HEMA DAY 1 Flashcards
1
Q
Males have significantly higher volume of blood compared to females.
Male:
Female:
A
Male: 5-6 L
Female: 4-5 L
2
Q
Blood Components
Solid portion:
<_% Buffy Coat
_% Formed Elements
_% Fluid portion
- __% water
- __% proteins, carbohydrates, salts, hormones and other substances
A
Blood Components
Solid portion: 20g/100mL of Blood
<1% Bufy Coat
45% Formed Elements
55% Fluid portion
- 90% water
- 10% proteins, carbohydrates, salts, hormones and other substances
3
Q
This hormone promotes the production of RBC
A
Testosterone
4
Q
This hormone has an inhibitory effect on the production of RBC
A
Estrogen
5
Q
3 Layers of Buffy Coat
- Uppermost:
- Middle:
- Lower layer:
A
3 Layers of Buffy Coat
- Uppermost: Platelets
- Middle: Agranulocytes (Monocyte & Lymphocyte)
- Lower layer: Granulocytes, nRBC
6
Q
Blood pH
Range:
Average:
Arterial Blood:
Venous Blood:
A
Blood pH
Range: 7.35-7.45
Average: 7.40
Arterial Blood: 7.45
Venous Blood: 7.35
7
Q
Buffy coat can be used for the following tests:
1.
2.
3.
A
Buffy coat can be used for the following tests:
1. WBC Count
2. Platelet Count
3. LE Cells
8
Q
Can nucleated RBC be present in the bloodstream of a patient in normal conditions?
A
No. Because nRBCs are only found in the bone marrow.
9
Q
The blood makes up 75-85%mL/kg or __-__% of the total body weight
A
The blood makes up 75-85%mL/kg or 7-8% of the total body weight
10
Q
Blood Specific Gravity
Serum:
Plasma:
Whole Blood:
A
Blood Specific Gravity
Serum: 1.024-1.028
Plasma: 1.025-1.029
Whole Blood: 1.045-1.066
11
Q
Plasma vs. Serum
This is the fluid portion of the anticoagulated blood
A
Plasma
12
Q
Plasma vs. Serum
This has slightly hazy appearance
A
Plasma
13
Q
Plasma vs. Serum
This contains all coagulation factor
A
Plasma
14
Q
Plasma vs. Serum
This contains normal yellowish or straw-colored appearance
A
Both
15
Q
Plasma vs. Serum
Fluid portion of non-anticoagulated blod
A
Serum
16
Q
Plasma vs. Serum
Clear appearance
A
Serum
17
Q
Plasma vs. Serum
Lacks fibrinogen group
A
Serum
18
Q
Which factors belong to the Fibrinogen Group
A
Factors I, V, VIII and XIII
19
Q
Color of oxygenated/arterial blood
A
Bright red
20
Q
Color of deoxygenated/venous blood
A
Dark purplish red
21
Q
All arteries carry oxygenated blood, EXCEPT
A
Pulmonary arteries
22
Q
Thickest blood vessel
A
Arteries
23
Q
Concentrations used in EDTA
Range:
Average:
A
Concentrations used in EDTA
Range: 1.5-2.0 mg/dL
Average: 1.5 mg/mL
24
Q
Forms of EDTA
Dry Form
1.
2.
Liquid Form
1.
A
Forms of EDTA
Dry Form
1. Na2 EDTA
2. K2 EDTA
Liquid Form
1. K3 EDTA
25
Preferred EDTA of CLSI due to less shrinkage of RBC
K3 EDTA
26
Preferred EDTA of Rodak's due to ease in mixture
K2 EDTA
27
Disodium salt is also known as ______, in _______ form
VERSENE, POWDERIZED
28
Tripotassium is also known as _______, in _______ form
SEQUESTRENE, LIQUID
29
Excessive EDTA concentration causes platelets to _____ and ____ that will lead to ________________ of Platelet Count
Excessive EDTA concentration causes platelets to swell and fragment that will lead to false increase of Platelet Count
30
Which factors are not stable in EDTA?
