Lab Di Lab Exam 1 Cunningham

Front 1

Lab test are only as good as the _______ received for testing.

Back 1

specimens

Front 2

Blood specimens are obtained by

Back 2

phlebotomy

Front 3

What is the technical definition of phlebotomy?

Back 3

an incision of a vein

Front 4

If phelbotomy is incision of a vein, then veinipuncture is?

Back 4

penetrating the vein with a needle and collection apparatus or syringe

Front 5

The collection of capillary blood after an incision is made in the skin w/ a lancet.

Back 5

skin or dermal puncture

Front 6

How is WHOLE blood obtained?

Back 6

by having a tube that has ANTICOAGULANT preventing clotting of blood specimen

Front 7

Why is it important that the blood and anticoagulant are well mixed in whole blood collection?

Back 7

hematology cell counting

Front 8

When blood is ALLOWED TO CLOT, the UPPER portion is called __________. Describe:

Back 8

SERUM: clear liquid portion of blood, contains NO fibrinogen.

Front 9

When collecting serum, what is technique?

Back 9

Allow to clot, then centrifuge ~20 min. Clotted cellular elements pushed to bottom, upper is serum.

Front 10

What places/establishments want SERUM?

Back 10

most chemistry and serology testing, blood banks

Front 11

Describe PLASMA collection and why plasma is different from serum?

Back 11

Whole blood WITH ANTICOAGULANT is centrifuged. Uncoagulated cellular elements pushed to bottom. Upper portion is PLASMA.

Front 12

Plasma is the fluid portion of blood containing ______________. Serum does not contain this.

Back 12

FIBRINOGEN is in plasma.

Front 13

Why collect plasma?

Back 13

Coagulation studies, plasma chemistries

Front 14

What is capillary blood?

Back 14

a COMBINATION of venous blood, arterial blood and tissue fluid obtained through skin puncture (finger/heel stick)

Front 15

Why is a heel or finger stick not as good a sample?

Back 15

Quality less because contains tissue fluid (versus drawing directly from a vein)

Front 16

When is heel stick used?

Back 16

newborns and children

Front 17

When might the reliability/ingtegrity of a specimen be compromised? (2)

Back 17

1. Inappropriate method of collection, 2. Mishandling specimen after collection

Front 18

4 sources of compromised specimen reliability:

Back 18

Hemolysis/Lipemia/Improperly filled tubes/Specimen contamination

Front 19

Hemolysis

Back 19

RUPTURE of RBC's that results in plasma/serum appearing PINK>RED, due to release of HEMOGLOBIN

Front 20

What causes a collected sample to appear pink or red?

Back 20

HEMOGLOBIN released due to hemolysis

Front 21

Two causes of hemolysis (releases hemoglobin into sample):

Back 21

TRAUMATIC phlebotomy (incision of vein) OR release of INTRACELLULAR CONTENTS

Front 22

Traumatic phlebotomy resulting in hemolysis may be due to

Back 22

rarer cases of INTRAVASCULAR DISEASE and RBC fragility

Front 23

What intracellular contents of an RBC are released during phlebotomy & how does this screw chemical analysis?

Back 23

K+, LDH from lysed RBC's during traumatic phelbotomy causes COLOR interference with chemical analysis

Front 24

LIPEMIA compromised blood specimen?

Back 24

CLOUDY, TURBID appearance of specimen due to presence of LIPIDS (may indicate a non-fasting specimen)

Front 25

How does LIPEMIA interfere with specimen analysis?

Back 25

CHYLOMICRON interference

Front 26

IMPROPERLY FILLED TUBE compromised blood specimen?

Back 26

VACUUM was not exhausted during collection, ergo ratio of blood to anticoagulant upset = most important for coagulation testing!

Front 27

SPECIMEN CONTAMINATION of compromised collection?

Back 27

Improper ANTISEPTIC cleaning of venipuncture SITE. This confounds BLOOD CULTURES.

Front 28

4 specimen HANDLING requirements

Back 28

FASTING - TIMED - ICED - PROTECTION FROM LIGHT [Pro F.I.T.]

Front 29

Pro F.I.T.

Back 29

Specimen handling requirements: Protection from light - Fasting - Iced - Timed

Front 30

Pro F.I.T. = FASTING?

Back 30

FASTING: no eating or drinking (water ok) for 8-12 hours before blood draw (ex. - triglycerides, glucose)

Front 31

Pro F.I.T. = TIMED?

