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Lab Medicine > Blood > Flashcards

Blood Flashcards

1
Q

RBCs lifespan = ____ days

A

120

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2
Q

RBCs are removed by ________

A

macrophages of spleen, liver, and bone marrow

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3
Q

Which part of a RBC is recycled?

A

Iron in Hb

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4
Q

What is Hematopoiesis? What is formed?

A

Formation of blood or all types of blood cells
MUST KNOW EVERYTHING BELOW RED LINE IN PIC

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5
Q

Thrombocytes =

A

PLTs

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6
Q

Platelets are membrane bound cell fragments resulting from fragmented _______

A

Megakaryocytes

Red Bone Marrow -> Myeloid Stem Cell -> Megakaryocytes -> Platelets

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7
Q

Platelet formation is regulated by _____

A

Thrombopoietin

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8
Q

PLTs last for

A

8-10 days

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9
Q

Which 3 factors do PLTs secrete, causing local PLT aggregation, Vasoconstriction, and Blood coagulation?

A
  • Thromboxame A
  • Serotonin
  • Thromboplastin
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10
Q

Platelets:
- Clinically significant bleeding is usu <___K.
- Trauma or Sx = ____K

A
  • usu <10K
  • Trauma or Sx = 50K
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11
Q

List the abundance of Plasma Proteins from Greatest -> Least

A
  1. Albumin
  2. B-Globulin
  3. Y-Globulin (antibodies_)
  4. A2-Globulin
  5. Fibrinogen
  6. A1-Globulin
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12
Q

Causes of Erythrocythemia

A

Conditions CAUSING low O2
- Heart Dz (CHD, HF)
- Congenital hemoglobinopathies
- High Altitude
- COPD, lung DOs
- Sleep Apnea
- Smoking

Performance Enhancing Drugs
- Anabolic Steroids, EPO
- Blood Doping (transfusions)
- Kidney CA/Transplants (incr EPO)

Bone Marrow Overproduction
- Polycythemia Vera and Myeloproliferative DOs

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13
Q

Causes of Anemia (low RBCs)

A

Underproduction
- Iron deficiency (MC)
- Vit B12 / Folate Deficiency
- Bone Marrow Dz (Leukemia, Myelofibrosis)

Excessive Destruction
- Fragmentation d/t mechanical issues
- Sickle Cell Anemia
- Autoimmune hemolytic anemia
- Hereditary Spherocytosis

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14
Q

Hereditary Spherocytosis
- Inheritance pattern
- SS
- Tx

A
  • Autosomal Dominant
  • SS: pale, fatigue, hemolytic anemia, jaundice, gallstones, +/- big spleen, short stature, delayed puberty, skeletal abnormalities
  • Tx: Splenectomy, RBC transfusions, Folic acid supplementation, cholecystectomy
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15
Q

Removing which 2 organs are Tx options for Hereditary Spherocytosis

A

Spleen
Gallbladder

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16
Q

_____ Supplements may help Hereditary Spherocytosis

A

Folic Acid

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17
Q

Hereditary Spherocytosis inheritance pattern

A

Austosomal Dominant

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18
Q

Causes of HIGH and LOW Hgb/Hct

A
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19
Q

What causes a HIGH Reticulocyte Ct?

A
  • HEMOLYTIC ANEMIA
  • ACUTE BLOOD LOSS
  • Transfusions
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20
Q

Causes of LOW Retic Ct

A
  • APLASTIC ANEMIA
  • BONE MARROW SUPPRESSION (drug, toxin, virus)
  • Pure red cell aplasia
  • Bone marrow infiltration (leukemia, lymphoma, carcinoma)
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21
Q

Causes of Normal Retic Ct

A
  • IRON DEFICIENCY ANEMIA
  • ANEMIA OF CHRONIC DZ
  • CHRONIC RENAL FAILURE
  • Megaloblastic anemia
  • Myelodysplasia
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22
Q

List 3 hypochromic microcytic anemias

A
  • Iron deficiency anemia
  • Thalassemia
  • Anemia of chronic dz
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23
Q

Sources of error in manual cell counts

A
  • in wedge-pushed smears, WBCs tend to gather at the edges, so must scan entire slide
  • poor smear prep/stain
  • small sample size 100200 cells
  • CV is felt to be 5-10%
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24
Q

Normal HgB values
- Men?
- Women?
- Children?
- Newborn?

