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Questions and Answers
What is a hemogram?
What is a hemogram?
- A type of blood film
- A complete blood count (correct)
- A test for hemoglobin levels
- A process for blood donation
What is the purpose of a purple top tube?
What is the purpose of a purple top tube?
- For urine analysis
- For venous blood collection
- For peripheral blood smear (correct)
- For coagulation studies
Why is liquid tripotassium EDTA more preferred over powder form?
Why is liquid tripotassium EDTA more preferred over powder form?
Liquid mixes more easily with blood.
What can result from using more than five hours of EDTA for peripheral blood smear?
What can result from using more than five hours of EDTA for peripheral blood smear?
What is the action of EDTA on platelets?
What is the action of EDTA on platelets?
What phenomenon may occur with some patients' platelets when placed in EDTA?
What phenomenon may occur with some patients' platelets when placed in EDTA?
What phrase describes platelets that surround or adhere to neutrophils?
What phrase describes platelets that surround or adhere to neutrophils?
What errors can result from using EDTA?
What errors can result from using EDTA?
How can EDTA problems be prevented?
How can EDTA problems be prevented?
What is the multiplier for WBC and platelet count in sodium citrate?
What is the multiplier for WBC and platelet count in sodium citrate?
What should be expected when films are made from a drop of fingerstick blood or collected from heparinized tubes?
What should be expected when films are made from a drop of fingerstick blood or collected from heparinized tubes?
How can the problems of heparinized microhematocrit tubes be eliminated?
How can the problems of heparinized microhematocrit tubes be eliminated?
What technique is the easiest to master for making peripheral blood smears?
What technique is the easiest to master for making peripheral blood smears?
What are the dimensions of glass slides used in blood smears?
What are the dimensions of glass slides used in blood smears?
What device is attached to EDTA tubes for peripheral blood smear?
What device is attached to EDTA tubes for peripheral blood smear?
What does a slow push create in blood smear preparation?
What does a slow push create in blood smear preparation?
How is a push type wedge preparation performed?
How is a push type wedge preparation performed?
What fraction of the slide length should be covered with peripheral blood?
What fraction of the slide length should be covered with peripheral blood?
What is the ideal shape of a blood film?
What is the ideal shape of a blood film?
What is the Sysmex SP-10 used for?
What is the Sysmex SP-10 used for?
How many blood films can the Sysmex SP-10 make every second?
How many blood films can the Sysmex SP-10 make every second?
What artifact can occur from blowing on a slide to dry it?
What artifact can occur from blowing on a slide to dry it?
What are the stains used for peripheral blood smear?
What are the stains used for peripheral blood smear?
What does the Giemsa stain contain?
What does the Giemsa stain contain?
What stains neutral components?
What stains neutral components?
What is the buffer for oxidized methylene blue and eosin?
What is the buffer for oxidized methylene blue and eosin?
What is free methylene blue?
What is free methylene blue?
What does free eosin stain?
What does free eosin stain?
How long does staining take for each stage?
How long does staining take for each stage?
What are the types of automated slide stainers?
What are the types of automated slide stainers?
What do quick stains entail?
What do quick stains entail?
What stain is used in quick stains?
What stain is used in quick stains?
What buffer is used in quick stains?
What buffer is used in quick stains?
What should be used to wipe the back of quick stains?
What should be used to wipe the back of quick stains?
What color indicates RBC in an alkaline stain?
What color indicates RBC in an alkaline stain?
What color indicates WBC in an alkaline stain?
What color indicates WBC in an alkaline stain?
What do gray granules in an alkalinic stain represent?
What do gray granules in an alkalinic stain represent?
What condition does a blue blood film indicate?
What condition does a blue blood film indicate?
What do holes in the film signify?
What do holes in the film signify?
At what objective do blood films begin?
At what objective do blood films begin?
What indicates an unacceptable film?
What indicates an unacceptable film?
What signifies unacceptable films in LTO?
What signifies unacceptable films in LTO?
At what power can WBC estimate be performed?
At what power can WBC estimate be performed?
How do you calculate WBC?
How do you calculate WBC?
What does OIO stand for?
