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MLS 1114 Hematology > UNIT 1 > Flashcards

UNIT 1 Flashcards

Manual Hematology Methods Microhematocrit ESR Slide Making and Staining Manual Differential Hemocytometer Cell Counts Understand the WBC Scatterplot Instrumentation Flags Correct WBC Count

1
Q

Hematology

A

Study of cellular components of blood

  • Cell identification
  • Blood forming organs: BM, liver
  • Blood related disorders
  • Heme lab tests
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2
Q

Hemostasis

A

aka Coagulation System

A study of the mechanisms that the body employs to ensure balance & order in the circulatory system.

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3
Q

Hematocrit

A

Percentage of packed RBCs in a given volume of centrifuged blood.

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4
Q

Manual Differential

A

Count the first 100 WBCs seen on the slide & report the # of each types using 100x with oil.

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5
Q

Buffy Coat

A

Makes up < 1%

Made up of WBC & Platelets

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6
Q

EDTA

A

A Ca2+ chelating agent that is used as an anticoagulant

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7
Q

Na+ Citrate 3.2%

A

Blue tube that chelates Ca2+
Must fill tube 9:1 ratio.
Ideal for platelet clumper patients

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8
Q

Rouleaux

A

Penny stacking of RBCs

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9
Q

Zeta Potential

A

A negative charge that causes red cells to repel each other. (Aggregation inhibited by the electrical charge on RBCs).
Decreases when inflammatory proteins are increased.

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10
Q

Microhematocrit

A

Quick screening for Anemia, uses small volume of blood & spun at high speed.

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11
Q

Falsely Increased Microhematocrit

A

Excessive Trapped Plasma
Centrifuge Speed Too Low
Not Centrifuging Long Enough
Poikilocytosis

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12
Q

Poikilocytosis

A

Variation of RBCs shape. Thus, RBCs are stacked higher than normal, causing a falsely increased microhematocrit.

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13
Q

Falsely Decreased Microhematocrit

A 
Tissue Fluids
Severe Edema
Milking Fingerstick
Hemolysis
Excessive Anticoagulants
Improper Clay Seal
Cells Lost During Centrifugation
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14
Q

Microhematocrit Procedure

A

Fill 2 capillary tubes 3/4 way full with EDTA or from a finger stick.
Seal 1 end with clay
Put in centrifuge with open end toward the center
Results must be within +/-1% of each other
Report Avg as percent of packed RBCs compared to blood volume

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15
Q

ESR

A

Measurement of rate that RBCs sediment in the period of 1 Hr.

A NON-SPECIFIC test for inflammatory processes.

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16
Q

Aggregation Phase

A

1 of 3 Phases of ESR.

RBCs come together & form a rouleaux

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17
Q

Sedimentation Phase

A

2 of 3 Phases of ESR.

Aggregates fall out of solution

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18
Q

Packing Phase

A

3 of 3 Phases of ESR.

Aggregates pack together

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19
Q

ESR Procedure

A
  1. Slowly push pipette through the top of the well.
  2. Fill pipette to or beyond 0 mark at the top
  3. Make sure there’s no air bubbles
  4. Place onto rack & let it sit undisturbed for 1 Hr
  5. Record mm’s of sedimentation.
    DO NOT include Buffy Coat!
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20
Q

What causes elevated ESR?

A

Too Warm of Room Temperature
Tilted Tube
Agitation

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21
Q

ESR Red Range (male >50)

A

0-20 mm/Hr

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22
Q

ESR Ref Range (women <50)

A

0-20 mm/Hr

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23
Q

ESR Ref Range (child)

A

0-10 mm/Hr

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24
Q

ESR Ref Range (male <50)

A

0-15 mm/Hr

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25
Q

ESR Ref Range (woman >50)

A

0-30 mm/Hr

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26
Q

Characteristics of a well-made smear

A

No lines and holes
Thick & thin areas with gradual transition
Feathered Edge with Rainbow effect

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27
Q

What are the components of the Wright Stain?