Labile factors - V AND VIII
31
Most preferred anticoagulant for platelet studies/aggregation test/platelet function test?
Citrate
32
Most preferred anticoagulant for blood cell counting and observation of cell morphology
EDTA
33
Venous blood is more acidic compared to arterial blood due to ______
Carbon dioxide
34
Expired EDTA causes the following
False decreased platelet count
35
Which anticoagulant inhibits Fibrinogen-thrombin action
EDTA
36
Increase/excess EDTA in ESR and hematocrit results
False decreased platelet count
37
______ might cause platelet satellitosis, that is then rectified by the use of _______
EDTA might cause platelet satellitosis, that is then rectified by the use of sodium citrate
38
Not rectified platelet satellitosis causes
False decrease automated platelet count
39
What is the most important function of blood? Clue: In the respiratory system
Transportation of blood gases, specifically RBC
40
What are the two types of citrate?
Blue and black top
41
The most preferred anticoagulant for ESR testing
Black top tube Citrate
42
Anticoagulant of choice for Standard Westergren
Black top tube Citrate
43
Anticoagulant of choice in coagulation studies
Blue top tube Citrate
44
Which citrate has the ratio of blood to anticoagulant is 9:1
Blue top tube Citrate
45
Which anticoagulant is buffered and used in concentration of 3.2%?
Blue top tube Citrate
46
Which anticoagulant is buffered and used in concentration of 3.8%?
Black top tube Citrate
47
Which anticoagulant is not recommended in coagulation studies because it can falsely prolong coagulation results
Black top tube Citrate
48
Which citrate has the ratio of blood to anticoagulant is 4:1
Black top tube Citrate
49
Other term for polycythemia
Erythrocytosis
50
What is the formula for hematocrit >55%
(100-Hct/595-Hct) (#mL of Whole Blood)
51
The action of this anticoagulant is to bind calcium and form soluble complex
Sodium citrate
52
The action of this anticoagulant is to bind calcium and form insoluble complex
Oxalate
53
Different forms of oxalate
1.
2.
3.
4.
Different forms of oxalate
1. Lithium oxalate
2. Sodium oxalate
3. Potassium oxalate
4. Double oxalate
54
This is the combination of potassium oxalate and ammonium oxalate
Double balanced oxalate
55
This type of oxalate causes cell swelling; 3 parts
Ammonium oxalate (Winthrobe's)
56
This type of oxalate causes cell shrinkage; 2 parts
Potassium oxalate (Paul Heller's)
57
This anticoagulant is used as an in vitro and in vivo
Heparin
58
This is considered as a "natural anticoagulant"
Heparin
59
Underfilling/Excess citrate/Short draw of the tube can cause _________________ due to excess citrate in plasma
Prolonged PT and PTT results
60
Which citrate tube color can preserve Factors V and VIII
Blue top tube Citrate
61
Which anticoagulant is not recomended for coagulation studies because it inhibits all stages of coagulation cascade especially thrombin
Heparin
62
Which anticoagulant has the 15 to 20 Uml of blood or 15 to 30 U/ml of blood (0.2mg/ml of blood)?
Heparin
63
Which test has increased values in leukomoid reaction and decreased in CML?
LAP test
64
Which anticoagulant is used during percutaneous transluminal coronary angioplasty (PTCA) and cardiopulmonary bypass (CPB) to prevent clot formation
Heparin
65
Which anticoagulant is not prefered in hematology and blood smear preparation?
Heparin
66
Which anticoagulant can:
- produce a bluish background on Romanowsky stained smear
- destroy WBC and platelets
Heparin
67
Which chemical can be used in blood alcohol determination
Ethanol
68
This tube is commonly used for glucose determination
Sodium fluoride (Gray top tube)
69
Can be used in determination of lactic and blood alcohol
Sodium fluoride (Gray top tube)
70
What is the correct order of draw in venipuncture?
1. Sterile - Blood
2. Light blue - Sodium citrate
3. Red - Clotting tube 1
4. SST - Clotting tube 2
5. PST - Clotting tube 3
6. Green - Heparin
7. Lavender - EDTA
8. Gray - Sodium fluoride
9. Black - Oxalate
71
What is the correct order of draw in capillary puncture?
