2. Common Hematologic (Blood) Tests Flashcards
2.5 What would increase white blood cell count?
May be increased with infections, inflammation, cancer, and leukemia
2.5 What would decrease a white blood cell count?
May decrease with some medications, bone marrow failure, chemotherapy, and congenital marrow aplasia
2.5 Which cells does a white blood cell count survey?
% of each of the 5 major types of leukocytes (neutrophils, eosinophils, basophils, monocytes, and lymphocytes)
And also band neutrophils (immature neutrophils)
2.5 Significant increases in particular types of cells in a white blood cell count can be associated with certain acute and/or chronic conditions. What is an example of this?
An increased number of lymphocytes is seen with acute or chronic lymphocytic leukemia.
2.7 What can increase and what can decrease a red blood cell count?
Decreased with anemia
Increased with excess production or fluid loss due to diarrhea, dehydration, and burns
2.7 What CBC count will the hemoglobin count mirror?
Hemoglobin count mirrors RBC count
2.7 What CBC count will the hematocrit mirror?
Hematocrit mirrors RBC count
- 9 Hemoglobin
- How much mass of a RBC is hemoglobin?
- Explain the weakness and tiredness of anemia in regards to hemoglobin
Hemoglobin make up one third of the mass of each red blood cell.
In anemia, less hemoglobin is available to carry oxygen to tissues, which results in weakness and tiredness.
2.10 What is MCV (Mean corpuscular volume) and what does it count?
Mean corpuscular volume
- Measurement of the average size of RBCs
2.10 What can cause an increase in Mean corpuscular volume (macrocytic RBC’s)?
Anemia caused by vitamin B12 deficiency can lead to RBC’s larger than normal
2.10 What can cause a decrease in Mean corpuscular volume (microcytic RBC’s)?
Anemia caused by iron deficiency or thalassemias (blood disorder resulting in abnormally small RBC’s)
2.12 What does Mean corpuscular hemoglobin measure?
Mean corpuscular hemoglobin (MCH)
- Calculation of the average amount of oxygen-carrying hemoglobin inside a RBC
2.12 What would increase Mean corpsucular hemoglobin and what would decrease Mean corpuscular hemoglobin?
Macrocytic RBC’s would tend to have a higher MCH
Microcytic RBC’s would tend to have a lower MCH
2.12 What does Mean corpuscular hemoglobin concentration measure?
Mean corpuscular hemoglobin concentration (MCHC)
- Calculation of the average concentration of hemoglobin inside a red blood cell
2.12 What would cause a decrease in Mean corpuscular hemoglobin concentration value?
Iron deficiency anemia and in thalassemia
- Conditions where hemoglobin are abnormally diluted inside the red cells
2.12 What would cause an increase in Mean corpuscular hemoglobin concentration value?
Burn patients and hereditary sphereocytosis
- Conditions where hemoglobin are abnormally concentrated inside red blood cells
- 14 What is Red cell distribution width?
- What’s normal value?
Calculation of the variation in the size of RBC’s
11-15%
2.14 What could increase Red cell distribution width?
Some anemias (like pernicious anemia)
- RBC’s will be of unequal size (anisocytosis)
- RBC’s will be of unequal shape (poikilocytosis)
2.15 What can increase or decrease platelet count?
Both increases and decreases can point to abnormal conditions of excess bleeding or clotting
2.15 What can cause an increased mean platelet volume?
(Measurement of the average size of platelets)
New platelets are large, so MPV can increase when platelets are being produced
2.16 What is the function of platelets?
To stop bleeding from injured small blood vessels as in cuts or abraision by sticking together and forming plugs.
2.16 What can decrease platelet count?
A variety of disease conditions can cause low numbers of platelets (such as thrombocytopenia). Some patients may also bleed more easily and excessively.
- 17 Describe the Comprehensive metabolic panel (CMP)
- Ordered for what occasions?
- How many blood tests?
- How long to fast?
CMP typically ordered for history & physical exam, but also to monitor a disease process or ongoing treatment effectiveness.
Panel of 14 individual blood tests
Patient fasts for 10-12 hours before blood drawn
2.18 Basic components of the Comprehensive Metabolic Panel (CMP)
Sodium, Potassium, Calcium, Chloride Carbon Dioxide Glucose Blood Urea Nitrogen (BUN) and Creatinine Albumin and Total Protein Total Bilirubin Alkaline Phosphatase (ALP), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT)
- 19 Glucose
- What kind of compound? Usage?
