Optical scatter (hydrodynamic focusing) 1. in line w/ the laser, tells cell size? 2. 45ish degrees from laser, tells surface complexity & internal granules? 3. it tells degree of staining, more intense staining = more nuclei acid (immature cells)

1. FS: forward scatter 2. SS: side scatter 3. Fluorescent detector

HEMA - PAHABOL NOTES Flashcards by Patricia Baltazar

Poikilocyte seen in patients with renal insufficiency:

Burr cell (Burr cell is associated with uremia) / echinocytes/ crenation cells

How well did you know this?

Not at all

Perfectly

50 bilobed nucleus; 5 peanut shaped nucleus, what type of anomaly:
a. May Heglin
b. Pelger Huet
c. Alder Reilly
d. Chediak-Higashi

b. Pelger Huet

*Pelger Huet causation: due to mutations in the lamin B receptor (LBR) gene

How well did you know this?

Not at all

Perfectly

Question about mixing studies (deficient factor): corrected with aged serum but not with adsorbed plasma:
Need initial APTT and PT result prior testing studies, but likely deficient factors: 7, 9, 10
Aged serum: without 1, 5, 8, 13, 2
Adsorbed plasma: without 2, 7, 9, 10
a. Factor VIII
b. Factor IX

How well did you know this?

Not at all

Perfectly

Why is plasma floating compared to Red blood cell?
A. Rbc has greater mass than plasma
B. Rbc has greater volume than plasma
C. Rbc has greater density than plasma
D. Rbc has more cellular components than plasma”

C. Rbc has greater density than plasma

**life span of rbc- 120 days

How well did you know this?

Not at all

Perfectly

Hema - underfilled tube and its effect

prolonged APTT, and PT, false low hct (manual), falsely decreased ESR

** If the concentration of anticoagulant is increased, the ESR will be falsely low as a result of sphering of the RBCs, which inhibits rouleaux formation

How well did you know this?

Not at all

Perfectly

3 part differential cell counter-

Electronic impedance; CBC plus a 3 part WBC count

**Gives neutrophils, lymphocytes, & mixed cells (mono, eos, baso)

How well did you know this?

Not at all

Perfectly

5 part differential counter

Flow cytometry
CBC plus a 5 part WBC count
Gives neutrophils, eosinophils, basophils, monocytes, & lymphocytes

How well did you know this?

Not at all

Perfectly

Past methods for Hemoglobin:

cyanmethemoglobin and oxyhemoglobin

How well did you know this?

Not at all

Perfectly

Scattergram:

on x axis?
on y axis?

Scattergram:

*X axis is granularity,
*y is size

How well did you know this?

Not at all

Perfectly

Histograms:

on x axis?
on y axis?

*Size on x axis
*number of cells on y axis

How well did you know this?

Not at all

Perfectly

Radio frequency & direct current method

DC change tells ____
RF change tells ____

size of cells
density of cells

**Improvement allowed distinction of all cell types, 5part

How well did you know this?

Not at all

Perfectly

Uses SLS (sodium lauryl sulfate) for hgb @ 555nm
5 part diff, retics, & nuc RBCs
Auromine o supraviolet stain
Hydrodynamic focusing
Optical scatter & fluorescent

Sysmex

How well did you know this?

Not at all

Perfectly

Uses VCS (volume complexity scatter) for 5 part diffs
Hgb @ 525nm
Electrical impedance for CBC

Beckman Coulter

How well did you know this?

Not at all

Perfectly

Optical scatter (hydrodynamic focusing)

in line w/ the laser, tells cell size?
45ish degrees from laser, tells surface complexity & internal granules?
it tells degree of staining, more intense staining = more nuclei acid (immature cells)

FS: forward scatter
SS: side scatter
Fluorescent detector

How well did you know this?

Not at all

Perfectly

Uses peroxidase staining for diffs, basophils & lymphocytes peroxidase neg
Hydrodynamic focusing

Sieman’s ADVIDA

How well did you know this?

