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74 Cards in this Set
- Front
- Back
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Waived test
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test that does not require patient, sample or reagent preparation. Minimal risk of harm to patient if result is inaccurate.
Test include: hemoglobin determination microhematocrit, spun prothrombin time Dipstick/tablet urinalysis Glucose determination Tests have been cleared by the FDA for home use |
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Provider performed microscopy (PPM)
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Test must be classified as moderate complexity and be performed regularly during course of patient exam
Primary instrument must be a microscope Testing is performed on labile specimens with little specimen handling or processing required 22% of patient’s labs fall under this category Ex: urine sediments: microscopic urinalysis, KOH preparations, direct qualitative exam of vaginal or cervical mucous, wet mounts, pin worm examination, fern test, nasal smear for eosinophils, fecal leukocyte examination, qualitative semen analysis |
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Quality Control purpose
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- Included in quality assurance program
- Monitors the testing method procedures - Follow manufacturer’s instructions for operation and test performance - Create procedure manual describing testing and reporting processes - Perform and document two levels of control each day for appropriate test procedures - Perform and document remedial actions taken - Perform and document calibration every six months for appropriate instruments - Maintain quality control records |
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Microscope stage
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where specimen sits
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Condenser
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directs light onto the sample
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Condenser focusing knob
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moves condenser up and down
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Condenser diaphragm
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increases depth and resolution
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Centering screws
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adjust to make sure light is coming up through the center of our specimen and field of view
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Field lens
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adjusts amount of light that will go up to the condenser
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Field diaphragm ring
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adjust diaphragm to adjust amount of light going to the condenser
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Resolving power of lens (resolution)-
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the ability to distinguish two separate objects located close to one another and reveal the fine detail in a specimen; it is a function of the numerical aperature of the lens – the higher the NA, the greater the resolving power
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aberration
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optical defect that degrades the quality of the image
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chromatic aberrations
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give rise to color fringes and poor image definitions; inability of the lens to bring the different wavelengths into focus at a single point
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spherical aberrations
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– give rise to poor image definitions and loss of contrast; depends on thickness of the lens that the light passes through
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field curvature aberrations
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result in the periphery of the field being slightly out of focus when the center is in focus; result of the image in the focal plane being slightly curved by the objective
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Koehler illumination purpose
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utilizes a double diaphragm illumination. The condenser aperature diaphragm determines the resolution, contrast, and depth of field. The field diaphragm determines the illuminated area on the specimen surface in relation to the field of view on the microscope. The procedure should be done on each objective and done daily before microscope use. The two diaphragms are adjusted so as to give uniform illumination of the field of view and optimum contrast and resolution of a specimen by focusing and centering the light path.
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potential sources or error in phlebotomy
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Hemolysis
Hemoconcentration Clots Short draw Stress Exercise Time of draw Posture |
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hemolysis
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shaking of tube, using needle that is too small, expelling blood too quickly through syringe. Transfusion reaction, autoimmune hemolytic anemia, paroxysmal nocturnal hemoglobinuria (PNH), disseminated intravascular coagulation (DIC)
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Hemoconcentration
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Tourniquet on for too long (no longer than 1 inute)
Increased RBC, WBC, Hb, K |
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Clots
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Failure to mix anticoagulant tube properly, improperly filled tube, inactive anticoagulant, failure to expel blood quickly enough into tube
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Short draw
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Needle comes out of vein, vein collapse, insufficient vacuum in the tube
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what does stress do to a blood specimen
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WBC will be falsely increased
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what does exercise do to a blood specimen
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Creatine kinase or WBC may be altered
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why is time of draw important
