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Hemotology/Hemostasis > Practicum > Flashcards

Practicum Flashcards

1
Q

Normal values for WBC

A

5000-10000

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2
Q

Normal values for RBC

A

male: 4.7 - 6.1 million/cm3
female: 4.2 - 5.4

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3
Q

Normal values for Hgb

A

male 14-18 g/dL

female 12-16 g/dL

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4
Q

Normal values for Hct

A

males 42-52%

females 37-47%

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5
Q

Normal values for Platelets

A

150,000-400,000

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6
Q

Normal values for Retics

A

0.5% - 2% (avg 1%)

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7
Q

Normal values for ESR

A

male: 0 - 15 mm/hr
female: 0 - 20

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8
Q

What quick quality control calculation can be used to check the accuracy of the RBC parameters as they are obtained from an automated counter?

A

RBC x 3 = Hgb

Hgb x 3 = Hct

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9
Q

Factors which can increase ESR.

A 
anemia
pregnancy
infections
alcoholism, cirrhosis, hepatitis
MM
Tilted tube
Specimen too warm
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10
Q

Factors which can decrease ESR

A

polycethemia
sickle cell anemia (abnormally shaped RBCs in general)
spherocytosis
delay in performing test

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11
Q

What is the chief use of the osmotic fragility test?

A

Diagnosis of spherocytosis

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12
Q

What test is best to use to differentiate between homozygous and heterozygous sickle cell disease?

A

Hemoglobin electrosphoresis

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13
Q

How are reticulocytes stained? Which dye is best?

A

New methylene blue or cresyl blue are used as reagents to separate RNA in cells. Wright’s (supravital stain) is used to make RNA visible.
Retics seen as Polychromatophilic (“blue-green”)

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14
Q

What is the use of the reticulocyte test to the physician?

A

Helps in diagnosis and monitoring of anemia.

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15
Q

In what conditions would one expect to see an increased reticulocyte count?

A

Hemorrhage, including hidden bleeding or hemolysis
Splenectomy
Various anemias, especially hemolytic anemia

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16
Q

In what conditions would one expect to see an decreased reticulocyte count?

A

Bone marrow suppression (toxins, chemotherapy, radiation, etc.)
Aplastic anemia
Ineffective erythropoiesis (IDA, PA)

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17
Q

What is the proper procedure for a hematocrit?

A

Blood is collected in heparinized (red) capillary tubes. Seal one end. Spin in microhematocrit centrifuge to obtain optimal packed cells. Use Macromethod of Wintrobe or Micromethod (which needs non-heparinzed blue top tube if a venous draw) for Hct determination.

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18
Q

What happens to the value if microhematocrits are spun too long? Not spun long enough?

A

Too long:Hemolysis (falsely decreased Hct) Not long enough: cells will not pack

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19
Q

From the indices, be able to describe red cell morphology or give the morphological classification of the anemia.

A

MCV: indicates RBC size: 100=macrocytic
MCHC: indicates degree of hypochromia:

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20
Q

With what condition are burr cells associated?

A

Renal failure

Kidney disease

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21
Q

In what condition is punctate basophilia (basophilic stippling) frequently seen?

A

Lead poisoning

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22
Q

With what condition are Heinz bodies most closely associated?

A

G6PD deficiency

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23
Q

How are basophilic stippling and reticulum differentiated in the lab?

A

Baso stippling: stained with Romanowski (Wrights) and New Methylene Blue
Reticulum: use New Methylene Blue only

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24
Q

What is the best specimen to use for blood smears for RBC morphology?

A

Whole blood from EDTA tube

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25
Q

How can you adjust the color of Wrights stained smear?

A

Adjust the pH

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26
Q

What is the most prominent feature in a blood smear from a patient with ABO HDN?

A

Spherocytes

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27
Q

How to calculate MCV

A

MCV = Hct divided by # of RBCs times 10

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28
Q

Normal values for MCV?

A

Male: 80 - 94 fL (femtoliters)
Female: 81 - 99

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29
Q

How to calculate MCH

A

MCH = Hgb divided by # of RBCs times 10

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30
Q

Normal values for MCH?

A

Male & Female: 27 - 31 pg (picograms)

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31
Q

How to calculate MCHC

A

MCHC = Hgb divided by Hct times 100

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32
Q

Normal values for MCHC?

A

32% - 36% (or g/dL)

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33
Q

From the indices, be able to suggest a diagnosis of anemia.

A

MCV increased, MCHC normal(Macrocytic/Normochromic) = liver disease, B12 deficiency, folate deficiency, PA, alcoholism
MCV, MCHC decreased (Microcytic/Hypochromic) = IDA, Sideroblastic, Thalassemia, Lead Poisoning
MCV, MCHC normal (Normocytic/Normochromic) = Aplastic anemia, and any other anemia not listed above

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34
Q

What is the appearance of the blood smear in iron deficiency anemia?

A

Microcytic, Hypochromic

also, serum iron decreased, TIBC increased

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35
Q

What is the appearance of the blood smear in folic acid deficiency?

