Test Bank For A Manual of Laboratory a
Tests 7th Edition Frances T Fischbach.
,2 Blood Studies; Hematology and Coagulation
A Manual of Laboratory and Diagnostic Tests
2
Blood Studies; Hematology and Coagulation
OVERVIEW OF BASIC BLOOD HEMATOLOGY AND COAGULATION TESTS
Composition of Blood
Blood Tests
BLOOD SPECIMEN COLLECTION PROCEDURES
Capillary Puncture (Skin Puncture)
Venipuncture
NOTE
NOTE
Bone Marrow Aspiration
BASIC BLOOD TESTS
Hemogram
Complete Blood Count (CBC)
TESTS OF WHITE BLOOD CELLS
White Blood Cell Count (WBC; Leukocyte Count)
Differential White Blood Cell Count (Diff; Differential Leukocyte Count)
NOTE
Segmented Neutrophils (Polymorphonuclear Neutrophils, PMNs, Segs, Polys)
Eosinophils
Basophils
Monocytes (Monomorphonuclear Monocytes)
Lymphocytes (Monomorphonuclear Lymphocytes); CD4, CD8 Count; Plasma Cells
Lymphocyte Immunophenotyping (T and B Cells)
STAINS FOR LEUKEMIAS
Sudan Black B (SBB) Stain
Periodic Acid–Schiff (PAS) Stain
Terminal Deoxynucleotidyl Transferase (TDT) Stain
Leukocyte Alkaline Phosphatase (LAP) Stain
Tartrate-Resistant Acid Phosphatase (TRAP) Stain
TESTS OF RED BLOOD CELLS
Red Blood Cell Count (RBC; Erythrocyte Count)
Hematocrit (Hct); Packed Cell Volume (PCV)
Hemoglobin (Hb)
Red Blood Cell Indices
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Mean Corpuscular Hemoglobin (MCH)
Red Cell Size Distribution Width (RDW)
Stained Red Cell Examination (Film; Stained Erythrocyte Examination)
NOTE
Reticulocyte Count
Sedimentation Rate (Sed Rate); Erythrocyte Sedimentation Rate (ESR)
TESTS FOR PORPHYRIA
Erythropoietic Porphyrins; Free Erythrocyte Protoporphyrin (FEP)
Porphyrins; Fractionation of Erythrocytes and of Plasma
ADDITIONAL TESTS FOR HEMOLYTIC ANEMIA
Pyruvate Kinase (PK)
Erythrocyte Fragility (Osmotic Fragility and Autohemolysis)
Glucose-6-Phosphate Dehydrogenase (G6PD)
Heinz Bodies; Heinz Stain; Glutathione Instability
,Hypercoagulability States
Disorders of Hemostasis
Clinical Alert
Clinical Alert
Tests for Disseminated Intravascular Coagulation (DIC)
Bleeding Time (Ivy Method; Template Bleeding Time)
Platelet Count; Mean Platelet Volume (MPV)
Platelet Aggregation
Thrombin Time (TT); Thrombin Clotting Time (TCT)
Partial Thromboplastin Time (PTT); Activated Partial Thromboplastin Time (APTT)
NOTE
Activated Coagulation Time (ACT)
Prothrombin Time (Pro Time; PT)
Coagulant Factors (Factor Assay)
Plasminogen (Plasmin; Fibrinolysin)
Fibrinolysis (Euglobulin Lysis Time; Diluted Whole Blood Clot Lysis)
Fibrin Split Products (FSPs); Fibrin Degradation Products (FDPs)
D-Dimer
Fibrinopeptide A (FPA)
Prothrombin Fragment (F1 + 2)
Fibrin Monomers (Protamine Sulfate Test; Fibrin Split Products)
Fibrinogen
Protein C (PC Antigen)
NOTE
NOTE
Protein S
Antithrombin III (AT-III; Heparin Cofactor Activity)
BIBLIOGRAPHY
OVERVIEW OF BASIC BLOOD HEMATOLOGY AND COAGULATION TESTS
Composition of Blood
The average person circulates about 5 L of blood (1/13 of body weight), of which 3 L is plasma and
fluid derives from the intestines and lymphatic systems and provides a vehicle for cell movement. T
primarily by bone marrow and account for blood “solids.” Blood cells are classified as white cells (le
(erythrocytes), and platelets (thrombocytes). White cells are further categorized as granulocytes, lym
monocytes, eosinophils, and basophils.
