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Hematology PPT Flashcards Unit 1

The study of blood cells is called ___ HematologyA human body contains about ____ liters of blood 5Blood transports _____ from the lungs to the tissues. O2

Blood also clears those tissues of _____ CO2

The liquid portion of blood is called ___ PlasmaDescribe the morphology of a normal RBC Biconcave discHow many nuclei does a normal human RBC contain NoneRBC’s are filled with a reddish protein called HemoglobinWhat is the diameter of a normal RBC 6-8 micronsThe center of an RBC will appear _____ compared to the rest of the cell

Pale

When did the first automated particle counters become available

1958

The _____ Principle of direct current electrical impedance is still used today in automated profiling instruments

Coulter

An RBC count below normal is AnemiaAn RBC count above normal is PolycythemiaHow is hemoglobin concentration derived. Sample is measured in a photometer at

540 nm after conversion of hemoglobin to cyanmethemoglobin with Drabkin’s reagent.

Hematocrit is a ratio of ___ over ___ Volume of RBC’s over volume of whole blood

A normal hematocrit approaches ___% 50Who first described worms in the blood back in the mid-1600s

Athanasius Kircher

Who first gave an account of RBCs around the same time

Antony van Leeuwenhoek

Who described platelets as petite plaques over 200 years ago

Giulio Bizzozero

In 1902 James Homer Wright developed the Wright stain. Why was this so important.

It allowed detailed visual examination of blood using a microscope of things previously difficult or impossible to see.

RBC are fully described using these 6 parameters Shape, color, size, central pallor, contents and function

How many red blood cells are in 5 liters of blood? 30 trillion

What cells have no nucleus? Red blood cellsWhy are red blood cells biconcave? To increase surface areaWhat are the smallest cells in the body? Red blood cellsWhat are red blood cells filled with that carry oxygen throughout the body?

Hemoglobin

What is the average lifespan of an erythrocyte? 120 daysWhere in the body are old erythrocytes destroyed? In the spleen and liver

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What percentage of the body's cells are RBC's? 25%How many RBC's are destroyed (as well as made) per second?

2.4 million

How many RBC's are made each hour? 8.6 billionWhere are RBC's made? In the red bone marrowHereditary spherocytosis is a red cell membrane disorder

True

What is the condition in which too many red blood cells are produced and requires therapeutic phlebotomy?

Polycythemia

What is any condition of red blood cells in which the blood's capacity for carrying oxygen is diminished?

Anemia

What is the lack of oxygen to the tissues called? Hypoxia

What is the reduced blood flow to a tissue called? IschemiaWhat are some of the causes of hypoxia? Ischemia, malfunctioning hemoglobin,

increasing altitudeWhat is the characteristic sign of anemia? Reticulocytes in the bloodWhat are reticulocytes? Immature red blood cellsAnemia can be caused by too few RBCs. TrueAnemia can also be cause by iron deficiency. TrueWhat is the rupture of RBCs? HemolysisHemolytic anemia can be ______, from autoimmune disorders or G6PD deficiency, or ________, from infections, or receiving the incorrect blood type in a transfusion.

Hereditary, acquired

G6PD deficiency is hereditary and X-linked, so almost all are ______.

Male

G6PD is an ______ that is important for RBC metabolism.

Enzyme

G6PD is the most common human enzyme deficiency.

True

Pernicious anemia is also known as ___. Megaloblastic anemia

Pernicious anemia is caused by a lack of vitamin B12 or intrinsic factor.

True

After gastric bypass surgery, the stomach is no longer able to produce intrinsic factor, which is needed to absorb ______, which is needed to make _____ in RBCs.

Vitamin B12, hemoglobin

Without vitamin B12, the blood cells become fewer and larger than normal, or _______.

Megaloblastic

Gastric bypass surgery patients must take vitamin B12 shots or sublingual supplements for the rest of their lives.

True

What is Thalassemia? A hereditary form of anemia where the

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RBCs have abnormal hemoglobin that deforms the cells

What is sickle cell disease? A hereditary mutation resulting in one valine amino acid substituted for glutamic acid.

Which group of people that sickle erythrocytes present than other groups?

people with African ancestry

What kind of infections that the sickle shape can prevent?

helps prevent malaria infections, but it also causes blood clots.

What is hereditary spherocytosis? The red blood cells shrink over time due to problems with the red blood cell membrane.

What is red blood cell (RBC) count? is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions.

What does Hemoglobin (Hgb) measures? the amount of oxygen-carrying protein in the blood.

What does Hematocrit (Hct) measures? the percentage of red blood cells in a given volume of whole blood.

What is a quick screening test for anemia? the hematocrit testHow to perform the hematocrit test? A drop of blood is drawn up a small

glass capillary tube and the tube is centrifuged to pack the red blood cells at the bottom with the plasma on top.

What does hematocrit measures? the percentage of blood volume that consists of erythrocytes.

What is the ratio of the hematocrit? the ratio of packed red blood cells to total blood volume.

What percentage is normal hematocrit about 45% (46% for men and 38% for women.)

What is a measurement of the average size of your RBCs?

Mean corpuscular volume (MCV)

What is elevated when RBC are larger than normal? Mean corpuscular volume (MCV)

What is the term for larger than normal RBC? MacrocyticName one condition where MCV is elevated Anemia caused by B12 deficiencyWhat is the term for smaller than normal RBC? MicrocyticWhat is a calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell?

Mean corpuscular hemoglobin (MCH)

What is a calculation of the average concentration of oxygen on the hemoglobin molecules inside a red cell?

Mean corpuscular hemoglobin concentration (MCHC)

What is the term for decreased MCHC values? HypochromiaWhat is the term for increased MCHC values? HyperchromiaWhat is a calculation of the variation in the size of Red cell distribution width (RDW)

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your RBCs?Having few RBC’s with various shapes is called? AnisocytosisHaving many RBC’s with various shapes is called? PoikilocytosisWhat is the practice of boosting the number of red blood cells in the bloodstream by giving an athlete an unnecessary blood transfusion in order to enhance athletic performance?

Blood doping

Which athlete who won seven straight Tour de France titles confessed to using blood doping?

Lance Armstrong

What is the technique for determining which specific protein type is present on the RBC membranes?

Blood typing

What are the proteins called when the cell membranes of the red blood cells carry certain types of proteins that another person’s body will think is a foreign body and reject it?

Antigens (something that causes an allergic reaction)

What are the 2 types of blood antigens? Type A and Type BIf a person with type A blood gets a transfusion of type B blood, what would happen?

the donated blood will clump in masses (coagulation), and the person will die.

Which blood type is considered the universal donor? Why is this possible?

O negative. It is possible because there are no antigens on the blood cell.

Which blood type is considered the universal acceptor? Why is this possible?

AB positive. This is possible because the plasma does not contain antibodies to A or B or Rh antigens.

What is the rarest blood type? AB negativeWhat protein does the term “positive” or “negative” refer to in blood typing.

Rh Factor

What occurs when an Rh- mother has an Rh+ fetus in her womb (from an Rh+ father), and she has antibodies to the Rh factor?

her antibodies will attack the red blood cells of the fetus because her body detects the Rh protein on the baby’s red blood cells and thinks they are foreign objects. This is called Hemolytic Disease of the Newborn (HDN).

If a woman is Rh- and pregnant the doctor will administer an injection of what at 18 weeks and again within 72 hrs after giving birth?

Rhogam

About how old is a fetus when it begins making Rh factor?

18 weeks

True or False:During an Rh- woman's first pregnancy an Rh+ baby is not at risk of Hemalytic Disease of the Newborn.

True; during the first birth (or miscarriage), the placenta tears away and that’s when the baby’s blood cells get into the mother’s bloodstream. This begins the immune response.

What protein is another RBC antigen and similar to Rh factor; in that, it can cause Hemolytic Disease of the Newborn.

The Kell protein. People either have big K or little k proteins. Most people have little kk. If one parent has big K (either Kk or KK), the child can get Hemolytic

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Disease of the Newborn.Define Pathogen Something that causes a disease.Bacterium, virus, fungi, yeast, protozoa, and worms are examples of what type of pathogen?

Biological Pathogens

What is an example of a non-biological pathogen? Toxic chemicals, asbestos are two examples.

How many bacteria can fit inside a white blood cell? Bacteria are so small that hundreds of them can fit inside one WBC.

Where do bacteria live in the body? They usually do not invade cells, they live between cells of the body, using nutrients in the area.

How do bacteria cause harm? By secreting toxinsHow many viruses can fit inside the nucleus of one white blood cell?

Thousands

How many viruses can fit inside the nucleus area of a bacterium?

Hundreds

Where do viruses live in the body and why? They always try to invade body cells because they need host DNA or RNA to replicate

What happens when a body cell has been invaded by a virus?

The entire host cell must be killed by a white blood cell.

What is an antigen? An Antigen is anything that can cause an immune response, not necessarily a biological pathogen.

What are some examples of non-biological antigens? Pollen, dust, grass, or anything that a person is allergic to.

List the Leukocytes 1) Basophils-Mast Cells

2) Eosinophils3) Neutrophils4) Monocytes

-Macrophages5) Lymphocytes

-B cells-T cells

What percentage of all Leukocytes are Basophils? • 0.5 %What is secreted by Basophil granules and why? • Histamines. It causes

vasodilation so more WBCs can get to the infection site.

What interferes with the function of Basophils? • AntihistaminesWhat is a Basophil that leaves the blood vessel and enters the tissues?

• Mast Cell

What percentage of Leukocytes are Eosinophils? • 1-4%What roles do eosinophils play? • Ending allergic reactions and

parasitic infections. They increase in numbers during these

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conditions (Eosinophilia)Which is the most numerous White Blood Cell? • NeutrophilsWhich White Blood Cell is the first to respond to infection?

• Neutrophils

What roles do neutrophils play in response to infection?

1) Phagocytize and destroy bacteria2) Also destroy bacterial toxins in

body fluids•

How many lobes does the nucleus of an Eosinophil have?

a) 2-6 lobes

How do Neutrophils contribute to immunity? b) Engulfing bacteria and foreign bodies (thorns, dirt) in a process called phagocytosis. They release the contents of lysosomes onto invader, dissolving it.

When bacteria have capsules, they are harder to phagocytize. What action makes this process easier?

c) Opsonization by antibodies

What has some bacteria around them developed as a defense against phagocytosis.

d) Capsule

True or False: If a bacteria develops a capsule, neutrophils nor macrophages can not engulf that particular bateria.

e) 1

The process of facilitation of phagocytosis is called? f) OpsinizationWhat is the structure called when an invading bacteria has the antibody attached to its cell membrane?

g) Antigen-antibody complex

If a bacterium does not have a this structure, the neutrophil can destroy it without opsonization.

h) Capsule

When a capsule is present around a bacterium, what two that best work together are needed to kill the bacteria?

i) Neutrophil and antibody

This type of cell comprise about 5% of all WBC’s. j) MonocytesThis type of leucocyte use antibodies for opsonization. They phagocytize bacteria,old cells, and foreign bodies.

k) Monocytes

When monocytes leave the bloodstream and enter the tissue, they are called?

l) Macrophages

What cells are considered to be the most numerous of white blood cells?

m) Neutrophils

True or False: There are more macrophages in the tissue of the body than they are everywhere.

n) 1

Neutrophils live only a few days where as Monocytes/Macrophages live for how long?

o) Monocytes/Macrophages live for a few months.

What cells phagocytize bacteria until they die? Neutrophilsp)

What type cell phagocytize and then take pieces of dead bacteria and present them to lymphocytes so a larger immune response can occur?

Macrophages

What are the two type of phagocytes? Neutrophils and macrophagesWhat are Lymphocytes mostly needed to do? Kill off body cells infected by viruses.Neutrophils and macrophages main function is not to phagocytize viruses, but to what?

To phagocytize bacteria

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What do macrophages have that make them recognize the surface of the pathogen’s cell membrane?

Surface receptors

When macrophages phagocytize bacteria, pop their lysosomes onto it and dissolve it, what do the macrophages do to their own cell membrane and for what reason?

Macrophages place a piece of the bacteria’s cell membrane on it’s own cell wall until the macrophage finds a lymphocyte to present it to.

Macrophages present pieces of T cell lymphocytes and that T cell will present it to a what type of lymphocyte?

B cell lymphocyte

The B lymphocyte feels the shape of the bacteria pieces, and the B lymphocyte can them launch an attack in the rest of that type of bacteria still alive in the body. What is this process called?

