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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
Q

what is light scattering what is it used for?

A

light sensitive detector measures light scattering

the size of the pulse detected proportionate to the size of the particle

26
Q

what is cytochemical reaction?

A

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
Q

what is a non specific marker for inflammation ?

A

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
Q

micro ESR has a greater utility in what type of patients ?

A

in pediatric patients

29
Q

in patient with known cancer is the ESR is above 100 mm/hr WHAT does it mean?

A

metastasis has occurred

30
Q

ESR is particularly useful n monitoring which disease ?

A

polymyalagia rheumatica and temporal arteritis

septic arthritis and pelvic inflammatory diseases and appendicitis

31
Q

what are the bone marrow examination indications ?

A

abnormal peripheral blood stain
anemia
neutropnea , thrombocytopnea , pancytopnea
paraprotein

for staging - lymphoma

therapy response - leukaemia , multiple myeloma , lymphoma

32
Q

marrow films are stained with what type of staining method ?

A

wright giemsa

longer staining time needed with marrows that have a high

33
Q

in bone marrow examination what are you looking for ?

A

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
Q

what are the complains of an anaemic patient ?

A

easy fatigue
dyspnea on exertion
vertigo

signs - pallor , rapid bouncing pulse , low bp

35
Q

what is the morphology of iron deficiency anaemia ?

A

hyochromic microcytic anemia

MCV AND MCH REDUCED

36
Q

children between what ages are susceptible to iron deficiency anaemia ?

A

6-24 months

insuff dietary iron to meet the demands of rapid growth because after 4-6 months the ironstones have been exhausted

37
Q

iron def in adults occur because ?

A

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
Q

all cases of iron deficiency anaemia in males are due to chronic blood loss , why ?

A

his body iron stores can last up to 3-4 years with no iron intake

39
Q

in iron deficiency anaemia of chronic cases what does the cells look like ?

A

microcytosis , anisocytosis (unequal size) , poikilocytosis (uneven shape cannot be found in full blood count -not in RDW) - including elliptical and elongated cells

40
Q

what are other changes in iron deficiency anaemia

A

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
Q

what re other lab measurements of iron in blood

A

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
Q

iron deficiency anaemia management

A

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
Q

macrocyti anaemia which is not megaloblastic is due to

A

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
Q

how does Macrocytic anemias associated with megaloblastosis differ from nonmegaloblastic macrocytic anemia

A

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
Q

what can cause megaloblastic anemia?

A

anti parietal cell antibodies
anti intrisc factor antbodies
folic acid deficiency
vitb12 deficicny

46
Q

what is anaemia of chronic disease ?

A

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
Q

what causes normocytic normochromic anaemia ?

A

non hemolytic - anaemia of chronic disease
nephritic syndrome - kidney disease

hemolytic - malaria
sickle cell anaemia
autoimune - SLE

48
Q

in anaemia of chronic disease what is reduced?

A

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
Q

does chronic disease anemia fail to respond to iron therapy ?

A

yes , but patients treated with EPO has shown improvement

50
Q

microcytic anemia in ?

A

T - thalaemia
A - anaemia of chronic disease
I - iron deff
L - lead

clinical lab (9 decks)

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