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MTLE refresher notes Flashcards

1
Q

Hand-held device that aids in visualization prior to phlebotomy

A

AccuVein

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2
Q

Blood to anticoagulant ratio in black-top tubes

A

4:1

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3
Q

Blood to anticoagulant ratio in light blue-top tubes

A

9:1

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4
Q

Anticoagulant used for trace elements and toxicology determination

A

Sodium heparin

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5
Q

Anticoagulant used for fragility testing and Blood Gas Analysis

A

Heparin

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6
Q

Disadvantage of using Serum Separator Tubes (SSTs)

A

It interferes with (TDM) Therapeutic Drug Monitoring

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7
Q

Clotting time for:
Tubes with activator, with gel separators, and without anticoagulant

A

With gel: 30 mintues
With clot atvator: 5 mins
w/o anticoagulant: 60 mins

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8
Q

arterial puncture order of preference

A
  1. Radial artery 2. Brachial artery 3. Femoral artery
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9
Q

Test prior to radial artery puncture

A

Modified Allen Test

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10
Q

Amount of anticoagulant for arterial puncture

A

0.05 mL of liquid heparin or 1,000 u/mL

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11
Q

Blood Gas Collection for Newborns

A

Indwelling Umbilical Artery Catheter

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12
Q

Order of draw for catheter liines

A
  1. Discard 2-5 mL of blood and discard.
  2. Blood culture
  3. Anticoagulated tubes
  4. Serum tubes
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13
Q

Order of draw for capillary puncture

A
  1. Tubes for blood gas analysis
  2. Smear/Slide Preparation
  3. EDTA
  4. Other anticoagulated tubes
  5. Serum tubes
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14
Q

Order of Draw for Venipuncture

A
  1. Yellow top
  2. Light Blue top
  3. Red top (serum tubes)
  4. Green top
  5. Lavender top
  6. Gray top
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15
Q

Size of the drop of blood in wedge smears

A

2-3 mm

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16
Q

How to make a thin smear

A

Increased pressure
Decrease the (ASS) Angle, Speed, and Size of blood drop

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17
Q

How to make a thick smear

A

Derease the pressure
Increase the (ASS) Angle, Speed, and Size of blood drop

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18
Q

Physiological factors that may lead to pre-analytical variations

A

Position - increase values of large molecules
Diurnal variation- increase (WBCs) eosinophils in the afternoon
Stress - increase WBC count
Smoking - Increase WBC hematocrit, RBC count and hemoglobin
Exercise - increase WBC count
Diet- Affects hemoglobin and coagulation tests

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19
Q

Prolongged tourniquet application results to?

A

hemoconcentration

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20
Q

Light senstitive substances

A

Bilirubin, Vitamin A, Beta-carotene, porphyrins, Iron

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21
Q

Samples to be chilled

A

Ammonia, Gastrin, PTH, Lactic Acid

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22
Q

Blood films from EDTA should be made within how many hours

A

2-3 hours

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23
Q

EDTA-containg tubes

A

Lavender
Pink
Tan
White
Royal Blue

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24
Q

Automated smear-making and staining system (wedge type method)

A

Sysmex SP-10

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25
Q

Automated staining system (dip-batch staining)

A

MIDAS III

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26
Q

Automated staining (propelled towards two rotating plantars)

A

HemaTek

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27
Q

RBCs with blunt or pointed protrusions that are evenly spaced

A

Echinocytes

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28
Q

Macroscopic appearance of a well-stained smear

A

Purple/Pink-colored film

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29
Q

Macroscopic appearance of a stained film obtained from blood samples with INCREASED PROTEIN LEVELS

A

Blue color

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30
Q

Macroscopic appearance of stained film obtained from blood samples with INCREASED LIPIDS

A

Has holes

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31
Q

Macroscoopic appearance of a stained film obtained from blood samples with INCREASED WBC AND PLATELETS

A

Bluish lateral edges

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32
Q

Macroscopic appearance of a stained film obtained from blood samples with RBC aggregates

