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Hematology 2 Lab > LABORATORY ACTIVITY 3 AND LABORATORY ACTIVITY 4 > Flashcards

LABORATORY ACTIVITY 3 AND LABORATORY ACTIVITY 4 Flashcards

1
Q

Features of a well-made wedge peripheral blood film
1. The film is (?) the length of the slide
2. The film is (?), (?) at the feather edge, not (?); this provides the widest area for examination
3. The (?) of the film are visible.
4. The film is smooth without (?)
5. When the slide Is held up to the light, the thin portion (feather edge) of the film has a (?).
6. The (?) is picked up and spread.

A

two thirds to three fourths

finger shaped; very slightly rounded; bullet shaped

lateral edges

irregularities holes, or streaks

“rainbow” appearance

whole drop of blood

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2
Q

: concentrated cell at the middle portion

A

Too short

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3
Q

The (?), the better distribution

A

longer

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4
Q

The (?) the tail, the better (more distribution)

A

wider

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5
Q

: wider and more distribution

A

Finger

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6
Q

: congested cells

A

Pointed

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7
Q

: concentrated and big cells may overlap

A

Bullet

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8
Q

of the edge of the smear and slide should be visible to push the cells outward/sideward

A

Margination

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9
Q

Causes of holes:

A

dirty slides and wet slides

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10
Q

Causes of wave-like motion:

A

flowing or dropping while wet

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11
Q

To know that blood is well-distributed below

A

“rainbow” appearance.

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12
Q

: inadequate blood

A

thin

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13
Q

: congested cells

A

thick

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14
Q

: should not be defined

A

feather edge

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15
Q

stains:

A

methanol (fixative), eosin (acidic; negatively charged), methylene blue (basic; positively charged), water (to wash off residue)

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16
Q

Methods

A

Two-glass method (75 mm x 25 mm)
Spreader slide method

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17
Q

drop of blood:

A

2-3 mm

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18
Q

angle:

A

30-45 degrees

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19
Q

(4 factors affecting consistency of smear)

A

PASS: Pressure, Angle, Size of blood, Speed

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20
Q

(intact rbcs): many rbc (polycythemia), thick and viscous

A

Inc Hematocrit

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21
Q

: concentrated wbc at the edge

A

Too slow

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22
Q

Thin PASS

A

↑ ↓ ↓ ↓

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23
Q

Thick (↑ Hematocrit) PASS

A

↓ ↑ ↑ ↑

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24
Q

Microscopic examination

A
  1. 10x Objective Examination
  2. 40x High-Dry Objective Lens
  3. 100x Oil Immersion Objective Examination
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25
Q
  1. 10x Objective Examination
A

a. Distribution of cells
b. Edge (transitioning of distribution of cell)
c. Fibrin strands (coagulation and clot formation – improper inversion leading to low rbc and consumed plt)
d. Wbc distribution (should not be concentrated at the edge but throughout the tail)

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26
Q
  1. 40x High-Dry Objective Lens
A

a. Evaluation of roleaux formation
b. Wbc estimate

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27
Q
  1. 100x Oil Immersion Objective Examination
A

a. Platelet estimate (smaller - needs magnification)
b. Blood cell morphology evaluation

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28
Q

Where to perform
a. In an area where RBC’s has (?)
b. (?) oil immersion field is counted
c. (?) = approximate platelet/mm3

A

few overlapping

10

Ave no of plt/oil immersion field x 20,000 (standard factor)

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29
Q

Example: 12 to 16 plt/field
Average: 14

A

14 x 20000 = 280,000 plt/uL

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30
Q

: expect adequate platelet count

A

• 8-20/OIF

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31
Q

: expect lower platelet count and

A

• < 5/OIF

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32
Q

: expect higher platelet count

A

• > 20/OIF

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33
Q

Marked decreased

A

0 - 49,000

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34
Q

Moderate decreased

A

50,000 - 99,000

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35
Q

Slight decreased

A

100,000 - 149,000

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36
Q

Low normal

A

150,000 - 199,000

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37
Q

Normal

A

200,000 - 400,000

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38
Q

Slight increase

A

401,000 - 599,000

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39
Q

Mod. increase

A

600,000 - 800,000

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40
Q

Marked increased

A

Above 800,000

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41
Q

The (?) should correlate with the platelet count + 25%. If discrepancy exists, the platelet count and peripheral blood smear estimate should be repeated.

