Hematology Laboratory Safety Quiz
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Questions and Answers

The National Patient Safety Goals include:

  • use of the patient identifiers (correct)
  • proper disinfection of laboratory counter tops (correct)
  • use of proper evacuated collection tube anticoagulants (correct)
  • proper donning of latex gloves (correct)

    • The primary intended purpose of the laboratory safety manual is to:

  • comply with OSHA regulations
  • comply with local health and state regulatory requirements
  • protect laboratory and other hospital personnel
  • protect the patient and laboratory personnel (correct)

    • If a blood specimen is spilled on a laboratory bench or floor area, the first step in cleanup should be:

  • clean with freshly prepared 1% chlorine solution
  • wear gloves and a lab coat (correct)
  • absorb blood with disposable towels
  • wash with water

    • The likelihood of infection after exposure to HBV-infected or HIV-infected blood or body fluids depends the least on the:

    <p>presence of nonintact skin (C)</p> Signup and view all the answers

    Standard precautions have been instituted in clinical laboratories to prevent __________ exposures of healthcare workers to bloodborne pathogens such as HIV and HBV.

    <p>all of the above (D)</p> Signup and view all the answers

    Exposure to __________ constitutes the major source of HIV and HBV infection in health care personnel.

    <p>blood (D)</p> Signup and view all the answers

    Diluted bleach for disinfecting work surfaces, equipment, and spills should be freshly prepared by making a __________ (6) dilution of household bleach. This dilution requires __________ (7) mL of bleach diluted to 100 mL with H2O.

    <p>1:10, 10</p> Signup and view all the answers

    In which of the following laboratory situations is a verbal report permissible?

    <p>When the patient is going directly to the physician’s office and would like to have the report available (A)</p> Signup and view all the answers

    The most frequent type of laboratory specimen error is

    <p>preanalytical error (A)</p> Signup and view all the answers

    The delta check is used to detect:

    <p>the difference between current and past patient results (B)</p> Signup and view all the answers

    Which of the following errors represent a preanalytical (preexamination) error?

    <p>wrong assay performed (A), Failure to run a normal control specimen when testing (B), incorrect labeling of a specimen (D)</p> Signup and view all the answers

    Instrument calibration should be performed, at least, __________, according to CLIA.

    <p>twice a year</p> Signup and view all the answers

    A control specimen is:

    <p>a known value in a specimen similar to a patient specimen (A)</p> Signup and view all the answers

    The term accuracy means:

    <p>closeness to the true value (C)</p> Signup and view all the answers

    The term precision means:

    <p>how close test results are when repeated (A)</p> Signup and view all the answers

    The term calibration means:

    <p>the process of monitoring accuracy (A)</p> Signup and view all the answers

    Which of the following is not a function of a quantitative QC program?

    <p>Confirms the correct identity of patient specimens (C)</p> Signup and view all the answers

    The standard deviation is:

    <p>The degree to which test data vary about the average (B)</p> Signup and view all the answers

    The term variance means:

    <p>sum of the squared differences from the mean (C)</p> Signup and view all the answers

    When validating a control reference range, what is the minimum number of patient samples needed to calculate the deviations from the mean value?

    <p>20 (A)</p> Signup and view all the answers

    Acceptable limits of a control value must fall:

    <p>within ±2 standard deviations of the mean (D)</p> Signup and view all the answers

    A trend change in QC data is:

    <p>a progressive change all in one direction away from the mean for at least 3 days (C)</p> Signup and view all the answers

    A continuously increasing downward variation in a control sample in one direction from the mean can indicate:

    <p>all of the above (D)</p> Signup and view all the answers

    Which of the following statements is true of a Gaussian distribution?

    <p>It represents a normal bell-shaped distribution. (A)</p> Signup and view all the answers

    Two standard deviations (2 SD) from the mean in a normal distribution curve would include:

    <p>95% of all values (A)</p> Signup and view all the answers

    When the coagulation of fresh whole blood is prevented through the use of an anticoagulant, the straw-colored fluid that can be separated from the cellular elements is:

    <p>plasma (D)</p> Signup and view all the answers

    Which characteristic is inaccurate with respect to the anticoagulant K3 EDTA?