A

Grainy appearance

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33
Q

Objective used to estimate bone marrow cellularity

A

LPO

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34
Q

Objective used for WBC estimates

A

HPO

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35
Q

May be confused with plasma cells/plasmablast

A

Osteoblast

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36
Q

May be confused with megakaryocyte

A

Osteoclast

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37
Q

Objective used for WBC differential count, platelet estimates, and cell morphology

A

OIO

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38
Q

RBC per OIO field viewed in the correct are of the film

A

200-250 RBCs per OIO field

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39
Q

Number off WBCs to be differentiated when WBC count is >40 x 109/L

A

200-cell differential count

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40
Q

Number of WBCs to be differentiated when WBC count is >100 x 109/L

A

300 or 400-cell diifferenntial count

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41
Q

Number of WBCs to be differentiated when WBC count is <1 x 109/L

A

50-cell differential count

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42
Q

Increased number of bands or cells younger than bands in the PBS

A

Shift to the Left

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43
Q

Is the first immature neutrophil normally found in the peripheral blood

A

Band/Stab/Staff cell

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44
Q

SIte for bone marow syntesis in adults and children more than 2 yrs old

A

Posterior Superior Iliac Crest

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45
Q

Site for bone marrow aspirate collection for children less then 2 years old

A

Tibia

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46
Q

Alternative sites for bone marrow aspirate collection in adults

A

Sternum
spongy bone spicule of vertebrae
Other red marrow containing sites

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47
Q

Bone marrow sample management

A
  1. direct smears
  2. Anticoagulated smears
  3. Crush preparation
  4. Touch print technique
  5. Concentrated bone aspirate
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48
Q

Used for the evaluation of the morphology and distribution of hematopoietic cells (immature)

A

Bone marrow aspirate

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49
Q

Used when patients are suspected of focal lesions

A

Bone marrow core biopsy

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50
Q

Staining technique for bone marrow core biopsy

A

H & E staining

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51
Q

1 ml of bone marrow in heparin is used in

A

Cytology studies & Flow Cytometry Techniques

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52
Q

Most common erythrocytic stages found in the normal marrow

A

Polychromatophilic & Orthochromatophilic normoblasts or erythroblasts

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53
Q

What are the reagents used in Drabkin’s solution

A
  1. Potassium ferricyanide - converts hemoglobin to methemoglobin
  2. Potassium cyanide - converts methemoglobin to cyanmethemoglobin at 540 nm
  3. Sodium carbonate
  4. Surfactant
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54
Q

Used to assess the erythropoietic activity of the bone marrow

A

Reticulocyte count

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55
Q

What is the relationship of ESR to plasma viscosity?

A

Inversely proportional

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56
Q

What is the relationship of ESR to the RBC mass?

A

Directly Proportional

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57
Q

Passage of more than one cell a time through the aperture

A

Coincidence

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58
Q

Measures the pulse generated by the resistance of the cell as it passes through the current within the aperture

A

Electrical impedance

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59
Q

Measures the rate of conductivity

A

Radiofrequency

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60
Q

The principle in flow cytometers

A

Optical scatter & Immunofluorescence

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61
Q

Principle of Optical scatter

A

Uses laser beam to differentiate between different blood cell types

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62
Q

Principle of Immunofluorescence

A

Uses immunophenotyping
Uses fluorescent-labeled monoclonal antibodies

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63
Q

Combination of forward-low and forward-high scatter. A principle employed by Siemens system

A

Differential scatter

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64
Q

Represents excess signals at the lower threshold region of the WBC histogram

A

R1

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65
Q

Coulter’s technology of five-part WBC differential

A

VCS technology

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66
Q

MAPSS technology and three-color fluorescence

A

Abbott Celldyne Sapphire

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67
Q

Peroxidase-staining absorbance and light scatter

A

Siemens Advia

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68
Q

Detection of forward and side scattered light and fluorescence

A

Sysmex XN-1000

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69
Q

RBC in TAILS
(Thalassemia, Anemia of Chronic Disease, Iron deficiency anemia, Lead Poisoning, and Sicke Cell disease)