Back 31

TIMED: specimens to be collected at a SPECIFIC time (ex. - cardiac panels, antibiotic levels)

Front 32

Pro F.I.T. = ICED?

Back 32

ICED: Chilling specimen to SLOW DOWN metabolic processes (Ie - blood gases, ammonia levels) that continue after collection. Use CRUSHED or DRY ice.

Front 33

Pro F.I.T = Pro?

Back 33

PROTECTION from light: aluminum foil wrap or light blocking container to prevent light sensitive breakdown (bilirubin)

Front 34

Color coded collection tubes are for?

Back 34

the TYPE of specimen TO BE obtained [plasma, serum, whole blood] & type of ADDITIVE tube contains

Front 35

Can the order of the collection tubes used affect a blood draw?

Back 35

yes! There are rules to follow.

Front 36

Rules for ORDER of COLLECTION tubes;

Back 36

Sterile first, then tubes with NO anticoagulants, then tubes WITH anticoagulants.

Front 37

If only coagulation studies are being drawn, a plain _____-topped tube should be drawn first. WHY?

Back 37

RED for coagulation study only because CLEARS release of THROMBOPLASTIN from SKIN PUNCTURE (discard tube)

Front 38

Color of first draw tube?

Back 38

RED - sterile specimen for blood culture

Front 39

Color of second draw tube?

Back 39

RED/GREY MARBLED, or JUNGLE top - called the SST [Serum Seperator Tube]

Front 40

Color of third draw tube?

Back 40

LAVENDER (EDTA) drawn last because it contains ANTICOAGULANT

Front 41

Tube color if ONLY COAGULATION study to be done?

Back 41

RED = clears thromboplastin

Front 42

Additive of lavender tube that prevents clotting by removing calcium

Back 42

EDTA should be WELL mixed - inverted 6-8 times.

Front 43

Additive of red tube

Back 43

none!

Front 44

Additive of red/marbled tube

Back 44

gel separator/clot activator that should be inverted 5 times to expose blood to activator. Centrifuged after clot formation complete.

Front 45

The larger the gauge of the needle, the smaller the

Back 45

diameter

Front 46

Most commonly used needle

Back 46

21 g. by 1.5 inch needle

Front 47

A lancet penetration should never exceed ____ mm in depth

Back 47

2.4mm

Front 48

Why should a tourniquet NEVER be left on longer than 1 minute?

Back 48

Pressure from tourniquet causes biologic ANALYTES to LEAK out of the cells into the blood (contamination)

Front 49

We used alcohol for blood draw. When is IODINE used?

Back 49

Blood CULTURES and ALCOHOL levels

Front 50

Should a new pair of gloves be worn for each patient?

Back 50

Yes, of course.

Front 51

3 primary veins involved in venipuncture

Back 51

Cephalic, basilic/basilar, median cubital

Front 52

Vein of choice

Back 52

MEDIAN CUBITAL in area of antecubital fossa...Usually easiest to access and anchored best.

Front 53

Why use a tourniquet at all when choosing a vein?

Back 53

Causes VENOUS STASIS and VASODILATION, making vein selection easier

Front 54

The result of leaving a tourniquet on too long (longer than 1 minute) causes two things:

Back 54

HEMOCONCENTRATION (increased local cellular release of metabolic waste products) and PATIENT DISCOMFORT

Front 55

What fingers do you use to palpate a vein?

Back 55

tips of index or middle fingers for size, depth and direction of vein

Front 56

Before doing venipuncture, what should you ask your patient?

Back 56

NAME! State full name and identification number

Front 57

Tourniquet is applied ___-___" above intended site

Back 57

3-4"

Front 58

The needle is _______-up and collection tube is _______-down.

Back 58

bevel up, label down

Front 59

When to release tourniquet after blood draw has begun?

Back 59

After LAST TUBE BEGINS TO FILL

Front 60

Should you recap a used needle?

Back 60

NO!!! NEVER.

Front 61

When should you label draw tubes and with what information?

Back 61

AFTER blood draw. FULL NAME, IDENTIFICATION NUMBER (birthday), DATE AND TIME

Front 62

vasovagal syncope

Back 62

fainting upon blood draw due to emotional stimuli

Front 63

Hematoma

Back 63

blood leaks from vein into the surrounding tissue, resulting in a purple bruise

Front 64

An increase in analytes in the blood due to a shift in water balance. The tourniquet or massaging can cause this.