    <p>Is used for most routine coagulation studies (D)</p> Signup and view all the answers

    Heparin inhibits the clotting of fresh whole blood by neutralizing the effect of:

    <p>thrombin (A)</p> Signup and view all the answers

    The conventional color-coded evacuated tube stopper for EDTA anticoagulant is

    <p>lavender (C)</p> Signup and view all the answers

    The conventional color-coded evacuated tube stopper for heparin is

    <p>green (A)</p> Signup and view all the answers

    The conventional color-coded evacuated tube stopper for sodium citrate is

    <p>blue (D)</p> Signup and view all the answers

    The conventional color-coded stopper when no anticoagulant or additive is present in an evacuated tube is

    <p>red (C)</p> Signup and view all the answers

    List the following five procedural steps in the performance of a venipuncture in the correct sequence:

    <p>E = Introduce yourself and briefly explain the procedure to the patient. B = Identify the patient, check test requisitions, assemble equipment, wash hands, and put on latex gloves. A = Select an appropriate site and prepare the site. D = Reapply the tourniquet and perform the venipuncture. C = Remove tourniquet, remove needle, apply pressure to site, and label all tubes.</p> Signup and view all the answers

    The appropriate veins for performing a routine venipuncture are

    <p>the cephalic, basilic, and median cubital (A)</p> Signup and view all the answers

    A blood sample is needed from a patient with IV fluids running in both arms. Which of the following is an acceptable procedure?

    <p>Obtain sample from below the IV site with special restrictions. (E)</p> Signup and view all the answers

    The bevel of the needle should be held ______ in the performance of a venipuncture.

    <p>upward</p> Signup and view all the answers

    A hematoma can form if:

    <p>all of the above (D)</p> Signup and view all the answers

    Phlebotomy problems can include:

    <p>all of the above (D)</p> Signup and view all the answers

    Which of the following skin puncture areas is acceptable for the collection of capillary blood from an infant?

    <p>Medial or lateral plantar surface (A)</p> Signup and view all the answers

    The proper collection of capillary blood includes:

    <p>all of the above (D)</p> Signup and view all the answers

    A peripheral blood smear can be prepared from:

    <p>both A and B (B)</p> Signup and view all the answers

    Identify the characteristic(s) of a good peripheral blood smear.

    <p>All of the above. (D)</p> Signup and view all the answers

    Poor blood smears can be caused by:

    <p>all of the above (D)</p> Signup and view all the answers

    If a blood smear is too long, the problem can be resolved by:

    <p>increasing the angle of the pusher slide (C)</p> Signup and view all the answers

    The examination of bone marrow is useful in:

    <p>both B and C (A)</p> Signup and view all the answers

    Appropriate bone marrow aspiration sites in an adult are:

    <p>both A and B (D)</p> Signup and view all the answers

    A basic staining effect imparts a(n) _____________ color to blood cells.

    <p>orange-red</p> Signup and view all the answers

    A neutrophilic staining effect imparts a(n) _____________ color to blood cells.

    <p>pink-lilac</p> Signup and view all the answers

    Wright’s stain is a(n) ______ stain.

    <p>Romanowsky-type (A)</p> Signup and view all the answers

    If a blood smear stains too red on microscopic examination of a Wright-stained preparation, possible causes include that:

    <p>the buffer was too acidic and the exposure time was too short (B)</p> Signup and view all the answers

    The smallest organized unit of living tissue is the

    <p>cell (A)</p> Signup and view all the answers

    The cell membrane’s major components are

    <p>proteins and lipids (C)</p> Signup and view all the answers

    Which of the following is a characteristic of osmosis?

    <p>Movement of water molecules (C)</p> Signup and view all the answers

    Flashcards

    Patient Safety Goals

    Objectives to enhance patient safety like proper identification.

    Laboratory Safety Manual

    Document outlining safety procedures to protect personnel and patients.

    Standard Precautions

    Infection control practices to protect healthcare workers from bloodborne pathogens.

    Diluted Bleach Solution

    Used for disinfecting work surfaces; should be freshly prepared.

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    Preanalytical Error

    Errors occurring before the analysis phase of lab testing.

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    Delta Check

    Process to compare current lab results with previous ones to identify significant changes.