1. Green - Blood gases
2. Slide unless made from EDTA microcollection tube
3. EDTA microcollection tube
4. Other anticoagulated microcollection tube
5. Non anticoagulated microcollection tube
72
This stopper forms plasma, and can be used for SPS and ACD testing
Yellow stopper
73
This stopper is used in HBA1C and lipoprotein measurement
Purple top
74
This test type of yellow tube/stopper is the first tube in the sequence of order of draw
SPS
75
This type of yellow tube/stopper is the last tube in the sequence of order of draw
ACD
76
True or False: The following non-anticoagulated tubes can be used in chemistry tests
Glass red top tube (Without clot activator)
Plastic red top tube (With clot activator)
Orange top with thrombin clot activator
SST Gold with clot activator and gelp
SST Tiger (Mottled red-gray top) with clot activator and gel
t
77
How many inversions do the following tubes require
Plastic red top (with clot activator)
Orange top with thrombin clot activator (with gel)
SST Gold with clot activator and gel
SST Tiger (Mottled/marbled gray top) with clot activator and gel
5x inversions
78
WHICH OF THE FF IS THE CORRECT ORDER OF DRAW?I
A. YELLOW- RED-BLUE-PURPLE
B.YELLOW-BLUE-PURPLE-GREEN
C.PURPLE- BLUE-GREEN-YELLOW
D.BLUE-RED-GREEN-YELLOW
WHICH OF THE FF IS THE CORRECT ORDER OF DRAW?I
D.BLUE-RED-GREEN-YELLOW
79
PURPOSE OF ORDER OF DRAW?
PURPOSE OF ORDER OF DRAW?
ANS: Its purpose is to avoid possible test result error because of cross-contamination from tube additives
80
How many inversions does the Glass red top (without clot activator) require?
None
81
How many inversions does an Orange top with thrombin clot activator require?
8x inversions
82
Which stopper color is not used in chemistry laboratory?
Yellow
83
Other term for non-anticoagulated tubes
Serum tubes
Because serum is their end-product, and are therefore used in chemistry testing
84
Preferred way to collect blood sample from newborns and pediatric patients
Skin puncture
85
Used for blood culture specimen collections in microbiology.
SPS
86
Used in blood bank studies, lymphocytotoxicity testing, HLA testing, and DNA and paternity testing.
ACD
87
Depth of skin puncture shoul dbe not deeper than ____
2mm
88
Infants under 1 year old location of puncture in the heel
Lateral, medial and plantar
89
Which fingers cannot be used in capillary puncture?
Pinky, thumb and index fingers
90
Method: Skin puncture
Specimen: ________
Method: Skin puncture
Specimen: Capillary blood
91
What is the specimen collected in newborn screening?
Blood spot
92
A capillary blood sample is expected to have a ________ in WBC count
False increase
93
A capillary blood sample is expected to have a ________ in RBC count, Hematocrit, and Hemoglobin, and Platelet count
False decrease
94
True or False: ETS has a double pointed needle.
t
95
____________ is most widely used for collecting venous blood sample.
Evacuated tube system
96
The level of temperature and altitude is _____________ proportional to the volume of blood drawn.
Inversely
97
True or False: The shelf life of an evacuated tube is defined by the stability of the additive and vacuum retention
t
98
Veins in the arms- superficial veins of the _____________ (bend in the elbow) are the most common sites for venipuncture.
Antecubital fossa
99
This vein is the least preferred because it is near to brachial artery and nerves
Basilic vein
100
The following are the alternate vein sites
1.
2.
3.
4.
5.
The following are the alternate vein sites
1. Ventral forearm
2. Wrist
3. Back of the hand (Dorsal)
4. Ankle
5. Foot
101
Venipuncture cannot be done in the ______________
Ventral of the hand
102
Blood collection in __________ should be avoided in patient with DM and hypertension.