Before birth, hematopoiesis occurs in the liver. In midfetal life, the spleen and lymph nodes play a m
production. Shortly after birth, hematopoiesis in the liver ceases, and the bone marrow is the only s
erythrocytes, granulocytes, and platelets. B lymphocytes are produced in the marrow and in the sec
organs; T lymphocytes are produced in the thymus.
Blood Tests
Tests in this chapter are basic screening tests that address disorders of hemoglobin (Hb) and cell p
(hematopoiesis), synthesis, and function. Blood and bone marrow examinations constitute the majo
determining certain blood disorders (anemias, leukemia and porphyrias disorders, abnormal bleedin
inflammation, infection and inherited disorders of red blood cells, white blood cells, and platelets. S
obtained through capillary skin punctures (finger, toe, heel), dried blood samples, arterial or venous
marrow aspiration. Specimens may be tested by automated or manual hematology instrumentation
BLOOD SPECIMEN COLLECTION PROCEDURES
Proper specimen collection presumes correct technique and accurate timing when necessary. Mos
, drop of blood.
Clinical Alert
1. Do not squeeze the site to obtain blood because this alters blood composition and invalidate
2. Warming the extremity or placing it in a dependent position may facilitate specimen collectio
Interventions
Pretest Patient Care
1. Instruct patient about purpose and procedure of test.
2. Follow Chapter 1 guidelines for safe, effective, informed pretest care.
Posttest Patient Aftercare
1. Apply small dressing or adhesive strip to site.
2. Evaluate puncture site for bleeding or oozing.
3. Apply compression or pressure to the site if it continues to bleed.
4. Evaluate patient's medication history for anticoagulation or acetylsalicylic acid (ASA)-type dru
5. Follow Chapter 1 guidelines for safe, effective, informed posttest care.
Clinical Alert
Dried Blood Spot
In this method, a lancet is used, and the resulting droplets of blood are collected by blotting them w
directly. Check the stability of equipment and integrity of supplies when doing a finger stick. If prov
humidity indicator patch on the filter paper card. If the humidity circle is pink, do not use this filter p
humidity indicator must be blue to ensure specimen integrity.
After wiping the first drop of blood on the gauze pad, fill and saturate each of the circles in numeric
the blood droplet with the filter paper. Do not touch the patient's skin to the filter paper; only the blo
come in contact with the filter paper. If an adult has a cold hand, run warm water over it for approx
The best flow occurs when the arm is held downward, with the hand below heart level, making effe
If there is a problem with proper blood flow, milk the finger with gentle pressure to stimulate blood
second finger stick; do not attempt more than two. When the blood circles penetrate through to the
filter paper, the circles are fully saturated.
Venipuncture
Venipuncture allows procurement of larger quantities of blood for testing. Usually, the antecubital ve
choice because of ease of access. Blood values remain constant no matter which venipuncture site
as it is venous and not arterial blood.
1. Observe standard precautions (see Appendix A). If latex allergy is suspected, use latex-free s
equipment (see Appendix B).
2. Position and tighten a tourniquet on the upper arm to produce venous congestion.
3. Ask the patient to close the fist in the designated arm. Select an accessible vein.
4. Cleanse the puncture site and dry it properly with sterile gauze. Povidone-iodine must dry tho
5. Puncture the vein according to accepted technique. Usually, for an adult, anything smaller tha
might make blood withdrawal more difficult. A Vacutainer system syringe or butterfly system m
6. Once the vein has been entered by the collecting needle, blood will fill the attached vacuum tu
Tests 7th Edition Frances T Fischbach.
