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MLS > Hematology > Flashcards

Hematology Flashcards

1
Q

RBC (m)

A

4.5-5.5 x 10⁶ / uL (mm³)

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2
Q

RBC (f)

A

4.0-5.0 x 10⁶ / uL (mm³)

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3
Q

WBC

A

4.5-11.0 x 10³ / uL (mm³)

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4
Q

HGB (m)

A

14.0-17.4 g/dL

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5
Q

HGB (f)

A

12.0-16.0 g/dL

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6
Q

HCT (m)

A

42-52%

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7
Q

HCT (f)

A

36-46%

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8
Q

MCV (mean corpuscular volume)

A

80-100 fL

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9
Q

MCH (mean corpuscular hemoglobin)

A

28-34 pg

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10
Q

MCHC (mean corpuscular hemoglobin concentration)

A

32-36 g/dl

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11
Q

PLT

A

150-400 x 10³ / uL (mm³)

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12
Q

RDW (red cell distribution width)

A

12-16

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13
Q

MPV (mean platelet volume)

A

6.8-10.2 fL

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14
Q

Rule of 3

A

RBCs X 3 = HGB and HGB x 3 = HCT

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15
Q

MCV Calculation

A

HCT / RBC x 10

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16
Q

MCH Calculation

A

HGB / RBC x 10

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17
Q

MCHC Calculation

A

HGB / HCT x 100

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18
Q

WBC Critical Values

A

< 2.0 x 10³ / uL (mm³)
-or-
> 50.0 x 10³ / uL (mm³)

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19
Q

HGB Critical Values

A

< 7.0 g/dL

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20
Q

HCT Critical Values

A

< 21.0%

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21
Q

PLT Critical Values

A

< 20 x 10³ / uL (mm³)
-or-
> 1000 x 10³ / uL (mm³)

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22
Q

nRBC Threshold

A

5 / 100 WBC

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23
Q

WBC Flag: H or L

A

If critical, call floor and document;
Perform a WBC diff

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24
Q

WBC Flag: * and/or R

A

Consider/investigate the following:
* nRBCs – do diff and if >5 nRBCs/100 WBCs, correct WBC count and diff absolute values
* Large platelets – review smear and note if present
* Clumped platelets – review smear and note if present
* Clots - If none of the above are present, assume sample is clotted and redraw sample

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25
Q

RBC Flag: H or L

A

No action unless MCHC Flagged H, indicating cold agglutinins

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26
Q

Response to Cold Agglutinin

A

Warm specimen and rerun

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27
Q

HGB Flag: H or L

A

If critical, call floor and document;
If MCHC also flagged H, consider the following:
* Lipemia/icterus (indicated by false increase in Hgb without agglutination pattern); perform plasma blank/saline replacement and correct values
* Spherocytes; examine peripheral smear and document
* Cold agglutinins (pattern of low RBC, high MCV and high MCHC); warm sample and rerun
* Instrument malfunction – if none of the above are present; problem solve instrumentation
*super elevated white cells

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28
Q

HGB Flag: Delta Δ

A

Check surgery and transfusion records (could have gone up or down) and document; if no explanation for change, call floor

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29
Q

HCT Flag: H or L

A

If critical, call floor and document

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30
Q

HCT Flag: Delta Δ

A

Check surgery and transfusion records (could have gone up or down) and document; if no explanation for change, call floor

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31
Q

MCV Flag: H or L

A

Review smear, confirm macrocytes or microcytes, respectively;
If MCHC also flagged H and RBC flagged L, consider cold agglutinins

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32
Q

MCV Flag: Delta Δ

A

Patient likely misidentified; redraw sample

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33
Q

MCH Flag: H or L

A

No action necessary

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34
Q

MCHC Flag: H

A

Consider:
* Lipemia/icterus (indicated by false increase in Hgb without agglutination pattern); perform plasma blank/saline replacement and correct values
* Spherocytes; examine peripheral smear and document
* Cold agglutinins (pattern of low RBC, high MCV and high MCHC); warm sample and rerun
* Instrument malfunction – if none of the above are present; problem solve instrumentation

