MLT Clinical Practicums > Hematology Study Guide > Flashcards

Hematology Study Guide Flashcards

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1
Q

Normal value WBC

A

5000-10000

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2
Q

Normal value for RBC

A

m: 4.7 - 6.1 mil/cm3
f: 4.2-5.4 mil/cm3

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3
Q

Normal value for Hgb

A

male 14-18 g/dL

female 12 - 16 g/dL

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4
Q

Normal value for Hct

A

male 42-52%

female 37-47%

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5
Q

Normal value for Platelets

A

150,000 - 400,000

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6
Q

Normal value for Retics

A

0.5-2%

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7
Q

Normal value 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

3 x RBC = Hgb

3 x Hgb = 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 decrease ESR

A 
polycythemia
sickle cell
poik
delay in performing test
spherocytosis
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11
Q

What is the chief use of osmotic fragility test?

A

diagnosis of spherocytosis

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12
Q

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

A

hemoglobin electrophoreisis

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13
Q

How are retics stained?

Which dye is best?

A

New Methylene Blue; separate RNA
Cresyl blue

Wrights Stain - supravital, makes RNA visable

retics seen as polychromatic

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14
Q

What is the use of the retic test to a 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 retic count?

A

Hemorrhage
Hemolysis
Splenectomy
Various, hemolytic, anemias

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16
Q

In what conditions would you see a decreased retic count?

A

BM suppression
Aplastic anemia
Ineffective erythropoeisis (IDA, PA)

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17
Q

What is the proper procedure for a hematocrit?

A

Blood is collected in heparinized capillary tubes. Seal one end. Spin in microhematocrit centrifuge to obtain optimal packed cells. Micromethod for hct determination.

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18
Q

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

A

hemolysis; false decrease

cells will not pack

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19
Q

Red cell morpholgy or classification on anemia based on MCV indice.

A

Size

100 macrocytic

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20
Q

Red cell morpholgy or classification on anemia based on MCHC indice.

A

hgb concentration

degrees of hypochromia

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21
Q

With what conditions are burr cells associated?

A

renal failure

kidney disease

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22
Q

In what condition is basophilic stippling frequently seen?

A

lead poisoning

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23
Q

With what condition are Heinz bodies most closely associated?

A

G6PD deiciency

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24
Q

How are basophilic stippling and reticulum differentiated?