Ankle or foot
103
Routinely used gauge of needle
Adult:
Newborn/Pedia:
Routinely used gauge of needle
Adult: 21 g
Newborn/Pedia: 23 or 22 g
104
What is the sterilization technique used for Evacuated tubes?
Gamma Radiation
105
Venipuncture angle
Standard:
Range:
Venipuncture angle
Standard: 15°
Range: 15-30°
106
↑ Temperature = __ Blood volume (And vice versa)
↑ Temperature = ↓ Blood volume (And vice versa)
107
↓ Altitude = __ Blood volume (And vice versa)
↓ Altitude = ↑ Blood volume (And vice versa)
108
_______ is the ideal size of needle in venipuncture for better control.
1 inch
109
What is the maximum time for the application of tourniquet?
1 minute (Or the least in the option)
110
The proper tourniquet application is ___________inches above the venipuncture site.
3-4 inches
111
Collection of blood with IV line should be _______ inches below the IV line
1-2 inches
112
Anchoring of vein should be ______ inches below the venipuncture site
1-2 inches
113
The loose end of the tourniquet should be facing ________ and should not be a hindrance in the venipuncture procedure.
Upward
114
Number of atttempts in venipuncture
Twice then call another medtech
115
Position of the patient
Lying down - ________: __ Packed cell Volume by 8%, ↓ WBC
Standing - ________: __ Packed cell volume 8%, ↑ WBC
Position of the patient
Lying down - hemodilution: ↓ Packed cell Volume by 8%, ↓ WBC
Standing - hemoconcentration: ↑ Packed ccell volume 8%, ↑ WBC
116
Waste Disposal
Yellow bag:
Waste Disposal
Yellow bag: Infectious waste
117
Waste Disposal
Orange bag:
Waste Disposal
Orange bag: Radioactive waste
118
Waste Disposal
Red bag:
Waste Disposal
Red bag: Sharp waste
119
Waste Disposal
Yellow with black band:
Waste Disposal
Yellow with black band: Chemical waste
120
Waste Disposal
Green bag:
Waste Disposal
Green bag: Non-infectious wet waste or biodegradable
121
Waste Disposal
Black bag:
Waste Disposal
Black bag: Infectious dry waste or non-biodegradable
122
Patient with IV line
1: Use the opposite arm
2: in case of both arm with IV line, ask the nurse to stop the IV
for 2 mins, discard 5 ml
3: then collect sample below the IV line (1 to 2 inches below)
123
Mastectomy patient
1: draw blood from the opposite arm
2: In case of double mastectomy, draw blood from the back of the hand or perform skin puncture. do not use tourniquet
124
Refusal by the patient to have blood drawn
Remedy:
Refusal by the patient to have blood drawn
Remedy: Note the refusal and notify the hematology supervisor
125
Difficulty in obtaining a specimen; the bore of the needle is against the vein wall
Remedy:
Difficulty in obtaining a specimen; the bore of the needle is against the vein wall
Remedy: Slightly pulling back the needle
126
Movement of the vein
Remedy:
Movement of the vein
Remedy: Have firm pressure on the arm below the venipuncture site (Anchor)
127
Sudden movement by the patient or phlebotomist; needle came out prematurely
Remedy:
Sudden movement by the patient or phlebotomist; needle came out prematurely
Remedy: Immediately remove tourniquet, place gauze and apply pressure
128
Fainting or illness subsequent to venipuncture
Remedy:
Fainting or illness subsequent to venipuncture
Remedy: First aid procedures of the laboratory
129
Blood clot formation in anticoagulated tubes
Remedy:
Blood clot formation in anticoagulated tubes
Remedy: Promptly after termination of the venipuncture procedure, any tubes containing an anticoagulant should be gently inverted several times to mix the specimen
130
Refers to a device that is applied or tied around a patient's arm prior to venipuncture to compress the veins and restrict blood flow
