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Mercy CLS 6: Hematology > Lab Exam 2 > Flashcards

Lab Exam 2 Flashcards

1
Q

stains used for retic ct

what shows up in retics?

A

supravital stain
new methylene blue
brilliant cresyl blue
crystal violet

reticulum

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2
Q

usually retics lose their reticulum within —– hours of leaving the BM

A

10

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3
Q

retic RR
adult
baby

A

adult —0.5-2.0%
baby —2.5-6.5%

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4
Q

absolute retic calc

A

absolute = %retics(RBC)

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5
Q

sudden retic increase 3-4 days after acute hemorrhage

A

retic shower

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6
Q

very high glucose can affect…

A

appearance of reticulum in retics

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7
Q

methylene blue will also stain…

A

HJ bodies
heinz bodies

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8
Q

how to count retics

A
  • 100x
  • miller ocular
  • all RBCs in small square
  • all retics in large square
  • exactly consecutive fields
  • stop when you reach 112 RBCs
  • count 2 smears
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9
Q

47 retics = ——-% retics

A

4.7%

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10
Q

corrected retic takes into account that…

A

retics being released are sent into a smaller pool of blood in states of anemia

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11
Q

corrected retic calc

A

corrected retic = retic%(Hct/45)

normal Hct may also be taken from a table of norms

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12
Q

RPI calc

A

RPI = corrected retic/maturation time

maturation time from table

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12
Q

RPI takes into account that…

A

BM is releasing more retics than normal during anemia, and they take longer to mature in PB than normal retics, falsely elevating count

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13
Q

immature retic fraction (IRF) is used…

A

in place of RPI when performed on autoanalyzer

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14
Q

↑ IRF indicates…

may make ———- unnecessary

A

adequate BM response to anemia
cell recovery

transfusion

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15
Q

RET-He or CHr indicates…

equivalent to —– in RBCs

A

Hgb content of retics

MCH

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16
Q

hemoglobins migrate toward the ——

A

anode (+)

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17
Q

the most ———- charged hgbs are “fast”

A

negatively

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18
Q

controls the pH and carries the Hgbs through the gel medium

A

buffer

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19
Q

precipitates the Hgb into the gel to immobilize and prevent diffusion of bands

A

acid alcohol

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20
Q

allows visualization and densitometric scanning

A

stain

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21
Q

“fixes” stain to Hgb bands and washes stain from background

A

acetic acid

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22
Q

Hgb electro preferred sample

A

EDTA WB

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23
Q

alkaline gel and pH

A

cellulose acetate
8.4

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24
Q

acid gel and pH

A

citrate agar
6.0-6.2

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25
Q

if Hgbs cannot be fully identified with alkaline and acid gels, use ———- to ID

A

isoelectric focusing

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26
Q

uses gels with a pH gradient, and each Hgb migrates to point where pH is equal to pI

A

isoelectric focusing

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27
Q

alkaline gel buffer and stain

A

B2 buffer
blue stain

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28
Q

acid gel buffer and stain

A

maleic acid buffer
violet stain

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29
Q

A >97%
A2 1.5-3%
F <1%

A

normal

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30
Q

S 90%
F 10%
slight A2
no A

A

sickle cell disease

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31
Q

A 60%
S 40%

A

sickle cell trait

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32
Q

C 95%
F 5%

A

Hgb C disease

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33
Q

A 60%
C 40%

A

Hgb C trait

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34
Q

S 50%
C 50%

A

S/C disease

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35
Q

A most
A2 3.5-7%
F minor component

A

β thal minor

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36
Q

F 90%
A2 10%
A minor component

A

β thal major

37
Q

alkaline gel migration pattern

A

+
A
F
SDGL
CEOA2
=

38
Q

acid gel migration pattern

39
Q

not recommended to quantitate by scanning

A

A2
F

column chromatography instead

40
Q

column chromatography procedure

A
  • column has resin full of + charged molecules
  • buffer and pH levels are controlled to cause different Hgbs to bind to resin
  • elution buffer is added to remove Hgb A2, and other Hgb are retained
  • absorbance of A2 eluate fraction and total Hgb are read, and A2 is expressed as a percent
41
Q

cause increased osmotic fragility

A

spherocytes
burn patients
AIHA

42
Q

cause decreased osmotic fragility

A

target cells
sickle cells
hypochromic cells
thalassemia

43
Q

preferred osmotic fragility specimen

A

Na heparin

44
Q

osmotic fragility % hemolysis calc

A

% hemolysis = (ODx - OD.85)(100)/(OD0) - (OD.85)

