) Simplate Method

A

Contains a spring-loaded blade within a plastic case which holds a double blade.

59
Q

(Module 3) Surgicutt Method

A

Utilizes a slicing action using a surgical blade

60
Q

(Module 3) Mielke Method

A

Utilizes a template containing a standardized slit in place of a disposable lancet

61
Q

In Rumpel-Leede/ Capillary Fragility Test/Hess Test/Tourniquet Test
if positive there’s a presence of?

A

Petechiae

62
Q

Platelet adhesiveness test. If we collect the sample using a glass
bead system the expected platelet count will be?

A

Decreased compared to the original sample collected using EDTA

63
Q

Conditions that causes RBC’s Fall out

A
  • Glanzmann thrombasthenia
  • Disseminated Intravascular coagulation (DIC)
  • Hypofibrinogenemia
  • Dysfibrinogenemia
64
Q

(Module 3) Start of clot retraction

A
  • 30 mins
65
Q

(Module 3) Normal Clot retraction

A

2-4 hours - Normal
4-24 hours - Poor retraction
Above 24 hours - there is no retraction at all

66
Q

In what method do we use castor oil?

A

Hirschboeck Method

67
Q

How do we report clot retraction?

A

-using the grading or percentage of the serum extruded
○ 0: no serum extruded
○ 1+: 5-10% serum extruded
○ 2+: 10-20% serum extruded
○ 3+: 20-35% serum extruded
○ 4+: 35-50% serum extruded

68
Q

Qualitative abnormalities of platelets are suspected if:

A
  • Bleeding manifestation (mucocutaneous bleeding)
  • Platelet count above 50, 000/mL
69
Q

3 Methods of Aggregation

A

● Optical density/light transmittance - we are using platelet rich
plasma
● Electrical impedance/ Electrical resistance - we are using WHOLE
BLOOD
● Lumi Aggregometry- Either Platelet rich plasma/ Whole blood

70
Q

Temperature during aggregometry

A

18-24 degree celsius

71
Q

How long would you analyze after centrifugation to obtain platelet rich
plasma?

A

Within 30mins

72
Q

What reagent are used in Lumiaggregometry?

A

Firefly-derived luciferin-luciferase reagent

73
Q

Formula of %platelet adhesiveness

A

(𝑃𝐶 𝑤𝑖𝑡ℎ𝑜𝑢𝑡 𝑔𝑙𝑎𝑠𝑠 𝑏𝑒𝑎𝑑𝑠 − 𝑃𝐶 𝑤𝑖𝑡ℎ 𝑔𝑙𝑎𝑠𝑠 𝑏𝑒𝑎𝑑𝑠 / 𝑃𝐶 𝑤𝑖𝑡ℎ𝑜𝑢𝑡 𝐺𝑙𝑎𝑠𝑠 𝑏𝑒𝑎𝑑𝑠) x 100

74
Q

What is the relationship between clot retraction and platelet
concentration?

A

Directly Proportional

75
Q

Anticoagulant of choice in Aggregometry test

A

3.2% Sodium Citrate

76
Q

When do we start the timer in bleeding time?

A

As we seen the blood

HEMA II LEC (6 decks)

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