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Blood Flashcards

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1
Q

Hematopoiesis

A

Hematopoietic stem cells are multipotent and can differentiate into all 10 cell lineages→ erythrocytes, platelets, neutrophils, eosinophils, basophils, monocytes, T and B lymphocytes, natural killer cells, and dendritic cells.

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2
Q

Cost-effectiveness-CBC

A

Expense : Low*
High yield of information for cost involved
* higher $$ if admitted in hospital

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3
Q

CBC overview

A

one of the most important laboratory tests used
Part of routine medical exam (physical), or if you are evaluating infection, inflammation, or a neoplastic process.
CBC= WBC, RBC and platelets

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4
Q

Anemia

A

not enough RBC –> less Hb –> less iron–> iron deficient

If you suspect anemia, order a CBC

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5
Q

Iron-deficiency anemia

A

Most common, decreased iron in body, can be caused by blood loss, pregnancy, poor diet, gastric bypass

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6
Q

Vitamin-deficiency anemia

A

low levels of vitamin B12 or folate from poor diet, vitamins required for erythropoiesis

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7
Q

Aplastic anemia

A

rare, results when body stops erythropoiesis, results from chemicals, drugs, autoimmune causes

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8
Q

Hemolytic anemia

A

destruction of RBCs resulting from multiple causes, inherited, infection

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9
Q

Anemia of chronic disease

A

occurs in the presence of multiple chronic conditions, results from decreased RBC production by bone marrow, chronic inflammatory and neoplastic states that impair RBC production

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10
Q

Sideroblastic anemia

A

multiple causes, bone marrow produces abnormal RBCs which prevent iron from being incorporating in hemoglobin

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11
Q

Thalassemia

A

Body produces abnormal alpha or beta chain of hemoglobin, genetic- middle eastern origin especially

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12
Q

WBC normal

A

NORMAL = 4.5-11.0 x 10^3/uL

4,500-11,000

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13
Q

WBC

A

Refers to the total WBC count and includes all WBCs together (monocyte, lymphocyte and the “three phials”).

The white blood cell, also called a leukocyte, is responsible for fighting off infection and disease.

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14
Q

Leukocytosis

A

elevated WBC count
Due to:

Infections- MOSTLY BACTERIAL

Certain medications → Corticosteroids

Smokers

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15
Q

Leukopenia

A

decreased WBC count
Due to:
Infections- VIRAL, parasitic, some bacterial

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16
Q

Neutrophils

A

the majority of mature WBCs are Neutrophils (60%!) so a change in WBC is generally a good reflection of neutrophil change.
Therefore these terms are used interchangeably:
Leukocytosis = neutrophilia
Leukopenia = neutropenia

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17
Q

Granulocytosis

A

leukocytosis due to increased numbers of neutrophils, eosinophils, or less commonly, basophils
increase in any of the Phils!

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18
Q

Neutrophil normal

A

On a CBC w/differential
NORMAL = 50-70% of WBCs
Normal absolute neutrophil ≈1.8-7.8 x 10^3/uL
1,800- 7,800

Example: 	WBC count 6,000 
		Segs = 30%
		Bands = 3%
		Total = 33%
So, ANC = 6,000 x 33% = 2,000 or 2.0 x 103 
This is within normal range.
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19
Q

Severe neutropenia

A

500 (0.5 x 103) = high risk for overwhelming and life threatening bacterial infection

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20
Q

Band

A

Band neutrophils = less mature nucleus

These are also called “stabs” (means “stick”)

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21
Q

Segmented

A

Segmented neutrophils = mature nucleus

These are also called “segs”, “polys” or “PMNs” = polymorphonuclear cells

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22
Q

The Left shift

A

the neutrophil cell and the level of maturation of the cells found in a particular blood sample.

The term “left shift” means that there is a higher predominance of immature neutrophils (bands) present on a particular CBC.

infection or inflammatory response

Bands> segs

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23
Q

eosinophils normal

A

NORMAL = 0-7% of WBCs

Absolute eosinophil count =0.00-0.45 X 10^3/uL

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24
Q

Eosinophilia

A

Parasites!

Allergic Disorders!

