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Hematology 1 > (M) Week 7: CBC and other procedures I part 2 > Flashcards

(M) Week 7: CBC and other procedures I part 2 Flashcards

1
Q

familiarize the reagents and equipment for blood smear

A
  1. slides
  2. hematological stains
  3. microscope
  4. schilling counter
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2
Q

what are the stains used in differential counts

A
  1. Wright’s
  2. Giemsa
  3. Leishman’s
  4. other romanowsky stain
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3
Q

Romanowsky stain’s dip method uses which reagents

A

a. methanol (fixative for blood smear)
b. eosin (primary stain)
c. methylene blue (secondary stain)
d. distilled water (washes out excess stain)

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4
Q

rack method

stains that are too acidic changes the __________ or the ____________ of the cell

A

appearance or morphology of the cell

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5
Q

rack method

stains that are too acidic changes the cell color to

A

bright red or pink

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6
Q

rack method
stains that are too basic or alkaline can appear (darker / lighter in color)

A

darker

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7
Q

rack method

what helps maintain the integrity of the blood smear

A

washing

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8
Q

what type of microscope is used for differential count

A

bright-field

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9
Q

what type of Romanowsky stain is routinely used

A

Wright’s

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10
Q

which type of Romanowsky stain is used in searching for malarial parasites

A

Giemsa

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11
Q

What causes falsely increased WBC when the patient is crying?

A

WBC in the marginating pool migrates to the circulating pool

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12
Q

familiarize the procedure

A
  1. check slide identification
  2. perform patient specimen orientation
  3. perform low power scan to review blood film adequacy
  4. perform diff leukocyte count
  5. classify 100 leukocytes using the battlement track method
  6. report results of the 100 cells classified as percentage
  7. keep separate count of nucleated RBCs
  8. Note and report the abnormal leukocyte morphology
  9. Identify and report any miscellaneous non-leukocyte abnormal cells such as endothelial cells, basket cells, or NRBCs
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13
Q

in what areas of the smear do we perform cell counting?

A

uniform monolayer of smear

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14
Q

What are the criteria for leukocyte identification

A
  1. cell size
  2. nuclear - cytoplasmic ratio
  3. cytoplasmic characteristics
  4. nuclear characteristics
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15
Q

what does high NC ratio mean in leukocyte identification

A

immature cell

(nucleus occupies most cell areas with only a small rim)

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16
Q

what does low NC ratio mean in leukocyte identification

A

mature cell

nucleus is small in relation to volume of cytoplasm

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17
Q

what are the three cytoplasmic characteristics

A

a. color of background cytoplasm
b. presence of absence of granules
c. color and size of granules

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18
Q

what are the nuclear characteristics

A
  1. shape
    b. color
    c. chromatin pattern
    d. presence or absence of nucleus
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19
Q

neutrophil with more than 5 lobules

A

hypersegmented

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20
Q

neutrophil with less than 3 lobules

A

hyposegmented

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21
Q

sign of maturation in neutrophil

A

conspicuous filament / constrictioni that connects segments

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22
Q

an immature neutrophil (no restriction)
- c or s shaped

A

band neutrophil

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23
Q

there is a slight indentation, kidney bean-shaped with lilac granules

A

metamyelocyte

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24
Q

has fine chromatin sturcture and uniform nucleus, cytoplasm appears sky blue in color

A

lymphocytes

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25
Q

what is the sign of maturation for lymphocytes

A

granules

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26
Q

what are the sizes of lymphocytes

A

small, medium, and large

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27
Q

this WBC has frosted glass appearance, kidney bean shaped with rough nucleus

A

monocyte

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28
Q

what is the largest cell in circulation

A

monocyte

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29
Q

which has the least number among all the WBCs

A

basophils

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30
Q

WBC with highly intense granules that appear blue to black in color, may undergo degranulation (in allergic reactions)

