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Lab Di 1st lab exam

QuestionAnswer
The way blood specimens are obtained, as an incision of a vein phlebotomy
What is penetrating a vein with a needle and collection apparatus or syringe called? venipuncture
What is a skin/dermal puncture? the collection of CAPILLARY blood after an incision is made in the skin with a lancet (finger stick, heel stick)
In which blood specimens is anticoagulant used? whole blood and plasma
What is a whole blood specimen? Tube which contains anticoagulant, tube contains cells(RBS, WBCS, plts) AND plasma. TUBE MUST BE MIXED WELL.
what is serum blood specimen? Blood is allowed to clot (no anticoagulant for about 20 mins) and then centrifuged. The clotted cellular elements go to the bottom of tube, and the upper portion is the serum.
What is whole blood used for? hematology cell counting
Serum contains no? no fibrinogen
What is serum used for? most chemistry, and serology testing, blood banking
What is plasma blood specimen? Whole blood (use anticoag) is centrifuged - uncoagulated cellular elements are pushed to the bottom of the tube, upper portion is called plasma.
What does plasma contain? fluid portion of blood which contains fibrinogen
What type of experiments is plasma used for? coagulation studies, plasma chemistries
What is capillary blood, and who is it used most on? A combo of venous and arterial blood, and tissue fluid obtained thru a skin puncture usually used on newborns and children
Why is capillary blood not as good of a sample? tissue fluid within, and mixture of the bloods
What may compromise the integrity/reliability of a specimen? 1. inappropriate method of collection 2. mishandling of specimen after collection
What is hemolysis in relation to compromised reliability? rupture of RBCS resulting in plasma/serum appearing pink/red d/t release of hbg
What causes specimen hemolysis? traumatic phlebotomy (rarer cases of intravascular dz and RBC fragility)
What else does specimen hemolysis release? hgb, K+, LDH
What is interfered with chemical analysis of specimen hemolysis? color interfernece
What is specimen lipemia? specimen has a clody turbid appearance due to the presence of lipids ( may indicate non-fasting specimen)
What is interferred with chemical analysis with specimen lipemia? chylomicron interference
In order to obtain proper ratio of blood to anticoagulant, tubes should be filled until...? Tubes should be filled until the vacuum is exhausted
What test do improperly filled tubes affect? most important for coagulation testing
How does specimen contamination occur? by improper antiseptic cleaning of venipuncture site (blood cultures)
What are four sources of compromised reliability? 1. hemolysis 2. lipemia 3. improperly filled tubes 4. specimen contamination
What are 4 specimen handling requirements? 1. fasting 2. timed 3. iced 4. protection from light
How long must a pt not eat or drink for before venipuncture for glucose/triglyceride tests? 8-12 hours
What are examples of timed specimens, meaning they must be collected @ a specific time? cardiac panels antibiotic levels
Why must some specimens be iced?... and what are examples of testing that should be iced? Should be chilled to slow down the metabolic processes which continue after blood is drawn ex: ammonia levels, arterial blood gases
What is an exmaple where the specimen's protection from light is important? When components test for a break down when exposed to light, like in bilirubin testing... aluminum foil is wrapped around or placed in light inhibiting container
What two things are collection tubes colored for? 1. the type of specimen that will be obtained (plasma, serum, whole blood) 2. the type of additive the tube contains
Place these in order of first to last for multiple draws: serum tubes w/ or w/o gel or clot activator EDTA tubes heparin tubes blood culture tubes oxalate/fluride tubes sodium citrate tubes Blood culture tubes or vials sodium citrate tubes serum tubes w/ or w/o gel or clot activator heparin tubes EDTA tubes oxalate/fluoride tubes
If only coagulation studies are being drawn, what do some labs advise drawing first? A plain red top tube to clear the release of tissue thromboplastin from the skin puncture
What color tube is used for wholbe blood count? and CBC? lavender
what color tube had EDTA in it? lavender
What can't lavender tubes test for? Ca2+ because they remove calcium to prevent clotting
If the tube is not red, it has what in it? anticoagulant, and preservation
What color top is used for blood typing and blood banking? Red