Not at all

Perfectly

Correction mechanisms and associated discrepancies for automated analyzer problems:

Low RBCs, High MCV & MCHC, grainy appearance

Cold agglutinins

**Correct: warm sample to 37 & rerun

How well did you know this?

Not at all

Perfectly

Uses MAPSS - multi-angle polarized light scatter separation technology for diffs

Abbott CELL-DYNE sapphire

How well did you know this?

Not at all

Perfectly

Correction mechanisms and associated discrepancies for automated analyzer problems:

High WBCs & hgb

Lyse resistant RBCs w/ abnormal hgb

Correct: dilute, allow time for lysis

How well did you know this?

Not at all

Perfectly

Correction mechanisms and associated discrepancies for automated analyzer problems:

Low RBCs & hematocrit

Hemolysis

**Correct: new sample

How well did you know this?

Not at all

Perfectly

Correction mechanisms and associated discrepancies for automated analyzer problems:

High hgb & MCH

Lipemia, icterus, chylomicrons:

**Correct: plasma replacement

How well did you know this?

Not at all

Perfectly

Correction mechanisms and associated discrepancies for automated analyzer problems:

Low RBCs

Microcytes, Schistocytes

**Correct: review film

How well did you know this?

Not at all

Perfectly

Correction mechanisms and associated discrepancies for automated analyzer problems:

High WBCs

Nucleated RBCs, megakaryocyte fragments, micromegakaryocytes:

**Correct: count nuc RBCs or micromegakaryocytes per 100 WBCs & correct

How well did you know this?

Not at all

Perfectly

Correction mechanisms and associated discrepancies for automated analyzer problems:

High hgb, RBCs, Incorrect hematocrit, abnormal indices

WBCs > 100,000:

**Correct: spun HCT, manual hgb, correct RBC count, recalculate indices, if above linearity dilute for correct WBC
count

How well did you know this?

Not at all

Perfectly

what type of anemia is Myeolodysplastic anemia

normocytic, normochromic

How well did you know this?

Not at all

Perfectly

Correction mechanisms and associated discrepancies for automated analyzer problems: Low WBC, high platelets

Leukemia w/ chemo: **Correct: review film, perform phase platelet count

Correction mechanisms and associated discrepancies for automated analyzer problems: High MCV, MPV, Low platelet

Old specimen: *Correct: establish stability & sample rejection criteria

Correction mechanisms and associated discrepancies for automated analyzer problems: Low platelet, High WBCs

Platelet clumps *Correct: Redraw in Na citrate, multiply result by 1.1

Activates extrinsic pathway?

release of TF from endothelial cells **The extrinsic pathway of coagulation is initiated by tissue factor (TF), also known as tissue thromboplastin, which is released from damaged tissues and interacts with factor VII to activate factor X, ultimately leading to clot formation.

Major site of heme synthesis: A) BONE-85% B) LIVER -15%

A) BONE-85% Heme synthesis involves the cytoplasm and mitochondria. Primarily occurs in the bone marrow, liver and other hematopoietic tissues. (1st choice: Bone marrow)

Enhances platelet activity a. Stasis of blood flow b. Disturbance of blood flow c. Increased procoagulant ? d. Decreased procoagulant ?

a. Stasis of blood flow

seen in Sysmex hematology analyzers and indicate the likelihood of abnormal cells in a blood sample.

Q flag **>100 is abnormal

Most common form of childhood leukemia

- ALL

Folate acid deficiency except a. Howell jolly bodies b. Burr cells- more commonly associated with uremia/PK deficiency c. Oval macrocytes d. Segmendted neutrophils??

b. Burr cells- more commonly associated with uremia/PK deficiency

IIntermediate precursor of metamyelocytes a. Myelocyte b. Band

a. Myelocyte

Smear angle- 30-45 a. 10-15 b. 30-35 c. 50-55 ?

b. 30-35 *30-40 is optimal

Not part of histogram of blood cells a. RBC b. Hgb c. WBC d. Plt

b. Hgb

Hemoglobin is measured directly using ___, ___, ____

cyanmethemoglobin SLS Hemocue methods.

