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Liz's Hematology Module 1 > Lab Evaluation of RBCs > Flashcards

Lab Evaluation of RBCs Flashcards

Manual RBC Intro to Hemacytometers Retic Counts Manual Hb, Microhematocrits, ESRs, RBC Indices

1
Q 
RBC count (manual or automated)
- Basic procedure
A

Whole blood diluted w/ isotonic diluting fluid and RBCs counted

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2
Q 
RBC count (manual or automated)
- Normal (adult) reference values
A

4-6 million /mm^3

- NOTE DIFFERENCES B/W MEN AND WOMEN

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3
Q

Retic count

- Basic procedure

A

Whole is diluted w/ supravital stain, smears made, retics count–expressed as %

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4
Q

Retic count

- Normal (adult) reference values

A

0.5-1.5%

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5
Q

Hemoglobin

- Basic procedure

A

Whole blood is diltued w/ reagent containing a lysing agent

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6
Q

Hemoglobin

- Normal (adult) reference values

A

Male: 14-18 g/dL
Women: 12-16 g/dL

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7
Q

Microhematocrit

- Basic procedure

A

Whole blood spun down 5 minutes in 2 microhematocrit tubes, sealed at one end w/ clay; determined using reader

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8
Q

Microhematocrit

- Normal (adult) reference values (% of packed cell volume)

A

Men: 42-54%
Women: 36-48%

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9
Q

Erythrocyte sedimentation rate (ESR)

- Basic procedure

A

Allow specific amount of blood to sit in vertical position for 1 hour; measure how far, in mm, that RBCs fall

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10
Q

Erythrocyte sedimentation rate (ESR)

- Normal (adult) values

A

Men: 0-15 mm
Women: 0-20 mm

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11
Q

Volume factor for all 9 squares on a hematocytometer

A

1/(1 x 1 x 0.1 x 9) = 1.1

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12
Q

Volume factor for 4 W corners on a hematocytometer

A

1/(1 x 1 x 0.1 x 4) = 2.5

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13
Q

Volume factor for center square on a hematocytometer

A

1/(1 x 1 x 0.1 x 1) = 10

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14
Q

Volume factor for manual RBC area on a hematocytometer

A

1/(0.2 x 0.2 x 0.1 x 5) = 50

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15
Q

Retic counts

- Type of stain used

A

Supravital

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16
Q

Retic counts

- Two retic stains commonly used

A
  • New methylene blue

- Brilliant cresyl blue

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17
Q

Retic counts

- Composition of reticulum

A

RNA

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18
Q

Calculate uncorrected retics

A

(# retics/1000) = (x/100)

- Expressed as a %

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19
Q

Calculate corrected retics

A

observed retics x (patient’s Hct/”normal” Hct)

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20
Q

Calculate RPI

A

(corrected retic count)/2

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21
Q

Calculate absolute retic count

A

(uncorrected retic count x RBC count)/100

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22
Q

Form of Hb that can’t be measured by cyanmethemoglobin method

A

Sulfhemoglobin

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23
Q

4 causes for falsely elevated Hb determination

A
  • High WBC count (>20,000/mm^3)
  • High PLT count (>700,000/mm^3)
  • Lipemia
  • RBCs resistant to hemolysis (Hb-S, Hb-C)
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24
Q

Rule of 3

A
  • RBC x 3 = ~ Hb

- Hb x 3 = ~ Hct +/- 3

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25
Q

Predict causes for discrepancies w/ regard to Hb and Hct not being “in balance”

A

??

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26
Q

Undercentrifugation will ____ Hct

A

Falsely ↑

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27
Q

↓ blood: anticoagulant ratio will ____ Hct

A

Falsely ↓ (“short draw”)

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28
Q

EDTA tube allowed to set out all night at room temp will ____ Hct

A

Falsely ↑

- Glucose is used up (4-6 hours), cell membrane breaks down and fluid leaks into cells making them more spherical)

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29
Q

Buffy coat included in reading will ____ Hct

A

Falsely ↑

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30
Q

3 stages that occur during 60-minute setting period of ESR

A
  • Rouleaux (~10 minutes)
  • Rapid fall (~40 minutes)
  • Packing (~10 minutes)
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31
Q

How does an ↑ in plasma proteins affect ESR?

A

↑ plasma proteins coats RBCs → ↓ zeta potential (surface charge becomes more positive) → RBCs stick together more → ↑ rouleaux → ↑ mass → bigger fall → ↑ ESR

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32
Q

Plasma proteins w/ the greatest affect on ESR

A

Fibrinogen

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33
Q

↓ blood:anticoagulant ratio will ____ ESR

A

Decrease

- B/c of ↑ [anticoagulant], RBCs become spherical inhibiting rouleaux

34
Q

EDTA blood tube allowed to sit out overnight at room temp will ____ ESR

A

Decrease
- As glucose is used up (4-6 hours), cell membrane leaks fluid into RBC causing them to become spherical which affects rouleaux; if there’s poik cells, then RBCs won’t rouleaux

35
Q

Sedimentation tube isn’t perpendicular will ____ ESR

A

Increase (even a slight tilt)

36
Q

Rack holding tubes placed next to a centrifuge will ____ ESR

A

Increase (from vibrations)

37
Q

Average RBC volume

38
Q

MCV formula

A

(Hct x 10)/RBC count

39
Q

Normal MCV range

40
Q

RBC morphology seen w/ decreased/increased MCV

A

Decreased MCV → microcytic

Increased MCV → macrocytic

41
Q

Average RBC Hb mass

42
Q

MCH formula

A

(Hb x 10) /RBC count

43
Q

Normal MCH range

44
Q

Average relative [Hb] per RBC; relates to stained RBC color intensity

45
Q

Normal MCHC range

A

32-36% (spherocytes)

46
Q

RBC morphology seen w/ decreased/increased MCHC

A

Decreased MCHC → hypochromic RBCs

Increased MCHC → >38% should not happen! (Incorrect calc? Lipemia? Cold agglutinin?)

