Hematology Flashcards
Venipuncture order of draw
Yellow (SPS, blood culture tubes)
Light Blue (sodium citrate)
Red (serum with or without gel separator)
Green (heparin)
Lavender (EDTA)
Gray (sodium fluoride or oxalate)
Skin puncture order of draw
Tube for blood gas analysis
Slides
EDTA microcollection tube
Other microcollection tubes
Serum microcollection tubes
Tourniquet is wrapped around the arm about _____ above the selected site
3-4 inches (7.5-10 cm)
Tourniquet should not remain on the arm for longer than
1 min (or 2 mins)
Length of needle used in phlebotomy
1 (to 1.5) inch
Needle angle for venipuncture
15 (to 30) degrees, bevel up
Most common needle size and length for adult venipuncture
Gauge 21, 1 inch
Needle gauge for PEDIATRIC phlebotomy
Gauge 23 (or 22)
Needle gauge for bleeding donors
Gauge 16
Needle gauge for TUBERCULIN syringe
Gauge 25
Needle gauge for TRANSFER of blood from syringe to tube
Gauge 19
Size of BLOOD DROP for smear preparation
2-3 mm
Distance of blood drop from the frosted edge of the slide
1 cm (0.25 inch)
Distance where smears terminates near the end of slide (automated spreader)
0.5 inch
Angle between 2 slides when making blood smear
30-45 degrees
Slide angle for blood smear preparation if patient has POLYCYTHEMIA
25 degrees (decrease)
Size of square coverslip
22 x 22 mm
Wintrobe tube length
115 mm
Wintrobe tube bore
3 mm
Wintrobe tube is graduated at
0-100 mm
Length of capillary tube
7.0-7.5 cm (70-75mm)
Bore of capillary tube
1.0 (or 1.2) mm
Thickness pf clayseal in microhematocrit tube
4-6 mm
Centrifugation speed and time for microhematocrit method
10,000-15,000g for 5 mins
Microhematocrit tubes should be read within how many minutes
10 minutes after centrifugation
Trapped plasma increases hematocrit reading by how much
1-3%
Coefficient of variation for most hematology tests should be
<5%
Marks seen on a Thoma WBC pipet
0.5, 1, 11
Marks seen on a Thoma RBC pipet
0.5, 1, 101
Total are of the Levy chamber
9mm^2
Patient has a normal RBC count. How many RBCs will be seen per OIF
200-250
Dilution for RBC count using automated counting instrument
1:50,000
Factor used when performing WBC estimate using OIO
3,000
Factor used when performing WBC estimate using HPO
2,000
After charging, allow WBCs to settle in hemocytometer for ___ minutes
5 (or 10) minutes
Most commonly used dilution for WBC count
1:20
Dilution used when WBC count is <3.0 x 10^9/L
1:10 (or 1:11)
Dilution used when WBC count is >30.0 x 10^9/L
1:100 (or 1:101)
Dilution used when WBC count is between 100-300 x 10^9/L
1:200 (or 1:201)
WBC count is <1.0 x 10^9/L, how many WBCs are counted in the differential
50
WBC count is >40 x 10^9/L, how many WBCs are counted in the differential
200
WBC count is 100 x 10^9/L, how many WBCs are counted in the differential
300-400
WBC count should be corrected when there are how many nRBCs present
5 (or 10)
Life span of RBC
120 days
Average diameter of RBCs
6-8 um (or 7.2 um)
Size of microcytic RBCs
<6 um
How many hours does a neutrophil stay in the peripheral blood
7 hours
Life span of neutrophils
5 days
Maturation time of eosinophils
3.5 days
Half-life of eosinophil in the blood
8 (or 18) hours
Maturation time of basophils
7 days
Average diameter of platelets
2.5 um
Standard dilution for platelet count
1:100
Dilution if <50 platelets are counted on each side of hemacytometer
1:20
Dilution if >500 platelets are counted on each side of hemacytometer
1:200
After charging, allow platelets to settle in hemocytometer for ___ minutes
