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Hospital Blood Transfusion Services
Blood Bank Specialist
What is blood bank management system?
Blood Bank Management System (BBMS) is a browser based system that is designed to store, process, retrieve and analyze information concerned with the administrative and inventory management within a blood bank. Inventory management in blood bank for storage and issuance of blood.

A blood bank is a center where blood gathered as a result of blood donation is stored and preserved for later use in blood transfusion.

Blood Bank Technology Specialist (SBB)

What is a blood bank technology specialist?
A specialist in blood bank technology (SBB) works in a laboratory overseeing and performing routine tests as well as advanced and specialized tests on blood samples. They work in hospitals, labs, transfusion centers, research facilities, and community blood banks. They test for blood group antigens, investigate abnormalities identifiable in the blood, take care of blood collection and processing, draw and type blood, and perform pre-transfusion screening.

What does a specialist in blood bank technology do?
Although medical technologists and medical laboratory technicians also perform various blood tests, the blood bank technology specialist's training enables him or her to perform specialized tests, such as those dealing with the study of blood and its immunities (immunohematology).

What is the laboratory of blood bank?
Transfusion medicine is the branch of medicine that is concerned with the process of collecting (donation), testing, processing, storing, and transfusing blood and its components. It is a cornerstone of emergency and surgical medicine. The blood collection process typically takes place in donor centers.

Why do people need blood transfusions?
1. Trauma.
2. Surgery.
3. Hematological or oncological medical conditions.

How much blood do blood banks transfuse each year?
In a state, two hospitals transfused more than 18,000 blood units to patients every year.

How do blood banks get blood?
1. Voluntary donors in the hospital.
2. Blood collected from donor sites and blood drives organized across the state.
3. Attendants, first degree relatives, or close friends of patients.

Why do some people hesitate to donate blood?
Lack of awareness, fear, and myths associated with it. Blood donation weakens them, which is a total myth.

Who can donate blood?
A healthy person, preferably more than 21 years of age, can donate blood safely every three months.

What trauma, surgical, hematological, or oncological medical conditions need blood?
Here are further guidelines.
Blood Donor Center
Outpatient Infusion Unit
Apheresis Unit
Guidelines for blood donations
Transfusion Service
Histocompatibility (HLA) Laboratory
Blood Bank Jobs, Employment
    Doctor Asif Qureshi can guide all professions listed here, including teachers, lawyers, engineers, and physicians.
    Specialist in Blood Banking Technology, SBB(ASCP) Certification
    Technologist in Blood Banking, BB(ASCP)
    Generalist Medical Technologist - Blood Bank
    Donor Phlebotomy Technician, DPT(ASCP)
Practice Quiz for Blood Components
The Human ABO markers: The A, B, and O alleles
Practice Quiz for ABO blood types
Rh Blood Types
Practice Quiz for Rh Blood Types
Human Blood: Blood Components
GUIDELINES FOR REMOTE BLOOD STORAGE
What Happens to Donated Blood?
Blood Types
Blood Testing
History of Blood Transfusion
Location
Hematology
What is blood?
What is the function of blood?
What are the components of blood?
Where are blood cells made?
What are the functions of blood cells?
What is a complete blood cell count (CBC)?
Adverse Reactions to Blood Products
How is blood stored in a blood bank?
How can one donation help multiple people?
1. Do I need to know my blood type?

2. Who is a universal blood donor and a universal blood recipient?

3. Besides ABO and Rh, are there other types of red blood cell antigens?

1. Do I need to know my blood type?

Your blood will always be typed before you receive any blood to make sure that it is safe for you. The only time blood is given without blood typing is if there is an extreme emergency and there isn't enough time to perform the test before the blood needs to be transfused. In this case, group O, Rh negative blood (the universal donor blood) is administered since this blood type does not have any A, B, or Rh antigens that can potentially cause a hemolytic transfusion reaction.

2. Who is a universal blood donor and a universal blood recipient?

A universal blood donor is someone who has an O blood type and is Rh negative. This means that they have no A or B antigens or Rh factor on their red blood cells. Their red blood cells can be given to a person with any ABO or Rh blood type, because there are no A, B, or Rh factor antigens on the donors red blood cells for the antibodies of a person with a different blood type to react with. Hence, there is no potential for a hemolytic transfusion reaction due to ABO or Rh incompatibility. A universal recipient is a person who has an AB blood type and is Rh positive. They can receive red blood cells of any ABO or Rh type with no risk of a serious hemolytic transfusion reaction due to ABO or Rh incompatibility.

3. Besides ABO and Rh, are there other types of red blood cell antigens?

Yes, there are numerous other antigens present on the surface of red blood cells. These minor RBC blood group antigens include, for example, Kell, Kidd, Duffy, and other Rh antigens. Antibodies to these antigens are not made naturally and are only produced by the body when exposed to them through blood transfusion or when a mother is exposed to a baby's blood cells during pregnancy. These antibodies are not detected with routine blood grouping but may be found with an Indirect Antiglobulin Test. For more on these, see the article on Red Blood Cell Antibody Identification.

