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Hematology 1 > Hematology laboratory > Flashcards

Hematology laboratory Flashcards

1
Q

Angle between two slides of the manual wedge technique

A

30-45 degrees

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2
Q

Correct size of the drop of blood in blood film preparation

A

2-3 mm

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3
Q

Result if the angle of the spreader is too high and too low

A

Too high: Thicker smear

Too low: Thin smear

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4
Q

How far from the labeled end should you place the drop of blood in the blood smear?

A

1 cm

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5
Q

Best for evaluation of blood cell morphology

A

Anticoagulant-free blood

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6
Q

Pattern for longitudinal scanning method of PBS

A

Tail to head

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7
Q

Pattern of battlement scanning method of PBS

A

Back and forth serpentine

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8
Q

Correct shape of the blood smear

A

Finger shaped

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9
Q

Recommended length of the blood smear

A

2/3 to 3/4 if the length of the blood film slide

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10
Q

Glass slide- Coverslip method

A

Beacom’s method

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11
Q

Two coverslip method

A

Ehrlich’s method

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12
Q

Only advantage of coverslip technique

A

Excellent in WBC distribution

–> may be used for bone marrow aspirate smears

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13
Q

Portable automated smearing method that stimulates the manual wedge technique of blood smear prep

A

Miniprep

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14
Q

Specimen for the centrifugal (spinner ) type automated method of smearing

A

0.2 mL anticoagulated blood

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15
Q

This type of automated method decreases the smudge cells

A

Centrifugal (Spinner) Type

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16
Q

Nuclear remnants of the lymphocytes

A

Smudge cells

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17
Q

Automated methods that are capable of blood slide making and staining

A

Coulter LH & Sysmex SP-10

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18
Q

Most commonly used anticoagulant in Hematology

A

EDTA

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19
Q

Commonly used stain in the hematology laboratory

A

Romanowsky stain

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20
Q

Correct pH of blood smear staining

A

6.4-6.8 pH

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21
Q

4 Automated methods of staining

A
  1. Midas III
  2. Hema-Tek
  3. Coulter-LH
  4. Sysmex SP-10
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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

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23
Q

Correct blood smear color

A

Pink to purple

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24
Q

Microscopic color of RBCs in a stained PBS

A

Orange to salmon pink

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25
Q

Microscopic color of WBCs in a stained PBS

A

Purple to Blue

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26
Q

Microscopic color of neutrophils in a stained PBS

A

Pink to tan with violet to lilac granules

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27
Q

Microscopic color of Eos in a stained PBS

A

Bright orange

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28
Q

Ideal pH of a blood smear

A

6.4-6.8 pH

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29
Q

Patients suspected for having blood smears bluer than normal

A

Plasma cell myeloma / Multiple myeloma patients * due to the increased protein

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30
Q

Patients with cold hemagglutinin diseases may exhibit a _ appearance in the PBS

A

Grainy appearance * due to RBC Agglutination

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31
Q

Holes all over the PBS may indicate _

A

Patient has increased lipid levels

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32
Q

Presence of more than 4x the number of WBCs per field at the lateral edges of the smear

A

Snowplow effect * must reject this specimen

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33
Q

If fibrin strands are seen in the 10x objective examination, what should be done to the specimen

A

Reject the specimen. * Fibrin strands indicate that the specimen has already clotted

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34
Q

How many fields should be scanned using a 40x high dry objective to estimate the total WBC count

A

10 fields

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35
Q

Multiplication factor for WBC determination using 40x high-dry objective and 50x oil immersion

A

40x high dry = 2,000

50x oil immersion = 3,000

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36
Q

If an average of 5 WBCs were observed per field, using 40x high dry objective, the WBC estimate is _

A

= 5 x 10 fields
= 50 x 2,000 (multiplication factor)
= 10,000 /uL

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37
Q

Normal RBC count as seen in an 100x OIO

A

200-250 RBCs per 100x OIF

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38
Q

Give the group of parasites that may be found in the blood:

A
  1. Malaria parasites
  2. Filaria parasites
  3. Trypanosomes
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39
Q