A
  • Men 13.5-17.5
  • Women 12-15.5
  • Children 11-13
  • Newborn 17-22

Highest in neonates
Lower in kids and women

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25
Q

HCT = ___X Hemoglobin

A

3

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26
Q

Norm HCT
- Men?
- Women?

A
  • Men 40-54%
  • Women 36-48%
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27
Q

Sickle cell trait vs Sickle cell disease?

A

Trait = 1 gene for sickle Hb
Disease = 2 genes for sickle Hb

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28
Q

What are the 4 major RBC indices?

A
  • MCV = Mean Corpuscular Volume (calculated)
  • MCH = Mean Corpuscular Hemoglobin (calculated)
  • MCHC = Mean Corpuscular Hemoglobin Concentration (calculated)
  • RDW = Red Cell distribution Width (Measured)
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29
Q

Poss reasons for a FALSE HIGH and LOW MCH

A

*False highs or lows d/t automated analyzer error *

FALSE HIGH
* High WBC >50K
* Suprisingly high Hgb with a “low” RBC Ct

FALSE LOW
- Suprisingly LOW Hgb with a “High” RBC ct

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30
Q

RBC Shape change =
RBC Size change =

A

shape change = Poikilocytosis
size change = anisocytosis

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31
Q

What DOs cause RBC agglutination

A
  • Cold hemagglutination Dz
  • Paroxysmal cold hemoglobinuria

NO WARM AGGLUTINATION

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32
Q

What causes Rouleaux RBCs?

A
  • Hyperproteinemias -> Multiple Myeloma, Waldenstrom’s macroglobulinemia
  • Chronic inflammatory DOz
  • some Lymphomas
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33
Q

Why is RDW valuable?

A
  • helps with anemia Dx
  • can be used to flag smalpes that may need peripheral smear exam

HIGH RDW is seen with red cell fragmentation, agglutination, or dimorphic cells

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34
Q

Causes of a HIGH MCHC

A
  • Incr Spherocytosis
  • Autoimmune Hemolytic Anemia
  • Homozygous Sickle Cell or Hgb C Dz
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35
Q

List which of the following causes HIGH vs LOW MCHC:
- Agglutination
- Clotted Sample
- HIGH WBC
- Hyperglycemia

A
  • HIGH MCHC = Aautoagglutination, Clotted sample
  • LOW MCHC = HIGH WBC, Hyperglycemia
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36
Q

RBC Ct are lower in which groups?

M? F? Peds?

A

Women
Children

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37
Q

Things are measured by the ______ method

A

Coulter

Sizing and counting particles is based on measurable changes in electrical impedance produced by nonconductive particles suspended in an electrolyte. A small opening (aperture) between electrodes is the sensing zone through which suspended particles pass.

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38
Q

RBC ct are measured at what unit

A

uL

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39
Q

Hyperchromia = MCHC >____%
- Causes?

