Hematology Flashcards
At what temperature is PT best performed?
37°C
Identify what RBC anomaly:
Red cells that look like shooting targets with a central bullseye and a darker outer edge.
Codocytes/Target cells
Maturational sequence of thrombocyte:
Megakaryoblast - Promegakaryocyte - Megakaryocyte - Thrombocyte
Associated with abetalipopreteinemia
Acanthocytes
Thrombin is what factor
Factor IIa
Factor II
Prothrombin, Prethrombin, Thrombogen
Factor I
Fibrinogen, Thrombin substrate
Factor VII
Stable factor, Proconvertin, Autoprothrombin I, Serum Prothrombin Conversion Accelerator
Factor X
Stuart-prower factor, Autoprothrombin III
FDP is measured using
D-dimer
D-dimer test could be used to diagnose:
DIC, DVC, Pulmonary embolism
When should you remove the tourniquet?
Not more than 1 minute
The tourniquet should be ____ inches or ____ cm above the puncture site.
3-4 inches; 8-10 cm
In what organ does platelet sequestration occur?
spleen
___ of total population of platelets are sequestered in the spleen
1/3
Size of the spleen is ____ to the number of platelets, and ____ to platelet count.
directly proportional; inversely proportional
Red marrow exists in all of the following, except:
Distal ends of long bones
Red marrow to yellow marrow ratio
1:1; 50:50
Yellow marrow is composed of ____, _______, & _______
Adipocytes, mesenchymal, macrophages
What happens when the medtech uses a needle with a larger bore than required?
Hematoma formation
Common gauge of needle in Adults
g21
Major production of EPO occurs in:
Kidneys
Production of platelets:
Thrombopoiesis
could also be thrombocytopoiesis
A child accidentally ingested rat poison. which of the ff tests should be performed to test the effect of the poison on the child’s coagulation mechanism?
PT
Note: rat poison: coumadin: warfarin-like
How will you differentiate Leukemoid reaction from CML?
LAP (Leukocyte Alkaline Phosphatase) score
LAP score method of counting
Kaplow count
What is being described?
Count 100 neutrophils and rate 0-4 depending on its staining; differentiate as CML (Low activity) or Leukemoid reaction (High activity)
LAP score
Microscopic method for sickle cells
Sodium Metabisulfite
Positive reaction for sodium metabisulfite
sickling
Positive reaction for sodium dithonite
Turbidity: black lines
Both myeloid and monocytic cells are present to the extent of at least 20% of the total leukocytes:
M4
Normal value of APTT
25-35 seconds; < or = 32
A clot retraction test is
A reflection of the quantity and quality of platelets and other factors
Pelger-Huet Anomaly: Bilobed or Hyposegmented?
Both
If no both answer Bilobed
Identify the Plasmodium Species:
Gametocytes are crescent, banana or sausage shaped. The chromatin is in a single mass (macrogamete) or diffuse (microgamete).
P. falciparum
P. falciparum causes ____ malaria
severe
What Plasmodium species:
Causes relapsing fever; resides in the liver
vivax
What Plasmodium species:
Only affects young RBCs
P. vivax & P. ovale
What Plasmodium species:
Only affects old or mature RBCs
P. malariae
What Plasmodium species:
- Affects all types of RBCs.
Invades other organs - Invade other organs
- cerebral malaria
- black urine
P. falciparum
Test for PNH
Sucrose Hemolysis
Sugar water screening test indicates ___% lysis to be considered as PNH
5
Confirmatory tests for PNH
Sucrose hemolysis & Acid serum test
Other name for Acid serum test
Ham’s acidified test
Ham’s acidified Test
pH:
Temperature & time:
Sample:
pH: 6.5
Temperature & time : 37 for 1 hour
Sample: Whole blood difribinated
Gold standard for PNH
Flow cytometry (FLAER)
Test for Intrinsic and Common factors
APTT
Test for Extrinsic and common factors
PT
What factor deficiency?
- (+) bleeding
- (N) other parameters
Factor XIII deficiency
Test for factor XIII deficiency
Duckert’s test
Red marrow to yellow marrow
retrogression
Sites of active marrow in adults
Ribs
Skull, sternum
Vertebrae
Proximal portion of long bones & Pelvis
Specific site for EPO production in adults
Renal cortex peritubular cells
Major site for EPO production in fetus
liver
Aside from the kidneys, EPO can also be made by the ___, ____, ____, _____
spleen, liver, bone marrow, lungs, & brain
Regulates EPO
PO2
Solution for PCV
Therapeutic phlebotomy
Difference between primary and secondary PCV
1° = dec to normal EPO
2° = Increased EPO
A single megakaryocyte could form ____ to ___ platelets
2000 to 4000 platelets
10 fold increase of platelets
Immune thrombocytopenic pupura
Average size human: 10^8 megakaryocytes producing 10^11 platelets per day and a total turnover rate of __ to __ days.
