Glossary:
1. Serum The liquid separated from the natural coagulation of isolated blood
2. Anticoagulants or anticoagulant substances Substances that inhibit blood clotting
3. Basic dyes The colored part is cationic, which can combine with acidic substances in cells, such as DNA, RNA, etc., and is mainly used for staining the nucleus
4. Red blood cell count (RBC) , combined with hemoglobin and hematocrit, is often used as one of the main indicators for diagnosing anemia, polycythemia vera and polycythemia
5. Hemoglobin (Hb or HGB) is a binding protein containing pigment prosthetic groups synthesized in human nucleated erythrocytes and reticulocytes, and is a transport protein in erythrocytes
6. Reticulocytes (RET) are transitional cells between late immature red blood cells and mature red blood cells, slightly larger than mature red blood cells
7. Erythrocyte sedimentation rate (ESR) Under specified conditions, the natural sinking rate of red blood cells in anticoagulated whole blood in vitro
8. Uneven size of neutrophils The size of neutrophils varies greatly, and the heterogeneity increases
9. Toxic granules In the case of severe infection and extensive burns, neutrophils appear in the cytoplasm of neutrophils, which are thicker than normal neutrophils, with different sizes and uneven distribution of purple-black or dark purple-brown granules
10. Left shift of nucleus Increased neutrophils in peripheral blood or metamyelocytes, myelocytes and even promyelocytes
11. Nucleus shifted to the right. Neutrophils in the peripheral blood were increased, and the number of neutrophils above 5 lobes was >3%
12. Under the stimulation of virus, protozoan infection, drug reaction, connective tissue disease, stress state or allergen and other factors, atypical lymphocytes proliferate and undergo morphological changes. Increased alkalinity, nucleoblastification
13. Degeneration Cell body enlargement, blurred structure, unclear edges, nuclear pyknosis, nuclear swelling, nuclear dissolution, etc., are common in aging and diseased cells
14. Basophilic stippling erythrocytes are immature erythrocytes, granules formed by residual nucleic acid denaturation and aggregation in the cytoplasm, after staining with basic dyes, deeply stained granules can be seen in the cells
15. Blood type and blood type system Blood type: the genetic traits of various blood component antigens, which is one of the main characteristics of blood Blood type system: a group of antigens produced by a single gene or alleles of multiple closely linked loci
16. Cross-matching blood test Based on blood type identification, it is a test to further check whether the blood of the recipient and the donor contains incompatible antigens and antibody components
17. ABO blood group identification The ABO blood group antibody is mainly IgM, which belongs to complete antibody. The molecular chain of IgM antibody is longer, which can overcome the repulsive force on the surface of red blood cells. At the same time, its relative molecular mass is relatively large, and it can specifically bind to the corresponding antigen in normal saline to cause agglutination phenomenon visible to the naked eye.
18. Red blood cell histogram The normal red blood cell histogram is a unimodal curve with approximately normal distribution, usually in the range of 36~360fl, the abscissa indicates the volume of red blood cells, and the ordinate indicates the probability of red blood cells with different volumes
19. Platelet histogram Normal platelet histogram is a unimodal smooth curve with skewed distribution, usually in the range of 2~30fl, mainly concentrated at 2~15fl
20. The laser light scattering method injects the diluted, stained and spheroidized cell suspension into the center of the sheath flow, and the single cells are neatly arranged along the two streams of the suspension and the sheath flow, and pass through the quartz capillary at a constant flow rate, that is, the fluid dynamics Learning Focus Technology
21. Glomerular proteinuria After the glomerular filtration membrane is damaged by inflammation, immunity, metabolism and other factors, the pore size of the filtration membrane increases, breaks and the electrostatic barrier function is weakened, and plasma proteins, especially albumin, are filtered out. Proteinuria due to proximal tubular reabsorptive capacity
22. Chyluria is due to the rupture of lymphatic vessels in the urinary system or the obstruction of deep lymphatic vessels, causing chyle fluid or lymph fluid to enter the urine, and the urine is milky white and turbid
23. Microscopic hematuria No red in the urine appearance, red blood cells > 3/HP under the centrifugal urine microscope
24.
25. Renal tubular proteinuria When the renal tubules are infected, poisoned, damaged or secondary to glomerular diseases, the reabsorption capacity is reduced or inhibited, resulting in proteinuria mainly composed of proteins with relatively small molecular weights
26. Tissue proteinuria is derived from the protein produced by renal tubule metabolism, tissue destruction and decomposition, inflammation or drug-stimulated urinary system secretion, which enters the urine to form proteinuria
27. Urine specific gravity The ratio of urine to the weight of the same volume of pure water at 4°C is an indicator of the concentration of solutes contained in urine
28. Urine osmolarity is the total number of osmotically active solute particles in urine, which has nothing to do with particle size and charge. Macromolecular substances such as protein and glucose have little influence on it, and can accurately reflect the concentration and dilution functions of the kidney.