Tourniquet
131
The most common type of tourniquet
Strap tourniquet
132
1. When do you release the tourniquet if there is sufficient blood collected?
2. When do you release the tourniquet if you do not see blood flow in the hub?
A. As soon as there is blood flow
B. Before you remove the needle
C. After you remove the needle
D. Remove anytime you want
1. B
2. A
133
The antiseptic technique used in venipuncture is _________ with the ________ motion
70% Isopropyl alcohol, circular or back and forth (superior)
134
Blood pressure cuff as tourniquet
Standard:
Range:
Ivy method:
In obese patient:
In capillary fragility test:
Blood pressure cuff as tourniquet
Standard: 60 mmHg
Range: 40-60 mmHg
Ivy method: 40 mmHg
In obese patient: 40 mmHg
In capillary fragility test:
- < 50 mmHg/10 mins
- <100 mmHg/5 mins
135
Special considerations in venipuncture
❌
❌
❌
❌
Special considerations in venipuncture
❌ Arm with cannula or fistula
❌ Same side as the mastectomy
❌ Areas with scars or burns
❌ Edematous areas
136
In case of both arm with IV line, ask the nurse to stop the IV for ___________ and discard _______
2 mins, 5 mL
137
In case of double masectomy, 2 options possible
1.
2.
NOTE:
In case of double masectomy, 2 options possible
1. Back of the hand (Dorsal)
2. Skin puncture
NOTE: Do not use tourniquet
138
Phlebotomy Complications
1. (Most common)
2.
3.
4.
5.
6.
Phlebotomy Complications
1.Vascular (Most common)
2. Infectious
3. Cardiovascular
4. Anemia
5. Neurological
6. Dermatological
139
Phlebotomy Complications: Bleeding, hematoma, bruising, pseudo-aneurysm, thrombosis, reflex arteriospasm, and arteriovenous fistula formation
Vascular complications
140
Phlebotomy Complications: Cellulitis (inflammation of tissue), phlebitis (inflammation of blood vessel), sepsis, septic arthritis, and osteomyelitis
Infectious complications
141
Phlebotomy Complications: Orthostatic hypotension, syncope, shock, and cardiac arrest
Cardiovascular
142
Phlebotomy Complications: Iatrogenic, nosocomial, physician induced, anemia resulting from blood loss
Anemia
143
Phlebotomy Complications: Diaphoresis, seizure, pain, and nerve damage
Neurological
144
Phlebotomy Complications: Allergic reaction to iodine, necrosis, basal cell carcinoma, and scarring
Dermatological
145
Results when leakage of a large amount of blood around the puncture site causes the area to rapidly swell.
Hematoma
146
The most common complication encountered in obtaining a blood specimen
It is caused by leakage of a small amount of blood in the tissue around the puncture site.
Bruising(ecchymosis)
147
Stress causes a temporary ______in WBC count
Increase
148
Increased ACTH and cortisol results in decreased ___________
Eosinophil count
149
There is an _____________ WBC count in the afternoon compared to morning and evening
Increased
150
Chronic effects of smoking lead to _____________ Hb concentration, erythrocyte (RBC) count, MCV, and leukocyte (WBC) count.
Increased
151
Smokers tend to have ____________ than nonsmokers and may have polycythemia.
Higher hematocrits and neutrophil
152
Wedge smear
Uses 2 slides; angle between the 2 slides → __ / __-__ / __-__° angle (PREFERRED)
- Recommend by CLSI for ___________________ counting
- Slide: 3 x 1 inch or 75mm x 25mm, 1-1.2 mm thick
Wedge smear
- Uses 2 slides; angle between the 2 slides → 25 / 30-40 / 30-45° angle (PREFERRED)
Easiest to master
-Recommended by CLSI for WBC differential counting
- Slide: 3 x 1 inch or 75mm x 25mm, 1-1.2 mm thick
153
Distance of smear from the sides of the slide
Head: _____
Terminate: ___
Distance of smear from the sides of the slide
Head: 1cm
Terminate: 1 cm
154
Spun Smear
- For platelet and WBC count (<1.0x10%L), and for demonstration of LE cells: _______________
Thick blood smear is the gold standard for ______________
Spun Smear
- For platelet and WBC count (<1.0x10%L), and for demonstration of LE cells: Buffy coat smear
Thick blood smear is the gold standard for blood parasites (malaria)
155
LE Cells are found in patients with ______.
