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clinical lab > basic examination of blood and bone marrow . Lab assessment > Flashcards

basic examination of blood and bone marrow . Lab assessment Flashcards

1
Q

every study and clinical examination of a patient starts with what ?

A

full blood count

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2
Q

what is haemoglobin made of ?

A

it is tetramere made out of 2 pairs of polypeptide chain , echo four polypeptide chain containing a heme group

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3
Q

what is the hemoglobincyanide method ?

A

hemoglobin is oxidised into cyanmethemoglobin by the addition of cyanide
cyanmethemoglobin is there determined by spectrophotometry at 540nm

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4
Q

what are the haemoglobin types ?

A

Hbf
HbA
HbA2
methemoglobin , sulfhemoglobin ,carboxyhemoglobin

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5
Q

what is HbF?

A

made out of the alpha globulin and to gamma globulin
it is in fetuses
until the 18th month it changes to HbA

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6
Q

HbF is raised in adults due to what condition?

A

sickle cell anaemia , thalassemia

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7
Q

what is HbA ?

A

composed of two alpha globulins and two beta globulins.

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8
Q

what is the HbA2?

A

made out of alpha globulins and delta globulins - it is a NORMAL type of haemoglobin found in small concentration in adults

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9
Q

how do individuals obtain methemoglobin ?

A

due to exposure of drugs and chemicals
which oxidise HbO2
these include nitrates , chlorates , and quinones

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10
Q

what is hematocrit ?

A

the ratio or volume of erythrocytes to the whole volume of blood , reflect the concentration of red blood cells and not the total mass

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11
Q

what happens to the hematocit levels of blood keep at room temperature between 6-24 hours ?

A

the rbc swells raining the hct and Mcv

only stable at room temperature for 4 degrees

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12
Q

how do you measure the hematocrit ?

A

centrifugation micro method and macro method

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13
Q

when is hematocrit low ?

A

in pregnancy , but total number of RBC not reduced

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14
Q

when is the hct high ?

A

high or normal in shock - hemoconcentration increases - due to blood loss

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15
Q

when is hct unreliable as an estimate of anaemia ?

A

after blood loss

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16
Q

what is the unit for mean cell volume? and what does it calculate ?

A

average volume of red blood cells
fl - femtolitres
mcv- hct x 1000/rbc

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17
Q

what is MCH?

A

it is mean cell haemoglobin
the weight of haemoglobin in an AVERAGE red blood cell

expressed in PICOGRAMS (pg)

MCH = hb/ erys

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18
Q

what is the MCHC?

A

mean cell haemoglobin concentration
avergae concentration of hb in a GIVEN volume of packed red cells
calculated in g/l

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19
Q

what is RDW?

A

the red cell distribution width - cell diameter distribution

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20
Q

normal erythrocyte morphology correlates with what curve in RDW?

A

price jones curve for cell diameter distribution

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21
Q

discrpincies in RDW is an indication of what ?

A

microspherocytes - small cells with light central pallor

22
Q

what staining is used for red blood cel counting manually ?

A

giemsa - stained red

new methylene blue - stained blue

23
Q

what are the non manual ways for red blood cell counting ?

A

radio frequency conductivity
light scattering
cytochemical reaction

coulter principle -
cell pass through an opening in which a current is flowing spices an equal volume of conductive fluid
increasing the electrical resistance changes and creating a voltage pulse
these pulses are proportional in height to the volume of the cells

the cells are in an isotonic conductive suspension which preserves the cells shape

24
Q

what is radiofreuency conductivity and what is it used for ?

A

a high frequency electromagnetic probe providing the cells internal information - granular composition in cytoplasm , nuclear characteristics

helpful in differentiating between cells of the same size - small lymphocytes and basophils