Back 64

HEMOCONCENTRATION (increased local cellular release of metabolic waste products) and PATIENT DISCOMFORT

Front 65

The damaging or breakdown of red blood cells with the release of hemoglobin into the specimen.

Back 65

Hemolysis/Lipemia/Improperly filled tubes/Specimen contamination

Front 66

COPPER SULFATE screening method is for

Back 66

Hemoglobin - the carrier protein of O2 and CO2 [~95% of RBC protein]

Front 67

Test used to screen for ANEMIA because it is most sensitive

Back 67

COPPER SULFATE test for hemoglobin

Front 68

Normal values of hemoglobin in copper sulfate screen to test for anemia

Back 68

males 13.2-1.3, Females 11.7 - 15.5 g/dl

Front 69

HEMATOCRIT

Back 69

The PERCENTAGE of blood volume occupied by RBC's (packed cell VOLUME)

Front 70

How to calculate Hematocrit?

Back 70

For anemia: after spinning capillary tube, measure height in mm. of column of blood (plasma & cells) = A; height of RBCs = B so B/A x 100 = HCT%

Front 71

Normal hemocrit (HCT%) for males and females:

Back 71

males 39 - 49%, Females 35 - 45%

Front 72

ESR is a ______________ measure of INFLAMMATION.

Back 72

NON-specific

Front 73

Normal ESR values

Back 73

males 0-15 mm/hr, Females 0-20 mm/hr. RBC's are NEGATIVELY charged and REPEL each other = ZETA POTENTIAL.

Front 74

When ZETA POTENTIAL breaks down, what happens to RBC's?

Back 74

Stack up like coins = ROULEAUX formation. These rouleaux have weight and the stacked coin RBC's, normally neg/zeta, now settle out of plasma.

Front 75

How to tell the level of INFLAMMATION (inflammatory proteins) like fibrinogen?

Back 75

During ESR, zeta potential is broken down by increased inflammation, causing normally repellant RBC's to stack in rouleaux and precipitate to bottom.

Front 76

The precipitation of normally repellant/zeta RBC's due to inflammation is called testing the?

Back 76

Erythrocyte Sedimentation Rate [ESR] as a non-specific indicator of inflammation

Front 77

2 main blood grouping systems:

Back 77

ABO & Rh

Front 78

Describe ABO system of blood grouping

Back 78

A,B, AB and O groups due to AUTOSOMAL CO-DOMINANT GENETIC EXPRESSION (gene from mom & dad are = expressed)

Front 79

The 4 main erythrocyte (RBC) groups are genetically determined by

Back 79

TWO ANTIGENS, A & B, and their presence on or their absence from the RBC membrance

Front 80

What two criteria must be present when we consider blood typing for the purpose of donating or receiving blood?

Back 80

both ABO and Rh type - these 2 components MUST be COMPATIBLE between donor and recipient when transfusing

Front 81

Phenotype A

Back 81

Genotype: AA, AO / Antigen: A / Antibodies: anti-B / Receive: A,O / Donate: A, AB / Population: 40%

Front 82

Phenotype B

Back 82

Genotype: BB, BO / Antigen: B / Antibodies: anti-A / Receive: B,O / Donate: B, AB / Population: 11%

Front 83

Phenotype AB

Back 83

Genotype: AB / Antigen: A & B / Antibodies: NONE! / Receive: ALL - universal recipient / Donate: AB ONLY / Population: 40%

Front 84

Phenontype O

Back 84

Genotype: OO / Antigen: NONE / Antibodies: anti A & B / Receive: O ONLY / Donate: all - UNIVERSAL DONOR / Population: 45%

Front 85

The O-gene represents the lack of either A or B antigens. Why?

Back 85

There is no O antigen so there is no A or B antigen in type O blood.

Front 86

When TRANSFUSING blood, you are giving?

Back 86

PACKED RBC's. The plasma which contains any antibodies has been REMOVED.

Front 87

Why should you consider what ANTIGENS are on the DONOR'S RBC's? What else should you consider in transfusion?

Back 87

Because the plasma which contains protective antibodies has been removed from the donor blood. Only donor antigens will react w/ recipient's antibodies if incompatible, causing HEMOLYSIS.

