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Heme Final Part 1

MLS 310 with Ismail El-Amouri

Where does hematopoiesis take place from early fetal development to late fetal development and adult life? Yolk Sac (2wks-2months) Spleen and Liver (2-7months) Bone marrow (7months-birth and through adult life)
What are the purposes of making blood films? Quality Control Leukocyte diff and morphology evaluation Evaluation of red cell distribution Evaluation of red cell and platelet morphology
At what angle should your spreader slide be when making a blood film? 30-45 degrees
What is the criteria for a good blood film? Cover at least 2/3 to 3/4 of the slide Homogenous with no gaps or streaks No bullet shape (slightly curved) Later edges visible Should be easily labeled
What should you do to your blood film if the patient has a low red cell count? Blood is thin so raise the angle or increase the stroke speed
What should you do to your blood film if the patient has a high red cell count? Blood is thick so lower the angle and decrease the stroke speed
What should you do to your blood film if you have a large drop? Makes a longer, thicker smear. Raise the angle and increase the stroke speed
What should you do to your blood film if you have a small drop? Makes a shorter, thinner smear. Lower the angle and decrease the stroke speed.
What structures attract the basic blue dye? Acidic structures. DNA, RNA, immature or reactive cytoplasm, proteins, and acidic granules of basophils.
What structures attract the acidic red dye? The basic structures. Hemoglobin and basic granules in eosinophils
What causes a too dark or too blue stain? Prolonged staining Inadequate washing Stain too basic
What cause a too pale or too red stain? Insufficient staining Prolonged washing Stain to acidic
The WBC/field in the feather edge should be ______ times more then WBC/field in the exam area. < or equal to 4 times
How do you correct platelet satellitism. This reduces the PLT count so redraw into a sodium citrate tube.
What is the order of red cell maturation according to CAP? Pronormoblast Basophilic normoblast Polychromatic normoblast Orthochromic normoblast Polychromatic erythrocyte Erythrocyte
What is the order of red cell maturation according to ASCP? Rubriblast Prorubricyte Rubricyte Metarubricyte Reticulocyte Erythrocyte
Erythropoietin is produced by what organ? By the kidneys in response to tissue hypoxia
Under normal conditions retics spend how much time in the bone marrow and PB? 3 days in BM and 1 day in PB
Under abnormal conditions retics spend how much time in the bone marrow and PB? Less time in bone marrow, and more time in PB.
What stage of maturation marks the beginning of hemoglobinization? Polychromatic normoblast
When should you do a corrected WBC count? When there are 5 or more nRBCs. nRBCs increase the leukocyte count because they get mistaken for WBCs
How do you calculate corrected WBC? (Count x 100)/(# of nRBCs + 100)
What is rouleax? RBCs look like a stack of coins. Caused by abnormally high ration of serum proteins such as globulins and fibrinogen
What is agglutination? RBCs are clumped. Caused by presence of cold antibodies (IgM) This causes your RBC count and Hct to be lower, and your MCV will be higher
What is a normal MCHC? 32-36% g/dL
What is hypochromasia? When the central pallor is greater than 1/3 of the cell. Decreased Hgb. MCHC will be less than 32%
What is polychromasia? Increased reticulocyte count (blue cells)
What is anisochromia? Mixed cell population of normal cells and hypochromic cells
What is a normal MCV? 80-100 fL
What is anisocytosis? Variation in red blood cell size. Increases what the RDW
Which red cell shape alterations are caused by abnormalities in the amount of the membrane lipid? Target cells, echinocytes (burr cells), and acanthocytes (spur cells)
Which red cell shape alterations are caused by abnormalities in the membrane proteins? Elliptocytes/ovalocytes, stomatocytes, and spherocytes
Which red cell shape alterations are caused by trauma? Tear drops (dacrocytes), Schistocytes (fragment cells), Keratocyte (horned, helmut, or bite cell), and micropherules
Which red cell shape alterations are caused by abnormalities in the Hgb molecule? Hgb S, C, and SC
What is poiklocytosis? Variation in red cell shape
Do spherocytes have a high or low MCHC? High, >36%
What causes basophilic stippling? aggregates of ribosomes (RNA)
