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KLUBSYBEAR HEMATOLOGY > HEMA DAY 1 > Flashcards

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

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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

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3
Q

This hormone promotes the production of RBC

A

Testosterone

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4
Q

This hormone has an inhibitory effect on the production of RBC

A

Estrogen

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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
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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

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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

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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.

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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

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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

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11
Q

Plasma vs. Serum
This is the fluid portion of the anticoagulated blood

A

Plasma

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12
Q

Plasma vs. Serum
This has slightly hazy appearance

A

Plasma

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13
Q

Plasma vs. Serum
This contains all coagulation factor

A

Plasma

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14
Q

Plasma vs. Serum
This contains normal yellowish or straw-colored appearance

A

Both

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15
Q

Plasma vs. Serum
Fluid portion of non-anticoagulated blod

A

Serum

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16
Q

Plasma vs. Serum
Clear appearance

A

Serum

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17
Q

Plasma vs. Serum
Lacks fibrinogen group

A

Serum

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18
Q

Which factors belong to the Fibrinogen Group

A

Factors I, V, VIII and XIII

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19
Q

Color of oxygenated/arterial blood

A

Bright red

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20
Q

Color of deoxygenated/venous blood

A

Dark purplish red

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21
Q

All arteries carry oxygenated blood, EXCEPT

A

Pulmonary arteries

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22
Q

Thickest blood vessel

A

Arteries

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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

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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

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25
Q

Preferred EDTA of CLSI due to less shrinkage of RBC

A

K3 EDTA

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26
Q

Preferred EDTA of Rodak’s due to ease in mixture

A

K2 EDTA

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27
Q

Disodium salt is also known as ______, in _______ form

A

VERSENE, POWDERIZED

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28
Q

Tripotassium is also known as _______, in _______ form

A

SEQUESTRENE, LIQUID

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29
Q

Excessive EDTA concentration causes platelets to _____ and ____ that will lead to ________________ of Platelet Count

A

Excessive EDTA concentration causes platelets to swell and fragment that will lead to false increase of Platelet Count

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30
Q

Which factors are not stable in EDTA?

A

Labile factors - V AND VIII

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31
Q

Most preferred anticoagulant for platelet studies/aggregation test/platelet function test?

A

Citrate

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32
Q

Most preferred anticoagulant for blood cell counting and observation of cell morphology

A

EDTA

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33
Q

Venous blood is more acidic compared to arterial blood due to ______

A

Carbon dioxide

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34
Q

Expired EDTA causes the following

A

False decreased platelet count

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35
Q

Which anticoagulant inhibits Fibrinogen-thrombin action

A

EDTA

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36
Q

Increase/excess EDTA in ESR and hematocrit results

A

False decreased platelet count

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37
Q

______ might cause platelet satellitosis, that is then rectified by the use of _______

A

EDTA might cause platelet satellitosis, that is then rectified by the use of sodium citrate

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38
Q

Not rectified platelet satellitosis causes

A

False decrease automated platelet count

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39
Q

What is the most important function of blood? Clue: In the respiratory system

A

Transportation of blood gases, specifically RBC

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40
Q

What are the two types of citrate?

A

Blue and black top

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41
Q

The most preferred anticoagulant for ESR testing

A

Black top tube Citrate

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42
Q

Anticoagulant of choice for Standard Westergren

A

Black top tube Citrate

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43
Q

Anticoagulant of choice in coagulation studies

A

Blue top tube Citrate

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44
Q

Which citrate has the ratio of blood to anticoagulant is 9:1

A

Blue top tube Citrate

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45
Q

Which anticoagulant is buffered and used in concentration of 3.2%?

A

Blue top tube Citrate

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46
Q

Which anticoagulant is buffered and used in concentration of 3.8%?

A

Black top tube Citrate

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47
Q

Which anticoagulant is not recommended in coagulation studies because it can falsely prolong coagulation results

A

Black top tube Citrate

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48
Q

Which citrate has the ratio of blood to anticoagulant is 4:1

A

Black top tube Citrate

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49
Q

Other term for polycythemia

A

Erythrocytosis

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50
Q

What is the formula for hematocrit >55%

A

(100-Hct/595-Hct) (#mL of Whole Blood)

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51
Q

The action of this anticoagulant is to bind calcium and form soluble complex

A

Sodium citrate

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52
Q

The action of this anticoagulant is to bind calcium and form insoluble complex

A

Oxalate

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53
Q

Different forms of oxalate

1.
2.
3.
4.