A

36
- Hemolytic anemias d/t burns
- spherocytosis

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40
Q

Causes of Hypochromic anemia

A
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41
Q

Polychromatophile =

A

grey-blue in color and usu larger than the normal RBC

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42
Q

Polychromatophile Causes

A

Conditions with bone marrow stimulation
- Acute and chronic hemorrhage
- Recovery from a nutritional deficiency anemia

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43
Q

Causes of Target Cells (Codocytes)

A
  • Liver Dz (high bad cholesterol)
  • Hemoglobinpathies
  • Thalassemia

Incr in RBC surface membrane
Bell shaped in free flow
Excess membrane cholesterol and decr Hgb

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44
Q

Causes of Spherocytes

A
  • Hereditary Spherocytosis
  • Autoimmune hemolytic anemias and other
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45
Q

Causes of Stomatocytes

A
  • Hereditary stomatocytosis
  • Hemolytic anemias
  • Alcoholic cirrhosis
  • Acute alcoholism
  • Rh null Dz (mutation in the Rh30 and RhAg genes)
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46
Q

Causes of Ovalocytes

A
  • Myelodysplastic syndrome
  • Thalassemic syndromes
  • Megaloblastic process (Macrocyte)
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47
Q

Causes of Elliptocytes

A
  • Iron deficiency anemia
  • Hereditary Elliptocytosis
  • Idiopathic myelofibrosis
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48
Q

Are ovalocytes or Elliptocytes egg-shaped?

A

Ovalocytes = Egg shape
Elliptocytes = Pencil shape

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49
Q

Causes of true burr cells (echinocyes)

A
  • Uremia
  • Heart Dz
  • Stomach CA
50
Q

Hereditary cause for Acanthocytes

A

Abetaliprotenemia

51
Q

Causes of dacrocytes (tear drop cells)

A
  • Idiopathic myelofibrosis
  • Thalassemia
  • Drug-induced heinz-body formation
52
Q

Cause of Drepanocytes

A
  • polymerization of Hgb

crescent or sickled shaped cells . projections at ends

53
Q

Cause of blister cells

A
  • G6PD Deficiency
  • Oxidation or fragmentation injury
54
Q

Causes of Howell-Jolly Bodies

A
  • Splenectomy
  • Asplenia
  • Severe megaloblastic anemia
  • Severe hemolytic anemia
55
Q

Causes of Heinz bodies

A
  • G6PD deficiency
  • NADPH deficiency
  • Chronic Liver Dz
  • Alpha Thalassemia
  • Asplenism
56
Q

Causes of Pappenheimer Bodies

A
  • Splenectomy
  • Hemolytic Anemia
  • Sideroblastic Anemia
  • Megaloblastic Anemias
  • Hemoglobinopathies
57
Q

Causes of Cabot Rings

Looped rings within RBC cytoplasm
+/- “beads on a string”
Microtubular remnants of mitotic tubules from mitosis

A
  • Myelodysplastic Syndrome
  • Megaloblastic Anemia

abnormality in RBC prod

58
Q

What are the inclusions in these inclusion bodies?
- Howel-Jolly bodies?
- Heinz bodies?
- Pappenheimer bodies?
- Hgb H inclusions?
- Basophilic stippling?

A
  • Howel-Jolly bodies = DNA
  • Heinz bodies = Hgb
  • Pappenheimer bodies = Iron deposits
  • Hgb H inclusions = Hgb
  • Basophilic stippling = Ribosomes
59
Q

Which inclusion bodies are seen after post-splenectomy

A

Howell-Jolly bodies

60
Q

_______ cells are seen in G6PD deficiency and are cells in which a Heinz Body has been removed

A

Helmet

61
Q

Howell-Jolly bodies vs Heinz bodies

A
  • Howell-Jolly bodies are seen with supravital stain and can be found throughout the cell
  • Heinz bodies are basophilic, seen on Wright’s Stain smears, and are found at the periphery of the cell
62
Q

Causes of Basophilic Stippling
- Coarse?
- Fine?

accumulations of RNA and Ribosomes
AKA Puntate Basophilia

A

COARSE = Impaired Hgb synthesis
- Megaloblastic and other severe anemias
- Thalassemia
- Lead poisoning

FINE
- Incr RBC prod
- Incr polychromatophilia

63
Q

SS of PLT Associated Bleeding?

