MTAP W2 (Hematology W10: Lab Evaluation) Flashcards
CBC IS ALSO KNOWN AS
HEMOGRAM
INCLUDES
1. ENUMERATION OF CELLULAR ELEMENTS
2. QUANTITATION OF HGB
3. STATISTICAL ANALYSES OF CELL APPEARANCES
CBC/HEMOGRAM
PREVENTS PLATELETS FROM CLUMPING ON GLASS SLIDE MAKING IT MORE ACCURATE DURING FILM EVALUATION
EDTA
SPECIMEN OF CHOUCE FOR EVALUATION OF BLOOD CELL MORPHOLOGY
ANTICOAGULANT-FREE BLOOD
PERIPHERAL BLOOD FILM
EDTA BLOOD (PURPLE TOP)
MADE WITHIN – OF DRAWING THE SPECIMEN- HIGH QUALITY FILMS
2-3 HOURS
ADVANTAGES
1. MULTIPLE SLIDES
2. PREP AT LATER TIME
3. AVOIDS PLT CLUMPING
EDTA
PREFERRED EDTA TUBE WHEN MAKING PERIPHERAL BLOOD FILM
IT MIXES MORE EASILY WITH BLOOD
TRIPOTASSIUM EDTA/LIQUID FORM
PERIPHERAL BLOOD FILM
EDTA TUBES THAT REMAIN FOR MORE THAN -
BLOOD CELL ARTIFACTS:
1. VACUOLATED NEUTROPHILS
2. ECHINOCYTIC RBCS
3. NECROBIOTIC LEUKOCYTES
4. SPHEROCYTES
5 HOURS
PERIPHERAL BLOOD FILM
EDTA LEFT FOR 5 HOURS
BLOOD CELL ARTIFACTS (4)
- VACUOLATED NEUTROPHILS
- ECHINOCYTIC RBCS
- NECROBIOTIC LEUKOCYTES
- SPHEROCYTES
VENS
PERIPHERAL BLOOD FILM
CAUSE PLATELET SATELLITOSIS
EDTA SPECIMEN
PERIPHERAL BLOOD FILM
PLATELETS SURROUND OR ADHERE TO THE NEUTROPHILS
PLATELET SATELLITOSIS
PERIPHERAL BLOOD FILM
PLATELET SATELLITOSIS:
FALSE DECREASE DUE TO ADHERANCE TO NEUTROPHIL
PSEUDOTHROMBOCYTOPENIA
PERIPHERAL BLOOD FILM
PLATELET SATELLITOSIS:
FALSE INCREASE OF WBC, CLUMPS WILL BE READ AS WBC DUE TO ITS SIZE
PSEUDOLEUKOCYTOSIS
PLATELET SPECIFIC AUTOANTIBODIES THAT REACH BEST AT RT ARE ONE OF THE MECHANISMS KNOWN TO CAUSE THIS PHENOMENON
PLATELET SATELLITOSIS
PERIPHERAL BLOOD FILM
PLATELET SATELLITOSIS:
CORRECTION: RECOLLECT BLOOD SAMPLE USING -
3.2% NA CITRATE (BLUE TOP)
PERIPHERAL BLOOD FILM
PLATELET SATELLITOSIS:
CORRECTION: RECOLLECT BLOOD SAMPLE USING 3.2 NA CITRATE
ADJUSTMENT MUST MULTIPLY TO -
PLATELET COUNT X 1.1
PERIPHERAL BLOOD FILM
ADVANTAGE:
1. MADE AT PX SIDE
2. SOME ARTIFACTS MAY BE PREVENTED
ANTICOAGULANT-FREE BLOOD
METHODS OF BLOOD FILM PREPARATION
EASIEST, MOST CONVENIENT, COMMONLY USED
MANUAL/PUSH-WEDGE METHOD
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
USES SLIDE AS PUSHER/SPREADER
FILM SLIDE: 3X1 INCH (75 X25 MM)
ANGLE OF PUSHER/SLIDE: -
30-45 DEGREE
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
BLOOD IS DROPPED AT ABOUT - FROM END OR FROSTED
0.25/ 1/4 INCH
1 CM
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
DROP OF BLOOD: -
2-3MM
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
DROP OF BLOOD: 2-3MM
LARGE AMOUNT OF BLOOD= - SMEAR