A

Different forms of oxalate

  1. Lithium oxalate
  2. Sodium oxalate
  3. Potassium oxalate
  4. Double oxalate
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54
Q

This is the combination of potassium oxalate and ammonium oxalate

A

Double balanced oxalate

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55
Q

This type of oxalate causes cell swelling; 3 parts

A

Ammonium oxalate (Winthrobe’s)

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56
Q

This type of oxalate causes cell shrinkage; 2 parts

A

Potassium oxalate (Paul Heller’s)

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57
Q

This anticoagulant is used as an in vitro and in vivo

A

Heparin

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58
Q

This is considered as a “natural anticoagulant”

A

Heparin

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59
Q

Underfilling/Excess citrate/Short draw of the tube can cause _________________ due to excess citrate in plasma

A

Prolonged PT and PTT results

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60
Q

Which citrate tube color can preserve Factors V and VIII

A

Blue top tube Citrate

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61
Q

Which anticoagulant is not recomended for coagulation studies because it inhibits all stages of coagulation cascade especially thrombin

A

Heparin

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62
Q

Which anticoagulant has the 15 to 20 Uml of blood or 15 to 30 U/ml of blood (0.2mg/ml of blood)?

A

Heparin

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63
Q

Which test has increased values in leukomoid reaction and decreased in CML?

A

LAP test

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64
Q

Which anticoagulant is used during percutaneous transluminal coronary angioplasty (PTCA) and cardiopulmonary bypass (CPB) to prevent clot formation

A

Heparin

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65
Q

Which anticoagulant is not prefered in hematology and blood smear preparation?

A

Heparin

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66
Q

Which anticoagulant can:
- produce a bluish background on Romanowsky stained smear
- destroy WBC and platelets

A

Heparin

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67
Q

Which chemical can be used in blood alcohol determination

A

Ethanol

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68
Q

This tube is commonly used for glucose determination

A

Sodium fluoride (Gray top tube)

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69
Q

Can be used in determination of lactic and blood alcohol

A

Sodium fluoride (Gray top tube)

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70
Q

What is the correct order of draw in venipuncture?

A
  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
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71
Q

What is the correct order of draw in capillary puncture?

A
  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
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72
Q

This stopper forms plasma, and can be used for SPS and ACD testing

A

Yellow stopper

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73
Q

This stopper is used in HBA1C and lipoprotein measurement

A

Purple top

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74
Q

This test type of yellow tube/stopper is the first tube in the sequence of order of draw

A

SPS

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75
Q

This type of yellow tube/stopper is the last tube in the sequence of order of draw

A

ACD

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76
Q

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

A

t

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77
Q

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

A

5x inversions

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78
Q

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

A

WHICH OF THE FF IS THE CORRECT ORDER OF DRAW?I

D.BLUE-RED-GREEN-YELLOW

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79
Q

PURPOSE OF ORDER OF DRAW?

A

PURPOSE OF ORDER OF DRAW?
ANS: Its purpose is to avoid possible test result error because of cross-contamination from tube additives

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80
Q

How many inversions does the Glass red top (without clot activator) require?

A

None

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81
Q

How many inversions does an Orange top with thrombin clot activator require?

A

8x inversions

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82
Q

Which stopper color is not used in chemistry laboratory?

A

Yellow

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83
Q

Other term for non-anticoagulated tubes

A

Serum tubes

Because serum is their end-product, and are therefore used in chemistry testing

84
Q

Preferred way to collect blood sample from newborns and pediatric patients

A

Skin puncture

85
Q

Used for blood culture specimen collections in microbiology.

A

SPS

86
Q

Used in blood bank studies, lymphocytotoxicity testing, HLA testing, and DNA and paternity testing.

A

ACD

87
Q

Depth of skin puncture shoul dbe not deeper than ____

A

2mm

88
Q

Infants under 1 year old location of puncture in the heel

A

Lateral, medial and plantar

89
Q

Which fingers cannot be used in capillary puncture?

A

Pinky, thumb and index fingers

90
Q

Method: Skin puncture
Specimen: ________

A

Method: Skin puncture
Specimen: Capillary blood

91
Q

What is the specimen collected in newborn screening?

A

Blood spot

92
Q

A capillary blood sample is expected to have a ________ in WBC count

A

False increase

93
Q

A capillary blood sample is expected to have a ________ in RBC count, Hematocrit, and Hemoglobin, and Platelet count

A

False decrease

94
Q

True or False: ETS has a double pointed needle.