A
  • skin cut bleeding CAN be controlled by pressure
  • Spon bleeding into the skin (petechiae, purpura, ecchymoses)
  • Bleeding into mucus membranes (bloody nose, GI bleed, Intraretinal, Intracranial)
64
Q

____ is a contractile protein that is a major part of PLT cytoplasm

A

Thrombosthenin

65
Q

Do mammals have nucleated PLTs?

A

NO!!!
but other animals do

66
Q
  • Normal PLT Ct =
  • BAD = < ____ - ____ K
A
  • Norm = 150-350K per mm3 (uL) of blood
  • BAD = < 10-40K
67
Q
  • Old PLTs are destroyed by the _____
  • Extra PLTs are stored in the _____
A

SPLEEN (BOTH)

68
Q

3 As of Primary Hemostasis (PLT Plug)

A

Adhesion
Activation
Aggregration

69
Q
  • Arterial clotting is primarily done by _____
  • Venous clotting is primarily done by _____
A
  • Arterial = PLT
  • Venous = Fibrin
70
Q

Causes of Thrombocytopenia

(LOW PLT)

A
  • ITP -> idiopathic, drugs, Onyalai (acquired)
  • Familial Thrombocytopenia
  • Thrombotic Thrombocytopenic Purpura
  • HELPP Syndrome
  • HUS
  • Aplastic Anemia
  • Chemo
  • Transfusions
  • Hepatic Dysfn, Familial Nonhemolytic jaundice
  • Splenomegaly (Gaucher’s Dz)
  • Gilbert’s Syndrome
  • Babesiosis (tick parasite)
  • Dengue Virus (Mosquitos)
71
Q

Causes of Thrombo-cytosis/cythemia

HIGH PLT

A

Reactive
- Chronic Infx/Inflammation
- Malignancy
- Hyposplenism
- Iron Deficiency
- Acute blood loss

Myeloproliferative DOs
- Essential thrombocytosis
- Polycythemia Vera

Other myeloid neoplasms
Congenital

72
Q

Causes of Thrombocytopathy

Dysfunctional PLTs

A
73
Q

Drugs affecting PLT Fn

A
74
Q

Taking ____ before Aspirin will prevent the irreversible inhibition of cyclooxygenase-1

A

Ibuprofen

75
Q

2 NSAIDs that affect PLT Fn

A

Aspirin
Ibuprofen

76
Q
  • Drugs that SUPPRESS PLT Fn?
  • Drugs that STIMULATE PLT Fn
A

SUPPRESS
* Aspirin
* Clopidrogel
* Cilostazol
* Ticlopidine
* Ticagrelor
* Prasugrel

STIMULATE
- Thrombopoietin mimics
- Desmopressin
- Factor VIIa

77
Q

What is Samter’s Triad?

A

*** AERD = Aspirin-Exacerbated Respiratory Dz **
* Rhinosinusitis, Asthma
* NSAID Intolerance
* used to be known as Samter’s Triad
* ACQUIRED DO OF PLT ADHESION

78
Q

Which coagulation factors are known by name?

4 of them

A
  • Factor I = Fibrinogen
  • Factor II = Prothrombin
  • Factor III = Tissue Factor, Thromboplastin
  • Factor IV = Calcium
79
Q

PLT Ct Sources of ERROR

A
  • Both Automated and Manual Counts -> Improper collection, slightly clotted sample
  • Automated Counts -> PLT clumping, Presence of RBC fragments, Presence of Microcytes
  • Blood smear evaluation will reveal the presence of the problems causing issues in the automated count
80
Q

If PLT ct and bleeding time is NORMAL, what else could the cause of bleeding problem?

A

PLT Fn

bleeding time detects issues with vessel wall/SQ tissue

81
Q

PTT will NOT detect a factor ____ defect, bc it’s not in the intrinsic pathway

A

VII

82
Q

Bleeding tests
- PLT Ct
- Bleeding time
- PT/INR
- PTT
- +/- Factor ____ assays

A

XIII (13)

Stabilizes the fibrin mass
Deficiency -> unstbale clots
Fibrin dissolves into Urea W/O XIII

83
Q
  • ______ Anticoagulant throws off PTT data
  • ______ Anticoagulant throws off PT data
A

Lupus Anticoagulant = PTT wrong
Citrate Anticoagulant = PT wrong

84
Q

Which bleeding tests does Heparin interfere with?