Resistant to p. falciparum infections

A

Sickle cell trait patients

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40
Q

Smear prepared for malaria

A

Thick blood smear

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41
Q

The 3 drops for the thick blood smear should measure approximately _

A

1-2 cm

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42
Q

Parasite that causes calabar swellings

A

Loa-loa

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43
Q

Filaria parasites that causes elephantiasis

A
  1. Wuchereria bancrofti

2. Brugia malayi

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44
Q

Storage of blood smears slides

A

At LEAST 7 days before proper disposal

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45
Q

Give the diameters of the blood vessels:

  1. Veins
  2. Arteries
  3. Capillaries
A
  1. Veins = 5mm (largest)
  2. Arteries = 4mm
  3. Capillaries = 8 um (smallest, most abundant)
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46
Q

What is the smallest, most abundant blood vessel in the body?

A

Capillaries (8um)

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47
Q

What is the normal pH of blood?

A

7.35-7.45 pH

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48
Q

Blood is slightly alkaline/acidic

A

Alkaline

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49
Q

What is the average specific gravity of blood?

A

1.055

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50
Q

Blood is _ times thicker than water

A

3.5 to 4.5 thicker than water

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51
Q

Blood makes up _ mL per body weight

A

75-85 mL / body weight

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52
Q

There are about _ grams of solids per 100 mL of blood

A

20 g

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53
Q

It is the mortal sin of a phlebotomist and the most critical step in blood collection

A

Mislabeling

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54
Q

Patient identification is done by asking him/her to state and spell _

A
  1. Name
  2. Age
  3. Gender
  4. Birthdate
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55
Q

Posture (shift from supine to standing/sitting) may increase the levels of _

A

PIC

  1. Protein
  2. Iron
  3. Cholesterol
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56
Q

The diurnal rhythm may falsely elevate _ and decrease _ in the morning

A 
CITe 
May elevate 
1. Cortisol 
2. TSH 
3. Iron 
4. eos. ct.

*in the afternoon, vice versa

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57
Q

Stress may elevate _

A

WBCs and Fibrinogen group (aka Thrombin-sensitive group)

58
Q

The factors included in the Fibrinogen group

A

1, 5, 8, 13

59
Q

After a fatty meal, hemoglobin and alkaline phosphatase may falsely _

60
Q

Smoking may increase _

A

WBCs and Cortisol

61
Q

Sodium Fluoride preserves glucose for _ days, while Lithium Iodoacetate preserved glucose for _ days

A

Sodium Fluoride: 3 days

Lithium iodoacetate: 1 day (24 hrs)

62
Q

Anticoagulant of Sodium Fluoride

A

Potassium Oxalate

63
Q

What are the antiglycolytic additives

A
  1. Sodium Fluoride (grey/8 inv.)

2. Lithium iodoacetate (grey/8 inv.)

64
Q

Sodium fluoride and lithium iodoacetate are used for _

A
  1. Blood glucose determination

2. Blood alcohol level determination

65
Q

Give the Clot activators quicken the clotting of the blood specimen used in Hematology laboratory

A
  1. Glass / Silica particles (Activates Factor XII)

2. Thrombin (Fibrinogen group 1,5,8,13)

66
Q

Glass/ Silica particles activate _ factor

A

Hageman factor

67
Q

Give the Clot activators quicken the clotting of the blood specimen used in Hematology laboratory

A
  1. Glass / Silica particles (Red/5 inv.)

2. Thrombin (Orange/8 inv.)

68
Q

Clot activator tubes are used for _

A

Red - Stat serum determination

Orange - serum determination

69
Q

Anticoagulant used for CBC

70
Q

Optimal anticoagulant concentration of EDTA

A

1.5 mg per mL of blood

71
Q

Action of EDTA

A

Chelation of calcium

72
Q

EDTA causes swelling of platelets (_% MPV) during the first hour.

73
Q

CBC using EDTA may be performed on blood stored at room temperature for up to _ hrs.

A

CBC room temp 4 hrs.

74
Q

WBC ct, Hematocrit, and Platelet counts can be determined up to _ hrs after blood is collected in EDTA at 4C

75
Q

ESR should be set up within how many hours after collection with EDTA at room temperature?

A

2 hrs

–> If refrigerated: 6 hrs

76
Q

What is the preferred anticoagulant for platelet count?