A

For Peripheral Smear & Bone Marrow Films, they contain Eosin (Red) & Methylene (Blue)

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28
Q

What is the formula for the Platelet Estimate?

A

Average x 15 = PLT Count/uL

or

Average x 15,000 = PLT Count/uL

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29
Q

What is the formula for WBC Estimate?

A

Average x 2 = WBC Count/uL

or

Average x 2000 = WBC Count/uL

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30
Q

Proper peripheral smear technique examination

A

Scan on 10x, look for unusual distribution of cells
Look for platelet clumps in feathered edge (Redraw if you see any clumps - Blue tube and multiply by 1.1)
Go to 40x, find a “good area” where 1/2 RBCs are overlapping
Do manual WBC estimate if necessary
Go to 100x with oil & perform- Manual WBC Diff, RBC morphology eval, PLT estimation (abnormally shaped)

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31
Q

Battlement Pattern

A

Used to scan for cells during a differential. Following this pattern helps to ensure that we do not count the same cell more than once

Start from the feathered edge

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32
Q

Where are the lymphocytes in the Battlement Pattern?

A

Center

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33
Q

Where are the Neutrophils in the Battlent Pattern?

A

Near the Edge

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34
Q

Which WBCs are granulocytes?

A

N, E, B
Neutrophil
Eosibophil
Basophil

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35
Q

Which WBCs are NON-Granulocytes?

A

Lymphocyte

Monocyte

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36
Q

Characteristics of basophil

A

Segmented nucleus, abundant dark blue or purple granules

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37
Q

Characteristics of neutrophil

A

Polymorphonuclear and Seg, 2-5 Lobes

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38
Q

Characteristics of lymphocyte

A

Round/Oval shaped nucleus
Nucleus size of RBC.
N:C - Nucleus ratio > Cytoplasm

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39
Q

Characteristics of monocyte

A

Nucleus larger than RBC
Butt/kidney shaped nucleus
Lots of Vacuoles, Pseudopods

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40
Q

Hemocytometer Formula

A

(# Cells Counted)(Dilution Factor) / (# Sq Counted)(Sq Volume) = cells/mm3

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41
Q

What is the square volume of WBC?

Hint: Hemocytometer Cell Count

A

0.1 mm^3

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42
Q

What is the square volume of RBC?

Hint: Hemocytometer Cell Count

A

0.004 mm^3

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43
Q

LEVEY-JENNINGS CHART

A

A graph used to plot and visualize the results of control over time.

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44
Q

What is a “Shift” in Levey-Jennings Chart?

A

A sudden change in values that remain consistent

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45
Q

Which is the correct match of each component of VCS technology with what the WBCs are hit with?

A. Conductivity - Laser Beam, Nuclear Lobularity
Volume - Alternating Current, Measures Nucleus Volume
Light Scatter - Direct Current

B. Volume - Direct Current
Conductivity - Alternating Current, Measures Nucleus Volume
Light Scatter - Laser Beam, Nuclear Lobularity

C. Conductivity - Direct Current
Volume - Laser Beam, Nuclear Lobularity
Light Scatter - Alternating Current, Measures Nucleus Volume

A

B
Volume - Direct Current

Conductivity - Alternating Current, Measures nucleus volume

Light Scatter - Laser Beam, Nuclear Lobularity

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46
Q

What is VCS? What does it stand for?

A

Volume
Conductivity
Light Scatter

It allows the instrument to analyze WBC immediately (That’s a basophil! Thats a neutrophil!) & can be accurately identified. WBCs pass single filed through aperture & hit by (electrical currents, laser beam, radio waves)

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47
Q

Delta Check

A

Automatic check performed by LIS to notify tech of significant difference btwn recent test results

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48
Q

What should you do if the LIS notifies you of a Delta Check?

A

Check sample quality (clots, vole etc)
Check if patient had a tranfusion, surgery, etc
Make sure tube is properly labeled

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49
Q

What is QC?

A

Ensuring test work is done properly

  • Controls frequently ran
  • Controls have defined value
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50
Q

What is QA?

