Introduction to Hematology and Blood Vessels

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Questions and Answers

What are the three most common sites for venipuncture?

  • Superficial veins of the dorsum of the foot (correct)
  • Superficial veins of the ankle
  • Superficial veins of the dorsum of the hand (correct)
  • Superficial veins of the antecubital fossa (correct)
  • Superficial veins of the neck

What is the most common skin antiseptic used for venipuncture?

  • 10% povidone-iodine
  • 70% isopropyl alcohol (correct)
  • 1% iodine tincture
  • 2% chlorhexidine gluconate

What is the recommended depth of skin puncture for infants (< 1 year old)?

  • < 2.0 mm (correct)
  • 2.0 mm - 2.5 mm

What is the recommended depth of skin puncture for adults?

<p>2.0 mm - 2.5 mm (A)</p> Signup and view all the answers

What is the most common type of anticoagulant used for routine hematology determinations?

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

What is the preferred anticoagulant used for counting platelets?

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

How many times should a blood collection tube be inverted for adequate mixing?

<p>8 times</p> Signup and view all the answers

What is the first tube collected in the order of draw for skin puncture?

<p>Tube for blood gas analysis (B)</p> Signup and view all the answers

Warming the skin puncture site for no longer than 3 to 5 minutes can increase blood flow sevenfold.

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

Prolonged tourniquet application can cause hemolysis in the blood sample.

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

The first drop of blood from a skin puncture should be discarded.

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

What is the minimum amount of information that should be on a blood collection tube?**

<p>The minimum amount of information required on a blood collection tube includes: Patient's full name, Patient's unique identification number, Date and time of collection (military time), Phlebotomists initials or code number.</p> Signup and view all the answers

A phlebotomist should NEVER puncture a patient more than twice.

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

Choose the venipuncture site that should be avoided.

<p>Fistula (A), Inflamed sites (B), Veins in the feet (C), Edematous sites (E), Arteries (G)</p> Signup and view all the answers

Choose all the factors that can affect the results of hematological tests when a prolonged tourniquet is used.

<p>Hemolysis (A), Shortened coagulation times (C), Hemoconcentration (E)</p> Signup and view all the answers

The EDTA anticoagulant concentration should be between 1.5 and 2.0 mg per mL of blood.

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

It is recommended to perform a CBC (Complete Blood Count) on EDTA blood specimens that are between 2 - 4 hours old.

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

Which of the following is NOT a true statement about heparin?

<p>Heparin can be used for <em>lithium</em> level determination. (E)</p> Signup and view all the answers

A gold top blood collection tube contains thixotropic gel.

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

Sodium Fluoride is an anticoagulant.

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

Which of the following is NOT a type of anticoagulant?

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

Flashcards

Plasma

Liquid portion of unclotted blood specimen.

Serum

Liquid portion of clotted blood specimen.

RBCs

Red blood cells, also known as erythrocytes or erythroplastids.

WBCs

White blood cells, also known as leukocytes or leukoplastids.

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Platelets

Platelets, also known as thrombocytes or thromboplastids.

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Arteries

Distributing blood vessels that leave the heart. They have the thickest walls of the vascular system.

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Veins

Collecting blood vessels that return to the heart. They are the largest and have an irregular lumen compared to arteries.

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Capillaries

Connect arterial and venous systems. They are the smallest, thinnest-walled and most numerous blood vessels.

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Hematology

The study or science of blood.

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Anemia

Abnormal decrease in the number of red blood cells, hemoglobin, or packed red cell volume.

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Hemolysis

The destruction of red blood cells before the end of their normal lifespan.

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Elevated Erythrocyte Sedimentation Rate(ESR)

An abnormal increase in the speed with which red blood cells settle out of plasma.

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Hemostasis

The study of the mechanism by which the body controls bleeding.

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Erythropoiesis

The study of the process by which red blood cells are produced in the bone marrow.

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Vitamin B12 deficiency

Anemia due to a deficiency of vitamin B12.

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Folate deficiency

Anemia due to a deficiency of folic acid.

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Megaloblastic anemia

Anemia characterized by the presence of large, immature red blood cells (megaloblasts) in the bone marrow.

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Aplastic anemia

Anemia caused by a decrease in the production of red blood cells in the bone marrow.

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Iron deficiency anemia

Anemia due to a deficiency of iron.

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Microcytic anemia

Anemia characterized by abnormally small red blood cells.

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Intravascular hemolysis

The process of destroying red blood cells within the blood vessels.

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Extravascular hemolysis

The process of destroying red blood cells outside the blood vessels, primarily in the spleen.

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Anemia of chronic inflammation

Anemia due to inflammation.

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Thalassemia

A genetic disorder characterized by decreased or absent production of alpha or beta globin chains.

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Porphyria

A disease characterized by an abnormal production of heme due to a deficiency in one of the enzymes of the heme biosynthesis pathway.

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Hemolytic anemia

Anemia in which red blood cells are abnormally shaped and have a decreased lifespan.

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G6PD deficiency

A condition in which there is a deficiency of the enzyme G6PD, leading to hemolytic anemia.

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Sickle cell anemia

A recessive genetic disorder in which the beta globin gene is affected, leading to the production of abnormal hemoglobin S.

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Ferrochelatase deficiency

A condition in which there is a deficiency of the enzyme ferrochelatase, leading to sideroblastic anemia.

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Hemoglobinopathies

A group of genetic disorders characterized by an alteration in the amino acid sequence of hemoglobin.

