2: Common Hematologic (Blood) Tests Flashcards
What are the basic components of the CBC?
WBC count WBC differential count RBC Count Hematocrit (Hct) Hemoglobin Mean Corpuscular Volume (MCV) Mean Corpuscular Hemoglobin (MCH) Mean Corpuscular Hemoglobin Concentration (MCHC) Red Cell Distribution Width (RCW) Platelet Count Mean Platelet Volume (MPV)
What is a CBC?
A complete blood count used as a broad screening test to check for such disorders as anemia, infection, and other disease.
-Panel of tests that examine different parts of the blood.
What is the WBC count? When can it be increased or decreased?
-Count of actual number of white blood cells per volume of blood.
- Increased w/ infections, inflammation, cancer, leukemia
- Decreased w/ some medications, bone marrow failure, chemotherapy, & congenital marrow aplasia (marrow doesn’t develop normally)
What is a WBC differential count?
% of each of the 5 major types of leukocytes
What are band neutrophils?
Immature neutrophils and are also apart of the WBC differential count.
What can significant increase in lymphocytes be associated with?
ACUTE or CHRONIC LYMPHOCYTIC LEUKEMIA
What is a Red Blood Cell Count? What are the effects when they are decreased and increased?
Count of actual number of RBCs per volume of blood.
- When decreased associated with ANEMIA
- When increased associated with Fluid loss due to DIARRHEA, DEHYDRATION, and BURNS
What is the Hemoglobin test?
Measures the amount of oxygen- carrying proteins in the blood
**Mirrors RBC count results
What is Hematocrit?
Measures the percentage of RBCs in a given volume of whole blood
**Mirrors RBC count results
What is Hemoglobin?
An iron containing protein found inside RBCs
-Carries oxygen & necessary for maintaining an oxygen-carrying capacity compatible w/ life.
Hemoglobin makes up ______________ of the mass of each red cell? Do men or women have a higher level?
1/3
Men have higher levels b/c they have more RBCs
Describe the globin subunits in hemoglobin
The 4 globin subunits (made of amino acids) are each complexed w/ an heme molecule, w/ IRON.
What causes Anemia?
A lack of iron due to poor diet or chronic blood loss
Why does Anemia lead to weakness and tiredness?
Les hemoglobin is available to carry oxygen to the tissues which may result in weakness and tiredness
What is the Mean Corpuscular volume (MCV)?
Measurement of the average size of RBCs
What is MACROCYTIC? What is an Example?
MCV is Elevated when RBCs are larger than normal.
Ex: In Anemia caused by vitamin B12 deficiency
What is MICROCYTIC? What is an Example?
When the MVC is decreased, RBCs are smaller than normal
Ex: Seen in iron deficient anemia or thalassemias
What is the Mean Corpuscle Hemoglobin? (MCH). How could the values increase or decrease?
The calculation of the average amount of oxygen-carrying hemoglobin inside a RBC.
- Macrocytic RBCs have a HIGHER MCH
- Microcytic RBCs habe a LOWER MCH
What is the Mean Corpuscular Hemoglobin MCHC? What can cause it to decrease or increase ?
Calculation of the average concentration of hemoglobin inside a red cell.
**Decreased MCHC with HYPOCHROMIA are seen in conditions where the hemoglobin is abnormally diluted inside the red cells. Seen with IRON DEFICIENCY ANEMIA & THALASSEMIA
**Increased MCHC values w/ HYPERCHROMIA seen in conditions where the hemoglobin is abnormally concentrated inside the red cells. Seen with Hereditary SPHEROCYTOSIS (rare congenital disorder)
What is the Red Cell Distribution Width (RDW) ?
Calculation of the variation in the size of RBCs.
***Normal range is 11-15% in RBCs
What is Anisocytosis? What is Poikilocytosis?
Anisocytosis= The amount of variation in RBC size like in pernicious anemia (increase in the RDW)
Poikilocytosis= The amount of variation in size and shape, causes an increase in RDW
What is the Platelet count ?
The number of platelets in a given volume of blood
-Both increases and decreases can point out abnormal conditions of excess bleeding or clotting
What is the Mean Platelet Volume (MPV) ?
When do you get an increase in MPV?
A machine- calculated measurement of the average size of platelets
***New platelets are larger, & increased MPV occurs when increased numbers of platelets are being produced
What is the function of platelets?
In conjunction w/ blood clotting cascade is to stop bleeding from injured small blood vessels as in cuts/abrasion by sticking together FORMING PLUGS.
What is thrombocytopenia?
Patients can bleed out easily & excessively. A variety of disease conditions can cause low numbers of platelets
What is CMP? When is CMP (Complete metabolic panel) ordered for?
- A panel of 14 individual blood tests
- Ordered as part of a history & physical examination, but can also be used to monitor a disease process or the effectiveness of treatment
- **Patient fasts for 10-12 hours before
What are the components of a CMP?
1) Sodium 2) Potassium 3) Calcium 4) Chloride 5) Carbon dioxide 6) Glucose 7) Blood Urea Nitrogen (BUN) Creatinine 8) Albumin 9) Total Protein 10) Total Bilirubin 11) Alkaline Phosphate (ALP) 12) Aspartate Aminotransferase (AST) 13) Alanine Aminotransferase (ALT)
What is Glucose ? What does measuring it do?