,2 Blood Studies; Hematology and Coagulation
A Manual of Laboratory and Diagnostic Tests
2
Blood Studies; Hematology and Coagulation
OVERVIEW OF BASIC BLOOD HEMATOLOGY AND COAGULATION TESTS
Composition of Blood
Blood Tests
BLOOD SPECIMEN COLLECTION PROCEDURES
Capillary Puncture (Skin Puncture)
Venipuncture
NOTE
NOTE
Bone Marrow Aspiration
BASIC BLOOD TESTS
Hemogram
Complete Blood Count (CBC)
TESTS OF WHITE BLOOD CELLS
White Blood Cell Count (WBC; Leukocyte Count)
Differential White Blood Cell Count (Diff; Differential Leukocyte Count)
NOTE
Segmented Neutrophils (Polymorphonuclear Neutrophils, PMNs, Segs, Polys)
Eosinophils
Basophils
Monocytes (Monomorphonuclear Monocytes)
Lymphocytes (Monomorphonuclear Lymphocytes); CD4, CD8 Count; Plasma Cells
Lymphocyte Immunophenotyping (T and B Cells)
STAINS FOR LEUKEMIAS
Sudan Black B (SBB) Stain
Periodic Acid–Schiff (PAS) Stain
Terminal Deoxynucleotidyl Transferase (TDT) Stain
Leukocyte Alkaline Phosphatase (LAP) Stain
Tartrate-Resistant Acid Phosphatase (TRAP) Stain
TESTS OF RED BLOOD CELLS
Red Blood Cell Count (RBC; Erythrocyte Count)
Hematocrit (Hct); Packed Cell Volume (PCV)
Hemoglobin (Hb)
Red Blood Cell Indices
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Mean Corpuscular Hemoglobin (MCH)
Red Cell Size Distribution Width (RDW)
Stained Red Cell Examination (Film; Stained Erythrocyte Examination)
NOTE
Reticulocyte Count
Sedimentation Rate (Sed Rate); Erythrocyte Sedimentation Rate (ESR)
TESTS FOR PORPHYRIA
Erythropoietic Porphyrins; Free Erythrocyte Protoporphyrin (FEP)
Porphyrins; Fractionation of Erythrocytes and of Plasma
ADDITIONAL TESTS FOR HEMOLYTIC ANEMIA
Pyruvate Kinase (PK)
Erythrocyte Fragility (Osmotic Fragility and Autohemolysis)
Glucose-6-Phosphate Dehydrogenase (G6PD)
Heinz Bodies; Heinz Stain; Glutathione Instability
,Hypercoagulability States
Disorders of Hemostasis
Clinical Alert
Clinical Alert
Tests for Disseminated Intravascular Coagulation (DIC)
Bleeding Time (Ivy Method; Template Bleeding Time)
Platelet Count; Mean Platelet Volume (MPV)
Platelet Aggregation
Thrombin Time (TT); Thrombin Clotting Time (TCT)
Partial Thromboplastin Time (PTT); Activated Partial Thromboplastin Time (APTT)
NOTE
Activated Coagulation Time (ACT)
Prothrombin Time (Pro Time; PT)
Coagulant Factors (Factor Assay)
Plasminogen (Plasmin; Fibrinolysin)
Fibrinolysis (Euglobulin Lysis Time; Diluted Whole Blood Clot Lysis)
Fibrin Split Products (FSPs); Fibrin Degradation Products (FDPs)
D-Dimer
Fibrinopeptide A (FPA)
Prothrombin Fragment (F1 + 2)
Fibrin Monomers (Protamine Sulfate Test; Fibrin Split Products)
Fibrinogen
Protein C (PC Antigen)
NOTE
NOTE
Protein S
Antithrombin III (AT-III; Heparin Cofactor Activity)
BIBLIOGRAPHY
OVERVIEW OF BASIC BLOOD HEMATOLOGY AND COAGULATION TESTS
Composition of Blood
The average person circulates about 5 L of blood (1/13 of body weight), of which 3 L is plasma and
fluid derives from the intestines and lymphatic systems and provides a vehicle for cell movement. T
primarily by bone marrow and account for blood “solids.” Blood cells are classified as white cells (le
(erythrocytes), and platelets (thrombocytes). White cells are further categorized as granulocytes, lym
monocytes, eosinophils, and basophils.