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Polycythemia

A condition in which the body produces an abnormal amount of red blood cells.

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Study Notes

Introduction to Hematology

  • Hematology is the study of blood, derived from Greek words haima (blood) and logos (study).
  • Blood circulates in the heart, veins, arteries, and capillaries.
  • Arteries carry blood away from the heart.
  • Veins return blood to the heart.
  • Capillaries connect arteries and veins.
  • Blood has several functions, including:
    • Transport of oxygen
    • Transport of nutrients
    • Transport of waste products
    • Buffering action
    • Maintaining body temperature
    • Transporting hormones
    • Defense mechanisms

Blood Vessels

  • Arteries have thick walls.
  • Veins have thinner walls.
  • Capillaries are the smallest and most numerous blood vessels, connecting arteries and veins.

Blood Composition

  • Blood has a liquid portion (plasma) and a solid portion (formed elements).
  • Plasma includes:
    • Water
    • Proteins (albumin, globulins, clotting factors)
    • Electrolytes
    • Nutrients
    • Waste products
  • Formed elements include:
    • Red blood cells (erythrocytes)
    • White blood cells (leukocytes)
    • Platelets (thrombocytes)

Blood Collection

  • Patient identification is crucial for blood collection.
  • The patient must identify themselves, ideally.
  • Phlebotomists should maintain good hygiene and health.
  • Proper use of gloves and hand washing are essential.
  • Standard precautions must be followed.
  • Mislabeling a specimen is a critical error.

Physiological Factors Affecting Test Results

  • Posture:
    • Shift to sitting or standing can increase protein, cholesterol, and iron levels.
  • Diurnal Rhythm:
    • Hormone levels (e.g., cortisol, TSH) and iron levels fluctuate throughout the day (↑ in the morning, ↓ in the afternoon).
  • Stress:
    • Increases WBC and fibrinogen levels.
  • Exercise:
    • Increases WBC and certain plasma proteins (ex. fibrinogen).
  • Diet:
    • A fatty meal can elevate hemoglobin levels.

Skin Puncture

  • Preferred for:
    • Newborns and pediatric patients
    • Severely burned patients
    • Patients with fragile veins
  • Recommended depth:
    • Infants and children: <2 mm
    • Adults: 2 mm - 2.5 mm

Venipuncture

  • Common sites:
    • Antecubital fossa (inside the elbow) - use veins in the area as needed
  • Most frequent skin antiseptic: 70% isopropyl alcohol
  • Crucial to avoid applying pressure to the puncture site - this can lead to hemolysis and errors in testing due to the presence of excess interstitial fluid.
  • Necessary to allow puncture site to air dry.
  • First blood drop is discarded, as excess tissue fluid and skin cells are in the first drops

Blood Collection Tubes

  • Different tubes have specialized additives to preserve and collect blood.
  • Key additives and their purpose are outlined in the provided document.
  • Proper handling including the number of inversions needed are also described in the document for each additive.

Blood Collection Tube Additive Considerations

  • Proper use of collection tubes - including how many times to invert and appropriate time frames for use - are outlined.
  • Additives are used for clotting, preventing clotting, and preservation of particular specimen types (e.g., for lead analysis).

Blood Film Preparation and Staining

  • Methods for preparing a blood film (two-glass slide, coverslip, automated) and staining techniques (Wright, Giemsa) are described for use in clinical settings.
  • Techniques/methods for proper use, along with cautions/disadvantages of each technique, can be found in the document.

Blood Smear Interpretation

  • Characteristics of a well-stained blood smear (macroscopically and microscopically) are presented, including optimal RBC and WBC distribution (for manual methods and automated interpretation).
  • Issues associated with staining are explained, along with potential errors or quality control issues that may arise during staining.

Parasites in Blood Smears

  • How malaria parasites may appear on a blood smear and how to interpret these findings.
  • Other parasites and their associated blood smear findings (ex. filaria, trypanosomes) are included.

Hematopoiesis (Blood Cell Formation)

  • Defined stages of blood cell production.
  • The process starts in early embryonic life in the yolk sac, moves to the liver, and finally, to the bone marrow for adult hematopoiesis.
  • The bone marrow is the primary location for mature blood cell formation.
  • The locations for blood cell development change throughout the lifespan of a person.

Erythropoiesis (RBC Production)

  • Details of the different cell types produced during the process of erythropoiesis.
  • The process is discussed in terms of the morphology of each cell type and the steps that occur as cells mature, from immature erythroblasts to mature erythrocytes.

Iron Metabolism

  • The process of iron absorption, transport, storage, and utilization are discussed, including the role of hepcidin in regulating iron metabolism.
  • The presence of different storage forms of iron (ferritin and hemosiderin) and how to evaluate each of these when assessing iron stores.

Anemia

  • Various causes of anemia are presented, including those from bleeding, hemolysis, and diminished erythropoiesis.
  • Different types of anemia are presented (normocytic, normochromic, microcytic, hypochromic, macrocytic).

Hemoglobin

  • Hemoglobin structure and function are described.
  • Methods for checking the hemoglobin in a sample.
  • A variety of associated disorders are briefly described.

Other Hematologic Disorders

  • A variety of cell types (e.g. lymphocytes, macrophages, and neutrophils), their morphology, and functions are outlined.
  • Related disorders and relevant findings
  • Methods for assessing the different WBC types are discussed.
  • Normal values for each of the different blood cell types in human specimens

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