Front 88

Genetic/inherited blood types are called

Back 88

autosomal co-dominant: Blood types A & B can be either homozygous (AA,BB) or heterozygous (AO,BO). Ergo, sometimes kids have different blood types than parents (chi square)

Front 89

What possible blood types can the children of a type A mom and type AB father have?

Back 89

mother homozygous: 50% type A, 50% type AB… mother heterozygous: 50% type A, 25% type AB, ***25% type B

Front 90

Which transfusion-transmitted disease carries the greatest risk?

Back 90

Heppy B

Front 91

There are more than 40 antigens associated with this system. Despite its complexity, blood banks only care about its 5 MAJOR anitigens:

Back 91

Rh System: D, C, c, E, e

Front 92

For our purposes regarding the Rh system, we will only discuss the ____ antigen

Back 92

D

Front 93

Rh positive antigen

Back 93

D

Front 94

Rh negative antigen

Back 94

D

Front 95

Why is “D” used to signify someone as Rh positive?

Back 95

“D” is for Dominant – you only need one parent with the Rh gene that produces D antigen

Front 96

Like the O gene represents lack of either A or B antigen, the “d” gene represents lack of the D antigen, because there is no ___ antigen.

Back 96

D

Front 97

The D gene is extremely antigenic. What does that mean?

Back 97

It produces a VERY STRONG immunologic response (at 37 deg body temp). The anti-D antibody we produce is VERY STRONG.

Front 98

Remember you are considering the donor's RBC ________ and the recipient's _______

Back 98

Donor = antigens, Recipient = antibodies

Front 99

Rh pos [D] phenotype has ____ & ____ genotype, and makes ____ antigens. Does Rh positive [D] produce antibodies?

Back 99

Rh positive phenotype has DD & Dd genotype, D-antigens and produces NO antibodies. Pt can therefore receive Rh (+) OR (-) blood.

Front 100

the Rh positive patient can receive either (+) or (-) blood but can only donate?

Back 100

Rh positive. This is 85% of the population.

Front 101

the Rh neg (d) phenotype has ___ genotype and makes ____ antigens. Does Rh negative (d) produce antibodies?

Back 101

Rh negative phenotype has dd genotype, NO antigens itself and produces anti-D antibodies {IgG}. Pt can only receive Rh (-) blood.

Front 102

The Rh negative patient can only receive Rh ____ blood but can donate?

Back 102

Rh negative blood but can donate to either Rh (+) or (-) recipients because Rh neg donors don't make any antibodies that would attack the recipient.

Front 103

Percentage of Rh negative people?

Back 103

15.00%

Front 104

Hemolytic disease of newborn where second baby is exposed to mother's new Rh pos/anti-D that crosses the placenta and hemolyzes baby's RBC's

Back 104

Erythroblastosis Fetalis = acquired Rh pos/anti-D status by mother from her first child (via father's Rh pos/D gene) that screws subsequent siblings.

Front 105

cure for Erythroblastosis fetalis

Back 105

RHOGAM – the anti-D given to mother by intramuscular injection; removes baby's D antigen circulating in mother's blood before mother's body attacks w/ anti-D (Rh neg)

Front 106

RHOGAM must be given to the mother within the first ____ hours post partum

Back 106

72 – it is also given at 28 weeks gestation (Placenta Previa)

Front 107

Is it possible for Rh neg mother (d) and Rh positive father [D] to have an Rh neg child?

Back 107

Yes, if father is heterozygous 50% chance. Rhogam still given at 28 wks. Gestation since baby's blood type unknown, but not after birth.

Front 108

If father is homozygous for Rh pos [D] but mother is Rh neg, can baby be negative?

Back 108

No. D stands for Dominant

Front 109

dermal puncture procedure (lancet) is also called

Back 109

microcollection

Front 110

Recommended site for dermal puncture is

Back 110

palmar surface of distal phalanx of ring or middle finger in central fleshy area to either side of pad, perpendicular to fingerprint

Front 111

Always ? When collecting capillary blood from dermal finger/heel puncture

Back 111

wipe away first drop to prevent contamination of residual alcohol and introduction of excess tissue fluid

Front 112

Most common test used to evaluate circulating blood cells

Back 112

CBC

Front 113

WBC count

Back 113

blood sampled directly from tube, mixed w/ lysing reagent that removes RBC's from solution and strips WBC's of membrane. Nuclei then counted by electrical impedance or light scattering methods.