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25
Q

Platelet normal

A

Normal value: 150-450 X 10^3/uL

150,000-450,000

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26
Q

Reactive thrombocytosis

A

(cytokine driven)- more common***
overproduction of platelets:
Infection
Post-surgery

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27
Q

Autonomous thrombocytosis

A

overproduction of platelets

from: malignancy

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28
Q

Thrombocytopenia

A

insufficient platelets
Lab error- platelets can be clumped by EDTA in blood collection tube or by error in automated cell counter at lab
Drug induced- multiple
Infection- HIV, Hepatitis C, Epstein Barr virus, sepsis, parasites

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29
Q

RBC normal

A

Normal:
Male: 4.6-6.0 x 106/uL
Female: 3.9-5.5 x 106/uL
# RBC/VOLUME

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30
Q

Increased RBC count

A

Cigarette smoking
Dehydration
Increase in production of erythropoietin (EPO)
*remember that RBC is taken per volume

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31
Q

Polycythemia

A

abnormally high RBC count & corresponding high hemoglobin count

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32
Q

Decreased RBC count

A

Anemia
Bleeding – GI or GYN primarily
Hematopoetic failure- radiation, toxins or tumors
Poor nutrition- B6, B12, Folate, Iron

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33
Q

Hemoglobin normal

A

Normal value: Males- 13.6-17.2 g/dL
Females- 12.0-15.0 g/dL
Content of Hb/VOLUME of blood

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34
Q

Increased Hemoglobin

A 
Tobacco use and advanced COPD
Alcohol abuse
Dehydration (false elevation)
         RBC, Hemoglobin and Hematocrit are all dependent on RBC mass and plasma volume
(Living at high altitude)
Also:
EPO abuse
Myeloproliferative disease
Polycythemia
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35
Q

Decreased Hemoglobin

A

*****Acute blood loss anemia - Where is this person bleeding from? (Colon- in older person, colon CA until proven otherwise!!)
Also:
Malnutrition- Poor intake or absorption of B12, Iron, Folate
Renal failure- EPO produced in kidneys
Disorders of hemoglobin structure (thalassemia, sickle cell anemia)

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36
Q

CBC–> Hematocrit

A

percentage of whole blood that it made up of RBCs

Also called Packed Cell Volume (PCV)

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37
Q

Hematocrit Normal

A

Normal values: Male- 41-50% Female- 35-45%

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38
Q

CBC → red blood cell indices (mcv, mchc,mch, rdw)

A

The red blood cell indices give a great deal of information about the types and causes of anemia
The MCV, MCHC and MCH are calculated mathematically and automatically using the RBC, Hgb and Hct values

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39
Q

RDW

A

RDW = Red blood cell distribution width
RDW refers to the variation of the RBC VOLUME, not the diameter of the erythrocyte from the standard deviation (as a percentage)
Calculated = RDW = (Standard deviation of MCV ÷ mean MCV) × 100
A percentage of RBC volume variation, can indicate Fe deficiency
Higher RDW = larger variation in RBC volume

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40
Q

Anisocytosis

A

cells of varying size

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41
Q

Lymphocytes

A

Three types of Lymphocytes: T cells, B cells and NK cells
these cells function to form immunity against foreign cells and pathogens
can measure via a CBC w/diff

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42
Q

T and B cells

A

These cells have binding sites that are specific for certain antigens. Once bound, these cells will help to destroy the foreign body/pathogen

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43
Q

NK cells

A

Natural Killer cells

involved in the destruction of tumor and virally infected cells

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44
Q

Normal Lymphocyte count on a CBC w/diff

A

about 20-40% of WBC
Absolute lymphocyte count is 1.8-4.8x10^3/uL
1,800-4,800/uL
Higher levels in infants and children

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45
Q

Lymphocytosis

A 
increased lymphocyte count
Usually due to a VIRAL infection
Mono
CMW
Primary HIV infection
Viral pneumonia
mumps
varicella
rubella
influenza
hepatitis
measles
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46
Q

Other reasons for lymphocytosis

A

*higher in infants and young children

certain drugs, especially anticonvulsants, can cause a high lymphocyte count

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47
Q

Lymphocytopenia

A

decreased lymphocyte count
due to a bacterial or fungal infection
can also happen in a post-operative state, or if the patient is going through chemo/radiation. Also a sign of general malignancy

48
Q

Monocytes

A

the precursor to the macrophage
Function is to help remove dead or damaged tissue by evolving into macrophages and removing cellular debris
Found on a CBC w/diff

49
Q

Normal monocyte count

A

2-8% of WBCs

absolute count can be from 0-800 cells/uL

50
Q

increased monocyte count

A

indicative of viral/bacterial/parasitic infection

51
Q

Eosinophils

A

normal level is 0-7% total WBCs

absolute count is from 0-450/uL

52
Q

Eosinophilia

A

elevated eosinophil level due to Parasites and Allergic disorders

53
Q

Eosinopenia

A

decreased eosinophil level

acute bacterial infection

54
Q

Basophils

A

Found on CBC w/diff
Similar to eosinophil function, in that involved in parasitic infections and allergy related illnesses
Basophil count probably the least used component of the CBC

55
Q

Basophils normal

A

0-3% WBC’s

absolute value: 0-200/uL

56
Q

Platelets

A

smallest, but most numerous of the three main blood cell types.
Make up only small fraction of blood volume
Their goal in life is to keep you from bleeding to death.