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Cortisol highest in morning. Eosinophils higher in the afternoon. Platelets highest in the evening
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why is posture significant when drawing blood
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Protein, lipid, calcium, and Hg will be increased with changes in position
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Anticoagulants
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EDTA
Sodium Citrate Heparin Potassium Oxalate / Sodium Fluoride |
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EDTA (purple)
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For blood cell counts and morphologic examination
Chelates or irreversibly binds calcium 1.5 mg/mL Most common cation is potassium (don’t contaminate other tubes) |
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Sodium Citrate (blue)
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3.2%
For coagulation testing (PT, APTT) Binds to calcium in a soluble complex 1 part anticoagulant to 9 parts blood |
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Heparin (green)
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For chemistry (electrolytes, blood gases, ammonia)
Forms complex with antithrombin III, complex neutralizes thrombin 15-30 units /mL |
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Potassium Oxalate / Sodium Fluoride (gray)
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For glucose testing
Na fluoride - prevents glycolysis – therefore glucose results will not be falsely decreased (2.5 mg/ml) K oxalate - binds calcium (2 mg/ml) |
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order of draw
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1. sterile cultures
2. blue – sodium citrate (for coagulation testing) 3. red – no anticoagulant (serum)/tiger 4. green – heparin (Na, K, Cl) (blood chemistry) 5. purple – EDTA – inhibits coagulation by chelating the Ca present in the blood sample 6. grey – K oxalate / Na fluoride (blood sugars, blood alcohol) |
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MCV
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size (<82 microcytic; >98 macrocytic)
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MCHC
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color, Hb conc (<32 hypochromic; >36 problem w/ specimen or high spherocytes)
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Platelets
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(<140 thrombocytopenia; >400 thrombocytosis)
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RBC
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(low – anemia, high – polycythemia)
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Hct
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HGB X 3 = HCT (difference should be < 4)
represents the packed RBC volume |
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RDW
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shows variation of size
<11.5- >14.5% anisocytosis – increased variation in size |
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Leukocyte count
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(<4 leukopenia; >11 leukocytosis)
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Leukocyte differential
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Segmented neutrophils – bacteria (granulocytes) – innate immune response (high - neutrophilia)-most numerous
Lymphocytes – viruses, encapsulated bacteria like strep pneumonia – adaptive immune response (low - lymphocytopenia)-2nd most numerous Monocytes – scavenger cell, also immune response Eosinophils – allergic reactions and parasitic infections Basophils – inflammatory response, hypersensitivity reactions |
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RBC histogram
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• If RBC histogram is shifted to left – microcytic (MCV < 82)
• If RBC histogram is shifted to right – macrocytic (MCV >98) • Broad peak in RBC histogram – anisocytosis |
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o Iron deficiency
o thalassemia |
microcytic hypochromic anemias
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o Hemolytic anemia (sickle cell)
o Aplastic anemia (WBCs and platelets also low) o Chronic inflammatory disease, neoplasm, etc |
normocytic normochromic anemias
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dec RBC, inc MCV, norm MCHC
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– macrocytic normochromic anemias
o Alcoholism o Aplastic anemia o Liver disease o Megaloblastic anemia o Myelodysplastic syndrome |
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deceased neutrophils
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o viral infection
o aplastic anemia o megaloblastic anemia o myelodysplastic syndromes |
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increased neutrophils
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o bacterial infection
o inflammation o hemorrhage o anxiety or stress o acute leukemia o myeloproliferative disorders (CML) |
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decreased platelets
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o aplastic anemia
o megaloblastic anemia o immune thrombocytopenic purpura (ITP) o acute leukemia o myelodysplastic syndromes |
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• increased platelets
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o following splenectomy
o hemorrhage o iron deficiency anemia o myeloproliferative disorders |
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PLT/RBC Histogram
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• 1st curve – PLT (0)
• 2nd curve – RBC (50) |
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WBC Histogram
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• 1st curve – lymphocytes (60)
• 2nd curve – mid-size cells like monocytes (120) • 3rd curve – granulocytes like segmented neutrophils (260) |
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Peripheral Blood Smear Examination
10x objective |
100 magnification
o Assure even distribution of leukocytes, look for abnormal cells, platelet clumps o Look for abnormal RBC distribution patterns – rouleaux or agglutination o Locate optimal examination area o Erythrocyte estimate (normal, increased, decreased) o Leukocyte estimate (in 5 fields – take average – multiply by 200) – should agree to 25% of CBC result |
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Peripheral Blood Smear Examination
100x objective |
1000 magnification