THICKER/LONGER
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
DROP OF BLOOD: 2-3MM
SMALL AMOUNT OF BLOOD= -SMEAR
THINNER/SHORT
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
SPEED OF SPREADER:
TOO FAST= - SMEAR
THICKER
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
SPEED OF SPREADER:
TOO SLOW= - SMEAR
THINNER
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
HEMATOCRIT OF PX:
TOO HIGH (>60%) ANGLE SHOULD BE LOWERED AS LOW AS -
25 DEGREE
METHODS OF BLOOD FILM PREPARATION
MANUAL WEDGE TECHNIQUE aka PUSH-WEDGE METHOD
HEMATOCRIT OF PX:
TOO LOW (>45%) ANGLE SHOULD BE RAISED -
> 45 DEGREES
METHODS OF BLOOD FILM PREPARATION
TOO THICK SMEARS
PRESSURE: -
LOW
METHODS OF BLOOD FILM PREPARATION
TOO THICK SMEARS
ANGLE: -
HIGH
METHODS OF BLOOD FILM PREPARATION
TOO THICK SMEARS
SPEED: -
FAST
METHODS OF BLOOD FILM PREPARATION
TOO THICK SMEARS
SIZE OF BLOOD: -
LARGE
PERIPHERAL BLOOD FILM
COVERSLIP METHOD OF BLOOD FILM PREPARATION
- METHOD: GLASS SLIDE + COVERSLIP
BEACOM
PERIPHERAL BLOOD FILM
COVERSLIP METHOD OF BLOOD FILM PREPARATION
- METHOD: 2 COVER SLIP METHOD
EHRLICH METHOD
PERIPHERAL BLOOD FILM
FEATURES OF A WELL-MADE WEDGE PBS
FILM IS - LENGTH OF SLIDE
2/3-3/4
PERIPHERAL BLOOD FILM
FEATURES OF A WELL-MADE WEDGE PBS
THE FILM SHOULD BE - SHAPED NOT BULLET
FINGER
PERIPHERAL BLOOD FILM
FEATURES OF A WELL-MADE WEDGE PBS
SLIDE HELD UP TO THE LIGHT THIN PORTION MUST BE HAVE A - APPEARANCE
RAINBOW
PERIPHERAL BLOOD FILM
FILM THAT IS - (COLOR) THAN NORMAL MAY INDICATE THAT THE PX HAS
- INCREASED BLOOD PROTEINS
- PLASMA CELL MYELOMA
- ROULEAUX
BLUER
PERIPHERAL BLOOD FILM
A - APPEARANCE TO THE FILM MAY INDICATE RBC AGGLUTINATION FOUND IN COLD HEMAGGLUTIN DISEASES
GRAINY
PERIPHERAL BLOOD FILM
- ALL OVER THE FILM INDICATES INCREASED LIPID LEVELS
HOLES
PERIPHERAL BLOOD FILM
SLIDES STAINED AFTER - OR LONGER TURN OUT TOO BLUE
SHOULD ONLY BE STORED FOR -
1 WEEK
PERIPHERAL BLOOD FILM
FILMS PRODUCED EVERY 30SEC
SYSMEX SP10
PERIPHERAL BLOOD FILM
AUTOMATED SLIDE STAINERS
MIDAS AND HEMA TEK
PERIPHERAL BLOOD FILM
DEMONSTRATES LE CELLS
CONCENTRATES THE NUCLEATED CELLS PRESENT
BUFFY COAT SMEAR
PERIPHERAL BLOOD FILM
USES BUFFY COAT SMEAR ON PATIENTS WITH EBC COUNT
<1X10^9/L
PERIPHERAL BLOOD FILM
-BLOOD SMEAR USED FOR SCREENING OF BLOOD PARASIRES
THICK SMEARS
PERIPHERAL BLOOD FILM
- STAIN USED FOR BM AND PBS
WRIGHT/ GIEMSA STAIN
PERIPHERAL BLOOD FILM
FIXATIVE: -
METHANOL
PERIPHERAL BLOOD FILM
ACTUAL STAINING DOES NOT OCCUR UNTIL - IS ADDED
BUFFER
PERIPHERAL BLOOD FILM
