Manual Hematology

  1. what is the purpose of a CBC?
    • monitor blood and tissue
    • monitor overall general wellbeing
  2. what is the purpose of the microhematocrit determination?
    measure packed red cell volume
  3. In this test EDTA whole blood is centrifuged and total PCV is exprssed as a percentage of whole blood volume.
    microhematocrit determination
  4. This layer of blood contains H2O, electrolytes, glucose, fats, proteins, gasses and clotting factors.
    Plasma layer
  5. this is the layer where leukocytes and platelets are present.
    buffy coat layer
  6. this is the layer used to determine HCT known as the packed cell volume.
    red blood cell layer
  7. how full should you fill capillary tubes?
    three fourths of the way
  8. how long should microhematocrit samples be centrifuged for?
    5 minutes at 14,500rpm
  9. duplicates of microhematocrit should be within ____.
  10. how do you report microhematocrit determination results?
    • average the duplicate results
    • report as a percentage
  11. microhematocrit reference values
    Adult male:
    adult female:
    infant child:
    • adult male: 42-52%
    • adult female: 37-47%
    • infant child: 30-43%
    • newborn: 53-65%
  12. What are four conditions increased HCT can be seen in?
    • polycythemia
    • dehydration
    • high altitudes
    • COPD
  13. what four conditions decreased HCT can be seen in?
    • anemia's
    • hemorrhage
    • vitamin or mineral deficiency
    • pregnancy
  14. what are six sources of error for microhematocrit determination?
    • intersitial fluid
    • incomplete sealing
    • buffy coat
    • force stop
    • hemoconcentration
    • medication
  15. The purpose of this test is to screen for anemia in conjunction with the HCT and RBC count.
  16. what is the main component of RBC's?
  17. this transports oxygen to and CO2 from body tissues.
  18. all forms of circulating hemoglobin (except sulfhemoglobin) readily convert to ________.
    cyanmethhemoglobin (HiCN)
  19. what is the reagent that oxidizes Hgb to methemoglobin by potassium ferricyanide?
    drabkin's reagent
  20. methemoglobin converts to ____________ in presence of potassium cyanide.
  21. what is the machine used to perform a hemoglobin test?
  22. hemoglobin normal reference values
    adult male:
    adult female:
    • adult male: 14-17 g/dL
    • adult female: 12-16 g/dL
    • newborn: 17-23 g/dL
    • infant: 9-14g/dL
  23. decreased Hgb can be seen in what two conditons?
    • anemia
    • excessive bleeding
  24. increased Hgb can be seen in what two conditons.
    • polycythemia
    • dehydration
  25. what are five sources of error in Hbg?
    • drabkin's reagent in direct sunlight
    • Hgb C and Hgb S
      tech error
  26. Why would Hgb C and Hgb S be sources of error in Hgb testing?
    • yield turbid solution
    • fail to lyse red cells
  27. The purpose of this test is to detect leukopenia or leukocytosis and to monitor progress of diseases.
    WBC count
  28. what is the methodology of a WBC count?
    unopette method
  29. what are the three components of the diluent in an unopette?
    • buffered ammonium oxalate
    • sorensen's buffer
    • thimerosal
  30. what is the purpose of buffered ammonium oxalate in an unopette?
    • dilutes sample
    • lyse RBC's
    • perserves WBC's, Plt's, retics, and NRBCs
  31. what is the purpose of sorensen's buffer in an unopette?
    maintain pH of reagent
  32. what is the purpose of thimerosal in an unopette?
    acts as an antibacterial agent
  33. what volume does the unopette capillary pipet hold?
    20 microliters
  34. What is the device used to perform a WBC and platelet count?
  35. how many primary squares are there in a hemacytometer?
  36. where do you perform an erythrocyte count in a hemacytometer?
    four coner and center secondary squares of center primary squares
  37. where do you perform a leukocyte count on a hemacytometer?
    four corner primary squares
  38. where do you perform a platelet count on a hemacytometer?
    25 secondary squares of center primary square
  39. what is the normal reference values for WBC count
    • Adult: 4.8-10.8x103/mm3
    • Newborn: 9.0-30.0x103/mm3
  40. Leukopenia is seen in what four conditons?
    • Radiation
    • Medication
    • Chemotherapy
    • idiopathic
  41. Leukocytosis is seen in what five conditions?
    • infections
    • leukemia
    • smoking
    • pregnancy
    • appendicitis
  42. to detect thrombocytosis and thrombocytopenia is the purpose of what test?
    platelet count
  43. normal reference value for platelet count
  44. thrombocytosis can be seen in what four condtions?