29. Urine centrifugal staining microscopy is used to identify pathological formed elements and improve the contrast of white blood cells, flash cells, epithelial cells, casts, crystals, bacteria and fungi, which is helpful to identify cells and casts, especially to prevent missed detection Clear casts that can be examined microscopically after staining
30. Transparent cast , also known as glass cast, is mainly composed of TH protein, also contains albumin and sodium chloride, is colorless and transparent, and can dissolve and disappear in alkaline urine
31. Calcium oxalate crystals Colorless square shimmering octahedron or envelope-like, with two diagonals intersecting each other, sometimes diamond-shaped, occasionally dumbbell-shaped or pie-shaped
32. Urine Formed Components Components that are excreted through urine and can be detected under a microscope
33. Metabolic diabetes is caused by hyperglycemia caused by abnormal secretion of endocrine hormones and glucose metabolism
34. Waxy casts are derived from granular casts, or casts gradually formed after amyloidogenic epithelial cells are lysed, and may also be evolved from hyaline casts that stay in the renal tubules for a long time
35. Occult Blood Test (FOBT) A test to check for fecal occult blood
36. Intestinal flora disorder The ratio of Gram-positive cocci to Gram-negative bacilli in feces is >1:10, normal flora decreases or even disappears, and staphylococci or fungi increase significantly
37. Sperm motility rate Directly observe the ratio of motile sperm to the total number of sperm under a microscope
38. Sperm motility The ability of sperm to move forward
39. Spermatogenic cells are immature germ cells, which refer to hypoplastic germ cells at various stages, such as spermatogonia, primary spermatocytes, secondary spermatocytes and hypoplastic sperm cells
40. Sperm count One refers to counting the number of sperm in a unit volume, that is, sperm concentration. The other is the total number of sperm, that is, the absolute number of sperm discharged at a single time (sperm concentration × volume of semen this time)
41. Prostatic fluid An opaque, light milky liquid secreted by the prostate gland, which is an important part of semen
42. Phosphatidylcholine body The main component is phosphatidylcholine, which is round or oval, with strong refraction, uneven size, similar to platelets, but slightly larger, so it should be distinguished from platelets when observed
43. Vaginal discharge The fluid secreted by the female reproductive system is mainly composed of secretions from the vaginal mucosa, cervical glands, Bartholin glands and endometrium, commonly known as leucorrhea
44. Cerebrospinal fluid is a colorless and transparent liquid present in the ventricles, subarachnoid space, and central canal of the spinal cord
45. Mucin typing test is a simple mucin screening test that can roughly distinguish inflammatory effusions from non-inflammatory effusions
46. Bloody exudate is generally red, dark red or jam-colored, and is common in trauma, malignant tumor, tuberculous effusion and pulmonary infarction
47. Transudate Fluid in body cavity caused by heart failure, hypoproteinemia, etc. Non-inflammatory effusion accumulated in tissue space or body cavity
48. Exudate Fluid exuded during inflammation Inflammatory effusion caused by local tissue inflammation
49. Carcinoembryonic antigen alpha-fetoprotein sugar chain antigen serosal effusion tumor marker
Answer questions:
1. Commonly used anticoagulants and anticoagulant principles for blood samples
anticoagulant
Principle of anticoagulation
Ethylenediaminetetraacetate (EDTA)
Combine with Ca2+ in the blood to form a chelate, interrupting the coagulation process
sodium citrate
Binds to Ca2+ in blood
heparin
Strengthened antithrombin inactivates serine proteases, preventing thrombin formation
Oxalate
Combine with Ca2+ in blood to form calcium oxalate precipitate
2. Blood collection method of skin blood collection method
u Gently massage the blood collection site (the inner side of the ring finger of the left hand or the earlobe) to make the local tissue congest naturally
u Disinfect the skin, after it dries, pinch both sides of the blood collection site tightly
u Hold a disposable sterilized blood collection needle in your right hand and insert it quickly (the depth is preferably 2-3mm), and the blood will flow out by itself or after a little squeezing. Because the first drop of blood is mixed with tissue fluid, it is generally discarded, or it is decided whether to use it according to the requirements of the test items.
u After the blood collection, press the blood collection site with a sterile dry cotton swab to stop the bleeding
3. Precautions for skin blood collection method
u Pay attention to strict disinfection and biosafety precautions when collecting blood, and the blood collection needle is for one-time use
u Squeeze slightly when taking blood, but do not use too much force to avoid mixing too much tissue fluid into the blood
u Blood collection should be done quickly to prevent coagulation of the outflowing blood
u When multiple routine examinations are performed manually, the order of blood sample collection is platelet count, red blood cell count, hemoglobin determination, white blood cell count and white blood cell differential count
4. Blood collection method of soft-connected two-way blood collection needle
u Tie the cuff on the upper end of the puncture point, and ask the subject to clench his fist to make the vein full and exposed
u Pull out the sheath of the blood collection puncture needle, fix the blood vessel with the left hand, hold the puncture needle with the thumb and index finger of the right hand, pierce the skin along the direction of the vein so that the needle and the skin form an angle of 30°, and then puncture forward (the needle forms an angle of 5° with the skin) Vein wall enters venous cavity
u After blood returns, insert the rubber plug puncture needle (the other end of the two-way needle is covered with soft rubber latex) directly into the center of the rubber head cover of the negative pressure blood collection tube, the blood will be automatically sucked into the blood collection tube, and the cuff will be loosened at the same time
u If multiple tubes of blood samples are required, pull out the puncture needle and then puncture another blood collection tube
u After blood collection, ask the subject to loosen his clenched fist, press the puncture point with a sterile dry cotton swab, pull out the puncture needle, and continue to press the puncture point for several minutes
5. Clinical significance of physiological increase in red blood cells
u hypoxia, such as newborns (35% increase), mountain dwellers (14% increase), mountaineers, strenuous exercise and manual laborers
u Increased androgen, such as adult males are higher than females
u Increased adrenal cortex hormones, such as mood swings (emotional impulse, excitement, fear)
u long-term heavy smoking
u Venous compression time > 2 minutes (10% increase)
u Capillary blood is higher than venous blood (increased by 10%~15%)
u Intra-day difference, as the number of red blood cells is the highest at 7 am in one day
u Drug effects, such as the application of epinephrine, glucocorticoid drugs
6. Briefly explain the cause of pathological increase in red blood cells
increase
reason
Relative hypertrophy (decreased blood volume)
Vomiting, high fever, diarrhea, polyuria, sweating, extensive burns
Absolute increase
secondary increase
1. Tissue hypoxia: severe chronic cardiopulmonary disease, cyanotic congenital heart disease
2. Compensatory increase in erythropoietin (EPO): abnormal hemoglobinopathies
3. Uncompensated increase of erythropoietin (EPO): kidney cancer, liver cancer, uterine fibroids, ovarian cancer, renal embryonic tumor, hydronephrosis, polycystic kidney and kidney transplantation
primary hyperplasia
polycythemia vera
7. Clinical significance of reticulocyte count
u Evaluate bone marrow proliferative ability and judge the type of anemia
u Evaluate curative effect
u Monitoring of radiotherapy and chemotherapy
u drug effects
8. Quality assurance items and evaluation of blood smear preparation
project
evaluate
glass slide
Keep it neutral, clean and non-greasy
Preparation of blood smear
1. The "standard" of a good blood smear is that the blood film gradually transitions from thick to thin. The thickness should be appropriate, the head, body, and tail should be distinct, evenly distributed, with gaps on both sides, and neat edges
2. The thickness and length of the blood film are related to the size of the serum, the angle between the slide and the slide, the speed of the slide and the hematocrit (HCT). The blood drop is large and the angle is large. If the film is pushed fast, the blood film will growl; otherwise, the blood film will be thin.