Q) How much blood is donated each year?
Q) Who needs blood?
Q) Who donates blood?
Q) What are the criteria for blood donation?
Q) Who should not donate blood?
Q) Where is blood donated?
Q) What is apheresis?
Q) What is the most common blood type?
Q) What tests are performed on donated blood?
Q) How is blood stored and used?
Q) What is the availability of blood?
Q) Is there a substitute for blood?
Q) Is it safe to give blood/platelets?
Q) Does blood differ by race or ethnic group?
Q) How will I feel after donating?
Q) How soon after donating can I return to normal activities?
Q) Can I donate during menstruation?
Q) Are there any materials used to collect blood that can cause an allergic reaction?
Q) How do I make an appointment to donate blood or platelets?
Q) Where is the Blood Donor Room located?
Q) Can you explain the blood donation process?
Q) Are there any special instructions I should follow before donating whole blood?
Q) Does it hurt to donate blood?
Q) How long will it take to replenish the pint of blood I donate?
Q) What happens to the blood I donate?
Q) How often can I give whole blood?
Q) What is a directed donation?
Q) Why do some __________ patients need platelets?
Q) Is it safe to donate platelets?
Q) Are there any special instructions I should follow before donating platelets?
Q) How often can I donate platelets?
Q) Can I give whole blood and also be a platelet donor?
Q) How Often Can You Donate Blood?
Q) What Screening Is Done on Your Blood?
Q) What Happens If We Find a Problem with Your Blood?
How much blood is donated each year?
AABB estimates that eight million volunteers donate blood each year. According to the 2005 National Blood Collection and Utilization Report about 15 million units of whole blood and red blood cells were donated in the United States in 2004.

Typically, each donated unit of blood, referred to as whole blood, is separated into multiple components, such as red blood cells, plasma, platelets, and cryoprecipitated AHF (antihemophilic factor). Each component generally is transfused to a different individual, each with different needs.

Who needs blood?
The need for blood is great — on any given day, an average of 39,000 units of red blood cells are needed. Blood transfusions often are needed for trauma victims — due to accidents and burns — heart surgery, organ transplants, and patients receiving treatment for leukemia, __________ or other diseases, such as sickle cell disease and thalassemia. In 2004, nearly 29 million units of blood components were transfused. And with an aging population and advances in medical treatments and procedures requiring blood transfusions, the demand for blood continues to increase.

Who donates blood?
Although an estimated 37.8 percent of the U.S. population is eligible to donate blood at any given time*, less than 10 percent do so annually. According to studies, the average donor is a college-educated white male, between the ages of 30 and 50, who is married and has an above-average income. However, a broad cross-section of the population donates every day. Furthermore, these “average” statistics are changing, and women and minority groups are volunteering in increasing numbers to donate. Persons 69 years and older account for approximately 10 percent of the population, but they require 50 percent of all whole blood and red blood cells transfused. Using current screening and donation procedures, a growing number of blood banks have found blood donation by seniors to be safe and practical.

Patients scheduled for surgery may be eligible to donate blood for themselves, a process known as autologous blood donation. In the weeks before non-emergency surgery, an autologous donor may be able to donate blood that will be stored until the surgical procedure.

*Many individuals may be only temporarily ineligible to donate due to mild illnesses (colds or flu), symptomatic allergies, hypertension, diabetes and anemia.

What are the criteria for blood donation?
To be eligible to donate blood, a person must be in good health and generally must be at least 16 years of age (or in accordance with applicable state law). Minimum weight requirements may vary among facilities, but generally, donors must weigh at least 110 pounds. Most blood banks have no upper age limit. All donors must pass the physical and health history examinations given prior to donation. Volunteer donors provide nearly all blood used for transfusion in the United States. The donor's body replenishes the fluid lost from donation in 24 hours. It may take up to two months to replace the lost red blood cells. Whole blood can be donated once every eight weeks (56 days). Two units of red blood cells can be donated at one time, using a process known as red cell apheresis. This type of donation can be made every 16 weeks.

Who should not donate blood?
* Anyone who has ever used intravenous drugs (illegal IV drugs)
* Men who have had sexual contact with other men since 1977
* Anyone who has ever received clotting factor concentrates
* Anyone with a positive test for HIV (AIDS virus)
* Men and women who have engaged in sex for money or drugs since 1977
* Anyone who has had hepatitis since his or her eleventh birthday
* Anyone who has had babesiosis or Chagas disease
* Anyone who has taken Tegison for psoriasis
* Anyone who has risk factors for Crueutzfeldt-Jakob disease (CJD) or who has an immediate family member with CJD
* Anyone who has risk factors for vCJD
* Anyone who spent three months or more in the United Kingdom from 1980 through 1996
* Anyone who has spent five years in Europe from 1980 to the present.

Where is blood donated?
There are many places where blood donations can be made. Bloodmobiles (mobile blood drives on specially constructed buses) travel to high schools, colleges, churches, and community organizations. People can also donate at community blood centers and hospital-based donor centers. Many people donate at blood drives at their places of work. You may use the online Locator or consult the yellow pages to locate a nearby blood center or hospital to donate.

