Hematology worksheets (cbc &results interpretation)

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Please FULLY complete the assigned worksheets attached to this post (attached at the bottom)

Serious inquiries only. Science majors ONLY. (Medical Laboratory Science preferably) 

Education/clinical experience: Hematology 

PLEASE COMPLETE THESE WORKSHEETS BY TUESDAY 11/30/2021 11:59 PM EST

MLSC-382A INSTRUCTOR: BETH RAWSON

1

Results Interp Wksht Updated: 8/20/2020

RESULTS INTERPRETATION Worksheet STUDENT NAME: __________________

SECTIONS 1 AND 2:
Given the following results, identify the abnormal or questionable results, and provide at least one
explanation for them (there may be multiple explanations possible). The first thing you have to decide is
whether the values presented are valid or spurious (i.e. inaccurate due to either specimen quality or
handling). The second consideration is what could explain the abnormalities you are seeing (what kind
of clinical situation OR specimen problem is suspected).

The time listed in the “Previous” column refers to the interval between the current results and the most
recent previous values. If no values are listed in the “Previous” column, assume there is no known
history. Generic reference ranges are provided.

NOTE: A key ability for any laboratory professional is to be able to distinguish spurious results (those
due to improper specimen collection methods) from true clinical variation due to a pathological
condition.

SECTION 1: CBC Testing

For each example, note which parameter(s) are pertinent to your explanation. An asterisk next
to a value indicates that it has been flagged by the instrument. Delta flags are indicated by [%D]
next to the value.

CBC #1: 57-year old Caucasian male, presented to the ED with chest pain, diagnosed with myocardial
infarction and admitted to the ICU 2 days earlier.

CURRENT PREVIOUS
(8 hours)

REFERENCE
RANGE

UNIT

WBC 4.8 5.4 4.5 – 11.5 103/uL
RBC 2.87 4.65 4.60 – 6.00 (m) 106/uL
HGB 10.1 [%D] 14.2 14.0 – 18.0 (m) g/dL
HCT 29.1 [%D] 42.4 40.0 – 54.0 (m) %
MCV 101 [%D] 91 80 – 98 fL
MCH 35.1 30.5 26 – 32 pg
MCHC 34.7 33.4 32 – 36 g/dL
RDW 12.5 13.3 11.5 – 14.5 %
PLT 224 292 150 – 450 103/uL
MPV 7.9 8.1 6.8 – 10.2 fL

MLSC-382A INSTRUCTOR: BETH RAWSON

2

Results Interp Wksht Updated: 8/20/2020

CBC #2: 27-year old Greek female, presented for prenatal evaluation (20 weeks pregnant).

CURRENT PREVIOUS REFERENCE
RANGE

UNIT

WBC 6.6 4.5 – 11.5 103/uL
RBC 5.13 4.00 – 5.40 (f) 106/uL
HGB 10.7 12.0 – 15.0 (f) g/dL
HCT 34.9 35.0 – 49.0 (f) %
MCV 68 80 – 98 fL
MCH 20.9 26 – 32 pg
MCHC 30.7 32 – 36 g/dL
RDW 27.3 11.5 – 14.5 %
PLT 309 150 – 450 103/uL
MPV 7.4 6.8 – 10.2 fL

CBC #3: 19-year old African American male, presented to the outpatient draw station subsequent to his
yearly physical examination; he did not have any complaints.

CURRENT PREVIOUS REFERENCE
RANGE

UNIT

WBC 5.6 4.5 – 11.5 103/uL
RBC 3.58 4.60 – 6.00 (m) 106/uL
HGB 11.0 14.0 – 18.0 (m) g/dL
HCT 46.4* 40.0 – 54.0 (m) %
MCV 130 80 – 98 fL
MCH 30.7 26 – 32 pg
MCHC 23.7* 32 – 36 g/dL
RDW 22.4 11.5 – 14.5 %
PLT 8* 150 – 450 103/uL
MPV 9.7 6.8 – 10.2 fL

MLSC-382A INSTRUCTOR: BETH RAWSON

3

Results Interp Wksht Updated: 8/20/2020

CBC #4: 21-year old Filipino female, diagnosed 10 days earlier with walking pneumonia due to
Mycoplasma pneumoniae.

CURRENT PREVIOUS
(10 days)

REFERENCE
RANGE

UNIT

WBC 3.8 5.6 4.5 – 11.5 103/uL
RBC 2.37 3.91 4.00 – 5.40 (f) 106/uL
HGB 12.0 11.0 12.0 – 15.0 (f) g/dL
HCT 22.3 [%D] 32.5 35.0 – 49.0 (f) %
MCV 94.1 [%D] 83.1 80 – 98 fL
MCH 50.5* 28.0 26 – 32 pg
MCHC 53.6* 33.7 32 – 36 g/dL
RDW 15.3 12.2 11.5 – 14.5 %
PLT 306 284 150 – 450 103/uL
MPV 9.9 9.6 6.8 – 10.2 fL

CBC #5: 41-year old Caucasian female, presented to the ED 12 hours earlier with multiple compound
fractures and major blood loss subsequent to a car accident, and was admitted to the SICU following
surgery.