A

Macrocytic, Hypochromic

PA, but no neurological symptoms

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36
Q

What are the causes of aplastic anemia? What are the blood findings?

A

Bone marrow suppression, failure or replacement, usually from chemical or radiation exposure.
Pancytopenia (WBC, RBC, Plt, Retic have low counts)
Normocytic/Normochromic
No signs of increased RBC formation, decreased bone marrow.

37
Q

What is a common characteristic of all hemolytic anemias?

A

Increased RBC destruction

38
Q

What is an unusal finding that is a means of differentiating AIHA from other hemolytic anemias?

A

Positive DAT (Direct Coombs Test)

39
Q

What is pancytopenia?

A

Decreased RBC, WBC and platelets

40
Q

What information is included in a WBC differential?

A
  1. Count & classification of leukocytes
  2. Platelet count
  3. RBC morphology
41
Q

What is the most common WBC in a differential?

A

Segmented Neutrophils

42
Q

What is the most common WBC in children under one year of age?

A

Lymphocytes

43
Q

What is the least common WBC in a normal smear?

A

Basophils

44
Q

What is the largest WBC in a normal smear?

A

Monocyte

45
Q

Which immature RBCs are classified as NRBCs in a differential?

A

Blast cells
Prorubricytes
Rubricytes
Metarubricytes

46
Q

What is the appearance of a plasma cell?

A

Eccentric nucleus with clumped chromatin, basophilic cytoplasm with a clear perinuclear halo (hof).


47
Q

Is a plasma cell likely to be found in the peripheral blood?

A

No.

normally ~1% of nucleated cells in bone marrow

48
Q

What is the meaning of the term “shift to the left”?

A

Increased immature granulocytes (blast, pro, myel, meta, band)

49
Q

What is the meaning of the term “shift to the right”?

A

Increased mature cells (segs & hypersegs)

50
Q

How is a diagnosis of Hereditary Elliptocytosis made?

A

At least 25% of RBCs are elliptical/oval shape in peripheral blood smear, osmotic fragility testing, an autohaemolysis test, and direct protein assaying by gel electrophoresis. [fun fact: it’s normal in camels]

51
Q

What are the distinguishing characteristics of Hodgkin’s disease?

A
  1. Slow relentless progression
  2. Leukemoid rxn w/ eosinophils
  3. Reed-Sternberg cells
52
Q

What are the normal features of a smear from a newborn that might be considered abnormal in an adult?

A

NRBCs
Polychromasia
young WBCs, etc.

53
Q

How would you describe a Downey type atypical lymphocyte as is appears on a Wright’s stained smear?

A

Eccentric nucleus w/ dense chromatin, may have open spaces. Abundant smooth cytoplasm that’s pale near nucleus, various shades of blue toward periphery & scallops around surrounding RBCs with blue tint where it touches RBCs. May have azurphilic granules & vacuoles. Easily confused w/ monocytes.

54
Q

At what stage of development does differentiation of the granules of a granulocyte take place?

A

Myelocyte

55
Q

How is the metamyelocyte differentiated from the myelocyte?

A

Myelo: nucleus round to oval, may have one flat side
Meta: nucleus kidney bean shaped

56
Q

Procedure for performing a total eosinophil count.

A

Must be done so as to count a larger volume, either by using a special counting chamber or by counting both sides of a Neubauer hemocytometer. Whole blood is diluted w/ staining sol’n. Use maximum light on microscope, count entire ruled area on both sides on low power. Calculation: Total # cells times 10 (dilution) divided by 1.8 mm3.

57
Q

With what conditions are an increased eosinophil count associated?

A 
allergic disease
skin disorders
parasitic infections
blood diseases
splenectomy
58
Q

Normal values for CSF cell counts

A

adults: 0 - 5 mononuclear cells/uL, zero RBCs
neonates: 0-30 mononuclears, zero RBCs

59
Q

What test is the best measure of the erythroid activity of the bone marrow?

A

Reticulocyte count

60
Q

What conditions can not be absolutely diagnosed without a bone marrow aspirate?

A 
Myeloproliferative disorders
Aplastic anemia
Lymphoma
Tumors
Leukemia
Pernicious anemia (has megaloblasts in marrow)
61
Q

What is the chief use of the LAP?

A

Differentiate leukemoid reaction (increased) from CML (decreased)

62
Q

Why is it necessary to correct a WBC count if more than 5 NRBCs are present on a peripheral blood smear and how is the correction made (be able to do calculation)?

A

False increase of WBC count.

Calculate: # WBCs times 100 divided by 100 plus the # of NRBCs per 100 WBCs

63
Q

Incidence of leukemia in various age groups.

A

ALL - most common in children
CML - middle age
CLL - older pt.s

64
Q

What is the typical picture in the peripheral blood in acute leukemia?

A

Severe normocytic-normochromic anemia
Decreased RBCs
Thrombocytopenia
Increased immature cells

65
Q

At the time of diagnosis, which leukemia frequently presents with a greatly increased platelet count?