15 minutes
Area of square used for counting platelets using ammonium oxalate
1 mm^2
Number of platelets per OIF when doing platelet estimate
8-20
Factor used when doing a platelet estimate in the peripheral blood smear
20,000
Normal value for MPV
7.0 to 12.0 fL
Normal value for PDW
<20%
Normal template bleeding time
6-10 minutes
In DIC, D-dimer test will be positive after how many hours
4 hours
Specimens for PT and APTT must be centrifuged within
1 hour
Reference range for PTT
25 - 35 seconds
Reference range for PT
12.6 - 14.6 seconds
Reference range for thrombin time
21 seconds or less than
INR for DEEP VEIN THROMBOSIS and myocardial infarction
2.0 to 3.0
INR for patients with PROSTHETIC HEART VALVES
2.5 to 3.5
INR for patients with PULMONARY EMBOLISM
3.0
Peripheral blood smear should be __________ the length of the slide
2/3 to 3/4
The shape of blood smear should be
Finger-shaped
Pressure in THICK smear should be
Decreased
Pressure in THIN smear should be
Increased
Angle, size of blood, speed of spreader in the THICK smear should be
Increased
Angle, size of blood, speed of spreader in the THIN smear should be
Decreased
Too pale or red RBCs and barely visible WBCs is caused by
Too acidic buffer or stain
Gray RBCs and too dark WBCs is caused by
Too alkaline buffer or stain
Holes in the smear means that
There is a dirt or grease on the slide
“Snowplow” effect on a blood smear must be examined using what objective
LPO
Tube layers of spun hematocrit
Fatty layer (top)
Plasma (2nd layer)
Buffy coat (3rd layer)
Packed RBCs (4th layer)
Clay (5th layer)
Wax (6th layer)
Cell cycle phase: Resting phase
Gap 0 (G0)
Cell cycle phase: Ready for DNA SYNTHESIS
Gap 1 (G1)
Cell cycle phase: DNA REPLICATION
Synthesis (S)
Cell cycle phase: Ready for CELL DIVISION
Gap 2 (G2)
Cell cycle phase: Ready to COMPLETE DIVISION
Mitosis (M)
Duration of Synthesis
8 (or 7.5) hours
Duration of Gap 2
4 (or 3.5) hours
KIT ligand, FLT3 ligand, GM-CSF, INTERLEUKINS 1, 3, 6, 11 has (positive/negative) influence on HSC stem cells and progenitors
Positive
Transforming growth factor-B, TNF-a, INTERFERONS has (positive/negative) influence on HSC stem cells and progenitors
Negative
Erythroid with a “WHEEL SPOKE” pattern of chromatin
Basophilic normoblast
Cell with a nucleus having “CHECKERBOARD” appearance
Polychromatic normoblast
Most reliable criterion to differentiate mature from immature cell
Nuclear chromatin
Embryonic Hemoglobins
Gower I
Gower II
Portland
Normal hemoglobins
HbF
HbA
HbA2
Abnormal hemoglobins
Bart
HbH
2 zeta, 2 epsilon
Gower I
2 alpha 2 epsilon
Gower II
2 zeta 2 gamma
Portland
2 alpha 2 GAMMA
HbF
2 alpha 2 BETA
HbA
2 alpha 2 DELTA
HbA2
4 gamma
Bart
4 beta
HbH
Hemoglobin solubility test / Dithionite test is a screening test for
Hemoglobin S
Dithionite test reagents
Sodium hydrosulfite (dithionite), saponin, filter paper
Dithionite test principle
Reduction
Positive result for dithionite test
Solution becomes turbid (black lines cannot be seen)
Negative result for dithionite test
Solution remains clear (black lines are visible)
Conditions with INCREASED ESR
*Macro HAM High VREeD
Macrocytosis
Hyperfibrinogenemia
Anemia
Multiple myeloma
High room temperature
Vibration
Refrigerated sample (not returned to room temp)
DM
Spur/thorn cell
Acanthocyte
Punched-out cell
Anulocyte
Target/mexican hat cell/leptocyte
Codocyte
Teardrop/pear-shaped cell
Dacryocyte
Bite cell
Degmacyte
Sickle cell/menisocyte
Drepanocyte
Burr cell/sea urchin/crenated cell
Echinocyte
Rod/cigar-shaped cell
Elliptocyte