A

Microcytic

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70
Q

RBC in Vit. B12 deficiency, folate deficiency, and pernicious anemia, Steatorrhea, sprue, D. latum infection

A

Macrocytic

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71
Q

Test involving the formation of Holly Leaf appearance

A

Sodium Metabisulfate

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72
Q

Screening test for hemoglobin S solubility

A

Sodium dithionate

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73
Q

Forward light scatter measures

A

cell volume

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74
Q

Side-angle scatter measures

A

internal complexity

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75
Q

Falsely high ESR

A

Heat from the back of refrigerator
Vibrations from opening and closing the refrigerator

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76
Q

Falsely low ESR

A

Cool air from refrigerator

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77
Q

Decreased ESR is caused by the what

A

Poikilocytes
Thalassemia
Over-anticoagulation
Bubbles
Delayed reading

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78
Q

Increased ESR is caused by what

A

Multiple myeloma
Waldenstrom’s macroglobulinemia
Anemia
Bacterial infection
Carcinoma
Pregnancy
Menstruation
High room temperatures
Tilting

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79
Q

A fluid used for the determination of eosinophil count

A

Pilot’s fluid

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80
Q

Three components of the Pilot’s fluid

A
  1. Phloxine B - stains eosinophil bright red
  2. Propylene glycol - lyses RBCs
  3. Heparin - prevents leukocyte aggregation
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81
Q

Diluting fluids for WBC count

A

Turk’s and HCl

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82
Q

The most commonly used RBC count diluting fluid

A

Formol citrate

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83
Q

Color of Wright-stained red cells may be adjusted by?

A

Adjusting the buffer

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84
Q

Causes of excessively pink smears

A

Thin smears
Acidic buffer
Prolonged washing
Insufficient staining time
Old fixative

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85
Q

Causes of excessively blue smears

A

Think smears
prolonged staining
Insufficient washing
Alkaline buffer
Heparinized sample

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86
Q

Characterized by increased Osmotic Fragility Testing

A

Shperocytes

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87
Q

Characterized by decreases OFT

A

Target cells

88
Q

Test for the identification of Factor XIII deficiency

A

Ducker’s test

89
Q

Type of lymphocyte seen in Infectious Mononucleosis

A

Type II Reactive Lymphocyte/IM Lymphocyte

90
Q

What cells are infected by the causative agent of IM

91
Q

A reactive lymphocyte also known as “Turk’s Irritation Lymphocyte”

92
Q

The causative agent of Infectious Mononucleosis

A

Epstein-Barr Virus

93
Q

Mode of transmission of EBV

A

Kissing
Blood transfusion
Organ transplant
sexual contact

94
Q

Which cells are infected by EBV

A

CD21/B cells

95
Q

A congenital form of Red Cell Aplasia

A

Diamond-Blackfan Anemia

96
Q

A congenital form of Aplastic Anemia

A

Fanconi Syndrome

97
Q

The classic drug associated with bone marrow aplasia

A

Chloramphenicol - an antibacterial drug

98
Q

An inherited form of Aplastic Anemia

A

Fanconi syndrome and Idiopathic Aplastic anemia

99
Q

Acquired Aplastic Anemia is caused by what

A

Chronic exposure to certain drugs and chemicals,
Chronic exposure to radiation,
Abnormal Immune Mechanisms,
Miscellaneous (PNH, Non-A, Non-B hepatitis)

100
Q

Drugs Associated with Aplastic Anemia

A

Anti-bacterial= Chloramphenicol & sulfonamides
Anti-inflammatory = Phenylbutazone, Oxyphenobutazone, Gold salts, Indomethacin
Anti-convulsants = Phenytoin, methoin
diuretics = Chlorothiazide
Anti-thyroid = Propyl/Methylthiouracil, Carbimazole, Thiocyanate, Potassium perchlorate
Oral hypoglycemic = Chlorpropamide
Anti-malarial = Amodaquine, Chloroquine, mepacrine

