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Blood Flashcards

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
Platelet normal
Normal value: 150-450 X 10^3/uL | 150,000-450,000
26
Reactive thrombocytosis
(cytokine driven)- more common*** overproduction of platelets: Infection Post-surgery
27
Autonomous thrombocytosis
overproduction of platelets | from: malignancy
28
Thrombocytopenia
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
29
RBC normal
Normal: Male: 4.6-6.0 x 106/uL Female: 3.9-5.5 x 106/uL # RBC/VOLUME
30
Increased RBC count
Cigarette smoking Dehydration Increase in production of erythropoietin (EPO) *remember that RBC is taken per volume
31
Polycythemia
abnormally high RBC count & corresponding high hemoglobin count
32
Decreased RBC count
Anemia Bleeding – GI or GYN primarily Hematopoetic failure- radiation, toxins or tumors Poor nutrition- B6, B12, Folate, Iron
33
Hemoglobin normal
Normal value: Males- 13.6-17.2 g/dL Females- 12.0-15.0 g/dL Content of Hb/VOLUME of blood
34
Increased Hemoglobin
``` 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 ```
35
Decreased Hemoglobin
*****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)
36
CBC--> Hematocrit
percentage of whole blood that it made up of RBCs | Also called Packed Cell Volume (PCV)
37
Hematocrit Normal
Normal values: Male- 41-50% Female- 35-45%
38
CBC → red blood cell indices (mcv, mchc,mch, rdw)
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
39
RDW
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
40
Anisocytosis
cells of varying size
41
Lymphocytes
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
42
T and B cells
These cells have binding sites that are specific for certain antigens. Once bound, these cells will help to destroy the foreign body/pathogen
43
NK cells
Natural Killer cells | involved in the destruction of tumor and virally infected cells
44
Normal Lymphocyte count on a CBC w/diff
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
45
Lymphocytosis
``` increased lymphocyte count Usually due to a VIRAL infection Mono CMW Primary HIV infection Viral pneumonia mumps varicella rubella influenza hepatitis measles ```
46
Other reasons for lymphocytosis
*higher in infants and young children | certain drugs, especially anticonvulsants, can cause a high lymphocyte count
47
Lymphocytopenia
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
Monocytes
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
Normal monocyte count
2-8% of WBCs | absolute count can be from 0-800 cells/uL
50
increased monocyte count
indicative of viral/bacterial/parasitic infection
51
Eosinophils
normal level is 0-7% total WBCs | absolute count is from 0-450/uL
52
Eosinophilia
elevated eosinophil level due to Parasites and Allergic disorders
53
Eosinopenia
decreased eosinophil level | acute bacterial infection
54
Basophils
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
Basophils normal
0-3% WBC's | absolute value: 0-200/uL
56
Platelets
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
normal platelet value
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
Thrombocytosis
elevated platelet | 2 types-Reactive thrombocytosis and Autonomous thrombocytosis
59
Reactive thrombocytosis
``` cytokine driven more common due to: infection post-op malignancy post-splenectomy acute blood loss ```
60
Autonomous thrombocytosis
overproduction of platelets due to malignancy not as common
61
thrombocytopenia
``` 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
RBC
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
Anemia causes
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
RBC normal male
4.6-6.0 x 10^6/uL
65
RBC normal Female
Female: 3.9-5.5 x 10^6/uL
66
increased RBC
due to: cigarette smoking dehydration
67
Decreased RBC
``` due to: Anemia bleeding (GI or gyn usually) Hematopoetic failure- radiation, toxins or tumors Poor nutrition- B6, B12, Folate, Iron ```
68
Hemoglobin
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
Hemoglobin normal male
13.6-17.2 g/dL
70
Hemoglobin normal female
12.0-15.0 g/dL
71
increased hemoglobin
``` due to: tobacco use advanced COPD alcohol abuse Dehydration can cause a false elevation ```
72
Decreased hemoglobin
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
Hematocrit
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
Hematocrit normal male
41-50%
75
Hematocrit normal female
35-45%
76
Red blood cell indices
*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
RDW
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
RDW normal value
11.5-14.5%
79
Anisocytosis
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
MCV
mean corpuscle volume Measures the average volume of the RBC by dividing the Hct/Hgb Used in classification of type of anemia
81
MCV normal value
80-100 femtoliters
82
Microcytic RBC
decreased MCV
83
Normocytic RBC
normal MCV
84
Macrocytic RBC
increased MCV
85
MCH
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
MCH normal
27-33 picograms/cell
87
MCHC
mean corpuscular hemoglobin concentration Measures the proportion of each RBC that is taken up by hemoglobin used in determination of type of anemia
88
MCHC normal
33-37 g / deciliter
89
Hypochromic RBCs
decreased concentration of hemoglobin (↓ MCH or MCHC)
90
Normochromic RBCs
normal concentration of hemoglobin (Normal MCH/MCHC)
91
Hyperchromic RBCs
increased concentration of hemoglobin (↑MCH or MCHC)
92
normocytic anemias
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
microcytic anemia
MCV is decreased
94
Macrocytic anemia
``` MCV is increased > 100 femtoliters due to: Alcoholism B12 or Folate deficiency Liver disease ```
95
reticulocyte count
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
Increased Reticulocyte count
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
decreased reticulocyte count
``` Represents decreases in RBC production due to: Vitamin deficiency anemia Iron deficiency anemia Bone marrow failure Decreased EPO production (renal disease/failure) ```
98
Hemoglobin A
two alpha and two beta chains
99
Hemoglobin A2
composed of two alpha and two delta chains
100
Hemoglobin F
two alpha and two gamma chains
101
Adult Hemoglobin
two alpha and two beta globin chains
102
Fetal hemoglobin
two alpha and two gamma chains (higher oxygen affinity in utero)
103
Hb electrophoresis adult normal
Hb A→ 95% to 98% Hb A2 → 2% to 3.5% Hb F→
104
Hb electrophoresis child normal
``` Hb F (newborn)→ 50% to 80% Hb F (6 months)→ 8% Hb F (> 6 months)→ ```
105
Alpha Thalassemia
impaired production of alpha chains
106
Beta Thalassemia
impaired or very reduced beta hemoglobin chains; common in Mediterranean, Asian, African descent
107
Hemoglobin S
Sickle cell trait or disease
108
Hemoglobin C
mild anemia
109
Hemoglobin E
mild anemia, common in Asian descent
110
Increased Hemoglobin A2
beta thalassemia or heterozygous for trait
111
Decreased Hemoglobin A2
alpha thalassemia or heterozygous for trait
112
Blood Type 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
Blood type B
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
Blood type AB
``` 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
Blood type O
``` 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
Rh type
Complex system involving 3 genes that produce Rh antigens C,D,E → D is most important Approximately 15% of population is Rh negative
117
hemolytic disease of the newborn
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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