Antigen presentation

What is a lymphocyte? Lymphocytes are cells which produce antibodies to kill any pathogens which invade the body.

There are two types of lymphocytes. What does one do and what does the other do?

One makes antibodies and the other engages in direct combat with viruses.

What are the two main classes of lymphocytes? B cells and T cellsWhere do the B cells originate from? Bone marrowB cell that has not been presented to an invader is called a?

Virgen B cell

After a B cell has been introduced to an invader, the B cell will mature into a what?

Plasma cell

A mature plasma cell fights infection by producing what? AntibodiesAfter the war of infection is over, the plasma cell will mature into a queen called a what?

Memory cell

Where do the T cells originate from? Thymus glandWho do the T cells attack directly. They attack foreign cells including organ

transplants.What does a B cell mature into once they have been presented to?

Plasma Cell

What is a function of a Plasma Cell? Secrete AntibodiesWhat is the function of the antibody from a Plasma cell?

Kill the attacking cell

How do the antibodies of a Plasma Cell kill an attacking cell?

They attach to bacteria and pop the cell membrane


They attach to encapsulated bacteria to help neutrophils and macrophages to phagocytize them


They agglutinate (clump all over the bacteria, binding their receptor site so they cannot cause harm)

Define the term Mononucleosis A disorder of B-cell lymphocytesWhat is the cause of Mononucleosis? The Epstein Barr VirusWhat is a characteristic of Mononucleosis? Inflammation of lymph

vessels(lymphangitis)What is Lymphangitis? Lymph vessel inflammation; usually

from infection

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What is a visual characteristic of Mononucleosis? Infected lymphocytes have a scalloped edge where they touch RBC’s

What is the function of a T-cell? Coordinate the immune response by recruiting other white blood cells.

How does a T-cell directly destroy bacteria? Popping their cell membraneHow does a T-cell directly destroy a foreign cell? Popping their cell membraneHost body cells that have become infected with viruses may be killed by what type of cell?

T-cell

What are characteristics of a T-cell regarding the killing of an invading cell?

They do not need to phagocytize the invading cell, they just kill the cell and the macrophage dissolves the debris.

What is the relationship of a T-cell and antibodies? T-cells do not need the assistance of antibodies in order to destroy an invading cell.

Which type of patient is at risk due to the function of T-cells?

Organ transplant patients

What type of cell attacks the organs of an organ transplant patient?

T-cell

What types of drugs are designed to inhibit the action of T-cells?

Immunosuppressive drugs

What cell is attacked by the HIV (AIDS) virus? T-cellWhere do T-cells originate from? Thymus GlandWhat does the Thymus Gland secrete? Certain hormones which can cause T-

cells to become immunocompetentWhat happens when a T-cell becomes immunocompetent?

Makes the cells mature and start to work

What are the three types of T-cells? Cytotoxic (killer), Helper, and Suppressor T-cells

What is the function of a Cytotoxic (killer) T-cell? Go out and directly kill bacteria or infected host cells

What are the functions of a Helper T-cell? Release chemicals called “cytokines” to call more white blood cells of all types to join the war.

Present the macrophage’s antigen to a B-cell.

What happens when a T-cell presents a macrophage’s antigen to a B-cell?

Produce antibodies against that particular bacteria

What are the functions of a Suppressor T-cell? Stop the immune process when it is overTell plasma cells to “remember” how to destroy that specific pathogen.

What type of B-cell remembers how to destroy a pathogen that has once invaded the body?

Memory B-cells

What is the function of Memory B-cells? React to remembered pathogens faster the next time it invades.

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Why can Memory B-cells react to remembered pathogens faster?

Memory B-cells already have the proper antibodies stored up for that pathogen.

True or False?A pathogen can get past the body’s physical and chemical barriers and the inflammation response.

True

What are pathogens engulfed by? MacrophagesWhat is another word for macrophage? NeutrophilWhat does the macrophage release onto a bacterium to dissolve it?

The contents of its lysosomes

True or False?There are still some pieces of the bacterium’s cell membrane left.

True

What are surface proteins of macrophages also known as?

Antigens

Where does the macrophage force the antigens of the bacterium?

To it’s own cell surface.

True or False:B-cells touch these surface antigens to make a copy of their shape.

False.Correct cell: Helper T-cells

Which cell is presented the surface antigen? B-cellsB-cells create ________ against pathogens. AntibodiesTrue or False?Helper T-cells multiply and have two main roles

True

Helper T-cells activate which type of cells? B-cells and Killer T-cellsWhat does the Helper T-cell “tell” the B-cells to do? Helper T-cells tell B-cells how to

neutralize the pathogen by presenting the pieces of the bacterium cell membrane.

What do the B-cells turn into? Plasma cellsPlasma cells multiply and produce _________ to ________ a specific pathogen

Antibodies; neutralize

What is the second role of the Helper T-cells? To activate the Killer T-cells.What do Killer T-cells secrete? CytokinesTrue or False?Killer T-cells can destroy the pathogen itself (bacteria)

True

Why would a Killer T-cell destroy an entire body cell?

It is infected with a virus

When an immune response is over, what kind of cell stops the process?

Suppressor T-cells

What do Supressor T-cells “tell” some B-cells to do? Suppressor T-cells “tell” some B-cells (plasma cells) to “remember” how to destroy that specific pathogen

B-cells (plasma cells) now become __________. Memory B-cellsWhat is leukemia? And what kind of cell does it involve?

Cancer of the blood involving the white blood cells

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What happens when one stem cell does not function properly?

It will make huge amounts of clones of itself which do not function the right way, resulting in not enough normal WBC being made

What is a result from a decrease of WBC? The body cannot fight infectionWhere are the immature white cells sent to? The bloodstreamDefine Leukemia Leukemia can be defined as too few

mature WBCTrue or False?Even though WBC count is high, they are all immature forms

True

Leukemia is a form of cancer classified as a disorder of ________ where too few mature ______ are made

Leukocytes; WBCs

True or False?Lymphoblastic is defined as too many mature lymphocytes

False. Lymphoblastic is defined as too many immature lymphocytes

Too many immature neutrophils is defined as? MyeloblasticWhat do people with severe leukemia need transplated?

A bone marrow transplant

Before a bone marrow transplant, what has to happen with the recipients WBCs?

The WBCs of the recipient have to be killed off with a medicine since they are mostly malfunctioning.

The donor usually has a small cylinder of bone removed from their _____

Hip

How is the bone marrow given to the recipient? Via i.vTrue or False?The new WBC’s may kill the patient or it may save their life

True

Define WBC count A count of the actual number of white blood cells per volume of blood.

True or False?An increase or decrease is WBC’s can be significant

True

Define White blood cell differential It identifies the types of white blood cells present

How many different types of WBC are there? FiveName the different types of WBC’s Neutrophils, lymphocytes, monocytes,

eosinophils, and basophils.Neutrophils are also known as Segs, PMNs, granulocytes, gransExcess neutrophils is defined as NeutrophiliaToo few neutrophils is defined as NeutropeniaDefine thrombocytophilia Excess plateletsDefine thrombocytopenia Too few plateletsHow long do Lymphocytes live can live a lifetimeHow long do Erythrocytes live 4 monthsHow long do Platelets live about 2 months

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How long do Monocytes live 30 daysHow long do Neutrophils live about a weekAntibodies are also known as what? immunoglobulins, abbreviated IgWhat are antibodies made by? are proteins made by plasma cells.What are typically basic structural unit? each with two large heavy chains and

two small light chainsWhat shape does the antibody form? to form a unit shaped like the letter “Y”What are the tips of the “Y” ? have receptors that are specific for a

particular antigenWhat does the stem of the “Y” do? can be grasped by a phagocyte.What is the hypervariable region? Small region at the tip of an antigen

allowing millions of antibodies with slightly different tip structures, or antigen binding sites, to exist

What is the advantage of the hypervariable region? allows the immune system to recognize an equally wide diversity of antigens

What is the function of IgD? initiation of immune responseWhat is the function of IgE? stimulates allergic reactions, good for

worm infectionsWhat is the function of IgG? highest concentration in blood, highest

amounts in most secondary responses. Indicates infection was in the past. It can also cross the placenta.

What is the function of IgA? secretory Ig, found in secretions,highest concentration in body

What is the function of IgM? produced first, best at C’ activation. Indicates infection is current

Why are people sick more often as children than in their 20’s and 30’s?

we build up many varieties of memory lymphocytes during childhood, providing immunity from more and more antigens during adulthood

What is Myasthenia gravis (MG)? autoimmune disease where antibodies destroy or block receptors for acetylcholine, a neurotransmitter.

What are symptoms of MG? Causes flaccid muscle paralysisWhat are platelets made from? Pieces break off of a megakaryocte and

are known as plateletsWhat happens when a platelet encounters a broken blood vessel?

it uses clotting factors (made in the liver and circulating in the blood) to form a web to clots blood.

Platelets are responsible for what? clot (thrombus) formationWhat is a platelet? Is the cell fragment that is broken off

from megakaryocytes.What is the primary function of a platelet? Function in clotting of bloodWhere are platelets located? In the plasma called Clotting factor in

order for then to become activated form

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a clot. They are found in Fibrin; it is made from Fibrinogen.

What Term means lack of platelets? Thrombocytopenia; it is abnormal lowing concentration of platelets.

Primary vitamin that is needed for blood clotting factor?

Vitamin K

Where is vitamin K found? Found in green, leafy vegetables. What is a Therapeutic use for Aspirin Can help blood clots by blocking the

action of platelets. ItWhat is hemophilia? A hereditary disease of males, where

they are unable to clot properly because they are missing some clotting factors.When they get even a slight bump or bruise they have to have an intravenous infusion of clotting factors or they will bleed to death.

What is a thrombus? A clot in a vesselWhat is an Embolism? A thrombus that broke away and travels

in the blood stream. It usually lodges in a smaller blood vessel and blocks circulation distal to that point.

What is platelet count? The platelet count is the number of platelets in a given volume of blood.

What can thrombocytophilia and thrombocytopenia indicate?

Both increases (thrombocytophilia) and decreases (thrombocytopenia) can point to abnormal conditions of excess bleeding or clotting.

What is the Mean Platelet Volume and how does it relate to the age of platelets?

Mean platelet volume (MPV) is a machine-calculated measurement of the average size of your platelets. New platelets are larger, and an increased MPV occurs when increased numbers of platelets are being produced.

What are the uses of PT and PTT tests and which are the coagulation factors they evaluate?

The PTT test is used to investigate unexplained bleeding or clotting. It may be ordered along with a PT (Prothrombin Time) test to evaluate hemostasis (the process of clot formation).The PTT evaluates the coagulation factors XII, XI, X, IX, VIII, V, II (prothrombin), and I (fibrinogen).A PT test evaluates the coagulation factors VII, X, V, II, and I (fibrinogen). By evaluating the results of the two tests together, a doctor can gain clues as to

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what bleeding or clotting disorder may be present.

How Heparin is used as anticoagulant drug therapy? These tests are used to monitor heparin anticoagulant therapy. Heparin is a drug that is given intravenously (IV) or by injection to prevent and to treat blood clots. IV’s are also flushed with heparin to prevent clot formation. When it is administered for therapeutic purposes, it must be closely monitored. If too much is given, the treated person may bleed excessively; with too little, the treated person may continue to clot.

What primary diseases are monitored by CBC and what are the parts of a Complete Blood Count?

The complete blood count or CBC test is used as a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood and includes the following:White blood cell (WBC) countWhite blood cell differentialRed blood cell (RBC) countHemoglobinHematocritMean corpuscular volume (MCV)Mean corpuscular hemoglobin (MCH)Mean corpuscular hemoglobin concentration (MCHC)Red cell distribution width (RDW)platelet countPT, PTT (separate test from CBC)

List the three different types of granulocytes in the blood

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List the two agranulocytes in the blood

What is septicemia? Septicemia (aka bacteremia or toxemia) is the condition when bacteria invade the body and circulate in the blood.

What entry points bacteria can use in order to gain access to the blood?

Bacteria can enter the bloodstream as a severe complication of infections (like pneumonia or meningitis), during surgery (especially when involving mucous membranes such as the gastrointestinal tract), or due to catheters and other foreign bodies entering the arteries or veins (including intravenous drug abuse).

What consequences the presence of bacteria have in the blood?