o Platelet estimate (in 5 fields – take average – multiply by 20,000 if capillary blood or 15,000 if EDTA anticoagulated blood) o RBC morphology RBC size – should be the same size as the nucleus of a lymphocyte) RBC color – area of central pallor should be about 1/3 of cell RBC shapes – change is poikilocytosis RBC inclusions o Leukocyte differential – count 100 cells per slide Mature neutrophils Banded neutrophils Lymphocytes Monocytes Eosinophils Basophils |
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megaloblastic anemia
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Oval macrocytic RBCs with hypersegmented neutrophils
• decreased platelets • deceased neutrophils dec RBC, incr MCV, normal MCHC |
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Reactive lymphocytes
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– really big lymphocytes, more abundant cytoplasm, increased deep blue color to cytoplasm, enlarged and elongated nucleus, open chromatin, look like they are kissing RBC
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Chronic myelogenous leukemia (CML)
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– increase in WBC, various stages of neutrophil development, increase in basophils, wide age range (usually over 20)
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Chronic lymphocytic leukemia (CLL)
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increase in mature appearing lymphocytes, all appear the same, usually in age 60 or over
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Acute myelogenous leukemia
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problem in maturation of neutrophils, high number of blasts – very large cells, large nucleus, blue cytoplasm with no granules, nucleoli can be seen in nucleus
variable number of WBC, dec RBC, dec PLT |
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Acute lymphocytic leukemia
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block in maturation of lymphocytes, high number of blasts, large nucleus, darker blue cytoplasm
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microscopic elements in urine
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Cells: RBC, WBC, squamous epithelial
Casts: hyaline, granular Crystals not clinically significant: Acid Urine-Uric Acid, Calcium Oxalate Alkaline Urine- Triple phosphate Crystals clinically significant: Acid Urine- leucine, tyrosine, cystine Misc: yeast(budding, small circles in a line), bacteria (little white specs and rods in the background), mucus |
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False reactions on reagent strips associated with:
vitamin C |
False negative for glucose
False negative for blood bilirubin False negative for nitrite |
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Old urine
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The following will decrease if present: glucose(any present bacteria will use it up), bilirubin(deteriorates in the presence of light), ketones(they are volatile)
The following will increase if present: nitrite(bacteria multiplying and utilizing urinary nitrate), pH(becomes more alkaline) Microscopic changes: Cells and casts will disappear(lyse and or disintegrate), crystals may appear |
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Specificities of each reagent test pad
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-Urobilinogen doesn’t measure absence of urobili.
-protein pad detects only albumin -blood pad detects RBCs, free hemoglobin, myoglobin -nitrite pad detects only those genus of bacteria capable of utilizing urine nitrate -once every 8 hours or when new bottle of reagent strips opened or when there is a change in testing personnel . |
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Cystitis lab results
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Urinary tract disorder
*UA results: (=) or increased Blood (=) or decreased Protein Increased leukocyte esterase Increased nitrite *Microscopic: WBC’s Bacteria Transitional cells *Distinguished in part by the absence of casts in the microscopic UA |
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Pyelonephritis lab results
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Tubulointerstitial disorder
*UA results: Turbid (=) or decreased Protein Increased Nitrite Increased Leukocyte esterase *Microscopic: Extreme increase in WBC’s WBC clumps Glitter cells Casts – Hyaline, granular, WBC *Positive immunofluorescent antibody coated bacteria *May involve infection, toxin, neoplasm, transplant rejections, vascular disorder, may be due to cystitis, catheterization |
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Strenuous Exercise
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UA pad would be (+) for protein transient protein
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Trauma
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UA pad would be (+) for blood (+) due to intact RBCs, hemoglobin,
myoglobin (heme-like compound found in muscles, UA (+) for muscle damage, trauma, or crush injury) |
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Diabetes mellitus
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UA pad would be positive for glucose and maybe ketones
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Hepatitis
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UA pad would be (+) for bilirubin
(*Post hepatic jaundice due to gallstones: very low urobilinogen in UA) |
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dec neutrophils, inc platlets, dec RBC, inc MCV, normal MCHC
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megaloblastic anemia
myelodysplastic syndrome aplastic anemia |
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inc neutrophils, increased platelets, dec RBC, normal MCV and MCHC
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hemorrhage
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variable WBC, dec platelets, dec RBC
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acute leukemia
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dec RBC, dec MCV, dec MCHC, inc platelets
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iron def anemia
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inc neutrophils, inc platelets, dec RBC
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myeloproliferative disorders
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hemolytic anemia
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RBC's affected, PLT normal
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megaloblastic anemia
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dec RBC, inc MCV, normal MCHC, dec PLT-due to alcoholism, confirm with a reflex test-Folic acid and look for dec
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