A

Making sure final results we report are correct (right test on right sample, right result reported on right pt)

  • Maintenance
  • Validation & Calibration of Instrument
  • SOP
  • Quality Control
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51
Q

How is Hemoglobin measured?

A

Hgb is directly measured using Cyanmethemoglobin test methodology

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52
Q

The _______ is an analyzer’s method of measure RBCs, which impede the _______ because they are ______ conductors.

A

Coulter Principle,
Direct current,
Poor

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53
Q

A Hgb molecule is tetrameric (4 Globin molecules placed in a quaternary structure). True or False?

A

True

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54
Q

Where is the iron ion found?

A

In the Fe2+ Ferrous state

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55
Q

Cyanmethemoglobin Method

A

Considered a Gold Standard.

Methemoglobin combines with residual cyanide ions to form cyanmethgb.

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56
Q

Hemoglobin

A

A molecule inside RBC that carries O2 & CO2

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57
Q

Where is oxyhemoglobin found?

A

In the ferric (Fe3+) state

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58
Q

MCV is directly measured. True or False?

A

False

MCV is directly measured

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59
Q

MCH, MCHC is Calculated Results. True or False?

A

True

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60
Q

What is the Ferric State of Hgb Formation?

A

Fe3+

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61
Q

What is the Reduced State of Hgb Formation?

A

Fe2+

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62
Q

An adult patient’s CBC shows a WBC count of 12.4x10^3 and a relative monocyte count of 8%. What is the absolute monocyte count?
What does it show?

A

0.9 Absolute Monocytosis

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63
Q

An adult patient’s CBC result shows a WBC count of 15.7x10^3 and the automated diff shows 30% Neutrophils. To describe this patient’s result, you would say this patient has ______ and ______.

A

Absolute Leukocytosis and Relative Neutropenia

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64
Q

You walk into a lab where a tech is performing an ESR. Upon closer examination, you realize the testing is being performed directly adjacent to a centrifuge. You tell the tech this may cause a _____ test result.

A. Falsely Decreased
B. Falsely Increased
C. Normal
D. None of the above

A

B. Falsely Increased

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65
Q

Select what criteria from a CBC printout would lead you to believe a patient has a Cold Agglutinin.

A. High MCHC (>36)
B. Polymodal Peak in RBC histogram
C. Low MCHC (<36)
D. R flag on RDW
E. High Hemoglobin
A

A. High MCHC (>36)
B. Polymodal Peak in RBC histogram
D. R flag on RDW

66
Q

What does the conductivity component of VCS technology measure?

A

Volume of the Nucleus

67
Q

++++++

A

Result exceeds instrument linearity

68
Q

A CBC gives you a +++++ flag saying the result exceed the instrument linearity. What should you do?

A

Make a dilution and rerun

69
Q

Why does this flag occur?

A

“Total Voteout”

Cell counts occur in triplicate. Voteout occurs when 2 of the 3 counts disagree.

Caused by: Dirty apertures, Clotted spec, Not enough spec

70
Q

You are asked to perform an estimated WBC count. After counting 10 fields, the average number of WBCs seen per field is 3. What is the estimated WBC count (in WBC countx10^3/uL)?

A

Average x 2000 = WBC Count/uL

3 x 2000 = 6000 or 6.0 x 10^3/uL

71
Q

What is the Rule of 3?

A

Helps identify testing abnormalities.

Results follow rules of 3 when RBCs completely normal.
RBC x 3 = Hgb +/-3
Hgb x 3 = Hct +/-3

72
Q

According to the rule of 3, if a patient’s hemoglobin is 15.0g/dL, what range should their hematocrit fall in?

A

15 x 3 = 45

So +/- 3 is 42~48.

73
Q

A patient’s MCH is 40pg. You look at their cells under the microscope and would report them as hyperchromic. True or False?

A

False! RBC cannot hold more Hgb than its size allows.

Low value indicate hypochromic. But there is NO such thing as hyperchromic.