A

platelet estimate

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42
Q

platelet estimate

Ex. 98,000 x 0.25 = 24,500

110,000

A

110,000 – 98,000 = 12,000 √

43
Q

Platelet satelitism will result in (?) platelet counts.

A

FALSELY DECREASED

44
Q

Platelet clumping around neutrophil

A

Platelet satelitism

45
Q

counted as wbc, not counted as plt

A

Platelet satelitism

46
Q

plt ct is lower in

A

automation

47
Q

falsely decreased:

A

automation

48
Q

no effect:

A

estimation

49
Q

reject specimen and redraw blood with (?) (only occurs w/ EDTA)

A

sodium citrate

50
Q

(volume correction factor)

A

ct x 1.1

51
Q
  • time a blood will clot/would will close
A

Bleeding Time

52
Q

• Time that takes for a standard wound at a standard pressure to stop bleeding.

A

Bleeding Time

53
Q

standard wound (?)

A

lancet: 2 mm

54
Q

standard pressure (?)

A

40mmHg

55
Q

• Screening test for:

A

vascular disorder and platelet function defects

56
Q

Can detect problems in

A

primary hemostasis

57
Q

-Standardised incision is made on the

A

forearm (volar – muscular portion)

58
Q

-(?): recorded
-(?): recorded
-Compute for minutes it take to stop bleeding

A

Incision bleeding

Cessation of bleeding

59
Q

-Result is dependent on:

A

a. # of platelet
b. ability of platelet to adhere and aggregate to the subendothelium

60
Q

( fewer platelet = shorter platelet plug =?)

A

prolonged bleeding time

61
Q

Earlobe/heel of foot/ fingertip

A

Duke Method

62
Q

Forearm

A

Ivy Method
Template BT (Mielke)

63
Q

1-3 mins

A

Duke Method

64
Q

1-7 mins

A

Ivy Method

65
Q

1 puncture

A

Duke Method

66
Q

3 puncture

A

Ivy Method

67
Q

standard slit

A

Template BT (Mielke)

68
Q

Template BT (Mielke) length and depth

A

11 mm (deep) x 1 mm (long)

69
Q

Duke Method Advantage

A

a. Easy to perform
b. Requires minimal equipment -alcohol -lancet -stop watch -filter paper
c. Earlobe is vascular

70
Q

Duke Method Disadvantage

A

a. Difficult to standardize the wound

71
Q

Duke Method equipment

A

-alcohol
-lancet
-stop watch
-filter paper

72
Q

Ivy Method Advantage

A

a. Standardized method
b. More accurate than Duke (less accurate than template bt)
c. Required materials: -lancet -stopwatch -filter paper (cicular, whattmann no. 1) -blood pressure cuff

73
Q

Ivy Method Disadvantage

A

a. Not reliable
b. Puncture wound may close before bleeding stops

74
Q

Ivy Method materials

A

-lancet
-stopwatch
-filter paper (cicular, whattmann no. 1)
-blood pressure cuff

75
Q

Template BT (Mielke) Advantage

A

a. wound can be reproduced from 1 px to another
b. Very sensitive and reproducible
c. Detects even minor alteration in platelet. function

76
Q

Template BT (Mielke) Disadvantage

A

a. Scar formation (slit)

77
Q

Ivy Method Factors affecting

A
  • aspirin intake (pain-reliever)
  • fruit intake
  • blood thinners (heparin, coumadin)
78
Q

Ivy Method Sources of Error

A

-Intake of aspiring (7-10 days) : prolonged BT
-Improper performed instruction (too shallow or deep puncture)
-Residual alcohol
- Prolonged BT
-Proper timing of the bleeding
-Touching of the incision- falsely elevated result
-Improper calibration of stopwatch

