Hematology - Scut Monkey and Lecture No. 1

Question 1

true or false; wbc is highest at birth and then tapers to adult levels by puberty

Answer 1

true

Question 2

does hct always reflect the blood loss? why or why not?

Answer 2

no b/c plasma and rbc are lost in equal amounts during hemorrhage so the hct does not immediately reflect the loss sometimes not for 2 to 3 hours later

Question 3

what determines cell age for PMNs?

Answer 3

the degree of nuclear lobulation (younger you are, less lobes you have)

Question 4

more than 20 five-lobed cells/100 WBCs is indicative of what?

Answer 4

megaloblastic anemia

Question 5

bacterial infection, toxemia and hemorrhage are indicative of what type of shift?

Answer 5

left shift

Question 6

what are three common examples of right shift?

Answer 6

liver disease, megaloblastic anemia, iron deficiency anemia

Question 7

what tube top color is used for a retic count?

Answer 7

lavendar

Question 8

true or false: the retic count is part of cbc

Answer 8

nope; false

Question 9

reticulocytes are juvenile rbc’s with remnants of what?

Answer 9

cytoplasmic basophilic RNA

Question 10

bsophilia of the RBC cytoplasm on a Wright stain is indicative of the presence of what?

Answer 10

reticulocytes

Question 11

what is the formula for the corrected reticulocyte count?

Answer 11

reported count x patients hct/normal hct

Question 12

the corrected reticulocyte count is a great indicator of what?

Answer 12

erythropoietic activity

Question 13

what is the normal corrected reticulocyte count typically about?

Answer 13

less than 1.5%

Question 14

normal bone marrow responds to decrease in erythrocytes with an increase production of what?

Answer 14

retics

Question 15

PMN depression when mild is referred to as what? when severe?

Answer 15

neutropenia; agranulocytosis

Question 16

what is hematocrit really defined as?

Answer 16

The ratio of red blood cells to the total volume of blood.

Question 17

what is known as the amount of hemoglobin in the average red cell?

Answer 17

MCH (mean corpuscular/cellular hemaglobin)

Question 18

how do you define the MCV?

Answer 18

mean corpuscular volume/measure of the average red blood cell volume (i.e. size).

Question 19

what is defined as the average concentration of Hbg in a given volume of red blood cells?

Answer 19

mean corpuscular hbg concentration (mchc)

Question 20

hemoglobin/hematocrit is the formula for what?

Answer 20

mchc

Question 21

the term poikilocytosis means what?

Answer 21

irregular RBC/wbc SHAPE

Question 22

what does the term anisocytosis mean?

Answer 22

irregular RBC/wbc SIZE

Question 23

only test used to monitor low molecular weight heparin.

Answer 23

anti-xa test (blue tube top); also used to monitor heparin therapy when PTT not available

Question 24

test used to document neutralization of heparin

Answer 24

activated clotting time (ACT)

Question 25

test for the presence of antibody on the patient's cells and for the screening for autoimmune hemolytic anemia

Answer 25

Coombs test, direct

Question 26

test for antibodies against red cell antigens in the patient's serum; check for cross-match before transfusion

Answer 26

coombs test, indirect

Question 27

what is the most common hereditary coagulation disorder in the US?

Answer 27

factor V leiden (activated protein c resistance)

Question 28

used to evaluate the extrinsic coagulation system.

Answer 28

PT

Question 29

used to evaluate the intrinsic coagulation system

Answer 29

PTT, aPTT

Question 30

what gauge needle should be used when collecting venous blood? if this is not available, should you go higher or lowe?

Answer 30

22 - higher

Question 31

why is it not advised to use small needles when trying to collect venous blood?

Answer 31

b/c small needles cause hemolysis

Question 32

routine cbc is collected in a tube of what coloring with what special ingredient added?

Answer 32

purple; EDTA

Question 33

how is the fresh blood collection to be shaken once collected with EDTA? why is this?

Answer 33

shaken gently back and forth as to avoid hemolysis

Question 34

most samples that are sent for coagulation are sent with what tube top coloring?

Answer 34

blue/citrate

Question 35

true or false: capillary heel and finger sticks can yield a falsely low hematocrit? what is the reading produced after milking these areas?

Answer 35

true; milking leads to readings that are falsely high

Question 36

true or false: wright stain blood smear is automatically done along with the automated cell count

Answer 36

false - must be requested

Question 37

what is the main reason to order a wright stain?

Answer 37

main advantage is that it identifies abnormal cells; in more detail, it provides a manual differential leukocyte count (useful for anemia and certain infections)

Question 38

mcv and hemoglobin concentration are two factors used to calculate what?

Answer 38

hematocrit

Question 39

true or false: an acute bleed will be normocytic for the first couple of hours.

Answer 39

true - will have normal hematocrit although volume measures will be dropping

Question 40

predominance of immature white cells is called _____ and can be indicative of the body responding to loss by increasing the rate of new cell production - while older cells are the ones being lost

Answer 40

shift to the left

Question 41

a predominance of cells with four or more lobes is called what?

Answer 41

shift to the right

Question 42

a single six or seven lobed PMN would be diagnostic for what?

Answer 42

megaloblastic anemia

Question 43

what do terms "bands", "stabs" and "segs" refer to?

Answer 43

first two are immature wbc, the last references mature wbc

Question 44

about what percentage of bands being present would be indicative of a "left shift"

Answer 44

10 to 12%

Question 45

stress reaction can be indicated in a shift to the left or to the right?

Answer 45

right shift

Question 46

what is the presence of basophilia of the RBC cytoplasm on a Wright Stain called? (the presence btw is indicative of retics)

Answer 46

polychomasia

Question 47

what are the 7 differentials for an increased eosinophil count?

Answer 47

NAACP: neoplasm, allergies, asthma, addison's, collagen-vascular disease, and parasites and pulmonary disease.

Question 48

what will steroids do the the level of eosinophils?

Answer 48

decrease

Question 49

what are subsets of lymphocytes most useful for diagnosing?

Answer 49

AIDS, leukemia, lymphoma

Question 50

true or false: a significant portion of the US population has a decreased lymphocyte count as their normal

Answer 50

true (22%)

Question 51

what is the most likely cause of >20% presence of atypical lymphs?

Answer 51

mononucleosis -- other possible causes include CMV, toxo, or malignancy

Question 52

what is the most likely cause of lymphocytes being down (less than 20%)?

Answer 52

rickettsial infection, or common viral infections

Question 53

monocytes will be increased during what kind of infections?

Answer 53

bacterial infections such as subacute bacterial endocarditis, TB, etc.

Question 54

what is the approx. normal male hct? female?

Answer 54

40-54% and 37-47% | 50 to 60 and 40 to 50 if easier

Question 55

what does megaloblastic anemia do to MCH? what about iron deficiency anemia

Answer 55

increase; decrease

Question 56

what does severe prolonged dehydration do to mchc?

Answer 56

increases it

Question 57

this is known as the measure of degree of anisocytosis (the variation in size of rbc)

Answer 57

red cell distribution wideth

Question 58

abnormalities of function of this type of cell are assessed by bleeding time and platelet aggregation - what is the cell type?

Answer 58

platelets

Question 59

these type of cells are specific monoclonal antibodies

Answer 59

lymphocyte subsets

Question 60

when using lymphocyte subsets to diagnose AIDS, what is the marker you are looking for?

Answer 60

CD4/CD8 ratio less than one