45
Q

control OF patient should start hemolysis around —–% and end around —–%

46
Q

elongated crystals of polymerized Hgb S

47
Q

causes for crises in sickle trait pts

A
  • respiratory infection
  • anesthetsia
  • extreme exercise
  • congestive heart failure
48
Q

preferred sickle solubility sample

49
Q

sickle solubility reagent

A

Na hydrosulfite/Na dithionite

50
Q

sickle solubility test has —–% HgbS sensitivty

51
Q

other sicklings Hgbs detected by solubility test

A
  • Hgb C Harlem
  • Hgb C Georgetown
  • Hgb Memphis
  • Hgb Bart
52
Q

sickle solubility false +

A

too many RBCs
↑ Hct
↑ protein

53
Q

sickle solubility false =

A

Hgb S <10%
multiple transfusions
newborns

54
Q

QC requirements for sickle solubility

A
  • room temp reagent
  • pos and neg controls
  • correction of sample volume based on Hgb
55
Q

preferred KB sample

56
Q

negative control for KB is…

A

normal male blood

57
Q

positive controls for KB

A

1:10 and 1:20 cord blood + adult blood

58
Q

in the KB test, cells are exposed to ——— which destroys Hgb A and leaves Hgb F

A

acid buffer

59
Q

standard ESR method

A

Westergren method

60
Q

2 forces at work during ESR test

A
  • downward force of the RBCs
  • retarding force of the plasma
61
Q

3 stages of settling in ESR

A
  1. Initial aggregation (10 min)—rouleaux occurs
  2. Fast, constant settling (40 min)
  3. Final packing (10 min)—sedimentation slows
62
Q

plasma factors that ↑ ESR

A
  • ↑ fibrinogen
  • ↑ alpha and gamma globulins (↓ zeta potential of RBCs)
63
Q

plasma factors that ↓ ESR

A
  • extreme increase in plasma viscosity
64
Q

RBC factors that ↑ ESR

A
  • anemia
  • microcytes
65
Q

RBC factors that ↓ ESR

A
  • high RBC count
  • irregular shape (sickle, spherocyte)
  • macrocytes
66
Q

preferred ESR specimen

A

EDTA or Na citrate WB

67
Q

tube additive that falsely ↑ ESR

68
Q

ESR specimen stability

A

12 hours refrigerated
8 hours room temp

69
Q

ESR RR

A

male: 0-15 mm
female: 0-20 mm

70
Q

chief value of ESR (2)

A
  • differentiate among diseases with similar sx
  • indicates extend of inflammatory response
71
Q

how does temp affect ESR?

A

↑ temp (>27°) falsely ↑ ESR

72
Q

examples of ESR used in differential dx

A
  • bacterial infection, but not viral infection, ↑ ESR
  • MI with angina, but not angina without MI, ↑ ESR
  • RA, but not osteoarthritis, ↑ ESR
73
Q

peak mono age

74
Q

EBV transmission

A

infected saliva

75
Q

EBV infects…
protection mediated by…

A

B-cells, oropharynx, cervix

T-cells

76
Q

at risk for serious complications from EBV (eg B-cell tumors)

A

immunocompromised (AIDS, transplant)

77
Q

EBV sx

A
  • fever
  • pharyngitis
  • lymphadenopathy
  • lethargy
  • h/a
  • nausea
  • anoxia
  • severe: splenomegaly, hepatomegaly, jaundice
78
Q

complications of EBV

A
  • hepatitis
  • AIHA (anti-i cold agglutinin)
  • ↓ platelets
  • agranulocytosis
  • aplastic anemia (rare)
79
Q

EBV lab findings

A
  • ↑ WBC (12-25) with absolute lymphocytosis
  • > 20% atypical lymphs
  • occasional immunoblasts, plasma cells
  • slight ↓ platelet
80
Q

other causes of mono-like illnesses

A
  • CMV
  • toxoplasma
  • viral hepatitis
81
Q

rapid mono test is for the ——– Ab

A

heterophile

82
Q

reacts with Ag common to multiple species

A

heterophile Ab

83
Q

rapid mono test detects…

A

heterophile Ab which agglutinates sheep, horse or bovine RBCs

84
Q

limitations of rapid mono test

A

false negative results in 10-20% of adults, 50% children <4yo

85
Q

reflex test for rapid mono

A

if negative, do EBV serologies or repeat in 1 week if sx persist

86
Q

disadvantages of EBV serologies

A
  • more expensive
  • take longer
87
Q

Ab detected in EBV serology tests

A
  • VCA-IgM
  • VCA-IgG
  • EBNA
  • EBVEA
88
Q

when does EBNA rise?

A

early convalescent period (recovery) and persists along with IgG

89
Q

VCA

A

viral capsid antigen
(EBV)

Mercy CLS 6: Hematology (25 decks)

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