*Presence of such results in prolonged APTT, uncorrected APTT in mixing studies (both pre-incubation and post-incubation)

Lupus anticoagulant

*Test for lupus anticoagulant:

Dilute Russell’s Viper Venom Time

Flow cytometry: Controls the flow of the cell suspension.

Fluidics System:

Flow cytometry: Measures cell size and volume.

Forward Scatter (FSC):

Flow cytometry: Reflects cell granularity and internal complexity (e.g., nuclear structure, cytoplasmic granules).

Side Scatter (SSC):

Flow cytometry: Process the data and generate reports.

Electronics and Computer:

Flow cytometry: Indicates the presence and intensity of fluorescently labeled molecules (e.g., antibodies, dyes) bound to the cell surface or inside the cell.

Fluorescence:

Flow cytometry: Capture the light signals.

-Detectors:

Flow cytometry: Focuses the laser beam and collects the scattered light and fluorescence.

Optics System:

Insufficient centrifugation effect on Hct: a. False increase b. False decrease

a. False increase

RBC count: Conventional unit: ____ x 106/uL SI unit: _____ x 1012/L

No correct answer, but remember, The normal red blood cell (RBC) count in grams per liter (g/L) is typically measured as hemoglobin (Hb) level

Units used in RBC count A. Grams per liter B. Volume expressed in liters C. Centimeter D. Percent

A. Grams per liter

Which of the following is not part of blood cell development A. Thrombocytosis B. Erythropoiesis C. Angiogenesis

C. Angiogenesis **Angiogenesis is the formation of new blood vessels from existing ones.

Sickling of cell A. Metabisulfite B. Dithionite

A. Metabisulfite **Metabisulfite test- screening test for presence of HbS. Sodium metabisulfite is a reducing agent which deoxygenates hemoglobin. Deoxygenated Hb S crystalizes leading to the formation of sickled RBCs or holly leaf cells.

all of the following are found in bone marrow except A. Plt B. Megakryocyte C. mononuclear cell

A. Plt

RBC histograms: Indicates macrocytic RBCs (larger than normal), often seen in vitamin B12 or folate deficiency.

Rightward Shift:

Which of the following counts is affected by the presence of smudge cells A. WBC B. RBC C. Plt D. Hgb

A. WBC *Smudge cells are remnants of lymphoid cells seen in CLL patients. They should be counted as lymphocytes, as excluding these cells can affect the accuracy of the results (Rodaks).

RBC histograms: Can indicate the presence of two distinct populations of red blood cells, which might be seen in conditions like dimorphic anemia or after blood transfusion.

Bimodal Distribution:

pos result of Sodium dithionite?

(+) turbidity

Which of the following is not part of RBC histogram A. WBC B. RBC C. Plt

A. WBC

RBC histograms: Indicates microcytic RBCs (smaller than normal), often seen in iron deficiency anemia.

Leftward Shift:

RBC histograms: Can be recognized by the presence of a second peak with double the normal corpuscular volume.

RBC clumping:

Formula for corrected reticulocyte count

CRC = %retics x (Hct/45%)

Control center of platelet activation

Dense tubular system functions to regulate platelet activation by sequestering or releasing calcium.

Which is NOT a function of basophil? a. phagocytosis b. something about attacking helminths c. immunity against ticks d. none

None of these

Reticulated platelets are also known as what;

Stress platelets

Which is NOT an inherited platelet disorder? A. Glanzmanns B. BSS C. DIC

C. DIC **DIC is not an inherited disorder but often occurs as a complication of other primary conditions

needle-shaped structures found in the cytoplasm of certain blood cells, particularly myeloblasts (immature white blood cells), and are a hallmark of acute myeloid leukemia (AML), especially acute promyelocytic leukemia (APL).

