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Sandy
Olson, MT (ASCP) SH
Reviewed 2006
OUTLINE
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A. Fingerstick procedure
B. Preparation of blood films
C. Wright staining techniques
D. Chamber cell counts
E. Red Cell indices
F. Use of microscope
G. Normal differential counts |
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A. Vocabulary/medical terminology
B. Normal erythrocyte development
C. Erythrocyte production
D. Erythrocyte function
E. Erythrocyte destruction
F. Anemias
G. Granulocyte production/function |
HEMATOLOGY PRE-CLINICAL COMPETENCIES
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A. Fingerstick procedure. Reference:
Brown Hematology, 5th Ed. The student will be able to describe key
features of the following: |
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1. Patient identification
2. Selection of finger
3. Cleaning of finger
4. Puncture technique
5. Blood film preparation
6. Closing the wound |
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B. Preparation of blood films. The
student will be able to prepare 8 out of 10 acceptable blood films.
The student will be able to explain the importance of the following: |
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1. Cleanliness of slides
and spreader slides
2. Size of blood drop
3. Angle and speed of spreader slide
4. Rapid drying
5. Identification of slide
6. Troubleshooting of poor slides |
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C. Staining of peripheral blood smears |
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1. State the
components of Wright's stain and indicate the organelles or chemical
constituents expected to react with each stain component.
2. Describe the steps necessary to produce a high quality stained
blood film. |
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D. Chamber cell counts. Reference:
Brown, Hematology, 5th Ed. The student will be able to accurately
perform manual platelet and WBC cell counts. Points to be explained: |
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1. Cleanliness
of equipment (counting chamber and pipette)
2. Dilution with appropriate diluent -- describe properties of each
diluent
3. Loading chamber -- distribution of cells
4. Counting/cell identification (platelets, red cells, white cells)
5. Calculations and dilution problems
6. Sources of error
7. Safety |
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E. Red cell indices. The
student will be able to calculate MCV, MCH, MCHC, state the normal
values and discuss the significance of results as related to red cell
morphology on a peripheral smear. |
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F. Proper use of microscope.
Reference: Brown, Hematology, 5th Ed. The student will be able
to identify parts of the microscope and demonstrate correct usage
and care. Cover the following points: |
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1. Vocabulary
and microscope anatomy - include the meaning of "parfocal"
2. Correct procedure for counting cells in counting chamber
3. Correct procedure for examining stained blood films
4. Care of microscope
5. Troubleshooting |
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G. Normal differential
counts. The student will be able to perform normal differential counts
from a peripheral blood smear demonstrating accuracy and precision
within allowable limits.
NOTE: It is imperative that the student demonstrate competency in
the above stated "Basic Technique" category. HCMC will provide
self-instructional review units if necessary, but will not formally
cover these areas again. |
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A. Vocabulary/medical
terminology. Students will be able to define/describe and/or identify
the following: |
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acanthocyte
agglutination
anemia
anisocytosis
basophilic stippling
bilirubin
biliverdin
buffy coat
burr cell
Cabot ring
conjugated bilirubin
crenation
EDTA
erythropoietin
feather edge
ferritin
Heinz body
helmet cell
hematocrit
hemochromatosis
hemolysis
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hemopexin
hemorrhage
hemosiderin
heterozygous
Howell-Jolly body
hypochromasia
hypersegmentation
Hgb A1
Hgb A2
Hgb C
Hgb F
Hgb M
Hgb S
iron binding capacity
iron stores
jaundice
karyolysis
karyorrhexis
MCH
MCHC
MCV
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microcytic
ovalocyte (elliptocyte)
plasma
poikilocytosis
polychromasia
polycythemia
porphyrin
protoporphyrin
reticulocyte
Rouleaux formation
schistocytes
serum
serum iron
sickle cell
siderocyte
spherocyte
splenomegaly
target cell
teardrop form
transferrin |
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B. Normal development
and metabolism of the erythrocyte |
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1. Define
the word "erythron."
2. List the steps of normoblast maturation. List the features used
to identify normoblast: cell size, nuclear size, cytoplasmic basophilia,
chromatin clumping, presence of nucleoli, presence of cytoplasmic
hemoglobin. Using these morphologic features the student will be able
to identify the stages of normoblast development.
3. Describe the shape, diameter, and volume of a normal red cell.
4. List the functions of the 4 major red cell enzyme pathways: Embden-Meyerhoff
pathway, Hexose monophosphate shunt, methemoglobin reductive pathway
and the Luebering-Rapaport pathway.
5. List laboratory tests for evaluating red cell production.
6. State the normal life span of a red cell. |
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C. Production of erythrocytes |
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1. List the
nutritional requirements for red cell production.