A

basophil

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31
Q

normal reference value for WBCs from most concentrated to least concentrated

A

NEVER LET MONKEY EAT BANANA

neutrophil
lymphocyte
monocyte
eosinophil
basophil
stab/ band cell

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32
Q

what is the normal reference value for neutrophil

A

47-49

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33
Q

what is the normal reference value for lymphocyte

A

14-47

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34
Q

what is the normal reference value for monocyte

A

2-11

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35
Q

what is the normal reference value for eosinophil

A

0-7

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36
Q

what is the normal reference value for basophil

A

0-2

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37
Q

what is the normal reference value for stab / band cell

A

0-7

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38
Q

this provides the number of specific WBC type per cubic millimeter of blood

A

absolute count

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39
Q

T or F

relative count is more informative than absolute count

A

f (absolute count)

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40
Q

what is the formula for the absolute count

A

relative count (%) x WBC count

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41
Q

please check out the normal reference value for absolute counte

A

edi dont

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42
Q

familiarize the irregularities in blood smear preparation affecting leukocytes

A
  1. squashed / distorted lymphocytes
  2. accumulated white cells
  3. smudge cells
  4. disintegrated or ruptured cells
  5. poorly stained leukocytes
  6. precipitated stain
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43
Q

these causes which type of irregularity in blood smears

  1. incorrect pH or buffer
  2. improper mixing of stain and buffer
  3. too short staining period
A

poorly stained leukocytes

44
Q

when should 200-differential be performed?

A

when leukocyte number is in excess of 35.0 X 10^9 / L

45
Q

What should be used if WBC count is less than 1.0 x 10^9

A

buffy coat smear

46
Q

When using a high power objective, how is WBC count done?

A

scan the smear and average the WBCs per field

47
Q

platelet estimate:

starting from normal upwards just (subtract / add) _______________

From marked decreased to normal

A

subtract 50,000

48
Q

platelet estimate:

starting from normal downwards just (subtract / add) _______________

From normal to marked increase

A

add 200,000

49
Q

platelet estimate reporting:

0-49,000 /uL

A

marked decrease

50
Q

platelet estimate reporting:

50,000 - 99,000 / uL

A

moderately decrease

51
Q

platelet estimate reporting:

100,000 - 149,000 / uL

A

slightly decrease

52
Q

platelet estimate reporting:

150,000 -199,000 /uL

A

low normal

53
Q

platelet estimate reporting:

200,000 to 400,000 / uL

A

normal

54
Q

platelet estimate reporting:

401,000 - 599,000 / uL

A

slightly increase

55
Q

platelet estimate reporting:

600,000 - 800,000 / uL

A

moderately increased

56
Q

platelet estimate reporting:

above 800,000 /uL

A

marked increase

57
Q

this is the number of platelets in 1L or 1mL of whole blood

A

platelet count

58
Q

platelets are counted in the ____________ in the large center square of the hemacytometer

A

25 small squares

59
Q

what microscope is used to count platelets in the hemacytometer?

A

phase-contrast microscope or Bright-field microscope

60
Q

what type of microscope is used in the Brecher and Cronkite method of platelet count?

A

phase-contrast microscope

61
Q

what type of microscope is used in the Rees and Ecker method of platelet count

A

bright-field microscope

62
Q

Which methods fall under the Manual indirect method of platelet counting?

A

Fonio’s
Olef’s
Dameshek

63
Q

Which methods fall under the Manual direct method of platelet counting?

A

Guy and Leake
Rees and Ecker
Brecher and Cronkite

64
Q

Which methods fall under the electronic method of platelet counting

A

voltage-pulse counting
electro-optical counting

65
Q

In Fonio’s method in manual indirect platelet count, where is the diluting fluid placed?

A

site of puncture

66
Q

what is the diluting fluid for Fonio’s method

A

magnesium sulfate

67
Q

what is the ratio of blood to diluent in Fonio’s Method?