CURRENT PREVIOUS
(8 hours)

REFERENCE
RANGE

UNIT

WBC 18.4 [%D] 10.6 4.5 – 11.5 103/uL
RBC 2.85 2.00 4.00 – 5.40 (f) 106/uL
HGB 8.62 [%D] 6.58 12.0 – 15.0 (f) g/dL
HCT 26.1 [%D] 19.2 35.0 – 49.0 (f) %
MCV 91.4 [%D] 96.3 80 – 98 fL
MCH 30.2 32.9 26 – 32 pg
MCHC 33.1 34.2 32 – 36 g/dL
RDW 17.6 13.1 11.5 – 14.5 %
PLT 124 [%D] 245 150 – 450 103/uL
MPV 8.4 8.5 6.8 – 10.2 fL

MLSC-382A INSTRUCTOR: BETH RAWSON

4

Results Interp Wksht Updated: 8/20/2020

SECTION 2: Coagulation Testing
For each scenario the relevant screening test results are given (PT/INR, PTT, Fibrinogen, D-Dimer
values), and any anticoagulant therapy is noted. Mixing studies or additional coagulation studies
are noted as appropriate.

Coagulation #1: 22-month old male presented to the pediatrician for evaluation of history of easy
bruising and right knee swelling after the child ran into an end table during play.

CURRENT PREVIOUS
(2 hours)

REFERENCE RANGE UNIT

PT 10.6 10.2 12.6 – 14.6 seconds
INR 1.0 0.9 0.9 – 1.2
PTT 48.5 52.1 23.8 – 34.2 seconds

Fibrinogen 422 160 – 455 mg/dL
D-Dimer 0.21 <0.50 mg/L

Anticoagulant None None None None

A mixing study was performed; results are as follows:

Coagulation #2: 42-year old Hispanic male presented to the ED with lower left leg pain. Patient has a
history of DVT (3 years prior).

CURRENT PREVIOUS REFERENCE RANGE UNIT
PT 15.8 12.6 – 14.6 seconds

INR 1.5 0.9 – 1.2
PTT 23.8 23.8 – 34.2 seconds

Fibrinogen 115 160 – 455 mg/dL
D-Dimer 32.7 <0.50 mg/L

Anticoagulant None None None

PTT MIX Initial, 1:1 mix with
PNP

60 minutes, 37º, 1:1
mix with PNP

UNIT

PATIENT 27.6 26.9 seconds
CONTROL 28.5 29.1 seconds

MLSC-382A INSTRUCTOR: BETH RAWSON

5

Results Interp Wksht Updated: 8/20/2020

Coagulation #3: 73-year old Asian-American female, presented to primary care physician for routine
examination and anticoagulant medication management.

CURRENT PREVIOUS
(14 days)

REFERENCE RANGE UNIT

PT 72.2 20.7 12.6 – 14.6 seconds
INR 6.4 2.0 0.9 – 1.2
PTT 35.4 23.8 – 34.2 seconds

Fibrinogen 160 – 455 mg/dL
D-Dimer <0.50 mg/L

Anticoagulant Coumadin Coumadin None None

Coagulation #4: 67-year old Indian male, admitted for removal of right foot abscess.

CURRENT PREVIOUS
(24 hours)

REFERENCE RANGE UNIT

PT 9.4 13.1 12.6 – 14.6 seconds
INR 0.8 1.0 0.9 – 1.2
PTT 16.4 28.7 23.8 – 34.2 seconds

Fibrinogen 160 – 455 mg/dL
D-Dimer <0.50 <0.50 mg/L

Anticoagulant None None None None

MLSC-382A INSTRUCTOR: BETH RAWSON

6

Results Interp Wksht Updated: 8/20/2020

SECTION 3: Hemoglobinopathy Testing
For each of 8 patient examples you are given the citrate agar (acid pH); the cellulose acetate (alkaline
pH); the hemoglobin, hematocrit, and MCV; and patient demographics.

For each patient example, given the agar/acetate and CBC results, determine ALL possible hemoglobin
phenotypes. If there are multiple options, which one is most likely? (HINT: look at ethnicity)

Refer to the “Hgb Electrophoresis Interpretation” lecture on Canvas for more guidelines and examples.

List the hemoglobin fractions that travel with each of the 4 control fractions. Only consider A, A2, F, S,
C, D, G, E, and O for this exercise.
Acid agar: Alkaline acetate:
F: ________________ A: _______________

A: ________________ F: _______________

S: ________________ S: _______________

C: ________________ C: _______________

Patient #1: 4-month old Caucasian male
Hgb 14.2 g/dL
Hct 45.1 %
MCV 100 fL

Final phenotype: ______________________________ (HINT: Is this normal for age?)