Systemic lupus erythematosus
156
This cell is neutrophil with round homogenous body
LE Cells
157
Blood smear considerations
- Size (drop of blood): ____________
- Speed of spreader: ____________
- Distance of the drop of blood to the end of slide: ____________
Hct of Patient
- Polycythemia vera (increased hematocrit) = angle of the spreader must be lowered to ° angle
- Anemia (decreased Hematocrit) = angle of the spread must be higher than ° angle
Blood smear considerations
- Size (drop of blood): 2-3 mm or 0.05 mL
- Speed of spreader: Rapid and smooth
- Distance of the drop of blood to the end of slide: 1 cm/0.25 inch
Hct of Patient
- Polycythemia vera (increased hematocrit) = angle of the spreader must be lowered to 25° angle
- Anemia (decreased Hematocrit) = angle of the spread must be higher than 45-degree angle
158
What cause(s) too thick smears?
↓ Pressure
↑ Angle
↑ Speed
↑ Size of blood
159
What cause(s) too thin smears?
↑ Pressure
↓ Angle
↓ Speed
↓ Size of blood
160
CHARACTERISTIC OF AN IDEAL BLOOD SMEAR (Wedge method)
- Gradual transition from ___ to ___ area
- ___ to ___ the length of the film slide
- ___-shaped
CHARACTERISTIC OF AN IDEAL BLOOD SMEAR (Wedge method)
- Gradual transition from thick to thin area
- 2/3 to 3/4 the length of the film slide
- Finger-shaped
161
What could possibly the cause of: Presence of streaks, lines, and irregularities
A. Chipped or rough edge on spreader slide.
B. Hesitation in forward motion of spreader slide.
C. Spreader slide pushed too quickly.
D. Drop of blood too small.
E. Drop of blood not allowed to spread across the with of the slide.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
G. Uneven pressure on the spreader slide.
H. Time delay; drop of blood began to dry prior to spread.
A. Chipped or rough edge on spreader slide.
162
What could possibly be the cause of: A wavy smear
A. Chipped or rough edge on spreader slide.
B. Hesitation in forward motion of spreader slide.
C. Spreader slide pushed too quickly.
D. Drop of blood too small.
E. Drop of blood not allowed to spread across the with of the slide.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
G. Uneven pressure on the spreader slide.
H. Time delay; drop of blood began to dry prior to spread.
B. Hesitation in forward motion of spreader slide.
163
What could possibly be the cause of: Smear too short
A. Chipped or rough edge on spreader slide.
B. Hesitation in forward motion of spreader slide.
C. Spreader slide pushed too quickly.
D. Drop of blood too small.
E. Drop of blood not allowed to spread across the with of the slide.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
G. Uneven pressure on the spreader slide.
H. Time delay; drop of blood began to dry prior to spread.
C. Spreader slide pushed too quickly.
164
What could possibly be the cause of: Short smear
A. Chipped or rough edge on spreader slide.
B. Hesitation in forward motion of spreader slide.
C. Spreader slide pushed too quickly.
D. Drop of blood too small.
E. Drop of blood not allowed to spread across the with of the slide.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
G. Uneven pressure on the spreader slide.
H. Time delay; drop of blood began to dry prior to spread.
D. Drop of blood too small.
165
What could possibly the cause of: Uneven distribution of smear
A. Chipped or rough edge on spreader slide.
B. Hesitation in forward motion of spreader slide.
C. Spreader slide pushed too quickly.
D. Drop of blood too small.
E. Drop of blood not allowed to spread across the with of the slide.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
G. Uneven pressure on the spreader slide.
H. Time delay; drop of blood began to dry prior to spread.
E. Drop of blood not allowed to spread across the with of the slide.
166
What could possibly the cause of: Holes
A. Chipped or rough edge on spreader slide.
B. Hesitation in forward motion of spreader slide.
C. Spreader slide pushed too quickly.
D. Drop of blood too small.
E. Drop of blood not allowed to spread across the with of the slide.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