3. When the HCT is increased, the blood viscosity is high, and it is advisable to keep a smaller angle to obtain a satisfactory blood smear; on the contrary, when the HCT is lower than normal, the blood is thinner, and a larger angle and a faster pusher should be used Only at high speed can a satisfactory blood smear be obtained
dyeing
Blood smears should be stained within 1 hour, or fixed with anhydrous methanol and stained within 1 hour
9. The clinical significance of pathological increased ESR
disease
clinical significance
tissue damage
After severe trauma and major surgery, serum acute phase reactive protein increases rapidly 3-4 days after myocardial infarction
malignant tumor
Associated with tumor necrosis, increased fibrinogen, infection, and anemia
inflammatory disease
Acute bacterial infection (rapid increase in acute phase reactive proteins)
Active rheumatic disease (increased antigen-antibody complexes)
Active tuberculosis, active rheumatic fever (fibrinogen significantly increased)
HIV infection (positive serum markers with increased erythrocyte sedimentation rate is an early predictor of AIDS)
autoimmune disease
Connective tissue disease, ESR has similar sensitivity to C-reactive protein, rheumatoid factor, antinuclear antibody, etc.
Hyperglobulinemia
Multiple myeloma, macroglobulinemia, systemic lupus erythematosus, liver cirrhosis, chronic nephritis,
Increased immunoglobulin
Hypercholesterolemia
Atherosclerosis, diabetes mellitus, myxedema, primary familial hypercholesterolemia
other
Degenerative disease, giant cell arteritis, polymyoma rheumatica
10. Factors affecting the determination of erythrocyte sedimentation rate
Variety
factor
evaluate
speed up
Plasma factor
Fibrinogen, gamma globulins and abnormal clonal immunoglobulins, alpha and beta globulins, elevated cholesterol and triglycerides
red blood cell factor
Large red blood cells are easy to form a thread, which accelerates the erythrocyte sedimentation rate; anemia of various causes
infection factor
Certain viruses, bacteria, drugs, metabolites, and abnormal antibodies neutralize the negative charges on the cell surface
drug factors
Glucose, polyvinylpyrrolidone, gelatin, penicillamine, oral contraceptives, methyldopa, dextran, procainamide, theophylline, vitamin A
Specimen and Physical Condition
Specimen hemolysis, erythrocyte sedimentation tube tilted, temperature too high
slow down
Plasma factor
Increases in albumin, glycoprotein, and phosphatidylcholine inhibit the formation of erythrocyte strings
red blood cell factor
Increased number, uneven size, or increased spherical and sickle cells, which is not conducive to the formation of cords
physical conditions
The erythrocyte sedimentation tube is not clean or the blood column contains air bubbles, and the temperature is too low
drug factors
aspirin, cortisone, quinine
11. Causes of increased reactivity of white blood cells (neutrophils)
category
reason
acute infection
Bacterial, certain viral, fungal, spirochete, rickettsial, and parasitic infections (most common)
inflammation
Rheumatoid arthritis, rheumatic fever, bronchitis, nephritis, pyelonephritis, colitis, pancreatitis, thyroiditis, dermatitis
tissue damage
Severe trauma, major surgery, extensive burns, acute myocardial infarction
blood cell destruction
severe intravascular hemolysis
acute blood loss
Gastrointestinal bleeding, spleen rupture, rupture of ectopic pregnancy
malignant tumor
Non-hematopoietic malignancies, especially gastrointestinal malignancies (liver cancer, gastric cancer) and lung cancer
acute poisoning
Metabolic, chemical, drug, biotoxin, etc. intoxication (associated with increased chemokines)
12. According to the dynamic characteristics of granulocytes, briefly describe the distribution, cell pool and cell types of granulocytes
distributed
cell pool
cell type
Dynamic characteristics
marrow
split pool
Raw grains ~ middle and young grains
With the ability to divide, one myeloblast can proliferate into 16-32 metamyelocytes after 3-5 divisions
marrow
mature pond
late granules and rods
Without the ability to divide, after 3 to 5 days, it will gradually mature
marrow
storage pool
Rod and lobed nuclei
Stay for 3 to 5 days, the amount is about 5 to 20 times that of peripheral blood. The maturation time from mesenchyme to lobular granulocyte is about 5-7 days, which can be shortened to 2 days when stimulated
blood
circulation pool
Few rod-shaped nuclei, lobed nuclei
It is 50% of the granulocytes released into the blood from the bone marrow storage pool, and stays for about 10-12 hours with the blood circulation, and the half-life is about 6-7 hours
blood
edge pool
Lobular nucleus
In order to release the other 50% of the granulocytes in the peripheral blood, adhere to the blood vessel wall, exchange with the granulocytes in the circulating pool at any time, and maintain a dynamic balance, and together with the circulating pool are called the total granulocyte pool
tissue or body cavity
tissue intrinsic pool
Lobular nucleus
The granulocytes escape the blood vessel wall and enter the tissue or body cavity, survive for 1 to 4 days, perform defense functions, no longer return to the blood, and are destroyed, cleared or eliminated in the tissue
13. Causes and significance of pathological thrombocytosis and decrease
platelets
reason
clinical significance
reduce
Generate obstacles
Acute leukemia, aplastic anemia, myeloid neoplasm, radiation injury, megaloblastic anemia
too much damage
Idiopathic thrombocytopenic purpura, hypersplenism, systemic lupus erythematosus
consume too much