Helmet cell
Keratocyte
Ball/bronze cell
Spherocyte
Mouth cell
Stomatocyte
Half moon/crescent cell
Semi-lunar bodies
Neutrophil granules formed during PROMYELOCYTE stage
Primary (azurophilic)
Neutrophil granules formed during MYELOCYTE stage
Secondary (specific)
Neutrophil granules formed during METAMYELOCYTE and BAND stages
Tertiary
MYELOPEROXIDASE is seen in what neutrophil granules
Primary (azurophilic)
LYSOZYME is seen in what neutrophil granules
Tertiary
Primary granules of EOSINOPHILS consists of
Charcot-Leyden crystal protein
Catalase and elastase are seen in what eosinophil granules
Small lysosomal granules
CYCLOOXIGENASE is seen in what type of eosinophil granules
Lipid bodies
Eosinophil granules that CARRIES PROTEIN from secondary granules to be released into the extracellular medium
Storage vesicles
Basophil granules that carries histamine, platelet-activating factor, vascular endothelial growth factor and chondroitin sulfates
Secondary granules
Not an obligate end cell
Lymphocyte
Most fragile blood cell
Lymphocyte
DECREASED NUCLEAR SEGMENTATION in neutrophils
Pelger-Huet anomaly
GIANT LYSOSOMAL GRANULES in granulocytes, monocytes, and lymphocytes
Chediak-Higashi disease
Thrombocytopenia, GIANT PLATELETS, pale blue inclusion and LARGE Dohle body-like inclusions in WBCs
May-Hegglin anomaly
Presence of PHILADELPHIA CHROMOSOME
CML (chronic myelogenous leukemia)
INCREASED LAP (leukocyte alkaline phosphatase) is seen in what condition
PV (polycythemia vera)
DECREASED LAP (leukocyte alkaline phosphatase) is seen in what condition
CML (chronic myelogenous leukemia)
Transforms into ACUTE LEUKEMIA
CML (chronic myelogenous leukemia)
Acute UNDIFFERENTIATED leukemia
M0
Acute myeloblastic leukemia (AML) WITHOUT maturation
M1
Acute myeloblastic leukemia (AML) WITH maturation
M2
Acute promyelocytic leukemia (APL)
M3
APL associated with DIC and numerous FAGGOT CELLS
M3
Acute myelomonocytic leukemia (AMML) also known as Naegeli’s leukemia
M4
Acute monoblastic leukemia (AMoL) WITHOUT maturation
M5a
Acute monoblastic leukemia (AMoL) WITH maturation
M5b
Erythroleukemia / Di Guglielmo’s syndrome
M6
Acute megakaryoblastic leukemia (AMegL)
M7
Acute basophilic leukemia
M8
Acute lymphoblastic leukemia (ALL) with SMALL, HOMOGENOUS cell and SCANTY cytoplasm
L1
Acute lymphoblastic leukemia (ALL) with LARGE, HETEROGENOUS cell and LARGE nucleoli
L2
Acute lymphoblastic leukemia (ALL) with LARGE, HOMOGENOUS cell and PROMINENT cytoplasmic vacuolation
L3 / Burkitt Type
Cottage loaf nucleus
M3
Both myeloid and monocytic cells are present; at least 20% of the total leukocytes
M4
Erythroid and granulocytic precursors; megakaryocytic and monocytic proliferations
M6
UNDIFFERENTIATED leukemia
Stem cell leukemia
POORLY differentiated leukemia
Acute lymphoblastic leukemia
WELL differentiated leukemia
Chronic lymphocytic leukemia
Solid tumor counterpart of myeloma
Plasma cell leukemia
PPE for enteric isolation
Gloves and gown
PPE for protective isolation
Gown, gloves, mask
An example of conditions that requires protective isolation
Leukemia
Sheep RBC receptor, (+) E rosette assay
CD2
Helper T cell
CD4
Also known as CALLA (common acute lymphocytic leukemia antigen)
CD10
NK cells marker
CD 16, CD 56
Hematopoietic stem cells marker
CD34
Platelet structure that consists of surface coat (glycocalyx) and is responsible for ADHESION and AGGREGATION
Peripheral zone
Platelet structure that MAINTAINS THE POSITION of the organelles
Sol-Gel Zone
Sol-Gel Zone that is composed of ACTIN AND MYOSIN to form actomyosin / thrombosthenin
