lab final Flashcards
normal values of Hgb
in the teens
normal values of Hct
30s to 50s
normal MCHC
32-36
normal MCH
27-32
normal MCV
80-90
normal counts for Eos
150-300
normal counts for platelets
150,000-450,000
normal count for retics
0.5-2%
normal count for RBC
millions
normal count for WBC
5,000-10,000
what diluent was used in the manual counts of eosinophils
philoxine
what diluent was used in manual count for platelets
ammonium oxalate
what was used in the manual count for retics
new methylene blue
what was used in the manual count for RBC
saline/NaCl
what was used in the manual count for the WBC
acetic acid
what is the dilution ratio for eosinophils
1:32
what is the dilution ratio for platelets
1:100
what is the dilution ratio for retics
1:2
what is the dilution ratio for RBC
1:200
what is the dilution ratio for WBC
1:20
what is the principle of the sedimentation rate? (ESR)
measures the suspension stability of the red cells
what are the two methods of the ESR (sedimentation rate)?
westergren and wintrobe
what is the normal value in the ESR for males and females?
M: 0-15 mm/hr F: 0-20 mm/hr
how do you calculate MCV
mean corpuscular volume= average size of red blood cell (Hct/RBC in millions) X 10
how do you calculate MCH
mean corpuscular hemoglobin= concentration (Hgb/RBC in millions) X 10
how do you calculate MCHC
average amount of Hgb in RBC (w/v) (Hgb/Hct) X 100 (reported in %)
what is the principle of the osmotic fragility test?
Red cells are exposed to decreasing concentration of saline to observe the point of complete hemolysis
what conditions are associated with decreased OF?
sickle cell anemia thalassemia liver disease
what conditions are associated with increased OF?
hereditary spherocytosis
explain the principle of the tube solubility method for SCA screening?
expose the red cells to a reducing agent and hemoglobin S is insoluble positive test is cloudy/turbid (will not be able to see black lines behind tubes) negative test has no Hemoglobin S and is clear
how does a doctor use the reticulocyte count?
measure effective erythropoiesis evaluate/diagnose anemia
state three reasons for performing a WBC differential
count and classify 100 WBCs
observe RBC morphology
diagnose patients conditions
monitor therapy picture of general health
be able to show how you would calculate a total cell count (not a standard count) if you are given the dilution, the volume counted, and the number of cells counted
cells counted X reciprocal of dilution (ex. 1/20 multiply by 20) X (1/volume counted)
volume of small square 0.004
large square 0.1
how could you vary the counting procedure if you had to count (manually) an extremely high WBC count?
use a red cell pipette to make a 1:100 or 1:200 dilution
name the most commonly used anticoagulant for blood specimens to be used for coagulation testing and be able to tell how it works
sodium citrate- binds calcium
why do you need to perform coagulation testing within two hours after specimen collection?
results will be too high because of the loss of labile factors
need to do:spin down blood and refirgerate plasma
PT:
reagents used
normal range
system of coagulation
clinical use
thromboplastin CaCl mix
10-14 seconds
extrinsic system
monitor coumadin (warfarin) therapy
PTT reagents used
normal range
system of coagulation
clinical use
platelet substitute and CaCl
less than 35 seconds
intrinsic system
heparin therapy
compare the pirnciple of the fibrometer with that of the CoaDATA2000
fibrometer: when clot forms it completes circuit and turns off timer
CoaDATA2000: change in optical density detects the clot
what are two functions of the automatic pipette on the fibrometer
dispenses reagents turns on timer
what are two functions of the probe arm of the fibrometer?
holds the electrodes mixes the reagents senses the clot
what is the site of puncture and normal value for the duke method for bleeding time?
earlobe 1-3 minutes
what is the puncture site and normal value for the ivy method for bleeding time?
forearm 1-7 minutes
be able to list two tests that you think should be included in a screen for coag disorders and indicate why you chose each test
PT- check for extrinsic factors
PTT- checks for intrinsic factor
bleeding time- measures platelet function
if normal plasma fails to correct an abnormal PT and PTT, what is the best explanation for the results?
circulating anticoagulant/ antibody to a clotting factor
what is the only factor that will give an increased thrombin time? (it will also be corrected by normal plasma, but not by either absorbed plasma or aged as there are usually insufficient amounts of it in absorbed plasma to correct a deficiency and it is not found in aged serum at all.)
fibrinogen (factor 1)
what test measures platelet function?
bleeding time
what test measures stage 1 of coagulation
PTT
what test measures stage 2 of coagulation ?
PT
what test measures fibrinolysis?
FDP, D-Dimer
what are the factors of absorbed plasma
1, 5, 8, 11, 12 (lacks vitamin K, contains labile factors)
what are the factors of aged serum
2, 7, 9, 10, 11, 12 (contains vitamin K, lacks labile factors)
what are the factors of labile factors?