101
Q

Diagnostic Criteria for Aplastic Anemia

A

Bone marrow cellularity
WBC count <500/uL
Plt count <20,000/uL
Anemia with <1% reticulocytes

102
Q

A blood and bone marrow cancer characterized by pancytopenia with an unknown cause

A

Acute Lymphoblastic Leukemia (ALL)

103
Q

Common childhood ALL

104
Q

Common adulthood ALL

105
Q

Burkitt type leukemia

106
Q

An antigen present on the leukemic cells of 70% of ALL patients

A

CALLA (Common Acute Lymphoblastic Leukemia)

107
Q

ALL Cytochemical stain rxn

A

MPO & SBB (-)
ACP (+)
NSE - (+)
TdT- Terminal deoxyribonucleotide transferase(+)

108
Q

Presence of TdT and HLA-DR only

A

uALL (uncategorized ALL)

109
Q

Presence of CALLA, TdT, and HLA-DR

A

cALL (common ALL)

110
Q

Has a T cell antigen but lacks sheep erythrocyte receptor (CD2)

111
Q

Has cytoplasmic immunoglobulin but no surface immunoglobulins (no IgG & IgM)

112
Q

Presence of T antigens and sheep erythrocyte receptor

113
Q

Presence of B antigens and surface immunoglobulins

114
Q

A rare type of leukemia characterized by splenomegaly and mononuclear cells with hair-like or ruffled projections

A

Hairy Cell leukemia

115
Q

Which enzyme is positive in Hairy cell leukemia

A

Tartrate Resistant Alkaline Phosphatase

116
Q

Most common malignant disease of plasma cells

A

Multiple Myeloma

117
Q

Have the same characteristics as multiple myeloma but is not a malignant condition

A

Benign Monoclonal Gammopathy

118
Q

Russell bodies accumulation exhibits what

A

Grape cell/Mott celllMorula cell

119
Q

What are the cellular inclusions in Multiple Myeloma

A

Dutcher Intranuclear bodies

120
Q

A type of cell that exhibits blue color and mottled appearance

A

Plasmablast

121
Q

Crew-cut appearance on skull X-ray is found in

A

Beta-Thalassemia major

122
Q

is a structural variant and rare type of δbeta-thalassemia caused by a fusion of δbeta-globin genes

A

Hemoglobin Lepore

123
Q

The first type of cell in a developing embryo

124
Q

The most abundant hemoglobin in newborn

125
Q

The most abundant hemoglobin in adults

126
Q

first identifiable RBC stage under the light microscope

A

rubriblast

127
Q

Last stage of mitosis of RBC presursor

128
Q

Last nucleated stage in RBC precursor

A

Metarubricyte

129
Q

Last stage capable of hemoglobin synthesis in RBC precursor

A

Reticulocyte

130
Q

Last erythropoietic stage with a nucleus present
Most common nucleated RBC that interferes with RBC counting

A

metarubricyte

131
Q

Last erythropoietic stage where mitosis occurs
Hemoglobin component of RBCs are first detected

132
Q

Pica is commonly associated with?

133
Q

Release by the liver in response to high iron levels
Neutralizes ferroportin

134
Q

Aplastic anemia is characterized by ?

A

Normocytic, normochromic anemia

135
Q

Other conditions assoc with normocytic, normochromic anemia

A

Hemolytic anemia
Aplastic anemia
Anemia of chronic blood loss
Myelophthisic anemia
Stem cell related anemia

136
Q

Abnormal cell seen in uremia

137
Q

an enzyme that converts phosphoenolpyruvate to pyruvate generating two molecules of adenosine triphosphate; essential for aerobic anaerobic glycolysis

A

Pyruvate kinase

138
Q

dark blue granules and filaments in cytoplasm (seen in reticulocytes)

