Term
Which of the following is responsible for the MOST SERIOUS Laboratory ERROR?
A. Leaving the tourniquet on for too long
B. Missing the Vein
C. Misidentifying the patient
D. Drawing the wrong collection tube |
|
Definition
| C. Misidentifying the patient |
|
|
Term
Of the following bottles, which should be drawn first:
Blood Culture Bottles
EDTA Tubes
Coagulation Tubes
Tubes containing no anticoagulant |
|
Definition
|
|
Term
Of the following bottles, which should be drawn second:
Blood Culture Bottles
EDTA Tubes
Coagulation Tubes
Tubes containing no anticoagulant |
|
Definition
| Tubes containing no anticoagulant |
|
|
Term
Of the following bottles, which should be drawn third:
Blood Culture Bottles
EDTA Tubes
Coagulation Tubes
Tubes containing no anticoagulant |
|
Definition
|
|
Term
Of the following bottles, which should be drawn fourth:
Blood Culture Bottles
EDTA Tubes
Coagulation Tubes
Tubes containing no anticoagulant |
|
Definition
|
|
Term
| Forcing blood drawn in a syringe into a lavender tube could result in ______. |
|
Definition
|
|
Term
Of the following tubes, which color is acceptable for testing if the blood is clotted:
Lavender
Blue
Red |
|
Definition
|
|
Term
| Will an individual living at high altitudes have a higher or lower hematocrit than one living at sea level? |
|
Definition
|
|
Term
| Why will an individual living at high altitudes have a higher hematocrit than one living at sea level? |
|
Definition
| Lower Oxygen tension at higher altitudes will stimulate kidneys to excrete more erythropoietin to increase RBC Production |
|
|
Term
| Where on a manual smear will larger cells such as blasts be found? |
|
Definition
| Near the edges or at the feathered edge |
|
|
Term
| Describe the cause of water artifact on a stained blood smear? |
|
Definition
| Inadequate drying of smears before staining |
|
|
Term
| Describe what a water artifact resembles on the blood smear? |
|
Definition
| Makes cells look hypochromic |
|
|
Term
| How can you prevent the formation of a water artifact? |
|
Definition
| Allow smears/slides to dry longer or fix in methanol |
|
|
Term
Which condition is most likely on a patient with a WBC of 25,000/microliter, platelet count of 11,000/microliter, and a left shift including several blasts:
A. Chronic Leukemia
B. Acute Leukemia
C. Bacterial Infection
D. Viral Infection |
|
Definition
|
|
Term
If a PTT was performed on serum instead of plasma, the result would be:
A. The same as plasma
B. Lower than plasma
C. Higher than plasma |
|
Definition
|
|
Term
Which of the following is an acceptable site for blood collection?
A. Same side as a recent mastectomy
B. Above and IV
C. Thrombosed vein
D. Below a cast |
|
Definition
|
|
Term
| A specimen from a difficult draw has flags for decreased RBC count, decreased Hct, and an increased Hgb. What should be suspected? |
|
Definition
|
|
Term
| What is the best remedy for a Hemolyzed Specimen? |
|
Definition
|
|
Term
| An automated cell counter prints a WBC of 220,000/microliter. What other parameters will be affected? |
|
Definition
|
|
Term
| When the automated cell counter prints a WBC of 220,000/microliter, how can the affected parameters (Hgb, Hct, & RBC Count) be corrected? |
|
Definition
| Dilute WBC & Recount. Calculate indices. Subtract WBC from RBC. Perform manual Hct. Use Hgb value from dilution & multiply factor or perform manual Hgb after removing the WBCs through centrifugation. |
|
|
Term
| A cell counter prints a Plt count of 26 x 10^3/microliter. The manual smear has platelet clumps. What should be done? |
|
Definition
| Vortex and repeat, or Redraw using sodium citrate or by fingerstick. |
|
|
Term
| What is the most common reason for platelet clumps? |
|
Definition
Inadequate or delayed mixing of the collection tube after phlebotomy.
Fingersticks are also prone to platelet clumps. |
|
|
Term
| Why is it important to centrifuge coagulation tests for the time and speed listed in the procedure? |
|
Definition
Plts must be removed from the plasma and they are the last to spin out
--Plts also activate the coagulation cascade |
|
|
Term
| When preparing a cytospin smear, which of the following preserves the cells and keep them intact as they are deposited onto the slide? |
|
Definition
|
|
Term
Severe lipemia interferes with which of the following:
Hgb
Hct
MCH
PTT |
|
Definition
|
|
Term
Severe lipemia interferes with all of the following EXCEPT:
Hgb
Hct
MCH
PTT |
|
Definition
|
|
Term
How can hematology results be corrected when lipemia is present?