Auer rods

Change of color in RBCs choices: polychromasia, hypochromia, hyperchromia

polychromasia

neutrophil granule?

myeloperoxidase

Leukemia with auer rods-

a type of acute myeloid leukemia (AML) characterized by the proliferation of both myeloid and monocytic cells, with more than 20% but less than 80% of the bone marrow cells being of monocytic lineage

M4 leukemia," or acute myelomonocytic leukemia (AMML)

A patient shows all negative cytochemical stain, but the cd markers shows myeloid and also conclude that the cell is myeloid. What type of leukemia is present?

AML

WHAT IS THE PRINCIPLE OF FIBROMETER-

- electromechanical detection of fibrin clot

what type of anemia is Sickle cell anemia:

normocytic, normochromic

single passage a. Voltage pulse B. hydrodynamic focusing

B. hydrodynamic focusing **Cell count = number of pulses (impedance), cells passing through the laser (flow cytometry)

Which of the following has normal cell inclusion? a. Pelger-Huet Anomaly- hyposegmentation b. Alder Reilly Anomaly- with partially degraded polysaccharides c. Giant Platelet Syndrome- alpha granule deficiency d. Glanzmann’s thrombosthenia

d. Glanzmann’s thrombosthenia **Glanzmann’s thrombasthenia is a platelet function defect, not an inclusion/morphology defect,

Bean or kidney shaped cell inclusion WBC- Precursor with kidney-shaped nucleus-

metamyelocyte

How is Alder-reily identified: Choices: cytoplasm with inclusions, nucleus, granules

granules

What will you do to increase blood flow? a. Instruct the patient to do fist clenching the whole venipuncture process b. Use tourniquet and remove it once the tube is almost filled c. Instruct the patient to hold firmly in a stress ball

b. Use tourniquet and remove it once the tube is almost filled

cytoplasmic inclusions **large, dark-purple staining granules in the cytoplasm of neutrophils, lymphocytes, and monocytes.

Alder-reilly bodies

hemoglobin photometer absorbance range? hemoglobin is converted to stable _______, and the absorbance or color intensity of the solution is measured in a spectrophotometer at _____wavelength.

cyanmethemoglobin (hemiglobincyanide) 540 nm

what test detects pernicious anemia. Vit b12 absorption

Schilling's Test:

Thrombocytopoiesis (Platelet Shedding) *How many platelet are shed? *In an average-size healthy human there are 10 raised to 8 megakaryocytes producing 10 raised to 11 platelets per day, a total turnover rate of ___ days

2000-4000 8 to 9 days.

Prevents coincident passage loss:

hydrodynamic focusing

Formula of HCT in hematology analyzers.

RBC x MCV/10

** Which of the following is the term for erythrocytes resembling a stack of coins on thin sections of a peripheral blood smear? a. Anisocytosis b. Poikilocytosis c. Agglutination d. Rouleaux formation

d. Rouleaux formation

**Which of the following blood films findings indicates EDTA-induced thrombocytopenia? a.The platelets are pushed to the feathered end. b.The platelets are adhering to WBCs c. No platelets at all are seen on the film d. The slide has a bluish discoloration when examined macroscopically

b. The platelets are adhering to WBCs

** Failure to obtain blood in venipuncture using an evacuated tube is caused by the following, except: a. Use of tourniquet b. Incorrect needle position c. Inadequate vacuum in tube d. Collapsed

a. Use of tourniquet

**Most common cause of acquired platelet dysfunction: A. HUS B. DIC C. Drug-induced D. Heparin-induced

C. Drug-induced **Uremia is their answer but the book and journals say drug induced…

these are the most common causes of acquired platelet dysfunction.