- Term for high glucose? Low glucose?
- What condition is associated with Type 1 or Type 2 diabetes mellitus?
Carbohydrate, used as major fuel source for cells
Hyperglycemia and hypoglycemia
Fasting hyperglycemia associated with Type 1 or Type 2 DM
2.20 Sodium
What are some of the bodily needs for Na+?
- Regulation of plasma volume
- Generation of nerve impulses
- Generation of muscle contractions
- Facilitation of glucose absorption in the small intestine
2.20 Sodium
What are the terms for high and low sodium imbalance?
Hypernatremia
Hyponatremia
2.21 Potassium
What are some of the bodily needs for K+?
- Generation of nerve impulses
- Generation of muscle contractions
- Acid-base balance
2.21 Potassium
What are the terms for high and low potassium imbalances?
Hyperkalemia and hypokalemia
2.22 Calcium
What are some bodily needs for calcium?
- Muscle contraction
- Cardiac function
- Enzyme activation
- Exocytosis of neurotransmitters
- Blood clotting
- Normal bone and tooth structure
2.22 Calcium
What are the terms for high and low calcium imbalances?
Hypercalcemia and hypocalcemia
2.23 Chloride
What are some bodily needs for chloride?
- Acid-base balance
2. Facilitates actions of certain neurotransmitters (GABA, glycine)
- 24 Albumin / Total Protein
- Where is Albumin synthesized in the body?
- Why is it tested for?
Albumin is a protein synthesized by the liver
Used to determine nutritional status or to screen for certain liver and kidney disorders as well as other diseases
- 24 Albumin / Total Protein
- Functions?
- Maintenance of oncotic pressure
- Transportation of thyroid hormones, fat-soluble hormones, “free” fatty acids, unconjugated bilirubin, many drugs
- Competitively binds calcium ions (Ca2+)
- Maintenance of pH (acts as a buffer)
- 25 Creatinine
- Made where?
- Presence of creatinine is a sign of what?
Made in skeletal muscles, filtered by the kidneys
The level of creatinine will increase when the kidneys fail to filter it out of circulation.
- 26 Blood Urea Nitrogen (BUN)
- Urea made where?
- Presence of high levels of urea a sign of what?
Urea made in the liver from amino acid metabolism
The levels of urea in blood will increase when the kidneys fail to filter it.
- 28 Alanine aminotransferase
- Found where
- Function
- High levels indicate what?
An enzyme mainly found in the liver
Involved in amino acid catabolism
High levels indicate liver damage
- 28 Aspartate aminotransferase (AST)
- Found where
- Function
- High levels indicate what?
An enzyme found in the liver and heart and skeletal muscles
Involved in amino acid catabolism
High levels indicate liver damage
- 28 Alkaline phosphatase (ALP)
- Found where
- High levels indicate what?
Enzyme related to bile ducts and also found in bone
High levels indicate liver damage and also blockage/inflammation of bile ducts
- 29 Total Bilirubin
- Waste product of what process?
Waste product of metabolism of hemoglobin
- 29 Total Bilirubin
- What three tisues involved in removing deteriorating RBCs from circulation?
- Where does all degraded bilirubin get sent to?
- What part of hemoglobin gets converted into bile?
Liver, spleen, and bone marrow
All degraded bilirubin gets sent to and processed by the liver
The heme segment without the iron is what is conerted into biliverdin, bilirubin, and then bile
- 30 Carbon Dioxide
- Waste product of what process?
Aerobic metabolism
2.31 What is a Lipid panel?
A complete cholesterol test
- Low-density lipoprotein (LDL)
- High-density lipoprotein (HDL)
- Triglycerides
- Total cholesterol
2.32 What is the purpose of a Lipid panel?
To assess a patient’s risk of coronary artery disease or risk of vascular disease in other parts of the body (e.g. carotid -> stroke)
2.34 What are the two main sources of cholesterol?
- The Liver (endogenous cholesterol)
2. The Diet (exogenous cholesterol)
2.36 What is high LDL-C associated with that has made LDL-C become portrayed as the “bad” cholesterol?
LDL-C is associated with the accumulation of fatty deposits (plaques) in the arteries (artherosclerosis), which reduces blood flow.