G. Uneven pressure on the spreader slide.
H. Time delay; drop of blood began to dry prior to spread.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
167
What could possibly the cause of: Uneven feather edge part
A. Chipped or rough edge on spreader slide.
B. Hesitation in forward motion of spreader slide.
C. Spreader slide pushed too quickly.
D. Drop of blood too small.
E. Drop of blood not allowed to spread across the with of the slide.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
G. Uneven pressure on the spreader slide.
H. Time delay; drop of blood began to dry prior to spread.
G. Uneven pressure on the spreader slide.
168
What could possibly the cause of: Uneven thickness of the middle and side portion of the smear
A. Chipped or rough edge on spreader slide.
B. Hesitation in forward motion of spreader slide.
C. Spreader slide pushed too quickly.
D. Drop of blood too small.
E. Drop of blood not allowed to spread across the with of the slide.
F. Dirt or grease on the slide; may also be PB specimen elevated lipids.
G. Uneven pressure on the spreader slide.
H. Time delay; drop of blood began to dry prior to spread.
H. Time delay; drop of blood began to dry prior to spread.
169
COMMONLY USED DRYING TECHNIQUE
1.
2.
3.
COMMONLY USED DRYING TECHNIQUE
1. Air dry
2. Small fan
3. Automated dryer
170
Thinnest part of the smear
Tail
171
Thickest part of the smear
Head
172
The following refers to _______________________ stain
* Thin smears
* Insufficient staining
* Prolonged washing
* Mounting the coverslips before they are dry
* Too high acidity of the stain or the buffer
Excessively pink stain
173
The following refers to ____________________ stain
* Thick films
* Prolonged staining time
* Inadequate washing
* Too high alkalinity in the stain
Excessively blue stain
174
SCANNING / COUNTING METHODS OF CELLS
1. _______________: WBCs are counted in consecutive fields as the blood film is moved from side to side
2. _______________: WBCs are counted in consecutive fields from tail toward the head of the smear
3. Battlement/Track pattern/______________________: uses a pattern of consecutive fields beginning near the tail on a horizontal edge: count three consecutive horizontal edge field, count two fields towards the center of the smear, count two fields horizontally, count two fields vertically to the edge. Most preferred counting method
SCANNING / COUNTING METHODS OF CELLS
1. Cross sectional / Crenellation: WBCs are counted in consecutive fields as the blood film is moved from side to side
2. Longitudinal: WBCs are counted in consecutive fields from tail toward the head of the smear
3. Battlement/Track pattern/Back and forth serpentine: uses a pattern of consecutive fields beginning near the tail on a horizontal edge: count three consecutive horizontal edge field, count two fields towards the center of the smear, count two fields horizontally, count two fields vertically to the edge. Most preferred counting method
175
A polychrome stain that is defined as any stain containing methylene blue and/or its products of
oxidation and a halogenated fluorescein dye, usually Eosin B or Y.
Romanowsky Stains
176
Examples of Romanowsky stain
1.
2.
3.
4.
5.
Examples of Romanowsky stain
1. Wright's stain
2. Giemsa stain
3. Leishman stain
4. Jenner stain
5. May Grunwald
177
The most common Romanowsky stain used in blood film preparation
Wright's stain
178
The Romanowsky stain used for Malaria
Giemsa stain
179
Blood Film Staining
Fixative:
Stain:
Buffer:
Blood Film Staining
Fixative: Methanol
Stain: Wright's stain- Methylene blue + Eosin Y
Buffer: Aged distilled water or 0.05M sodium phosphate (pH 6.4-6.8)
180
For best results, blood smears should be stained __ to __ hours of specimen collection
For best results, blood smears should be stained 2 to 3 hours of specimen collection
181
pH
• For blood and Bone marrow staining:
• For Malarial parasites:
pH
• For blood and Bone marrow staining: pH 6.8
• For Malarial parasites: pH of 7.2
182
WELL STAINED PERIPHERAL BLOOD FILM
Macroscopically
- A well-stained blood film should be ____ to _____
Microscopically
- _____ should appear orange to salmon pink
- _____ nuclei should be purple to blue.