A

1 part blood : 5 parts magnesium sulfate

68
Q

how many RBCs should be counted in Fonio’s method

A

1000

69
Q

what is considered as the best indirect method of platelet counting

A

Olef’s method

70
Q

Confirmation of the platelet count is done on the bases of _____________________ in the peripheral smear

A

occurrence of platelets

71
Q

Olef’s method reporting:

5 to 20 platelets / OIO field (with occasional clumping)

A

adequate supply of platelets

72
Q

Olef’s method reporting:

> 25 platelets / OIO field

A

increase in the number of platelets

73
Q

what are the diluents used in Dameshek’s method

A

brilliant cresyl blue
sodium citrate
sucrose
formalin

74
Q

dameshek’s method uses the same technique as

A

Fonio’s

75
Q

what is the counterstain for Dameshek’s method

A

Wright’s stain

76
Q

what is the formula for calculation for platelets

A

platelets / uL = platelet x RBC count / 1000

77
Q

What is the equipment used in direct methods in platelet counting

A

hemocytometer

78
Q

Which direct method in platelet counting utilizes a diluent composed of :

sodium oxalate
40% formalin
crystal violet

A

Guy and Leake

78
Q

Which one is more accurate?

direct vs indirect methods of platelet counting

A

direct

79
Q

Which methods fall under the Manual direct method of platelet counting:

sodium oxalate
brilliant cresyl blue
formalin
distilled water

A

Rees and ecker

80
Q

what is the calculation for guy and leake

A

platelet/uL = platelet counter x 5 (area of square counted) x 10 (depth of counting chamber) x 100 (dilution factor)

81
Q

what is the formula for Rees and Ecker?

A

platelets / uL = platelets counted x 10 x 200 /4

82
Q

What is the platelet calculation formula for Dameshek’s method

A

platelet x RBC / 1000

83
Q

What is the platelet calcularion for Brecher and Cronkite?

A

same as Guy and Leake

platelet/uL = platelet counter x 5 (area of square counted) x 10 (depth of counting chamber) x 100 (dilution factor)

84
Q

platelets are stained _____________ in Rees and Ecker’s method

A

light blue

85
Q

what is the percent error in Brecher and Cronkite’s method

A

11-15%

86
Q

what is the microscope used for brecher and cronkite

A

phase contrast microscope

87
Q

what is the diluent for Brecher and Cronkite

A

1% ammonium oxalate

88
Q

This is the most accurate method because there is no difficulty in distinguishing platelets from debris because the diluting fluid swells the platelet a little and hemolyze the red cells

A

Brecher and Cronkite

89
Q

What is the formula for Brecher and Cronkite

A

platelet x 5 x 10 x 100

90
Q

What should be done first in the Electronic method in platelet counting

A

red cells must be removed from whole blood (either via sedimentation or centrifugation)

91
Q

What is the dilution for Voltage-Pulse counting

A

1:3000 (3uL blood + 9mL isotonic NSS)

92
Q

What is the diluent in Voltage-pulse counting

A

iosotonic NSS

93
Q

Voltage-Pulse counting

If the platelet count is less than 250,000 /uL what should be the dilution instead?

A

1:300 (20uL blood / 6mL diluent)

94
Q

what is the principle used in Voltage-Pulse counting

A

electronic impedance

95
Q

what is the dilution in electro-optical counting

A

1:1500

96
Q

what is the diluent for electro-optical counting

A

2M Urea

97
Q

Electro-optical counting

these 2 are observed in some patients’ EDTA treated blood

A

platelet satellitosis
platelet clumping

98
Q

what should be done to resolve platelet satellitosis

A

redraw the blood to sodium citrate and multiply platelet count result to 1.1

99
Q

this is due to a type of agglutinin found in the patient at a certain temperature, may occur in cases of poor venipuncture

A

platelet clumping

100
Q

Unopette system

this is where sample is obtained

A

reservoir

101
Q

Unopette system

you need to puncture _________________ using the tip of the pipette to facilitate the flow of the sample to the counting chamber

A

diaphram

102
Q

familiarize:

reasons why platelets are hard to count

A
  1. easily disintegrate / lyse
  2. small size, mistaken for debris
  3. easily clumps and adhere to glass and other contact surfaces
  4. uneven distribution of the blood
103
Q

Familiarize;

sources of error in platelet counting

A
  1. error in handling
  2. operator’s error
  3. error in equipment and reagent
  4. inherent error and field error
104
Q

Familiarize:

cases of platelet clumping

A
  1. initiation of plt aggregation
  2. clotting before blood reaches the anticoagulant
  3. imperfect venipuncture
  4. delay in sampling
105
Q

platelet count is slightly (lower / higher) at birth than in older children and adults

A

lower

Hematology 1 (28 decks)

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