DIC, thrombotic thrombocytopenic purpura
abnormal distribution
Splenomegaly, blood thinning
Congenital
Neonatal thrombocytopenia, giant platelet syndrome
increase
primary
Chronic myeloid, essential thrombocythemia, polycythemia vera
reactivity
Acute suppurative infection, massive bleeding, acute hemolysis, tumor
other
After surgery, splenectomy
14. Clinical significance of prolonged and shortened prothrombin time (PT)
u extend:
1. Congenital FⅡ, FⅤ, FⅦ, FX deficiency and low (no) fibrinogenemia
2. Acquired coagulation factor deficiency, such as severe liver disease, vitamin K deficiency, primary fibrinolysis
3. There are anticoagulants in the blood circulation, such as oral anticoagulants
u Shorten:
1. Congenital FⅤ hyperplasia
2. Hypercoagulable state and thrombotic disease
3. Drug effects, such as long-term use of contraceptives
15. Clinical significance of determination of fibrinogen (Fg) content
u Fg increased:
1. Infection: toxemia, pneumonia, subacute bacterial endocarditis
2. Aseptic inflammation: nephrotic syndrome, rheumatic fever, rheumatoid arthritis
3. Prethrombotic state and thrombotic diseases: diabetes, acute myocardial infarction
4. Malignant tumor
5. After trauma, burns, surgery, radiation therapy
6. Others: late pregnancy, pregnancy-induced hypertension syndrome
u Fg reduction:
1. Primary fibrinogen reduction or structural abnormality: low or no fibrinogenemia, dysfibrinogenemia
2. Secondary fibrinogen reduction: advanced DIC, hyperfibrinolysis, severe hepatitis and cirrhosis
16. The site where the ABO blood group system antigen exists
u Complete antigen: on the cell membrane of red blood cells, lymphocytes, platelets, epithelial cells, etc.
u Hapten: in various body fluids or secretions except cerebrospinal fluid
17. The clinical significance of Rh blood group identification
u transfusion
Although about 99.6% of Chinese are Rh positive, and there is generally no Rh antibody in the serum of healthy people, in order to ensure the safety of blood transfusion, RhD antigen identification must be done before blood transfusion, and Rh negative blood recipients must be transfused with Rh negative blood
u Discovered hemolytic disease of the newborn
If the maternal blood contains IgG Rh antibodies against fetal red blood cells, IgG antibodies can pass through the placenta and destroy fetal red blood cells, causing hemolytic disease of the newborn. Therefore, identify the Rh blood type of the newborn and the mother and check the incomplete antibody of Rh to facilitate the detection of hemolytic disease of the newborn
18. Clinical significance of cross-matching blood test
u match to a suitable blood source, verify the blood type
Match to a suitable blood source, and further verify whether the blood type identification of the blood recipient and the blood donor is correct, so as to avoid severe hemolysis reaction after blood transfusion caused by wrong blood type identification
u Discover subtypes
For example, some people of A2 subtype contain anti-A1 serum, and when they are matched with A1 red blood cells, agglutination may occur
u found irregular antibodies
Although the ABO blood type is the same, severe hemolytic transfusion reactions can also occur when the Rh or other blood types are different. Even if Rh or other blood types are not identified, blood type incompatibility or immunity between the recipient and the blood donor can be found through cross-matching Antibody
19. Briefly describe the quality assurance in blood analyzer testing
u The quality assurance of blood analyzer test results shall run through the application of clinicians, nurses or test personnel to collect samples, transport personnel to transfer samples, test personnel to receive samples, test, review and confirm, print results, issue reports, and clinical satisfaction. The whole process
u Quality assurance before testing:
1. Qualified inspectors 2. Suitable testing environment 3. Qualified blood analyzer
4. Supporting reagents 5. Qualified test specimens
u Quality assurance during testing:
1. Instrument startup 2. Indoor quality control 3. Specimen detection 4. Instrument cleaning
u Post-test quality assurance:
1. Analysis of results in the laboratory
2. Combined with the clinical situation for correlation analysis
3. Regularly solicit clinical evaluation of test results
4. Record and report test results that are difficult to interpret
20. Detection principle of electrical impedance hematology analyzer
u The blood cells suspended in the electrolyte solution are non-conductive particles relative to the electrolyte solution. When blood cells (or similar particles) with different volumes pass through the counting hole, it can cause changes in the internal and external current or voltage of the small hole, forming a The pulse voltage with the same volume and size can indirectly distinguish the blood cell groups and count them separately. This is the principle of electrical impedance
21. Types of blood cell count errors and ways to reduce them
Type of error
reason
error reduction method
technical error
Improper blood collection site, inaccurate dilution factor, improper filling, uneven mixing of diluted blood, blood coagulation, improper handling and use of equipment, and wrong cell identification
Standardize operation, use equipment correctly, and improve operation skills
instrument error
Equipment (counting plates, coverslips, pipettes) are inaccurate and imprecise
Calibration of various equipment
count field error
Uneven distribution of blood cells in the counting chamber, etc.