Bacteremia can have several consequences. The immune response to the bacteria can cause sepsis and septic shock, which has a relatively high mortality rate (kills 1 person in 5). Bacteria can also use the blood to spread to other parts of the body (which is called hematogenous spread), causing infections away from the original site of infection. Examples include endocarditis or osteomyelitis.

What is the treatment of septicemia? Treatment is with antibiotics, and prevention with antibiotic prophylaxis can be given in situations where problems are to be expected.

What are the stem cells? STEM CELL: A cell that has not matured and differentiated yet.

What are the advantages of stem cells and why would research use embryos as stem cell sources rather than the placenta?

An embryo has lots of stem cells which have not decided to become a nerve cell, muscle cell, liver cell, etc. Stem cells become the type of cell the body needs. The placenta of a newborn infant has many of these stem cells, too, but not as many as an embryo. That’s why people

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want to research stem cells on embryos; there are more stem cells there.

What is the first step for a stem cell? To differentiate in order to decide which cell it belongs to.

What is hematopoiesis? blood cell formationHow many new blood cells are formed each day? 100 billionWhere are plasma proteins made? In the liverWhere are blood cells made? In the red bone marrow/spongy boneWhere is red bone marrow located? Epiphyses of long bones, girdles

(clavicle, scapula pelvic bones), axial skeleton (sternum and vertebral bones)

What are characteristics of yellow bone marrow? Contains many fats cells, located in long bones of adults, has nothing to do with forming blood cells.

What is released into the bloodstream once completely mature?

blood cells

Where are blood cells destroyed once they are old?

in the spleen and the liver

Where do T cells mature? the thymus glandWhat cells originate from blood stem cells? erythroblasts: red blood cells

lymphoblasts: lymphocytesmyeloblasts: all other white blood cells

What happens when a RBC loses its nucleus? it gains room for more hemoglobinWhat are reticulocytes? cells with some bits of nucleus for about

two daysWhat is the relationship between lymphoblasts and lymphocytes

Lymphoblast give rise to lymphocytes

What are myeloblasts? These are the stem cells that mature into the other leukocytes.

What is Leukemia? Leukemia is cancer of the stem cellsWhat is an inflammation reaction? When you get stuck by a thorn or have

an infected cut, the body goes through a series of events called an inflammatory reaction.

What are the four signs of inflammation? – Redness (erythema or rubor)

– Heat (calor)– Swelling (edema or

tumor)Pain (dolor)

What causes redness in the stages of inflammation?

a. Redness is caused from the blood vessels dilating to allow more blood flow to the area. Within the blood are platelets to clot the blood, proteins to

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repair the damage, and macrophages, which are white blood cells that eat up the foreign body, bacteria, or the dead cells.

What causes heat in the stages of inflammation? b. Heat is caused because of the extra amount of warm blood flow to the area.

What causes swelling in the stages of inflammation?

c. Swelling is caused from the plasma that leaks out of the swollen blood vessels.

What causes pain in the stages of inflammation? d. Pain is caused from the pressure of the extra fluid pressing on nerves in the area.

What are the two types of immune response? The immune response is divided into two parts: Innate Immunity (WBC) and Adaptive Immunity

e. (Antibodies)What are the two types of Adaptive Immunity? Active immunity and Passive immunityWhat is active immunity? Active means the person’s own body

makes the antibodies. Naturally Acquired

– The body is naturally exposed to an infectious agent and launches an immune reaction

Artificially AcquiredThe person is injected with a weakened (attenuated) or killed organism, as found in a vaccination

What is naturally acquired active immunity? It is when the body is exposed to an infectious agent and the body has to work to produce antibodies which specifically attack that infectious agent.

In naturally acquired active immunity, which cells secrete these antibodies, how long can they live, and how do they attack?

The white blood cells secrete these antibodies which will continue to circulate sometimes for years, ready to attack that type of bacteria and cause them to pop like a balloon before the body can become sick.

Can you get the same cold virus twice? No, you will become immune to it. Your next cold is from a different virus.

Which diseases may kill you at first exposure? Polio, diphtheria, tetanus, and influenza.

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What is a vaccine? It is an altered or attenuated form of the virus that the body recognizes as foreign, but they can’t cause disease.

What is the point of vaccination? If the person is exposed to the real organism later, the antibodies are already there to kill it off without the body getting sick.

What is an example of Artificially Acquired Active Immunity?

An example is when a child is vaccinated against measles as a baby, so when he gets to school and is exposed to the disease, he doesn’t get sick.

What does passive in Passive Immunity mean? PASSIVE means the person’s body does not have to make the antibodies.

What is an example of naturally acquired immunity?

An example is the passing of antibodies from mother to infant in breast milk.

What are the two types of passive immunity? Naturally acquired or artificially acquired

What are two examples of artificially acquired immunity?

The first example is when a person receives an infusion of antibodies from someone else. The second is an example of an ebola survivor that donates his blood to another infected person.

Are active or passive immunity for life or short life?

Active immunity is long-lived, and may last for years or even a life time.Passive immunity is short lived, and may last only for a few months.

What are allergies? It is a hypersensitivity to substances such as pollen or animal hair that would not ordinarily cause a reaction.

What are the two types of allergic responses? Immediate and delayed.What is an immediate allergic response? A reaction that occurs within seconds of

contact with the thing causing the allergy.

What will stop an allergic reaction for peanuts or seafood?

A shot of epinephrine will stop the reaction.

What is a delayed allergic response? When the body’s first exposure to the substance will not cause a reaction, but all exposures afterward will trigger the response.

What is an example of a delayed allergic response?

Not itching the first time you touch poison ivy.

What are the two types of chemical mediators of allergies?

Pre-formed and newly formed

What are the two preformed chemical mediators of allergies?

Histamine and proteases.

What are the newly formed chemical mediators of Leukotrienes, platelet activating factor,

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allergies? prostaglanin D2, cytokines,Bodily reactions to histamine? Elevated vascular permeability; smooth

muscle contractionBodily reactions to proteases? Mucous secretion, generation of

complement splitproducts

Bodily reactions to Leukotrienes? Elevated vascular permeability; contraction of pulmonary smooth muscles

Bodily reactions to platelet activating factor? Platelet aggregation; contraction of pulmonary smooth muscles

Bodily reactions to prostaglanin D2? Vasodilation; contraction of smooth muscles

Bodily reactions to cytokines? Chemotactic and inflammatoryWhere to symptoms of allergic reactions manifest themselves?

They are dependent upon site of allergen exposure

What is a wheal-and-flare reaction? Pruritis (itching), erythema on the skinWhat are some examples of symptoms of an allergic reaction?

bronchoconstrictionmucous secretionvasodilation (shock)

What is localized anaphylaxis? A reaction limited to the site of allergen exposure

What is the definition of pruritis? ItchingWhat is the definition of urticarial? HivesWhat is allergic rhinitis? Hay feverWhat is atopic dermatitis? EczemaWhat are the types of stimulants of an allergic asthma attack?

Airborne, blood borne, and degranulation of mast cells due to IgE cross-linking in the lower respiratory tract.

What are the symptoms of an allergic asthma attack?

airway edemamucous secretioninflammation

What percent of the U.S. population is hypersensitive to allergens, and classified as asthmatic?

5%

What is an autoimmune disease? A hereditary problem where the body thinks its own tissues are foreign bodies, and it constantly tries to kill off its own tissues.

What is Hematology? Study of the diseases of bloodWhat is done in a Hematology Laboratory? The fundamental concepts of biology

and chemistry are applied to the medical diagnosis and treatment of various disorders.

What is one of the most common types of tests CBC

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performed in Hematology Laboratory?What is a CBC? Complete Blood Count, for example,

Red Blood Cells diagnosis Anemia, White Blood Cells diagnosis Leukemia’s and Platelet diagnosis coagulation.

What are two common instruments used in molecular diagnostics?

Flow cell cytometry and Digital Imaging

What types of people are employed in a Hematology Laboratory?

MLS, MLT, Lab assistants, and phlebotomists play a major role in patient care.

Assays and examinations performed in the Laboratory are used for what purpose?

Establish a diagnosis, rule out a diagnosis, detect anUnsuspected disorder, monitor the effects of therapy,Detect minimal residual disease following therapy.

What are some of the safety procedures in a Hematology Laboratory?

Exercising good technique, staying alert, a formal safety program, specifically mandated plans for example, chemical hygiene, bloodborne pathogens, identification of various hazards for instance, chemical and biological.

What are the duties of the safety officer? Duties affecting staff including compliance with existing regulation affecting laboratory and staff for instance labeling of chemicals and providing supplies for proper handling and disposal of biohazardous materials

What are OSHA Standards? Occupational Safety Health Administration Acts is to ensure safe and healthful working conditions for workers suitable protective equipment, exposure control procedure, and implementation of training and education programs

What is a Chemical Hygiene plan? Ensures Laboratory workers are fully aware of hazards associated with chemicals in their workplaces.

What is a MSDS? Material Safety Data Sheet describes hazard, safety handling, storage and disposal of hazardous chemicals.

How were HAZCOM Standards procedures described?

• Revised criteria for the classification of chemical hazards

• Revised labeling provisions that

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include requirements for the use of standardized signal words, pictograms, hazard statements, and precautionary statements

• A specified format for safety data sheets (currently known as material safety data sheets)

Related revisions to definitions of terms used in the standard and requirements for employee training on labels and safety data sheets

How were HAZCOM standards administrated by OSHA?

Legislation on chemical hazard precautions, such as state “right to know” laws, and OSHA document 29 CFR 1910 set the standards for chemical hazard communication (HAZCOM) and determine the types of documents that must be on file in a laboratory.

1.When did Occupational Exposure to Bloodborne Pathogens become law?

March 1992

Occupational Exposure to Bloodborne Pathogens standard requirements:

Regulation requires that laboratories develop, implement, and comply with a plan that ensures the protective safety of laboratory staff to potential infectious bloodborne pathogens, hepatitis B virus (HBV), and human immunodeficiency virus (HIV).

Know how to handling medical waste: The law further specifies the rules for managing and handling medical waste in a safe and effective manner.

How did the CDC and CLSI involve in the safety precaution standards?

The CDC also recommends safety precautions concerning the handling of all patient specimens, known as standard precautions. New the CLSI also establish guidelines for laboratory work in regard to the protection from blood-borne diseases spread through contact with patient specimens.

What did CDC provide in HIV prevention and treatment?

CDC provides recommendations for treatment after occupational exposure to potentially infectious material.

How did the HIV-1 prevention administrated? The recognition of HIV-1 generated new policies from the CDC and mandated regulations by OSHA: Guidelines "Recommendations for Prevention of

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HIV Transmission in Health-Care Settings"Dept. of Labor, OSHA has “Occupational Exposure to Blood-borne Pathogens"

When did HHS regulations pass? US Department of HHS regulations for Implementing the Clinical Laboratory Improvement Amendments of 1988How did the HIV transmit into human body?

HIV has been isolated from blood and body fluids for example semen, imaginal secretions, saliva, tears, breastmilk, cerebral spinal fluid (CSF), amniotic fluid, and urine, but only blood semen factional secretions and breastmilk have been implicated in transmission of HIV to date new recently, sperm cells themselves have been discovered to be able to be capable of transmitting HIV.

Does HIV transmit through human saliva? Evidence for the role saliva in the transmission of the virus is unclear, but standard precautions do not apply to saliva uncontaminated with blood.

What were the OSHA requirements for an employer?

Provide a safe work environment.OSHA mandates that an employer

− Educate and train all healthcare workers in standard precautions and in preventing bloodborne infections.

− Provide proper equipment and supplies, e.g., gloves.

Monitor compliance with the protective biosafety policies.

How many cases were estimated of needlestick injuries occur in US each year?

The CDC estimates that more than 380,000 needlestick injuries occur in US hospitals each year

What is the most risk device that is caused injuries?

61% of these injuries are caused by hollow-bore devices.

What is the most infected HIV varieties at workplace?

Blood is the most frequently advocated infected body fluid and HIV and HBV exposure in the workplace.

How does the HIV transmission? Occupational exposure is a percutaneous

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injury, for example needlestick or cut with a sharp object, or contact by mucous membranes or nonintact skin (especially when the skin is chapped, Abraded, or affected with dermatitis), or the contact is prolonged or involves an extensive area with blood, Tissues, blood-stained body fluids, body fluids to which standard precautions apply, or concentrated virus.

What is the HIV prevention procedure among healthcare personnel?