77
Q

Mean platelet count should be based on EDTA specimens between _ hrs

78
Q

Blood smears can be made from EDTA within _ hrs after collection

79
Q

Other term for complete blood count

80
Q

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

A

Delta check

81
Q

It is the formation of a ring-shaped molecular complex in which a metal ion is covalently bound

82
Q

A test being ordered automatically based on the results of prior test or present parameters

A

Reflex test

83
Q

Insufficient EDTA is caused by _

A

Overfilled tubes

–> results to presence of clots

84
Q

Excessive EDTA is caused by_

A

Underfilled tubes

  • -> Decrease HCT, ESR, WBC
  • -> Increase: MCHC, platelet ct.
85
Q

Optimal anticoagulant concentration of Heparin

A

15-20 units per mL of blood

86
Q

Uses of Heparin

A

**= in Hematology

  1. **Flow Cytometry
  2. ** Osmotic fragility test
  3. Plasma chemistry
  4. Blood gas analysis
87
Q

What is heparin used for in hematology laboratory?

A
  1. Flow cytometry

2. Osmotic fragility test

88
Q

The anticoagulant of choice for OFT and Blood gas studies

89
Q

In the three heparin formulations, which causes the least interference in chemistry testing?

A

Lithium Heparin

Formulations:

  1. Ammonium heparin
  2. Sodium heparin
  3. Lithium heparin
90
Q

Most widely used anticoagulant for plasma and while blood chemistry tests

A

Lithium heparin

91
Q

True / False: Lithium heparin is used for lithium level determination

A

False. it is NOT used for lithium level determination

92
Q

Falsely elevated WBC ct.

A

Pseudoleukocytosis

93
Q

Can heparin be used for blood smear preparation?

A

No because it causes morphologic distortion of platelets and leukocytes & causes bluish coloration of the background

94
Q

Critical ratio between anticoagulant and blood in 3.2% sodium citrate

95
Q

Action of 3.2% Sodium citration

A

Chelation of Calcium

–> same action w/ EDTA

96
Q

Anticoagulant for Coagulation tests

A
  1. 2% sodium citrate

- -> inverted 3-4 times only because excessive inversions activate platelets and shortens the coagulation time

97
Q

Order of Draw for Blood Collection Tubes

A

BCSHES

  1. Blood Culture ———-> yellow
  2. Citrated —————–> light blue
  3. Serum ——————–> red
  4. Heparinized ————>heparin
  5. EDTA ———————-> purple/pink
  6. Sodium Fluoride ——> grey
98
Q

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
A
  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
Q

Color of tube top for Lead determination

A

Tan top

–> K2EDTA

100
Q

Color of tube top used for Westergren ESR

A

Black top

  • ->3.8% sodium citrate
  • -> 1:4 anticoag:blood ratio
101
Q

Anticoagulant for platelet function assays

A

CTAD (Citrate Theophylline Adenosine Dipyrimadole)

102
Q

Platelets adhere to the surface of WBCs

A

Platelet satellitosis / Platelet rosette

103
Q

Correction for platelet satellitosis when collected with EDTA

A

Recollect using 3.2% Sodium citrate

104
Q

The correction factor when using 3.2% Sodium Citrate

A

1.1 (both for WBC and plt. ct.)

105
Q

Platelet satellitosis results to _

A

Pseudothrombocytopenia (Falsely low platelet ct.)

Pseudoleukocytosis (platelet clumps mistaken as WBCs)

106
Q

What is the best specimen for evaluation of blood cell morphology?

A

Anticoagulant-free blood

–> made at the patient’s side

107
Q

Another name for the two-glass slide method

A

Manual Wedge Technique

> Utilizes a pusher slide and a film slide

108
Q

If the Hct of the patient is too high (polycythemia vera), what should be done to the blood smear?

A

Lower the angle to 25 degrees

109
Q

If the Hct of the patient is too low (anemia) what should be done to the blood smear?

A

Angle should be raised

110
Q 
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
A
  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
Q

What is the purpose of blood smear staining?