79
Q

Template BT (Mielke) Clinical Significance

Prolonged in:

A

a. Thrombocytopenia
b. Platelet disorders
c. Afibrogenemia
d. Hypofibrinogenemia
e. Vascular disorders
f. Aspirin
g. Anemia, Leukemia, Liver Diseases
h. VW disease
i. Factor deficiency (Factor V and XI)

80
Q

Platelet adhesion is affected by:

A

Calcium, ADP, Fibrinogen

81
Q

ASPIRIN TOLERANCE TEST
-Aspirin inhibits synthesis of (?), by inhibiting the (?):

A

Thromboxane A2

Cyclooxygenase

82
Q

(imp for plt activation; indirect relationship)

A

Thromboxane A2

83
Q

-Prolonged BT

A

ASPIRIN TOLERANCE TEST

84
Q

ASPIRIN TOLERANCE TEST Procedure:

A

2 tablets aspirin
2 hours Bleeding Time

85
Q

-Aspirin is effective within

A

30 minutes

86
Q

: BT is doubled

A

-Normal

87
Q

: immune to aspirin

A

1 to 7 mins

88
Q

: highly sensitive to aspirin

A

> 14 misn

89
Q

Prolonged Bleeding time

A

: when platelet count is lower than 30 - 50, 000/µL or when platelets are dysfunctional.
: in vWD
: after ingestion of aspirin/aspirin-containing compounds, anti-inflammatory, anticoagulants, and some antibiotics

90
Q

: Puncture is done on the earlobe. bleeding ceases.

A

Duke method

91
Q

Duke method Reference value:

A

1 - 3 mins

92
Q

: Done on the forearm

A

Ivy method

93
Q

Standard pressure applied is 40 mmHg

A

Ivy method

94
Q

Ivy method Reference value:

A

1 - 7 mins.

95
Q

: Uses a template containing a standardized slit

A

Template BT (by Mielke)

96
Q

A properly prepared blood smear is utilized for [?] and for the observation of any abnormal platelet size and distribution.

A

platelet estimation

97
Q

Specimen Needed:

A

Wright- or Giemsa-stained blood smear

98
Q
  1. Select an area of the blood film in which most RBCs are separated from one another with [?] and where platelets are not clumped.
  2. Using the [?], count the number of platelets in [?] consecutive fields, and calculate the average number of platelets per field.
  3. To obtain the platelet estimate per µL or mm3 of blood, multiply the average number of platelets per field by [?].
  4. Report the platelet count qualitatively using the following references:
A

minimal overlapping of RBCs

100x oil immersion objective; 10

20,000

99
Q

Accurate estimates are possible only when there are no platelet clumps, or at most, rare clumps of [?].

A

2 to 3 platelets

100
Q

A better estimate is possible using venous blood with [?] as an anticoagulant, in which platelets are evenly distributed and where clumping normally does not occur.

A

EDTA

101
Q

On average, there are [?] per field with [?] red cells.

A

8 – 20 platelets

200

102
Q

is the time it takes for a standard wound at a standard pressure to stop bleeding

A

Bleeding time

103
Q

This serves as a screening test for detecting disorders of platelet function and the ability of the small blood vessels to control bleeding after injury.

A

Bleeding time

104
Q
  1. Place a blood pressure cuff on the patient’s arm above the elbow.
  2. Increase the pressure to [?] and hold this exact pressure for the entire procedure.
  3. Cleanse lateral part of forearm with [?]. Dry.
  4. Choose an area approximately [?] below the bend of elbow and make [?] skin punctures. Incision must be made parallel to the elbow crease. Note: Avoid underlying subcutaneous veins.
  5. Start stopwatch as soon as blood appears from the puncture.
  6. Blot the blood from each puncture with the edge of a filter paper every [?] interval. Note: Care must be taken not to touch the incision.
  7. End point is when no blood comes out of the punctured area/blood does not stain the filter paper.
  8. Record the bleeding time of the [?] puncture sites and report the average of the two results.
A

40 mmHg

70% ethyl alcohol

three finger-width; 2

30 seconds

2

Hematology 2 Lab (7 decks)

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