A

t

95
Q

____________ is most widely used for collecting venous blood sample.

A

Evacuated tube system

96
Q

The level of temperature and altitude is _____________ proportional to the volume of blood drawn.

A

Inversely

97
Q

True or False: The shelf life of an evacuated tube is defined by the stability of the additive and vacuum retention

A

t

98
Q

Veins in the arms- superficial veins of the _____________ (bend in the elbow) are the most common sites for venipuncture.

A

Antecubital fossa

99
Q

This vein is the least preferred because it is near to brachial artery and nerves

A

Basilic vein

100
Q

The following are the alternate vein sites
1.
2.
3.
4.
5.

A

The following are the alternate vein sites
1. Ventral forearm
2. Wrist
3. Back of the hand (Dorsal)
4. Ankle
5. Foot

101
Q

Venipuncture cannot be done in the ______________

A

Ventral of the hand

102
Q

Blood collection in __________ should be avoided in patient with DM and hypertension.

A

Ankle or foot

103
Q

Routinely used gauge of needle

Adult:
Newborn/Pedia:

A

Routinely used gauge of needle

Adult: 21 g
Newborn/Pedia: 23 or 22 g

104
Q

What is the sterilization technique used for Evacuated tubes?

A

Gamma Radiation

105
Q

Venipuncture angle
Standard:
Range:

A

Venipuncture angle
Standard: 15°
Range: 15-30°

106
Q

↑ Temperature = __ Blood volume (And vice versa)

A

↑ Temperature = ↓ Blood volume (And vice versa)

107
Q

↓ Altitude = __ Blood volume (And vice versa)

A

↓ Altitude = ↑ Blood volume (And vice versa)

108
Q

_______ is the ideal size of needle in venipuncture for better control.

A

1 inch

109
Q

What is the maximum time for the application of tourniquet?

A

1 minute (Or the least in the option)

110
Q

The proper tourniquet application is ___________inches above the venipuncture site.

A

3-4 inches

111
Q

Collection of blood with IV line should be _______ inches below the IV line

A

1-2 inches

112
Q

Anchoring of vein should be ______ inches below the venipuncture site

A

1-2 inches

113
Q

The loose end of the tourniquet should be facing ________ and should not be a hindrance in the venipuncture procedure.

A

Upward

114
Q

Number of atttempts in venipuncture

A

Twice then call another medtech

115
Q

Position of the patient

Lying down - ________: __ Packed cell Volume by 8%, ↓ WBC
Standing - ________: __ Packed cell volume 8%, ↑ WBC

A

Position of the patient

Lying down - hemodilution: ↓ Packed cell Volume by 8%, ↓ WBC
Standing - hemoconcentration: ↑ Packed ccell volume 8%, ↑ WBC

116
Q

Waste Disposal

Yellow bag:

A

Waste Disposal

Yellow bag: Infectious waste

117
Q

Waste Disposal

Orange bag:

A

Waste Disposal

Orange bag: Radioactive waste

118
Q

Waste Disposal

Red bag:

A

Waste Disposal

Red bag: Sharp waste

119
Q

Waste Disposal

Yellow with black band:

A

Waste Disposal

Yellow with black band: Chemical waste

120
Q

Waste Disposal

Green bag:

A

Waste Disposal

Green bag: Non-infectious wet waste or biodegradable

121
Q

Waste Disposal

Black bag:

A

Waste Disposal

Black bag: Infectious dry waste or non-biodegradable

122
Q

Patient with IV line

A

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
Q

Mastectomy patient

A

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
Q

Refusal by the patient to have blood drawn

Remedy:

A

Refusal by the patient to have blood drawn

Remedy: Note the refusal and notify the hematology supervisor

125
Q

Difficulty in obtaining a specimen; the bore of the needle is against the vein wall

Remedy:

A

Difficulty in obtaining a specimen; the bore of the needle is against the vein wall

Remedy: Slightly pulling back the needle

126
Q

Movement of the vein

Remedy:

A

Movement of the vein

Remedy: Have firm pressure on the arm below the venipuncture site (Anchor)

127
Q

Sudden movement by the patient or phlebotomist; needle came out prematurely

Remedy:

A

Sudden movement by the patient or phlebotomist; needle came out prematurely

Remedy: Immediately remove tourniquet, place gauze and apply pressure

128
Q

Fainting or illness subsequent to venipuncture

Remedy:

A

Fainting or illness subsequent to venipuncture

Remedy: First aid procedures of the laboratory

129
Q

Blood clot formation in anticoagulated tubes

Remedy:

A

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
Q

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

A

Tourniquet

131
Q

The most common type of tourniquet

A

Strap tourniquet

132
Q
  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

A
  1. B
  2. A
133
Q

The antiseptic technique used in venipuncture is _________ with the ________ motion

A

70% Isopropyl alcohol, circular or back and forth (superior)

134
Q

Blood pressure cuff as tourniquet

Standard:
Range:
Ivy method:
In obese patient:
In capillary fragility test:

A

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
Q

Special considerations in venipuncture

❌
❌
❌
❌

A

Special considerations in venipuncture

❌ Arm with cannula or fistula
❌ Same side as the mastectomy
❌ Areas with scars or burns
❌ Edematous areas

136
Q

In case of both arm with IV line, ask the nurse to stop the IV for ___________ and discard _______

A

2 mins, 5 mL

137
Q

In case of double masectomy, 2 options possible
1.
2.
NOTE:

A

In case of double masectomy, 2 options possible
1. Back of the hand (Dorsal)
2. Skin puncture
NOTE: Do not use tourniquet

138
Q

Phlebotomy Complications

  1. (Most common)
  5. 6.
A

Phlebotomy Complications

1.Vascular (Most common)
2. Infectious
3. Cardiovascular
4. Anemia
5. Neurological
6. Dermatological

139
Q

Phlebotomy Complications: Bleeding, hematoma, bruising, pseudo-aneurysm, thrombosis, reflex arteriospasm, and arteriovenous fistula formation

A

Vascular complications

140
Q

Phlebotomy Complications: Cellulitis (inflammation of tissue), phlebitis (inflammation of blood vessel), sepsis, septic arthritis, and osteomyelitis

A

Infectious complications

141
Q

Phlebotomy Complications: Orthostatic hypotension, syncope, shock, and cardiac arrest

A

Cardiovascular

142
Q

Phlebotomy Complications: Iatrogenic, nosocomial, physician induced, anemia resulting from blood loss

A

Anemia

143
Q

Phlebotomy Complications: Diaphoresis, seizure, pain, and nerve damage

A

Neurological

144
Q

Phlebotomy Complications: Allergic reaction to iodine, necrosis, basal cell carcinoma, and scarring

A

Dermatological

145
Q

Results when leakage of a large amount of blood around the puncture site causes the area to rapidly swell.

A

Hematoma

146
Q

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.

A

Bruising(ecchymosis)

147
Q

Stress causes a temporary ______in WBC count

A

Increase

148
Q

Increased ACTH and cortisol results in decreased ___________

A

Eosinophil count

149
Q

There is an _____________ WBC count in the afternoon compared to morning and evening

A

Increased

150
Q

Chronic effects of smoking lead to _____________ Hb concentration, erythrocyte (RBC) count, MCV, and leukocyte (WBC) count.

A

Increased

151
Q

Smokers tend to have ____________ than nonsmokers and may have polycythemia.

A

Higher hematocrits and neutrophil

152
Q

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

A

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
Q

Distance of smear from the sides of the slide

Head: _____
Terminate: ___

A

Distance of smear from the sides of the slide

Head: 1cm
Terminate: 1 cm

154
Q

Spun Smear

  • For platelet and WBC count (<1.0x10%L), and for demonstration of LE cells: _______________
    Thick blood smear is the gold standard for ______________
A

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
Q

LE Cells are found in patients with ______.

A

Systemic lupus erythematosus

156
Q

This cell is neutrophil with round homogenous body

A

LE Cells

157
Q

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

A

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
Q

What cause(s) too thick smears?

A

↓ Pressure
↑ Angle
↑ Speed
↑ Size of blood

159
Q

What cause(s) too thin smears?

A

↑ Pressure
↓ Angle
↓ Speed
↓ Size of blood

160
Q

CHARACTERISTIC OF AN IDEAL BLOOD SMEAR (Wedge method)
- Gradual transition from ___ to ___ area
- ___ to ___ the length of the film slide
- ___-shaped

A

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
Q

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

A. Chipped or rough edge on spreader slide.

162
Q

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.

A

B. Hesitation in forward motion of spreader slide.

163
Q

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.

A

C. Spreader slide pushed too quickly.

164
Q

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.

A

D. Drop of blood too small.

165
Q

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.

A

E. Drop of blood not allowed to spread across the with of the slide.

166
Q

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.