5, 8
what are the factors of the Vitamin K dependent factors
2, 7, 9, 10
use of PT and PTT substitution test
narrow down possible coagulation factors that are deficient
why not perform a series of specific factor assays
expensive and time consuming
what are some possible sources of error in coagulation testing?
improper ratio of anticoagulant to blood
sit at room temp too long
expired reagents
hemolyzed specimens (shortens clotting time as tissue factor is present lipemia
why should a doctor order presurgical coagulation screening test?
if patient has low-normal range, bleeding out could occur (if never had surgery) could decrease to a critically low level. normal 50-100% surgery decreased: 30-40% decreased less than 30% can start to bleed out
why is it important for a hospital to establish its own normal range for the PT and PTT and how would a doctor utilize this information?
each hospital uses different reagents, instruments, and has different patient population doctors want patients to be 1.5 to 2.5 times the normal range
if a patient has an increased PTT and increased bleeding time, what is the diagnosis and how could you prove it?
factor 8- Von Willebrand’s disease prove with factor 8 assay or substitution test
what is the antidote for coumadin (warfarin)?
vitamin K
what is the antidote for heparin?
protamine sulfate
what is the INR and how is it used in the lab?
international normalized ratio regulates/ compares PTs done in different labs
what test did we do in lab that are used primarily in the diagnoses of finbrinolysis?
thrombowellco, D-dimer
Acute Lymphocytic Leukemia (ALL)
blast and lymphs
Acute monocytic Leukemia (AMoL)
blast and monos
+ esterase stains
complete inhibition by fluoride
Acute myelocytic Lukemia (AML)
blast and mature granulocytes
Autoimmune hemolytic Anemia (AIHA)
spherocytes
Chronic lymphocytic Leukemia (CLL)
small mature clumpy lymphs older person smudge cells
chronic myelogenous leukemia (CML)
all stages of granulocytes increases bands alot of cells in bone marrow
hemophilia A
male bleeding of joints PTT increased absorbed plasma sex linked
idiopathic thrombocytopenic purpura (ITP)
coagulation test normal bleeding time increased decreased platelets
infectious mononucleosis (IM)
15-33 years
atypical lymphs not found in bone marrow
atypical lymphs in lymphnodes and PBS
slight fever
iron deficiency anemia (IDA)
MCV less than 80 MCH less than 32 bone marrow no iron (no blue/green dye) precursors jagged edge hypochromic
pernicious anemia (PA)
hypersegs oval macrocytes
low counts (decreased RBC WBC platelets)
increased MCV
neurological symptoms(tingling extremities)
dividing cells
sickle cell anemia (SCA)
genotype: SS
small pale cells
some evidence of bleeding
decreased MCV
decreased MCHC
iron stain of bone marrow will have no blue/green no iron
thalassemia major
microcytic hypochormic NRBCs howell jolly bodies bone marrow increased increased Hgb A2 and F increased iron target cells envelope cells
Von Willebrand’s disease
factor 8 deficient PTT abnormal corrected increased bleeding time
promyelocyte
blue cytoplasm and granules
basophilic stippling
made of RNA
seen in hemolytic anemia, thalassemia, SCA
target cells
seen in liver disease
metamyelocyte
nucleus is kidney bean shaped
seen in bacterial infections and leukemoid reactions
myelocyte
seen in CML
atypical lymphocytes
hypersegmented neutrophil
seen in PA, megaloblastic anemia b12 deficiency
ovalocytes/elliptocytes
hereditary elliptocytosis
sickle cell
genotype : SS
dohle body
light blue staining areas in neutrophil
seen in bacterial infections, pregnancy, toxic states
spherocyte
increased osmotic fragility
blast
nucleoli lighter stained area
plasma cells
MM
smudge cells
seen in CLL
rubricyte
LE cell
metarubricyte
NRBC
seen in hemolytic anemia, SCA, thalassemia
basophil
multiple myeloma
rouleaux
eosinophil
reddish granules
seen in parasitic infections and CML
pelger huet
hyposegmented neutrophils
dumbbell shaped nucleus
bi lobed
hairy cell
segmented neutrophil
burr cells
seen in chronic liver disease
band neutrophil
hemoglobin C crystals
rectangular shaped crystals in hemoglobin C disease
toxic granulation of band neutrophil
auer rod
because this is an auer rod and if it is present then you can eliminate lymphocytes
pappenheimer bodies
made of iron
vacuole
hemogloin SC crystals
hemoglobin SC disease
howell jolly bodies
made of DNA
seen in hemolytic anemia and thalassemia
schistocytes
fragments of RBC
seen in hemolytic anemia, severe burns, renal graft rejection
reitculocyte
seen in erythrocyte maturation
microcytic-hypochromic
IDA
polychromasia
seen in effective treatment for anemia
acute and chornic hemorrhage hemolysis
neonates
acanthocytes
“spurr”
seen in severe liver disease, splenectomy, vitamin E deficiency
monocytes
lymphocytes
mott cells
cancer?