What is apheresis?
Apheresis, an increasingly common procedure, is the process of removing a specific component of the blood, such as platelets, and returning the remaining components, such as red blood cells and plasma, to the donor. This process allows more of one particular part of the blood to be collected than could be separated from a unit of whole blood. Apheresis is also performed to collect red blood cells, plasma (liquid part of the blood), and granulocytes (white blood cells).

The apheresis donation procedure takes longer than that for whole blood donation. A whole blood donation takes about 10 to 20 minutes to collect the blood, while an apheresis donation may take about one to two hours.

What is the most common blood type?
The approximate distribution of blood types in the U.S. population is as follows. Distribution may be different for specific racial and ethnic groups:

O Rh-positive --- 38 percent
O Rh-negative --- 7 percent
A Rh-positive --- 34 percent
A Rh-negative --- 6 percent
B Rh-positive --- 9 percent
B Rh-negative --- 2 percent
AB Rh-positive --- 3 percent
AB Rh-negative --- 1 percent

In an emergency, anyone can receive type O red blood cells, and type AB individuals can receive red blood cells of any ABO type. Therefore, people with type O blood are known as “universal donors,” and those with type AB blood are known as “universal recipients.” In addition, AB plasma donors can give to all blood types.

What tests are performed on donated blood?
After blood has been drawn, it is tested for ABO group (blood type) and Rh type (positive or negative), as well as for any unexpected red blood cell antibodies that may cause problems in a recipient. Screening tests also are performed for evidence of donor infection with hepatitis B and C viruses, human immunodeficiency viruses HIV-1 and HIV-2, human T-lymphotropic viruses HTLV-I and HTLV-II, and syphilis. The FDA is allowing national deployment of investigational nucleic acid amplification tests (NAT) to screen blood for West Nile virus (WNV) genetic material — an approach similar to that taken for NAT to detect HIV and HCV.

The specific tests currently performed are listed below:

* Hepatitis B surface antigen (HBsAg)
* Hepatitis B core antibody (anti-HBc)
* Hepatitis C virus antibody (anti-HCV)
* HIV-1 and HIV-2 antibody (anti-HIV-1 and anti-HIV-2)
* HTLV-I and HTLV-II antibody (anti-HTLV-I and anti-HTLV-II)
* Serologic test for syphilis
* Nucleic acid amplification testing (NAT) for HIV-1 and HCV
* NAT for WNV

How is blood stored and used?
Each unit of whole blood normally is separated into several components. Red blood cells may be stored under refrigeration for a maximum of 42 days, or they may be frozen for up to 10 years. Red cells carry oxygen and are used to treat anemia. Platelets are important in the control of bleeding and are generally used in patients with leukemia and other forms of __________. Platelets are stored at room temperature and may be kept for a maximum of five days. Fresh frozen plasma, used to control bleeding due to low levels of some clotting factors, is kept in a frozen state for usually up to one year.

Cryoprecipitated AHF, which contains only a few specific clotting factors, is made from fresh frozen plasma and may be stored frozen for up to one year. Granulocytes are sometimes used to fight infections, although their efficacy is not well established. They must be transfused within 24 hours of donation.

Other products manufactured from blood include albumin, immune globulin, specific immune globulins, and clotting factor concentrates. Commercial manufacturers commonly produce these blood products.

What fees are associated with blood?
While donated blood is free, there are significant costs associated with collecting, testing, preparing components, labeling, storing and shipping blood; recruiting and educating donors; and quality assurance. As a result, processing fees are charged to recover costs. Processing fees for individual blood components vary considerably. Processing fees for one specific component also may vary in different geographic regions. Hospitals charge for any additional testing that may be required, such as the crossmatch, as well as for the administration of the blood.

What is the availability of blood?
The blood supply level fluctuates throughout the year. For example, after the Sept. 11 attacks, the blood supply swelled to very high levels, due to the overwhelming response of donors. During holidays and in the summer, levels tend to fall because donations decline, but demand remains stable or even increases. In addition, policies recommended by the Food and Drug Administration can eliminate, or defer, donors who may be at risk for variant Cruetzfeldt-Jacob disease (vCJD), the human variety of the disease that is commonly known as “mad-cow” disease. Also, FDA can recommend that a potential donor who may be at risk for a transfusion-transmissible disease such as West Nile virus be deferred. These policies reduce the number of people who are eligible to donate.

What can you do if you aren’t eligible to donate?
While a given individual may be unable to donate, he or she may be able to recruit a suitable donor. Blood banks are always in need of volunteers to assist at blood draws or to organize mobile blood drives. In addition, monetary donations are always welcome to help ensure that blood banks can continue to provide safe blood to those in need.