A
  • PT
  • PTT
  • Thrombin Time
85
Q

Abnormal Bleeding Time may be d/t

A

thrombocytopenia

order a PLT Ct -> if norm -> prob is either vessel wall/SQ tissue issue or PLT Fn.
Order a bleeding time to determine if vessel wall/SQ tissue issue

86
Q

Normal Thrombin time

A

<22 sec (~ 14-16sec)

87
Q

Condition?
- PT: LONG
- PTT: Norm
- Thrombin Time: Norm
- PLT Ct: Norm

A
  • Factor VII
  • deficiency early oral anticoagulation
88
Q

Condition?
- PT: Norm
- PTT: LONG
- Thrombin Time: Norm
- PLT Ct: Norm

A
  • Circulating anticoagulants
  • VonWillebrand Dz
  • Factor VIII:C, IX, XI, XII deficiency
  • Perkallikrein
  • HMWK
89
Q

Condition?
- PT: LONG
- PTT: LONG
- Thrombin Time: Norm
- PLT Ct: Norm

A
  • Vit K Deficiency
  • Oral anticoagulant
  • FActor V, VII, X, II Deficiency
90
Q

Condition?
- PT: LONG
- PTT: LONG
- Thrombin Time: LONG
- PLT Ct: Norm

A
  • Fibrinogen defiicency
  • Liver Dz
  • Heparin
  • Hyperfibrinolysis
91
Q

Condition?
- PT: Norm
- PTT: Norm
- Thrombin Time: Norm
- PLT Ct: LOW

A

Thrombocytopenia

92
Q

Condition?
- PT: LONG
- PTT: LONG
- Thrombin Time: Norm
- PLT Ct: LOW

A
  • Liver Dz
  • Massive Transfusion
93
Q

Condition?
- PT: LONG
- PTT: LONG
- Thrombin Time: LONG
- PLT Ct: LOW

A
  • ACUTE Liver Dz
  • DIC
94
Q

Plasmin cleaves fibrin -> ______

Major degradation product

A

D-Dimer (Fibrin DDimer)

Norm Fibrin = <500 ng/mL
Norm D-Dimer = <250 ng/mL

95
Q

Clinical uses for D-Dimer

4 of them

A
  • DVT
  • PE
  • DIC
  • Primary Hyperfibrinolysis
96
Q
  • ____ out of 30 blood groups are considered clinically significant
  • List the grps
  • They are known to cause which 2 conditions?
A

**9 grps **
- ABO
- Rhesus (Rh)
- Kell
- Kidd
- Duffy
- MNS
- P
- Lewis
- Lutheran

2 Conditions
- Hemolytic Transfusion Rxns (HTR)
- Hemolytic Dz of the fetus and Newborn (HDFN)

97
Q

Is blood type O autosomal dominant or recessive?

A

RECESSIVE

AO = A phenotype
OO = O Phenotype

98
Q

AB grp blood
- antigens in RBC?
- Antibodies in plasma?

A
  • A & B antigens in RBC
  • NO Antibodies in plasma
99
Q

O grp blood
- Antigens in RBC?
- Antibodies in plasma?

A
  • NO antigens in RBC
  • A&B antibodies in plasma
100
Q

____ blood grp antibodies are the only ones present in blood prior to any rxn or exposure

A

ABO

101
Q

Hemolytic Dz of Fetus and Newborn (HDFN) is an autoimmune condition developing in a paripartum fetus when the ____ antibodies produced by mom crosses the placenta and attacks fetal RBCs

A

IgG

102
Q

In hemolytic dz of fetus and newborn, are there HIGH or LOW erythroblasts in the fetal blood?