Among healthcare personnel with documented occupationally acquired HIV infection, prior percutaneous exposure is the most prevalent of infection.

What will be the higher risk of HIV infection? Certain percutaneous injuries carry a higher risk of infection.

1) A deep injury late stage HIV disease in the source patient

2) Visible blood on the device that caused the injury

Injury with a needle that had been placed in a source patient's artery or vein

How risk does a non-intact HIV transmit through human skin or mucous membranes?

There are a small number of instances when HIV has been acquired through contact with non-intact skin or mucous membranes:

a) Splashes of blood in the eyeAerosols

What were the risks of HIV infection? The risk of infection not only varies with the type of exposure but also may be influenced by:

q) Amount of infected blood in the exposure Length of contact with infectious material

r) Amount of virus in the patient's blood or body fluid or tissue at the time of exposure

When did the needlestick Safety and Prevention become law?

Needlestick Safety and Prevention Act became law, November 6, 2000.

What were the requirements for needlestick Safety and Prevention Act?

1) Requires healthcare employers to provide safety engineered sharp devices and it'll assist him to employees to reduce the risk of occupational exposure to HIV,

22


hepatitis C, and other blood-borne disease.

2) Expands the definition of engineering controls to include devices with engineered sharps injury protection.

3) Requires that exposure control plans document consideration and implementation of safer medical devices designed to eliminate or minimize occupational exposure.

4) Annual review of occupational exposure implementation

5) Requires each healthcare facility to maintain a sharps entry along with detailed information regarding cutaneous injuries

Requires employers to solicit input from healthcare workers when identifying and selecting sharps and document process.

What was the good news in Occupational Exposure to Bloodborne Pathogens recently?

Good news-most occupational exposures do not result in infection

•How was the risk of HIV transmission? The average risk of HIV transmission

after exposure to infected blood is low--about three per 1000 entries.

What is used as the most widespread control measure required by OSHA and CLSI in sharps prevention?

Puncture-resistant sharps containers.

What is the primary purpose of a sharps container?

To eliminate the need for anyone to transport needles and other sharps while looking for a place to discard them.

Where are sharps containers to be located? Located in the patient areas as well as conveniently placed in the laboratory.

Who should carry these red, puncture-resistant containers in their collection trays?

Phlebotomists.

How should needles not be placed in the container?

Needles should not project from the top of the container.

What does the use of special sharps containers allow?

It permits quick disposal of a needle without recapping and other sharp devices that may be contaminated with blood.

What is the recommendation of the manipulation of any “sharp” by hand?

It is recommended that you not recap, bend, break, or otherwise manipulate any needle or lancet device.

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How have most needlestick accidents occurred? During the recapping of a needle after phlebotomy.

How can other accidents happen? During housekeeping, when contaminated sharps are left on a bed, concealed in linens or disposed of improperly in a trash can.

How can these disposal-related exposures be eliminated?

With the proper use of sharps containers.

How are sharps containers discarded? The containers are closed and placed in biohazard waste.

Who should you report your needlestick injury to?

Either the supervisor or another designated individual.

Medical personnel must be aware that what two viruses are totally different?

HBV and HIV.

How common is exposure to HIV in an occupational transmission to a healthcare personnel with no other know high risk factors?

Uncommon but it has been documented.

Why shouldn’t HIV be underrated? Although is an unlikely work-related hazard, it can be fatal.

What is the least likely to occur if proper safety practices are followed?

HIV.

What is fatal and more probable than HIV? HBV.Which virus is found in lower concentrations of blood and which is found in higher concentrations of blood?

HIV is usually found in lower concentrations where as HBV is found in higher concentrations and is present in blood or blood products.

How many days does HIV retain infectivity for? Three days in dried specimens at room temperature,one week in an aqueous environment at room temp.

What was the leading occupationally acquired infection of healthcare workers before the invention of its vaccine?

Hepatitis B virus (HBV).

Approximately how many healthcare workers are still infected with HBV each year following occupational exposure?

800.

What factors does the likelihood of infection after exposure of HBV or HIV depend on?

The concentration of the virus in the sample (HBV has a higher level of viral concentration than HIV), if there are any skin lesions or abrasions on the exposed skin of the healthcare worker, and the immunity status of the healthcare worker for HBV.

What federal standard did OSHA issue in 1991 as a mandate to employers to provide?

It requires employers to provide the hepatitis B vaccine to all employees at no cost to them who have or may have

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had an occupational exposure to blood or potentially infective materials.

What must an employee do if they refuse a vaccine?

They must sign a declination form.

What is the best prophylaxis against blood-borne pathogen exposure?

Vaccination against HBV and compliance with precautions.

What is given if an individual has not been vaccinated for HBV and is exposed to hepatitis B in a penetrating injury?

Hepatitis B immune globulin (HBIG) is given concurrently with hepatitis B vaccine.

If administered in accordance with the manufacturers directions, what are both of these products considered?

Both (HBIG and hepatitis B vaccine) are considered safe and proven free of any risk of infection with HBV or HIV.

What is the most important strategy for reducing risk of occupational HIV transmission?

To prevent exposures but there should be a plan for post exposure management.

What organization has issued guidelines for the management of healthcare personnel exposures to HIV and recommendations for PEP.

The CDC.

Why is occupational exposure considered to be an urgent medical concern?

To ensure timely post exposure management.

What should the lab staff members be informed of if an accidental occupational exposure does occur?

They should be informed of their options for treatment.

Why should a course of action be planned ahead of the occurrence of an actual incident?

Because it can trigger an emotional response.

If a “source patient” can be identified, what should the work up then include?

The work up should include testing the patient for various infectious diseases.

How do the patients rights in regard to testing of a source patient vary?

The laws vary from state to state.

What does the ACIP recommend after Skinner mucosal exposure to blood?

Immunoprophylaxis, depending on several factors.

If an individual has not been vaccinated, what is given?

HBIG is usually given within 24 hours, concurrently with hepatitis B vaccine.

What does HBIG contain? Antibodies to HBV and offers a pump but short lived protection.

What should the doctors be alerted of if an exposure occurs?

Risk of infection, and be evaluated medically for any history, signs or symptoms consistent with HIV infection.

If a parenteral exposure takes place, what should a laboratory professional do?

They may request follow-up monitoring for hepatitis or HIV antibodies.

Monitoring and follow-up counseling should be what?

Provided free of charge.

What happens if voluntary informed consent is obtained?

The source of the potentially infections material and the technical/technologist should be tested immediately.

When should the laboratory professional be Immediately, but also at intervals after

25


tested? exposure.What should be filed after exposure? An injury report.What are not recommended for PEP or hepatitis C?

Immune globulin and anti-viral agents (interferon with or without ribavirin).

What are some steps you must follow after post-exposure?

* Although the most important strategy for reducing the risk of occupational HIV transmission is to prevent occupational exposures, plans for post exposure management of healthcare personnel should be in place.* The CDC has issued guidelines for the management of healthcare personnel exposures to HIV and recommendations for PEP.* An occupational exposure should be considered to be an urgent medical concern to ensure timely post exposure management.* If an accidental occupational exposure does occur laboratory staff members should be informed of options for treatment.* Because a needle stick can trigger an emotional response it is wise to think about the course of action before the occurrence of an actual incident.

When can a TB test come out to be a false negative?

When the healthcare worker has recently spent time with and been exposed to someone with active TB, their skin test may not yet be positive.

When will a healthcare worker need to get a second Tb test?

They may need a second skin test 10 to 12 weeks after the last time they had contact with the infected person.

How long does it take for the immune system to react to the TB skin test?

It can take up to several weeks after the exposure.

What does a second negative TB test mean? They may need a second skin test 10 to 12 weeks after the last time they had contact with the infected person.

What should workers who have strongly positive reactions, with a skin test diameter greater than 15 mm, and symptoms suggestive of TB do?

They should be evaluated clinically and microbiologically, and two sputum specimens collected on successive days should be investigated for TB by microscopy and culture.

What are some vaccines that all lab staff needs to have if antibodies are not demonstrable?

Rubella and Hepatitis B

Why is immunization of all lab staff important? Individuals are recognized for being at

26


risk for exposure to, and possible transmission of, diseases that can be prevented by immunizations.

What is an important component of a health care organization?

A well-planned and properly implemented immunization program.

Where can programs’ information about employees’ vaccination be found?

They are available from advisory committee on immunization practices hospital infection controls practices advisory committee and CDC.

What are some major considerations of employees’ vaccination program information’s?

Space characteristics of healthcare workers employed an individual served, as well as the requirements of realtor agencies and local, state, and federal regulations.

Preemployment health profiles with baseline screening of students in laboratory staff should include?

An immune status evaluation for hepatitis B, rubella, and measles at a minimum.

What is something that a laboratory must always have?

Each laboratory must have an up-to-date safety manual.

What does a SDS contain? This manual contains a comprehensive listing of approved policies, accept practices, questions including standard precautions.

How long does each lab requires to evaluate the effectiveness of its plan?

At least annually And two updated as necessary.

Who should the written plan be available to? Employees

What must a lab written plan include? The purpose and scope of the plan, references, definitions of terms and responsibilities, and detailed procedural steps to follow.

Because many hazards in the clinical laboratory happened, what word was created?

A uniquely special term biohazard was devised.

Why is this word posted throughout the lab? To denote infectious materials or agents that presents a risk to humans’ health or animals and the laboratory.

Where can you encounter potential risk? Through direct infection or through the environment.

How does an infection occur in the lab? During the process of specimen collection or from handling, transporting, or testing the specimen.

Where are laboratory policies found? They are included in the laboratory reference manual that is available to all hospital personnel.

Where are manuals frequently published, and They are frequently published online

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what do they contain? and contain information regard patient preparation for laboratory tests.

Where are approved policies regarding the reporting of abnormal values are clearly stated in?

In the safety manual.

What is a very important safety precaution? Hand washingWhen should hand washing be performed? After contact with patients and

laboratory specimens.Gloves should be used as an? 1)____and not as a? 2) ______ for?______.

1) Adjunct2) Substitute3) Hand washing

What is the efficacy of hand washing? Reducing transmission of microbial organisms.

When, at the very minimum, should hands be washed with soap and water (if visibly soiled) and or by hand anti-sepsis with an alcohol-based hand rub (if hands are not visibly soiled)?

1) After completing laboratory work and before leaving the laboratory.2) After removing gloves.Glove quality variability with leakage in 4% to 63% of vinyl gloves and 3% to 52% of latex gloves3) Before eating, drinking, applying makeup, and changing contact lenses, as well as before and after using the lavatory.4) Before all activities that involve hand contact with mucous membranes or breaks in the skin.5) Immediately after accidental skin contact with blood, body fluids, or tissues.

When should the gloves be removed and hands thoroughly washed?

If the contact occurs through breaks in the gloves

What should you do if accidental contamination occurs to an exposed area of the skin or because of a break and gloves?

One must wash first with the liquid soap, rinse well with water, and apply a 1:10 dilution of bleach or 50% isopropyl or a full alcohol. Then the bleacher alcohol is left on the skin for at least one minute before final washing with liquid soap and water.

Two important points in the practice of hand hygiene technique are:

1) When decontaminating hands with the waterless of antiseptic agent (e.g., an alcohol-based hand rub), apply product the palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the manufacturer's recommendations on the volume of product to use. If an

28


adequate volume of an alcohol-based hand rub is used it should take 15 to 25 seconds for hamster dry.2) When washing with a non-antimicrobial or antimicrobial soap, wet hands first with warm water, apply 3 to 5 mL of detergent to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with warm water and dry thoroughly with a disposable towel. Use the tile to turn off.

What does PPE stand for ? Personal Protective EquipmentWho is responsible for regulating standards and guidelines to protect employees from exposure of pathogens present in human blood and body fluids ?

OSHA

What does PPE mean? Personal protective equipment use of specialized clothing or equipment used by workers to protect from direct exposure to blood or other potential infections or hazardous material

What are some examples of PPE use GlovesLaboratory facial shields maskEye protection and breathing apparatus

Use of latex free is provided by the healthcare to use when dealing with personnel with sensitivity to latex?

True

You do not need to use of gloves when working in the laboratory processing area ?

False

When performing phlebotomy procedure for each patient you must wear gloves and disposed of them in a proper biohazard container the one that is provided by your work facility and should use of a new pair of gloving for each new patient ?

True

A laboratory coat should be used whenever laboratory personnel are working with potentially infectious specimens.