Aspirin and other drugs **Given the high consumption of pharmacological agents in western societies, it is not surprising at all that drugs represent the most common cause of acquired platelet dysfunction.

** Increase in electrical resistance that occurs when a poorly conductive particle passes through an electrical field is known as: Impedance

Impedance

**A blood film for a patient with a normal RBC count has an average of 10 platelets per OIO. Which of the following values best correlates with the estimate per microliter? a.20,000 b.100,000 c.200,000 d.400,000

**A simple platelet estimate assumes a normal proportion of platelets to rbcs of about 1:20, thus multiplying the average number of platelets/100× field by 20 × 103/ μL provides a good estimate of the platelet count.

**which is friction in rough surface? Laceration Abrasion Contusion None

Abrasion *Friction causes abrasions. Friction is the movement of a hard, uneven or rough surface, object or material against your skin.

**Which of the following activates fibrinolysis? A. Plasmin B. PAI-1 C. TAFI D. Tissue plasminogen activator

D. Tissue plasminogen activator **The activation of fibrinolysis is achieved by converting plasminogen to plasmin through the action of either tissue plasminogen activator (tPA), which is released by activated endothelial cells, or urokinase plasminogen activator (uPA), which is produced mainly by macrophages and monocytes.

ECs, as well as other cells, secrete _____, a ____control protein that inhibits plasmin generation and fibrinolysis. Another inhibitor of plasmin generation, _____, is activated by thrombin bound to EC membrane ___. Elevations in PAI-1 or TAFI can slow fibrinolysis and increase the tendency for thrombosis.

*plasminogen activator inhibitor 1 (PAI-1) *TPA *thrombin-activatable fibrinolysis inhibitor (TAFI) *thrombomodulin

a deep cut or tear in skin or flesh.

Laceration:

is the medical term for a bruise. It is the result of a direct blow or an impact, such as a fall; are common sports injuries.

Contusions

M4 ?

**Acute myelomonocytic leukemia:

** What type of sample is used in the Sysmex XE-series machine Citrated blood EDTA blood NaF blood Heparinized blood

EDTA blood

*White blood cells with “more azurophilic” and “less granules” Early neutrophilic myelocyte Myeloblast Late neutrophilic Metamyelocyte

Early neutrophilic myelocyte

**R flagging (Region) When cell populations overlap or a distinct separation of populations does not exist, a region alarm (R flag) may be triggered that indicates the area of interference on the volume-distribution histogram. An ______ represents excess signals at the lower threshold region of the WBC histogram and a questionable WBC count. This interference is visualized as a high takeoff of the curve and may indicate the presence of nucleated RBCs, clumped platelets, unlysed RBCs, or electronic noise.

R1 flag

**A reduction in thrombin generation in patients with Scott syndrome results from: (Rodaks) A. Defective granule secretion B. Altered platelet aggregation C. Altered expression of phospholipids on the platelet membrane D. Deficiency of vitamin K-dependent clotting factors

C. Altered expression of phospholipids on the platelet membrane

a rare autosomal recessive disorder of calcium induced membrane phospholipid scrambling (necessary for coagulation factor assembly) and thrombin generation on platelets. Platelets secrete and aggregate normally but do not transport phosphatidylserine and phosphatidylethanol amine from the inner leaflet to the outer leaflet of the plasma Membrane

Scott syndrome **In Scott syndrome, platelet plug formation (including adhesion, aggregation, and secretion) occurs normally, but clotting factor complexes do not assemble on the activated platelet surface, and thrombin generation is absent or much reduced.

**Fibrinogen/Fibrin fragments EXCEPT: During coagulation, fibrin polymers become cross-linked by factor XIIIa and simultaneously bind plasma plasminogen and tissue plasminogen activator (TPA). Over several hours, bound TPA activates nearby plasminogen to form plasmin. The bound plasmin cleaves fibrin and yields the FDPs _____

*Fragment Z *D, E, X, and Y and D-dimer.

