(M) Week 8: CBC and other procedures II part 2 Flashcards
What is the reagent used in the New Methylene blue technique in dry method reticulocyte count
New Methylene blue
what reagent is used in the Cook, Meyer, and Tureen Method in dry method reticulocyte count
brilliant cresyl bleu
What is the reagent used in the Selverd’s method in dry method reticulocyte count
Brilliant Cresyl Blue
What are the microscopic wet methods of reticulocyte count
- light microscope method
- calibrated miller disk method
What reagent is preferred for Osgood-Wilhelm method
new-methylene blue
this is an optical aid inserted into the eyepiece of the microscope, allows for more accurate count
Miller disc
Miller disc
The disc ruling consists of a center
square containing a secondary square
ruled area that is ____ the area of the
larger square.
1/9
what is the computation for the miller disc method
%reticulocyte = no. of reticulocytes in large square x 100/ no. of rbc in small square x 9
What the automated method of reticulocyte count shown in the lecturer
Sysmex R - 1000
its like gawk gawk 3000 but reticulocytes
What is the principle of sysmex R-1000 for the determination of the percent reticulocyte and the absolute reticulocyte count
Sysmex R-1000
flow cytometry
What are the stains for reticulocyte count
- New methylene blue
- Brilliant cresyl blue
what is the composition of new methylene blue
1gm new methylene blue
80mL NSS
20mL 3% sodium citrate
increase / decrease in reticulocytes in blood
hemolytic anemia
lead poisoning
malaria
parasitic infections
blood intoxication
increase
increase / decrease in reticulocytes in blood
kala-azar
erythroblastic anemia
sickle cell anemia
relapsing fever
leukemia
splenic tumor
increase
increase / decrease in reticulocytes in blood
aplastic anemia
acute benzol poisoning
chronic infections
anaplastic crisis of hemolytic anemia
decrease
increase / decrease in reticulocytes in blood
pregnancy
at birth
menstruation
increase (physiologic)
What are the main sources of technical sources of technical error in reticulocyte count
- failure to mix the blood and stain completely
- presence of refractile artifacts
- increased blood glucose level
- presence of pappenheimer bodies, heinz bodies, and howell-jolly bodies
this is classically employed as an index of the presence of active diseases like tuberculosis, tonsilitis, rheumatic fever, and rheumatic heart disease
erythrocyte sedimentation rate
this is a non-specific test and results are affected by factors other than that of the blood cells and the plasma
erythrocyte sedimentation rate
erythrocyte sedimentation rate
The test depends on the fact that in the blood to which ___________ has been
added, the red corpuscles sediment until they form a packed column in the
lower part of the tube or container
anticoagulant
What are the stages in ESR
- initial period of aggregation / rouleaux formation
- stage of fast setting
- final period of packing
at what time mark does the rouleaux formation occur in ESR
First ten minutes
when does ESR fast setting occur?
40 minutes
when does the final period of packing occur in ESR
LAST TEN MINUTES
When do you check the values of ESR again?
after an hour
reading the result less than an hour may cause a false (increase / decrease) of the ESR value
decrease
reading the result beyond an hour may cause a false (increase / decrease) of the ESR value
increase
What is the importance of ESR
- Used as an index of the presence of an active infection
- measures the suspension stability of RBCs
- Indicates abnormal concentration of fibrinogen, globulin, and other plasma proteins
T or F
under normal state, RBCs do not stick together as they are negatively charged
T
T or F
when proteins (positively charged) are increased, it will facilitate the formation of Rouleaux
T
increased rouleaux will also increase/decrease the ESR value
increase
increased albumin will increase/decrease ESR
Decrease
which one is more preferred for ESR
a. Wintrobe-Landsberg
b. Wesetergren
B
type of ESR method that is harder to use as it should only be placed in an undisturbed surface
westergren
wintrobe-landsberg
Wintrobe-Landsberg vs Westergren
Tube bore (diameter)
WL: 3mm
WG: 2.5
Wintrobe-Landsberg vs Westergren
Tube calibration
WL: 100mm
WG: 200mm
Wintrobe-Landsberg vs Westergren
Tube length
WL: 115mm
WG: 300mm
Wintrobe-Landsberg vs Westergren
Anticoagulant
WL: Hellen and Paul’s double oxalate (1 part citrate : 4 parts blood)
WG: 3.8 trisodium citrate
Wintrobe-Landsberg vs Westergren
Number of reading
WL: one reading only (after one hour)
WG: Two readings (after on hour and after two hours)
Normal values for Wintrobe-Landsberg
Men : 0-10 mm/hr
Women: 0-20 mm/hr
Normal values for Westergen
Men: 0-15 mm/hr
Women: 0-17 mm’hr
Wintrobe-Landsberg vs Westergren
Dilution
WL: no dilution
WG: 0.6 mL of sodium citrate to 1.4mL of blood
Wintrobe-Landsberg vs Westergren
bottom of tube
WL: open
WG: flat and closed
Wintrobe-Landsberg vs Westergren
correction for anemia
WL: applicable
WG: not applicable
Wintrobe-Landsberg vs Westergren
additional tests
WL: hct, microglobulin determination, and icterus index
WG: none
advantage of Wintrobe-Landsberg
smaller amount of blood needed
advantage for Westergren method
most sensitive method for serial study of chronic diseases
disadvantage of Wintrobe-Landsberg
large amount of blood is necessary
disadvantage of Westergren
less sensitive due to shorter column
What type of ESR method is preferred?
