Hematology laboratory Flashcards
(141 cards)
1
Q
Angle between two slides of the manual wedge technique
A
30-45 degrees
2
Q
Correct size of the drop of blood in blood film preparation
A
2-3 mm
3
Q
Result if the angle of the spreader is too high and too low
A
Too high: Thicker smear
Too low: Thin smear
4
Q
How far from the labeled end should you place the drop of blood in the blood smear?
A
1 cm
5
Q
Best for evaluation of blood cell morphology
A
Anticoagulant-free blood
6
Q
Pattern for longitudinal scanning method of PBS
A
Tail to head
7
Q
Pattern of battlement scanning method of PBS
A
Back and forth serpentine
8
Q
Correct shape of the blood smear
A
Finger shaped
9
Q
Recommended length of the blood smear
A
2/3 to 3/4 if the length of the blood film slide
10
Q
Glass slide- Coverslip method
A
Beacom’s method
11
Q
Two coverslip method
A
Ehrlich’s method
12
Q
Only advantage of coverslip technique
A
Excellent in WBC distribution
–> may be used for bone marrow aspirate smears
13
Q
Portable automated smearing method that stimulates the manual wedge technique of blood smear prep
A
Miniprep
14
Q
Specimen for the centrifugal (spinner ) type automated method of smearing
A
0.2 mL anticoagulated blood
15
Q
This type of automated method decreases the smudge cells
A
Centrifugal (Spinner) Type
16
Q
Nuclear remnants of the lymphocytes
A
Smudge cells
17
Q
Automated methods that are capable of blood slide making and staining
A
Coulter LH & Sysmex SP-10
18
Q
Most commonly used anticoagulant in Hematology
A
EDTA
19
Q
Commonly used stain in the hematology laboratory
A
Romanowsky stain
20
Q
Correct pH of blood smear staining
A
6.4-6.8 pH
21
Q
4 Automated methods of staining
A
- Midas III
- Hema-Tek
- Coulter-LH
- Sysmex SP-10
22
Q
In the quick technique of staining, the stain used is _ , and _ is used as the buffer
A
Wright / Wright - Giemsa stain ; Aged distilled water as buffer
* done in 1 min; use of coplin jars
23
Q
Correct blood smear color
A
Pink to purple
24
Q
Microscopic color of RBCs in a stained PBS
A
Orange to salmon pink
25
Microscopic color of WBCs in a stained PBS
Purple to Blue
26
Microscopic color of neutrophils in a stained PBS
Pink to tan with violet to lilac granules
27
Microscopic color of Eos in a stained PBS
Bright orange
28
Ideal pH of a blood smear
6.4-6.8 pH
29
Patients suspected for having blood smears bluer than normal
Plasma cell myeloma / Multiple myeloma patients * due to the increased protein
30
Patients with cold hemagglutinin diseases may exhibit a _ appearance in the PBS
Grainy appearance * due to RBC Agglutination
31
Holes all over the PBS may indicate _
Patient has increased lipid levels
32
Presence of more than 4x the number of WBCs per field at the lateral edges of the smear
Snowplow effect * must reject this specimen
33
If fibrin strands are seen in the 10x objective examination, what should be done to the specimen
Reject the specimen. * Fibrin strands indicate that the specimen has already clotted
34
How many fields should be scanned using a 40x high dry objective to estimate the total WBC count
10 fields
35
Multiplication factor for WBC determination using 40x high-dry objective and 50x oil immersion
40x high dry = 2,000
| 50x oil immersion = 3,000
36
If an average of 5 WBCs were observed per field, using 40x high dry objective, the WBC estimate is _
= 5 x 10 fields
= 50 x 2,000 (multiplication factor)
= 10,000 /uL
37
Normal RBC count as seen in an 100x OIO
200-250 RBCs per 100x OIF
38
Give the group of parasites that may be found in the blood:
1. Malaria parasites
2. Filaria parasites
3. Trypanosomes
39
Resistant to p. falciparum infections
Sickle cell trait patients
40
Smear prepared for malaria
Thick blood smear
41
The 3 drops for the thick blood smear should measure approximately _
1-2 cm
42
Parasite that causes calabar swellings
Loa-loa
43
Filaria parasites that causes elephantiasis
1. Wuchereria bancrofti
| 2. Brugia malayi
44
Storage of blood smears slides
At LEAST 7 days before proper disposal
45
Give the diameters of the blood vessels:
1. Veins
2. Arteries
3. Capillaries
1. Veins = 5mm (largest)
2. Arteries = 4mm
3. Capillaries = 8 um (smallest, most abundant)
46
What is the smallest, most abundant blood vessel in the body?
