Infection Control and Safety Practices

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Questions and Answers

What is the expected serum iron level for a patient with Hodgkin lymphoma?

  • Decreased (correct)
  • Increased
  • Variable
  • Normal

Which condition is associated with increased Total Iron Binding Capacity (TIBC)?

  • Vitamin B12 deficiency
  • Sickle cell anemia
  • Iron deficiency (correct)
  • Aplastic anemia

What is the iron saturation level expected in a patient with Vitamin B12 deficiency?

  • Normal (correct)
  • Undetectable
  • Increased
  • Decreased

How does serum ferritin levels present in iron deficiency anemia?

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

Which of the following has a normal serum transferrin level?

<p>Vitamin B12 deficiency (B)</p> Signup and view all the answers

What is the likely serum iron status in a patient with aplastic anemia?

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

In which of these conditions is serum iron level increased?

<p>Sickle cell anemia (C)</p> Signup and view all the answers

What happens to the serum transferrin in cases of iron deficiency?

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

Which structure is primarily responsible for maintaining the shape of a cell?

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

Which term describes the process of formation and development of blood cells?

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

During the second trimester of fetal development, where is the primary site of blood cell production?

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

Which organ is responsible for the maturation of T lymphocytes?

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

What is one of the body's responses when there is severe anemia and the bone marrow cannot produce red blood cells effectively?

<p>Extramedullary hematopoiesis in the liver and spleen (D)</p> Signup and view all the answers

Which cytokine is required very early in the differentiation of a hematopoietic stem cell?

<p>FLT3 ligand (C)</p> Signup and view all the answers

What is the primary role of platelet-derived growth factor (PDGF) in hematopoiesis?

<p>Stimulating the growth of blood cells (C)</p> Signup and view all the answers

What does G-CSF primarily stimulate in the context of blood cell production?

<p>Production of granulocytes (B)</p> Signup and view all the answers

What is the primary function of 2,3-BPG in its interaction with hemoglobin?

<p>Binds to amino acids of the globin chain, inhibiting oxygen binding (C)</p> Signup and view all the answers

Which protein is responsible for transporting iron out of enterocytes into plasma?

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

In what order do the steps of iron absorption and transport occur?

<p>v, iv, i, ii, iii (B)</p> Signup and view all the answers

What is the major metabolically available storage form of iron in the body?

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

What happens to the transferrin receptor after delivering iron to a cell?

<p>It is recycled to the plasma membrane and can re-bind (D)</p> Signup and view all the answers

What role does transferrin play in iron transport?

<p>It binds ferric iron and transports it in plasma (D)</p> Signup and view all the answers

Which of the following statements about 2,3-BPG is true?

<p>It decreases the oxygen affinity of hemoglobin (A)</p> Signup and view all the answers

Which process occurs first in iron absorption?

<p>DMT1 transports iron into the enterocyte (C)</p> Signup and view all the answers

What technique change would improve the production of blood films that are too long and thin?

<p>Increasing the downward pressure on the pusher slide (D)</p> Signup and view all the answers

Which measurement is obtained using low-voltage DC?

<p>Total cell volume (C)</p> Signup and view all the answers

What could be the most likely cause of RBCs appearing redder than normal in a blood film?

<p>The slide was overstained (A)</p> Signup and view all the answers

Orthogonal light scatter is primarily used to measure which aspect of blood cells?

<p>Internal complexity of the cell (D)</p> Signup and view all the answers

What is likely the reason a stained blood film appears bluer than normal?

<p>The buffer used was too alkaline (C)</p> Signup and view all the answers

Which of the following techniques is used for measuring the complexity of cells?

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

If a blood film appears to have barely visible neutrophils, what might be a potential issue?

<p>Insufficient staining time (D)</p> Signup and view all the answers

The measurement of cellular granularity is best achieved through which technique?

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

Which parameter is directly measured and used in the calculation of hematocrit on Beckman Coulter instruments?

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

What is the most likely WBC estimate based on the observed counts: 8, 4, 7, 5, 4, 7, 8, 6, 4?

<p>5.9 x 10^9/L (D)</p> Signup and view all the answers

For a very anemic patient with an RBC count of 1.25 x 10^12/L, which estimate of platelets per microliter is most closely correlated with an average of seven platelets per field?

<p>44,000 (A)</p> Signup and view all the answers

What condition is most likely reflected in the blood picture with WBC of 86.3 x 10^9/L and HGB of 9.7 g/dL?