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    Quality Control (QC)

    Procedures to ensure accuracy and reliability of lab test results.

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    Control Specimen

    Known sample used to assess the accuracy of testing methods.

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    Accuracy in Testing

    The degree to which a test result matches the true value.

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    Precision in Testing

    The consistency of test results when repeated under unchanged conditions.

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    Calibration

    The process of adjusting the accuracy of an instrument.

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    Hematopoiesis

    The formation of blood cells in the body.

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    Erythropoietin (EPO)

    Hormone that stimulates the production of red blood cells.

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    Macrocytic Anemia

    Condition where red blood cells are larger than normal.

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    Microcytic Anemia

    Condition where red blood cells are smaller than normal.

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    Normocytic Anemia

    Anemia with red blood cells of normal size but inadequate numbers.

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    Spherocytes

    Abnormally round red blood cells often associated with hemolytic anemia.

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    Hemoglobin Function

    Hemoglobin binds to oxygen in red blood cells for transport to tissues.

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    Thrombocyte

    Another term for platelets, vital for blood clotting.

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    Wright's Stain

    A staining technique used for blood and bone marrow smears.

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    Apoptosis

    Programmed cell death that occurs naturally in the body.

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    Lymphocytes

    A type of white blood cell involved in the immune response.

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    Plasmodium falciparum

    A parasite that causes severe malaria; infects red blood cells.

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    Anisocytosis

    Variation in the size of red blood cells seen in various anemias.

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    Nucleated Red Blood Cells

    Immature red blood cells that still contain a nucleus.

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    Transient Leukocytosis

    Temporary increase in white blood cell count due to stress or infection.

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    Reference Range

    Normal values for blood tests used to compare individual results.

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    Hemoglobin Structure

    Consists of four heme groups and globin chains for oxygen transport.

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    Common Anticoagulants

    Substances like EDTA that prevent blood clotting in test samples.

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    Glycogen

    A stored form of glucose in the body, primarily found in the liver and muscles.

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    Study Notes

    Hematology Laboratory - Patient Safety

    • The National Patient Safety Goals include using patient identifiers, proper collection tubes, proper disinfection of lab countertops, and proper donning of gloves.
    • The primary purpose of the laboratory safety manual is to protect patients and laboratory personnel, comply with local health and state regulations, and comply with OSHA regulations.
    • If a blood specimen is spilled, the first step in cleanup is to wear gloves and a lab coat, absorb the blood with disposable towels, then clean with a 1% chlorine solution, and finally wash with water.
    • The likelihood of infection after exposure to infected blood or body fluids depends least on the presence of nonintact skin, the concentration of the virus, or the duration of contact. The greatest risk factor is the source (anatomical site) of the blood or fluid.

    Standard Precautions

    • Standard precautions have been instituted in clinical laboratories to prevent healthcare workers from exposures to bloodborne pathogens such as HIV and HBV.
    • Exposure to blood, sputum, urine, and semen constitutes the major source of HIV and HBV infection in healthcare personnel

    Dilution of Bleach

    • Diluted bleach should be freshly prepared by mixing a 1:10 dilution of household bleach with water (10 mL bleach in 100 mL H₂O).

    Verbal Reports

    • Verbal reports are permissible in situations when a patient is going directly to the physician's office and would like the report, or if the report cannot be found at the nurse's station

    Quality Assessment

    • The most frequent type of laboratory specimen error is preanalytical, analytical, or postanalytical.
    • The delta check is used to detect whether the correct anticoagulant was used, the time of specimen storage, discrepancies between current and past results, and the correct collection time.
    • Instrument calibration must be performed, at least, annually according to CLIA.

    Accuracy and Precision

    • Accuracy refers to closeness to the true value, while precision refers to how close test results are when repeated.
    • Calibration is the process of monitoring accuracy and reproducibility of known control results.

    Quality Control

    • A control specimen is a known value in a specimen similar to a patient specimen, closeness to the true value, or the process of monitoring accuracy.

    Additional Information

    • Minimum number of samples for control reference range validation is 30.
    • Acceptable limits for a control value must fall within ±2 standard deviations of the mean.
    • A trend change in QC is a progressive change in one direction away from the mean for at least 3 days.
    • A standard deviation is the difference between upper and lower measurements in a series of results, expressed as the average degree to which test data vary about the average.
    • Variance is a measurement of how much the test data varies about its average.