**How is Hematocrit measured?

individual RBC pulse height (represents cell volume)

**shaded area of histogram: **____ is x axis;____ is y axis

*Coefficient of variation of the size of erythrocytes *side scatter fluorescent intensity

**“C” in VCS Hematology Coulter Technology:

CONDUCTIVITY

the most powerful tool available for blood cell analysis; proprietary technology offers the greatest sensitivity, specificity and efficiency of any cell analysis system available today.

VCS Technology (Volume, Conductivity and Scatter)

**Labile factor:

Factor V

**Differentiation among RBCs, yeast, and oil droplets may be accomplished by all of the following except: A. Observation of budding in yeast cells B. Increased refractility of oil droplets C. Lysis of yeast cells by acetic acid D. Lysis of RBCs by acetic acid

C. Lysis of yeast cells by acetic acid

**auer rods seen in

: AGL or AML

**Where are RBCs counted in hemacytometer?

CENTER square

**Which of the following is represented by the first peak in this picture? a. Lymphocytes b. Neutrophils c. Monocytes d. Eosinophils

a. Lymphocytes

**An automated haematology analyser provides ______ by plotting the sizes of different blood cells on X-axis and their relative number on Y-axis.

blood cell histograms

**Giant platelets:

BSS (Bernard Soulier syndrome)

____it occurs for inherited diseases like Bernard–Soulier syndrome, gray platelet syndrome and May–Hegglin anomaly. _____ (stained purple) are visible in this image from a light microscope (40×) from a peripheral blood smear surrounded by red blood cells

giant platelets Two giant platelets

**Lymphocytes are distributed between ___ fL, **mixed cell population (monocytes, basophils and eosinophils) between ___fl **neutrophils between ___fl

50-100fl 100-150 fL 150-300 fL

**Venipuncture sites EXCEPT:

PALMAR SURFACE OF THE HAND

Generalized bleeding may exhibit a mucocutaneous (systemic) or a soft tissue (anatomic) pattern. ______ may appear as _____, pinpoint hemorrhages into the skin; ____, purple lesions of the skin greater than 3 mm caused by extravasated (seeping) red blood cells (RBCs); or _____greater than 1 cm typically seen after trauma

Mucocutaneous hemorrhage petechiae purpura ecchymoses (bruises)

**Bleeding in mucocutaneous areas, except: Ecchymosis Hematoma Purpura Hematemesis-anatomic

Hematemesis-anatomic

**What is not an end stage of cellular toxicity? Neoplasia Loss of function Cellular swelling Recovery with minimal function

Loss of function

Most toxic effects, especially due to xenobiotics, are due to specific biochemical interactions without causing recognizable damage to a cell or its organelles. Cellular or biochemical toxicity leads to:

o The tissue being completely repaired and returned to normal. o The tissue being incompletely repaired but capable of functioning with reduced capacity. o Death of the organism or complete loss of a tissue or organ. o Neoplasm or cancers.

**What is the average diameter of RBCs? (Turgeon) a. 6 um b. 5 um c. 8.2 um d. 7.2 um

d. 7.2 um

**Which of the following distinguishes Chediak-Higashi from others that has inclusion bodies? a.Foamy cytoplasm b.With neutrophils and lymphocytes c. large pink lysosomal granules or cytoplasmic inclusions in neutrophils.

c. large pink lysosomal granules or cytoplasmic inclusions in neutrophils.

it represents a defect in neutrophilic microtubule function. Essentially, this dysfunction presents through an inability of the lysosome and phagosome to fuse post ingestion of microorganisms. Lysosomal trafficking is impaired, resulting in high incidence of recurrent pyogenic infections.

Chediak–Higashi syndrome **This anomaly is transmitted in an autosomal recessive pattern. This disorder is associated with large pink lysosomal granules or cytoplasmic inclusions in neutrophils. Coarse clumping of melanin granules is associated with color dilution of the haircoat and irises.