A

For the evaluation of cellular morphology

112
Q

Indicate the important solutions for blood staining:

  1. Fixative
  2. Stain
  3. Buffer
A
  1. Fixative –> Methanol
  2. Stain –> Wright/Wright Giemsa
  3. Buffer –> 0.05 M Sodium Phosphate (6.4pH) /or/ Aged distilled water
113
Q

In order to prepare aged distilled water, distilled water should be placed in a glass bottle for _

A

At least 24 hrs for a pH 6.4-6.8

114
Q

It is defined as any stain which contains methylene blue (and/or products of oxidation), and a halogenated fluorescein dye (eosin Y/ B)

A

Romanowsky’s stain

115
Q

A basic stain which colors the nucleus and some cytoplasmic structures blue or purple

A

Methylene blue

116
Q

Wright stain, Giemsa stain, and May-Grunwald stain are examples of _

A

Romanowsky stains

117
Q

Give examples of automated techniques of staining

A
  1. Midas-III
  2. Hema-Tek
  3. Coulter-LH **
  4. Sysmex SP-10 **

** = capable of slide making and slide staining

118
Q

How many minutes will it take for:

  1. Manual method of staining
  2. Automated method of staining
  3. Quick method of staining
A
  1. Manual: 1-3 min.
  2. Automated: 5-10 min
  3. Quick: 1 min
119
Q

Give a probable reason

Smear:
RBCs: gray (or blue)
WBCs: too dark
Eosinophils: gray

A
  1. Stain/buffer is too basic (most common)
  2. Inadequate rinsing
  3. Heparinized blood was used
120
Q

Give a probable reason

Smear:
RBCs: too pale
WBCs: barely visible

A
  1. Stain/buffer is too acidic (most common)
  2. Over rinsing
  3. Underbuffering
121
Q

Blue specs outside the feathered edge indicate _

A

Increased WBCs and Platelets

122
Q

This objective is used to assess the overall film quality, color, and distribution of cells and detect the snowplow effect

A

10x objective examination

123
Q

Why should you avoid the feathered edge and the thick part in the PBS when doing a microscopic examination?

A

Feathered:
–> Red cells appear macrocytic, lacks central pallor; White cells appear distorted
Thick:
–> Red cells appear microcytic and they form rouleauz

124
Q

Factor to be multiplied when using a 40x High-Dry objective and 50x Oil Immersion Objective

A

40x High Dry –> x2,000
50x OIO –> 3,000

** This is only for WBC estimate

125
Q

Compute: If an average of 5 WBCs were observed per field, using the 40x high-dry objective, the WBC estimate is:

A

5x10(fields)=50

50x2,000=100,000/uL

126
Q

Compute: If an average of 5 WBCs were observed per field, using the 50x OIO, the WBC estimate is:

A

5x10=50

50x3,000=150,000/uL

127
Q

Estimation of platelet count is done in what objective?

128
Q

Compute for the platelet estimate:

Platelets counted in a field: 30
No. of fields counted: 10

A

30x 10 = 300

30x 20,000 = 6,000,000 plt. ct./uL

129
Q

Factor multiplied to average plt. count when using 100x OIO

130
Q

Formula used when determining the plt. count of an anemic patient

A

(Ave. no. of platelets per field x total RBC ct.)/200 RBCs per field

131
Q

Most pathologic plasmodium spp.

A

P. falciparum

–> Sickle cell trait patients are resistant

132
Q

Duffy a-, b- are resistant to what parasites?

A

P. vivax and P. ovale

133
Q

Malarial parasites metabolize _

A

Hemoglobin

–> making hemozoin or malaria pigment

134
Q

Stain used for the visualization of parasites in the blood smear

A

Wright-Giemsa

135
Q

How many blood films must be prepared ASAP after collection of Venous blood (EDTA) when determining malaria infection?

A

At LEAST 2 thick and 2 thin blood films

136
Q

Film used for the initial screening of blood

A

Thick

–> use water-based Wright-Giemsa (without methanol fixation) to LYSE the RBCs

137
Q

Film used for the identification / determination of percent parasitemia

138
Q

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?

A

300 fields

139
Q

Determined by counting the no. of parasitized RBCs (asexual stage) among 500-2,000 RBCs on a thin blood film and converting to percentage

A

Percent parasitemia

140
Q

Microscopy can detect how many parasites per microliter of blood?

A

5-20 parasites / microliter of blood (0.0001%)

141
Q

How many seconds should you mix the 3 small drops of blood for the thick blood smear to produce a 1-2 cm diameter?

Hematology 1 (13 decks)

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