Microfilaments
Sol-Gel Zone that is composed of TUBULIN which maintains platelet’s discoid SHAPE
Microtubules
A contractile protein important in CLOT RETRACTION
Thrombosthenin
Platelet structure that is composed of dense granules, alpha-granules, lysosomes and mitochondria
Organelle zone
Megakaryocytic differentiation stage with INDENTED nucleus
MK-II (promegakaryocyte)
Megakaryocytic differentiation stage with MULTILOBED nucleus
MK-III (megakaryocyte)
Megakaryocytic differentiation stage with a VARIABLE nucleoli
MK-II (promegakaryocyte)
Megakaryocytic differentiation stage with MODERATELY condensed chromatin
MK-II (promegakaryocyte)
Megakaryocytic differentiation stage with DEEPLY but VARIABLY condensed chromatin
MK-III
Megakaryocytic differentiation stage where ENDOMITOSIS ENDS
MK II (promegakaryocyte)
Megakaryocytic differentiation stage where there is NO ENDOMITOSIS
MK-III (megakaryocyte)
Megakaryocytic differentiation stage that has an EOSINOPHILIC and GRANULAR cytoplasm
MK-III (megakaryocyte)
Present in ALL megakaryocytic differentiation stages (MK-I, MK-II, MK-III)
Alpha and dense granules, demarcation system
Associated with endomitosis
Thrombocytes
Acquired platelet dysfunctions
*LUPA
Liver disease
Uremia
Pernicious anemia
Aspirin (drugs)
Hereditary platelet dysfunctions
von Willebrand disease
Bernard-Soulier syndrome
Thrombasthenia (Glanzmann’s, essential)
Factor I
Fibrinogen
Factor II
Prothrombin
Factor III
Tissue factor
Factor IV
Calcium
Factor V
Labile factor / Proaccelerin
Factor VII
Stable factor / Proconvertin
Factor VIII
Anti-hemophilic factor A
Factor IX
PTC (plasma thromboplastin component) / Anti-hemophilic factor B / Christmas factor
Factor X
Stuart factor
Factor XI
PTA (plasma thromboplastin antecedent) / Anti-hemophilic factor C
Factor XII
Hageman factor / Contact factor
Factor XIII
Fibrin stabilizing factor / Laki-Lorand factor
PK
Prekallikrein / Fletcher factor
HMWK
Fitzgerald factor
Prothrombin (PT) group
II, VII, IX, X
Fibrinogen group
I, V, VIII, XIII
Contact group
XI, XII, PK, HMWK
Calcium dependent, Vitamin K DEPENDENT *dede
Prothrombin group (II, VII, IX, X)
Calcium INdependent, vitamin K INdependent
Contact group (XI, XII, PK, HMWK)
Calcium dependent, vitamin K INDEPENDENT
Fibrinogen group (I, V, VIII, XIII)
Completely consumed during coagulation
Fibrinogen group (I, V, VIII, XIII)
First coagulation factor affected by COUMARIN
Factor VII
(VII ➡️ IX ➡️ X ➡️ 2)
Factor VIII:C
Factor VIII procoagulant activity
Initial vWD workup
CBC, PT, APTT
Deficiencies of factors II, V, VII, X ; prolonged clotting time. What test
Prothrombin time (PT)
Deficiencies of ALL factors EXCEPT VII, XIII ; prolonged clotting time. What test
Partial thromboplastin time (PTT)
PT reagent composition
Thromboplastin + phospholipids + calcium chloride
APTT reagent composition
Activator + phospholipid
How many uL of PT reagent
200 uL
PROLONGED (PT), PROLONGED (APTT) , PROLONGED (CT)
Fibrinogen
PROLONGED (PT), PROLONGED (APTT) , NORMAL (CT)
II, V, X
PROLONGED (PT), NORMAL (APTT) , NORMAL (CT)
VII
NORMAL (PT), PROLONGED (APTT) , NORMAL (CT)
VIII, IX, XI
NORMAL (PT), NORMAL (APTT) , NORMAL (CT)
XIII
Platelet size threshold
2-20 fL
High-angle forward scatter, 5-15 degrees
Technicon Angle 2
Instrument POSITIVE errors
Bubbles in the sample
Electrical pulses
Aperture plugs
Instrument NEGATIVE error
Excessive lysing of RBCs
Giant platelets may be counted as
RBC or WBC
Increased number of _____ makes accurate RBC and platelet count imposible