**FLAGS - Flags abnormal cell populations or distributions.

SUSPECT

**FLAGS Defines the limit of normal values. Increase or decrease for all CBC parameters based on numeric limits set by lab.

DEFINITIVE

**FLAGS - Indicates whether WBC, RBC, or PLT populations are normal or abnormal.

CONDITION

**Which one of the following cells is a product of the CLP (Common lymphocyte progenitor)? Megakaryocyte T lymphocyte Erythrocyte Granulocyte

T lymphocyte

**Inflamed tissue; What contributes to show signs of inflammation :

PROSTAGLANDIN

Prostaglandin: Any of a family of unsaturated 20-carbon fatty acids that are cleaved from cell membrane phospholipids and serve as intracellular activators and inhibitors. The prostaglandins include _____, a platelet activator, and _____, a platelet inhibitor produced by endothelial cells.

thromboxane A2 prostacyclin

**Cell for hemostasis:

Thrombocytes

**Monocytes are often mistaken as: a. Lymphocytes b. WBCs c. RTE d. RBCs

a. Lymphocytes **Monocytes may be mistaken for large lymphs when their cytoplasm stains too lightly, when the characteristic granules are indistinct, or when the nucleus is rounded or only slightly indented.

** Platelet Histogram Criteria for fitted curve A. platelet count above 20,000/microliter B.log-normal distribution C.no platelet count vote-out D. AOTA

D. AOTA

**Most common Hereditary disease associated with excess iron storage? Hemochromatosis vWD Anemia DIC

Hemochromatosis

**A blood sample with high titer agglutinins was tested in room temperature with an electron particle scanner(?). What indices/count would be erroneous. MCHC and WBC MCV and Hgb MCHC and MCV WBC and RBC

MCHC and MCV

The presence of cold agglutinins can falsely ____

decrease the hematocrit.

____ manifest as a classic pattern of increased MCV (frequently greater than 130 fL), markedly decreased RBC count, and increased MCHC (frequently greater than 40 g/dL).

Cold agglutinins

**Lipemia is associated with which of the following? 1. the presence of excess fats in the blood 2. falsely elevated Hgb 3. falsely elevated MCH a. 1,2,3 b. a1,2 c. 2,3 d. 1,3

a. 1,2,3

CTERICIA also falsely elevates __ and __

Hgb and MCH

**Which is a characteristic of anemia of renal disease. a. Severe hypochromatosis with microcytosis b. Normocytic, hypochromic c. Presence of burr cells in the pbs d. Normocytic, normochromic

d. Normocytic, normochromic

**Automated problems remedies:

1. Cold agglutinins: warm blood to 37 degrees 2. Hgb's/ lysis resistant RBC's- manual dilutions 3. increased WBC's (leukemia): Dilute the specimen and perform a manual cell count 4. Platelet clumps: agitate the specimen to disperse agglutinated platelets recollect with sodium citrate 5. Giant platelets: recollect with sodium citrate ruling out reactivity with EDTA

*Disadvantage of automated hematology analyzer, EXCEPT: a. None b. multiple test in one parameter c. clumped platelets are counted as one d. comments on RBC morphology can’t be determined

b. multiple test in one parameter

**Components of Perl’s Prussian blue 5% ferric chloride, 2% HCl 2% aqueous potassium ferrocyanide, 2% HCl 2% ferric chloride, 5% HCl 5% aqueous potassium ferrocyanide, 2% HCl

2% aqueous potassium ferrocyanide, 2% HCl

—The solution is a mixture of 2% K4Fe(CN)6 stock solution and 2% HCl in a ratio of 1:1. The solution should be freshly made with 20% K4Fe(CN)6 stock solution and 20% hydrochloric acid (HCl) before use.