    • splenectomy
    • myeloprliferative disorders
    • acute blood loss
    • surgery
  45. thrombocytopenia can be seen in what three condtions?
    • decreased platelet production
    • increased platelet destruction
    • increased platelet sequestration
  46. what does ESR stand for?
    errythrocyte sedimentation rate
  47. to detect a nonspecific response to acute and chronic infection, inflammation, and tissue necrosis or infarction is the purpose of what test?
  48. what is the methodology for ESR?
    westergren method
  49. what test measures the rate RBC's fall in diluted human plasma?
  50. how long must the tube be allowed to stand in a vertical position undistuirbed in an ESR?
    one hour
  51. how do you report ESR results?
    • read the distance from the top of the tube to the plasma-red cell interface
    • report results using mm/hr as unit of measure
  52. normal reference values for ESR
    • Men: 0-15 mm/hr
    • Women: 0-20 mm/hr
  53. what type of ESR result would be seen in patients able to form rouleaux?
    increased ESR
  54. reading after ___ hours will falsely decrease ESR results.
    three hours
  55. what is the quality control for ESR.
    currently none required
  56. to determine the relative amount of effective erythopoiesis taking place in bone marrow is the purpose of what test?
    reticulocyte count
  57. what is the methodology for a reticulocyte count?
    new methyline blue method
  58. immature RBC's that still contain RNA and ribosomes are called what?
  59. ______ amounts of whole blood is incubated with new methylene blue for ___ minutes
    • equal
    • five minutes
  60. how may RBC's will you count when performing a reticulocyte count?
  61. how many discrete blue granules must be counted to call a RBC a reticulocyte?
  62. normal reference values for reticulocyte count
    • Adults: 0.5-2.0%
    • Newborns: 2.5-6.0%
  63. what are two conditions that increased retic counts may be seen?
    • hemolytic anemias
    • anemia
  64. what are two conditions that decreased retic counts may be seen in?
    • aplastic anemia
    • ineffective erythropoiesis
  65. The purpose of __________ is to serve as a quality control mechanism to check RBC count, Hgb and Hct measurements
    RBC Indices
  66. Average volume of RBC's in femtoliter (fL)
    Mean Corpuscular Volume (MCV)
  67. Average weight of Hgb in RBC's in picograms (pg)
    mean corpuscular hemoglobin (MCH)
  68. Average concentration of hemoglobin in each individual RBC in percent or grams/dL.
    Mean Corpuscular Hemoglobin Concentration MCHC
  69. A degree of cell size variation expressed in percent.
    Red Cell Distribution Width (RDW)
  70. formula for MCV
    MCV=(Hct)10/RBC Count
  71. Formula for MCH
    MCH=(Hgb)10/RBC Count
  72. Formula for MCHC
  73. formula for RDW
    RDW=SD of MCV/mean MCV
  74. normal reference value for MCV
  75. normal reference value for MCH
  76. normal reference value for MCHC
  77. normal reference value for RDW
    11.5 - 14.5%
  78. How do you interpret results of MCV?
    indicates size of RBC

    • normocytic
    • microcytic
    • macrocytic
  79. What does MCH indicate?
    Hgb content in RBC
  80. what can a decreased MCH be seen in?
    microcytic anemia
  81. what can an increased MCH be seen in?
    macrocytic anemia
  82. increased MCH can be seen in what?
    macrocytic anemia
  83. what does MCHC indicate?
    • concentration of Hgb in average RBC
    • central pallor
  84. what is the normal central pallor of a RBC?
    2-3 microns in diameter
  85. to provide additional information for the diagnosis of hematologic disorders in conjunction with the WBC, RBC and platelet counts is the purpose of what test?
    WBC Differential
  86. What is the definition f a WBC differential?
    the percentage of each type of WBC present in the blood
  87. what are the components of a WBC differential?