1. Why should I donate blood/platelets?
2. Who is eligible to give blood/platelets?
3. Do I need my parents' permission to give blood/platelets?
4. Do I need official identification?
5. Is there a substitute for blood?
6. Is it safe to give blood/platelets?
7. Does blood differ by race or ethnic group?
8. How will I feel after donating?
9. How soon after donating can I return to normal activities?
10. Can I donate during menstruation?
11. Are there any materials used to collect blood that can cause an allergic reaction?
12. How do I make an appointment to donate blood or platelets?
13. Where is the Blood Donor Room located?

1. Why should I donate blood/platelets?
The lives of many __________ patients depend on blood/platelet tranfusions to help them regain their strength, fight infections, and recover from __________ treatment. By donating your blood/platelets you will be helping patients fight against their __________.

2. Who is eligible to give blood/platelets?
Donors must be in good general health, be 17 to 75 years old, and weigh at least 110 pounds. However, there are certain exceptions to these guidelines. If you are 76 or older, you may still donate blood or platelets if you have written approval from your physician dated within six months of your donation. If you are 16 years old, you may donate blood if you have a consent form signed by your parent or legal guardian. Consent forms are available by calling the Blood Donor Program, 212-636-3666. If you are under 16, you may donate blood if you have a consent form signed by your parent or legal guardian, and written approval from your physician and you are approved for donation by our blood bank physician. A parent or guardian must be with you at the time of donation.

For more specific information about donor qualifications, see Additional Donor Requirements.

3. Do I need my parents' permission to give blood/platelets?
In New York, you do not need your parents' permission to donateblood/platelets if you are age 17 or older. If you are 16 years old, you may donate blood at Memorial Sloan-Kettering __________ Center if you have a consent form signed by your parent or legal guardian. To receive a consent form, call the Blood Donor Program at 212-639-3666.

4. Do I need official identification?
Yes, before you donate blood/platelets, regulations require that you show identification with your name and your signature or a photo.

5. Is there a substitute for blood?
No. Only the human body makes this precious fluid.

6. Is it safe to give blood/platelets?
Yes, it is safe to give blood/platelets. All needles and supplies used to collect blood/platelets are sterile, disposable, and used only once -- for you -- before being discarded.

7. Does blood differ by race or ethnic group?
No. Everyone has an ABO blood type, and most transfusions can be performed if the blood type of the donor and patient are compatible, regardless of their races or ethnicities.

8. How will I feel after donating?
Most donors feel fine after donating blood/platelets, but a small number of people may experience an upset stomach, feel faint or dizzy, or have bruising, redness or pain where the needle was inserted. It's helpful to drink extra fluids for 48 hours following your donation. Your body will replace the liquid part of the blood (plasma) and platelets within two days and the red blood cells within 56 days.

9. How soon after donating can I return to normal activities?
As long as you feel well, you can resume normal activities after leaving the Donor Room. However, you should avoid heavy lifting and pushing heavy objects for at least 24 hours after giving blood.

10. Can I donate during menstruation?
Yes, as long as you are feeling well.

11. Are there any materials used to collect blood that can cause an allergic reaction?
Some products used to collect blood contain iodine and natural rubber latex, which may cause allergic reactions. If you are allergic or think you may be allergic to these products, notify our staff at the time of your donation and substitute materials will be used.

12. How do I make an appointment to donate blood or platelets?
Call the Blood Donor Room at 212-639-7648.

13. Where is the Blood Donor Room located?
. Can you explain the blood donation process?
Donating blood takes about an hour from the time you arrive until you are ready to leave. First you must complete a registration form with basic information such as your name, address, and birthdate. You must also present identification that shows your name and your photo or signature. Then, one of our medical professionals will check your blood pressure, temperature, and hemoglobin level (iron); take a look at your arm to make sure it is clear of any signs of infection or intravenous drug use; and ask you confidential questions about your health to ensure that you are eligible to donate blood that day. The actual donation takes between ten and 20 minutes. Afterward, you will be given juice and a light snack to replenish the fluid donated and refresh you before leaving the Blood Donor Room.

2. Are there any special instructions I should follow before donating whole blood?
You should eat a regular meal and drink plenty of fluids one to two hours before donating blood.

3. Does it hurt to donate blood?
A skilled, professionally-trained staff will collect your blood. Except for a slight sting when the needle is inserted, you should not experience any pain during the donation.

4. How long will it take to replenish the pint of blood I donate?
Your body will replace the blood volume (plasma) within 48 hours. It will take four to eight weeks for your body to completely replace the red blood cells you donated. The average adult has eight to 12 pints of blood. You will not notice any physical changes related to the pint you donated.

5. What happens to the blood I donate?
All blood is tested for blood type, hepatitis, HIV (the AIDS virus), HTLV, and syphilis. Then it is separated into components -- red blood cells and plasma -- to help patients recover from __________ treatment and regain their strength.

6. How often can I give whole blood?
You can donate whole blood every 56 days.
1. What is a directed donation?
A directed donation is the donation of blood or platelets that is designated for a specific patient. There is no scientific evidence that designated blood is safer than blood from other volunteer donors. In fact, directed donors must meet the same eligibility criteria as other volunteer donors. If the directed donation is whole blood, generally only the red cells are reserved for the designated patient's use. The other blood components are put into the general inventory of Memorial Hospital's Blood Bank for use by other patients. To prevent blood from being wasted, if the designated patient does not use the red cells within 30 days, the unit will be made available for use by other patients. Platelets that are not used by a designated patient within 5 days will also be made available for use by other patients.