    Blood Samples and Collection Methods

    • Different anticoagulants are used for different types of tests.
    • The correct color-coded stopper for EDTA anticoagulant is lavender, heparin is blue, and sodium citrate is green.
    • The appropriate veins for venipuncture are the cephalic, basilic, and median cubital veins.
    • The bevel of the needle should be held upward during venipuncture.
    • Acceptable skin puncture areas for capillary blood collection from infants include the medial or lateral plantar surface, posterior curve of the heel, or arch.
    • The proper collection of capillary blood includes wiping away the first drop, occasionally wiping the site, and avoiding the introduction of air bubbles into the column.

    Blood Smear Preparation

    • The properly prepared peripheral blood smear begins with a delay in preparation after collection, with a normal drop size and angle during preparation.
    • For peripheral blood smears if too long, decreasing the angle or using a larger drop of blood will help.

    Bone Marrow Examination

    • Bone marrow examination helps in diagnosing bleeding disorders, erythrocyte disorders, leukocyte disorders, and acute leukemias.
    • Appropriate bone marrow aspiration sites are the anterior and posterior iliac crests, and the sternum.

    Stains

    • Basic staining effects imparts a color to specific cells. Different stains are used to color blood cells differently.
    • Differentiating acidic stains and neutrophil stains are based on the color of the stain used.

    Additional Hematology Information

    • General characteristics for maturation and development of erythrocytes include nuclear chromatin condensation in reticulocytes, a bluish tinge in Wright-stained reticulocytes, and megaloblastic maturation or the presence of abnormal ribosomal elements.
    • The typical characteristics for mature monocytic cells are a large, round nucleus, light gray cytoplasm, and a kidney-bean-shaped nucleus. A mature monocytes is larger than a mature lymphocyte, characterized by a kidney-bean-shaped nucleus, and a light-gray cytoplasm.
    • Typical characteristics of mature neutrophils include a segmented nucleus, light sky-blue cytoplasm, and an elongated/curved (or irregular) shaped nucleus.
    • A mature eosinophil is typically characterized by large orange granules, an elongated/curved (or irregular) shaped nucleus and light-gray cytoplasm. A mature lymphocyte is larger than a mature neutrophil, has a kidney-shaped nucleus and light-gray cytoplasm.
    • Methods to identify variations in erythrocyte size variations include macrocytosis, microcytosis, or anisocytosis, or variations in shape (e.g. spherocytosis.
    • Disorders associated with anemia include iron-deficiency anemia or pernicious anemia, or other abnormalities associated with defective erythropoietin.
    • The functions of platelets include maintaining vascular integrity, promoting fibrinolysis, or the formation of a platelet plug or promotion of fibrinolysis.
    • Causes of abnormal platelet counts can be due to inherited disorders.

    Other Notes

    • Common types of anemia include iron deficiency, pernicious, megaloblastic, or hemolytic.
    • Methods to assess reticulocytes, cell counts, or hemoglobin levels are available for laboratory testing.
    • Abnormal conditions in the bone marrow can result from extramedullary hematopoiesis. -Anemia, or deficient erythropoiesis or hematocrit, results in the body's cells not getting enough oxygen.
    • Important laboratory parameters for testing blood include MCV, MCH, MCHC, RDW, total WBC count, or reticulocyte count.
    • Important blood disorders to monitor include anemia, leukocytosis, polycythemia, or thrombocytopenia.
    • A normal range for reticulocytes in adults is 0.5–1.0% .
    • A normal range for PCV is 36–45%.
    • A normal range for total WBC count is 4.0–10.0 x 10⁶/L (or 4.5-11.0 × 10^9/L).
    • A normal range for lymphocytes in adults is approximately 20% to 45%.
    • If a patient has a high or low count of neutrophils or lymphocytes, this may be indicative of an infection, or other medical conditions.

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    Description

    Test your knowledge on patient safety and standard precautions in hematology laboratories. This quiz covers key safety protocols, infection risks, and proper procedures for handling blood specimens. Ensure you are familiar with the necessary regulations to protect both patients and laboratory personnel.

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