Expand cell count range and volume
22. The concept of blood analyzer alarm
There are three main functions of the blood analyzer:
1. Screening and reporting of normal inspection results, at this time, generally no alarm occurs
2. When the technical conditions are mature, approved by the State Food and Drug Administration, and the report is made within the test item rules set by the instrument or laboratory, there may be no alarm. However, in most cases, an alarm is still issued to remind inspectors to pay close attention to the abnormalities that have occurred
3. When the specimen cannot meet the pre-set rules of the laboratory, the instrument will inevitably alarm and must be re-examined.
u The alarm of the test result means that the reliability of the test result directly reported by the instrument to the clinic has been significantly reduced, and the test result report cannot be directly issued to the clinic without re-examination confirmation or effective explanation
23. General requirements for urine specimen collection
project
General requirements
patient request
The patient is in a quiet state, living and eating according to routine
Physiological state
Exercise, sex, menstruation, excessive fasting or eating, drinking, smoking, and posture and position can affect some test results
avoid pollution
1. The patient first washes his hands and cleans the external genitalia, urethral opening and surrounding skin
2. Female patients should especially avoid urine contamination by vaginal secretions or menstrual blood, and male patients should avoid mixing semen
3. To avoid the mixing of chemicals (such as surfactants, disinfectants), feces and other pollutants
collection time
Urine specimens for bacterial culture must be collected in sterile containers prior to treatment with antibiotics to facilitate bacterial growth
special requirements
1. When using urinary catheter specimens or suprapubic puncture urine specimens, the medical staff should first inform the patient and family members of the relevant precautions, and then the medical staff should collect them
2. When collecting infant urine samples, be guided by pediatric medical staff, and use a special urine bag for children to collect samples
24. Erythrocyte casts and their clinical significance
u Red blood cell casts: morphologically intact red blood cells embedded in the matrix of the casts
u Red blood cell casts are caused by glomerular or tubular hemorrhage, which can be seen in acute glomerulonephritis, acute exacerbation of chronic nephritis, renal hemorrhage, acute tubular necrosis, renal transplant rejection, renal vein thrombosis, and malignant hypertension etc., can also be seen with lupus nephritis, subacute endocarditis and IgA nephropathy
25. Hemoglobinuria and its clinical significance
u Hemoglobinuria: Plasma free hemoglobin increases during intravascular hemolysis, exceeding the globin binding capacity (about 1.3g/L). Because of its relatively small molecular weight, it can be filtered out by glomeruli to form hemoglobinuria
u Clinical significance: common in favism, paroxysmal nocturnal hemoglobinuria (PNH) and transfusion reactions of blood group incompatibility, paroxysmal cold hemoglobinuria (PCH), marching hemoglobinuria, immune hemolytic anemia, etc.
Common factors and diseases of intravascular hemolysis are shown in the table below
factor
disease
red blood cell destruction
Heart valve repair surgery, extensive burns, strenuous exercise, rapid marches, severe muscle trauma, and vascular tissue damage
biological factors
Malaria, contained bacillus poisoning
Hemolysis caused by animals and plants
Snake venom, bee venom, poisonous mushroom (xùn)
microvascular hemolytic anemia
DIC
drug effect
Primaquine, acetylsalicylic acid, sulfonamides, phenacetin
immune factors
Thrombotic thrombocytopenic purpura, paroxysmal cold hemoglobinuria, incompatible blood transfusion
26. Under what circumstances is microscopic examination performed during urinalysis
u The doctor asks for microscopic examination
u Patients with renal disease (regardless of initial or follow-up visits) should go directly to standardized microscopic examination
u Abnormal results of any urine physical and chemical examination. Especially dry chemical examination, if one of the four items of red blood cells, white blood cells, protein and nitrite is abnormal, a microscopic examination must be performed, and the results of the microscopic examination shall prevail
27. Detection principle of urine dry chemical method
u The chemical composition of the urine changes the color of the reagent module on the multiple test strip, and the color depth is proportional to the concentration of the chemical composition in the urine. When the test strip enters the colorimetric tank of the urine dry chemistry analyzer, each reagent module is sequentially irradiated by the light source of the instrument and produces different reflected light. Processing, calculate the reflectance of each detection parameter, compare and correct with the standard curve, and finally output the result automatically in a qualitative or semi-quantitative way
The essence of the detection principle of urine dry chemical method is the absorption and reflection of light. The depth of the color of the reagent module has different absorption and reflection of light. The darker the color, the greater the light absorption, the smaller the light reflection, and the smaller the reflectivity;
28. Tube type and forming conditions
u Casts are cylindrical protein aggregates formed by coagulation of proteins, cells and their disintegrated products in renal tubules and collecting ducts
u Tube formation should meet 3 conditions:
1. There are albumin and Tamm-Horsfall protein (TH protein) in the original urine: this is the matrix and the first condition to form the cast, among which TH protein is the most likely to form the core of the cast
2. The ability of renal tubules to concentrate and acidify urine: Concentration can increase the concentration of protein and salts that form casts, while acidification promotes further protein denaturation, aggregation and precipitation
3. The kidney has nephrons that can be used alternately: it is conducive to the formation and excretion of casts, that is, the urine stasis of nephrons in the "resting" state of lesions occurs, and there is enough time to form casts. When the nephrons get Repair and restore function When urinating again, the formed cast can be excreted with urine
29. Clinical significance of renal failure casts
u Renal failure casts are also called broad casts. Renal failure casts indicate serious renal disease. Patients with acute renal failure with polyuria and early rise may have a large number of wide casts in the urine, which will gradually disappear and disappear with the improvement of renal function. Renal failure casts may appear in advanced chronic nephritis with uremia, which often indicates a poor prognosis. Brown broad hemoglobin casts can be seen in the urine of acute renal failure caused by hemolytic reaction after heterozygous blood transfusion. Pigmented myoglobin casts in urine in acute renal failure following renal crush injury or extensive burns
30. Clinical significance of homogeneous red blood cell hematuria
u Mainly increased red blood cells, but no increase or no obvious increase in urine protein.