A

Baso - romanowski Wrights stain and new methylene blue

Retic - new methyolene blue only

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25
What is the best specimen to use for blood smears?
whole blood from EDTA tube
26
How can you adjust the color of Wrights stain smear?
adjust the pH
27
What is the most prominent feature of an ABO HDN blood smear?
spherocytes
28
Calculate MCV
Hct/RBC
29
Normal values for MCV
male 80-94 fL (femtoliters) | female 81-99 fL
30
Calculate MCH
Hgb/RBC
31
Normal values for MCH
27-31 pg (picograms)
32
Calculate MCHC
(Hgb/Hct) * 100
33
Normal values for MCHC
32-36% g/dL
34
Suggest diagnosis for Macro/Normo anemia MCV increased MCHC normal
``` liver disease B12 deficiency Folate deficiency PA alcoholism ```
35
Suggest diagnosis for Micro/Hypo anemia MCV decreased MCHC decreased
IDA Sideroblastic Thalassemia Lead poisioning
36
Suggest diagnosis for Normo/Normo anemia
Aplastic anemia, various others not listed already
37
What is the appearance of the blood smear in iron deficiency anemia?
Micro/Hypo target, burr, oval, tailed rbc serum iron decrease TIBC increase
38
What are the causes of aplastic anemias?
``` BM suppresion, failure or replacement pancytopenia Normo/Normo anemia no rbc increase low retic decreased BM ```
39
What is a common characteristic of all hemolytic anemias?
increased RBC destruction
40
What is an unusual finding that also differentiates AIHA from other hemolytic anemias?
+ DAT
41
What is pancytopenia?
decreased RBC, WBC and Plt
42
What information is included in a WBC diff?
WBC count and classification plt count rbc morphology
43
Most common WBC in a diff
neutrophil
44
Most common WBC in a normal smear
neutrophil
45
Most common WBC in chilred under age 1
lymphocyte
46
Lest common WBC in a normal smear
basophil
47
Largest WBC in a normal smear
monocyte
48
Which immature RBC are classified as Nrbc in a diff?
blast cells prorubricytes rubricytes metarubricytes
49
What is the appearance of a plasma cell?
eccentric nucleus with clumped chromatin | basophilic cytoplasm with a clear perinuclear halo (hof)
50
Is a plasma cell likely to be seen in the peripheral blood?
No. approx 1% of nucleated cells in BM
51
Shift to the left
increase of immature granulocytes
52
Shift to the right
increase of mature granulocytes
53
How is diagnosis of Hereditary Elliptocytosis made?
``` at least 25% of rbc's or ellip/oval OF testing autohemolysis test Direct protein assays gel electrophoreisis ```
54
What are the distinguishing characteristics of Hodgkin's disease?
slow relentless progression leukemoid rxn with eos' Reed-Sternberg cells
55
What features of a blood smear are normal in a newborn but not an adult?
NRBCs Polychromasia young WBCs
56
describe a Downy atyipcal lymph from a Wright stain smear
``` eccentric nucleus dense chromatin may have open spaces abundant smooth cytoplasm, shades of blue near edges which may be scalloped may have azurophilic granules confused with a mono ```
57
What stage of development differentiates the granules of a granulocyte
myelocyte
58
How is a myelocyte differed from a metamyelocyte?
meta have kidney bean shaped nucleus
59
Procedure for performing a total eosinophil count
must be done to count a larger volume, either by using special counter or both sides of hemacytometer. Whole blood is diluted with staining solution. Use max light, count entire ruled area on both sides on low power. Calc: total # of cells x 10(dilution) / 1.8 mm3
60
Normal value for CSF cell count
adults 0-5, 8 mononuclear cells | neonates 0-30 mononuclear cells
61
What test is the best test for measure of erythroid activity in the BM?
reticulocyte count
62
What conditions can not be absolutely diagnosed without a BM aspirate?
``` Myeloproliferative disorders Leukemia PA Lymphoma Tumors Aplastic anemia ```
63
What is the main use of LAP
differentiate leukemoid rxn (increased) from CML (decreased)
64
Why correct WBC count if more than 5 nrbc present and how do you calculate for correction?
causes a false increase in WBC | #WBC * 100)/(#nrbc per 100 wbc
65
Incidence of leukemia in various age groups
ALL - most common in children CML - middle age CLL - older pts (>55)
66
What is the typical blood picture in acute leukemia?
N/N anemias decreased RBC thrombocytopenia increased immature cells
67
At the time of diagnosis, which leukemia frequently presents with a greatly increased platelet count?
CML | *case study*
68
AML blood picture
``` 60-90% blasts scattered segs but no intermediate cells severe N/N anemia polychromasia nRBC thrombocytopenia w/ large or abnormal plt possible auer rods ```
69
ALL blood picture
>60% lymphoblasts severe N/N anemia thrombocytopenia *case study*
70
CML blood picture
marked leukocytosis increase wbc, shift to right, eos, basos, plt(at first, then they decrease) N/N anemia, incl nrbc's
71
CLL blood picture
lymphocytosis, 60-95% small lymphs smudge cells, eos all stages of granulocytes N/N anemia
72
Hodgkin's blood picture
``` not terribly abnormal or specific mild anemia thrombocytopenia leukocytosis, grans espec. eos leukemoid rxn with eosinophilia decreased lymphs ```
73
Blood picture after splenectomy
``` Pappenheimer bodies HJB target cells Aniso&Poik (tear drop, bite, frags) increased platelets ```
74
Megaloblastic anemia blood picture
``` pancytopenia hypersegs oval macrocytes aniso&poik (schis, sphero, td, target, giant plt) shift to the right ```
75
Polycythemia Vera blood picture
``` N/N but may become Micro/Hypo increased rbc occasional nrbc ig's - myelo, metas increased eos and/or baso normal or increased plt, giant/bizarre ```
76
Myelfibrosis blood picture
``` moderate N/N anemia polychromasia nrbc's aniso & poik WBC normal to increased plt increase at first, then decreases - giant plts ig shift to the left ```
77
DIC blood picture | disseminated intravascular coagulation
``` thrombocytopenia microplatelets leukocytosis schis decreased retic ```
78
AIHA blood picture
``` N/N anemia Sphero macrocytic Polychromasia nRBC schisto, burr erythrophagocytosis by monos WBC increase, slight shift to the left ```
79
Thal Major blood picture
``` marked aniso & poik( td, burr, schisto...) many nRBC severe micro/hypo polychromasia HJB, baso-stipp increased WBC, shift to the left *case study* ```
80
Thal Minor blood picture
``` mild Micro/Hypo target baso-stipp polychromasia usually normal WBC occasional nrbc ```
81
Multiple Myeloma blood picture
``` rouleaux N/N anemia wbc normal to increased rare circulating plasma cell increase lymph, eos, immature grans decreased neutrophils ```
82
IM blood picture
slight leukocytosis atypical lymphs, Downey cells rare immature lymphs plt & rbc normal
83
how do you do an indirect platelet count and how do you report out platelets in reference to your estimation?
count platelets in 5 fields of high power at the feathered edge of smear, multiply by 4. report as decreased, increased or adequate
84
How are PNH and PCH diagnosed in the lab and how do they differ?
PCH: extrinsic, D-L antibody, extracorpuscular defect. Diagnose with D-L test PNH: intrinsic, acquired, sensitive to complement, Diagnosed by Ham's test or sugar water test
85
Which layer of blood is used for LE prep?
buffy coat
86
Which group of disorders is classified using the FAB system?
acute leukemias
87
What is the use of the Kleihauer-Betke technique or the Fetaldexx stain?
measures the amount of fetal Hgb transferred from fetal blood to maternal blood; used for D neg mothers; aids in correct dosage for RhoGam
88
Which age group has the highest values for RBC parameters?
newborns
89
What is the Coulter principle for cell counting
Flow cytometry; interruption of a light source as it passes through a flow cell
90
How would you obtain a blood specimen from a pt who has IV solutions running into both arms?
Draw below the IV site or ask nurse to turn off IV for 15 minutes before draw.
91
What is the appearance of folic aid deficiency?
Macro/Hypo | PA, no neurological symptoms
92
With what conditions are an increased eos count associated?
``` allergic disease skin disorders parasitic infections blood diseases splenectomy ```
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