Wintrobe-Landsberg
This method of ESR determination is the most sensitive
Westergren method
This method of ESR is an accurate method in majority of the cases
wintrobe-landsberg method
This method is considered the most sensitive for ESR determination. It can be used for the serial study of chronic diseases like tuberculosis and carcinoma.
Westergren method
An automated ESR system that is fully automated for ESR determination
Automated ESR system by Vega Biomedical
how many mL of blood is collected on an evacuated tube containing liquid sodium citrate
1mL
how many minutes does a Ves-Matic analyzer take to produce results
Ves-Matic analyzer
20-25
Automated ESR Ves-matic analyzer
can take 4 samples at one time
Mini-ves
Automated ESR Ves-matic analyzer
can take 20 samples at one time and print results
Ves-Matic-20
Automated ESR Ves-matic analyzer
can take 60 samples at one time, print results, and identifies sample by bar code
Ves-Matic 60
Intrinsic / Extrinsic factors affecting ESR
Plasma factors
red cell factors
intrinsic
Intrinsic / Extrinsic factors affecting ESR
Mechanical factors
Technical factors
Physical factors
extrinsic
What are plasma factors that increase the rate of fall
increased fibrinogen concentration
increased globulin concentration
cholesterol
What are red cell factors that increase the rate of fall?
macrocytes
anemia
hemolysis
Intrinsic / Extrinsic factors
1. Temperature will increase rate of ESR above 27-degree C.
2. Longer sedimentation tube.
3. Larger bore of sedimentation tube
4. Inclination of tilting of sedimentation tube. ( A 3 degree will result in an error up to 30%)
5. Increased dilution of blood.
6. Presence of air bubbles within blood column.
7. Wet glasswares
8. Hemolysis
Extrinsic
T or F
ESR is more constant in women
F (men)
When does ESR begin to increase in pregnancy?
3rd to 4th month
when does ESR return to normal in terms of pregnancy
It doesnt return until 3rd or 4th week postpartum
In newborns ESR is (increased/decreased)
decreased
In older adults, ESR is (increased/ decreased)
increased
Comments and Sources of Errors
ESR is a non-specific indicator of ______________
tissue damage
Comments and Sources of Errors
Conditions in which ___________________ is inhibited, such as sickle cell anemia; spherocytosis may be accompanied by a normal ESR or a low ESR
Rouleaux formation
Comments and Sources of Errors
Blood must be fresh. Leaving the specimen for more than 2 hours at room temperature will cause RBC to become ____________, thus inhibits ___________________-
spherical
rouleaux formation
Comments and Sources of Errors
whole blood specimens left overnight will result in (lower/higher) values
lower
Comments and Sources of Errors
Slight tilting of the sedimentation tube will increase/decrease results
increase
Comments and Sources of Errors
T or F
If area of reading is clear, read at the level where the full RBC density is apparent
F (hazy instead of clear)
Comments and Sources of Errors
The presence of anemia ____________ ESR as a tool to diagnose disease process
invalidates
Zeta sedimentation rate is performed using
zetafuge and special capillary tubes
ZSR is dependent on the concentration of ___________________ and _____________
fibrinogen and gamma globulins
What sample is used for ZSR?
EDTA-anticoagulated venous or capillary blood
formula for ZSR
ZSR% = HCT% x 100 / Zetacrit
ZSR reference range:
NORMAL
40-51%
ZSR reference range:
borderline normal
51-54%
ZSR reference range:
moderately elevated
60-64%
ZSR reference range:
mildly elevated
55-59%