(For CBC) |
|
Definition
| Saline replacement is most commonly used; remove plasma & replace with saline. |
|
|
Term
How can hematology results be corrected when lipemia is present?
(For Coagulation) |
|
Definition
| Remove lipemia by using an ultra centrifuge or run tests on a fibrometer or other mechanical method not effected by lipemia |
|
|
Term
Describe the appearance of a blood smear made from a 2 day old lavender top when dealing with:
RBCs |
|
Definition
|
|
Term
Describe the appearance of a blood smear made from a 2 day old lavender top when dealing with:
WBCs |
|
Definition
| Vacuolated or can disintegrate |
|
|
Term
Describe the appearance of a blood smear made from a 2 day old lavender top when dealing with:
PLTs |
|
Definition
| Can clump or disintegrate |
|
|
Term
Describe the appearance of a blood smear made from a 2 day old lavender top when dealing with:
HCT |
|
Definition
| RBCs swell increasing MCV & Automated HCT |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
Green top for coagulation |
|
Definition
B. Reject this specimen for testing; recollect
-Blue Top is Required |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
PTT on a blue top that was collected 2 days ago for a PT |
|
Definition
B. Reject this specimen for testing; recollect
-PTTs need fresh plasma |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
Patient has a Hct of 60% and elevated PTT |
|
Definition
B. Reject this specimen for testing; recollect
-Needs adjusted anticoagulant |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
Lavender top on an inpatient with no patient name |
|
Definition
B. Reject this specimen for testing; recollect
-Proper Label Required |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
PTT drawn from an indwelling line with no blood discarded prior to filling blue top |
|
Definition
B. Reject this specimen for testing; recollect
-Draw from Vein, Not Line |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
Lavender top 1/4 full for CBC |
|
Definition
B. Reject this specimen for testing; recollect
-Full Tube or follow lab policy regarding acceptance |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
Blue top for PT and PTT; plasma is as lipemic as cream |
|
Definition
C. Seek further information or run backup test
-Use ultra centrifugation or perform onfirbometer |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
CSF with only last name of patient and no ID number |
|
Definition
C. Seek further information or run backup test
-Have the floor label |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
Bone Marrow slides with the patient's name spelled incorrectly |
|
Definition
C. Seek further information or run backup test
-Get Correct Information and Relabel Slide |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
Lavender top for CBC on an 80 year old lady who was stuck 5 times to get a tube 2/3 full |
|
Definition
| A. Accept specimen for testing |
|
|
Term
Match the following statement with one of the following choices:
A. Accept specimen for testing
B. Reject this specimen for testing; recollect
C. Seek further information or run backup test
Hemoglobin and hematocrit collected at the patient's home yesterday |
|
Definition
A. Accept specimen for testing
-Accept and comment that sample is 24 hours old; be sure to follow lab policy |
|
|
Term
50 Plts are counted in the center square of a hemocytometer with the standard plt dilution (1:100).
How many platelets are in a microliter? |
|
Definition
| 50x10x100 = 50,000 / microliter |
|
|
Term
50 Plts are counted in the center square of a hemocytometer with the standard plt dilution (1:100).
Is the # of plts counted in the microliter normal? |
|
Definition
|
|
Term
50 Plts are counted in the center square of a hemocytometer with the standard plt dilution (1:100).
Since this count is NOT normal, what is the term used for this type of count? |
|
Definition
|
|
Term
A cloudy CSF is diluted 1:2 with saline. 200 WBCs are counted in all 9 large squared on one side of a hemocytometer. 210 were counted on the nine squares on the other side.
Is the agreement acceptable? |
|
Definition
|
|
Term
A cloudy CSF is diluted 1:2 with saline. 200 WBCs are counted in all 9 large squared on one side of a hemocytometer. 210 were counted on the nine squares on the other side.
What is the count in microliters? |
|
Definition
456 / microliter
(2x205x10)/9 |
|
|
Term
A cloudy CSF is diluted 1:2 with saline. 200 WBCs are counted in all 9 large squared on one side of a hemocytometer. 210 were counted on the nine squares on the other side.
Is the number counted in microliters a normal count for a CSF? |
|
Definition
|
|
Term
The differential in the cloudy CSF diluted 1:2 with saline revealed the WBCs were 90% neutrophils.