u found in:
1. Temporary microscopic hematuria: seen in healthy people, especially adolescents after strenuous exercise, rapid march, cold water bath, standing for too long or after heavy physical labor. Women should also pay attention to the pollution of menstrual blood, which should be distinguished through dynamic observation
2. Urinary system diseases: such as urinary system inflammation, tumor, tuberculosis, calculus, trauma, renal transplant rejection, congenital malformation, etc. Hematuria is sometimes the only clinical manifestation of urological malignancies
3. Reproductive system diseases: such as prostatitis, seminal vesiculitis, etc.
4. Others: bleeding disorders caused by various reasons, etc.
31. The clinical significance of red blood cell examination by stool microscope
u In the case of upper gastrointestinal bleeding, due to the digestion of gastric juice, the red blood cells have been destroyed and it is difficult to see them in the feces
u Different numbers of red blood cells may appear in lower gastrointestinal tract inflammation or bleeding, such as dysentery, ulcerative colitis, colon cancer, rectal polyps, hemorrhoids, acute schistosomiasis, etc.
Inflammatory injury and bleeding: white blood cells and red blood cells can exist at the same time
Bacillary dysentery: polydisperse red blood cells with normal morphology and fewer numbers than white blood cells
Amoebic dysentery: Red blood cells are more sticky and broken than white blood cells
32. Morphology and clinical significance of cells (red blood cells) in feces
cell
form
clinical significance
physiological
pathology
leukocyte
(pus cells)
No or occasionally white blood cells, and those with complete morphology are no different from granulocytes in blood
Neutrophils are grayish white, swollen, necrotic, damaged, with incomplete structure, the cytoplasm is full of fine particles, and the nucleus is not clear (ie, pus cells), often appearing in piles
1. Enteritis: leukocytosis is not obvious, generally <15/HP, scattered
2. Bacillary dysentery, ulcerative enteritis: a large number of white blood cells or pus cells appearing in piles, and small phagocytes that swallow foreign bodies can be seen
3. Irritable bowel syndrome, intestinal parasites (especially hookworm disease and amoebic dysentery): there are more eosinophils in the stool, which may be accompanied by Charcot-Leyden crystals
red blood cells
none
Grass-green, slightly refracting disc-shaped, sometimes shrunken due to the pH of the feces
In upper gastrointestinal bleeding, due to the digestion of gastric juice, the red blood cells have been destroyed and are difficult to see in the stool
Inflammation or hemorrhage of the lower gastrointestinal tract may have varying numbers of red blood cells, such as dysentery, ulcerative colitis, colon cancer, rectal polyps, hemorrhoids, acute schistosomiasis, etc.
33. Reference value and clinical significance of fecal occult blood test
u Reference value: Negative
u Clinical significance: FOBT is mainly used for the screening and identification of gastrointestinal bleeding and gastrointestinal tumors
1. Judgment of gastrointestinal bleeding: positive FOBT is seen in gastrointestinal bleeding, gastric mucosal damage caused by drugs (such as taking aspirin, indomethacin, glucocorticoids, etc.), intestinal tuberculosis, Crohn's disease, gastric ulcer, various gastritis, Ulcerative colitis, colon polyps, hookworm disease, malignant tumors of the digestive tract, etc.
2. Differentiation between peptic ulcer and tumor bleeding: FOBT positive diagnosis rate for peptic ulcer is 40%~70%, showing intermittent positive; after treatment, when the appearance of stool is normal, FOBT can still be positive for 5~7 days , If the bleeding stops completely, the occult blood test can be converted to negative. The positive rate of digestive tract malignant tumors is 20% in the early stage and 95% in the late stage, and the positive rate is persistent
34. The main purpose of semen examination
u Evaluate male reproductive function, provide basis for infertility diagnosis and curative effect observation
u Auxiliary diagnosis of male reproductive system diseases
u Observation of curative effect after vasectomy
u Screen high-quality sperm for in vitro fertilization and sperm bank
u Forensic identification
35. Clinical significance of decreased sperm motility
Decreased sperm motility is an important factor in male infertility. When the sperm motility rate is lower than 70%, it can reduce fertility, and if it is lower than 40%, it can lead to infertility. There are many factors that cause the decline of sperm motility:
u Varicocele
u Reproductive system infection, such as gonorrhea, syphilis, etc.
u Physical factors: such as high temperature environment (hot water bath), radiation factors, etc.
u Chemical factors such as certain drugs (anti-metabolites, antimalarials, estrogens), ethanol, etc.
36. Common diseases of reduced sperm count
When the sperm count is continuously <20×109/L, it is oligospermia; when there is no sperm in the semen multiple times, it is azoospermia (3 consecutive inspections, and there is still no sperm in the sediment after centrifugation). Common in:
u After male ligation: Generally, the inspection starts at the 6th week after ligation, 1-2 times a week, and no sperm is detected for 3 consecutive times, which indicates that the operation is successful
u Testicular lesions: such as varicocele, testicular deformity, inflammation, tuberculosis, gonorrhea, tumor and cryptorchidism, etc.
u Vas deferens diseases: such as vas deferens obstruction, congenital defects of vas deferens and immune infertility
u Others: retrograde ejaculation, harmful metal or radiation damage, environmental factors, the elderly, application of anticancer drugs, etc.
