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Hematology Study Guide Flashcards

1
Q

ESR Principle

A

Distance the RBCs fall after a specified time period (1hr). RBCs naturally repel; increased fibrinogen (acute phase reactant) reduce RBC charges which -> rouleaux formation

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2
Q

Sources of error for increased ESR

A
  • macrocytes/anemia
  • temperature >27C
  • tilt of 3 degrees - 30% of the EST
  • vibrations (centrifuge nearby)
  • hematological disorders that increase rouleaux formation
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3
Q

Sources of error for decreased ESR

A
  • poik/sickle cells/spherocytes (decrease rouleaux formation)
  • Temperature <20C
  • Excessive anticoagulant (shrinks cells)
  • Clotted specimen
  • time less than 1hr
  • Old sample >2hrs old (RBCs become spherical which inhibits rouleaux)
  • hematological disorders that prevent rouleaux formation
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4
Q

ESR purpose

A
  • determines a nonspecific response to tissue damage and inflammation
  • also used in differential diagnosis in addition to monitoring existing inflammatory disease
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5
Q

Retic % Formula

A

Retic % = Retic # / Total # of RBCs x 100

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6
Q

Corrected Retic Count Formula

A

corrected retic count = retic % x (patient Hct% / average Hct)

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7
Q

RPI formula

A

RPI = corrected Retic count / maturation time

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8
Q

Patient HCT % 40-45 maturation days

A

1

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9
Q

Patient HCT % 35-39 maturation days

A

1.5

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10
Q

Patient HCT % 25-34 maturation days

A

2

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11
Q

Patient HCT % 15-24 maturation days

A

2.5

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12
Q

Patient HCT % <15 maturation days

A

3

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13
Q

Structure of heme

A
  • 4 heme molecules: protoporphyrin IX + 1 iron atom (Fe ++)
  • each heme reversibly combines with one O2 molecule
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14
Q

Structure of globin

A
  • 4 globin chains (“tetramer”): 2 pairs of 2 different polypeptide chains
  • amino acid sequence determines the type of hemoglobin and its ability to take up and release O2
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15
Q

Fetal (F) Hemoglobin chains

A

2 alpha + 2 gamma

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16
Q

Adult (A-1) Hemoglobin chains

A

2 alpha + 2 beta

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17
Q

(A-2) Hemoglobin chains

A

2 alpha + 2 delta

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18
Q

Normal hemoglobin values for men

A

14 - 18 g/dL

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19
Q

normal hemoglobin values for women

A

12 - 15 g/dL

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20
Q

normal hemoglobin values for newborns

A

16.5 - 21.5 g/dL

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20
Q

MCV formula

A

MCV = Hct % x 10 / RBC count (x10^12/L)

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20
Q

Hct formula

A

HCT = RBC x MCV / 10

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21
Q

Iron deficiency anemia, thalassemia, sideroblastic anemia, other conditions of defective iron use, chronic infection or inflammation, unstable hemoglobin

A

microcytic; hypochromic RBC morph

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21
Q

MCH formula

A

MCH = Hb (g/dL) x 10 / RBC count (10^12/L)

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21
Q

MCHC formula

A

MCHC = Hb (g/dL) x 100 / Hct %

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22
Q

Microcytic; hypochromic RBC morph

A

MCV(fL) <80
MCHC(g/dL) <32

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23
Q

hemolytic anemia, leukemia, metastatic malignancy, bone marrow failure, chronic renal disease

A

normocytic; normochromic RBC morph

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23
Q

normocytic; normochromic RBC morph

A

MCV(fL) = 80-100
MCHC(g/dL) = 32-36

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23
Q

Macrocytic; normochromic RBC morph

A

MCV(fL) = >100
MCHC(g/dL) = 32-36

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23
Q

Liver disease, myelodysplasias, megaloblastic anemias

A

macrocytic; normochromic RBC morph

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24
Q

MCHC def

A

mean cell hemoglobin concentration

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25
Q

MCV def

A

mean cell volume

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26
Q

MCHC normal value

A

32-36 g/dL

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27
Q

causes of MCHC >36g/dL

A

error in hemoglobin value due to high WBC count, lipemia, Hgb S/C, cold agglutinin, spherocytes

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28
Q

hemoglobin rule of 3

A

RBC x 3 = HGB

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29
Q

hematocrit rule of 3

A

HGB x 3 = HCT

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30
Q

hematocrit normal range for men

31
Q

hematocrit normal range for women

32
Q

hematocrit normal range for 1 year old

33
Q

Sources of error for decreased HCT

A
  • improperly sealed capillary tubes
  • increased concentration of anticoagulant as a result of RBC shrinkage
  • blood loss (plasma is replaced faster than RBCs)
34
Q

Sources of error for increased HCT

A
  • fluid loss associated with dehydration
35
Q

Sources of error for retic

A
  • anemia or polycythemic
  • moisture in the air, poor drying of the slide
36
Q

retic normal value in adults

37
Q

retic normal value in infants

38
Q

hematocrit normal range for newborns

39
Q

MCV normal range

40
Q

Sources of error for increased MCV

A

cold agglutination or hyperglycemia

41
Q

sources of error for decreased MCV

A

poor blood sample collection technique, high levels of lipids or abnormal proteins in the blood (like agglutinins or cryoglobulins), excessive white blood cell count, electrolyte imbalances (like hyponatremia), improper analyzer settings, and technical issues with the automated blood analyzer

