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Clinical Patient Care 2023 > Additonal Testing > Flashcards

Additonal Testing Flashcards

1
Q

What happens when there is a folate or vitamin B12 deficiency

A
  1. RBC that are formed are large
    *megaloblastic or macrocyclic anemia
  2. WBCs are giant and segmented neutrophils
  3. Platelets are large and uncleated
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2
Q

What are the characteristics of a megaloblastic anemia cell

A
  1. Large red blood cells
  2. Hypersegmented neutrophil
    *have six or more nuclear segments
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3
Q

What does a serum folate test for?

A
  1. Quantifies the folate level in the blood
  2. Ordered in patients with megaloblastic anemia
  3. Used to assess nutritional status in alcoholics
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4
Q

What is folate

A
  1. Vitamin B9
  2. Cellular uptake of folate requires vitamin B12
    *b12 will convert inactive folate to active form
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5
Q

What is folate needed for?

A
  1. Normal function of RBC and WBC
  2. Needed for production of certain purines and pyrimidines
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6
Q

How is folate obtained

A
  1. Obtained form green leafy vegetables, fruits, supplemental cereals and beef
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7
Q

What are the labs of folate deficiency

A
  1. Megaloblastic anemia (hypersegmented neutrophils)
  2. High MCV
  3. High RDW
  4. Howell-Jolly bodies
  5. Low folate levels
  6. Low RBC folate less than 150 no/mL is diagnostic
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8
Q

What causes increased serum folate levels

A
  1. Pernicious anemia
    *inadequate amount of B12 to chemically change folic acid from inactive to active form, will cause levels of folate to rise
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9
Q

What causes decreased serum folate levels

A
  1. Malnutrition
    *MC
  2. Malabsorption
  3. Pregnancy
  4. Liver disease
  5. Renal disease
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10
Q

What drugs are folate antagonist and what does that mean

A
  1. Methotrexate
  2. Antimalarials
  3. Anticonvulsants
    *will interfere with conversion of inactive folate to active for
    *need to be on a supplement of folic acid 1mg daily
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11
Q

What does RBC folate test?

A
  1. Measures the folate in the RBC
    *folate is more concentrated in RBC than serum
    *RBC folate more closely reflect tissue stores
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12
Q

What is the most reliable indicator of folate status

A

RBC folate tests
*when used after screening serum folate
*more expensive, less available, time consuming = rarely ordered

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13
Q

What is the methylmalonic acid MMA test

A
  1. Direct measure of tissue B12 activity
  2. Helps diagnose early or mild B12 deficiency when B12 levels on low end of normal
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14
Q

When can MMA test be ordered (patient population)

A
  1. In asymptomatic adults at high risk or those taking certain drugs (metformin)
  2. Confirmatory test of choice for B12 deficiency
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15
Q

If there if not enough B12 available what happens to the MMA concentration

A

MMA concentration begins to rise
*elevated MMA indicated B12 deficiency. Normal in folate deficiency

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16
Q

what will cause elevated levels of homocysteine levels (HCY)

A

Deficiency in folate (B9), B12, or B6
*elevated HCY = 5x increase risk for stroke, dementia and atherosclerosis

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17
Q

What are homocysteine levels used for

A
  1. Detection and surveillance of malnutrition, CVD risk
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18
Q

What does AHA recommend the HCY levels to be

A

HCY can be useful for mactrocytosis if B12 and folate are borderline
1. Level of 9 or less
2. Greater than 15 is high risk for CVD

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19
Q

How to interpret the MMA and HCY levels

A
  1. MMA and HCY levels high, B12 borderline = mild B12 deficiency
  2. MMA normal HCY elevated = folate def
  3. MMA and HCY normal = unlikely B12 or folate def
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20
Q

What is methylenetetrahydrofolate reductase deficiency (MTHFR)

A
  1. Most common genetic cause of elevated HCY in the plasma
    *leads to to increase risk of venous thrombosis, CHD
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21
Q

Where is Vitamin B12 found

A
  1. Liver, muscle, eggs, dairy, and seafood (animal by products)
22
Q

What causes increased vitamin B12 levels

A
  1. Leukemia
  2. Polycythemia Vera
  3. Severe liver disease
  4. Myeloproliferative disease
23
Q

What is the main cause of decreased vitamin B12 levels

A
  1. Pernicious anemia (intrinsic factor deficiency)
    *can’t absorb B12
24
Q

With the different folate and vitamin b12 tests what will be elevated, normal or low

A

Serum vitamin B12
1. Low (B12)
2. Normal (folate)
Serum folate
1. Normal (B12)
2. Low (folate)
RBC folate
1. Normal to low (B12)
2. Low (folate)
MMA
1. High (B12)
2. Normal (folate)
HCY
1. High (B12)
2. High (Folate)

25
Q

What information can a peripheral smear show?

