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Calculate MCV, MCH, MCHC.
Refer to formula chart
Calculate Retic count
Refer to chart
What is Rule of three?
RBC X 3= HGB X 3= HCT +/- 3
Confirmatory testing options for sickle cell disease and trait
Electrophoresis
Sources of errors when performing manual microhematocrit
- Undercentrifugation, EDTA blood tube allowed to sit out overnight at RT, Buffy coat included in reading (increased)
- Decreased blood:anticoagulant ratio (decreased)
Normal Range for reticulocyte count
O.5-1.5%
RBC morphology with Increased Reticulocyte count
Moderate polychromasia and some nRBCs
Increased reticulocyte counts are associated with___
Hemolytic anemias
Decreased reticulocyte count is associated with ___
Aplastic anemia
Number of reticulocyte in a volume of blood (usually either microliter or liter)
Absolute retic count
Calculation used to compensate for the increased maturation time of shift retics or nRBCs in the peripheral blood.
Retic production index (RPI)
Calculation used when the patient has a decreased hematocrit.
Corrected Reticulocyte count
The purpose of the Kleihauer-Betke Stain?
To differentiate HGB A from HGB F
The appearance of fetal hemoglobin and A hemoglobin look like following an acid elution test.
HGB F: Dark Pink
HGB A: Ghost cells
Normal range for Kleihauer-Betke Stain
</= 2%
Diagnostic value of an erythrocyte sedimentation rate.
How far red cells fall in mm per hour
Three stages that occur during the 60 minutes waiting period in ESR.
Rouleaux-10 mins
Rapid fall-40 mins
Packing -10 mins
Normal ESR value for men and women.
Women: 0-20 mm/hr
Male: 0-15 mm/hr
Decreased ESR is due to____
Microcytes, Spherocytes, sickle cells, significantly delayed in testing
Increased ESR is due to ____
Rouleaux, Acute phase reactants (such as certain types of plasma proteins)
ESR is a nonspecific measure of
inflammation and tissue damage
Principle of the screening test of hemoglobing S.
Hemoglobin S is insoluble in a reducing agent, such as sodium dithionite, causing a turbid solution.
Three causes of a false positive sickle cell screening test.
Proteinemia, >18 g/dL HGB, Lipemic plasma, other sickling HGB
Three causes of a false negative sickle cell screening test.
<7 g/dL HGB, Multiple transfusion, testing newborns
Hemoglobin Electrophoresis for sickle cell anemia
S>F (no A)
Hemoglobin Electrophoresis for Sickle cell Trait (AS)
A>S
Probable cause of WBC being 99.9 and H and H in balance.
Leukemia patient
How would you report out a valid CBC result with leukemia patient.
WBCs dilute with saline and Microhemocritic (packed RBCs)
Probable cause of very high MCV, RBC low, H & H not balance.
Cold agglutinin
How would you report out a valid CBC result with cold agglutinin patient?
Look at the smear for clumps, then warm at 37 degree water bath then re try.
Probable cause of high MCHC, H & H not balance.
Lipemic plasma
How would you report out a valid CBC result with Lipemic plasma.
Confirm on microhemocritic- if it is milky then suspect lipemic plasma. and Want do plasma blank to correct hemoglobin
Reason for the WBC correction for the presence of nRBCs.
WBC will be falsely elevated.
Guideline to follow when WBC correction is done.
> 5 nRBCs
Formula for WBC correction.
WBC X100/ nRBCs+100