<p>Leukocytosis, normocytic-normochromic anemia, thrombocytopenia (C)</p> Signup and view all the answers

In a blood film with a normal RBC count and an average of 10 platelets per field, which platelet estimate is best correlated?

<p>200,000 (C)</p> Signup and view all the answers

Which blood disorder is characterized by an elevated WBC count with toxic granulation observed in neutrophils?

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

Which laboratory result is unlikely to correlate with leukocytosis?

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

What type of microscopy is likely used to analyze a blood film for cellular counts?

<p>Oil immersion microscopy (D)</p> Signup and view all the answers

Which abnormal RBC morphology is characterized by an irregular shape and is typically observed in certain hemolytic anemias?

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

Which condition is most likely if a patient presents with an MCV of 65 fL and an absolute reticulocyte count of 20 x 10^9/L?

<p>Iron deficiency anemia (B)</p> Signup and view all the answers

What laboratory finding would most likely indicate a sideroblastic anemia in a patient?

<p>Abundant stainable iron in the marrow (C)</p> Signup and view all the answers

In a patient with anemia characterized by an MCV of 125 fL and an RDW of 20%, which condition would be included in the differential diagnosis?

<p>Megaloblastic anemia (B)</p> Signup and view all the answers

Which of the following observations suggests hemolytic anemia rather than another type of anemia?

<p>Increased reticulocyte count (B)</p> Signup and view all the answers

What abnormal finding in a bone marrow biopsy could indicate a problem in erythropoiesis?

<p>High myeloid-to-erythroid ratio (C)</p> Signup and view all the answers

Which of these conditions is characterized by the presence of schistocytes in the blood smear?

<p>Microangiopathic hemolytic anemia (A)</p> Signup and view all the answers

Which lab results would indicate a laboratory error when interpreting iron studies?

<p>Inconsistent results between CBC and iron studies (D)</p> Signup and view all the answers

Flashcards

2,3-BPG function

2,3-BPG binds to hemoglobin, inhibiting oxygen binding.

Iron transport proteins

Ferroportin transports iron out of cells like macrophages and enterocytes.

Transferrin

Transferrin is the major plasma protein that binds and transports iron.

Major iron storage form

The major storage form of iron in the body is hemosiderin.

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Order of iron transport steps

Iron transport order: iii, iv, i, v, ii.

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Transferrin receptor fate

After delivering iron, the transferrin receptor is recycled to the plasma membrane.

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Iron absorption mechanism

DMT1 transports ferrous iron into enterocytes during absorption.

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Oxidation of hemoglobin

2,3-BPG can oxidize hemoglobin iron, decreasing oxygen binding.

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Hematocrit

The volume percentage of red blood cells in blood.

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RBC Count

The number of red blood cells in a given volume of blood.

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WBC Count

The number of white blood cells in blood, indicating immune response.

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Platelet Estimate

Approximation of platelets per microliter based on field observation.

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Leukocytosis

An increase in white blood cell count, often in response to infection.

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Anemia Types

Various classifications of anemia based on red blood cell size and color.

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MCHC

Mean Corpuscular Hemoglobin Concentration; the average concentration of hemoglobin in red cells.

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Thrombocytopenia

A condition of having low platelet count in the blood.

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Cell shape maintenance

The shape of a cell is primarily maintained by microtubules.

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Hematopoiesis

The process of formation and development of blood cells.

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Primary blood cell production site (fetal)

During the second trimester, blood cell production occurs mainly in the liver.

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T lymphocyte maturation

The organ responsible for T lymphocyte maturation is the thymus.

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Extramedullary hematopoiesis

Blood cell production occurring outside the bone marrow, often in the liver and spleen.

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Severe anemia response

In severe anemia, the body's response includes extramedullary hematopoiesis.

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Cytokines in hematopoiesis

Cytokines like IL-2 and FLT3 are required early in hematopoietic stem cell differentiation.

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Blood cell production increase

To meet increased demand in anemia, the body increases erythropoietin production.

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High-voltage RF waves

Electrical waves used to measure the internal complexity of cells.

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Optical scatter

Detection and measurement of changes in light between electrodes.

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Low-voltage DC measurement

Used to measure total cell volume and cellular characteristics.

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Orthogonal light scatter

A method to measure cell volume, internal complexity, and granularity.

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Cell nuclear volume

The volume occupied by the nucleus within a cell.

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Cellular granularity

The presence and distribution of granules within cells.