2. List the steps in the metabolism of iron.
3. Describe the chemical composition and structure of normal Hgb.
4. List the basic steps of porphyrin synthesis.
5. Describe the subcellular site of porphyrin synthesis.
6. Describe the structure and list steps in the production of globin. |
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D. Function of erythrocytes |
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1. List the
functions of the erythrocyte.
2. Define oxyhemoglobin and deoxyhemoglobin.
3. List the hemoglobins found in newborns and normal adults and the
percentages at which they occur. |
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E. Destruction of the
erythrocyte |
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1. List the
body sites of erythrocyte destruction.
2. List the steps in the process of normal degradation of Hgb and
its mode of
excretion.
3. Diagram and list the steps of intravascular and extravascular mode
of RBC destruction.
4. Define haptoglobin and discuss its role in hemoglobin destruction.
5. List the steps of hemoglobin catabolism, that is, the formation
of bilirubin, its transport, its metabolism (conjugation) in hepatic
cells and finally its excretion. |
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1. Define
anemia and discuss the clinical manifestations of anemia.
2. List and discuss the basic lab data used to evaluate and diagnose
anemia (not an inclusive list).
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a.
Hematologic
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1) Hgb concentration
2) Red cell indices, red cell count
3) Reticulocyte count
4) Platelet count
5) Hematocrit
6) Erythrocyte sedimentation rate
7) DAT
8) Examination of stained blood smear
9) Osmotic fragility |
b. Serum/plasma
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1) Iron and iron binding
capacity, serum ferritin
2) Bilirubin
3) Urea nitrogen
4) Creatinine
5) Proteins
6) Red cell folate
7) Serum folate
8) Vitamin B12
9) Haptoglobin
10) Serum hemoglobin |
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3. Describe the morphological classification of anemias, i.e. (1)
macrocytic, (2) hypochromic-microcytic, (3) normochromic-normocytic.
List typical indices and describe typical RBC morphology.
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a.
Macrocytic Anemia - Due to folic acid and Vitamin B12
deficiencies
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1) Define a
megaloblastic anemia.
2) List morphologic manifestations in peripheral blood,
being able to list, describe, and identify RBC, WBC, morphology
in a typical case of megaloblastic anemia.
3) List three common causes of B12 deficiencies.
4) List three common causes of folate deficiency.
5) List the sources of B12 and folate. |
b. Hypochromic/Microcytic Anemias
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1) Define hypochromic/microcytic
anemia.
2) List at list 6 causes Hypochromic/Microcytic Anemias.
3) Define iron deficiency anemia.
4) List at least 4 causes of iron deficiency.
5) Describe and identify the laboratory findings in blood
and bone marrow in Fe deficiency (emphasis on peripheral
blood).
6) Describe iron absorption.
7) State the normal values for serum Fe, iron binding
capacity, transferrin, % saturation.
8) Define sideroblastic anemia and the anemia of chronic
disease; be able to differentiate them from iron deficiency
anemia on the basis of laboratory data. |
c. Normocytic-Normochromic Anemias (NC/NC)
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1) Define normocytic-normochromic
anemia and prepare a chart containing common NC/NC anemias.
Include: anemia of acute blood loss, the hemolytic anemias,
anemia secondary to intrinsic bone marrow disease and
anemia secondary to decreased erythropoietin secretion.
2) List laboratory tests that would aid in diagnosis of
NC/NC diseases. Explain what a positive result would be. |
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G. White cell production
and function |
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1. State the origins of leukocytes.
2. List all stages of neutrophil development and identify using
the following features:
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a. Cell size
b. Nuclear cytoplasm ratio
c. Nuclear morphology (shape, chromatin color, chromatin clumping)
d. Nucleoli
e. Cytoplasmic morphology (texture, color of granulation)
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3. List the function of mature leukocytes.
4. Perform differential analysis of cells on normal peripheral blood
film (minimum of 25).
5. State the normal range for white cells in both adults and children.
6. Compare and contrast relative and absolute white cell counts.
7. Describe and be able to identify the following reactive changes
present in toxic neutrophils (toxic/azure granulation, Dohle bodies,
and cytoplasmic vacuolation) and reactive lymphocytes (increased
cytoplasmic basophilia, increased cytoplasmic granulation, and cytoplasmic
vacuolation).
1. Hematology: Principals and Procedures,
B. Brown, Lea Febiger, 5th Edition
2. Hematology, W. Williams et al, McGraw-Hill
Co., 4th Edition
3. Clinical Hematology, M. Wintrobe, Lea
and Febiger, 8th Edition
4. Laboratory Medicine-Hematology, J. Miale,
C.W. Mosby, 5th Edition
5. Blood: Textbook of Hematology, Jandl,
J.H., Little Brown, 1987
6. Technical Hematology, Simmons, A., J.B.
Lippincott, 1980
This is only a small sample of books available.
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