A

F. Dirt or grease on the slide; may also be PB specimen elevated lipids.

167
Q

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.

A

G. Uneven pressure on the spreader slide.

168
Q

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.

A

H. Time delay; drop of blood began to dry prior to spread.

169
Q

COMMONLY USED DRYING TECHNIQUE

  2. 3.
A

COMMONLY USED DRYING TECHNIQUE

  1. Air dry
  2. Small fan
  3. Automated dryer
170
Q

Thinnest part of the smear

A

Tail

171
Q

Thickest part of the smear

A

Head

172
Q

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
A

Excessively pink stain

173
Q

The following refers to ____________________ stain
* Thick films
* Prolonged staining time
* Inadequate washing
* Too high alkalinity in the stain

A

Excessively blue stain

174
Q

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
A

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
Q

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.

A

Romanowsky Stains

176
Q

Examples of Romanowsky stain

  4. 5.
A

Examples of Romanowsky stain

  1. Wright’s stain
  2. Giemsa stain
  3. Leishman stain
  4. Jenner stain
  5. May Grunwald
177
Q

The most common Romanowsky stain used in blood film preparation

A

Wright’s stain

178
Q

The Romanowsky stain used for Malaria

A

Giemsa stain

179
Q

Blood Film Staining

Fixative:
Stain:
Buffer:

A

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
Q

For best results, blood smears should be stained __ to __ hours of specimen collection

A

For best results, blood smears should be stained 2 to 3 hours of specimen collection

181
Q

pH

• For blood and Bone marrow staining:
• For Malarial parasites:

A

pH

• For blood and Bone marrow staining: pH 6.8
• For Malarial parasites: pH of 7.2

182
Q

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.

A

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
Q

This stain demonstrates the presence of DNA

A

Feulgen stain

184
Q

This stain demonstrates the presence of RNA

A

Supravital stains

185
Q

Positive in Feulgen stain

A

Howell-Jolly bodies

186
Q

Negative in Feulgen stain

A

Basophilic stippling
Cabot rings
Polychromatophilia
Reticulocytes
Pappenheimer bodies
Heinz bodies

187
Q

Positive in Supravital Stain

A

Basophilic stippling
Cabot rings
Howell-Jolly bodies
Polychromatophilia
Reticulocytes
Pappenheimer bodies
Heinz bodies

188
Q

Positive in Supravital Stain

A

Basophilic stippling
Howell-Jolly bodies
Reticulocytes
Pappenheimer bodies
Heinz bodies

189
Q

Negative in Supravital Stain

A

Cabot rings
Polychromatophilia

190
Q

Positive in Wright stain

A

Reticulocytes
Heinz bodies

191
Q

Negative in Wright stain

A

Basophilic stippling
Cabot rings
Howell-Jolly bodies
Polychromatophilia
Pappenheimer bodies

192
Q

Stain used for Heinz bodies

A

Crystal violet

193
Q

These are supravital stains

  2. 3.
A

These are supravital stains

  1. New methylene blue
  2. Brilliant cresyl blue
  3. Crystal violet
194
Q

Stain used for reticulocytes

A

New methylene blue

195
Q

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 _____________.
  3. Slides stained after 1 week or longer turn out too ____.
A

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.
  3. Slides stained after 1 week or longer turn out too blue.
196
Q

This can be demonstrated with crystal violet stain

A

Heinz bodies

197
Q

This can be demonstrated with new methylene blue

A

Reticulocytes

198
Q

______________________

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 __________

A

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
Q

WBC Estimate

Using 40X (HPO) = Average number of WBCs per field × _____
Using 50X (OIO) = Average number of WBCs per field × ______

A

WBC Estimate

Using 40X (HPO) = Average number of WBCs per field × 2000
Using 50X (OIO) = Average number of WBCs per field × 3000

200
Q

This can only be confirmed with microscopic analysis in 100x Oil Immersion Objective

A

Poikilocytosis

201
Q

In this objective, overall film quality, color and distribution of cells can be assessed

A

LPO (10x)

202
Q

This objective is used for the RBC, WBC, and platelet morphology evaluation

A

OIO (50x)

203
Q

In this objective, the main purpose is to estimate WBC

A

HPO (40x)

204
Q

Formula for Platelet Estimate

A

Average # x 20,000

205
Q

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.

A

8-20 PLTS/OIF - 1ST ANSWER
7-21 plts /OIF - 2ND ANSWER

KLUBSYBEAR HEMATOLOGY (2 decks)

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