Capillaries (8um)
47
What is the normal pH of blood?
7.35-7.45 pH
48
Blood is slightly alkaline/acidic
Alkaline
49
What is the average specific gravity of blood?
1.055
50
Blood is _ times thicker than water
3.5 to 4.5 thicker than water
51
Blood makes up _ mL per body weight
75-85 mL / body weight
52
There are about _ grams of solids per 100 mL of blood
20 g
53
It is the mortal sin of a phlebotomist and the most critical step in blood collection
Mislabeling
54
Patient identification is done by asking him/her to state and spell _
1. Name
2. Age
3. Gender
4. Birthdate
55
Posture (shift from supine to standing/sitting) may increase the levels of _
PIC
1. Protein
2. Iron
3. Cholesterol
56
The diurnal rhythm may falsely elevate _ and decrease _ in the morning
```
CITe
May elevate
1. Cortisol
2. TSH
3. Iron
4. eos. ct.
```
*in the afternoon, vice versa
57
Stress may elevate _
WBCs and Fibrinogen group (aka Thrombin-sensitive group)
58
The factors included in the Fibrinogen group
1, 5, 8, 13
59
After a fatty meal, hemoglobin and alkaline phosphatase may falsely _
Increase
60
Smoking may increase _
WBCs and Cortisol
61
Sodium Fluoride preserves glucose for _ days, while Lithium Iodoacetate preserved glucose for _ days
Sodium Fluoride: 3 days
| Lithium iodoacetate: 1 day (24 hrs)
62
Anticoagulant of Sodium Fluoride
Potassium Oxalate
63
What are the antiglycolytic additives
1. Sodium Fluoride (grey/8 inv.)
| 2. Lithium iodoacetate (grey/8 inv.)
64
Sodium fluoride and lithium iodoacetate are used for _
1. Blood glucose determination
| 2. Blood alcohol level determination
65
Give the Clot activators quicken the clotting of the blood specimen used in Hematology laboratory
1. Glass / Silica particles (Activates Factor XII)
| 2. Thrombin (Fibrinogen group 1,5,8,13)
66
Glass/ Silica particles activate _ factor
Hageman factor
67
Give the Clot activators quicken the clotting of the blood specimen used in Hematology laboratory
1. Glass / Silica particles (Red/5 inv.)
| 2. Thrombin (Orange/8 inv.)
68
Clot activator tubes are used for _
Red - Stat serum determination
| Orange - serum determination
69
Anticoagulant used for CBC
EDTA
70
Optimal anticoagulant concentration of EDTA
1.5 mg per mL of blood
71
Action of EDTA
Chelation of calcium
72
EDTA causes swelling of platelets (_% MPV) during the first hour.
20%
73
CBC using EDTA may be performed on blood stored at room temperature for up to _ hrs.
CBC room temp 4 hrs.
74
WBC ct, Hematocrit, and Platelet counts can be determined up to _ hrs after blood is collected in EDTA at 4C
24 hrs
75
ESR should be set up within how many hours after collection with EDTA at room temperature?
2 hrs
| --> If refrigerated: 6 hrs
76
What is the preferred anticoagulant for platelet count?
EDTA
77
Mean platelet count should be based on EDTA specimens between _ hrs
1-4 hrs
78
Blood smears can be made from EDTA within _ hrs after collection
2 hrs
79
Other term for complete blood count
Hemogram
80
It is the process in which a current test result is compared with the result of the same test from the previous specimen from the same patient
Delta check
81
It is the formation of a ring-shaped molecular complex in which a metal ion is covalently bound
Chelation
82
A test being ordered automatically based on the results of prior test or present parameters
Reflex test
83
Insufficient EDTA is caused by _
Overfilled tubes
| --> results to presence of clots
84
Excessive EDTA is caused by_
Underfilled tubes
- -> Decrease HCT, ESR, WBC
- -> Increase: MCHC, platelet ct.