The larger the gauge needle, the _____ the diameter of the needle larger gauge, smaller diameter
The most commonly used needles are ___ gauge by ___ inche needle 21 gauge by 15 inche needle
What is the mL range of collection tubes? 2-15 mL
What are syringes used for? for veins that are too fragile for the evacuated system
What is a butterfly used for? for difficult veins, hand veins, pediatrics and elderly pts
A lancet should never exceed __ mm in depth? 2.4 mm
The tornuquet should not be left on longer than ? than 1 minute
Antiseptic pad is used to? to prevent spsis, bacteriostatis.... used to clean site before venipucture
When is iodine used to clean before venipuncture? for blood cultures
Bandages should not be used on which age group? under 2 years because of aspiration
What are the 3 veins to choose from in the antecubital foosa? cephalic, basilica, median cubital
Which vein is the vein of choice, anchored best, and easiest to access median cubital
The tourniquet increase what? venous stasis and vasodilation
If the toruniqet is left on for more than 1 minute what occurs? hemoconcentration (increase in local cellular relase of metabolic waste prodcuts)& pt discomfort
What is hemoconcentration? increase in local cellular relase of metabolic waste products
What is an extremely important 2nd step in venipucnture? idefintifying the pt - asking pt to state full name and id number
How many inches above intended site should tourniquet be placed? 3-4 inches
What is in the alcohol pad? 70% isopropyl alcohol
When cleansing site you should make a ____ motion starting from the ___ circular motion starting from the center moving outward
What degree is the needle entered at? about 15-30 degree angle
When do you release the tourniquet once venipuncture has started? after last tube begins to fill
if you pt is obese and hard to find veins what can u do? apply a blood pressure cuff to help
Hemoconcentration is an increase of ___ in blodo analytes
If a pt had a mastectomy what should be a precaution? do not draw blood from same side as the mastectomy
what is the copper sulfate screening method for? hemogolbin
How do you calculate HCT? meausure ht in mm of total column of blood (plasma and cells) = A, and ht of RBCs = B. B/A x 100 = hct %
What does ESR measure? how far the RBCS fall (in mms) in 1 hr
RBCs are negatively charged and repel each other defined as? zeta potential
RBCs stack up like coins, name? rouleaux formation
What causes rouleaux formation? breakdown of zeta potential
What does rouleaux cause? causes increased settling out of rbcs from the plasma due to increased wt
If there's an increase in inflammation what is seen with the esr? see increase in rouleaux formation d/t increase of inflammatory proteins which breaks down zeta potential
what do inflammatory proteins break down? the zeta potential
What are the two main blood grouping systems? ABO systems ( 4 possible, A B AB O) and Rh systems (2 types Rh pos and Rh neg)
What is autosomal codominanct genetic expression and which system expresses this>? Gene from mom and dad both expressed EQUALLY. The ABO system expresses this
What antigen does phenotype A have? and antibody? Has the A antigen has the anti-b antibody
What antigen does phenotype B have? and what is the antibody? Antigen: B antigen Antibody: A antibody
What % of the population is A phenotype? 40%
What antigen does AB have? and what antibody? Antigen: AB Antibody: NONE
What blood phenotype is the universal recipient? AB +
What percentage of the population is phenotype B? 11%
what % of the population is AB? 4%
What percent ofthe population is O? 45%
What antigen does O phenotype have and antibody? Antigen: NONE, THERE IS NO O ANTIGEN Antibody: anti-A and Anti-B
The antibodies of ABO system are...? are naturally occurring -present @ birth
With donations it is the recipient's _____ that react with the donor's ____ causing the RBCs to ____ if the blood is NOT ____ it's the recipient's antibodies which react to the donor's RBC antigens causing the RBCs to hemolyze if the blood is not compatible
Which dzs have a 1:2000000 risk of being transfused? Hep C and HIV
What is the lowest risk of transfusion? Cytomegalovirus (infrequent)
NAT WNV RNA in a screening is? West Nile Virus
Anti-CMV EIA antibody is what in a screening? cytomegalovirus
HBsAg antibody is what in a screening? hep B surface antigen
What is ANti-HBc antibody in a screening? Hep B core antigen
What is NAT HCV RNA in a screening? Hep C virus
How many antigens are associated with the Rh system? 40!