8 to 9
___ drug inhibits Vitamin K epoxide reductase complex
warfarin
Vitamin K dependent factors and prothrombin group
9, 10, 7, 2
Prothrombin group is not consumed during clot formation except factor __
Factor 2
Contact group.
- Not consumed in clot formation
HK, PK, XII, XI
Fibrinogen group
1, 5, 8, 13
Sample for Sodium metabisulfite
Fresh blood
Reagents for Sodium metabisulfite test
0.2 g of SM in 10 mL of distilled water
FAB classification of AML > or = __% blasts
20%
Automated specimen and reagent volume:
APTT:
PT:
APTT: 0.2 mL plasma & 0.2 mLCaCl2
PT: 0.1 mL plasma & 0.2 thromboplastin reagent
Alder-reilly anomally
Abnormal granulation of metachromatic granules in WBC
Test for platelet quality
Bleeding time
If a pediatric preoperative patient has a family history of bleeding but has never had a bleeding episode herself, what test should be included in a coagulation profile in addition to the PT, APTT, and platelet count?
Bleeding time
If a blood smear is too long, the problem can be resolved by:
Increasing the angle of the pusher slide
Most common factor deficiency
Hemophilia A or factor 8 deficiency
Factor V
Labile factor, Accelerator Globulin (Ac globulin), Proaccelerin
In megaloblastic anemia, the typical erythrocytic indices are:
MCV inc, MCH inc, and MCHC normal
MCV of < 80 fL causes what anemias?
TAILS (Microcytic anemia)
What anticoagulant should be used in cases of platelet satellitism?
Citrate
Citrate to blood ratio
1:4
Correction factor for platelet satellitism
1.1
Example of closed wound
hematoma
Accumulation of blood in the tissue
Hematoma
Petechia: __ mm
1-3 mm
Purpura: __ mm
> or = 3 mm
Ecchymosis __cm
> or = 1 to 2 cm
What is abnormal in dysfribinogenemia?
a. PT
b. APTT
c. TT
d. Fibrinogen level
a, b, c
First step in cleanup when a blood specimen is spilled on a laboratory bench or floor area?
Absorb blood with disposable towels
As a blood cell matures, the N:C ratio:
decreases
Normal range for reticulocytes in adults:
0.5 to 1.5%
The average diameter of a normal erythrocyte:
7.2 um
Increased amounts of 2,3 DPG___ the O2 affinity of the Hb molecule.
Decreases
Variation in size
anisocytosis
variation in shape
poikilocytosis
Stages of neutrophilic granulocyte development
Myeloblast
promyelocyte
myelocyte
metamyelocyte
band & segmented neutrophil
On the basis of the ff data, calculate the absolute value of the segmented neutrophils. Total leukocyte count = 12X10^9; percentage of segmented neutrophils on the differential count = 80%. the absolute segmented neutrophil value is:
9.6x10^9L
Solution: 12x0.8
Niemann Pick Cells are what type of cells?
Macrophage
Low 2,3 DPG, H+, PCO2, T
Love O2
Shift to the Left
Rise in 2,3 DPG, H+, PCO2, T
Reject O2
Shift to the Right
Deficiency in B-glucocerobroside
Gaucher’s disease
Appearance of lysosomes are onion skin or crumpled paper
Gaucher’s disease
Gargoylism
Hunter’s syndrome
Foamy cells
Neimann-Pick disease
Beta-Hexosaminadase A deficiency
Tay-Sach’s diseas
A patient with a severe decrease in Factor X activity would demonstrate normal:
TT and BT
TT - fibrinogen
BT - Platelet function
Th function of thromboplastin in PT test is to provide _____ to the assay:
Phospholipoprotein
Which of the following parameters can be abnormal in classic vWD type 1?