True

Coats that become soil with blood or body fluids can still be use and could be disposed in a regular bid trash

False

What is a disinfected ? Eliminates many or all pathogenic microorganisms except for bacterial spores on in and objects

What is use as a multi-barrier strategy to prevent healthcare associated infections

Disinfectant

All work areas should be disinfected by the employee True

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at the beginning and end of shift or when needed to prevent infection to patient and staff ?There is no need of use of gloves when disinfecting an area with a 1 to 10 dilution of household bleach or EPA registered disingfectant?

False

What is the most widely used chlorine product of aqueous solutions of 5.25% to 6.15% disinfectants?

Hypochlorite

Which is a broad spectrum of antimicrobial activity and does not leave a toxic residue and is unaffected by water hardness ?

Bleach

A disinfectant of bleach should have a dilution of _____concentrated bleach solution ?

1:10

How employer should clean and the dilution at work? While wearing gloves employers should clean and sanitize all work surfaces at the beginning and end of their shift with household bleach 1:10 dilution

When instruments such as scissors or centrifuge carriages to be sanitize?

Before and after the workday with the diluted solution of bleach

Where are disposable materials contaminated with blood must be placed?

For example about studies have demonstrated the HIV is inactivated rapidly after being exposed to common chemical genocides at concentrations that are much lower than those used in practice.Disposable materials contaminated with blood must be placed in containers marked quote Biohazard" properly discarded

Where disposable materials contaminated with blood must be placed in?

containers marked quote Biohazard

How treat an area contaminated by either blood or body fluids needs

Potentially hazardous, with prompt removal and surface disinfection. Neither HBV (or HCV) nor HIVAs being transmitted from a housekeeping surface, e.g. countertops

What is protocol recommended for managing spells in the clinical laboratory?

- Wear gloves and a laboratory coat.

- Absorb the blood with disposable towels. Remove as much liquid blood or serum as possible before decontamination.

- Using a diluted bleach (1:10) solution, clean the spill site of all visible blood.

- Wipe down the spill site with paper towels soaked with diluted

30


bleach.- Place all disposable materials

used for decontamination into a biohazard container.

Decontaminate nondisposable equipment by soaking overnight in a dilute bleach (1:10) solution and rinsing with methyl alcohol and water before reuse. Disposable glassware or supplies that have come in contact with blood should be autoclaved or incinerated.

Who need programs to minimize risks to? The health and safety of employees, volunteers, and patients.

2.How to maintain safe operations? Suitable physical arrangements, and

acceptable work environment, and appropriate equipment need to be available to maintain safe operations.

How general infection control safety practices • All devices in contact with blood that are capable of transmitting infection to the donor or recipient must be sterile and nonreusable.

• Food and drinks should not be consumed in work areas or stored in the same area as specimens. Containers, refrigerators, or freezers used for specimens should be marked as containing a biohazard.

• Specimens needing centrifugation should be capped and placed into a centrifuge with a sealed dome.

Rubber-stoppered test tubes are opened slowly and carefully with a gauze square over the stopper to minimize aerosol production (the introduction of substances into the air).

What is autodilutor? 1. Autodilutors or safety bulbs are used for pipetting. Pipetting of any clinical material by mouth is strictly forbidden (see following discussion

How general infection control safety practices? • No tobacco products can be used

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in the laboratory.• No manipulation of contact

lenses or teeth-whitening strips should be done with gloved or potentially infectious hands.

• Do not apply lipstick or makeup.2. All personnel should be familiar

with the location and use of eyewash stations and safety showers.

How to use pipetting safeguards? Pipetting must be done by mechanical means.Such a device is a bottle top dispenser that can be used to deliver repetitive aliquots of reagents.It is designed bottle mounted system that can dispense selected volumes in an easy, precise manner.

• Is usually trouble-free and requires minimal maintenance.

How specimen processing protection • Protective gloves should always be worn for handling any type of biological specimen.

• Bio hazards are generally treated with great respect in the clinical laboratory.

• the adverse effects of pathogenic substances on the body are well documented.

• The presence of pathogenic organisms is not limited to the culture plates in the microbiology laboratory.

Airborne infectious particles, or aerosols, can be found in all areas of a laboratory where human specimens are used.

What can result in an occupational exposure in Hematology lab?

1. In the hematology laboratory, centrifuge accidents or the improper removal of rubber stoppers from test tubes, produce airborne droplets (aerosols) that can result in an occupational exposure.

What covered a cap when removed from a specimen tube or a blood collection tube?

2. the top should be covered with a disposable gauze pad or a special

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protective pad.What can reduce contamination of gloves? 3. Gauze pads with an impermeable

plastic coating on one sideHow the tube should be held? 4. The tube should be held away

from the body and the cap gently twisted to remove it.

What happen if snapping off the cap top? 5. Snapping off the cap top can cause some of the contents to aerosolize.

When not in place on the tube, what should kept? 6. Kept in the gauze and not placed directly on the work surface or countertop.

When specimens are being centrifuged, How the tube caps should kept?

7. the tube caps should always be kept on the tubes.

Should stopped centrifuge by the worker? 8. Centrifuge covers must be used and left on until the century stops. Centrifuge should be allowed to stop by itself it should not be manually stopped by the worker

What should be taken to control the hazard from aerosols?

is to exercise caution in handling pipettes and other equipment used to transfer human specimens, especially pathogenic materials.

9. These materials should be discarded properly and carefully.

Where constructed plastic splash shields? • It used in many laboratories for the processing of blood

specimens. Are removed behind or under the shield, which acts as a barrier between the person in the specimen to,.

• This is designed to prevent aerosols rendering the nose, eyes, or mouth.

What are laboratory safety boxes? Laboratory safety boxes are commercially available and can be used to remove stoppers tubes or perform other procedures that might cost spattering.Specials and safety boxes should be periodically decontaminated.

The proper handling of blood and body fluids is critical to the accuracy of laboratory results, and the (?) of all individuals who come in contact with

safety

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specimens must be guaranteed.If a blood specimen is to be transported, the shipping container must meet what organization requirements for shipping clinical specimens.

OSHA

Shipping containers must meet the packaging requirements of major couriers and (?) hazardous materials regulations.

Department of Transportation

Approved re-closable plastic bags for handling what type of specimens does amber bags for analysis of light-sensitive drugs are available.

Biohazard

T or F. Some specimens must be analyzed immediately after they reach the laboratory.

True

Blood specimens for hematology studies can be stored in the refrigerator for what amount of time before being used in testing?

2 hours

After storage, anticoagulated blood must be thoroughly mixed after it has reached what temperature?

room temperature.

T or F. Plasma and serum often can be frozen and preserved satisfactorily until a determination can be performed.

True

Whole blood cannot be frozen because RBCs ? unfreezing.

rupture

Freezing preserves (?) sensitive coagulation factors a laboratory determination is best done on a fresh specimen.

heat

On the Federal level, the storage and management of medical waste is primarily regulated by who?

OSHA.

Laws and statutes are defined by what 2 acts? The Occupational Health and Safety Act and The Clean Air Act.

The assessment of quality results for the various analyses is critical and is an important component of the operation of a high-quality (?)

laboratory.

What type of programs monitor the following

• Test request procedures• Patient identification• Specimen procurement• Specimen labeling• Specimen transportation and processing

procedures• Laboratory personnel performance• Laboratory instrumentation, reagents, and

analytical test procedures• Turnaround times

Quality assessment programs

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• Accuracy of the final result

In 1988, the U.S. Congress enacted the what amendment in response to concerns about laboratory testing errors?

Clinical Laboratory Improvement Amendments of 1988 ( CLIA' 88)

What was published in the Federal Register on January 24, 2003?

Laboratory Requirements Relating to Quality Systems and Certain Personnel Qualifications,

CLIA established a minimum threshold for all aspects of what type of testing?

clinical laboratory testing

What also incorporates proficiency testing in the regulations?

CLIA’88

A quality assessment system is divided into how many major components? nonanalytical factors in the analysis of quantitative data (quality control [QC]).

Two, nonanalytical factors in the analysis of quantitative data (quality control [QC]).

What type of assessment is used in the clinical hematology laboratory to ensure excellence in performance?

Quality assessment

Approach to quality assures that correct laboratory results are obtained in the (?) possible time and a reasonable cost?

shortest

The total testing process (TTP) is defined by activities in three distinct phases related to workflow outside and inside the laboratory, which are what?

•Preanalytical (preexamination)•Analytical (examination)

Postanalytical

What type of factors support quality testing which include the following:• Qualified personnel• Laboratory policies• Laboratory procedure manual• Test requisitioning• Patient identification and specimen

procurement and labeling• Specimen collection, transport, processing,

and storage• Preventive maintenance of equipment• Appropriate methodology• Accuracy in reporting results and

documentation

Nonanalytical

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The entry-level examination competencies of all certified persons and hematology must be (?).

validated

Validation takes the form of both external certification and new employee orientation to the what type of environment?

work environment

T or F? Participant patient and continuing education activities is essential to the maintenance of competency and is required in some instances to maintain professional certification.

True

Personnel performance should be monitored with 1 and 2.

1. periodic evaluations and reportsreports.

Quality assessment demands that a (?) monitors results of daily work and that all analytical (examination) reports produced during up to go should be evaluated for errors and omissions.

• Supervisor

Where is the Laboratory policy located? • In a laboratory reference manual.Who has access to the laboratory policy? • All hospital personnelWhat must each laboratory have? • An up-to-date safety manualWhat must each company’s manuals contain a listing of?

Approved policiesAcceptable practices• Precautions, including standard

blood and body fluid precautionsWhat must also be included in manuals? (Think large scale.)

OSHA regulationsSpecific regulations that conformed with current state and general requirement

Name the 3 other sources that have mandatory and voluntary standards.

JCAHO, CAP, and the CDC.

Laboratory procedures should be contained in a _______ and ________ document.

Current | Complete

Where can approved policies for the reporting of results be found?

In the laboratory procedures

Who reviews and updates the manuals? Supervisory staffHow often are manuals updated? Regularly, Annually, and as neededWhat format of standards do manuals have to comply with?

CLSI format standards.

What is CLSI? An internationally recognized group of laboratory professionals who lead quality assessment efforts.

To support a QC program, of methods to document a laboratory results, will be found where?

Procedure manual.

What does proper documentation ensures? That control specimens have been properly monitored.

What does the CLSI recommends that the procedure manual follow?

A specific pattern of organization.

True or False. Does each assay done in hematology laboratory must be included in the manual?

True

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Name the 11 minimal components that are to be included in the manual.

1. Title of the assay2. Principle of the procedure and

statement of clinical applications3. Protocol for specimen collection

and storage4. QC information5. Reagents, supplies, and

equipment6. Procedural protocol7. Reference “normal" ranges8. Technical sources of error9. Limitations of the procedure10. Proper procedures for specimen

collection in storageApproved policies for the reporting of results

Who can request a laboratory test? • A primary care provider or, in some states, the patient.

Name the 4 factors that have to be on the requisition (either hardcopy or electronic).

1. The patient identification data,2. The time and date of specimen

collection3. The source of specimen• Analyses to be performed.

What information accompanying a specimen must have and match exactly?

• Patient identification requisition.

When physicians need information to assist in ordering test, where will they find it?

• In an online database or printed handbook.

What is one of the first steps in establishing a quality assessment program for the clinical laboratory?

• An electronic database or handbook of specimen requirement information.

What current information about obtaining appropriate specimens should be included in the database?

Special collection requirements for various types of tests.Ordering test correctly

• Transporting and processing specimen.

It is important that patients are? Carefully identifiedWhat are the most common source of laboratory errors?

Pre-analytical (preexamination) errors

What education assessment is an asset to specimen identification?

Computerized barcoded

What is a must requirement on a specimen once it has been obtained from the patient?

That specimens are properly labeled

What do computer-generated barcode labels assist in? Making certain that the proper patient identification is noted on each specimen

True or False. Analytical result can only be as good True

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as a specimen received?What is critical to the accuracy of any test? Strict adherence to correct procedures

for specimen collection storage.How must specimens be transferred to the laboratory? EfficientlyName an example of special handling conditions that some assays require?

Placing the specimen on ice immediately after collection.

When should specimens be tested after collection to produce accurate results?

Within two hours.

What is important aspect of the quality assessment process?

The documentation of specimen arrival times the laboratory as well as other specific test request data.