When do you see basophilic stippling? In lead poisoning and thalassemia
What causes HJ bodies? Remnants of DNA
When do you see HJ bodies? In megaloblastic anemia and poor spleen function
What causes pappenheimer bodies? clusters of unused iron
When do you see pappenheimer bodies? In sideroblastic anemia and iron overlaod
What causes Heinz bodies? denatured or precipitated Hgb
When do you see Heinz bodies? In G6PD deficiency. Visible only with supravital stain.
What causes the Cabot ring? Remnants of mitotic spindles
What is a heme group? Porphyrin ring with ferrous iron in the center
What makes up the fetal Hgb (Hgb F)? 2 alphas and 2 gammas
What makes up the adult Hgb (Hgb A)? 2 alphas and 2 betas
What does it mean when you have a shift to the left in the OD curve? Increase O2 affinity, decrease O2 release
What things cause a shift to the left in the OD curve? low H+ (high pH), low CO2, low temp, low DPG, low P50, high abnormal and fetal Hgb
What does it mean when you have a shift to the right on the OD curve? Decrease O2 affinity, increase O2 release
What things cause a shift to the right in the OD curve? High H+ (low pH), high CO2, high DPG, high temp, high P50, and anemia
Which hemoglobin derivatives are irreversible? Sulfhemoglobin and cyanmethemoglobin
What is the reference method for measuring Hgb? Cyanmethemoglobin
What is Drabkins reagent made up of? Potassium Ferricyanide K3Fe(CN)6 Potassium cyanide KCN
What does potassium ferricyanide do? Oxidizes ferrous iron to ferric iron (methemoglobin)
What does potassium cyanide do? Combines with methemoglobin to create cyanmethemoglobin
All pigments are measured except for which one? Sulfhemoglobin
What can contribute to falsely elevated Hgb values? Lipemia Increase leukocyte count RBC agglutination
What is an inherent source of error with spun Hct? Trapped plasma
What are some technical source of errors with spun Hct? Poor sealing Anticoagulant ratio Clots Centrifugal force Spin time Misreading Hemolysis
How is Hct calculated? (MCV x RBC count)/10
What is the rule of threes? Hgb x 3 should equal Hct RBC x 3 should equal Hgb ONLY WORKS WITH NORMOCYTIC, NORMOCHROMIC
The rate of erythrocyte settling depends on what? The protein composition of the plasma Size and shape of RBCs RBC concentration Viscosity of plasma
What are some technical sources of error affecting the ESR? Specimen is too old Improper filing of ESR tube (bubbles) Excess diluent and anticoagulant Inaccurate timing Temperature Position of the tube (not vertical) Vibration of ESR tubes Hemolysis
What stain should reticulocytes be stained with? New methylene blue N (supravital stain)
How do you calculate Retic percentage? (# of retics/# RBCs) x 100
How do you calculate absolute retic count? Retic % x RBC count
How do you calculate correct retic count? Retic % x (Pat Hct/45)
How do you calculate RPI? CRC/maturation time
What is the principle of electrical impedance? Based on increased resistance that occurs when a blood cell passes through and electrical field. (3 part diff)
What is the principle of optical light scattering? Based on light scattering measurements obtained as a single blood cell passes through a beam of light (5 part diff)
Define anemia. Decrease in the oxygen carrying capacity due to decreased number of RBCs or decreased Hgb content
What is hypervolemia? Increased plasma volume while RBC mass stays the same which causes falsely low Hgb and Hct
What can cause hypervolemia? IV fluid
What is hypovolemia? Decreased plasma volume while RBC mass stays the same which causes falsely high Hgb and Hct
What can cause hypovolemia? Dehydration and vomiting
What is an example of an acute blood loss? Gun shot wound
What is an example of a chronic blood loss? GI bleed
How does an increase in heart rate and circulation rate affect blood flow? Increases the flow of oxygenated blood to vital tissues such as brain and heart
How does an increase in 2,3 DPG affect oxygen release? Shifts OD curve to the right, thus more O2 is released to the tissues.
How does an increase in anaerobic glycolysis? Increases lactic acid which decreases pH and shifts OD curve to the right which means more O2 released to the tissues
How do you calculate MCV? (Hct/RBC) x 10
How do you calculate MCH? (Hgb/RBC) x 10
How do you calculate MCHC? (Hgb/Hct) x 100
What is a normal MCH? 26-32 pg
Created by: roni_robinson56



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