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115 Cards in this Set

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MCH and formula
Expresses average weight of hemoglobin in cell. (hgb) times 10 / RBC = MCH.
Reference range of MCH
27-32 pg
MCHC and formula
Expresses the average concentration of hgb per unit volumes of RBCs. Defined as average weight of hgb to volume of RBCs. (Hgb) (100) / hct = MCHC
Reference range of MCHC.
32-36%.
Which of the indicies gives hemoglobin the "chromic" factor?
MCHC
The 3 "chromics"
Hypochromic, normochromic, and hyperchromic.
Red cell distribution width (RDW)
Measure of variation in red cell volume by distribution. It is calculated by automated cell counters from the histogram.
Formula for RDW and reference range
(SD) (100) / MCV = RDW
Ref. range: 11.5%-14.5%.
An increase of RDW can indicate:
Anisocytosis (diameter not equal) of RBC. Increased in many of the anemias where anisocytosis is observed.
What can a low reading of RDW indicate?
A more uniform RBC population.
What values are used to calculate erythrocyte indicies?
Hemoglobin, hematocrit, and RBC count.
What do the indicies give an idea of?
How the RBCs should appear on the stained blood smear.
What do normal RBCs look like?
Biconcave disks with a ring of hemoglobin on outer edge.
Average size of a normal RBC.
6-8 microns.
What does MCV stand for?
Mean corpuscular volume.
What does MCH mean?
Mean corpuscular hemoglobin.
What does MCHC stand for?
Mean corpuscular hemoglobin concentration.
What does RDW stand for?
Red cell distribution width.
MCV
Expresses the average volume of an erythrocyte.
Formula for MCV
Hct (10) / RBC = MCV
Which indicies value determines "cytic" size of cell?
MCV.
ESR
Aka erythrocyte sedimentation rate or sed rate. Measures the rate of settling of RBCs in human plasma over a period of time.
What happens when well mixed venous blood is placed in a vertical tube?
RBCs tend to fall to the bottom.
Length of fall (ESR) is measured with what measurements?
Mm.
Length of fall.
ESR.
ESR is a __________ indicator of disease.
Non specific.
When are increases ESR rates seen?
Acute and chronic inflammatory diseases and some malignancies.
Factors that increase ESR
Old age
Female
Pregnancy
Anemia
RBC abnormalities
Macrocytosis
Technical factors
Dilution problem
Increased temp of specimen
Tilted ESR tube
Elevated fibrinogen level
Infection
Inflammation
Malignancy
Factors that decrease ESR
Extreme leukocytosis
Polycythemia
RBC abnormalities
Spherocytosis
Acanthocytosis
Microcytosis
Technical factors
Dilution problem
Inadequate mixing
Clotting of blood sample
Short ESR tube
Vibration during test
Protein abnormalities
Hypofibrinogenemia
Hypogammaglobulinemia
Dysoproteinemia with hyperviscosity state
Factors with no effect on ESR
Aspirin
Obesity
Body temp
Recent meal
NSAIDs
Forces affecting the sedimentation of red cells.
Size and shape of cell
Viscosity of plasma
Repellent forces between the negatively charged cell surface
What does the surface of RBC contain?
Negatively charged sailic acid molecules which act to repel other RBCs.
What affects the quantity of the repellent force and allows formation of rouleaux?
Asymmetric proteins, especially fibrinogen and gamma globulin.
Which factor influences the ESR most?
Increased plasma proteins.
Rouleaux
The stacking up of red blood cells, caused by extra or abnormal proteins in the blood that decrease the normal distance red cells maintain between each other.
Appearance of rouleaux.
Look like a stack of coins pushed over.
Which ESR method did we perform in class?
Westergren.
Reference ranges of ESR
Children: 0-10 mm/hr
Males < 50: 0-15 mm/hr
Males >50: 0-20 mm/hr
Females <50: 0-20 mm/hr
Females >50: 0-30 mm/hr
Wintrobe method reference ranges of ESR.
Children: 0-13 mm/hr
Men: 0-9 mm/hr
Women: 0-20 mm/hr
Which ESR test uses a long tube?
Westergren.
Which ESR test uses a short tube?
Wintrobe.
How much sodium citrate is blood collected in for westergren procedure?
3.8%.
What can anti coagulated blood be diluted with?
2.0 mL of blood anti coagulated with EDTA may be diluted with 0.5 mL of 0.85% NaCl or 3.8% sodium citrate.
Ves-Matic system
Bench top analyzer designed to determine ESR by use of optoelectronic sensor that measures change in opacity of a column of blood as sedimentation of blood progress.
What angle is used for Ves-Matic analyzer?
18 degrees.
How long does it take Ves-Matic test to run?
20 mins.
What happens if the concentration of anticoagulant is increased?
ESR is falsely low.
What can cause the RBCs to shrink and falsely elevate the ESR?
Anticoagulants sodium or potassium oxalate and heparin.
A significant change in what temp alters ESR?
Room temp.
Slight tilt of _________ causes ESR to increase.
Pipette.
What happens if the specimen is allowed to sit at room temp for more than 2 hours before being tested? (ESR)
RBCs start to become spherical and may inhibit formation of rouleaux.
What can invalidate ESR test results?