1. What is different about donating platelets and how long does it take?
It is now easier, and in many cases faster, to donate platelets. Only one of your arms is used to withdraw blood, filter out the platelets, and return the rest of the blood to you. Your other arm is free to turn pages in a book, click on a laptop keyboard, or scratch an itch during the 70-90 minute donation procedure. This is in addition to the time it takes you to complete your registration form and have your medical history taken and reviewed. Plan to spend about 2 1/2 hours in the Blood Donor Room when you are donating platelets.

2. Why do some __________ patients need platelets?
Some __________ treatments cause a loss of platelets. These specialized blood cells help control blood clotting. When platelet levels fall too low, patients are given a transfusion of platelets to replenish their supply and prevent life-threatening hemorrhages. Some patients, especially those who have had a bone marrow transplant or who are being treated for leukemia, may require daily platelet transfusions for several weeks.

3. Is it safe to donate platelets?
Yes, it is safe to donate platelets. All needles and supplies used to collect platelets are sterile, disposable, and used only once -- for you -- before being discarded.

4. Are there any special instructions I should follow before donating platelets?

You should eat a regular meal and drink plenty of fluids one to two hours before donating platelets. We also suggest that you increase your consumption of calcium-rich foods (dairy products) or take a calcium supplement the evening before your donation and also the morning of your donation. Do not take aspirin, or products containing aspirin, for at least 72 hours before your appointment, and do not take any non-steroidal, anti-inflammatory medications (such as Ibuprofen) for 48 hours before your appointment. Tylenol is acceptable.

5. How often can I donate platelets?
You can donate platelets twice within a seven-day period if there is at least 72 hours between donations. You may donate up to 24 times a year.

6. Can I give whole blood and also be a platelet donor?
Yes. Donor eligibility criteria are the same for both platelet and whole blood donors. You can donate platelets 72 hours after donating whole blood. If you donate platelets first, you can donate whole blood 72 hours later.

How Often Can You Donate Blood?

Whole Blood

You must wait a minimum of 56 days between whole blood donations. You must wait at least 72 hours after donating blood before you can donate platelets.

Platelets

You can donate platelets once in a seven day period and up to 24 times a year. You must wait at least 72 hours after donating platelets before donating whole blood.

In any eight (8) week period, you can make one blood donation and one platelet donation or six (6) platelet donations.

What Screening Is Done on Your Blood?
After you have donated, your blood will be tested for syphilis, HIV (the virus that causes AIDS), hepatitis, and HTLV (Human T-Lymphotropic Virus), which can cause a blood or nerve disease. Your blood may also be used in studies to evaluate new research methods or investigational tests to improve the safety of the blood supply.

What Happens If We Find a Problem with Your Blood?
If you test positive for any of the diseases named above, you will be notified and your blood will not be used for transfusions. In addition, you may be asked to speak with one of our medical professionals at the Blood Bank and scheduled for a follow-up visit and further testing. Your consent for re-testing will be requested again at that time.

The names of donors with positive test results are kept in confidential files and will not be released without your written consent unless required by law. We will not notify you if your test results are negative (we do not find any problems) or if the blood samples we collected were insufficient to provide enough blood to complete laboratory tests.

Where does hematology end and oncology begin?
1. a. What anticoagulant is used to collect samples for most routine hematology tests?
b. How does this anticoagulant work?

2. What type of iron is found in normal hemoglobin?

3. What protein is the main carrier of free hemoglobin in the plasma?

4. List the three hemoglobins found in normal adult blood and state how much of each is present.

5. Which hemoglobin is present in the highest amount in newborns?

6. a. What reagent is used to measure hemoglobin by the cyanmethemoglobin method?

b. What does this reagent contain?
c. What type of hemoglobin cannot be measured by Drabkin’s reagent?

7. What is the “rule of three” as it relates to CBC results?

8. Name three conditions that may interfere with the cyanmethemoglobin method for hemoglobin.

9. a. What are the dimensions of a Newbauer hemacytometer on one side of the counting chamber?
b. What is the depth of the Newbauer hemacytometer?
c. What is the depth factor used in calculations?

10. For a manual RBC count,
1. what squares of a Newbauer hemacytometer are used?
b. what is the total area of the counting squares? c. what diluent is used?
d. what is the normal dilution?
11. For a manual WBC count,
a. what squares of a Newbauer hemacytometer are used?
b. what is the total area of the counting squares
c. what diluent is used?
d. what is the normal dilution ?