-: STAINS ACIDIC PARTS OF CELL SUCH AS RNA
METHYLENE BLUE
PERIPHERAL BLOOD FILM
-: STAINS BASIC PART OF CELL
EOSIN
PERIPHERAL BLOOD FILM
OXIDIZE METHYLENE BLUE AND EOSIN
STAINS NEUTRAL COMPONENT
THIZAINE-EOSINATE COMPLEX
PERIPHERAL BLOOD FILM
BUFFER IS ADDED TO STAIN SHOULD BE -M
0.05M SODIUM PHOSPHATE
PERIPHERAL BLOOD FILM
BUFFER ADDED TO STAIN FOR ATLEAST 24 HOURS
AGED DISTILLED WATER
MOST IMPORTANT PART OF STAINING
PH 6.4-6.8
PERIPHERAL BLOOD FILM
PH FOR MALARIAL PARASITES
7.2
WELL STAINED PERIPHERAL BLOOD FILM
MACRO: SHOULD BE (COLOR)
PINK TO PURPLE
WELL STAINED PERIPHERAL BLOOD FILM
MICRO: RBC SHOULD APPEAR
ORANGE-SALMON PINK
WELL STAINED PERIPHERAL BLOOD FILM
MICRO: WBC SHOULD BE
PURPLE TO BLUE
WELL STAINED PERIPHERAL BLOOD FILM
MICRO: CYTOPLASM OF NEUTROPHILS SHOULD BE
PINK TO TAN WITH VIOLET GRANULES
WELL STAINED PERIPHERAL BLOOD FILM
MICRO: EOSINOPHILS SHOULD HAVE - GRANULES
BRIGHT ORANGE
WELL STAINED PERIPHERAL BLOOD FILM
EXCESSIVELY - (COLOR) STAIN
- THICK
- PROLONGED STAINING
- INADEQUATE WASHING
- TOO ALKALINE
BLUE
PERIPHERAL BLOOD FILM
STAINING PROBLEM:
FAILURE TO HOLD THE SLIDE -
HORIZONTALLY
COMPLETE BLOOD COUNT
PERFORMED USING A - OR -
HEMACYTOMETER/ COUNTING CHAMBER
MOST COMMONLY USED HEMACYTOMETER
LEVY WITH NEUBAUER RULING
LEVY WITH NEUBAUER RULING
COMPOSED OF -MMX-MM SQUARE COUNTING AREA SEPARATED BY AN H SHAPED MOAT
3X3MM
TOTAL= 9MM2
LEVY WITH NEUBAUER RULING
TOTAL VOLUMR OF ONE ENTIRE GRID OF HEMACYTOMETER IS
0.9MM3
LEVY WITH NEUBAUER RULING
- EACH SECONDARY SQUARE EXCEPT CENTER
16 SQUARES
LEVY WITH NEUBAUER RULING
CENTER SECONDARY SQUARES -
25 SQUARES
LEVY WITH NEUBAUER RULING
READING OF PLATELETS
CENTER SQUARE
25 SECONDARY SQUARES
LEVY WITH NEUBAUER RULING
READING OF RBC
CENTER SQUARE
ONLY 4 CORNER AND CENTER OF SECONDARY SQUARES
LEVY WITH NEUBAUER RULING
READING OF WBC
4 CORNER SQUARES
16 SECONDARY SQUARES
LEVY WITH NEUBAUER RULING
CORNER SQUARES
16 SECONDARY SQUARES EACH WITH AREA OF -
0.0625 MM2
LEVY WITH NEUBAUER RULING
CENTER SQUARE
25 SECONDARY SQUARES EACH WITH AREA OF -
0.04MM2
HEMACYTOMETER
DEPTH: -
0.1MM
HEMACYTOMETER
DEPTH FACTOR: -
1/10 OR 10
HEMACYTOMETER
DISTANCE BETWEEN THE BOTTOM OF THE COVERSLIP AND SURFACE OF COUNTING AREA
DEPTH FACTOR
DILUTING PIPETTES
COMPOSED OF STEM DIVIDED INTO - EQUAL PARTS WITH BEAD THAT AIDS IN MIXING THE DILUENT
10 EQUAL PARTS
DILUTING PIPETTES
IN CALCULATING DILUTION, ONLY THE VOLUME CONTAINED IN THE - IS CONSIDERED
BULB
DILUTING PIPETTES
RBC PIPETTE: - MARK/ TOTAL UNITS
101 MARK