Before birth, hematopoiesis occurs in the liver. In midfetal life, the spleen and lymph nodes play a m
production. Shortly after birth, hematopoiesis in the liver ceases, and the bone marrow is the only s
erythrocytes, granulocytes, and platelets. B lymphocytes are produced in the marrow and in the sec
organs; T lymphocytes are produced in the thymus.
Blood Tests
Tests in this chapter are basic screening tests that address disorders of hemoglobin (Hb) and cell p
(hematopoiesis), synthesis, and function. Blood and bone marrow examinations constitute the majo
determining certain blood disorders (anemias, leukemia and porphyrias disorders, abnormal bleedin
inflammation, infection and inherited disorders of red blood cells, white blood cells, and platelets. S
obtained through capillary skin punctures (finger, toe, heel), dried blood samples, arterial or venous
marrow aspiration. Specimens may be tested by automated or manual hematology instrumentation
BLOOD SPECIMEN COLLECTION PROCEDURES
Proper specimen collection presumes correct technique and accurate timing when necessary. Mos
, drop of blood.
Clinical Alert
1. Do not squeeze the site to obtain blood because this alters blood composition and invalidate
2. Warming the extremity or placing it in a dependent position may facilitate specimen collectio
Interventions
Pretest Patient Care
1. Instruct patient about purpose and procedure of test.
2. Follow Chapter 1 guidelines for safe, effective, informed pretest care.
Posttest Patient Aftercare
1. Apply small dressing or adhesive strip to site.
2. Evaluate puncture site for bleeding or oozing.
3. Apply compression or pressure to the site if it continues to bleed.
4. Evaluate patient's medication history for anticoagulation or acetylsalicylic acid (ASA)-type dru
5. Follow Chapter 1 guidelines for safe, effective, informed posttest care.
Clinical Alert
Dried Blood Spot
In this method, a lancet is used, and the resulting droplets of blood are collected by blotting them w
directly. Check the stability of equipment and integrity of supplies when doing a finger stick. If prov
humidity indicator patch on the filter paper card. If the humidity circle is pink, do not use this filter p
humidity indicator must be blue to ensure specimen integrity.
After wiping the first drop of blood on the gauze pad, fill and saturate each of the circles in numeric
the blood droplet with the filter paper. Do not touch the patient's skin to the filter paper; only the blo
come in contact with the filter paper. If an adult has a cold hand, run warm water over it for approx
The best flow occurs when the arm is held downward, with the hand below heart level, making effe
If there is a problem with proper blood flow, milk the finger with gentle pressure to stimulate blood
second finger stick; do not attempt more than two. When the blood circles penetrate through to the
filter paper, the circles are fully saturated.
Venipuncture
Venipuncture allows procurement of larger quantities of blood for testing. Usually, the antecubital ve
choice because of ease of access. Blood values remain constant no matter which venipuncture site
as it is venous and not arterial blood.
1. Observe standard precautions (see Appendix A). If latex allergy is suspected, use latex-free s
equipment (see Appendix B).
2. Position and tighten a tourniquet on the upper arm to produce venous congestion.
3. Ask the patient to close the fist in the designated arm. Select an accessible vein.
4. Cleanse the puncture site and dry it properly with sterile gauze. Povidone-iodine must dry tho
5. Puncture the vein according to accepted technique. Usually, for an adult, anything smaller tha
might make blood withdrawal more difficult. A Vacutainer system syringe or butterfly system m
6. Once the vein has been entered by the collecting needle, blood will fill the attached vacuum tu