74
Q

Which of the RBC indices is directly measured?

A

MCV (Mean Corpuscular Volume)

75
Q

You perform a manual differential on an infant. The CBC gave you a WBC count of 41.0 x10^3. When performing the differential, you counted 212 nRBC among 100 WBCs. What is the corrected WBC count?

A

(Uncorrected WBC count)(100)/(# of nRBCs + 100) = Corrected WBC Count

Answer: 13.1

76
Q

The analyzer does not measure hematocrit. True or False?

A

True. The MLS directly measure the Hct.

77
Q

Neutrophil Reference Range

A

Absolute Count - 1.8 ~ 7.0x10^3/uL

Relative % - 40-80%

“In New England, the most start working at 18 and hope to retire at 70. But most find their second careers at 40 and retire at 80 instead”

78
Q

Lymphocyte Reference Range

A

Absolute Count - 1.0 ~ 4.8x10^3/uL

Relative % - 25~35%

79
Q

Monocyte Reference Range

A

Absolute Count 0.1~0.8x10^3/uL

Relative % - 2~10%

“MOnsters, change legal drinking at from 18 to 21.

80
Q

Eosinophil Reference Range

A

Absolute Count - 0.0 ~ 0.4x10^3/uL

Relative % - 0~5%

“Oklahoma area code 4-oh-5”

81
Q

Basophil Reference Range

A

Absolute Count - 0.0~0.2x10^3/uL

Relative % - 0~1%

82
Q

Bands Reference Range

A

Absolute Count - 0.0~0.7x10^3/uL

Relative % - 0~5%

“James BAnd agent triple-O-7 only had at most 0-5% luck with the ladies”

83
Q

If the WBC Count is high, this is called?

A

Absolute Leukocytosis

84
Q

If the Absolute Monocyte count is high, this is called?

A

Absolute Monocytosis

85
Q

If the Relative Monocyte Count is high, this is called?

A

Relative Monocytosis

86
Q

You are asked to perform an estimated PLT count. You count 10 fields, and on average see 25 platelets per field. What is the estimated platelet count?

A

Average x 15 = PLT Count

25 x 15 = 375 x 10^3/uL

87
Q

If the hematocrit is out of range, what are the possible causes?

A

Trapped Plasma
Hemolysis
Lipemia
Cold Agglutinin

88
Q

MCV NORMAL RANGE

A

80~100fL

89
Q

MCV Formula

A

(Hct/RBC) x 10 = MCV

90
Q

What is MCH (Mean Corpuscular Hgb)?

A

A CALCULATION showing the average amount or weight of hemoglobin in each RBC.

91
Q

What is the unit for MCH?

A

pg (picogram)

92
Q

MCH NORMAL RANGE

A

23~34 pg

93
Q

A ____ MCH would be accompanied by an ____ MCV.

A. High, Increased
B. Low, Decreased
C. High, Decreased
D. Low, Increased

A

A. High, Increased

94
Q

MCH FORMULA

A

(Hgb/RBC) x10 = MCH

95
Q

What would the RBC look like if the MCH was low?

A

Hypochromic. There would be increased central pallor

96
Q

What is MCHC (Mean Corpuscular Hgb Concentration)?

A

A CALCULATION showing the concentration of Hgb in each RBC

97
Q

MCHC NORMAL RANGE

A

32~36 g/dL

Sometimes reported as %

98
Q

MCHC FORMULA

A

(Hgb/Hct) x 100 = MCHC

or

(MCH/MCV) x 100 = MCHC

99
Q

Which specimen criteria increases or decreases with its effect on the MCHC?

Hemolyzed Sample - ? 
Old Sample - ? 
Extreme Leukocytosis - ?
Lipemic Sample - ? 
Clotted Sample - ?
Cold Agglutinin - ?
A 
Hemolyzed Sample - Increased
Old Sample - Decreased
Extreme Leukocytosis - Decreased
Lipemic Sample - Increased
Clotted Sample - Increased
Cold Agglutinin - Increased
100
Q

What is RBC Agglutination?