- The fatty deposits sometime rupture and lead to major heart and vascular problems.
2.37 Why is HDL-C considered the “good” cholesterol?
It helps carry away cholesterol that the cells don’t need back to the liver, thus keeping arteries and blood flowing more freely. When the liver receives the cholesterol, it typically excretes it in the bile.
2.39 What is elevated triglycerides associated with?
What is the term for high serum triglycerides?
Associated with plaque formation and cardiovascular disease, although less strongly so when compared to LDL-C
Hypertriglyceridemia
- 40 What is erythrocyte sedimentation rate (ESR)?
- What does it help detect?
It is an easy, inexpensive, non-specific test that helps detect conditions associated with:
- Acute and Chronic inflammation - including infections, cancers, and autoimmune diseases
2.40 Is erythrocyte sedimation rate (ESR) specific or non-specific?
It is a non-specific test as it doesn’t determine where is the inflammation or what the cause is. For this reason, ESR is typically used in conjunction with other tests.
2.41 How does Erythrocyte sedimentation rate (ESR) work?
Anticoagulated blood is placed in a narrow vertical tube and RBC’s fall through plasma via gravity.
Normally, RBC will only drop a few millimeters in an hour.
When an inflammatory process is present, inflammatory mediators will cause RBC’s to form rouleaux stacks and fall faster down the tube.
The farther down the RBC’s the higher the ESR
2.43 What are some inflammatory conditions often associated with elevated ESR?
- Temporal arteritis (chronic inflammation of large arteries of head
- Polymyalgia rheumatica (shoulder and pelvic joint stiffness)
- Rheumatoid arthritis
- Systemic Lupus Erythematosus (SLE)
- Many others
- 45 What is the A1C test used for?
- What time range is it reporting?
- What is normal range?
A1c is used not only to diagnose diabetes mellitus but also to track management of diabetes mellitus.
Hemoglobin A1C test is most indicative of average blood glucose levels over the past 3-4 months.
The higher the level of blood glucose, the more glucose that attaches to RBCs.
Normal range is 4-6%
- 46 Define diabetes mellitus
- Cause?
Diabetes mellitus is a disorder of glucose metabolism in which the action of insulin on body cells is inadequate.
Causes:
- Impaired insulin production by β-cells of pancreas
- A combo of impaired insulin secretion and resistance of target tissues to insulin’s actions (insulin resistance)
2.47 Chronic hyperglycemia of diabetes mellitus is associated with long-term damage, dysfunction, and failure of the:
- Eyes
- Kidneys
- Nerves
- Heart
- Blood vessels
2.51 C-Reactive Protein
Inflammation of the arteries is a risk factor for cardiovascular disease. It is linked to an increased risk of what conditions and diseases?
Heart disease, heart attack, sudden death, stroke, and peripheral arterial disease.
- 51 C-Reactive Protein (CRP; hs-CRP)
- Where is CRP produced?
- Regarded as a marker for heightened state?
- Similar to cholesterol in that it is predicative of what?
CRP is a protein produced in the liver and secreted into the blood.
Considered a marker for inflammation, meaning its presence indicates a heightened state of inflammation in the body.
CRP seems to be at least as predictive of cardiac risk as cholesterol levels.
- 51 C-Reactive Protein
- Less than 1.0 mg/L = what risk level
Low Risk for CVD
- 51 C-Reactive Protein
- 1.0 - 2.9 mg/L = what risk level
Intermediate risk for CVD
- 51 C-Reactive Protein
- Greater than 3.0 mg/L
High risk for CVD
2.53. What is periodontal disease?
Chronic bacterial infection of the tissues that support the teeth - gingiva, cementum, periodontal ligament, and alveolar bone
2.54. What are the two links between periodontal disease and systemic disease?
- Periodontal disease is more severe and prevalent in patients with type 1 and type 2 diabetes mellitus
- Appears to be an association between periodontal disease and atherosclerotic cardiovascular disease
2.55 What does the American Journal of Cardiology and the Journal of Periodontology recommend that medical evaluations of patients with periodontal disease should have?
Lipid panel and blood glucose measurements (fasting and A1C)
A plasma hs-CRP determination should also be considered.