A

Diffuse basophilia

139
Q

Dark blue-purple, fine or coarse punctuate granules distributed throughout the cytoplasm

A

Basophilic stippling

140
Q

Dark blue-purple dense, round granule; usually one per cell; occasionally multiple

A

Howell-Jolly bodies

141
Q

Round, dark blue-purple granule attached to inner RBC membrane

A

Heinz bodies

142
Q

Irregular clusters of small, light to dark blue granules, often near periphery of the cell

A

Pappenheimer bodies

143
Q

Rings of figure-eights

A

Cabot rings

144
Q

Fine, evenly dispersed, dark blue granules; imparts “golf ball” appearance to RBCs

145
Q

Associated conditions with Howell-Jolly bodies

A

Hyposplenism
Postsplenectomy
Megaloblastic anemia
Hemolytic anemia
Thalassemia
Myelodysplastic syndromes

146
Q

Associated conditions with Heinz bodies

A

G6PD deficiency
Unstable Hemoglobins
Oxidant drugs/chemicals

147
Q

Associated conditions with Basophilic stippling

A

Lead poisoning
Thalassemias
Hemoglobinopathies
Megaloblastic anemia
Myelodysplastic syndrome

148
Q

Associated conditions with Pappenheimer bodies

A

Sideroblastic anemia
Hemoglobinopathies
Thalassemias
Megaloblastic anemia
Myelodysplastic syndromes
Hyposplenism
Postsplenectomy

149
Q

aka Pentose Phosphate shunt

A

Hexose Monophosphate Shunt

150
Q

Pathway that converts ferric iron to reduced ferrous iron

A

EMB pathway

151
Q

Nucleus is elongated, curved or sausage-shaped with rounded ends and areas of dense clumping at each pole

A

band cell/stab cell/ staff cell

152
Q

Stool containing dark red or black color

153
Q

Stool containing fresh blood

A

Hemotochezia

154
Q

Blood leakage into the joint cavity

A

Hemarthrosis

155
Q

Expectoration of blood

A

Hemoptysis

156
Q

Vomiting of blood

A

Hematemesis

157
Q

Excessive menstrual bleeding

A

Mennorhagia

158
Q

Uterine bleeding not related to menstruation

A

Metrorrhagia

159
Q

Platelet Distribution Width (PDW) & Mean Platelet Volume is derived from where

A

Platelet Histogram

160
Q

RDW & MCV are derived from where

A

RBC histogram

161
Q

The first factor affected by Coumarin therapy

A

Factor VII

162
Q

Coagulation factor deficiency that is commonly found in Ashkenazi Jews

163
Q

What is the effect of microcytosis in PLT count using automated counters?

A

Falsely elevated PLT count

164
Q

Most common problem in cell counting causing an increase in current

A

Positive error

165
Q

What causes Negative error?

166
Q

Hemoglobin that is insoluble under lowered oxygen tension

167
Q

Oxygen saturation which causes sickling in homozygotes

168
Q

Hemoglobin that is resistant to alkali denaturation

169
Q

Conditions associated with increased HbF

A

Infancy
Hemoglobinopathies
Doubly heterozygous conditions
Thalassemia
Aplastic anemia
Leukemia
Pregnancy

170
Q

What is the principle of Alkali Denaturation Test

A

Principle: Hemoglobin is denatured once exposed to an alkali environment
Hb F resists denaturation

171
Q

Hereditary hypersegmentation of PMNs

A

Undritz Anomaly

172
Q

Functional iron

A

Hemoglobin - blood
Myoglobin - muscles
Peroxidase, catalase, cytochromes, riboflavin enzymes in all cells

173
Q

Storage form of iron

A

Ferritin - macrophages
Hemosiderin - hepatocytes

174
Q

Transport iron

A

Transferrin

175
Q

Length of Wintrobe tube

176
Q

Length of Westergren tube

177
Q

Graduation lines of Wintrobe and Westergren

A

Wintrobe = 100
Westergren = 200

178
Q

Zetafuge and special capillary tubes are used for?