What is critical to obtaining accurate results? Correct storage of specimens.What is an important issue when blood is collected at a site away from the testing facility?

Specimen integrity

Name two test that are samples may need to be drawn several hours before testing.

Prothrombin time [PT] and activated partial thromboplastin time [aPTT])

What protocol by CLSI must blood samples collected for PT and aPTT analysis and tubes with sodium citrate should be handled using the following when collected off-site?

Collection, Transport, and Processing of Blood Specimens for Testing Plasma-Based Coagulation Assays, 2008

The sample tube should remain ________ before testing.

Unopened.

Name 2 things that are done to a specimen once it is received by the lab?

Centrifuged and testing

What is important to the quality of test performance? Monitoring of the temperatures of equipment and refrigerators.

What must microscopes, centrifuges, and other pieces of equipment need regularly to ensure accuracy?

Cleaned and checked

What all automated equipment have regularly? Preventive maintenance scheduleHow often should equipment such as microscopes, centrifuges, and spectrophotometers should be clean and check for accuracy?

On a regular schedule.

What can produce inaccurate test results and lead to expensive repairs?

Failure to monitor equipment regularly

Preventive maintenance of equipment includes: Instrument maintenance, reagent lot change, major component replacement, new software installation

How often should labs recalibrate an analytical examination method?

Every 6 months

Clinical labs must follow which requirements for instrument calibration frequency?

CLIA or the manufacturer's requirements

How often should labs recalibrate an analytical examination method?

Every six months

True or False: When new methods are introduced, it's important to check the procedure for accuracy and variability.

TRUE

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True or False: Replicate analyses using control specimens are recommended to check for: precision and similarities between technologists

FALSE

How do labs monitor individual patient results? By clinical values or the Delta check system

Why are delta checks investigated? To rule out arrows such as mislabeling of a specimen

What are examples of pre-analytical pre exam errors? Obtaining specimens from IV lines, specimen processing error, actual changes in the patient's clinical condition

The ongoing process of making certain that the correct lab result is reported for the right patient in a timely manner and at the correct cost is called?

Continuous quality improvement (CQI)

What is evaluated as part of the CQI process? Quality assessment indicatorsEach lab sets the same indicators FALSEWhen are test results recorded and reported? Whenever there is any problem or

situation that might affect the outcome of the test result

Documentation is an important aspect of quality assessment

TRUE

What is quality control used for? Monitors the accuracy and precision of a test performance over time

The purpose of quality control is to detect errors that result from:

Test system failure, adverse environmental conditions, variance: the factors or fluctuations that affect the measurement in operator performance

What are quality control activities? Monitoring the performance of a lab instrument, reagents, other testing products and equipment

Documentation of QC includes: Preventive maintenance records, temperature charts, and QC charts for specific assets.

Knowledge of statistics is important in hematology for which 2 reasons:

Application of statistical analyses of results and quality assessment protocols, instrumental applications of statistics to erythrocyte, leukocyte, platelet reports

What does Accuracy means in Clinical Quality Control ?

Accuracy is:How close a test result is to the true value.This term implies freedom from error.Reference samples and standards with known values are needed to check accuracy.

What term describes comparison of an instrument measurement or reading to a known physical

Calibration

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constant?What is a Control? A specimen that is similar in

composition to the patient's whole blood or plasma.The value of the control specimen is known.A control specimen must be carried through the entire test procedure and treated in exactly the same way as any unknown specimen; it is must be a affected by all variables that affect the unknown specimen.Control specimens are tested daily or in conjunction with the unknown patient specimen.Controls are the best measurements of precision and made a recent normal or abnormal test values

What is Precision? Precision is how close the test results are to one another when repeated analyses of the same material are performed.Precision reverse the reproducibility of test results.Is important to make a distinction between precision and accuracy.The term accuracy implies freedom from air; the term precision implies freedom from variation.

What is Proficiency testing? Proficiency testing is incorporated into the CLIA requirements, with each laboratory participating in an external PT program as a means of verification a laboratory accuracy.

How is Proficiency testing obtained? Periodically, identical samples are sent to a group of laboratories participating in the PT program; it's laboratory analyzes the specimen, reports the results to the agency, and is evaluating grade on this results in comparison to results from other laboratories.In this way, QC between laboratories is monitored.

Describe Standards Standards are Highly purified substances of known composition.A standard may differ from a control and it's overall composition and in the way it is handled in the test.

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Standards of the best way to measure accuracy.Standards are used to establish reference points in the construction of graphs (e.g., manual hemoglobin curve) or to calculate a test result.

What is the advantage of having quality controls? Quality control is a process that monitors the accuracy and reproducibility results through the use of control specimens.

List some of the functions of a Quality Control Program

Providing a guide to the functioning of equipment, reagents, and individual techniqueConfirming the accuracy of testing when compared with reference valuesDetecting an increase in the frequency of both high and low minimally acceptable values (dispersion)Detecting any progressive drift of values to one side of the average value for at least 3 days (trends)Demonstrating an abrupt shift or change from the established average value for 3 days in a row (shift)

Why do QC testing must be repeated? After the procedure has been reviewed for any indication of error and error has been found and corrected, testing must be repeated until the control value falls within the range.

Define terms such as Average, Mean, Median, Mode? Average is the Sum of the test results divided by the number of tests.Arithmetic mean value.Mean is the term used to express the average or arithmetic mean value.The mean value is 13.6 for the following series of values: 10, 11, 14, 16, and 17.•Median is the Middle value of a set of numbers arranged according to their magnitude.If two middle values exist in an even number of mathematical observations, the median is the arithmetic mean of the two middle values.The median value is 14 following five test values arranged in the order of size: 10, 11, 14, 16, 17.

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•Mode is the number or value that occurs with the greatest frequency is 45 if the following values are obtained for controlled blood test: 45, 48, 35, 39, 51, 42, 45, 39, 45, 44, and 45.

What are the measurements of variation? •Range:The difference between the highest and lowest measurements in the series.The range is expressed the same units as the raw data.The range is 0.5% to 2% for the following values expressed as percentages: 1, 1.5, 1, 0.5, 2.0, 1.5, and 1.0.•Variance:An expression of the position of each observation or test result in relation to the mean of the values.The variance is determined by examining the deviation from the mean of each individual value.The following test results were obtained: 3, 4, 5, 6, 8, 9, 10, 12, and 15.The variance from the mean (deviance from the mean) of each individual result is -5, -4, -3, -2

What is a Standard deviation (SD)? Standard deviation (SD) is Expresses degree to which the test data tend to vary about the average value (mean).To obtain a measure of the variation expressed in the same units as the raw data, the square root of the variance or the SD is used.Measure of variability,has meaning only when two or more sets of data having the same units of measurement are compared.Can be used to describe the single-set measurement.

How is Coefficient of variation (CV) obtained? Otherwise known as related standard deviation,A statistical tool used to compare variability in non-identical data sets,the CV of each data set allows comparison of two or more test methods, laboratories, or specimen sets.

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Variability in each data set must be expressed as a relative rather than absolute measure.Express the SD as a percentage of the mean.

What is the Z score? •The Z score measures how many standard deviations a particular number is from the right or left of the mean.A positive Z score measures the number of standard deviations and observation is above the meanA negative Z score gives the number of standard deviations on observation and observation is below the mean.The Z score is a unit less measure.

With the advent of computer technology and computerized instrumentation, many additional systems have been introduced to monitor test results numerically. What are some of those methods?

1. Levy Jennings chart2. The cumulative sum (Cusum)

method3. Trend line analysis4. Power function's

Name 2 traditional approaches in monitoring Quality Control?

Instrument calibration3. Lot-to-lot reagent changes

What is represented by confidence limits from a Levey-Jennings control chart?

3. A set of mathematically established limits into which the majority of values or results will fall.

True/False:Results that fall within the confidence limits are assumed to be accurate.

4. True

True/False:It is common practice to use +/- 3 SD as the limit of confidence.

5. False; the common limit of confidence is +/- 2 SD

Under what conditions are test results not reported? 6. If the control assay value is outside the confidence limits, the control value and the patient's values are considered to be out of control and cannot be reported.

What are the 3 types of changes commonly observed in the Levey-Jennings QC approach?

Systematic drift or trend Increased dispersion of results7. Shift or abrupt change in results

How would a systematic drift or trend be determined? • When the control value direction moves progressively in one direction from the mean for at least 3 days.

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Give 2 examples that may result in a drift/ trend. Deterioration or expiration of a reagent used

• Diluent contamination affects erythrocyte and leukocyte controls with an upward trend as bacterial growth increases.

What are some disadvantages to the Cumulative sum (Cusum) method?

Too many out-of-control results are obtained

Does not readily control for random error (precision).

Frequency distribution: In any large series of

measurements (test results) of a normal population, the results are evenly distributed about the average value.

10. Grouping of data in classes and determining the number of observations that fall in each of the classes

Histogram: 1. Bar chart that provides immediate information about a set of data in a condensed form

What is the term used to describe values that fall outside the confidence limits?

2. Out-of-control

The Gaussian distribution is also known as? 3. The bell-shaped curveErrors occurring within the process of phlebotomy may cause serious harm to patients either directly or indirectly. What are the included critical areas?

Appropriateness of the test request.Patient and sample identification.Criteria for acceptance and rejection of specimens.Communication and interpretation of results.

True or False.The accuracy of laboratory testing begins with the quality of the specimen received by the laboratory.

True

True or FalseIn phlebotomy, quality does not depend on how a specimen was collected, transported, and processed.

False (quality DEPENDS on how a specimen was collected, transported, and processed.)

True or FalseQuality assessment, as it applies to phlebotomy, includes preparation of a patient for any specimens to be collected.

True

True or FalseCollection of valid samples and proper specimen transport are not included in the Quality Assessment in phlebotomy.

False (Collection of valid samples and proper specimen transport are included in the Quality Assessment in phlebotomy.)

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When collecting blood specimens, it is important that the phlebotomist considers what?

The rights of the patient at all times.

True or FalseThe professional image of the laboratory is solely represented by the phlebotomist.

True (Because phlebotomist is the only laboratory staff member that a patient sees.)

True or FalseIt is important to be gentle and treat pediatric patients with compassion, empathy and kindness

True

True or FalsePhlebotomists must be relaxed and perceptive about any anxiety that adolescent patients may have.

True

True or FalseIt is okay to demean geriatric patients because they are really old and they cannot understand anything.

False

A __________collected blood specimen is essential to quality performance in the laboratory

Properly

Strict adherence to the rules of specimen collection is critical to the _______ of any test.

Accuracy

In hematological tests/studies, what is the type of specimen most frequently used?

Anticoagulated blood

What do you call the substance that prevents clotting when mixed with fresh whole blood?

Anticoagulant

What do you call the straw-colored fluid from an anticoagulated blood?

Plasma

What composes the BUFFY COAT?

White blood cells and platelets.

What type of additive/anticoagulant can be found in a green top tube?

Heparin

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A vacutainer/tube with a purple top contains what type of anti-coagulant?

Tripotassium ethylenediaminetetraacetate (EDTA)

A vacutainer/tube with a lightblue top contains what type of anti-coagulant?

Sodium citrate

Additives can alter the constituents and can have ________ amounts.A. CorrectB. IncorrectC. Non-consequential

None of the above

B

All employees should learn to use engineering tools. They also must:A. EvaluateB. SelectC. DocumentAll of the above

D

Can needles be removed in rare circumstances? YesMust usage of all needles be covered by the Exposure Control Plan?

Yes

Name some factors that impact the quality of blood collection. Choose two.A. Ambient Temperature, AltitudeB. Humidity, SunlightC. All of the aboveD. None of the Above

C

Most evacuated tubes have shelf lives of:A. 2 monthsB. 4 monthsC. 8 months12 months

D

Blood tubes can use several types of Anticoagulants. List three.A. Sodium CitrateB. HeparineC. K2, EDTAAll are blood tube Anticoagulants.

D

True or False. Is the correct order of draw?Yellow, Light Blue,Gold, Red, Red, Orange, Green, Lavender, White, Gray

True

For general protocol a phlebotomist should..A. Introduce themselvesB. Clearly explain the procedureC. Friendly courtesy in the patient’s native

language.All of the above

D

Wristbands can be a major source of pre- D

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analytical error. Name several error that can occur.A. Wrong wristbandB. Wearing more than one or noneC. Wristband ink is smudged or oldAll if the above are errors

What needs to be checked, assembled before blood collection and what needs to be labeled after blood collection?