A

HIGH = “Erythroblastosis Fetalis”

103
Q

Sickle Cell pts have HIGH levels of ____ antigens on their Sickles RBCs

A

Lu
(Lutheran blood grp)

104
Q

Blood Transfusion Indications

A
  • Acute blood loss >20% of blood vol
  • Hgb <8
  • Hgb <9 (Major Dz)
  • Hgb <10 (Autologous blood transfusion)
  • Hgb <11 (ventilator dependent)
105
Q

Hgb transfusion factors

A
  • Age and cardiovascular status
  • Anticipated additional blood loss
  • Arterial Oxygenation
  • Cardiac output
  • ## Oxygenation extraction ratio
106
Q

In antibody screens, which antibody is clinically significant?

IgM? IgG?

A

IgG

107
Q

Major vs Minor blood Crossmatch

A
  • Major = Donor Cell + Pt Serum
  • Minor = Pt cell + Donor serum/plasma
108
Q

a Major cross-match is basically a(n) _____ Coombs Test

Direct? Indirect?

A

INDIRECT

Donor cell + Pt serum

109
Q

The general rule is to transfuse RBC if Hgb <7. Does child with TOF and Hgb 8 with severe hypoxia need transfusion?

A

YES!!! Don’t be shy with the transfusions since they have TOF and severe hypoxia, regardless of the general Hgb level rule

110
Q

Who should be transfused first?
- A. Transfuse plasma in a pt with INR 1.7 that is taking an anticoagulant for an invasive procedure
- Child with TOF and Hgb 7

A

Child with TOF and Hgb 7

111
Q

Contraindications to Autologous blood donations

A
  • Infx, risk of sepsis
  • Scheduled Aortic Stenosis Sx
  • Active Sz DO
  • MI or CVA within 6mo
  • Significant Cardiac or pulm Dz
  • High grade LT main CAD
  • Cyanotic Heart Dz
  • Uncontrolled HTN
112
Q

Average blood volumes
- Preterm neonates?
- Full-term neonates?
- Infants?
- Adult M?
- Adult F?

A
  • Preterm neonates = 95 mL/kg
  • Full-term neonates = 85 mL/kg
  • Infants = 80 mL/kg
  • Adult M = 75 mL/kg
  • Adult F = 65 mL/kg

M are thicker than F and babies are thickest of all

113
Q
  • 1 unit RBCs = incr [hgb] ____g/dL = incr HCT ____%
  • 10mL/kg RBCs = incr [hgb] ___g/dL = incr HCT ____%
A
  • 1 unit RBCs = incr [hgb] 1 g/dL = incr HCT 3%
  • 10mL/kg RBCs = incr [hgb] 3 g/dL = incr HCT 10%
114
Q

If pt needs to incr HCT from 24% -> 30%, how many units of blood will need to be transfused?

A

2

1 unit blood = HCT incr 3%

115
Q

Plasma Transfusion Indications

A
  • INR >1.6
  • Emergent Warfarin Reversal
  • Acute DIC
  • Microvascular bleeding during massive transfusion (≥ 1 blood volume)
  • Replacement fluid for Apheresis in thrombotic microangiopathies
  • Hereditary angioedema
116
Q

PLT Transfusion Indications

A
117
Q

Always transfuse if neonate PLT Ct < _____

A

20

118
Q

Consider neonate PLT transfusion if PLT ct ___ - ____

A

20-30

119
Q

Indications for neonate PLT transfusion if PLT Ct 30-50 &….

A

low birth wt in 1st week

120
Q

When to transfuse cryoprecipitate

A
121
Q

Acute vs Delayed Transfusion Rxns

A
122
Q

It’s best to ______ if taking Aspirin and need elective Sx

A

Wait 1.5 weeks to do Sx for PLT levels to normalize

Lab Medicine (1 decks)

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