12. What is the generic formula for calculating a manual blood cell count using a Newbauer
hemacytometer?
13. a. What is the formula used to correct a WBC count for the presence of NRBC’s?
b. When must a WBC count be corrected for NRBCs?
14. For each of the following RBC indices, write the formula for calculation and the normal reference range.
a. MCV
b. MCH
c. MCHC

15. a. Which RBC indice is used to determine cell size?
b. Which RBC indice is used to determine hemoglobin content?
c. Which RBC indice is used to express variation in RBC size?
16. a. What term is used to describe a variation in RBC size within a single patient sample?
b. What term is used to describe a variation in RBC shape within a single patient sample?

17. Sed rate:
a. An elevated sed rate indicates the presence of what general condition?
b. What is the normal reference value for Westergren sed rate for an adult male?
18. State how each of the following will affect a patient’s sed rate (increased, decreased):
a. presence of macrocytes
b. tilt tube
c. air bubble in tube
d. incubation temperature > RT
e. increased plasma acute phase reactants

19. What is the life span of a platelet?

20. On a normal peripheral smear, how many platelets should be seen per oil immersion field?

21. How do you estimate the number of platelets using a peripheral smear?

22. State how each of the following conditions will affect a patient’s platelet count (increase, decrease).

a. specimen not well mixed upon collection

b. Polycythemia vera

c. normal response to blood loss

d. myelofibrosis

e. post-splenectomy

f. DIC

23. For a manual platelet count,

a. what squares of a Newbauer hemacytometer are used?

b. what is the total area of the counting squares?

c. what diluent is used?

d. what is the normal dilution?

24. When making a wedge peripheral smear, at what angle is the spreader slide held?

25. What two stains are present in the Wright stain used for peripheral blood smears?

26. How do you estimate the number of WBCs using a peripheral smear?

27. Name the cell type seen on a peripheral smear described by each of the following:

a. nucleus contains several lobes connected by strands of chromatin, abundant cytoplasm with granules

b. nucleus stains deep purple and may be round or slightly notched, small amount of “robin’s egg blue” cytoplasm

c. nucleus is horse-shoe shape with delicate chromatin, blue-gray cytoplasm which has “ground glass” appearance

d. nucleus is band or sausage shape, abundant cytoplasm with granules

e. bi-lobed nucleus, cytoplasm contains many acidophilic granules

28. What three types of cells are considered granulocytes?

29. What are the two main types (principle) of automated cell counters?

30. Using the Coulter principle, what five analytes are actually measured by the instrument?

31 Using the Coulter principle, how is the hematocrit determined?

32. What is displayed on the x- and y-axis of a histogram?

33. List the three categories of cells displayed on a WBC histogram (from left to right).

34. How is cell sizing of the WBCs performed on automated counter? Be specific.



35. RBC histogram

a. Which two RBC parameters are shown on the RBC histogram?

b. What is indicated when an RBC histogram is shifted to the right?

c. What is indicated when the RBC histogram is wider than normal?

36. Which histogram contains two curves, smooth and fitted?

37. Give three reasons why the above curve would only show a smooth curve.

38. a. Which stain is used to produce WBC scattergrams? b. Give the staining pattern for each type of WBC on a scattergram with the above stain. 39. What type of hemoglobin contains iron in the ferric state?

40. Name the sites of blood cell production in an adult.

41. Name the two sites normally used for bone marrow aspiration in an adult.

42. List the stages of development of the red blood cell from most immature to the mature red blood cell. Use both sets of names.

43. Which RBC stage does each of the following describe: a. First stage in which hemoglobin is formed? b. Last nucleated stage (nucleus is described as pyknotic)? c. Only stage normally found in bone marrow and peripheral blood?

44. Retics a. What stain is used to perform a retic stain? b. A technologist counts 25 retics in 700 RBCs on a patient with a hematocrit of 28 %. What is the patient’s corrected retic count?

45. Miller disc - retics a. Using a Miller disc, what is counted in the larger square A? b. Using a Miller disc, what is counted in the smaller square B? c. Write the formula used for calculating the result using a Miller disc. 46. Name the substance that normally attaches to the beta chains of hemoglobin A to prevent the binding of oxygen in the tissues. 47. For each method of hemoglobin electrophoresis, give the pH of the buffer used and list the hemoglobins in order of migration starting at the anode.

48. Kleihauer-Betke a. What cells are resistant to denaturation by acid and stain orange using eosin? b. Why is the K-B stain usually performed?

49. Give the scientific name for each abnormal RBC type. a. Helmet cell b. Burr cell c. Teardrop cell d. Cell fragment e. Target cell f. Target cell with target connected to cell membrane g. Sickle cell h. Mouth cell i. Round cell with no central pallor j. Cigar shaped cells

50. Complete the following chart for the RBC inclusions. Can be seen on Can be seen on Composition Wright stain supravital stain (RNA, DNA, etc) Basophilic stippling (a ) (b) (c) Cabot rings (d ) (e) (f) Heinz bodies (g ) (h) (i) Howell-Jolly body (j) (k) (l) Pappenheimer body (m) (n) (o)

51. For each of the following types of anemia, state the morphology of the RBCs. 1. Acute blood loss 2. Sickle cell 3. Iron deficiency 4. Aplastic anemia 5. Beta Thalassemia 6. B12/folate deficiency 7. Anemia of chronic disease 8. Chronic blood loss 52. What antibiotic is associated with aplastic anemia?

