Hematology Exam 4

Front 1

how many primary squares are there in a hemocytometer

Back 1

9

Front 2

how many secondary squares are in one primary square

Back 2

25

Front 3

how many tertiary squares are in a secondary square

Back 3

16

Front 4

Manual cell calculation

Back 4

Average # cells X dilution X 10 (depth)

divided by--------------------------------------

# of primary squares

Front 5

which squares and how many do you count for:

WBC

RBC

plts

Back 5

WBC: 4 primary

RBC: 5 secondary

PLT: 10 secondary

Front 6

What are the dilution factors for

WBC

RBC

PLT

Back 6

WBC: 1:100

RBC 1:200

PLT: 1:100

Front 7

What component in unopette lyses RBC?

Back 7

ammonium oxalate

Front 8

scientific notation for:

WBC

RBC

PLT

Eos

Back 8

WBC: one decimal X 10^3 (4.4-11.0)

RBC: two decimals X 10^6 (4.00-5.90)

PLT: no decimal X 10^3 (150-400)

Eos: whole # (542/mm^3)

Front 9

The error range on two counts on a hemocytometer need to be how close to each other?

Back 9

+/- 10%

Front 10

Hgb determination: cyanmethemoglobin method

Reagent:

Components:

What absorbance is used?

Back 10

Reagent: Drabkins

Components:

1. potassium ferricyanide (oxidizes Hgb to methemoglobin - ferric +3 state)

2. potassium cyanide converts methemoglobin to cyanmethemoglobin

Abs at 540nm

Front 11

What is the calculation for hemoglobin concentration using the cyanmethemoglobin method?

Back 11

make sure to have the concentration value in g/dL in calc

Front 12

how do you calculate the dilution factor

Back 12

total volume/sample volume

Front 13

Hemoglobin reference ranges for male and female

Back 13

male: 13.5-17.5

female: 12.0-16.0 g/dL

Front 14

T/F: drabkins reagent is sensitive to light

Back 14

True

Front 15

and icteric sample has too much what in it

Back 15

bilirubin

Front 16

what is an example of an abnormal Hgb that is resistant to lysis

Back 16

Hgb S and C

Front 17

what is a safer alternative to the cyanmethemoglobin method for hemoglobin determination.

HOW is it different?

What Abs is used?

Back 17

SLS: Sodium lauryl sulphate

Lysis BOTH RBC and WBC. Hgb is oxidizes to ferric +3 state and then combines with SLS to be a hemochrome mol

Abs at 555nm

Front 18

what is the def'n of hematocrit

reference ranges for male/female:

Back 18

percentage of whole blood that is occupied by RBCs (always done in duplicate)

male: 41-53%

female: 36-46%

Front 19

rule of three:

what is it used for?

Back 19

RBC x 3 = Hgb

Hgb x 3 = Hct

4, 12, 36

Used to verify the integrity of the sample

Front 20

What are the RBC indices?

Back 20

MCV, MCHC, RDW

Front 21

MCV: Mean cell volume

def'n:

calculation:

Ref range: ____ - _____ units?

Back 21

Def'n: ave size of RBC (indicator of micro/macrocytosis)

calculation: Hct x 10 / RBC in millions

Ref. range: 80-96 fL

Front 22

Mean cell hemoglobin (MCH)

def'n:

calculation:

Ref range: ____ - _____ units?

Back 22

Def'n: ave weight of Hgb per RBC (does NOT indicate chromia)

calculation: Hgb x 10 / RBC (in millions)

Ref range: 29-32 pg

Front 23

Mean cell hemoglobin (MCHC)

def'n: ....indicates

calculation:

Ref range: ____ - _____ units? don't need to memorize.

Back 23

def'n: average amount of red cell volume occupied by Hgb... indicates normo or hypochromia

calculation: (Hgb / Hct) x 100

Ref range: 33.4-35.5 g/dL

Front 24

Low MCV and Low MCHC =

Back 24

Hypochromic and microcytic

Front 25

MCHC

What are the "critical" high and low to remember?

Back 25

< 30 should not occur

>36 should not occur unless you have spherocytes .... lost membrane, normal Hgb, low Hct

Front 26

causes of a high MCHC >36 besides spherocytes

Back 26

cold agglutinin

lipemia (turbidity)

hemolysis (free hgb)

icteric (bilirubin abs)

Front 27

Red cell distribution width (RDW): CV

def'n... it quantitates...

ref. range:

Calculated:

Back 27

def'n: amount of red cell size variation, quantitates anisocytosis

ref. range: 11.5-15.0 g/L

directly calculated from RBC histo

= 1 SD/MCV x100%

Front 28

Red cell distribution width (RDW): SD

calculated using:

ref. range

Back 28

calculating the width in fL at the 20% height level on the RBC curve

ref. range: 39-47 fL

Front 29

last immature stage in RBC dev:

characteristics:

Back 29

reticulocytes. its right before it loses its nucleus

spends two days in marrow, and one day in peri

contains remnant cytoplasmic RNA

Front 30

what stain is used for retics

Back 30

supravital stain (New Methylene Blue)

Front 31

what does the reticulocyte count measure?

increased:

decreased:

Back 31

measures erythropoietic activity of the bone marrow

increased: bone marrow compensating

decreased: bone marrow lacks RBC to release to circulation

Front 32

how many "dots" does a reticulocyte need to be considered a reticulocyte?

Back 32

more than 2 dots

Front 33

if you counted 60 retics, what is the percent?