Test requisitions should be checked and the appropriate evacuate tubes assembled. All specimens should be properly labeled immediately after the specimen is drawn.

What is usually found on the label of the specimens during blood collection?

The patient’s name, unique identification number and room number or clinic, and date and time of collection are usually found on the label.

What type of disposable needles are required during blood collection?

Sterile disposable needles (double-pointed or syringe type)

What emergency equipment is necessary to prevent fainting during blood collection?

Spirits of ammonia breakable capsule.

During initiation of the venous blood collection what is the first step after introducing one’s self?

Identifying the patient.

What PPE is required to be worn prior to blood collection?

Gloves (Nitrile)

How does the syringe/needle and evacuated tube/needle differ in their preparation prior to blood collection?

If a needle and syringe are to be used, firmly secure the hubof the needle with its shield in place on the syringe.If an evacuated tube is to be used, the plastic shield is toremain on the needle until immediately before thevenipuncture.

What the person collecting the blood do prior to selecting the vein for venipuncture?

Visually inspect both arms.

In the arm, what are the three veins to be used for venipuncture?

Cephalic, basilic, and median cubital.

How does one apply the tourniquet? First one must place the tourniquet under the arm and adjust the tourniquet evenly then place tension on the tourniquet, cross one side over the other,

47


and slip a small loop under one side of the tourniquet.

How does one find a suitable vein for venipuncture? By palpitating it.

What are the possible sources of pre-analytical error in venipuntures?

Edema of the extremities IV lines Scarring or burn patients Dialysis patients

Postmastectomy patientsPrior to puncturing the vein, what must one do in order to prevent bacterial contamination/infection?

3) The puncture site must first be After the site is prepared with an alcohol sterile wipe.

After the needle is inserted in the puncture site and the tube is placed what is next?

4) Remove the tourniquet.

After all the tubes are filled, how does one terminate the procedure?

5) The procedure is terminated by covering the venipuncture site with a square of sterile gauze and applying pressure. A sterile adhesive bandage is then placed on the site.

How does one respond when the patient refuse to have his/her blood drawn?

6) Politely excuse yourself from the patient’s room, note the refusal on the requisition, and notify the hematology supervisor

How does one minimize the movement of the vein during venipuncture?

7) Always have firm pressure on the arm below the intended venipuncture site. The needle can be moved to reach the vein, but excessive probing in the tissues must be avoided.

Why does a lack of blood volume obtained during venipuncture or a “short draw” cause problems?

8) An excessive amount of EDTA in the evacuation tubes will produce shrinkage of erythrocytes, and an insufficient amount of blood in a sodium citrate tube will introduce a dilutional problem if the specimen is tested for coagulation studies.

When performing phlebotomy and collecting a blood sample, can you use any anticoagulant tube for any given test ?

No, improper anticoagulant for blood smears cannot be prepared from a heparinized blood sample will give a false diagnosing using the wrong anticoagulant tube

Can sudden movement of the patient or phlebotomist affect the factor for analyze of the blood sample

Yes, sudden movement by patient or phlebotomist will cause the needle to

48


obtain? come out prematurely and cause a false factor for analyze.

What does it mean to take quick action and void the phlebotomy procedure?

To immediately remove the tourniquet and place a gauze pad on the venipuncture site and apply pressure until bleeding has completely stopped.

What causes a hematoma ? When there is not enough pressure apply to the site of venipuncture.

True or false It is correct to apply firm pressure until bleeding has stop or for about 2min?

True

True or false any tubes containing an anticoagulant should be gently inverted several times to mix the specimen

True

What causes a blood clot formation in a anticoagulated tube?When a patient tells you verbally she or he is a fainter when drawing their blood what is the next step you should take ?

Have the patient lay down in a appropriate room given by facility or hospital

Of the following personnel, only a high school diploma is required of which one?

Phlebotomist

Which one of the following is a hematology test? CBC complete blood countWhich lab department would perform a hemogram ? HematologyThis department examines specimens microscopically for the presence of crystals, casts, bacteria, and blood cells

Urinalysis

There times where you will get patients where their veins are much more smaller or hidden veins, what are steps you can take for difficult blood draws ?

Adjust the position of the arm elbow outUse a smaller gauge needleUse a small syringeUse a butterfly neddle and multiple small syringesTighten the tourniquetLoosen the tourniquetApply hot packs to the armUse a second tourniquet below the siteUse a hand or wrist vein or veins on the underside of the arm

what are some special to considered when havins a pediatric patient you should consider as a professional phlebotomist ?

work quickly on premature infantswarm the blood collection site for 5 min this will increase blood flowcheck potential blood collection sites for redness or bruisingDo not attempt venipuncture unless obtaining enough blood collection for all ordered tests in one attempt is certain

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Is is okay to slap the arm to dilate the vein because you cant feel it enough when performing venipuncture ?

No, you shouldn’t slap the vein when performing venipuncture

What is a good practice to take when you have a elderly patient that may be confused and disoriented ?

Carefully identify the patient check the requisite make sure you have the right patient

What some considerations for geriatric patients to consider if the patients limb feels cold and clammy

Warm up the skin

True or false when the skin is fragile it is okay placing the tourniquet over the clothing for more comfort for the patient

True

What will you consider when prepping the vein and you feel it being a small or fragile vein?

Consider using a smaller gauge needle

Is it okay when performing venipuncture to have a shaky hand and inserting the needle in this form ?

No, you shouldn’t have a shaky hand should use one quick swiff motion when inserting the needle

After you have finish your blood collection tubes you are getting ready to but a bandage or tape on the skin sight you have puncture what is something you should pay attention too before determining what gauze to use ?

You should pay special attention to the fragility of the skin

What is the preferred site for the collection of capillary blood from the finger ?

Lateral and medial side of the fingerprint

What is the preferred site for a infant heel stick? Medial and lateral siteWhat is the correct way to prepare a blood smear? Once a small drop of blood has spread

by capillary action between the coverslips they should be pulled apart smoothly in a horizontal plane. The proper angle of the pusher slide is approximately 45 angle

Why is it important to smear the blood as soon as the drop is placed on the slide?

A delay in a smear preparation will be larger cells such as neutrophils and monocytes will be disproportionately located at the feathered edge when examined microscopically

Why is important to have the appropriate size of blood droplet in a smear sample?

Too large a drop of blood will produce a think, long smear. And to small drop of blood will produce a thin short smear

True or false slides should be free of dust and grease spots?

True

What 3 things determine the thickness of the smear ? Angle of the spreader slide angles thinknessSize of blood dropSpeed of spreading

Explain how to adjust the thickness of the smear with a high hematocrit

Decrease angle of spreader slide

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Explain how to adjust the thickness of the smear with a low hematocrit

Increase angle of spreader slide

List 4 technical causes of a poor blood smear Spreader slide is pushed in a jerky mannerFailure to keep entire edge of spread slide against the slide while making smearFailure to push spreader slide completely across

What are some stains that are alcoholic solutions with basic and acidic components

Romanowsky based stains such as wright, giemsa or may-grunwald stains

The wrigh’s stain is a _________stain. RomanowskyWhat is used to wash off stain ? Distilled waterWhat is a source of error when failure to filter the stain daily or before use ?

Failure to filter the stain daily or before use can produce sediment on blood films

If the precipitated sediment is very ____ it will be impossible to view the blood cell microscopic examination

Heavy

True or false improper timing of the stainining or buffering can produce faded staining or altered colors of the blood smears and too short a staininh time produce a blood smear that is too red on microscopic examination and if the staining time is too long the blood smear will be to dark on microscopic examination.

True

A. MicrotubulesB. CentrioleC. MembraneD. NucleusE. Nuclear membraneF. DNAG. Golgi apparatusH. MitochondrionI. LysosomeJ. CytoplasmK. NucleoliL. Rough ERM. Smooth ER

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A. PhospholipidsB. Protein

A. NormalB. HypotonicC. Hypertonic

Diffusion is: A passive process whereby fluid moves through a semipermeable membrane

Active transport is: Movement of a molecule against the concentration gradiant.

Active transport requires: ATPNa/K pump is active or passive? ActiveMaintenance of a constant volume despite extracellular and intracellular osmotic challenges is critical to the integrity of a cell

True

In order to return cell volume to its normal resting state, how do cells respond?

by swelling or shrinking by activating specific metabolic or membrane-transport processes

What is essential for the normal function and survival of cells?

Cell volume homeostasis

What is highly pleomorphic and has bizarre cytologic features associated with malignant tumors?

Anaplasia

What is atrophy? decrease in the number or size of cellsWhat has abnormal cytologic features and tissue organization

Dysplasia

What is hyperplasia The increase in the number of cells in a tissue

What is hypertrophy The increase in the size of cellsWhat is metaplasia It is the change from one adult cell type

to anotherOrganelles are functional units of a cell TrueWhat are the two central spots inside of the centrosomes.

Centrioles

What is the extensive lace-like network composed of membranes enclosing interconnecting cavities or

Endoplasmic reticulum

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cisterns called?What are the 2 classifications of the endoplasmic reticulum?

Rough and smooth

Which part of the ER can the ribosomes be found? Rough sectionsWhat appears as a horseshoe-shaped or hook-shaped organelle with an associated stack of vesicles or sacs.

Golgi apparatus

What do lysosomes contain? Hydrolytic enzymesWhat are microbodies? small, intracytoplasmic organelles,

limited by a single membrane that is thinner than the lysosome.

What are microfilaments? solid structures, consisting of the protein actin and the larger myosin filaments

What are microtubules? small, hollow fibers composed of polymerized, macromolecular protein subunits, tubulin.

What is composed of an outer smooth membrane and an inner folded membrane?

mitochondria

What is the function of the mitochondria? carry out the energy-producing reactions of the cell

What are small dense granules, that show a lack of membrane and are found both on the surface of the rough ER and free in the cytoplasm?

Ribosomes

Ribosomes contain a significant portion of RNA and are composed of unequally sized subunits.

True

The presence of many ribosomes produces cytoplasmic basophilia (blue color) when a cell is stained with Wright stain.

True

Where is the site of protein synthesis? The complex of the messenger RNA and a ribosome

What is a long-chain polysaccharide that is detectable with the PAS stain?

Glycogen

What is the PAS stain? Periodic acid-Schiff stainFerritin is a common storage form of iron. TrueFerritin is often found in iron-rich dense bodies called _______.

Telolysosomes

What term is used to refer to iron-saturated telolysosomes?

Siderosome

Histologists refer to granular, iron-rich pigment as ________.

Hemosiderin

The nucleus is surrounded by a _______ ______, which consists of an inner and outer membrane.

Nuclear envelope

Inside the nucleus, within the inner nucleoplasm, are the _______ and _______.

Nucleoli, chromatin

Chromatin dictates the nature of ________ that can be synthesized, thereby controlling the function of the cell.

Protein

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Chromatin transmits information for cellular control from one generation to the next.

True

Proteins associated with the nucleic acids are divided into basic, positively charged ______, and less positively charged ______.

Histones, nonhistones

Histones are believed to be essential to the structural integrity of ______.

Chromatin

Histones are important in facilitating the conversion of the thin chromatin fibers seen during ______ into the highly condensed chromosomes seen in _______.

Interphase, mitosis

Nonhistones are thought to play other roles, including ________ _________.

Genetic regulation

What is the general model of the organization of DNA and histones?

A regular spacing arrangement

What is the complete unit, consisting of a string of DNA wrapped around a histone core, called?

Nucleosome

What is deletion? is defined as the loss of a segment of chromosome.

What is translocation? is the process in which a segment of one chromosome breaks away (is deleted) from its normal location.

What is trisomy? is the failure of a homologous chromosome to separate from its sister chromatid. This leads to a set of three chromosomes in place of the normal pair.

What is clinical use of cytogenetics? Clinical cytogenetic contributes to understanding inborn or acquired genetic problems by providing a low-power screening method for detecting isolated or missing chunks of chromosomes.

What are three sub-phases of interphase? – G1, first gap– S phase

G2, second gapWhat are four phases of mitotic division? M phase

ProphaseMetaphaseAnaphase

a. TelophaseWhat is M phase? is the period of actual cell division.What is Prophase? is the period of replicated strands of

chromatin that become tightly coiled, distinctive structures.

What is metaphase? is the period when identical sister chromatids move to the center of the

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spindle (the equatorial plate).What is Anaphase? begins as soon as the chromatids are

pulled apart and lasts until the newly formed chromosomes reach the opposite poles of the spindle.