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35
Q

MCHC Flag: L

A

May observe smear for presence of hypochromia (not always required)

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36
Q

PLT Flag: H or L

A

If critical call floor and document;
If < 50 x 10³ / uL or > 1000 x 10³ / uL - Pathology Review

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37
Q

PLT Flag: R, *, Abnormal Histogram

A

Do platelet estimate on smear; if matches count, report value; if does not match count, perform manual platelet count

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38
Q

WBC Diff Flag: H or L

A

Perform manual differential;
Pathology review if absolute neutrophils (segs + bands) is less than 1.5 x 10³ / uL

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39
Q

WBC Diff Flag: */R

A

Perform manual differential

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40
Q

Segs (% and absolute)

A

40-60%
2.5-6.0 x 10³ / uL

41
Q

Band (% and absolute)

A

0-5%
0-500 / uL

42
Q

Lymphs (% and absolute)

A

20-40%
1.0-4.0 x 10³ / uL

43
Q

Eos (% and absolute)

A

1-3%
50-300 / uL

44
Q

Monos (% and absolute)

A

4-8%
200-800 / uL

45
Q

Myelocytes (% and absolute)

A

0%
0 / uL

46
Q

Basos (% and absolute)

A

0-1%
0-100 / uL

47
Q

Immature Granulocytes (IG) (% and absolute)

A

0-1%
0-100 / uL

48
Q

-cytosis

A

Elevated count

49
Q

-cytopenia

A

Reduced count

50
Q

Neutrophilia

A

Elevated neutrophils (either absolute or relative)

51
Q

Criteria for Pathology Review

A
  • Presence of blasts or lymphoma cells
  • Absolute neutropenia (<1.5 x 10³ / uL)
  • Platelet count (< 50 x 10³ / uL) or (> 1000 x 10³ / uL)
  • Questionable cells/morphology - include description in report
52
Q

Neutropenia

A

Reduced neutrophils (either absolute or relative)

53
Q

Normocytes

A

RBCs with normal cell volume

54
Q

Macrocytes

A

RBCs with increased cell volume

55
Q

Microcytes

A

RBCs with decreased cell volume

56
Q

Anisocytosis

A

Increased variability in RBC size (RDW > 16)

57
Q

Acanthocytes

A

“Spur cells”. Associated with:
- Severe liver disease
- Splenectomy

58
Q

Schistocytes

A

RBC Fragments. Includes “bite cells” and “blister cells”. Associated with:
- Hemolytic anemia
- Sever burns
- Renal graft rejection

59
Q

Echinocytes

A

“Burr cells”. Associated with:
- Uremia
- Hemolytic anemia
- Neonates

60
Q

Spherocytes

A

Spherical RBCs (no biconcave disk shape)
- No central pallor
- Suspect when high MCHC but normal RBC and MCV
Associated with:
- Severe burns
- Some hemolytic anemias
- Hereditary spherocytosis

61
Q

Codocytes

A

“Target cells”. Associated with:
- Hemoglobinopathies,
- Thalassemia
- Iron deficiency anemia
- Splenectomy

62
Q

Drepanocytes

A

Sickle Cells

63
Q

Ovalocyte

A

Oblong RBCs, Length <2x the Width
- Associated with megaloblastic anemia (macro-ovalocytes)
- Can be hereditary

64
Q

Elliptocyte

A

Oblong RBCs, Length >2x the Width. Associated with:
- Thalassemia major
- Iron deficiency anemia
- Can be hereditary

65
Q

Dacryocytes

A

“Teardrop Cells”
- must ‘point’ in different directions, otherwise suspect artifacting
- Thalassemia
- Myelophthisic anemia
- Extramedullary hematopoiesis

66
Q

Stomatocytes

A

“Mouth cells”
- Slit-like central pallor, not circular
- Common artifact of smear if only a few
Associated with:
- Alcoholism
- Liver disease
- RH null phenotype
- Can be hereditary

67
Q

Rouleaux

A

“Stacked coins”
- Only call if found in the normal counting area (near the feathers)