85
Optimal anticoagulant concentration of Heparin
15-20 units per mL of blood
86
Uses of Heparin
**= in Hematology
1. **Flow Cytometry
2. ** Osmotic fragility test
3. Plasma chemistry
4. Blood gas analysis
87
What is heparin used for in hematology laboratory?
1. Flow cytometry
| 2. Osmotic fragility test
88
The anticoagulant of choice for OFT and Blood gas studies
Heparin
89
In the three heparin formulations, which causes the least interference in chemistry testing?
Lithium Heparin
Formulations:
1. Ammonium heparin
2. Sodium heparin
3. Lithium heparin
90
Most widely used anticoagulant for plasma and while blood chemistry tests
Lithium heparin
91
True / False: Lithium heparin is used for lithium level determination
False. it is NOT used for lithium level determination
92
Falsely elevated WBC ct.
Pseudoleukocytosis
93
Can heparin be used for blood smear preparation?
No because it causes morphologic distortion of platelets and leukocytes & causes bluish coloration of the background
94
Critical ratio between anticoagulant and blood in 3.2% sodium citrate
1:9
95
Action of 3.2% Sodium citration
Chelation of Calcium
| --> same action w/ EDTA
96
Anticoagulant for Coagulation tests
3. 2% sodium citrate
| - -> inverted 3-4 times only because excessive inversions activate platelets and shortens the coagulation time
97
Order of Draw for Blood Collection Tubes
BCSHES
1. Blood Culture ----------> yellow
2. Citrated -----------------> light blue
3. Serum --------------------> red
4. Heparinized ------------>heparin
5. EDTA ----------------------> purple/pink
6. Sodium Fluoride ------> grey
98
Identify the anticoagulant present in th ff. tubes:
1. Yellow top (Blood culture)
2. Tan top
3. Royal Blue top
4. White top
5. Black top
6. Pink top
7. Light blue top
1. Yellow top --> SPS (Sodium Polyanethol Sulfonate) /or/ ACD (Acid Citrate Dextrose)
2. Tan top --> K2EDTA
3. Royal Blue top --> K2EDTA
4. White top --> K2EDTA with GEL
5. Black top --> 3.8% Sodium Citrate
6. Pink top --> K2EDTA
7. Light blue --> 3.2% Sodium Citrate /or/ CTAD (Citrate, Theophylline, adenosine, dipyrimadole)
99
Color of tube top for Lead determination
Tan top
| --> K2EDTA
100
Color of tube top used for Westergren ESR
Black top
- ->3.8% sodium citrate
- -> 1:4 anticoag:blood ratio
101
Anticoagulant for platelet function assays
CTAD (Citrate Theophylline Adenosine Dipyrimadole)
102
Platelets adhere to the surface of WBCs
Platelet satellitosis / Platelet rosette
103
Correction for platelet satellitosis when collected with EDTA
Recollect using 3.2% Sodium citrate
104
The correction factor when using 3.2% Sodium Citrate
1.1 (both for WBC and plt. ct.)
105
Platelet satellitosis results to _
Pseudothrombocytopenia (Falsely low platelet ct.)
| Pseudoleukocytosis (platelet clumps mistaken as WBCs)
106
What is the best specimen for evaluation of blood cell morphology?
Anticoagulant-free blood
| --> made at the patient's side
107
Another name for the two-glass slide method
Manual Wedge Technique
| > Utilizes a pusher slide and a film slide
108
If the Hct of the patient is too high (polycythemia vera), what should be done to the blood smear?
Lower the angle to 25 degrees
109
If the Hct of the patient is too low (anemia) what should be done to the blood smear?
Angle should be raised
110
```
Blood Smear:
Indicate if thinner/thicker:
1. Too large drop of blood
2. Too small drop of blood
3. Too fast drop of blood
4. Too slow drop of blood
5. Angle too high
6. Angle too low
```
1. Too large drop of blood --> thick
2. Too small drop of blood --> thin
3. Too fast drop of blood --> thick
4. Too slow drop of blood --> thin (poor WBC distribution)
5. Angle too high --> thick
6. Angle too low --> thin
111
What is the purpose of blood smear staining?