- __________________ should be pink to tan with violet or lilac granules.
- ____________ should have bright orange refractile granules.
WELL STAINED PERIPHERAL BLOOD FILM
Macroscopically
- A well-stained blood film should be pink to purple.
Microscopically
- RBCs should appear orange to salmon pink.
- WBC nuclei should be purple to blue.
- Cytoplasm of neutrophils should be pink to tan with violet or lilac granules.
- Eosinophils should have bright orange refractile granules.
183
This stain demonstrates the presence of DNA
Feulgen stain
184
This stain demonstrates the presence of RNA
Supravital stains
185
Positive in Feulgen stain
Howell-Jolly bodies
186
Negative in Feulgen stain
Basophilic stippling
Cabot rings
Polychromatophilia
Reticulocytes
Pappenheimer bodies
Heinz bodies
187
Positive in Supravital Stain
Basophilic stippling
Cabot rings
Howell-Jolly bodies
Polychromatophilia
Reticulocytes
Pappenheimer bodies
Heinz bodies
188
Positive in Supravital Stain
Basophilic stippling
Howell-Jolly bodies
Reticulocytes
Pappenheimer bodies
Heinz bodies
189
Negative in Supravital Stain
Cabot rings
Polychromatophilia
190
Positive in Wright stain
Reticulocytes
Heinz bodies
191
Negative in Wright stain
Basophilic stippling
Cabot rings
Howell-Jolly bodies
Polychromatophilia
Pappenheimer bodies
192
Stain used for Heinz bodies
Crystal violet
193
These are supravital stains
1.
2.
3.
These are supravital stains
1. New methylene blue
2. Brilliant cresyl blue
3. Crystal violet
194
Stain used for reticulocytes
New methylene blue
195
ADDITIONAL INFORMATION (STAINING)
1. Film that is ________ overall than normal may indicate that the patient has increased blood proteins, as in plasma cell myeloma, and that rouleaux may be seen on the film
2. A grainy appearance to the film may indicate _______________, as found in cold hemagglutinin diseases.
3.Holes all over the film could mean that the patient has _____________.
4. Slides stained after 1 week or longer turn out too ____.
ADDITIONAL INFORMATION (STAINING)
1. Film that is bluer overall than normal may indicate that the patient has increased blood proteins, as in plasma cell myeloma, and that rouleaux may be seen on the film
2. A grainy appearance to the film may indicate RBC agglutination, as found in cold hemagglutinin diseases.
3.Holes all over the film could mean that the patient has increased lipid levels.
4. Slides stained after 1 week or longer turn out too blue.
196
This can be demonstrated with crystal violet stain
Heinz bodies
197
This can be demonstrated with new methylene blue
Reticulocytes
198
______________________
The presence of more than four times the number of cells per field at the edges or feather compared with the monolayer area of the film indicates that the film is unacceptable (i.e., a "snowplow" effect), and the film should be __________
SNOW PLOW EFFECT
The presence of more than four times the number of cells per field at the edges or feather compared with the monolayer area of the film indicates that the film is unacceptable (i.e., a "snowplow" effect), and the film should be remade
199
WBC Estimate
Using 40X (HPO) = Average number of WBCs per field × _____
Using 50X (OIO) = Average number of WBCs per field × ______
WBC Estimate
Using 40X (HPO) = Average number of WBCs per field × 2000
Using 50X (OIO) = Average number of WBCs per field × 3000
200
This can only be confirmed with microscopic analysis in 100x Oil Immersion Objective
Poikilocytosis
201
In this objective, overall film quality, color and distribution of cells can be assessed
LPO (10x)
202
This objective is used for the RBC, WBC, and platelet morphology evaluation
OIO (50x)
203
In this objective, the main purpose is to estimate WBC
HPO (40x)
204
Formula for Platelet Estimate
Average # x 20,000
205
When the correct area of a specimen from a patient with a normal RBC count is viewed, there are generally about 200 to 250 RBCs per 100 x oil immersion field.
8-20 PLTS/OIF - 1ST ANSWER
7-21 plts /OIF - 2ND ANSWER