Perl's Prussian blue solution—

**Insufficient centrifuge how it affects hematocrit? False increase False decrease Increase Decrease

False increase

Falsely increased hematocrit

* Dehydration * Hemoconcentration * Insufficient Centrifugation time * Buffy coat inclusion

Falsely increased hematocrit

* Hemolysis * Increased Ac volume * Improper sealing of the capillary tube * Introduction of tissue fluid

also known as true or congenital PHA, is an autosomal dominant disorder characterized by decreased nuclear segmentation (bilobed, unilobed) and a characteristic coarse chromatin clumping pattern potentially affecting all leukocytes, although morphologic changes are most obvious in mature neutrophils.

Pelger-Huët anomaly (PHA)

**The mononuclear cells seen in WBC Histogram include: a. Platelet b. Erythrocytes c. Blast d. Leukocytes

c. Blast

**The following are examples of Romanowsky stains, EXCEPT Hematoxylin May Grunwald Leishman Giemsa

Hematoxylin **Some examples of Romanowsky stains include May-Grunwald, Giemsa's, Jenner's, Leishman's, and Wright's stains. These are considered neutral stains because they are composed of a basic dye and an acidic dye; the dyes impart color to cellular components they are attracted to.

**How do thrombocytes migrate from the bone marrow? a. Squeeze through the endothelial cells into the circulation b. Attach to white cells c. Megakaryocytes form processes that extend towards the endothelial lining to release platelets

c. Megakaryocytes form processes that extend towards the endothelial lining to release platelets **Megakaryocytes exit the marrow with white cells and then platelets fragment off once they reach the blood. Cytoplasmic extensions elongate and pierce between the endothelial cells that line the marrow sinuses; then they extend into venous blood. These extensions release platelets once they enter blood.

**Which of the following is the MAJOR post-analytical error? a. Patient’s critical result b. Sample transport c. Sample quality d. Patient’s specific diagnosis

a. Patient’s critical result

**smear normal color: Pinkish blue Pinkish red Pinkish purple None

Pinkish purple

**In protime, effect if tube is NOT filled: a. No effect b. Normal c. Shortened d. Prolonged

d. Prolonged

**Schistocytes, ovalocytes, and acanthocytes are examples of abnormal changes in RBC: a. Volume b. Shape c. Inclusions d. Hemoglobin concentration

b. Shape

**What is the morphology of the echinocyte? a. small, round, rbc --spherocyte b. scooped out part of an rbc -helmet cells c. short, scallop or spike like d. fragmented rbcs -schistocytes or schizocytes

c. short, scallop or spike like

**What are the initial laboratory tests that are performed for the diagnosis of anemia? a. CBC, iron studies, and reticulocytes b. CBC, retic count, and peripheral blood film examination c. Retic count, serum iron, Vitamin B12 and folate assays.

b. CBC, retic count, and peripheral blood film examination

**If a small blood clot exists in an anticoagulated blood specimen, which blood cell parameter will be affected the most? Leukocyte Erythrocyte Platelet count Microhematocrit

Platelet count

**Part of flow cytometry EXCEPT: a. digital b. optical c. fluidics d. electronics

a. digital

an automated method of sorting cells. It uses a cell suspension injected into a stream sheath fluid to determine specific characteristics of the cell, including size, complexity, immunophenoType, and cytochemistry

Flow cytometry

Cells in suspension move through sheath fluid in a single-file line, allowing each to individually pass through a laser light

Hydrodynamic focusing:

it is created to separate a specific population of interest ○ Performed during or after initial analysis

Gating: Electronic boundaries

can be used to determine cell lineage and aid in characterizing patient immunophenotype

Fluorescently tagged antibodies

**A hemoglobin molecule is composed of: a. One heme molecule and four globin chains b. Ferrous iron, protoporphyrin IX, and a globin chain c. Protoporphyrin IX and four globin Chains d. Four heme molecules and four globin chains

d. Four heme molecules and four globin chains

**What is the average liter of blood in humans: a. 6L b. 5L c. 7L d. 8L