For the evaluation of cellular morphology
112
Indicate the important solutions for blood staining:
1. Fixative
2. Stain
3. Buffer
1. Fixative --> Methanol
2. Stain --> Wright/Wright Giemsa
3. Buffer --> 0.05 M Sodium Phosphate (6.4pH) /or/ Aged distilled water
113
In order to prepare aged distilled water, distilled water should be placed in a glass bottle for _
At least 24 hrs for a pH 6.4-6.8
114
It is defined as any stain which contains methylene blue (and/or products of oxidation), and a halogenated fluorescein dye (eosin Y/ B)
Romanowsky's stain
115
A basic stain which colors the nucleus and some cytoplasmic structures blue or purple
Methylene blue
116
Wright stain, Giemsa stain, and May-Grunwald stain are examples of _
Romanowsky stains
117
Give examples of automated techniques of staining
1. Midas-III
2. Hema-Tek
3. Coulter-LH **
4. Sysmex SP-10 **
** = capable of slide making and slide staining
118
How many minutes will it take for:
1. Manual method of staining
2. Automated method of staining
3. Quick method of staining
1. Manual: 1-3 min.
2. Automated: 5-10 min
3. Quick: 1 min
119
Give a probable reason
Smear:
RBCs: gray (or blue)
WBCs: too dark
Eosinophils: gray
1. Stain/buffer is too basic (most common)
2. Inadequate rinsing
3. Heparinized blood was used
120
Give a probable reason
Smear:
RBCs: too pale
WBCs: barely visible
1. Stain/buffer is too acidic (most common)
2. Over rinsing
3. Underbuffering
121
Blue specs outside the feathered edge indicate _
Increased WBCs and Platelets
122
This objective is used to assess the overall film quality, color, and distribution of cells and detect the snowplow effect
10x objective examination
123
Why should you avoid the feathered edge and the thick part in the PBS when doing a microscopic examination?
Feathered:
--> Red cells appear macrocytic, lacks central pallor; White cells appear distorted
Thick:
--> Red cells appear microcytic and they form rouleauz
124
Factor to be multiplied when using a 40x High-Dry objective and 50x Oil Immersion Objective
40x High Dry --> x2,000
50x OIO --> 3,000
** This is only for WBC estimate
125
Compute: If an average of 5 WBCs were observed per field, using the 40x high-dry objective, the WBC estimate is:
5x10(fields)=50
50x2,000=100,000/uL
126
Compute: If an average of 5 WBCs were observed per field, using the 50x OIO, the WBC estimate is:
5x10=50
50x3,000=150,000/uL
127
Estimation of platelet count is done in what objective?
100x OIO
128
Compute for the platelet estimate:
Platelets counted in a field: 30
No. of fields counted: 10
30x 10 = 300
30x 20,000 = 6,000,000 plt. ct./uL
129
Factor multiplied to average plt. count when using 100x OIO
20,000
130
Formula used when determining the plt. count of an anemic patient
(Ave. no. of platelets per field x total RBC ct.)/200 RBCs per field
131
Most pathologic plasmodium spp.
P. falciparum
| --> Sickle cell trait patients are resistant
132
Duffy a-, b- are resistant to what parasites?
P. vivax and P. ovale
133
Malarial parasites metabolize _
Hemoglobin
| --> making hemozoin or malaria pigment
134
Stain used for the visualization of parasites in the blood smear
Wright-Giemsa
135
How many blood films must be prepared ASAP after collection of Venous blood (EDTA) when determining malaria infection?
At LEAST 2 thick and 2 thin blood films
136
Film used for the initial screening of blood
Thick
| --> use water-based Wright-Giemsa (without methanol fixation) to LYSE the RBCs
137
Film used for the identification / determination of percent parasitemia
Thin
138
At least how many fields on the thick and thin blood films must be examined (100x objective) before a negative result for the parasite is reported?
300 fields
139
Determined by counting the no. of parasitized RBCs (asexual stage) among 500-2,000 RBCs on a thin blood film and converting to percentage
Percent parasitemia
140
Microscopy can detect how many parasites per microliter of blood?
5-20 parasites / microliter of blood (0.0001%)
141
How many seconds should you mix the 3 small drops of blood for the thick blood smear to produce a 1-2 cm diameter?
30s