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Microscope blood film observation

Analyzing the color and visibility of blood components under a microscope.

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Blood film technique improvement

Adjusting downward pressure or angle to enhance blood film quality.

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Iron study results in Aplastic anemia

Decreased serum iron, increased TIBC, decreased transferrin, decreased ferritin.

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Iron study results in Sickle cell anemia

Increased serum iron, normal TIBC, increased transferrin, normal ferritin.

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Iron study results in Iron deficiency

Increased serum iron, increased TIBC, normal transferrin, increased ferritin.

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Iron study results in Vitamin B12 deficiency

Decreased serum iron, decreased TIBC, normal transferrin, normal ferritin.

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Hodgkin lymphoma iron studies

Confirms abnormal iron kinetics typical in Hodgkin's patients.

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Symptoms of postpartum depression

Fatigue, decreased energy, and concern for organic causes.

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Signs of lead poisoning

Headaches, dizziness, and potentially correlating home conditions.

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Hypochromia

A condition characterized by reduced hemoglobin in red blood cells, leading to paler cells.

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Poikilocytosis

Presence of abnormally shaped red blood cells in the blood.

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Schistocytes

Fragmented red blood cells often associated with hemolytic anemia.

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Acanthocytes

Abnormal red blood cells with spiky projections, often seen in liver disease.

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Myeloid-to-erythroid ratio

The ratio of myeloid cells (white blood cells) to erythroid cells (red blood cells) in the bone marrow.

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Sideroblastic anemia

A type of anemia caused by the inability to incorporate iron into hemoglobin despite having adequate iron stores.

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MCV (Mean Corpuscular Volume)

A measure of the average volume of red blood cells.

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RDW (Red Cell Distribution Width)

A measure of the variation in the size of red blood cells.

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Study Notes

Standard Precautions

  • Standard precautions apply to blood, cerebrospinal fluid, and semen.
  • Concentrated acids are an exception.
  • Handwashing is the most important practice in preventing the spread of disease.

Preventing Disease Spread

  • Identifying specimens from known or suspected HIV or HBV-infected patients with a red label is a practice for preventing disease spread.
  • Wearing disposable laboratory coats and masks during patient contact is also important.

Bleach Dilution

  • The appropriate dilution of bleach for laboratory disinfection is 1:100.

Fire Alarm/Sprinkler System Testing

  • Fire alarms and sprinkler systems should be tested quarterly.

Chemical Storage

  • Alcohol and other flammable chemicals should be stored in approved safety cans or cabinets away from heat sources.

Needle Puncture Prevention

  • Improper disposal of phlebotomy equipment is a frequent cause of needle punctures.

Safety Data Sheets (SDS)

  • SDSs are helpful in circumstances such as when a pregnant laboratory employee asks about working with a given reagent.
  • They are also useful if a laboratory has experienced a failed fire extinguisher or a safety inspection reveals a frayed power cord.

Medical Laboratory Scientist Safety

  • When pouring an aliquot, a shield should be used when opening a tube.
  • Mary should pour the sample into a sterile tube and wipe the tube with alcohol after replacing the stopper.
  • Using a gauze is a valid technique to safely pour off material from a tube.

Fire Extinguishers

  • Class B fire extinguishers should be used in a chemical cabinet fire.

Laboratory Coats

  • Laboratory coats should be water-resistant and readily launderable.
  • They must be long-sleeved and worn fully buttoned.

Safety Management Plan

  • A safety management plan includes job safety analysis, risk assessment of safety hazards, and mechanisms for reporting accidents.
  • Budgeting for engineering controls and personal protective equipment is also part of a safety management plan.

Blood Specimen Collection

  • Wearing gloves is part of standard precautions during venipuncture.
  • Positively identifying the patient is also crucial.

Blood Specimen Collection: Needle Selection

  • A one-inch, 21-gauge needle is the most common in standard venipuncture for adults.

Blood Specimen Collection: Blood Collection Order

  • The recommended order for blood collection using evacuated tubes is: nonadditive, additive, and gel separator, blood culture.

Skin Puncture: Infants

  • The lateral or medial plantar surface of the heel is an acceptable site for skin puncture on infants.

Anticoagulants

  • Anticoagulants are additives in evacuated tubes that prevent blood from clotting before testing.

Specimen Rejection

  • A specimen collected for cortisol in the morning is not a reason for rejection
  • A specimen in a lavender stopper tube that is grossly hemolysed is sufficient reason for rejection.

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