57
Q

normal platelet value

A

found on a CBC
150-450x10^3/uL
so, 150,000- 450,000
When you see unexplained bleeding, bruising- first thought should be platelet function or the underlying pathways involved in platelet function

58
Q

Thrombocytosis

A

elevated platelet

2 types-Reactive thrombocytosis and Autonomous thrombocytosis

59
Q

Reactive thrombocytosis

A 
cytokine driven
more common
due to:
infection
post-op
malignancy
post-splenectomy
acute blood loss
60
Q

Autonomous thrombocytosis

A

overproduction of platelets
due to malignancy
not as common

61
Q

thrombocytopenia

A 
decreased platelet count
Due to:
Lab error- can clump with EDTA
drug induced, multiple drugs can do this
HIV, Hep C, Epstein barr, sepsis, parasites
62
Q

RBC

A

The CBC also measures the volume of the RBC, the concentration/weight of hemoglobin in the RBC, and the average width of the RBC
important in anemia diagnosis

63
Q

Anemia causes

A

Anemia results from either blood loss, drop in production of RBCs or increase in destruction of RBCs
Lack of iron, B12 or folic acid can also cause anemia as these are co-factors in RBC production

64
Q

RBC normal male

A

4.6-6.0 x 10^6/uL

65
Q

RBC normal Female

A

Female: 3.9-5.5 x 10^6/uL

66
Q

increased RBC

A

due to:
cigarette smoking
dehydration

67
Q

Decreased RBC

A 
due to:
Anemia
bleeding (GI or gyn usually)
Hematopoetic failure- radiation, toxins or tumors
Poor nutrition- B6, B12, Folate, Iron
68
Q

Hemoglobin

A

measured in CBC
Function of hemoglobin is to carry oxygen
Varies based on laboratory and age group
Increased in newborns
Useful test- you will see abnormalities frequently!

69
Q

Hemoglobin normal male

A

13.6-17.2 g/dL

70
Q

Hemoglobin normal female

A

12.0-15.0 g/dL

71
Q

increased hemoglobin

A 
due to:
tobacco use
advanced COPD
alcohol abuse
Dehydration can cause a false elevation
72
Q

Decreased hemoglobin

A

due to:
Acute blood loss anemia - Where is this person bleeding from? (Colon- in older person, colon CA until proven otherwise!!)
Malnutrition- poor intake of B12, iron, folate
Renal failure
Disorder of the Hb structure- thalassemia, sickle cell anemia

73
Q

Hematocrit

A

measured in a cbc
percentage of whole blood that it made up of RBCs
Can be done by centrifuge of tube, but usually done with automated analyzer
Also called Packed Cell Volume (PCV)

74
Q

Hematocrit normal male

A

41-50%

75
Q

Hematocrit normal female

A

35-45%

76
Q

Red blood cell indices

A

*MCV = Mean Corpuscular Volume
*MCHC = Mean Corpuscular Hemoglobin Concentration
*MCH = Mean Corpuscular Hemoglobin
RDW = Red Blood Cell Distribution Width
indices give a great deal of information about the types and causes of anemia
* are calculated mathematically and automatically using the RBC, Hgb and Hct values

77
Q

RDW

A

Red blood cell Distribution Width
refers to the variation of the RBC VOLUME, not the diameter of the erythrocyte from the standard deviation (as a percentage)
RDW = (Standard deviation of MCV ÷ mean MCV) × 100
Higher RDW = larger variation in RBC volume

78
Q

RDW normal value

A

11.5-14.5%

79
Q

Anisocytosis

A

cells of varying size
indicated by RDW
The RDW appears to be the earliest manifestation of iron deficiency anemia and is frequently increased in nutritional-linked anemias

80
Q

MCV

A

mean corpuscle volume
Measures the average volume of the RBC by dividing the Hct/Hgb
Used in classification of type of anemia

81
Q

MCV normal value

A

80-100 femtoliters

82
Q

Microcytic RBC

A

decreased MCV

83
Q

Normocytic RBC

A

normal MCV

84
Q

Macrocytic RBC

A

increased MCV

85
Q

MCH

A

mean corpuscular hemoglobin
Measures the average WEIGHT of hemoglobin within the RBC by dividing the Hgb/RBC
Rises or falls with rise and fall of MCV (more volume = more Hgb)