Which antigens is the blood bank primarily concened with in the Rh system? The 5 major ones: D C c E e
When are antibodies produced in the Rh system? Only produced after in contact with antigen
What is the genotype of Rh pos? DD, or Dd
Who can Rh pos/D receive from, and donate to? Rh pos and Rh neg, and only donate to Rh pos
What % of population is Rh pos? 85%
What does the d gene represent? Represents the lack ofthe D antigen!
What antiobodies will Rh neg produce if in contact with Rh pos? anti-D (igG)
With transfusion your must consider the donor's RBC _____ and the recipients ____ Donor's RBC antigens and the recipients antibodies
What is the name given for hemolytic dz of the newborn? Erythroblastosis fetalis
If a Rh pos baby has a placental tear in a Rh neg mother what happens? Exchange of fetal blood, mother's blood sees it & makes anti-D and IgG, and now with future pregnancies she has the antibody which may cross the placenta & hemolyze babies RBCs
How does RHOGAM work? take out any of baby's D antigen curculating in mothers blood BEFORE mother's body can respond by making anti-D
How many hours is needed for body to produce it's own antibody, like anti-D in mothers? 72 HOURS
When is Rhogam given to mother and how? Given to mother intramuscularly at 28 weeks gestation, and 72 hrs post partum
What is placenta previa? 28 weeks gestation
If b
How many mL is in a whole blood donation? 500 mL
What consists of 200 mL of blood + 100 mL ADSOL? packed red blood cells
What is the shelf life of packed red blood cells? 42 days @ 1-6 degrees C
How many mLs are in platelet rich plasma? 300 mL
Whole blood donations are divided into what? Platlet rick plasma and packed red blood cells
What is the shelf life of donated platlets? 5 days @ room temp
How many mLs of donated platlets are obtained? 50 mL
What is platlet rich plasma from a whole blood donation divided into? platlets and plasma
What is FP24? Frozen plasma within 24 hours of collection
Within how many hours is fresh forzen plasma set to freeze? within 8 hrs of collection
How many mL of plasma is collected? 250 mL
What is the shelf life of plasma? 1 year @ -18 degrees C
What can plasma be divided into? Cryoprecipitate
What is the mL of cryoprceiptiate and what is the shelf life? 15 mL and shelf life is 1
Why would a dermal puncture (microcollection) be used in an adult? Inability to find a vein for venipuncture burned or scarred pts geriatric pts with fragile veins pts receiving chemo and when only a small sample is needed
What is the composition of blood from a dermal puncture? capillary blood, combo of venous, arterial and interstitial fluid
What is the best site for a finger puncture? palmar surface of the dist phalanx of the ring or mid finger
Puncture should be ____ to fingerprint perpendicular
Why should you always wipe the first drop of blood away after a finger puncture? because it prevents contaimination of residual alcohol and intro of excess tissue fluid
Who receives heal puncture? newborns and infants who have not started to walk
What is the location of the heal puncture? the medial and lateral areas of the plantar surface
What is the mc test to evaulate circulating blood? cbc
What is leukocytosis? increase in the number of circulating wbcs greater than 11000 mm3
what is leukopenia? decrease in # of circulating wbcs less than 4000mm3
What is done with the tube to collect wbcs? lysing reagent mixed to remove rbcs from solution and strips wbc membrane, therefore wbc nuclei are counted
How are wbc and rbc counted? by electrical impedance or light scattering methods
How is hgb sampled within the tube? reagent is added to lyse RBCs and to form cyanmethehmogolbin and read directly by its abitlity to absrob light
How is hct calculated in a cbc? based on MCV and RBC values hct= mcv x Rbc/10
What are the rbc indices within a cbc? mcv mch mchc
what is the manual mcv calcuation? hct x10/ rbc x10^6/mm3
mch is measured in what? measured in picograms
how is mchc exopressed? %
RDW is expressed as? an absolute # or graphed on a histogram
What produces platlets? megakaryoctyes
What is the life span of a platlet? 8-10 days
What is MPV? mean platlet volume
what does mpv measure? measures the avg volume (size) platlets