53. What term refers to a decrease in the number of all blood cell types?

54. Fill in the following microcytic, hypochromic anemias. Iron deficiency anemia Serum Iron: ____(a)_____ TIBC: ____(b) ___ Alpha Thalassemia Hemoglobin electrophoresis _______(c)________ Beta Thalassemia Hemoglobin electrophoresis _______(d)________

55. Which anemia is associated with the following finding on the peripheral smear? a. hypersegmented PMNs b. basophilic stippling c. target cells d. Pappenheimer bodies e. drepanocytes f. Heinz bodies

56. What amino acid substitution in the globin chains is seen with each of the following. Be specific. a. sickle cell anemia b. Hemoglobin C disease

57. Which anemia is diagnosed using the following tests? a. Schilling test b. Sucrose hemolysis c. Osmotic fragility d. Watson-Schwartz e. Ham’s test f. Donath Landsteiner g. antibodies to Intrinsic factor

58. Sickle cell screen a. What reagent is used to lyse the red blood cells? b. What reagent is used to reduces the hemoglobin, allowing the Hgb S to become insoluble?

59. List the stages of development in the granulocytic series in the order of maturation.

60. Which stage in the granulocytic series is described by the following? a. first stage to contain specific granules b. nucleus is kidney-shaped c. largest stage in series d. nucleus is uniform in width e. first stage to contain non-specific granules

61. List the stages of development in the monocytic series in the order of maturation.

62. List the stages of development in the lymphocytic series in the order of maturation.

63. Name the WBC inclusion or condition is described by the following. a. red needle like rods in cytoplasm of blast b. light blue inclusions in cytoplasm of neutrophil c. Dohle bodies and giant platelets d. neutrophils have bi-lobed nucleus e. neutrophils have impaired chemotaxis f. neutrophils contain precipitated mucopolysaccharides g. neutrophils can ingest, but not kill, bacteria h. foamy macrophages present in tissue g. monocytes contain cerebroside 64. List the site of maturation for B and T cells.

65. a. What percentage of circulating lymphocytes are T cells? b. What percentage are B cells?

66. For each of the following classification of acute leukemia, give the name. a. M1 b. M2 c. M3 d. M4 e. M5 f. M6 g. M7 h. L1 i. L2 j. L3 67. Which type of WBC blast can contain Auer rods?

68. Name the type of acute leukemia is described by the following.
a. patients develop DIC
b. patients may have eosinophilia
c. infiltration of gums by immature cells (two answers)
d. most common type in young children

69. What two types of WBCs stain positive with myeloperoxidase?

70. What component of a WBC is stained by:

a. Sudan Black B
b. PAS

71. What types of leukemia give a positive reaction with

a. non-specific esterase stains? b. TdT (terminal deoxynucleotidyl transferase)?
c. acid phosphatase with tartrate?
d. specific esterase?

72. a. What stain is used to differentiate leukemoid reaction from CGL?
b. What is the result in leukemoid reaction?
c. What is the result in CGL?

73. Name the type of malignant disorder associated with the following:
a. hypogammaglobulinemia
b. Philadelphia chromosome
c. presence of Bence Jones proteins in urine
d. Mycosis fungoides
e. monoclonal increase in IgG
f. monoclonal increase in IgM
g. presence of Reed-Sternberg cells

74. State the chromosomal translocation that occurs with the Philadelphia chromosome.

75. State the normal value for the following Hematology tests.

a. RBC
b. WBC
c. Platelet
d. Hemoglobin
e. Hematocrit
f. RDW
g. Diff
h. Retic

Do you typically treat patients with my diagnosis?
• What stage is my __________?
• Is there anything unique about my __________ that makes my prognosis better or worse?
• Should I get a second opinion?

__________ Treatment

• What is the goal of treatment?
• To cure my __________ or stop it from growing?
• What are my treatment options?
• How can each treatment option help me achieve my goal of therapy?
• What risks or potential side effects are associated with each treatment?
• What research studies (“clinical trials”) are available?
• Are there any clinical trials that are right for me?
• How long will I receive treatment, how often, and where?
• How will it be given?
• How will I know if the treatment is working?
• How might a disruption in my chemotherapy dose or timing affect my results?
• How and when will I be able to tell whether the treatment is working?
• What are the names of all the drugs I will be taking?
• Can I talk with another of your patients who has received this treatment?
• Are there any resources or Web sites you recommend for more information?

Tests

• What types of lab tests will I need?
• Will I need x-rays and scans?
• Can you explain the results of my complete blood count (CBC)?
• Are there tests for the genetic make-up of my __________?
• Will I benefit from having my __________ evaluated for its genetic make-up?
• How frequently will I get the tests?