    • 100 WBC Diff
    • WBC Morphology
    • WBC estimate
    • Platelet estimate
    • RBC morphology
  88. When scanning a blood smear under 10x what do you check?
    • cell distribution
    • platelet clumps
    • abnormal looking cells
    • rouleaux formation
  89. When performing a WBC diff what do you check under 40x?
    WBC estimate
  90. how do you perform a WBC estimate?
    under 40x count the number of WBC's in ten fields and devide by 10
  91. average WBC/HPF equates to how many estimated total WBC/mm3

    • average WBC/HPF =Total WBC/mm3
    • 2-4 = 4000-7000
    • 4-6 = 7000-10000
    • 6-10= 10000-13000
    • 10-20 = 13000-18000
  92. when performing RBC morphology what do you check?
    • anisocytosis
    • poikilocytosis
    • hypochromasia
    • polychromasia
    • RBC inclusion
  93. if there are more than 10 NRBC's in your peripheral blood smear what is the formula to correct the WBC count?
    (WBC x 100)/(100+NRBC)
  94. how would you report Megakaryocytic cells, smudge cells, or epithelial cells?
    list and report as #/100 WBC
  95. how is a platelet estimation performed on a WBC differential?
    under oil immersion count all platelets in 10 fields and devide by 10.
  96. how is a platelet estimation reported?
    report as adequate, increased, decreased, or clumped
  97. if platelet estimated differs from the automated count what should be checked?
    • check feathered edge for platelet clumps
    • check for platelet satelitism
  98. WBC Diff normal reference values
    • Segs: 40-80%
    • Band: 0-10%
    • Lymphs: 25-45%
    • Mono: 0-10%
    • Eosinophils: 0-7%
    • Basophils: 0-2%
  99. How are results reported for a WBC diff?
    • report out each type of WBC in %
    • annotate WBC morphology
    • annotate RBC morphology
    • annotate platelet estimation
  100. Neutrophilia is seen in:
    • Bacterial Infections
    • Chronic myelogenous leukemia (CML)
  101. Eosinophilia is seen in:
    • Allergic reactions
    • Parasitic infections
    • CML
  102. Basophilia is seen in:
    • Immediate hypersensitivity reactions
    • CML
  103. Lymphocytosis is seen in:
    • Viral infections
    • Chronic Lymphocytic Leukemia
    • infectious mononucleosis
  104. monocytosis is seen in:
    • tuberculosis
    • syphilis
    • monocytic leukemia
  105. what three things does CSF provide the CNS?
    • nutrients
    • removal of metabolic waste
    • cushion against trauma
  106. total volume of CSF
    • Adults: 140-170 ml
    • Neonates: 10-60 ml
  107. what five items is CSF examined for?
    • Color
    • Appearance
    • WBC count
    • RBC count
    • WBC Differential
  108. In CSF ________ in conjunction with a differential is useful in diagnosis of disease.
    Cell count
  109. What type of stain is used for a CSF differential
    wright stain
  110. how soon must a CSF differential be done
    within one hour
  111. CSF is collected in 3 plain sterile tubes. What is each tube used for?
    • Tube 1 for chemistry & serology
    • Tube 2 for microbiology
    • Tube 3 hematology
  112. between what vertebrae is a lumbar puncture performed?
    • 3rd and 4th lumbar vertebrae
    • 4th and 5th lumbar vertebrae
  113. what type of stain is used to perform a cell count on CSF?
    unna stain
  114. When performing a WBC count on CSF how where do you count the WBC's?
    in all 9 primary squares on both sides of the hemacytometer
  115. what is the formula to calculate the total WBC count in CSF?
    • WBC Count= average # of cells counted x 1.1
    • use mm3 as the unit of measurement
  116. true or false
    the same procedure is used in both the WBC count and RBC count in CSF
  117. what is the formula to detect added WBC due to traumatic tap in CSF?
    WBC added=(WBCblood x RBCcsf)/RBCblood

    WBC added - CSF WBC count= true CSF WBC count
  118. how do you report a CSF diff if <100 cells are counted?
    report the number of each cell
  119. normal reference values for CSF
    WBC count:
    RBC count:
    • color: colorless
    • appearance: clear
    • WBC: 0-5mm3
    • RBC: none seen
  120. normal reference values for CSF Diff
    • Lymphs: 70%
    • Monos: 30%
    • Segs: none to occasional
  121. how can you tell if xanthochromia is the result of intracranial hemorrhage?
