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74 Cards in this Set

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Waived test
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
Provider performed microscopy (PPM)
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
Quality Control purpose
- 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
Microscope stage
where specimen sits
directs light onto the sample
Condenser focusing knob
moves condenser up and down
Condenser diaphragm
increases depth and resolution
Centering screws
adjust to make sure light is coming up through the center of our specimen and field of view
Field lens
adjusts amount of light that will go up to the condenser
Field diaphragm ring
adjust diaphragm to adjust amount of light going to the condenser
Resolving power of lens (resolution)-
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
optical defect that degrades the quality of the image
chromatic aberrations
give rise to color fringes and poor image definitions; inability of the lens to bring the different wavelengths into focus at a single point
spherical aberrations
– give rise to poor image definitions and loss of contrast; depends on thickness of the lens that the light passes through
field curvature aberrations
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
Koehler illumination purpose
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.
potential sources or error in phlebotomy
Short draw
Time of draw
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)
Tourniquet on for too long (no longer than 1 inute)
Increased RBC, WBC, Hb, K
Failure to mix anticoagulant tube properly, improperly filled tube, inactive anticoagulant, failure to expel blood quickly enough into tube
Short draw
Needle comes out of vein, vein collapse, insufficient vacuum in the tube
what does stress do to a blood specimen
WBC will be falsely increased
what does exercise do to a blood specimen
Creatine kinase or WBC may be altered
why is time of draw important
Cortisol highest in morning. Eosinophils higher in the afternoon. Platelets highest in the evening
why is posture significant when drawing blood
Protein, lipid, calcium, and Hg will be increased with changes in position
Sodium Citrate
Potassium Oxalate / Sodium Fluoride
EDTA (purple)
 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)
Sodium Citrate (blue)
 3.2%
 For coagulation testing (PT, APTT)
 Binds to calcium in a soluble complex
 1 part anticoagulant to 9 parts blood
Heparin (green)
 For chemistry (electrolytes, blood gases, ammonia)
 Forms complex with antithrombin III, complex neutralizes
 thrombin
 15-30 units /mL
Potassium Oxalate / Sodium Fluoride (gray)
 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)
order of draw
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)
size (<82 microcytic; >98 macrocytic)
color, Hb conc (<32 hypochromic; >36 problem w/ specimen or high spherocytes)
(<140 thrombocytopenia; >400 thrombocytosis)
(low – anemia, high – polycythemia)
HGB X 3 = HCT (difference should be < 4)
represents the packed RBC volume
shows variation of size
>14.5% anisocytosis – increased variation in size
Leukocyte count
(<4 leukopenia; >11 leukocytosis)
Leukocyte differential
 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
RBC histogram
• 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
o Iron deficiency
o thalassemia
microcytic hypochromic anemias
o Hemolytic anemia (sickle cell)
o Aplastic anemia (WBCs and platelets also low)
o Chronic inflammatory disease, neoplasm, etc
normocytic normochromic anemias
dec RBC, inc MCV, norm MCHC
– macrocytic normochromic anemias
o Alcoholism
o Aplastic anemia
o Liver disease
o Megaloblastic anemia
o Myelodysplastic syndrome
deceased neutrophils
o viral infection
o aplastic anemia
o megaloblastic anemia
o myelodysplastic syndromes
increased neutrophils
o bacterial infection
o inflammation
o hemorrhage
o anxiety or stress
o acute leukemia
o myeloproliferative disorders (CML)
decreased platelets
o aplastic anemia
o megaloblastic anemia
o immune thrombocytopenic purpura (ITP)
o acute leukemia
o myelodysplastic syndromes
• increased platelets
o following splenectomy
o hemorrhage
o iron deficiency anemia
o myeloproliferative disorders
PLT/RBC Histogram
• 1st curve – PLT (0)
• 2nd curve – RBC (50)
WBC Histogram
• 1st curve – lymphocytes (60)
• 2nd curve – mid-size cells like monocytes (120)
• 3rd curve – granulocytes like segmented neutrophils (260)
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
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
megaloblastic anemia
Oval macrocytic RBCs with hypersegmented neutrophils
• decreased platelets
• deceased neutrophils
dec RBC, incr MCV, normal MCHC
Reactive lymphocytes
– really big lymphocytes, more abundant cytoplasm, increased deep blue color to cytoplasm, enlarged and elongated nucleus, open chromatin, look like they are kissing RBC
Chronic myelogenous leukemia (CML)
– increase in WBC, various stages of neutrophil development, increase in basophils, wide age range (usually over 20)
Chronic lymphocytic leukemia (CLL)
increase in mature appearing lymphocytes, all appear the same, usually in age 60 or over
Acute myelogenous leukemia
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
Acute lymphocytic leukemia
block in maturation of lymphocytes, high number of blasts, large nucleus, darker blue cytoplasm
microscopic elements in urine
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
False reactions on reagent strips associated with:

vitamin C
False negative for glucose

False negative for blood bilirubin

False negative for nitrite
Old urine
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
Specificities of each reagent test pad
-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 .
Cystitis lab results
Urinary tract disorder
*UA results: (=) or increased Blood
(=) or decreased Protein
Increased leukocyte esterase
Increased nitrite
*Microscopic: WBC’s
Transitional cells
*Distinguished in part by the absence of casts in the microscopic UA
Pyelonephritis lab results
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
Strenuous Exercise
UA pad would be (+) for protein  transient protein
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)
Diabetes mellitus
UA pad would be positive for glucose and maybe ketones
UA pad would be (+) for bilirubin
(*Post hepatic jaundice due to gallstones: very low urobilinogen in UA)
dec neutrophils, inc platlets, dec RBC, inc MCV, normal MCHC
megaloblastic anemia
myelodysplastic syndrome
aplastic anemia
inc neutrophils, increased platelets, dec RBC, normal MCV and MCHC
variable WBC, dec platelets, dec RBC
acute leukemia
dec RBC, dec MCV, dec MCHC, inc platelets
iron def anemia
inc neutrophils, inc platelets, dec RBC
myeloproliferative disorders
hemolytic anemia
RBC's affected, PLT normal
megaloblastic anemia
dec RBC, inc MCV, normal MCHC, dec PLT-due to alcoholism, confirm with a reflex test-Folic acid and look for dec