When does mpv increase? in cases of non marrow causes a decrease of platelet number as normal bone marrow produces younger and larger platelets to compensate
when does mpv decrease? decreases when lack of bone marrow functon is the cause of decreased platlet #. The megakaryocytes are small andtherefore platlets are small
What is PDW? platelet distribution width - a measure of the degree of uniforminty of size of plts expressed both as an absolute number and graphed on a histogram
What is the automated diff (differential WBC count)? gives relative #s of lymphocytes, monocytes, neutrophils, eosnophls and basophils
What are wbcs stained with? wright stain
name the granulocytes? neutrophils. eosinophils, basophils
name the agranulocytes lymphocytes monocytes
neutrophil size? and %? 10-15u (2x the size of an average RBC) and 60-70% of circulating WBCs
How does the nucleus of a neutrophil stain? dark purple
What do eosinophils protect against? protects against ingestion of parasites and limiting alerigc rxns
What cell nuc stains dark purple, usually blobed with coarsely clumped chromatin eosinophils
what size and % of wbcs are eosinophils? about 10-15 u, and 2-5%
Which wbc cell is involved with immediate hypersensitivity rxn by release of histamine and heparin from granules? basophil
what is the size and % of basophis? 10-15u, and 0-1%
which wbc has a segmented nuc but usually obscrubed by abundant large coarse blue-black staining cytoplasmic granules? basophils
What wbc protects the body from infection by phagocytosis of bacteria and other foreign organisms, and provides defense against microorganisms, removal of damaged or dead cells and removal of cellular debris? neutrophils
What type of wbc provides recognition and elimination of foreign stimuli includng synthesis and secretion of antibodies? lymphocytes
Which type of lympocyte is responsible for humoral immunity? B
what is the synthesis of antibodies in response to the antigen? humoral immunity
What type of cells are responsible for cellular immunity? T lymphocytes
What includes tumor suppression, graft rejection, protection from intracellular organisms, and delayed hypersensitivity? cellular immunity (t-lympho)
T lymphocytes also function in the regulation of ____ _____ rxns by helping or suppressing the ____ and the regulation of _____ by producing colony stimulating factors T lymphos regulate umoral immune rxns by helping or suprressing the b lymphos and the regulation of hematopoiesis by producing colony stimulating factors
What has a round unsegmented nucleus which stains dark blue-purple with coasrse and clumpy chromatin lymphocytes
What is the size and % of lymphocytes? size : 7-10 20-30%
What protects the body by phagocytosis of bacteria, fungi, viruses, dead and dying cells, and helps the neutrophil? monocyte
in infection ____ rises after neutrophils increase monocytes
what plays a role in processing specific antigens for the lymphocyte to recognize? monocyte
what produces and secretes various substances : lysosomes, colony stimulating factor, thromboplastin, platelet activating substances, complement,cytokines? monocytes
What size and % are monocytes? size: 12-20 2-8%
what cell stains blue-purple and has a folding shape, often horseshoe, or kidney bean with moderately clumped chromatin? monocytes
what cell often has a ground glass appearance in their cytoplam monocyte
all blood smear reports should contain a ____ ____ estimate a platelet number estimate
The standard varies from _____ per average oil immersion field of platelet estimate? Multipled by ____ gives the # per mm3 5-25 multi by 20,000
rbcs should be observed for abnormalities in ___, ___ ,____ and ____ size, shape, chromicity, and intracellular inclusions
what is variation in the size of rbcs due to a path condition? anisocytosis
anisocytosis is a ____ finding and generally indicates a change in the ___ function is a nonspecific finding generally indicates a change in the marrow function
What refers to rbcs that appear slightly basophilic? polychromic/basophilia
what is the amount of basophilia related to? the maturity of the cell
what is the actual cause of a hyperchromic cell? by an increase in mean cell thickness
what is a variation in the shape of a rbc? poikilocytosis
what is a definitive test to see if sickle cell anemia? hbg electrophoresis
Created by: margaretrhager