86
Q

MCH normal

A

27-33 picograms/cell

87
Q

MCHC

A

mean corpuscular hemoglobin concentration
Measures the proportion of each RBC that is taken up by hemoglobin
used in determination of type of anemia

88
Q

MCHC normal

A

33-37 g / deciliter

89
Q

Hypochromic RBCs

A

decreased concentration of hemoglobin (↓ MCH or MCHC)

90
Q

Normochromic RBCs

A

normal concentration of hemoglobin (Normal MCH/MCHC)

91
Q

Hyperchromic RBCs

A

increased concentration of hemoglobin (↑MCH or MCHC)

92
Q

normocytic anemias

A

most frequently encountered anemia and reflects decreased RBC production or increased RBC destruction
In this anemia, the Hgb/Hct decreased, but MCV normal
Due to: acute blood loss or anemia of chronic disease

93
Q

microcytic anemia

A

MCV is decreased

94
Q

Macrocytic anemia

A 
MCV is increased > 100 femtoliters
due to:
Alcoholism
B12 or Folate deficiency 
Liver disease
95
Q

reticulocyte count

A

Not part of the CBC blood test- used as a follow up to abnormal CBC results or to investigate for bone marrow disorders.
Reticulocytes are immature red blood cells that are visible due to the presence of ribosomal RNA that turns blue when stained
Reticulocytes approximate about 1% of RBCs, circulate in 1-2 days as reticulocytes and then mature
Average life span of RBC = 100-120 days

96
Q

Increased Reticulocyte count

A

In cases of severe anemia, reticulocytes are prematurely released into circulation, resulting in a higher than normal reticulocyte count
Represents recent or ongoing RBC production and activity. could be due to Hemolysis or Hemolytic anemia or acute blood loss

97
Q

decreased reticulocyte count

A 
Represents decreases in RBC production
due to:
Vitamin deficiency anemia
Iron deficiency anemia
Bone marrow failure
Decreased EPO production (renal disease/failure)
98
Q

Hemoglobin A

A

two alpha and two beta chains

99
Q

Hemoglobin A2

A

composed of two alpha and two delta chains

100
Q

Hemoglobin F

A

two alpha and two gamma chains

101
Q

Adult Hemoglobin

A

two alpha and two beta globin chains

102
Q

Fetal hemoglobin

A

two alpha and two gamma chains (higher oxygen affinity in utero)

103
Q

Hb electrophoresis adult normal

A

Hb A→ 95% to 98%
Hb A2 → 2% to 3.5%
Hb F→

104
Q

Hb electrophoresis child normal

A 
Hb F (newborn)→ 50% to 80%
Hb F (6 months)→ 8%
Hb F (> 6 months)→
105
Q

Alpha Thalassemia

A

impaired production of alpha chains

106
Q

Beta Thalassemia

A

impaired or very reduced beta hemoglobin chains; common in Mediterranean, Asian, African descent

107
Q

Hemoglobin S

A

Sickle cell trait or disease

108
Q

Hemoglobin C

A

mild anemia

109
Q

Hemoglobin E

A

mild anemia, common in Asian descent

110
Q

Increased Hemoglobin A2

A

beta thalassemia or heterozygous for trait

111
Q

Decreased Hemoglobin A2

A

alpha thalassemia or heterozygous for trait

112
Q

Blood Type A

A

Has A antigens
Has anti-B antibodies in serum
Can donate blood to Type A and AB people
Can receive blood from Type O and A people

113
Q

Blood type B

A

Has B antigens
has anti-A antibodies in serum
Can donate to type B and AB people
can receive from type B and O

114
Q

Blood type AB

A 
Has A and B antigens
has no antibodies in serum
can donate to type AB people
can receive from type A, type b, type AB and type O
The universal recipient
115
Q

Blood type O

A 
Has no antigens on RBC
Has anti-A and Anti-B antibodies in serum
Can donate to Types A, B, AB, and O
Can receive from only type O
The universal dOnor
116
Q

Rh type

A

Complex system involving 3 genes that produce Rh antigens C,D,E → D is most important
Approximately 15% of population is Rh negative

117
Q

hemolytic disease of the newborn

A

if mother is Rh – and has a Rh + positive baby as she may develop antibodies against her baby with subsequent pregnancies → hemolytic disease of the newborn

Clinical Science (15 decks)

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