42
Q

RBC count normal value for men

A

4.7 - 6.1 cells/mcL

43
Q

RBC count normal range for females

A

4.2 - 5.4 cells/mcL

44
Q

platelet normal range

45
Q

WBC count normal range

A

4.5 - 11 x 10^9/L

46
Q

RDW normal range

A

11.5 - 15%

47
Q

Causes of high RDW

A
  • anemia
  • nutrient deficiency
  • infection
  • dysfunction in the production of red blood cells
  • shortened lifespan of red blood cells
  • premature release of reticulocytes
48
Q

Normal adult MCH range

A

27-31 (pg/cell)

49
Q

normal newborn MCH range

A

32-34 (pg/cell)

50
Q

Causes of low MCH

A
  • iron deficiency anemia
  • thalassemia
  • blood loss
  • major surgery
51
Q

Causes of high MCH

A
  • vitamin deficiency
  • alcohol abuse
  • under active thyroid
  • anemia caused by low levels of folic acid or vitamin B12
52
Q

Electronic impedance principle

A

Based on the detection and measurement of changes in electrical resistance produced by cells as they traverse a small aperture

the number and size of the pulses are directly proportional to the number and size of the cells being counted

53
Q

Electronic impedance interpretation

A

the number and size of the pulses are directly proportional to the number and size of the cells being counted

54
Q

Cell counting by Radio frequency (RF) principle

A

high voltage electromagnetic current (RF) flowing between both electrodes simultaneously and measures interior density (conductivity) of cells

55
Q

Cell counting by optical scatter principle

A

hydroynamically focused sample stream is directed through a quartz flow cell past a focused light source (flow cytometry). Uses diffraction, reflection, and refraction of light waves.

56
Q

What errors happen on hematology analyzers when WBC >50,000

A

Turbidity may increase Hgb, increased RBC, Hct and other indices may be inaccurate

57
Q

What errors happen on hematology analyzers when cold agglutinins are present

A

Agglutinates are counted and sized as RBCs, decreased RBC, increased MCV, MCH, MCHC, Hct inaccurate

58
Q

what errors happen on hematology analyzers when NRBCs are present

A

Can be mistaken for WBCs, falsely increases WBC count

59
Q

What errors happen on hematology analyzers when lipemia is present

A

turbidity many affect HGB reading, may increase HGB, MCH, MCHC

60
Q

What errors happen on hematology analyzers when hemolysis is present

A

RBCs are lysed, decreases RBC and HCT, increases MCH and MCHC

62
Q

What errors happen on hematology analyzers when an old specimen was run

A

RBCs swell and platelets and WBCs degenerate, increases MCV, decreases platelet, auto diff count may be inaccurate

63
Q

what errors happen on hematology analyzers when schistocytes and microcytes are present

A

Not counted as RBCs, may be counted as platelets, decreases RBC, HCT and indices may be inaccurate

64
Q

what errors happen on hematology analyzers when resistant RBCs (HGB S or C) are present

A

RBCs dont lyse, counted as WBCs, increases WBC count, HGB is inaccurate

65
Q

what errors happen on hematology analyzers when fragile WBCs are present

A

WBCs are damaged in analyzer, may be couted as platelets, decreases WBC count, may increase platelet count

66
Q

Manual Count Formula

A

cells counted x DF x 10 / # of squares counted

67
Q

Dilution Factor Formula

A

1 / x = blood volume / total volume

68
Q

WBC Squares Volume

69
Q

RBC Squares Volume

70
Q

Basophilic stippling

A

RNA, lead poisoning

71
Q

Pappenheimer bodies

A

non-heme iron granules, sideroblastic anemia, hemoglobin disorders, post-splenectomy

72
Q

Reticulocyte

A

RNA, immature RBCs, accelerated erythropoiesis

73
Q

Heinz bodies

A

denatured precipitated hemoglobin, G6PD deficiency, unstable hemoglobins

74
Q

Cabot’s Rings

A

remnants of the mitotic spindle, severe anemia

75
Q

Hemoglobin Crystals (SC, CC)

A

crystallized abnormal hemoglobin, hemoglobin SC disease, hemoglobin C disease

76
Q

Hemoglobinpathies

A

qualitative disorders involving amino acid substitutions

77
Q

thalassemias

A

quantitative disorders involving decreased synthesis of globin chains

78
Q

Corrected WBC Formula

A

Corrected WBC= NRBC Count x [100/(NRBC +100)]

79
Q

Which CBC Parameters are measured directly?

A

RBC count and MCV

80
Q

Principles of RBC Cell Maturation

A
  • cell size decreases
  • RNA decreases (less basophilic cytoplasm)
  • hemoglobin increases
  • chromatin structure becomes more clumped to pyknotic
  • nuclear size decreases
81
Q

erythropoiesis

A

The kidneys detect when there is a decrease in oxygen in circulation and secrete the hormone erythropoietin, which stimulates the bone marrow to produce more RBCs

82
Q

RBC maturation order

A

proerythroblast
basophilic erythroblast
polychromatophilic erythroblast
orthochromatophilic erythroblast
retic
RBC

83
Q

WBC maturation order

A

Myeloblast
Promyelocyte
Myelocyte
Meta
Band
Seg

Hematology WSSU (12 decks)

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