Front 114

LEUKOCYTOSIS

Back 114

an increase in the # of circulating WBC's greater than 11,00/mm3

Front 115

LeukoPENIA

Back 115

a DECREASE in the # of circulating WBC's less than 4000/mm3 (penia means 'little' – go figure)

Front 116

RBC count = blood is sampled directly from tube and DILUTED; cells counted by

Back 116

electrical impedance or light scattering methods.

Front 117

Hgb

Back 117

Hemoglobin: blood sampled directly from tube, reagent lyses RBCs and form cyanomethemoglobin = read directly by ability to ABSORB light.

Front 118

RBCs are _______ discs whose main function is transport of _____ for delivery of Oxygen to cells

Back 118

biconcave, Hgb (90%). Lack cellular organelles. Life span = 120 days

Front 119

ERYTHROCYTOSIS

Back 119

an increase in the # of circulating RBCs

Front 120

A decrease in the total number of circulating RBC's is consistent with

Back 120

anemia! (also low H & H)

Front 121

Hct

Back 121

Hemocrit: calculated parameter based on RBC and MCV values...Hct = MCV x RBC/10

Front 122

What are the 3 RBC indices?

Back 122

MCV, MCH, MCHC

Front 123

MCV

Back 123

Mean Cell Volume: the SIZE of an RBC, based on the volume of the cell.

Front 124

RBC's that have a normal MCV

Back 124

NORMOcytic

Front 125

RBC's that have a LOW MCV, usually due to LOW Hgb production

Back 125

MICROcytic

Front 126

RBC's that have a HIGH MCV, usually due to a DEFECT in RBC maturation

Back 126

MACROcytic

Front 127

MCH

Back 127

Mean Cell Hemoglobin – the WEIGHT of Hgb in average RBC, expressed in pico de gyo grams MCH = Hgb x 10/RBC x 10 to 6th power

Front 128

MCHC

Back 128

Mean Cell Hemoglobin Concetration of Hgb per unit volume of RBC's. Expressed as a percentage. Hgb x 100/ HCT

Front 129

RBCs that have normal MCH and MCHC

Back 129

Normochromic

Front 130

RBCs that have low MCH and MCHC

Back 130

Hypochromic

Front 131

RBCs that have high MCH and MCHC

Back 131

Hyperchromic

Front 132

RDW

Back 132

the measure of degree of uniformity of size and shape. Can only have a positive value

Front 133

PLT

Back 133

Platelets/Thrombocytes = sampled directly from tube. Platelets are counted for RBC distribution

Front 134

Platelets are produced from

Back 134

megakaryocytes

Front 135

Where do megakaryocytes live and what do they make?

Back 135

Bone marrow – make platelets

Front 136

Platelets primary roles

Back 136

Hemostasis & vascular integrity. Live 8-10 days in circulation, once released from bone marrow by megakaryocyte parents.

Front 137

Decrease in number of platelets

Back 137

thrombocytoPENIA (penia means small – go figure)

Front 138

Increase in number of platelets

Back 138

thrombocytOSIS

Front 139

MPV

Back 139

Platelet SIZE

Front 140

MPV increased

Back 140

platelet size increased in cases of non marrow cause when the # of platelets decreases. Compensation as marrow produces younger, larger platelets to compensate.

Front 141

MPV decreased

Back 141

When there is LACK of bone marrow function, the megakaryocytes are small and therefore, so are their products = the platelets.

Front 142

PDW

Back 142

Platelet Distribution Width is a measure of degree of uniformity of size of platelets (standard deviation of MPV)

Front 143

gives relative numbers of lymphocytes, monocytes, neutrophils, eosinophils and basophils

Back 143

AUTOMATED DIFF (Differential WBC count)

Front 144

A peripheral blood smear is used to conduct a

Back 144

MANUAL WBC differential

Front 145

What kind of stain used on WBC's during manual WBC differential

Back 145

Wright stain – use the wright stain!

Front 146

How is the absolute number of WBC's obtained using a Wright stain?

Back 146

The number of each [NLMEB] is counted out of 100 (this is the relative # %), then % multiplied by total WBC count

Front 147

WBC that protects body from INFECTION by phagocytosing bacteria and foreign organisms. Defense, Trash removal.