A

Caused by cold agglutinin, an antibody that makes RBCs stick together.

101
Q

What should you do if you see some agglutination in patient’s specimen?

A

Incubate the sample at 37 degree Celsius for 15 mins

102
Q

What is the measurement of anisocytosis called?

A

RDW (Red Cell Distribution Width)

103
Q

What is Anisocytosis?

A

Variation in size of RBCs

104
Q

What is the unit of measure for MCV?

A

fL (femtoliters)

105
Q

If RDW is what tells us the variation in the size of the RBCs, then what does MCV give?

A

MCV only gives the AVERAGE SIZE

106
Q

RDW NORMAL RANGE

A
  1. 0~14.6%

* The actual result is a statistical value known as a Coefficient of Variation (CV)*

107
Q

What does a normal RBC histogram look like?

A

Unimodal, one-peak and follows a Gaussian ( bell shaped) curve

108
Q

What does a unimodal abnormal RDW look like?

What does it indicate?

A

Wider, it indicates Anisocytosis

109
Q

When would you see a polymodal histogram in a person?

A

Polymodal histogram indicates multiple distinct cell sizes. It is seen in someone who has received a tranfusion

110
Q

R-Flag (Review Flag)

A

Indicates a potentially erroneous result

111
Q 
Which of the following causes a R Flag? 
A. RBC Agglutination or fragmentation
B. Miscounted PLT as RBCs
C. Transfusion
D. All of the above
E. A and C
A

D - All of the above

112
Q

How are RBCs read as they are moved through the aperture? What technology is this called?

A

The Coulter Principle

113
Q

WBC NORMAL RANGE (ADULT)

A

4.5~11.0 x 10^3/uL

114
Q

WBC NORMAL RANGE (NEWBORN)

A
  1. 0~30.0 x 10^3/uL

* Higher for newborn to fight the infections b/c their acquired immune system has not been developed like adults.*

115
Q

WBC CRITICAL VALUE

A

Critically High > 50.0 x 10^3/uL

Critically Low < 1.5 x 10^3/uL

116
Q

What is an ABSOLUTE COUNT?

A

The actual number of a certain type of cell

117
Q

RELATIVE (%)

A

The percentage of a certain type of cell as compared to the total

118
Q

What does -cytosis and -philia suffixes indicate?

A

An elevated value

Leukocytosis
Monocytosis
Neutrophilia
Lymphocytosis
Basophilia
119
Q

An adult CBC shows the following results…

WBC: 30.9 x 10^3/uL
Monocyte: 4.2 x 10^3/uL

What is the Relative Monocyte Count?

A

(Absolute Count)(100) / (Total WBC Count) = Relative Count %

(4.2)(100) / (30) = 14 %

120
Q

Absolute Count vs Relative Count Formula

A

(Absolute Count)(100) / (Total WBC Count) = Relative Count

121
Q

An adult CBC shows the following results…

WBC: 10.0 x 10^3/uL
NE %: 76%

What is the Absolute Neutrophil Count?

A

(?)(100) / 10.0 = 76%

? = 7.6 x 10^3/uL

122
Q

An adult CBC shows the following results…

NE #: 5.5 x 10^3/uL
NE%: 30%

What is the Total WBC Count?

A

(5.5)(100) / ? = 30%

WBC: 18.3 x 10^3/uL

Absolute Lekocytosis
Relative Neutropenia

123
Q

Volume - The Coulter Principle

What current is used for total cell volume measurement?

A

Direct Current

124
Q

Conductivity - VCS

A

This produces an ALTERNATING ELECTRICAL CURRENT.

It measures the VOLUME OF THE NUCLEUS

125
Q

How does Light Scatter occur? What hits the cell?

A

A LASER BEAM!

Light scatters in all directions.

126
Q

What information is provided by the Light Scatter patterns?

A

Nuclear Lobularity
Structure
Shape
Granularity

127
Q

WBC Scatterplot

L, M, N, O (old/dying), E

Watch the Unit 1 Lecture 5 for photos

A

Quickly and easily identify abnormalities

128
Q

On the WBC Histogram, what anormalities may have caused R Flag?