Bubbles in column of blood.
Where must the blood be set at beginning of test?
Zero mark.
What type of specimen can't be used?
Clotted.
Which hemolytic disorders can decrease ESR?
Anemia and spherocytosis.
What is erythropoiesis?
Production of RBC.
Where does production of RBC begin?
Primitive yolk sac of embryo.
Where does production of RBC become extra medullary?
In fetus.
Where does RBC move in late fetal development and remains throughout adulthood?
Bone marrow.
What is erythropoiesis controlled by?
EPO aka the hormone erythropoietin.
Where is EPO produced?
Primarily in kidneys, but also liver.
What type of stain is Wright's stain?
Polychrome stain meaning many colors.
Which stain is used unless a different or special stain is specified?
Wright's.
What does Wright's stain consist of?
A fixative and two stains: Fixative is methyl alcohol and stains are eosin red and methylene blue.
Eosin red stain
Acidic stain that colors the chemically basic (acidophilic) portions of cells like proteins and hemoglobin.
Methylene blue
Basic stain that colors acid (basophilic) portions of cells.
What are the acidic portions of a RBC?
DNA and RNA.
What part of RBC is chemically basic? Love acid.
Hemoglobin and proteins.
Which cell gives birth to every other cell?
Rubriblast.
Size of rubriblast
12-19 microns.
Cytoplasmic ratio of rubriblast
4:1.
Nucleus of rubriblast
Round and contains from zero to two nuecleoli, dark in color, and fine chromatin pattern.
Cytoplasm of rubriblast
Basophilic and doesn't contain granules. Basophilia corresponds to the RNA activity needed to produce hemoglobin.
Hof
Area of clear next to nucleus where Golgi apparatus is found.
Size of prorubricyte and N:C ratio
12-17 microns. 4:1.
Appearance of prorubricyte
Nuclear chromatin becomes more clumped. Nucleoli aren't visible. Cytoplasm is basophilic.
Parachromatin
Lighter areas next to chromatin: clear. As it ages, it starts to clump.
Size of rubricyte and N:C ratio
11-15 microns in diameter. N:C ratio is 1:1.
Chromatin pattern of rubricyte
Increasingly clumped.
Which stage is the last to undergo mitosis?
Rubricyte.
What does the cell in the rubricyte stage start to synthesize?
Hemoglobin, which makes the cytoplasm a mix of pink with blue giving a grayish appearance.
In which stage does the chromatin appear gray?
Rubricyte.
What color does eosin cause the cytoplasm to become?
Pink.
Size of metarubricyte
8-12 microns.
Nucleus of metarubricyte
Completely condensed.
Pyknotic
Condensed.
Color of cytoplasm in metarubricyte stage.
Reddish pink due to large amount of hemoglobin.
What happens at the end of the metarubricyte stage?
Metarubricyte loses its nucleus.
What won't you see in metarubricyte stage?
Parachromatin.
Where is RBC located in metarubricyte stage?
Still in bone marrow, but about to be kicked into blood stream.
Which type of cell is a nucleated RBC in bloodstream?
Metarubricyte.
Other names for polychromatophilic erythrocyte
Reticulocyte and diffusely basophilic erythrocyte.
Size of reticulocyte
7-10 microns.
Where does the polychromatophilic stage take place?
Bone marrow and later in the circulating blood.
What does the polychromatophilic erythrocyte contain?
Fine, web-like (reticulum) network of remaining RNA.
When reticulum can be seen its referred to as _________ if stained with ____________________________.
Reticulocyte, New Methylene Blue N.
Why can't polychromatophilic erythrocytes be seen with wright's stain?
The excess RNA takes on the basic stain. When it's added to the pink of the hemoglobin, they appear grayish or polychromatophilic.
How long does the reticulocyte remain in the bone marrow after nucleus is lost?
2-3 days before entering circulation.
How long does the reticulocyte continue to produce hemoglobin after it enters circulation?
24 hours.
What happens during maturation of the reticulocyte?
RNA is catabolized and ribosomes disintegrate. Reaches full hemoglobization.
In normal circumstances, the number of reticulocytes in the bone marrow are ______ to the number seen in circulation.
Equal.
Life span of mature RBC.
120 days.
How much of circulating cells is lost and replaced each day?
1/120.
What do reticulocytes reflect?
Function of bone marrow.
What happens to retics under stimulation of erythropoietin and why?
May be released prematurely into circulation. Could be due to conditions such as an acute bleed.
Stress or shift reticulocytes.
When they're released under stimulation of erythropoietin into blood stream due to an acute bleed.
Reticulocyte reference range
0.5-1.5% in adults
2.5-6.5% in newborns
When does newborn reticulocyte reference range fall to adult level?
Within second week of life.
Mature erythrocyte
Biconcave and fully pink due to hemoglobin content.
Where do you look at slide when it is prepared for retic count?
Feathered edge.
What a retic looks like under slide.
Have dots in them. If it stays the same color when fine focusing, it's a reticulocyte.
Formula for calculating retics
# of retics counted / # counted x 100 = % of retics
What type of stain is new methylene blue n?
Supra vital: stain cells while alive, not fixed to slide.
Anisocytosis
Diameter not equal.
Reference range of MCV
80-96 fl.