What does OIO stand for?
What is the normal count of RBC in a normal patient?
What is the normal count of RBC in a normal patient?
What is CellaVision?
What is CellaVision?
What does anisocytosis refer to?
What does anisocytosis refer to?
What does hypochromia refer to?
What does hypochromia refer to?
What does poikilocytosis refer to?
What does poikilocytosis refer to?
Under what field is platelet estimation done?
Under what field is platelet estimation done?
What does leukocytosis mean?
What does leukocytosis mean?
What does leukopenia mean?
What does leukopenia mean?
What is indicated by a left shift?
What is indicated by a left shift?
What does the rule of three state?
What does the rule of three state?
What does mean cell volume provide?
What does mean cell volume provide?
What is the normal range for MCV?
What is the normal range for MCV?
What does normocytic mean?
What does normocytic mean?
What does microcytic mean?
What does microcytic mean?
What does macrocytic mean?
What does macrocytic mean?
What does mean cell hemoglobin concentration measure?
What does mean cell hemoglobin concentration measure?
What does normochromic refer to?
What does normochromic refer to?
What does hypochromic refer to?
What does hypochromic refer to?
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Study Notes
Hemogram and Blood Collection
- A hemogram is a complete blood count essential for diagnosing various conditions.
- Purple top tubes are used for preparing peripheral blood smears, crucial for blood analysis.
Importance of EDTA in Blood Sample Handling
- Liquid tripotassium EDTA is preferred over powder as it mixes more effectively with blood.
- Prolonged exposure (more than five hours) to EDTA can lead to anomalies in blood smears such as echynocytic RBCs, spherocytes, and necrobiotic leukocytes.
Effects of EDTA on Platelets
- EDTA prevents platelet clumping on slides, which is critical for accurate analysis.
- Platelet satellitosis occurs in some patients, causing their platelets to aggregate around neutrophils, leading to false low platelet counts (pseudothrombocytopenia).
- To avoid complications from EDTA, it is advisable to collect blood using sodium citrate tubes.
Slide Preparation Techniques
- Manual wedge technique is the most widely used and easiest method to prepare peripheral blood smears.
- Blood films should cover 2/3 or 3/4 of the slide and have a specific shape, slightly rounded at the feather edge, to ensure optimal analysis.
- The standard slide size is 3 inches by 1 inch.
Automated Systems and Staining
- Sysmex SP-10 is an automated slide maker that can produce 30 blood films per second.
- Staining techniques include pure Wright stain or Wright-Giemsa stain, for highlighting different cellular components.
- Quick stains can be completed in under 1 minute; modified Wright or Wright-Giemsa stains are used in rapid tests.
Interpretation of Stains
- Alkaline stains yield gray RBCs, while WBCs appear dark.
- Stains can reveal conditions like high proteins resulting in rouleaux formation or high lipid levels that create holes in the film.
Microscopy Techniques
- Initial observations of blood films occur at 10x or low power objectives, whereas WBC estimates are more accurately conducted at higher magnifications.
- For differential counts, Oil Immersion Objective (OIO) at 100x is utilized, with an acceptable RBC count being 200 to 250 RBCs per 100x field.
Cellular Characteristics
- Anisocytosis refers to varied RBC sizes; hypochromia indicates pale-colored RBCs, while poikilocytosis describes abnormal shapes.
- Leukocytosis denotes elevated WBC counts, while leukopenia indicates a decrease in WBCs.
Red Blood Cell Indices
- Mean cell volume (MCV) represents average RBC size, normal range is 80-100 fL.
- Classification by MCV:
- Normocytic: within normal range
- Microcytic: less than 80 fL
- Macrocytic: greater than 100 fL
- Mean cell hemoglobin concentration (MCHC) indicates the average concentration of hemoglobin within RBCs, with normochromic indicating normal MCHC levels and hypochromic less than the standard.
General Notes
- The rule of three states that hemoglobin should be approximately three times the hematocrit value.
- It’s crucial to observe for signs of deterioration in smear quality, such as fibrin strands or excessive cell accumulation at slide edges, which are red flags for inaccurate results.
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