Back 147

Neutrophils

Front 148

percentage of Neutrophils

Back 148

60-70%

Front 149

Protect body by ingesting PARASITES and limiting ALLERGIC reaction

Back 149

Eosinophils 2-5%

Front 150

HYPERSENSITIVITY reactions by releasing HISTAMINE and HEPARIN granules

Back 150

Basophils 10-15%

Front 151

Provide recognition and elimination of foreign bodies. Secrete ANTIBODIES

Back 151

Lymphocytes 20-30%

Front 152

HUMORAL immunity

Back 152

B-lymphocytes = make antibodies in response to antigen

Front 153

CELLULAR immunity

Back 153

T-lymphocytes = tumor suppression, graft rejection, delayed hypersensitivity, humoral immune reactions via B-cell suppression, colony stimulating factors

Front 154

Name 3 things T-cells do

Back 154

tumor suppression, graft rejection, delayed hypersensitivity, humoral immune reactions via B-cell suppression, colony stimulating factors

Front 155

Phagocytosis of bacteria, fungi, dead viruses and dying cells. Help NEUTROPHILS. ANTI-TUMOR agents. Self vs. Non self.

Back 155

Monocytes = also produce antigens for lymphocyte recognition and secrete cytokines and complements

Front 156

All blood smear reports should contain a _______ # estimate.

Back 156

Platelet

Front 157

There are 5-25 platelets in an average oil immersion field. How to get the # per mm3?

Back 157

Multiply by 20,000. Report any evidence of platelet aggregation/clumping.

Front 158

lymphocytes and monocytes

Back 158

Agranulocytes

Front 159

Peripheral smears are good for observing RBC size and shape, chronicity (color) and

Back 159

intracellular inclusions

Front 160

Anisocytosis

Back 160

SIZE variations in RBC's due to pathologic finding. Indicates change in MARROW FUNCTION. Non specific. Increased RDW

Front 161

Normocytic

Back 161

normal size and volume of RBC w/ normal MCV, though still might be anemic

Front 162

Microcytic

Back 162

describes RBC with decreased size and decreased MCV (iron deficient anemias, thalassemias and secondary anemias)

Front 163

Macrocytic

Back 163

Increased RBC size and increased MCV (vitamin B12 and folate deficiency and hepatic disease)

Front 164

Polychromic

Back 164

Basophilia = bluish tinted RBCs. The amount of basophilia is related to the MATURITY of the cell. BASOPHILIA – MATURITY – BLUE

Front 165

Normochromic

Back 165

normal coloration of RBC w/ darker outer rim and central pallor (biconcave). Normal MCH and MCHC.

Front 166

HypOchromic

Back 166

Low Hemoglobin content and so appears PALE. Low MCH and/or MCHC = iron deficiency anemias and hemoglobinopathies

Front 167

Hyperchromic

Back 167

oversaturated Hgb in RBC so very red, no pale center. High MCH and MCHC. B12 and folate deficiency

Front 168

Poikilocytosis

Back 168

variations in shaPe...should include what shapes!

Front 169

Case study #1 with elevated WBC, MCHC and Neutrophils, but low Lymphocytes

Back 169

MCHC is b/c he is aerobic exerciser so ok. RAISED WBC = LEUKOCYTOSIS and hyperchromic so neutrophils responding to bacterial infection. Test for strep pyogenes

Front 170

Universal recipient?

Back 170

AB+

Front 171

Donor's RBC _________ and recipient's _________

Back 171

Donor = antigens, Recipient = antibodies

Front 172

Hct equation

Back 172

B/A x 100 = Hct where B is Blood on bottom of tube and A is All of tube

Front 173

Low Hct means

Back 173

anemia! (also low H & H)

Front 174

High Hct means

Back 174

polycythemia (like thalassemia)

Front 175

Increased ESR means

Back 175

inflammation.

Front 176

ESR cannot be

Back 176

low

Front 177

Case stude #2 Low WBC, Low Neutrophils and High Lymphocytes. Maisy Turk fatigue lethargy low grade fevers

Back 177

INVERTED DIFF means VIRAL infection (low WBC/Neutrophils, high Lymphocytes). Leukopenia = low WBC. Atypical lymphocytes = CDA + T-lymphs

Front 178

Case study #3 Anthony Mylan no complaints High RBC (erythrocytosis) Low MCV and MCH, high RDW.

Back 178

Thalassemia. Anthony is probably Sicilian. Erythrocytosis, Microcytic and hypochromic cells. Thalassemia minor so do Hgb ELECTROPHORESIS.