How should the results of this CSF be handled? |
|
Definition
Call immediately to nursing unit or follow lab policies.
This is life threatening. |
|
|
Term
The differential in the cloudy CSF diluted 1:2 with saline revealed the WBCs were 90% neutrophils.
What condition is most likely? |
|
Definition
|
|
Term
The differential in the cloudy CSF diluted 1:2 with saline revealed the WBCs were 90% neutrophils.
What would be the expected CSF glucose result? |
|
Definition
| Decreased levels of Glucose |
|
|
Term
The differential in the cloudy CSF diluted 1:2 with saline revealed the WBCs were 90% neutrophils.
What would be the expected CSF protein result? |
|
Definition
| Increased levels of Protein |
|
|
Term
| Why are spinal fluids not generally counted on automated cell counters? |
|
Definition
| The counts are not high enough to exceed background or threshold values |
|
|
Term
You count 10 RBCs on each side of the hemocytometer on an infant's undiluted CSF.
What is the count you should report? |
|
Definition
|
|
Term
You count 10 RBCs on each side of the hemocytometer on an infant's undiluted CSF.
Is this a normal count for this type of patient? |
|
Definition
| Usually 0/microliter for CSF RBC, but infants often have this many due to difficulty in collecting the sample. |
|
|
Term
| What modification can be made to the osmotic fragility if it appears normal and yet the smear is suspicious for hereditary spherocytosis? |
|
Definition
| Repeat osmotic fragility to include a 2 hour incubation @ 37 degrees Celsius |
|
|
Term
Match the following testing methods with situations:
A. Manual count useful
B. Manual count not useful
Low Red Count |
|
Definition
| B. Manual count NOT useful |
|
|
Term
Match the following testing methods with situations:
A. Manual count useful
B. Manual count not useful
Fluids |
|
Definition
|
|
Term
Match the following testing methods with situations:
A. Manual count useful
B. Manual count not useful
Determining how low you can accept automated platelets |
|
Definition
|
|
Term
Match the following testing methods with situations:
A. Manual count useful
B. Manual count not useful
High white count |
|
Definition
| B. Manual count NOT useful |
|
|
Term
Match the following testing methods with situations:
A. Manual count useful
B. Manual count not useful
Confirmation of spurious results |
|
Definition
|
|
Term
Match the following testing methods with situations:
A. Manual count useful
B. Manual count not useful
Absolute eosinophil count |
|
Definition
|
|
Term
Match the following testing methods with situations:
A. Manual count useful
B. Manual count not useful
Extremely low white or platelet count |
|
Definition
|
|
Term
Which of the following manual counts is MOST useful in the average heme lab?
A. Hct
B. RBC Count
C. Hgb
D. MCV |
|
Definition
|
|
Term
| List as least one situation where using a hematocrit manual count in the average heme lab would be useful. |
|
Definition
| Verify spurious results such as with a cold agglutinin or very high WBC count |
|
|
Term
| Which CD markers indicate mature T helper and T suppressor cells? |
|
Definition
|
|
Term
| A patient has an absolute lymphocyte count 10,000/microliter. How many B cells would be expected? |
|
Definition
|
|
Term
A patient has a positive LE prep. Which of the following would NOT correlate with the findings?
A. Negative ANA
B. + Anti DNA
C. Pancytopenia
D. Increased Kidney function tests |
|
Definition
|
|
Term
| How would centrifuging a manual Hct too long affect the results? |
|
Definition
| No affect, once spun down the result would not go down farther. |
|
|
Term
| How would NOT centrifuging a manual Hct long enough affect the results? |
|
Definition
| Falsely elevated because RBCs didn't spin down all the way |
|
|
Term
| How would NOT centrifuging a manual Hct fast enough affect the results? |
|
Definition
| It appears as if there are more RBCs than are actually there. |
|
|
Term
How can the following Wright stained smears be improved?
Too Blue |
|
Definition
| Buffer Longer OR Stain Less |
|
|
Term
How can the following Wright stained smears be improved?
Too Pink |
|
Definition
| Buffer Less OR Stain More |
|
|
Term
How can the following Wright stained smears be improved?