A

Zeta Sedimentation Rate

179
Q

What is M4 called

A

Naegeli Monocytic Leukemia

180
Q

What is the FAB and WHO classification of Schilling’s Leukemia

A

FAB: Cute Monocytic Leukemia
WHO: t9:11

181
Q

M6
FAB classification: Erythroblastic Leukemia

A

DiGuglielmo’s Syndrome

182
Q

Poikilocyte in McLeod phenotype

A

Acanthocytes

183
Q

Infectious crisis is the common cause of death in ——

A

Sickle Cell Disease

184
Q

A rare disease characterized by impaired oxidative metabolism caused by decreased ability of neutrophils to undergo a respiratory burst after phagocytosis of foreign organisms.

A

Chronic Granulomatous Disease

185
Q

What tests are performed to diagnose CGD/

A

(1) Nitroblue tetrazolium test
(2) Chemiluminescence test

186
Q

A test that detects Prekallikrein

A

Activated Partial Thromboplastin time (aPTT)

187
Q

Hemoglobin that is bound carbon monoxide, which prevents normal oxygen exchange.

A

carboxyhemoglobin

188
Q

Irreversible hemoglobin variant

A

Sulfhemoglobin

189
Q

Abnormal form of hemoglobin in which the ferrous ion is oxidized to the ferric state; cannot carry oxygen.

A

Methemoglobin

190
Q

RBC inclusion: clamshell or bar of gold appearance
Hexagonal crystals with blunt ends that stains deeply
Found within RBC membrane

A

Hb CC crystal

191
Q

RBC inclusion: Washington monument appearnace

A

Hb-SC crystal

192
Q

What is the FAB Classification of M3

A

Acute Promyelocytic Leukemia

193
Q

Most fragile blood cell associated with Chronic Lymphocytic Leukemia

A

Smudge cells/Basket cell

194
Q

A taste of primary platelet function

A

Bleeding time

195
Q

What is the normal range for platelet

A

200,000 - 400,000/uL

196
Q

Platelet aggregometer measures_____?

A

Change in light transmission

197
Q

Platelet factor 3 is associated to the activated platelet’s____?

A

Phospholipid

198
Q

Stimulates aggregation

A

Platelet factor 4

199
Q

Estimated platelets per OIO field

200
Q

The outermost zone of platelets
Consists of glycoproteins and surface receptors for coagulation factors
Contains pores for communication between the intracellular and extracellular compartments of PLTs

A

Glycocalyx

201
Q

Glycoprotein that binds with vWF

A

Glycoprotein Ib

202
Q

Binds with fibrinogen

A

Glycoprotein IIb-IIIa

203
Q

Binds with thrombin

A

Glycoprotein V

204
Q

Site of prostaglandin and arachidonic acid synthesis

A

Dense Tubular System

205
Q

Inhibits platelet activation by increasing cAMP levels

A

Prostacyclin (PGI2)

206
Q

Its deficiency results to a normal platelet aggregation with decreased platelet adhesion

A

12-HETE (hydroxyeicosatetraenoic acid)

207
Q

An endothelia cell derived chemorepellent which inhibits platelet adhesion

A

13-HODE (hydroxyoctadecadienoic acid)

208
Q

Converts plasminogen to plasmin

209
Q

Binds and inactivates thrombin
enhances protein C action

A

Thrombomodulin

210
Q

Weakly enhances anti-thrombin III activity

A

Heparan Sulfate

211
Q

A substance that stimulates vasodilation

212
Q

A disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13.
Regulates the size of circulating von Willebrand factor by cleaving ultralong VWF multimers into shorter segments that have less hemostatic potential

213
Q

Recommended for detecting intrinsic and common factor deficiencies and monitoring heparin therapy

214
Q

Normal value of aPTT

A

20-45 seconds

215
Q

Used to rule out heparin as the cause of increased thrombin clotting time (TCT). Reverses the effects of heparin.

A

Protamine Sulfate

Hematology (5 decks)

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