Schistocytes
Agglutinated __________ may cause false-POSITIVE LEUKOCYTE counts
RBCs or platelets
When 2 cells pass through an orifice simultaneously and counted as 1 cell, it is called
Coincidence
Semi-automated coagulation instrument
Fibrometer
KC4 Delta
STart4
Automated coagulation instrument
MDA, AMAX, STA-R, BCR, ACL
Endpoint in electromechanical clot detection systems
Clot formation via clotting time
Parameter affected by cold agglutinins
Decrease RBC, Increased MCV and MCHC
Corrective action for cold agglutinins
Warm specimen to 37C and rerun
Parameters affected if specimen is lipemic / icteric
Increase hemoglobin and MCH
Parameters affected if specimen is hemolyzed
Decrease RBC and hematocrit
Parameters affected in the presence of microcytes / schistocytes
Increase platelets, decrease RBC
Parameters affected in the presence of nucleated RBCs and megakaryocyte
Increase WBCs
Parameters affected if there is a presence of platelet clumps
Decrease platelets, increase WBC
What is the corrective action for platelet clumps
Redraw specimen in SODIUM CITRATE, multiply result by 1.1
Aggregates of 3-4 RBCs. What rouleaux grading
1+
Aggregates of 5-10 RBCs. What rouleaux grading
2+
Numerous aggregates with few free RBCs. What grading
3+
1-2 RBC chains PER FIELD. What rouleaux grading
Slight
3-4 RBC chains PER FIELD. What rouleaux grading
Moderate
5 or more RBC chains PER FIELD. What rouleaux grading
Marked
Polychromasia grading of 1%
Slight
Polychromasia grading of 3%
1+
Polychromasia grading of 5%
2+
Polychromasia grading of 10%
3+
Polychromasia grading of >11%
4+
Macrocytosis grading of 25%
1+ (slight)
Macrocytosis grading of 25-50%
2+ to 3+ (moderate)
Macrocytosis grading of >50%
4+ (marked)
1/3 of the cell diameter. What hypochromia grading
Normal
1/2 of the cell diameter. What hypochromia grading
1+
2/3 of the cell diameter. What hypochromia grading
2+
3/4 of the cell diameter. What hypochromia grading
3+
Thin rim of hemoglobin / ANULOCYTE. What hypochromia grading
4+
> 2/3 of the cell diameter. What hypochromia grading
2+ to 3+ (moderate)
150,000 - 199,000 / uL platelet estimate
Low normal
100,000 - 149,000 / uL platelet estimate
Slight decrease
50,000 - 99,000 / uL platelet estimate
Moderate decrease
0 - 49,000 / uL platelet estimate
Marked decrease
200,000 - 400,000 / uL platelet estimate
Normal
401,000 - 599,000 / uL platelet estimate
Slight decrease
600,000 - 800,000 / uL platelet estimate
Moderate increase
> 800,000 / uL platelet estimate
Marked increase
“Normal / slight” what erythrocyte grading
0
“Small / few” what erythrocyte grading
1+
“Moderately” what erythrocyte grading
2+
“Many” what erythrocyte grading
3+
“Marked” what erythrocyte grading
4+
0-2 / OIF codocytes, ovalocytes, stomatocytes
Within normal limits
2-10/ OIF codocytes, ovalocytes, stomatocytes
1+
10-20 / OIF codocytes, ovalocytes, stomatocytes
2+
20-50 / OIF codocytes, ovalocytes, stomatocytes
3+
> 50/ OIF codocytes, ovalocytes, stomatocytes
4+
<1 / OIF acanthocytes, schisocytes
Within normal limits
2-5 / OIF acanthocytes, schisocytes
1+
5-10 / OIF acanthocytes, schisocytes
2+
10-20 / OIF acanthocytes, schisocytes
3+
> 20 / OIF acanthocytes, schisocytes
4+
1+ (1-5/field), 2+ (6-10/field), 3+ (>10/field). These are reportings for
Spherocytes, Acanthocytes, Schistocytes
1+ (3-10/field), 2+ (11-20/field), 3+ (>20field). These are reportings for
Codocytes, Ovalocytes, Stomatocytes
Sickle cells, BASOPHILIC STIPPLING, Pappenheimer and Howell-Jolly bodies are reported as
Positive