47
Q

Technique used to determine size of RBC by comparison w/ small lymphocyte

A

Find small, resting lymphocyte; RBCs should be about the size of the nucleus of the lymph or about 2/3 the size of the lymph itself

48
Q

Variation in RBC diameter (or volume) on blood film; correlates w/ RDW (> 14.5%)

A

Anisocytosis

49
Q

Presence in PB of RBCs w/ varying or bizarre shapes

A

Poikilocytosis

50
Q

Young non-nucleated RBCs that still contain some basophilic substance (RNA)

A

Polychromasia

51
Q

Small RBC w/ reduced MCV (

52
Q

RBC w/ abnormally large diameter seen on PB film and elevated MCV (> 100 fL)

53
Q

Acanthocyte

  • Morphology
  • Disorders/conditions
A
  • Lack central pallor, multiple irregularly spaced projections of varying length
  • Abetalipoproteinemia (hereditary)
54
Q

Blister cell

  • Morphology
  • Disorders/conditions
A
  • Heinz bodies pitted out by healthy spleen

- Burn patients, DIC

55
Q

Burr cell

  • Morphology
  • Disorders/conditions
A
  • Short, evenly spaced projections usually w/ central pallor

- HUS, PK deficiency

56
Q

Crenation

  • Morphology
  • Disorders/conditions
A
  • Almost always a drying artifact

- Severe electrolyte imbalance

57
Q

Elliptocytes

  • Morphology
  • Disorders/conditions
A
  • Cigar-shaped

- Hereditary elliptocytosis

58
Q

Hb C crystals

  • Morphology
  • Disorders/conditions
A
  • Dark red, hexagonal

- Homozygous Hb C disease

59
Q

Hb SC crystals

  • Morphology
  • Disorders/conditions
A
  • Dark red, 1-2 fingerlike projections (mitten-shaped)

- Hb SC disease

60
Q

RBC clumps (agglutination)

  • Morphology
  • Disorders/conditions
A
  • Clumping

- Ag-Ab reactions

61
Q

Rouleaux

  • Morphology
  • Disorders/conditions
A
  • Stack of coins

- Multiple myeloma

62
Q

Schistocytes

  • Morphology
  • Disorders/conditions
A
  • Fragments

- Burn patients, DIC

63
Q

Sickle cells

  • Morphology
  • Disorders/conditions
A
  • Elongated cell w/ point on each end; may be curved or S-shaped
  • Sickle cell anemia (homozygous Hb SC disease)
64
Q

Spherocytes

  • Morphology
  • Disorders/conditions
A
  • Round, no central pallor; darker color than surrounding RBCs
  • Hereditary spherocytosis, burn patients, thalassemia, transfusion w/ old blood
65
Q

Stomatocytes

  • Morphology
  • Disorders/conditions
A
  • Slit-like area of central pallor

- Rh null disease

66
Q

Target cells

  • Morphology
  • Disorders/conditions
A
  • Bull’s eye

- Thalassemia

67
Q

Tear drops

  • Morphology
  • Disorders/conditions
A
  • Shaped like tear drop or pear

- Tumor in BM

68
Q

Mixed cell population

  • Morphology
  • Disorders/conditions
A
  • 2 distinct RBC populations

- Sideroblastic anemia, transfusion therapy

69
Q

Macroovalocytes

  • Morphology
  • Disorders/conditions
A
  • Egg-shaped

- Megaloblastic anemia

70
Q

Round macrocytes

  • Morphology
  • Disorders/conditions
A
  • Associated w/ hemolytic conditions → reticulocytosis
71
Q

Basophilic stippling

  • Composition of inclusions
  • Disorders/conditions
A
  • RNA; fine or coarse punctuate granules fairly even distribution
  • Lead poisoning, thalassemia
72
Q

Howell-Jolly bodies

  • Composition of inclusions
  • Disorders/conditions
A
  • DNA; 1 per cell

- Sickle cell anemia, megaloblastic anemia

73
Q

Pappenheimer bodies (Wright stain); Siderotic granules (Prussian blue iron stain)

  • Composition of inclusions
  • Disorders/conditions
A
  • Non-heme iron; fine irregular granules in clusters around periphery of cell
  • Sideroblastic anemia, thalassemia
74
Q

Heinz bodies

  • Composition of inclusions
  • Disorders/conditions
A
  • Denatured Hb; generally membrane-bound

- Thalassemia, G-6-PD deficiency

75
Q

Cabot rings

  • Composition of inclusions
  • Disorders/conditions
A
  • Remnants or mitotic spindle; beads on a string
  • Pernicious anemia, lead poisoning
  • *Don’t confuse w/ Plasmodium species**
76
Q

Which RBC inclusion doesn’t stain w/ Wright stain? Which stain should be used?

A

Heinz bodies; use supravital stain (crystal violet)

77
Q

4 RBC morphologies that can be artificially created

A
  • Crenation → drying artifact
  • Rouleaux → sits on slide too long
  • Tear drop → too much pressure when making slide
  • Schistocytes → too much pressure
78
Q

RBC inclusion composed of ferric iron; w/ Prussian blue staining, appear as multiple dark blue irregular granules

A

Siderotic granules

79
Q

Cell volume of RBC

80
Q

Index calculated to correct for presence of shift/stress retics that may otherwise falsely elevated visual retic count

Liz's Hematology Module 1 (15 decks)

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