DILUTING PIPETTES
WBC PIPETTE: - MARK/ TOTAL UNITS
11 MARK
DILUTING PIPETTES
RBC PIPETTE
BULB: - UNIT
100 UNIT
DILUTING PIPETTES
RBC PIPETTE
STEM: - UNIT
1 UNIT
DILUTING PIPETTES
RBC PIPETTE
BLOOD DRAWN ON 0.5 MARK
DILUTION: -
1:200
DILUTING PIPETTES
RBC PIPETTE
BLOOD DRAWN ON 1.0 MARK
DILUTION: -
1:100
DILUTING PIPETTES
RBC PIPETTE
DILUENT IS DRAWN TO THE - MARK
101 MARK
DILUTING PIPETTES
WBC PIPETTE
BLOOD DRAWN ON 0.5 MARK
DILUTION: -
1:20
DILUTING PIPETTES
WBC PIPETTE
BLOOD DRAWN ON 1.0MARK
DILUTION: -
1:10
DILUTING PIPETTES
WBC PIPETTE
DILUENT IS DRAWN TO THE - MARK
11 MARK
DILUTING PIPETTES
WBC PIPETTE
VOLUME OF THE BULB
10
GENERAL FORMULA FOR MANUAL CELL COUNTS
TC= CC X DF/ AREA X 0.1
GENERAL FORMULA FOR MANUAL CELL COUNTS
THE DIFFERENCE BETWEEN THE TOTAL CELLS COUNTED ON EACH SIDE SHOULD BE -
<10%
MANUAL CELL COUNT
CONVENTIONAL UNIT
CELLS/UL
CELLS/MM3
MANUAL CELL COUNT
SI UNIT
CELLS/L
MANUAL CELL COUNT
REPORTING RBC
CONVENTIONAL UNIT
X10^6/MM3
X10^6/UL
MANUAL CELL COUNT
REPORTING WBC/PLPATELETS
CONVENTIONAL UNIT
X10^3/MM3
X10^3/UL
MANUAL CELL COUNT
REPORTING RBC
SI UNIT
X10^12/L
MANUAL CELL COUNT
REPORTING WBC/PLATELETS
SI UNIT
X10^9/L
WBC
DILUTION: 1:20
OBJECTIVE: 10X (LPO)
AREA COUNTED: -
4MM2
WBC
DILUTION: 1:100
OBJECTIVE:10X (LPO)
AREA COUNTED: -
9MM2
RBC
DILUTION: 1:100
OBJECTIVE: 40X (HPO)
AREA COUNTED: -
0.2MM2/ 5 SMALL SQAURES OF CENTER SQUARE
PLATELETS
DILUTION: 1:100
OBJECTIVE: 40X PHASE CONTRAST
AREA COUNTED: -
1MM2
WBC DILUTING FLUIDS
- 1% AMMONIUM OXALATE
- 1% HYDROCHLORIC ACID
- 3% ACETIC ACID
RBC DILUTING FLUID
ISOTONIC SALINE
PLATELETS DILUTING FLUID
1% AMMONIUM OXALATE
MANUAL RBC COUNT ARE RARELY PERFORMED
(2) CONCENTRATIONS ARE MORE DESIRABLE WHEN AUTOMATION IS NOT AVAILABLE
- MICROHEMATOCRIT
- HEMOGLOBIN
NORMAL RBC COUNT
MALE: -/L
4.20-6.00
X10^12/L
NORMAL RBC COUNT
FEMALE: -/L
3.80-5.20
X10^12/L
MANUAL RBC COUNT
AREA OF COUNTING CHAMBER USED: 5 CENTER SQUARES
EACH SQUARE: -
0.04MM
MANUAL RBC COUNT
AREA OF COUNTING CHAMBER USED: 5 CENTER SQUARES
5 SQUARES: -
0.2MM2
MANUAL RBC COUNT
MICROSCOPE OBJECTIVE: -
40X/ HPO
MANUAL RBC COUNT
USUAL DILUTION: -
1:100
MANUAL RBC COUNT
RBC DILUTING FLUIDS SHOULD BE - TO FACILITATE COUNTING AND PREVENT LYSIS OF RBCS
ISOTONIC
MANUAL RBC COUNT
BEST DILUTING FLUID FOR RBC
DACIES/FORMOL CITRATE
MANUAL RBC COUNT
RBC DILUTING FLUIDS (7)
1.DACIES/FORMOL CITRATE
2.3.8% SODIUM CITRATE
3.NSS
4.BETTHELL’S
5.HAYEM’S
6.TOISSON’S
7.GOWER’S
RBC PARAMETERS REPORTING
RBC COUNT
RBCS
X10^12/L
RBC PARAMETERS REPORTING
HGB
g/dL