A

CML (Chronic Myelocytic Leukemia)This is a case study

66
Q

AML

(the typical blood picture)

A

Large # myeloblasts (60-90% of cells)
Scattered segs but no intermediate cells (differentiates AML from CML or leukamoid rxn)
Severe N/N anemia
Polychromasia
NRBCs
Thrombocytopenia w/ large or bizarre looking plt.s

67
Q

ALL

(the typical blood picture)

A

> 60% lymphoblasts
Severe N/N anemia, usually no NRBCs
Thrombocytopenia
(this is a case study)

68
Q

CML

the typical blood picture

A 
Increased leukocytosis
 Increased all stages of granulocytes,
 Increased eos, 
 Increased basos, 
 Increased platelets at first, later decreases
 N/N anemia, incl. NRBCs
 Case study)
69
Q

CLL

the typical blood picture

A

60-95% small, mature lymphs
Increased Smudge cells & Eos
All stages granulocytes

70
Q

Hodgkin’s

the typical blood picture

A 
Not terribly abnormal or specific
 Mild anemia
 Thrombocytopenia
 Leukocytosis usually granulocytes, esp. Eos (leukemoid rxn w/ eosinophilia)
 Decreased lymphs
71
Q

Following splenectomy

the typical blood picture

A 
Pappenheimer bodies
 HJB
 Cabot rings
 Target Cells
 Aniso & Poik (tear drop, bite cell, frags)
 Increased platelets
72
Q

Megaloblastic anemia

the typical blood picture

A

Normochromic RBCs, Aniso & Poik
Macro Ovalocytes
Pancytopenia
Hyper segs w/ shift to right

73
Q

Polycythemia vera

the typical blood picture

A 
N/N RBCs but may become Micro/Hypo
 Increased RBCs
 Occasional NRBCs
 Immature grans (myelos & metas)
 Basophilic stippling
 Increase Eos & Basos
 Large, bizarre platelets with possible clumping
74
Q

Myelofibrosis

the typical blood picture

A

Moderate N/N anemia
Polychromasia
NRBCs
Aniso & Poik (tear drop, ovalo, sphero)
WBC normal to increased w/ shift to left
Plts increased at first, later decrease with giant, bizarre forms

75
Q

DIC

the typical blood picture

A 
Thrombocytopenia
 Micro-platelets
 Leukocytosis
 Schistocytes
 Decreased Retics
76
Q

AIHA

A 
N/N anemia
 Macrocytic Polychromasia
 Spherocytes
 NRBCs
 Schistocytes, Ancanthocytes, Burr Cells
 Erythrophagocytosis by monocytes
 WBC increased with shift to left
 (case study)
77
Q

Thalassemia major

A

Severe Microcytic/Hypochromic anemia
Aniso & Poik (target, burr, schisto, sphero, acantho)
Polychromasia
Many NRBCs
RBC inclusions (HJB, baso stippling, etc.)
Increased WBC with shift to left
(case study)

78
Q

Thalassemia minor

A 
Mild microcytic/hypochromic anemia
 Polychromasia
 Target cells
 Occassional NRBCs
 Baso stippling
 WBC usually normal
79
Q

Multiple myeloma

A 
N/N anemia
 Rouleaux
 WBC normal to decreased
 Occasional plasma cells & NRBCs
 Increase lymphs, Eos, & young granulocytes
80
Q

Infectious Mononucleosis

A

Slight luekocytosis
Atypical Lymphs (Downey cells) instead of monos
Rare to few immature lymphs
Plt & RBCs normal

81
Q

How do you do an indirect platelet count (platelet estimate) and how do you report out platelets in reference to your estimate?

A

(at CGH) Count platelets in 5 fields on high power at the feathered edge of smear, multiply by 4.
Report as adequate, increased, or decreased

82
Q

How are PNH and PCH diagnosed in the lab and how do these conditions differ?

A

PCH: extrinsic, D-L antibody, extracorpuscular defect. Diagnose by Donath-Landsteiner Test.
PNH: intrinsic, acquired, sensitive to complement. Diagnosed by Hams’s Test or Sugar Water Test.

83
Q

Which layer of the blood is used for making an L.E. prep?

A

Buffy coat

84
Q

Which group of disorders is classified by using the FAB system of classification?

A

Acute Leukemias

85
Q

What is the use of the Kleihauer-Betke technique or the Fetaldexx stain?

A

Measures the amount of fetal Hgb transferred from the fetal bloodstream to the mother’s bloodstream; used for D neg mothers.

86
Q

Which age group has the highest values for the RBC parameters?

A

newborns

87
Q

What is the Coulter principle for cell counting?

A

Interruption of a light source as it passes through a flow cell (flow cytometry)

88
Q

How would you obtain a blood specimen from a patient who has IV solutions running into both arms?

A

Choose a vein distal from (below) the IV site (such as the hand) or ask nurse to turn off one IV 15 minutes before draw.

Hemotology/Hemostasis (8 decks)

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