37. Common formed components of prostatic fluid and their clinical significance
component
clinical significance
Phosphatidylcholine bodies
In prostatitis, phosphatidylcholine bodies can be reduced, piled up, or unevenly distributed; in severe inflammation, phosphatidylcholine bodies are phagocytized by phagocytic cells and disappear
prostate granulosa cells
Increase is more common in the elderly, prostatitis (can increase by 10 times, with a large number of pus cells)
amyloid body
Generally without clinical significance, it can combine with cholesterol to form prostate stones
red blood cells
Increases are seen in prostatitis, prostate stones, prostate tuberculosis or malignant tumors, and after prostate massage
leukocyte
Increased and clustered, one of the characteristics of chronic prostatitis
Trichomonas
The discovery of trichomonas can be diagnosed as trichomonas prostatitis
Pathogen
Corresponding infection
38. Trichomonas vaginalis and its detection principle
u Trichomonas vaginalis: belongs to flagellate class, is a kind of pathogenic anaerobic parasitic protozoa that parasitizes in the vagina. Insect body diameter 8~45
, in the shape of an inverted pear with a wide neck and tail tip, 2 to 3 times the size of white blood cells. There are 4 flagella at the top of the worm body and 1 flagella at the rear end. The optimum pH for its growth is 5.5-6.0, and the optimum temperature is 25-42°C. Can be transmitted through sexual contact or contaminated items, causing trichomonas vaginitis
u Detection principle: 1. Direct smear method: use normal saline hanging drop method to observe under high power microscope
2. After Wright or Glan staining, observe the insect body structure with an oil lens, which can improve the detection rate
3. Culture method and immunological method: such as latex agglutination test, monoclonal antibody inspection, enzyme-linked immunosorbent assay and polyclonal antibody latex agglutination method, etc.
39. Clinical significance of purulent leucorrhea and bloody leucorrhea
Variety
clinical significance
purulent
1. Yellow or yellow-green, smelly: trichomonal or purulent infection
2. Foamy purulence: trichomonas vaginitis
3. Others: chronic cervicitis, senile vaginitis, infantile vaginitis, amoebic vaginitis, endometritis, infection caused by pyometra and vaginal foreign bodies
Bloody
1. Bleeding: cervical polyps, uterine submucosal fibroids, senile vaginitis, severe chronic vaginitis, side effects of intrauterine devices, etc.
2. Bloody, with a special smell: malignant tumors (cervical cancer, uterine body cancer)
40. Formation of cerebrospinal fluid
u It is mainly actively secreted by the choroid plexus of the ventricle, and some cerebrospinal fluid can also be secreted by ependymal cells, and a small amount of cerebrospinal fluid is formed by vascular filtrate entering the subarachnoid space
41. Detection principle of total cell count in cerebrospinal fluid
u Instrument counting method: the body fluid cell analyzer can automatically analyze and count cells
u Microscopic counting method: 1. Relatively clear or slightly cloudy cerebrospinal fluid: Use a dropper to draw a little of the mixed cerebrospinal fluid sample, fill it into the blood cell counting board, let it stand for 2~3min, and count the four corners of the 2 counting chambers under a low-magnification microscope The number of cells in 10 large squares with the central large square, that is, the total number of cells per microliter of cerebrospinal fluid, and then converted into the total number of cells per liter of cerebrospinal fluid when reporting. 2. Too many cells, turbid or bloody cerebrospinal fluid: can be used The red blood cell diluent is diluted and then counted, and finally converted into the total number of cells per liter of cerebrospinal fluid
42. Application of cerebrospinal fluid examination in viral meningitis
u The cerebrospinal fluid is dominated by lymphocytosis, and neutropenia may also appear in the early stage, which is replaced by small and medium lymphocytes and activated lymphocytes with darker cytoplasmic staining within a few days. When the abnormal cells subside and the normal ratio of lymphocytes and monocytes reaches a normal ratio, it indicates that the condition has improved, otherwise it reflects the aggravation or recurrence of the condition. The protein is slightly increased, and the glucose and chloride are generally normal; those with increased AST activity in the cerebrospinal fluid have severe brain tissue damage and poor prognosis; specific IgM antibody detection can be used for early diagnosis
43. Clinical significance of increased protein content in cerebrospinal fluid
lesion
clinical significance
Inflammatory lesions of brain tissue
When the brain tissue is infected, the permeability of the capillaries of the meninges and choroid plexus increases, and albumin increases first, followed by globulin and fibrin
Radiculopathy
Such as obstructive hydrocephalus, Guillain-Barre syndrome, often protein-cell dissociation
spinal canal obstruction
The brain and the subarachnoid space are not connected to each other, the plasma protein leaks from the spinal vein, and the protein content in the cerebrospinal fluid increases significantly (sometimes up to 30-50g/L), such as spinal cord tumors, metastatic cancer, and adhesive arachnoiditis
other
The protein content in the cerebrospinal fluid of premature infants can reach 2g/L, and that of newborns is 0.8~1.0g/L, and it will gradually drop to normal levels after 2 months of birth.
44. Changes and clinical significance of cerebrospinal fluid glucose
Variety
clinical significance
reduce
1. For acute suppurative meningitis, tuberculous meningitis, and fungal meningitis, the lower the glucose content, the worse the prognosis
2. Brain tumors, especially malignant tumors
3. Neurosyphilis
4. Low blood sugar
increased
1. After a full meal or intravenous glucose injection, blood glucose levels increase
2. Cerebral hemorrhage
3. Acute trauma or poisoning affecting the brainstem
4. Diabetes
45. The clinical significance of elevated cerebrospinal fluid immunoglobulin
Immunoglobulin
clinical significance
IgG
Neurosyphilis, suppurative meningitis, tuberculous meningitis, viral meningitis, chorea, nervous system tumors, and multiple sclerosis
IgA
Purulent meningitis, tuberculous meningitis, viral meningitis, tumor, etc.