BT (best answer)
PT (would be N° or Decreased)
Which parameters are calculated rather than directly measured?
a. HCT & RDW
b. RBC & WBC count
c. WBC count & HCT
d. Platelet count and PCV
A
What source of of error will have greatest effect on PCV (hematocrit)
a. Incorrect dilution of blood & diluent
b. Hemolysis of whole blood specimen
c. excessive anticoagulant will produce shrinkage of cells
C
Excess anticoagulant may cause ___ in HCT
False decrease
Insufficient centrifugation will cause ____ in HCT
False increase
Major application of flow cell cytometry:
a. determining cell size and granularity
b. sorting of cells and cellular identification using monoclonal Abs
c. treating cancer cells and identifying specific virus types
d. Counting leukocytes and platelets
B
Determines cell size and granularity
scatterplot
Passage of the cell in a single file in front of a LASER
Flow cell cytometry
In an erythrocyte histogram, the erythrocytes that are larger than normal will be the ___ of the normal distribution curve.
Right
Test most affected when there is excess anticoagulant:
a. RBC count
b. HGB
c. HCT
d. ESR
C
Poikilocyte with membrane folded over:
HGB C
Azurophilic granules are produced in what stage?
a. promyelocyte
b. myelocyte
c. metamyelocyte
d. band
A
Product of CLP
a. Megakaryocyte
b. T lymphocyte
c. HCT
d. granulocyte
T lymphocyte
Which of the ff morphologic changes occurs during normal blood cell maturation?
a. Inc. in cell diameter
b. development of cytoplasm basophilia
c. condensation of nuclear chromatin
d. appearance of nucleoli
C
An acquired platelet disorder:
a. Facto V deficiency
b. vWD
c. BSS
d. Uremia
D
Increased BUN and Crea
Normal PT and APTT
Increased BT
Uremia
Source of light in AccuVein
Near Infrared
Patient has normal PT, PTT, and TT
Factor XIII deficiency
Which organ is not hematopietic?
Kidneys
Hematopoietic organs include:
BM, Liver, & yolksac
RDW and MCV are quantitative description of red cells. if both of these are increased, ___ is possible.
a. megaloblastic anemia
b. acute aplastic anemia
c. Iron deficiency anemia
d. NOTA
A
Scatterplot cell population:
- Forward plot:
cell size or diameter
Scatterplot cell population:
- Side scatter:
cell granularity & cell complexity
Electronic impedance:
(+) resistance of electric charge = larger pulse of cell population
Fibrous tissue sources:
Fibroblast seen in connective tissues
APTT normal value for people under therapy:
1.5 - 2.5X
Snake bite
DIC
RBC size
6-8 um
Slide smear spread angle
< 30 - 45°
Macrocytes effect to ESR
Increased
Too much acids in slide preparation:
reddish cells
Coumadin
Vitamin K inhibitor
_ also affects protein C and protein S
What is deficient in Howell jolly bodies:
Bitamin B12 & Vitamin B9
Which of the ff is not STORED by the liver?
a. Vit A
b. Vit D
c. Vit C
d. Vit K
C
- vitamin C is excreted
ESR is increased. what is the cause of the increase with WBC as the basis?
Leukemia
Hyperfibrinogenemia _____ESR:
Increased
Which drug can cause AIHA:
Methyldopa
ESR is decreased. What is the cause of the decrease with WBC as the basis?
Leukocytosis
Precursor of Kallikrein
Prekallikrein, Fletcher factor
Aplastic anemia antibiotic:
Chloramphenicol
Normal newborn hemoglobin:
16.5 g/dL
Normal Hemoglobin in adults:
12-15 g/dL
Hemoglobin value as basis for blood bank transfusion:
< 7g/dL
Hemglobin value as basis for blood bank transfusion in patients with heart failure:
< 10 g /dL
Monocyte cytoplasm color with wright stain
Bluish gray
A small hemorrhagic spot but larger than petechiae characterized by a rounded or irregular blue or purplish patch; also known as bruise and is found in skin and mucus membrane.
Echymosis
Lymphocyte cytoplasm color in Wright stain
pale blue
RBCs color in Wright stain
Salmon Pink
Acute leukemia type of anemia
Normocytic, normochromic
> 11x10^9 WBCs
Leukocytosis
Tertiary granules appear during what stages?
Metamyelocyte/Band
It is referred to as gamma heavy chain disease
Franklin’s disease, Frank anemia
Serine proteases
2, 7, 9, 10, 11, 12, PK
Cofactors
3, 5, 8, HMWK
Intrinsic factors
8, 9, 11, 12
Extrinsic factors
3, 7