IT is a carbohydrate and major fuel for cells
-Measuring it determines if a patient is hyperglycemic or hypoglycemic
What is fasting hyperglycemia associated with?
Type 1 or Type 2 diabetes
What is some bodily needs for Sodium?
1) Regulation of plasma volume
2) Generation of nerve impulses
3) Generation of muscle contractions
4) Generation of glucose absorption in the small intestine
What is Hypernatremia & hyponatremia?
Imbalances of sodium
What are some of the needs the body ahas for potassium?
1) Generation of nerve impulses
2) Generation of muscle contractions
3) Acid base BALANCE
* ** good at maintaing our pH level
What is Hyperkalemia & Hypokalemia?
Potassium imbalances
What are some of the Needs the body has for calcium?
1) Muscle contraction
2) Cardiac function
3) Enzyme activation
4) Exocytosis of neurotransmitters
5) ESSENTIAL for Blood clotting ***
6) Normal bone & tooth architecture
Note: not soluble in the blood (half bound to albumin)
What is Hypercalcemia & Hypocalcemia represent?
Calcium imbalances
What are some needs the body has for chloride?
1) Acid-base balance
2) Facilitates action of certain neurotransmitters (GABA, glycine)
What is Albumin?
- A protein synthesized by the liver
- Used to determine nutritional status or to screen for LIVER/KIDNEY DISORDERS and other disease
What are the functions for Albumin/Total Protein
1) Maintenance of oncotic pressure
2) Transportation of thyroid hormones, fat-soluble hormones, “free” fatty acids, unconjugated bilirubin, many drugs
3) Competitively binds calcium ions (Ca++)
4) Maintenance of pH (acts as a buffer)
What is Creatinine? When is the level high?
- A waste product made in skeletal muscle and filtered by the KIDNEYS
- High when Kidneys fail to filter creatinine and level in blood increases
What is Blood Urea Nitrogen (BUN)
A measure of the amount of urea in the blood.
- Urea is a waster product made in the LIVER from ** AMINO ACID METABOLISM
- Similar to creatine it is filtered in the kidneys
When kidney problems or other conditions are suspected, serum Creatinine and what other test is ordered?
Blood Urea Nitrogen (BUN)
***Kidney should be filtering it!
Note: Changes in increase or decrease in blood can be seen
What is Alanine Aminotransferase (ALT)?
- An enzyme mainly found int he liver
- Involved in amino acid catabolism
What is Aspartate Aminotransferase (AST)?
- An enzyme found in the liver & few other places, particularly the heart & skeletal muscles
- Involved in amino acid catabolism
What is Alkaline Phosphatase (ALP)? What is it commonly associated with?
-An enzyme related to the BILE DUCTS
-Increased when they are blocked or inflamed
(When this occurs, ALP will overflow “like backed up sewer” and seep out of liver to bloodstream)
-Also found in BONE
When liver cells undergo necrosis (“go poof”) these ALP enzymes reflect what?
These enzymes are released into the blood and can reflect LIVER DAMAGE
What is Bilirubin?
A hydrophobic waste product from the metabolism of hemoglobin inside of RBCs
How long do RBCs live and what happens to them when they die?
- 90-120 days
- They are deteriorated structurally as they circulate in the bloodstream
Which 3 tissues are responsible for removing the deteriorating RBCs ? How is this done?
1) Liver
2) Spleen
3) bone marrow
**These tissues degrade the hemoglobin inside the RBCs & make BILIRUBIN (it is sent and processed by the liver)
How is Hemoglobin degraded?
Into Heme and Globin
***Heme is broken down into Biliverdin and Iron
(Biliverdin–>Bilirubin–>Bile–>Feces)
*Iron–> Storage –>Reuse–>Loss by menstruation, injury, etc.
***Globin–> Hydrolyzed to free amino acids
What is Carbon dioxide?
Waste produce from aerobic metabolism
What is a Lipid Panel (Profile)?
A complete cholesterol test, includes the measurement of 4 types of lipids in the blood.
1) LDL (Low-density lipoprotein cholesterol LDL-C
2) HDL (High-density lipoprotein cholesterol HDL-C
3) Triglycerides
4) Total Cholesterol
Why are cholesterol test done?
To help patients asses risk of coronary artery disease or other vascular disease in other parts of the body (e.g carotid–>stroke)
What are the sources of Cholesterol?
1) Endogenous Cholesterol (Made by the LIVER)
2) Exogenous Cholesterol (From the DIET)
What is LDL-C?
“BAD cholesterol”
- Associated w/ accumulation of fatty deposits (plaques) in the arteries
(arteriosclerosis) —>reduces blood flow - Plaques may rupture and cause heart & vascular problems
What are HDL-C’s?
- “GOOD cholesterol”
- Helps carry way cholesterol that cells don’t need back to the LIVER, keeping arteries open.
- Liver receives it and excretes it in the BILE
- *** HDL-C–> Deflated beach ball (high protein/fat ratio)
What three things can make Creatinine increase?