25
what is light scattering what is it used for?
light sensitive detector measures light scattering the size of the pulse detected proportionate to the size of the particle
26
what is cytochemical reaction?
determine the peroxidase activity in white blood cells mean peroxidase index a measure neutrophil staining intensity. the relative positivity seen in neutrophils eosinophils and monocytes used in conjunction with data derived from light scattering
27
what is a non specific marker for inflammation ?
erythrocyte sedimentation rate- increase in ra , chronic infections , neoplastic diseases monitoring disease activity normal ESR cannot exclude that a patient does not have inflammation or infection c reactive protein
28
micro ESR has a greater utility in what type of patients ?
in pediatric patients
29
in patient with known cancer is the ESR is above 100 mm/hr WHAT does it mean?
metastasis has occurred
30
ESR is particularly useful n monitoring which disease ?
polymyalagia rheumatica and temporal arteritis | septic arthritis and pelvic inflammatory diseases and appendicitis
31
what are the bone marrow examination indications ?
abnormal peripheral blood stain anemia neutropnea , thrombocytopnea , pancytopnea paraprotein for staging - lymphoma therapy response - leukaemia , multiple myeloma , lymphoma
32
marrow films are stained with what type of staining method ?
wright giemsa | longer staining time needed with marrows that have a high
33
in bone marrow examination what are you looking for ?
cellularity of the marrow distribution of mature cells presence of rare cell types abnormal cells number of megakarocytes proportion of sideroblasts , estimate of iron stored
34
what are the complains of an anaemic patient ?
easy fatigue dyspnea on exertion vertigo signs - pallor , rapid bouncing pulse , low bp
35
what is the morphology of iron deficiency anaemia ?
hyochromic microcytic anemia | MCV AND MCH REDUCED
36
children between what ages are susceptible to iron deficiency anaemia ?
6-24 months | insuff dietary iron to meet the demands of rapid growth because after 4-6 months the ironstones have been exhausted
37
iron def in adults occur because ?
gastroectomy prolonged treatment of peptic ulcer and acid reflux - defect in iron absorption sprue syndrome hemorrhagic lesion due to benign and malignant tumors chronic gastritis - helicobacter pylori
38
all cases of iron deficiency anaemia in males are due to chronic blood loss , why ?
his body iron stores can last up to 3-4 years with no iron intake
39
in iron deficiency anaemia of chronic cases what does the cells look like ?
microcytosis , anisocytosis (unequal size) , poikilocytosis (uneven shape cannot be found in full blood count -not in RDW) - including elliptical and elongated cells
40
what are other changes in iron deficiency anaemia
reticulocytes decreased in absolute numbers lukocyte normal or slightly lowered grnaulocytopnea and small amount of hypersegmneted neutrophils Platelets increased if loss of iron is due to blood loss
41
what re other lab measurements of iron in blood
serum iron the level is lower in iron deficiency and in infection , and anaemia of chronic disease total serum iron binding capacity in iron deficenciny anaemia it is increased in anaemia of chronic disease is normal or decreased when there is iron deficiency area and chronic infection then its normal percent saturation of total iron binding capacity the ratio of serum iron to TIBC normal 20-55 percent below 15 indicate iron deficient erythropoiesis serum ferritin is low - it is also acute phase reactant iron deficiency anaemia - ncreased serum levels of TfRs.
42
iron deficiency anaemia management
Ferrous iron is given orally reticulocyte count will reach a maximum at 5–10 days, then will gradually decrease toward normal. After the Hb has returned to normal, iron therapy should be continued for at least 2 months to replenish storage iron.
43
macrocyti anaemia which is not megaloblastic is due to
early release of erythrocytes from the marrow, so-called shift reticulocytes- response to acute blood loss, hemolysis, bone marrow infiltration, and high levels of EPO associated with bone marrow failure diseases - aplastic anemia, refractory anemia, and Diamond-Blackfan anemia hypothyroidism with excessive alcohol intake, liver disease
44
how does Macrocytic anemias associated with megaloblastosis differ from nonmegaloblastic macrocytic anemia
megaloblastic anemia : macroovalocytes and giant hypersegmented neutrophils are present in the blood enlargement of all rapidly proliferating cells - with retarded nuclear maturation sometimes giant metamyelocytes most charecteristic megakaryocytic too - large and separated nuclei globules PANCYTOPNEA is a rule micorcytes and dacrocytes howell jolly bodies- the nuclei undergo karryorhexis readily basophilic stippling, nucleated red cells with karyorrhexis anisocytosis and poikilocytosis leukopnea increased lobes in granulocytes
45
what can cause megaloblastic anemia?
anti parietal cell antibodies anti intrisc factor antbodies folic acid deficiency vitb12 deficicny
46
what is anaemia of chronic disease ?
an anemia syndrome - found in patients with chronic infections or inflammatory or neoplastic disorders characterised by reduced reticulocyte response accompanied by low serum iron despite adequate iron stores
47
what causes normocytic normochromic anaemia ?
non hemolytic - anaemia of chronic disease nephritic syndrome - kidney disease hemolytic - malaria sickle cell anaemia autoimune - SLE
48
in anaemia of chronic disease what is reduced?
the serum iron concentration is decreased TIBC is decreased or normal - in iron deficiency anaemia the TIBC is elevated erythrocyte protoporhyrin and serum ferritin increased Epo levels above normal hepcidin increased - through induction of IL-6 considered an acute phase reactant hepcidin interferes with the release of intracellular iron
49
does chronic disease anemia fail to respond to iron therapy ?
yes , but patients treated with EPO has shown improvement
50
microcytic anemia in ?
T - thalaemia A - anaemia of chronic disease I - iron deff L - lead

clinical lab (9 decks)

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