Back 33

6.0%

Front 34

how do you perform a retic count using a miller disc

Back 34

Count # of red cells AND reticulocytes in small square

count # of retics in the big square

Count until you get 111 in the small square, divide by 10

Front 35

how to calculate a corrected retic count...

what does it correct for?

when do you correct?

Back 35

Corrected reticulocyte count corrects for an abnormal hematocrit value

Retic % = raw retic % x (pt. Hct / 45)

Correct anytime the pts Hct is less than 45 (they have anemia)

Front 36

reticulocyte production index (RPI) def'n:

calculation:

Back 36

reticulocytes produced on a daily basis

calculation: corrected retic / # d to mature

for every 2% Hct deviation from 45% the maturation rises 0.1 days.

>3.0% is an adequate response

Front 37

Reference range for raw retic, corrected retic, and RPI

Back 37

0.5-1.5% NORMAL

Front 38

how long do RBC survive normally

Back 38

120d

Front 39

erythrocyte sedimentation rate (ESR)

Back 39

Rate of RBC settling in 1 hour mm/hr

directly proportional to RBC mass

(heavier = faster = more Hgb). inversely proportional to plasma viscocity (more viscous = slower)

Useful for monitoring disease or differentiating btwn similar diseases

Front 40

How do the following affect ESR:

Albumin

zeta potential

fibrinogen, globulins

Back 40

Albumin: decreases it.. more viscous

zeta potential: decrease it... RBC repel each other

proteins: increases it cause they cover up neg. charges

Front 41

ESR ref ranges

Back 41

male: 0-20

female: 0-30

Front 42

Ref. range:

MCV

MCH

MCHC

Back 42

MCV: 80-96 fL

MCH 29-32 pg

MCHC: 33.4-35.3 g/dL

Front 43

MCHC # < _______ = hypochromasia

MCV > ____ = macrocytic

MCV < ____ = microcytic

Back 43

MCHC <32 = hypochromasia

MCV >100fL = macrocytic

MCV <80fL =microcytic

Front 44

Coulter principle:

threshold is..

the area between thresholds is called

Back 44

thresholds are the set limit, the area between them is a channel

Front 45

Abnormal RBC histogram

Back 45

Cold agglutinin

Front 46

NORMAL

Back 46

Most RBCs fall between 80 and 100fl. The histogram should start at thebaseline on the left and a small “tail” may be evident on the right. This represents doublets and triplets (cellsthat go through the aperture in twos and threes).

Front 47

Abnormal RBC histogram

Back 47

MACROcytosis, target cells

Front 48

Abnormal RBC histogram

Back 48

Dimorphic RBC population, high RDW, anisocytosis, post-transfusion

Front 49

Abnormal RBC histogram

Back 49

Giant plt, RBC fragments

Front 50

NORMAL PLT histogram

Back 50

The PLT histogram has twocurves. One is the curve created fromthe directly measured PLT count and the other is Coulter’s patented curvefitting process which allows an accurate PLT count without interference from microcyticRBC or RBC fragments.

Front 51

Back 51

NORMAL WBChistogram. LBMEN. The lymphocytes (smallest cell) fall to the far left of the histogram. The lymphs are followed by the Basos,MonosEos and Neutrophils. Basophilic granules are water soluble, lose some of the granules when the basophils are put in solution. When this happens, the cell cytoplasm shrinksdown around the nucleus and the few remaining granules and makes the cellappear smaller than it is in vivo.

Front 52

Back 52

Immature neutrophils

Front 53

Back 53

Lymphocytosis, literally no other cell types

Front 54

Back 54

Varient lymph (reactive lymph) the peak is slightly shifted over to the right

Front 55

Back 55

immature neutrophil = shift to the left

Front 56

Back 56

Eosinophila, they are in the neutrophil range

Front 57

Back 57

Blasts

Front 58

In VCS tech, the following measures...

(Y) VOLUME=

(Z) CONDUCTIVITY=

(X) LIGHTSCATTER =

Back 58

VOLUME= SIZE

CONDUCTIVITY= INTERNAL COMPOSITION

LIGHTSCATTER = CELL SHAPE / SURFACE

Front 59

Back 59

NORMAL data plot

Front 60

Back 60

Front 61

Back 61

The strange “blip” at the end ofthe PLT histogram is indicative of very microcytic RBCs and RBC fragments thatare small enough to get in under the 20fl cutoff. In this instance it would be important toverify the PLT count.

Front 62

Back 62

Auer rods aredefined as acoalescence ofthe azurophilicgranules and areonly seen in non-lymphocyticleukemias

Front 63

MYELOPROLIFERATIVE DISORDERS

Back 63

Defined as a hypercellular bonemarrow with increased quantities of one or more of the cells lines:erythrocytes, leukocytes or platelets in the peripheral blood. It is thought to be a neoplastic, clonalproliferation of a single multipotential stemcell w/ one cell line predominating and often transforming into another.

Front 64

Sysmex - WBC. Measurethe forward scatter, side scatter and side fluorescence of the WBC populations

Back 64

Measurethe forward scatter (SIZE), side scatter (internal structure) and side fluorescence (RNA/DNA info) of the WBC populations

Front 65

Placementof cells in the scattergram is based on the size (forward scatter),internal composition (side scatter)

Back 65

Front 66

diff scatter.. memorzie locations

Back 66

Front 67

Sysmex-Hemoglobin uses what method

Back 67

SLS. Step one is denaturation of theglobin molecule. Step 2 is oxidation of the hememolecule. Finally Step 3 where the SLShemoglobin is converted to SLS hemoglobin which is read photometrically.