Side Effects of Treatment

• What possible side effects should I prepare for?
• When might they start?
• Will they get better or worse as my treatment goes along?
• How can I prepare for them or lessen their impact?
• Are there treatments that can help relieve the side effects? What are they? Do you usually recommend or prescribe them?
• Which risks are most serious?
• Will I require blood transfusions? Why?
• How can I best monitor myself for complications related to either my disease or my treatment?

Protecting Against Infection

• Will my type of chemotherapy put me at risk for a low white blood cell count and infection?
• Can I help protect myself against infection right from the start of chemotherapy, instead of waiting until problems develop? • Am I at special risk for infection?
• What are the signs of infection?
• How serious is an infection?
• How long will I be at risk for infection?
• What should I do if I have a fever?
• How are infections treated?

Daily Activities

• How will my __________ treatment affect my usual activities?
• Will I be able to work?
• Will I need to stay in the hospital?
• Will I need someone to help me at home?
• Will I need help taking care of my kids?
• Are there any activities I should avoid during my chemotherapy?

What to Expect After Treatment
• What happens after I complete my treatment?
• How can I best continue to monitor myself for complications related to either my disease or my treatment?
• What kind of lab tests will I need?
• How frequently should I get those lab tests?
• What types of x-rays and scans will I need?
• How often do I need to come in for checkups?
• When will you know if I am cured?
• What happens if my disease comes back?

* Why do I need bloodwork?
* What is a CBC?
* What is the normal range?
* What Is Chemotherapy?
* How Is Chemotherapy Given?
* How Often and For How Long Will I Get Chemotherapy?
* How Will I Feel During Chemotherapy?
* Will my chemotherapy make me sick?
* Will I lose my hair because of my treatment?
* Why is my CBC tested after treatment?

Why do I need blood work?
Your doctor orders blood tests to confirm or rule out a suspected illness, to follow the course of a chronic illness, or to see how you are responding to treatment.

What is a CBC?
A CBC is a Complete Blood Count. It measures your white blood cells (WBC), red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), platelets (PLT), the size of the red cells (MCV), as well as the mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC).

White blood cells fight infection. Red blood cells and hemoglobin carry oxygen. If your red cell count falls too low, your heart must work harder to deliver oxygen throughout your body. The hematocrit, mean cell hemoglobin, and mean cell hemoglobin concentration are various ways we measure your red cell count. If your red blood cells or hemoglobin are very low, you may feel tired or become short of breath. Platelets stick together to stop bleeding. If your platelet count is low, a cut may bleed longer than is normal.

What is the normal range?
A normal range for a lab test is based on the test results of a very large number of people. The test results of most, but not all, patients will fall into this normal range. Some healthy patients will always have counts that are lower or higher than the normal range --- that just happens to be normal for these patients. However, test results may be lower or higher than the normal range if you are ill or if you are receiving treatment. For example, a viral infection will cause your white blood cell count to go up or down. If you are receiving chemotherapy, your WBC will go down, then come back up, each time you receive treatment.

What Is Chemotherapy?
Chemotherapy is the treatment of __________ with drugs that can destroy __________ cells. These drugs often are called "anti__________" drugs. Anti__________ drugs destroy __________ cells by stopping them from growing or multiplying.

How Is Chemotherapy Given?
Chemotherapy is most often given intravenously (IV), through a vein. Usually a thin needle is inserted into a vein on the hand or lower arm at the beginning of each treatment session and is removed at the end of the session. It also can be given by mouth, injection, or topically on the skin.

How often and for how long will I get chemotherapy?
You may get treatment every day, every week, or every month. This all depends on the type of __________, the drugs that are used and how your body responds to the treatment. Chemotherapy is often given in cycles that include treatment periods alternated with rest periods. Rest periods give your body a chance to build healthy new cells and regain its strength.

How will I feel during chemotherapy?
Most people receiving chemotherapy find that they tire easily, but many feel well enough to continue to lead active lives. Each person and treatment is different, so it is not always possible to tell exactly how you will react. Your general state of health, the type and extent of __________ you have, and the kind of drugs you are receiving can all affect how well you feel.

Will my chemotherapy make me sick?
A number of very effective medications are now available to help lessen or prevent nausea and vomiting. These medications may be given to you intravenously during your chemotherapy, or you may be given a prescription medication to take at home. Call your nurse or doctor if you experience nausea.

Will I lose my hair because of my treatment?
Hair loss is a common side effect of chemotherapy, but not all drugs cause hair loss. The amount of hair loss varies from a slight thinning to complete baldness, affecting the scalp, eyelashes and eyebrows, legs, armpits, and pubic area. The loss may be gradual or sudden. The hair usually grows back after the treatments are over. Some people even start to get their hair back while they are still having treatments.

Why is my CBC tested after treatment?
Chemotherapy attacks fast-growing cells. __________ cells, white blood cells, red blood cells, and platelets are all fast-growing cells. Because chemotherapy does not know the difference between them, these cells are all affected during treatment. Your white blood cell count, red blood cell count, and platelet count may all go down. Your doctor monitors these counts to determine the toxicity of treatment and to predict your risk for complications, as well as to plan future therapy.
Last Updated: April 24, 2018