1) Kidneys not filtering it
2) Taking supplement (muscle builders)
3) Severely dehydrated
What is Stercobilin?
The brown pigment degradation product of heme in feces
What does elevated Triglycerides mean?
Shown to be associated with plaque formation & cardiovascular disease (but less strong when compared to LDL-C)
- **Normal range for serum triglycerides = 35-160 mg/dL
- **ABOVE this is = HYPERTRIGLYCERIDEMIA
What is the Erythrocyte Sedimentation Rate? (ESR)
- Easy,inexpensive & non-specific
- Tests that detects acute & chronic inflammation, infections, cancers, and autoimmune diseases.
Why is the ESR (Erythrocyte sedimentation rate) Non-Specific?
- Because results do not determine exactly where the inflammation is or what is causing it .
- Also can be affected by other conditions beside inflammation
- **used in conjunction with other tests
How is the EST test done?
- By placing anti-coagulated blood in a vertical tube allowing the RBCs to fall through the plasma under gravity
- *IT should drop only a few mm in an hour under NORMAL conditions
When is the Erythrocyte Sedimentation Rate highest?
The more RBCs that fall to the bottom of the tube in one hour the higher the ESR.
What is Rouleaux?
- When an inflammatory process is present, inflammatory mediators (made by the liver and immune sys) in blood causes RBCs to stack and stick to each other.
- **THIS ALLOWS THEM TO SETTLE FASTER TO THE BOTTOM OF THE TUBE
When does the rate of ESR increase?
-The rate increases in inflammatory diseases as seen in Westergren tubes…
What are some Inflammatory conditions often associated with Elevated ESR?
1) Temporal Arteritis (Chronic inflammation of the large arteries of the head)
2) Polymyalgia Rheumatica (Shoulder & pelvic joint stiffness)
3) Rheumatoid Arthritis
4) Systemic Lupus Erythematousus (SLE)
What is A1C test useful for?
***Most indicative of average blood glucose levels over the last 3-4 months !!!!
-Used not only to diagnose diabetes mellitus but to track the management of Diabetes Mellitus
When doing the A1C test, what is the correlation between glucose and RBCs ?
-It is normal for a certain % of glucose in the bloodstream to become attached to hemoglobin via glycation (4-6%)
- Once attached stays for the life of the RBC (90-120days).
- **The higher the level of blood glucose, the MORE glucose that attaches to RBCs.
What is Diabetes Mellitus?
Disorder of glucose metabolism in which insulin on body cells is inadequate because:
1) IMPAIRED insulin production by Beta cells of pancreas
2) Combination of impaired insulin secretion & RESISTANCE of target tissues to insulin’s actions (insulin resistance)
What are the long term implications of Diabetes?
-Chronic hyperglycemia is associated w/ long term damage, dysfunction & failure of EYES, KIDNEYS, HEART, NERVES, BLOOD VESSELS.
(Retinopathy, stroke, heart disease, autonomic neuropathy, peripheral neuropathy, & nephropathy )
What are the Criteria for the diagnosis of diabetes?
1) A1C test > 6.5 % **(increased risk)
2) FPG > 126 (fasting glucose) **(increased risk)
3) 2h plasma glucose > 200 **(increased risk)
4) Random plasma glucose test > 200 In a patient w/ classic symptoms of hyperglycemia
What is the C-Reactive Protein (CRP) ?
A protein produced in the liver & secreted into the blood and considered a “MARKER” for inflammation.
-presence indicates a heightened state of inflammation in the body !
What are CRP levels often associated with?
Levels of cardiac risk!
***Seems to be at least as predicative of cardiac risk as cholesterol levels
What are the ranges of CRP (C- reactive protein) correlated with high/low risk?
Less than 1.0 mg/L = LOW risk for CVD
1.0 - 2.9 mg/L = Intermediate risk
Greater than 3.0 mg/L HIGH risk for CVD
What is Periodontal Disease?
A chronic Bacterial infection of the tissue that support the teeth.
- Affects the gingiva, cementum, periodontal ligament and alveolar bone.
- **Major reason for TOOTH LOSS
What is the link between Periodontal Disease & Systemic Disease?
1) Periodontal disease is more severe & prevalent in patients w/ type 1 & 2 diabetes
2) Association between periodontal disease & atherosclerotic cardiovascular disease
Does periodontal disease increase the risk of developing cardiovascular disease? or is it the other way around ?
Probably a degree of BOTH
What are the recommendations for patients with periodontal disease?
Medical evaluations should include a lioid panel and blood glucose measurements (fasting & A1C)
**Plasma CRP determination should also be considered
If a patient has early periodontal disease. What kind of hematological data can be useful?
1) A1C
2) Plasma glucose
3) CRP
4) Lipid
What are example of Poikilocytosis RBCs?
1) Elliptocytes
2) Spherocytes
3) Sickle cell
4) Other
What are examples of Anisocytosis RBCs?
1) With Microcytosis- Iron deficiency, sickle cell
2) With Macrocytosis- Folate, Vitamin B12, Chronic liver disease