A

Small WBCs
Lyse Resistant RBCs
PLT Clump

129
Q

Red Cells supposed to be nucleated in the peripheral blood. True or False?

A

False!

Only exception is newborns

130
Q

nRBCs can be miscounted as WBCs. You need to correct this by doing a manual differential. What is the formula?

A

(Uncorrected WBC)(100) / (# of nRBCs + 100) = Correct WBC Count

131
Q

You ran the CBC & got a WBC count of 37.0 x 10^3/uL. While doing the manual differential you counted 126 nRBCs among 100 white cells. What is the correct WBCs?

A

(37)(100) / (126 + 100) = 16.4 x10^3

132
Q

PLT Count also uses the Coulter Principle. What type of current are we using?

A

Direct Current

133
Q

Any particle between ______fL is counted as a platelet & plotted onto a histogram.

A

2~20 fL

134
Q

Platelet Normal Range

A

150 ~ 450x10^3/uL

135
Q

If the particle count does not agree with the curve and is above 20fL, an R Flag is generated on the Platelet Histogram. True or Flase?

A

True

136
Q

What causes R Flag on Platelet Histogram?

A

Small/fragmented RBCs
Giant/Clumped PLTs
PLT size variation

137
Q

What should you do if you get an R Flag on PLT Histogram?

A
  1. Verify the results through smear review & manual PLT estimate
  2. PLT count & estimate cannot be reported if PLT clumping or PLT satellism is seen
  3. Have the specimen recollected/redrawn
138
Q

Platelet Satellism

A

All of these platelets have the tendency to surround the granular sites, specifically the neutrophils. So specimen has to be recollected

139
Q

An EDTA tube is best ran in _____ Hrs.

A

24

140
Q

When looking at a dry specimen under the microscope, you will move the condenser ______.

A

Up

141
Q

When looking at a wet specimen under the microscope, you will move the condenser ______.

A

Down

142
Q

Hematocrit percentage for males

A

45%

143
Q

Hematocrit percentage for females

A

35%

144
Q

If the blood in the ESR (drops below/rises above) the normal range, then the patient has an inflammatory issue.

A

Drops below

145
Q

Aggregation is promoted by _____ _____ _____.

CRP, Fibrinogen

A

Acute Phase Proteins

146
Q

The charge on the red blood cell is?

A

Negative

147
Q

The further the red blood cells drop during the Westergren ESR procedure, the _______ the ESR (inflammation).

A

higher

148
Q

Polychrome

A

Many colored granules

149
Q

Wright Stain

A

A type of stain most labs use for routine staining.

150
Q

Wright Giemsa Stain

A

A higher quality stain. Frequently used to stain bone marrow slides.

151
Q

Scan for platelet clumping in the feathered edge on _____x.

A

10x

152
Q

Perform a manual WBC estimation in _____x.

A

40x

153
Q

The further a ESR “falls” the _____ result.

A

Higher

154
Q

Romanowsky

A

Prototype polychrome stain

155
Q

Perform manual diff, RBC morphology, and platelet estimation in this field.

A

100x

156
Q

The ______ ion (Fe2+) is oxidized to the _____ state (Fe3+).

A

Ferrous

Ferric

157
Q

The deoxyhemoglobin ion is in the reduced ferrous (Fe2+) state. True or False?

A

True

158
Q

When K+ ferricyanide is added to Hgb, oxidizing all the ferrous ions (Fe2+) to ferric ions (Fe3+), the Fe3+ ions are known as

A

Methemoglobin

159
Q

_______ is found in the ferric (Fe3+) state. It has an oxygen molecule attached to the hemoglobin.

A

Oxyhemoglobin

160
Q

Cyanmethemoglobin is measured by __________. The amount of light absorbed is proportional to the amount of hemoglobin in the sample.

A

Spectrophotometry

MLS 1114 Hematology (1 decks)

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