IgM
Purulent meningitis, viral meningitis, tumor, multiple sclerosis, etc.
IgE
brain parasites etc.
46. Clinical significance of determination of chloride in cerebrospinal fluid
u Reduced: 1. Bacterial meningitis and fungal meningitis early, tuberculous meningitis
2. Vomiting, adrenal insufficiency and kidney disease
3. When viral encephalitis, poliomyelitis, or brain tumors occur, the cerebrospinal fluid chloride burn decreases or does not decrease
u increased: uremia, dehydration, heart failure and serous meningitis, etc.
47. Formation of serous cavity effusion
type
The mechanism
transudate
Increased capillary hydrostatic pressure
Reduced plasma colloid osmotic pressure
Blocked lymphatic drainage
sodium and water retention
exudate
Microbial toxins, hypoxia, and inflammatory mediators
Increased vasoactive substances, cancer cell infiltration
trauma, chemical irritation
48. Collection, preservation and reception of serous cavity effusion specimens
u Specimen collection:
Serosal cavity effusion specimens were collected by clinicians through serosal cavity puncture, and the middle fluid was collected in sterile test tubes, and appropriate anticoagulants were used for anticoagulation as needed. In addition, collect 1 tube of specimen without anticoagulant to observe whether the effusion has coagulation phenomenon
u Save and receive:
1. Proper storage: Specimens should be checked in time after receipt. The routine and chemical examination of serous cavity effusion must be completed within 2 hours after collection, otherwise the specimen should be refrigerated. Specimens can be stored for 24 hours if cytology counts and differentials are performed
2. Pay attention to the logo (zhì): the logo of the specimen collection container should be consistent with the inspection application form
49. Clinical significance of lactate dehydrogenase (LD) and adenosine deaminase (ADA) examination in serous cavity effusion
LD：
The detection of effusion LD is mainly used to identify the nature of effusion. Exudate LD has the highest activity in purulent infection effusion, and its average value can reach 30 times that of normal serum, followed by malignant effusion, and tuberculous effusion is slightly higher than that of normal serum. serum. The LD of malignant pleural effusion is about 3.5 times that of autologous serum, while that of benign pleural effusion is about 2.5 times
ADA：
The detection of ADA in serosal effusion is mainly used to differentiate tuberculous and malignant effusion. The ADA of tuberculous effusion is significantly increased, and >40U/L should be considered as tuberculous. The specificity for the diagnosis of tuberculous pleural effusion reaches 99%. , Superior to methods such as tuberculin test, bacteriology and biopsy. ADA decreases when anti-tuberculosis drug treatment is effective, so it can be used as an observation index for the effect of anti-tuberculosis treatment
50. Laboratory identification of exudate and transudate
project
transudate
exudate
Etiology
non-inflammatory
Inflammatory trauma, tumor or physical and chemical stimulation
color
pale yellow
yellow, red, milky white
transparency
clear transparent or amber
cloudy or chylus
proportion
<1.015
>1.018
pH
>7.3
<7.3
Coagulation
Not easy to solidify
Easy to solidify
Rivalta test
Negative
Positive
Protein content (g/L)
<25
>30
effusion protein/serum protein
<0.5
>0.5
Glucose (mmol/L)
close to blood sugar level
<3.33
LD（U/L）
<200
>200
Effusion LD/serum LD
<0.6
>0.6
Total number of cells (×106/L)
<100
>500
nucleated cell sorting
Predominantly lymphocytes, mesothelial cells may be seen
Acute inflammation is dominated by neutrophils, chronic inflammation or malignant effusion is dominated by lymphocytes
tumor cells
none
may have
bacteria
none
may have
Review points of exfoliative cytology
1. What is the epithelial type of the endometrium? Squamous epithelium, secretory glandular epithelium, ciliated epithelium , mesothelial cells
2. What is the cytoplasmic color of the parakeratized squamous epithelium in the Pap stainer?
3. What are the characteristics of nuclear chromatin in prekeratinized cells? Meticulous and even
4. What kind of cells are generally used as the ruler for comparison with other cells in the smear? red blood cells
5. What structure is the well-differentiated adenocarcinoma arranged in? entity structure
6. What structures are poorly differentiated adenocarcinomas arranged in?
7. What are the main manifestations of virus-infected cells? multi-core
8. What are the advantages of Papanicolaou staining? Cell transparency is good, the structure is clear, and the smear is rich and bright in color. Because it can show the different degrees of keratinization of the squamous epithelium, it is often used in vaginal smears to determine estrogen levels. Poorly differentiated squamous cell carcinoma small keratinocytes in cervical smears and sputum smears are orange-yellow, especially prominent in the red necrotic background, so it is difficult to miss the diagnosis
This staining method not only has the characteristics of clear nuclear structure, clear color separation, good transparency, and bright cytoplasm, but also the stained specimen is not easy to decolorize and can be stored for a long time.
9. Which type of cancer are signet ring cancer cells usually seen in? well differentiated adenocarcinoma
10. Which kind of cancer are pleomorphic cancer cells usually found in? Well differentiated squamous cell carcinoma
11. Well differentiated squamous cell carcinoma is equivalent to which layer of cancer cells?
12. Malignant cells derived from epithelial cells are called? cancer cell
13. Briefly describe cancer cell clusters and their characteristics: In cancer cell clusters, the cells are of different sizes, arranged in disorder, losing polarity, squeezing each other, mosaic or stacked.
14. Which tumor is more sensitive to radiotherapy? Retinoblastoma, nasopharyngeal carcinoma, dysgerminoma in ovarian cancer, testicular seminoma, renal embryonal tumor, malignant lymphoma, etc.