68
Q

Mentzer Index

A

MCV / RBC

69
Q

Mentzer Index Interpretation

A

> 14 = iron deficiency
12-14 = indeterminate
< 12 = thalassemia trait

70
Q

TAILS Anemias

A

Microcytic/hypochromic Anemias including:
- Thalassemia
- Anemia of chronic disease
- Iron deficiency
- Lead poisoning
- Sideroblastic anemia (congenital)

71
Q

Howell-Jolly Bodies

A

Single eccentric dot, made of DNA. Associated with:
- Splenectomy
- Megaloblastic anemia
- Hemolytic anemia

72
Q

Basophilic Stippling

A

Numerous small dots, made of RNA. Associated with:
- Lead poisoning
- Thalassemia
- Abnormal heme synthesis

73
Q

Pappenheimer Bodies

A

Clustered eccentric light blue dots, made of iron. Associated with:
- Splenectomy
- Hemolytic anemia
- Sideroblastic anemia
- Megaloblastic anemia
- Hemoglobinopathies

74
Q

Hypervolemia

A

Increased total blood volume

75
Q

Hypovolemia

A

Decreased total blood volume

76
Q

Functional Classifications of Anemia

A
  • Survival Defects
  • Proliferation defects
  • Maturation defects
77
Q

Morphological Classifications of Anemia

A
  • Microcytic/Hypochromic
  • Macrocytic/Normochromic
  • Normocytic/Normochromic
78
Q

Intrinsic vs Extrinsic Survival Defects

A

Intrinsic - hereditary abnormalities
Extrinsic - external injuries to the RBC

79
Q

Intravascular Hemolysis

A

Lysis in vessels

80
Q

Extravascular Hemolysis

A

Lysis in tissues (esp. the spleen)

81
Q

Macrocytic/Normochromic Anemias include

A
  • Megaloblastic anemia (asynchrony)
  • Liver disease
  • Hemolytic disease that elevates polychromia
82
Q

Normocytic/Normochromic (non hemolytic) anemia includes

A
  • Blood loss
  • Endocrine dysfunction
  • Renal disease
  • Aplastic anemia
  • RBC aplasia
  • Myelophthisic anemia
83
Q

DAT

A

Direct Antiglobulin Test (antibody to RBCs)

84
Q

AHT

A

Anti-human globulin Test (antibody to RBCs)

85
Q

Hemoglobin Electrophoresis

A

Cellulose Acetate at pH 8.4
- A (accelerated)
- F (fast)
- S (slow) – same distance as D
- C (crawls) – same distance as A2
Citrate Agar at pH 6.2
- F | D/A2/A | Origin | S | C

86
Q

Normal Hemoglobin Ratios

A

97% A
2-3% A2
<1% F

87
Q

Sickle Cell Anemia Hemoglobin Ratios

A

85-100% S
5-15% F

88
Q

Sickle Cell Trait Hemoglobin Ratios

A

50-60% A
35-45% S
<1% F
Slightly increased A2

89
Q

Hgb C Disease Hemoglobin Ratios

A

> 90% C
Slight increase in F

90
Q

Hgb C Trait Hemoglobin Ratios

A

60-70% A
30-40% C

91
Q

Hgb SC Disease Hemoglobin Ratios

A

50% S
50% C
Slightly increased F

92
Q

Hgb E Hemoglobin Ratios

A

90% E

93
Q

Variants of ß-Thalassemia Major (most to least severe)

A

ߺ/ ߺ (homozygous)
ß+/ ߺ (heterozygous)
ß+/ ß+ (homozygous)

94
Q

ߺ gene

A

completely blocked production of Hgb ß chain

95
Q

ß+ gene

A

partially blocked production of Hgb ß chain

96
Q

ß-Thalassemia Major Hemoglobin Ratios

A

Up to 90% F
Increased A2
Low A

97
Q

Hemoglobin H

A

Tetrads of Beta hemoglobin chains, precipitates into Heinz bodies, high O2 affinity
- Associated with α-Thalassemia

98
Q

Hemoglobin Barts

A

Tetrads of Gamma hemoglobin chains, extreme O2 affinity
- Associated with α-Thalassemia Major (Hydrops Fetalis)
- Usually results in stillbirth

MLS (18 decks)

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