A
  1. CBC asses for RBC, WBC, and platelets
  2. RBC indices help categorize anemias
  3. Peripheral smear provides window into functional status of bone marrow
26
Q

What is Rouleaux formation

A
  1. Abnormal RBC function due to elevated levels of plasma proteins
  2. RBC stick together like a stack of coins
  3. Seen in plasma cell myeloma
27
Q

When are spherocytes found (small and perfectly round RBC)

A
  1. Hereditary spherocytosis
  2. Acquired immunohemolytic anemia
28
Q

When are elliptocytes (crescent) found

A
  1. Hereditary elliptocytosis
  2. IDA
29
Q

When are fragmented RBC found (schistocytes, helmet cells)

A

Destruction within vascular spaces

30
Q

When are echinocytes (Burr cell) found

A

Burr cells are RBC with numerous, small, evenly spaced projections due to abnormal cell membranes
1. Uremia
2. Liver disease
3. Pyruvate kinase def

31
Q

When are bite cells found

A

Bite cells show a bite like deformity from phagocyte removal of denatured Hgb
1. G6PD def
2. Thalassemia
*looks like pac-man

32
Q

When are codocytes (Target cells) found

A

Targets cells of RBC with a dark bullseye center
1. IDA
2. Liver disease
3. Thalassemia

33
Q

When are hypochromic and hyperchromasia RBC found

A

Hypo
1. IDA
2. Thalassemia
Hyper
1. Hereditary spherocytosis

34
Q

When are nucleated (normoblasts) found

A
  1. Anemia
  2. Chronic hypoxia
  3. Normal for an infant
35
Q

What is basophilic stippling and when is that found

A

Refers to bodies enclosed or included in the cytoplasm of RBC
1. Sideroblastic anemai
2. Lead and heavy metal poisoning (arsenic)

36
Q

What are Howell jolly bodies and when are they found

A

Small, round remnants of nuclear material remaining within theRBC, usually removed by the spleen
1. Hemolytic anemia
2. Megaloblastic anemia
3. Functional asplenia (after splenic infarction)

37
Q

What are Heinz bodies and when are they found

A

Clumps of denatured Hbg attached to RBC
1. Seen with progressive oxidative injury in G6PD
2. Thalassemia
3. Chronic liver disease
*splenic macrophages will attack these cells and cause hemolysis

38
Q

What does methemoglobin test for

A
  1. Measures the amount of excess methmoglobin that can accumulate
  2. High level cause cyanosis and hypoxia
39
Q

What does carboxyhemoglobin test for

A
  1. Use to detect carbon monoxide poisoning
  2. > 20% is critical
  3. Specimens should be drawn ASAP, bc carbon monoxide can be rapidly cleared from Hgb by breathing normal air
40
Q

What are the normal ranges of carboxygemoglobin

A

Non-smoker <3%
Light Smoker 2-5%
Heavy smoker 5-10%
Newborn>12%

41
Q

When can a carboxyhemoglobin test be used

A
  1. To evaluate patients with headache, irritability, nausea, vomiting and vertigo
  2. Used in patients that were exposed to smoke
42
Q

When is sickle cell screen used

A
  1. Newborn screen
  2. Used to screen for the sickle cell disease or trait
43
Q

What does hemoglobin electrophoresis test for

A
  1. The test will detected abnormal forms of Hgb to be quantified
  2. Used to diagnose sickle cell anemia, thalassemia and ther hemoglobinopathies
44
Q

What does fetal Hgb and adult Hgb have

A

Fetal
1. 2 alpha
2. 2 gamma globin chain
Adult
1. 2 alpha
2. 2 beta globin chain

45
Q

Where does hematopoiesis occur in fetuses

A
  1. Spleen
    *after conversation to adult hemoglobin, hematopoiesis occurs in the bone marrow
46
Q

What are some factors to sickle cell screen

A
  1. Blood transfusions (3 to 4 months)
  2. Polycythemia Vera
  3. Infants less than 3 months (may have false negative results)
47
Q

What does erythrocyte fragility test for

A
  1. To detect hereditary spherocytosis and thalassemia
    *spherocytes have increased OF compared to normal RBC
48
Q

What is the Coombs test used for

A
  1. To identify immune hemolysis or to investigate hemolytic transfusion reactions
  2. Can determine if the patient is anemia due to autoimmune issue or drug reaction
49
Q

What does a direct Coombs test for

A
  1. Demonstrates RBC have been attacked by antibodies in the bloodstream
    *only on patients blood
    *serum is added and will clump if antibodies are present (+ result)
50
Q

What does indirect Coombs test for

A
  1. Detects minor serum antibodies prior to receiving a blood transfusion
    *recipient serum is added to donor RBC, then performed Coombs
    *if agglutination occurs recipient has antibodies to the donors RBCs (blood cannot used in that recipient)

Clinical Patient Care 2023 (33 decks)

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