What is Telophase? is the period when the chromosomes arrive at opposite poles of the cell in early telophase.

What is karyokinesis? Nuclear divisionWhat is cytokinesis? Division of cytoplasmWhat are the activities of the nucleus?

What is a means of distinguishing a morphologically distinctive form of programmed cell death that is associated with normal physiology?

Apoptosis

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What is Meiosis division?

What is a segment of DNA that is arranged along the chromosome at a specific position called a locus?

A gene

What is the coding sequences of a gene? Exons

What is the intervening sequences of a gene? IntronsWhat is the term that causes a change in the gene? MutationWhat is sickle cell mutation? Figure 3.11 Sickle cell trait and anemia.

When two persons with sickle cell trait (genotype: A/S) produce offspring, the expected genotypic ratio is 1:2:1, or a 25% chance of offspring with a normal hemoglobin (A/A), a 50% chance of offspring with sickle cell trait (A/S), and a 25% chance of offspring with sickle cell anemia (S/S). Hgb, hemoglobin.

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The hemoglobin S amino acid sequence differs from hemoglobin A amino acid sequence. This difference is due to one amino acid residue on the _____ chain of the hemoglobin molecule. On this chain, ____ is substituted for ____ at the sixth position of the chain.a. alpha, glutamic acid (Glu), valine (Val)b. beta, valine (Val), glutamine (Gln)c. alpha, aspartic acid (Asp), Alanine (Ala)d. beta, valine (Val), glutamic acid (Glu)

D

True or FalseIf parent '1' has type A hemoglobin (genotype: A/A) and parent '2' has sickle cell trait (genotype: A/S) the probability of the offspring receiving sickle cell trait is 25%.a.Trueb.False

B

Alterations in oncogenes, tumor-suppressor genes and microRNA genes can result in?a. tumor reductionb. cancer formationc. neither a or b

B

The gene important in regulation of the cell cycle and also functions as a tumor suppressor is..a. p24b. p53c. p63d. none of the above

B

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Tumor protein p53 does many things to help our cells repair themselves. Which of the following is incorrect?a. activate the repair of DNA when damaged.b. initiate apoptosis if the DNA is damaged beyond repair.c. prevents the division of cells with mutated or damaged DNA.d. None of the above are incorrect.

D

This list of analytical assays are of what type tests.Polymerase chain reaction (PCR)Ligase chain reaction nucleic acid amplification (LCR)Branched DNA (bDNA) amplificationProbe-hybridization assaysIntegrated PCR and probe-hybridization assaysMicroarraysA. ChemistryB. ImmunologicalC. Molecular TechniqueD. Serological

C

The term for the low level of disease, such as, leukemic cells, in a patient who appears to be in a state of clinical remission is.A. Minimal disease stateB. Minimal residual diseaseC. Minimal reduced diseaseD. Residual disease minimum

B

What does heating the DNA in accomplish in Polymerase chain reaction (PCR)A. Denatures it so it is destroyed.B. To separate the strands of DNAC. Recombine the pieces of DNAD. There isn't a heating stage in Polymerase chain reaction (PCR)

B

True or FalseThe stages of PCR are generally:- Target DNA is first melted using heat.- added primers bind to specific sequences within the target DNA as it cools.- New DNA strands are amplified- This is repeated over many cycles to create a surplus of target DNA- These copies are detected using electrophoresis and staining.a.True

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b.FalseWhat is a depiction of Polymerase Chain Reaction?

Polymerase Chain Reaction continued

What are three important application of PCR? 1) Amplification of DNA2) Identification of a target

sequenceSynthesis of a labeled antisense probe

What is considered to be the “Gold Standard” method to which other molecular methods are compared?

9) DNA Sequencing

What hybridization methods are used for the detection of disorder in which the DNA sequence of the mutated region has been identified (sickle cell)

10) Dot blot and reverse dot blot

This hybridization method is used to detect single-base mutations using allele-specific oligonucleotides (ASOs)

11) Dot Blot

Unlike other assays, the dot blot does not require which two parts of the procedure?

1) Enzyme digestion12) Electrophoretic separation of

DNA fragmentsWhat are the basic steps of the procedure? 1) Labeled oligonucleotide probes

of 15-19 base pairs are added.

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• DNA is amplified in the region of the known mutations, denatured and applied to areas of membrane or filter.

What is a Reverse Dot Blot? 3) Variation of Dot Blot procedureHow is the Reverse Dot Blot different? 4) The ASO probes are bound to a

filter and denatured DNA from the patient is added to the immobilized ASO. Hybridization occurs when base sequences are 100% complementary to the probe

What is an example of a southern blot?

This procedure is used for analysis of the proximal product of gene expression, mRNA. Cloned DNA probes can determine whether a given gene is expressed and, of so, how vigorously.

Northern Blot Blotting Protocol

This is a tissue-based molecular diagnostic assay. Common in situ hybridization (ISH), including fluorescent ISH (FISH), probes are used in the diagnosis of hematological malignancies in clouding CMLA, AML, Burkitt lymphoma and other lymphomas.

In Situ Hybridization

This gene expression profiling uses_____ analysis. A surface (in this example, a glass microscope slide) contains thousands of spots. Each spot contains a large number of DNA fragments. For each spot, the DNA fragments are derived from one specific gene.

Microarrays

Clinical applications include hematopathology diagnosis and monitoring. The distinct advantages of molecular testing include the following:-Faster turn around time-Smaller required sample volumes

Hematopathology

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-Increased specificity and sensitivityThis type of molecular technique monitors patient following bone marrow transplants, discovers and early relapses in patients treated for a hematological malignancy and detects minimal residual disease in hematological malignancies.

Molecular techniques provided my Hematopathology

Important in diagnostic hematopathology as indicator of clonality and as aids in determining the cellular lineage of a particular malignant proliferation.

Gene Rearrangement Studies

This categorization is aided by the use of cluster designation (CD) for specific lineages of cells.

Immunophenotyping categorization

What is Hematopoiesis? The process of blood cell production, differentiation, and development.

What consists of the hematopoietic system? Bone Marrow, Liver, Spleen, Lymph Nodes, and Thymus

What are the three types of human stem cells? Totipotential, Pluripotential and Multipotential stem cells.

Which type of human stem cell is present in the first few hours after an ovum is fertilized?

Totipotential stem cell

Which type of human stem cell is the most versatile type?


Which type of human stem cell can develop into any human cell type?


Which type of stem cell can develop into a fetus? Totipotential stem cellWhich type of human stem cell is present several days after fertilization?

Pluripotential stem cell

Which type of hum stem cell can develop into any cell type with the exception of developing into a fetus?

Pluripotential stem cell

Which type of human stem cell is derived from pluripotent stem cells?

Multipotential stem cell

Which type of human stem cell can be found in adults but are limited to specific types of cells to form tissues?

Multipotential stem cell

Below are images depicting a (normal/abnormal) bone marrow biopsy.

Normal

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Below is an image depicting a bone marros biopsy of (normal/abnormal) cellularity

Normal

Name the type of WBC’s labeled A.Lymphocyte

B. Basophil

C.Eosinophil

D. Segmented neutrophil

E. Band form neutrophil

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Figure (A) is an image depicting a child with red bone marrow. Figure (B) is an image depicting an adult. What major changes happen to the bone marrow as a child develops into an adult?

(A) (B)

In an adult, yellow marrow replaces red marrow. Red marrow activity occurs in the central portion of the skeleton

Using the Figure below, describe the size of the HSC population over a lifetime. (Only use once: Increase, Decrease, or remains the same)(a) __________(b) __________(c) __________

(a) Decrease(b) Remains the same(c) Increase

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Hematopoietic cells can be divided into how many phases?

three phases according to cell maturity

What is the Primitive, multipotential cells? The most immature group capable of self-renewal and differentiation into all blood cell lines

What are Intermediate cells? This group consists of committed progenitor cells destined to develop into distinct cell lines.

What are Mature cells? The most developed group with specific functions

Where does erythropoiesis occur? in distinct anatomical sites called erythropoietic islands, specialized niches in which erythroid precursors proliferate, differentiate, and enucleate

What is granulopoiesis? Myeloid cells account for 23% to 85% of the nucleated cells in normal bone marrow

Granulopoiesis can be recognized as what? a maturational unit.Where does Lymphopoiesis take place? in lymphoid follicles.Where does Megakaryopoiesis take place? adjacent to the sinus endotheliumWhat are two cells found in the bone marrow? Mast cells and marrow stromal cellsWhat are Marrow stromal cells? The meshwork of stromal cells is

composed of reticulum cells, histiocytes, adipose cells, and endothelial cells

What are Mast cells? Tissue mast cells, a connective tissue cell of mesenchymal origin, are normally observed in bone marrow

What is a macrophage? It is also called reticulum cell or histiocyte, appear as large cell in the

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bone marrow.What are bone cells called? They are called Osteoblasts that are

bone matrix–synthesizing cells that resemble plasma cells and are usually observed in groups.

What are interleukins? Protein molecules that work in conjunction with hematopoietic growth factors to stimulate proliferation and differentiation of specific cell lines

What do interleukins do? Interleukins are cytokines that act independently or in conjunction with other interleukins to encourage hematopoietic growth. Interleukins are cell signaling molecules and a part of the cytokine super family of signaling molecules

How to describe the function of interleukins? The interleukins were first described as signals for communication between (interbetween) white blood cells (leukfrom leukocytes).

What are the roles of interleukins? Interleukins are basically the method of immune cross talk and communication. Interleukins are the primary messengers and directors of the immune system.

How many types and function of interleukins in the immune system?

There are currently 35 well-known interleukins; however, there are many more to be found and characterized.

What are the three types of hematopoietic growth factors?

Hematopoietic growth factor is encoded by a single gene- G-CSF and GM-CSF predominantly affect myeloid cells-IL-7 stimulates T and B lymphocytes-IL-12 targets natural killer cells

What is an examination of maturing blood cells? It is a comprehensive examination of bone marrow involves examination of both bone marrow smears and histological tissue sections.

What can be guided by a variety of systematic features?

The identification and stage of maturation of stained blood cells can be guided by a variety of systematic features.

What are the two importatant charateristics to observe initially in caell identification?

• Overall cell sizeNuclear-cytoplasmic ratio

What is the important feature of the • Nuclear characteristics

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nucleus of the cell? play an important role in cell identification. Important features of the nucleus include the following:

• Chromatin pattern• Nuclear shape

8. The presence of nucleoli

What are the nuclear characteristics of the Chromatin pattern?

• Chromatin patterns• Lymphocytes exhibit a

smooth or homogeneous pattern of chromatin throughout development until the mature stage, when clumped heterochromatin is more obvious.

• Granulocytes progress from having a fine to a highly clumped pattern.

• Monocytes have a lacy pattern, which becomes finer as the cell matures.

• Erythrocytes continue to develop a more clumped pattern as maturation progresses, until the extremely dense (pyknotic) nucleus is lost (extruded) from the mature cell.

What are the different nuclear shapes of the cell?

• Nuclear shape• Lymphocytes usually

continue to have a round or oval nucleus. Some cells may have a small cleft in the nucleus.

• Monocytes have a kidney bean–shaped nucleus, but folded or horseshoe shapes are common.

11.Mature neutrophils, eosinophils, and basophils have segmented nuclei attached to one

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another by fine filaments. The number of distinctive lobes ranges from two to five depending on the cell type.

How does the pressence or absense of nucleoli is important in the identification in the cell?

• Presence of nucleoli• The presence or absence

of nucleoli is important in the identification of cells.

• The three cell lines of erythrocytes, leukocytes, and megakaryocytes all have nucleoli in the earliest cell stages.

As cells mature, nucleoli are usually not visible. These changes in the appearance of the nucleoli are related to the rate of synthesis of ribosomal RNA.

• What are the nuclear characteristics of the cell?

• Lymphoblasts have one or two nucleoli.

• Myeloblasts have one to five nucleoli.

• Monoblasts usually have one or two nucleoli but occasionally may have three or four.

• Erythroblasts may not have any nucleoli or may have up to two nucleoli that may stain darker than in other types of blast cells.

4. Megakaryoblasts typically have one to five nucleoli.

5. How can we identify Cytoplasmic Characteristics?

• Staining color and intensity

• Granulation• Shape• Quantity of cytoplasm• Vacuolization

6. Inclusion bodies

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