Patient #2: 24-year old Asian-American female

Hgb 12.5 g/dL
Hct 38.7 %
MCV 89 fL

Final phenotype: ______________________________

Patient #3: 45-year old Egyptian male
Hgb 13.3 g/dL
Hct 39.3 %
MCV 87 fL

Final phenotype: ______________________________

MLSC-382A INSTRUCTOR: BETH RAWSON

7

Results Interp Wksht Updated: 8/20/2020

Patient #4: 7-year old African-American male
Hgb 12.0 g/dL
Hct 34.5 %
MCV 68 fL

Final phenotype: ______________________________

Patient #5: 29-year old African-American male
Hgb 11.9 g/dL
Hct 36.5 %
MCV 82 fL

Final phenotype: ______________________________

Patient #6: 36-year old Thai male

Hgb 12.4 g/dL
Hct 37.0 %
MCV 74 fL

Final phenotype: ______________________________

Patient #7: 41-year old Indian female

Hgb 13.1 g/dL
Hct 38.6 %
MCV 84 fL

Final phenotype: ______________________________

Patient #8: 18-year old Israeli female

Hgb 11.3 g/dL
Hct 32.6 %
MCV 82 fL

Final phenotype: ______________________________

MLSC-382A INSTRUCTOR: BETH RAWSON

8

Results Interp Wksht Updated: 8/20/2020

Citrate Agar – Acid pH

Patient 1

Patient 2

Patient 3

Patient 4

Patient 5

Patient 6

Patient 7

Patient 8

CONTROL

C S A F

Cellulose Acetate – Alkaline pH

Patient 1

Patient 2

Patient 3

Patient 4

Patient 5

Patient 6

Patient 7

Patient 8

CONTROL

C S F A

PRACTICAL INSTRUCTIONS:

Please complete all sections of the exam before submitting the document to Canvas. You are allowed to use resources to complete the exam.

Section I: Peripheral Blood Smear Review (10)

Given the associated documents, complete a virtual smear review for each of the 10 “slides” as indicated below:

WBC DIFFERENTIAL:

There are 60 individual images included for the WBC differential section of each “slide. Identify each of the cells included per the included instructions and record your results in the tables below.

PLATELET ESTIMATE:

Using the RBC morphology images, complete platelet estimates using the semi-quantitative descriptive ranges as described below. Record your results in the indicated space.

· Extreme marked decrease (<20.0 x 103/uL)

· Marked decrease (20 – 50 x 103/uL)

· Decreased (50 – 150 x 103/uL)

· Normal (150 – 400 x 103/uL)

· Increased (400 – 700 x 103/uL)

· Markedly Increased (>700 x 103/uL)

· Note presence of platelet clumps if seen

RBC MORPHOLOGY:

Report RBC morphology using the procedure from your clinical site. Assume that each of the 4 images represents an individual high-power field from the same slide. Record RBC morphology in the indicated space.

Section III: Procedure Interpretation

Given the following GENERIC PROCEDURES, review the associated samples and questions and provide the best answer or resolution. Each set of questions is associated with a specific procedure. See Canvas for the two procedure documents.

NOTE: These generic procedures are meant to simulate real procedures used in the clinical laboratory; the referenced procedures within each may not exist in this context.

· CBC Automation: Results Verification and Reflex Testing

· Routine Coagulation Results Verification


SECTION I: PROCEDURE INTERPRETATION



CBC Automation: Results Verification and Reflex Testing

Given the following CBC results, note whether they would be autoverified or held for manual verification, according to the procedure. If they would be held for manual verification, note which parameter (or instrument flag) would be the reason, what kind of reflex testing is necessary, and whether there are any critical results which need to be calledd.

Specimen 1

Instrument flags: NONE

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?

Specimen 2

Instrument flags: Leukocytosis, IG Present

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?


Specimen 3

Instrument flags: NRBC Present, IG Present, Blasts/Abn Lympho?, RET Abn Scattergram

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?


Specimen 4

Instrument flags: Blasts/Abn Lympho?, Left Shift?, Atypical Lympho?

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?


Specimen 5

Instrument flags: Eosinophilia, IG Present, Blasts/Abn Lympho?

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?

Specimen 6

Instrument flags: NONE

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?

Specimen 7

Instrument flags: IG Present

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?

Specimen 8

Instrument flags: Neutrophilia, Monocytosis, Leukocytosis, IG Present, Left Shift?

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?


Specimen 9

Instrument flags: RBC Agglutination?, Turbidity/HGB Interfer?

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?

Specimen 10

Instrument flags: WBC Abn Scattergram, IG Present, Blasts/Abn Lympho?, Left Shift?

Autoverification passed: YES / NO

If NO, what parameter(s) held and why:

What reflex testing is necessary?

Are there any critical values which must be called/documented?



Routine Coagulation Testing: Results Verification

1. What are the stability timeframes for the following tests?

a. PT/INR:_____________________________

b. PTT: _______________________________

c. D-Dimer: ___________________________

2. What are the critical values for the following tests?

a. INR: ________________________________

b. PTT: ________________________________

c. Fibrinogen: __________________________

3. Given the following values, what actions must be taken prior to resulting?

a. PTT of <22.0 seconds: _______________________________________

b. INR of 4.7: ________________________________________________

c. PT or PTT with a delta check: __________________________________

4. How are hemolyzed specimens handled?

5. What should be done if it is noted that the patient has a hematocrit of >55%?

6. What further processing can be done to get valid results on a specimen which is flagged due to lipemia

1

Updated: 9/22/2020

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