    • blood is evenly distributed in all 3 tubes
    • no blood clots
    • CSF remains xanthochromic after centrifugation
  122. How can you tell if xanthochromia is the result of a traumatic tap?
    • Blood decreases from tube 1 thru 3
    • blood clots are present
    • RBC's form sediment when centrifuged
  123. if CSF is clotted but no blood is present what does that indicate?
  124. what are three causes of an increased WBC count in CSF?
    • Bacterial infection
    • viral infection
    • fungal infection
  125. What are three causes of increased neutrophils in CSF?
    • bacterial meningitis
    • early fungal and viral meningitis
    • cerebral hemorrhage
  126. what are two causes of increased lymphocytes in CSF?
    • multible sclerosis
    • all forms of meningitis
  127. what are two causes of increased moncytes in CSF?
    • TB
    • all forms of meningitis
  128. What are two causes of increased eosinophils in CSF?
    • parasitic infection
    • allergy
  129. what is a cause of a blast in CSF?
    Acute leukemia
  130. what are three results in CSF that require review?
    • NRBC
    • metastatic cancer cells
    • microorganisms
  131. what type of body fluid contains hyaluronate?
    synovial fluid
  132. what type of body fluid supplies nutrients to cartilage and acts as a lubricant for joints?
    synovial fluid
  133. what type of anticoagulant should be used on synovial fluid for a cell count or differential?
    EDTA or heparin
  134. why do you use a plain sterile tube for the viscosity and crystal exam on synovial fluid?
    because anticoagulants may crystalize and interfere with crystal ID
  135. what type of mycroscopy should be used for synovial fluid crystal exam?
  136. crystal exams must be run ASAP because of what two factors that affect crystal solubility in synovial fluid?
    temperature and pH
  137. what are the most common crystals seen in synovial fluid?
    • monosodium urate (MSU)
    • Calcium pyrophosphate dihydrate (CPPD)
  138. what is the appearance of MSU crystals?
    • needle shaped
    • negative birefringence
  139. how do CPPD crystals appear in polorized microscopy?
    • rod or rhombod shaped
    • positive birefringence
  140. normal reference value for synovial fluid
    WBC count:
    RBC count:
    • Color: pale yellow
    • Appearance: clear
    • WBC Count: 200-600/mm3
    • RBC count: none
  141. normal reference values for synovial fluid diff
    • Monos: =/> 75%
    • neutrophils: <25%
  142. what are two causes of an increased cell count in synovial fluid?
    • inflammation
    • infection
  143. what could cause an increased neutrophil in a synovial fluid diff
    septic condition
  144. what could cause an increase in lymphocytes in synovial fluid?
    non-septic inflammation
  145. why would inflammation cause a low viscosity in synovial fluid?
    inflammatory cells release enzymes that degrade hyaluronate
  146. what could cause the presence of MSU's in synovial fluid?
  147. what could cause the presence of CPPD in synovial fluid?
  148. what type of serous membrane lines cavity walls?
  149. what type of serous membranes covers organs within a cavity?
  150. The fluid between two serous membranes that is an ultrafiltrate of plasma is called what?
    serous fluid
  151. this type of serous fluid forms due to systemic disorders that result in a disruption of the balance in the regulation of fluid filtration and reabsorption.
  152. this type of serous fluid forms due to conditions directly involving the membranes themselves and results from inflammatory process
  153. what is the function of serous fluids?
    lubricates the surfaces of the serous membranes
  154. normal reference values for serous fluids
    WBC count:
    RBC count:
    • color: pale yellow
    • appearance: clear
    • WBC count: <1000/mm3
    • RBC count: none
  155. what are the predominant cells in serous fluid?
    mononuclears (monocytes, lymphocytes, mesothelial cells, macrophages)
  156. on a serous fluid diff what percent of your cells should be neutrophils?
  157. what could cause the following colors in serous fluid?
    yellow white:
    red brown:
    yellow brown:
    milky green:
    • Yellow white: inflammation
    • red brown: hemorrhage
    • yellow brown: bilirubin
    • milky green: chylous fluid
  158. what could cause an increased cell count in serous fluid?
    • infection
    • malignancy
  159. what could cause an increase in neutrophils in serous fluid?
    • sepsis
    • endocarditis
    • peritonitis
Card Set
Manual Hematology
manual hematology procedures 2.3