Water artifact |
|
Definition
| Air Dry OR Fix With Methanol |
|
|
Term
Describe a Dohle Body in terms of the following:
Which cell is it found? |
|
Definition
| Neutrophil - Blue oblong inclusion near periphery |
|
|
Term
Describe a Dohle Body in terms of the following:
What is the composition? |
|
Definition
| RNA or Rough Endoplasmic Reticulum |
|
|
Term
Describe a Dohle Body in terms of the following:
When is it found? |
|
Definition
| Bacterial Infection, Inflammation, or Burns |
|
|
Term
Describe a Dohle Body in terms of the following:
What other morphology often accompanies them? |
|
Definition
| Toxic Granulation And/or Vacuoles |
|
|
Term
Which type of Hemoglobin is associated with the following:
<3% of normal adult hemoglobin, migrates with C on cellulose acetate |
|
Definition
|
|
Term
Which type of Hemoglobin is associated with the following:
Abnormal Hgb found in 30% of people from SE Asia |
|
Definition
|
|
Term
Which type of Hemoglobin is associated with the following:
<2 of normal adult hemoglobin; 70% of hemoglobin in an infant |
|
Definition
|
|
Term
Which type of Hemoglobin is associated with the following:
Elevated in HPFH |
|
Definition
|
|
Term
Which type of Hemoglobin is associated with the following:
Contains 2 alpha chains and 2 beta chains |
|
Definition
|
|
Term
Which type of Hemoglobin is associated with the following:
Absent from those with SS, CC, or EE or beta thal disease |
|
Definition
|
|
Term
Which type of Hemoglobin is associated with the following:
In the homozygous form, causes the most serious disease |
|
Definition
|
|
Term
Which type of Hemoglobin is associated with the following:
Resistant to denaturation or lysis by acid |
|
Definition
|
|
Term
Which type of Hemoglobin is associated with the following:
Looks like ghost cells in Kleihauer-Betke stain |
|
Definition
|
|
Term
| A patient with multiple myeloma has an ESR of 42 mm/hr. Does this suggest that the patient has an infection besides the myeloma? |
|
Definition
| No, Multiple Myeloma patients usually have rouleaux. Rouleaux will make a high ESR that may be unrelated to inflammation. |
|
|
Term
| A patient's RBCs started to lyse at 0.35% salt on the osmotic fragility test and were 100% lysed at 0.00%. What would be the expected RBC morphology? |
|
Definition
|
|
Term
Which of the following conditions will result in stomatocytes on the peripheral smear?
A. Rh null
B. Liver disease
C. Artifact
D. All of the above |
|
Definition
|
|
Term
| When is a buffy smear used in hematology? |
|
Definition
| Looking for parasites or other abnormal elements present in small numbers. Also, use if performing a differential on very low WBC count, such as with oncology patients. |
|
|
Term
| Reticulocytes are immature erythrocytes that contain aggregates of ______. |
|
Definition
|
|
Term
| What is the normal range for an absolute retic count? |
|
Definition
0.5 - 1.5%
25,000 - 75,000 / microliter |
|
|
Term
Which of the following will falsely lower an otherwise elevated ESR?
A. Rouleaux
B. Anemia
C. Abnormal shaped cells such as spherocytes or sickle cells
D. Bubbles in the tube |
|
Definition
| C. Abnormal shaped cells such as spherocytes or sickle cells |
|
|
Term
| When reading a spun hematocrit, Where should the reading take place? |
|
Definition
| At the top of the RBC layer |
|
|
Term
Match the miscellaneous test with the conditions tested:
PNH Screening |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
Iron Deficiency |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
PNH Confirmatory |
|
Definition
| Ham's Test / Flow Cytometry |
|
|
Term
Match the miscellaneous test with the conditions tested:
AIHA |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
Sickle cell anemia confirmation |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
Hereditary Spherocytosis |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
Fetal Cell Identification |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
Presence of hemoglobin S (Screen) |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
Pernicious anemia |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
Cold autoantibody |
|
Definition
|
|
Term
Match the miscellaneous test with the conditions tested:
Glucose-6-phosphate dehydrogenase deficiency |
|
Definition
|
|
Term
| What is the stain used for manual eosinophil counts? |
|
Definition
|
|
Term
| What is the result of a blockage or missing enzyme to the heme synthesis pathway? |
|
Definition
|
|
Term
| In this blockage to the heme synthesis pathway, what happens to the heme concentration? |
|
Definition
| Will lessen heme production and therefore Hgb |
|
|
Term
| In this blockage to the heme synthesis pathway, what happens to the iron? |
|
Definition
| No where to go, so it stays in the cells as siderocyte. |
|
|
Term
| In this blockage to the heme synthesis pathway, how is this blockage diagnosed? |
|
Definition
|
|
