Blood Cells Flashcards
Hemogram/CBC
-RBC count
-hmg
-hct
-indicies: MCV**, MCH, MCHC
-platelet count
-WBC- differential:
-neutrophils
-lymphocytes
-monocytes
-eosinophils
-basophils
anemia
-low hmg***
-signs and symp of anemia- fatigue, tachypnea, pale (nails and conjunctiva), tachycardia, hypotension, chest pain (rarely)
-physical compensation- EPO
-production compensation- reticulocytes will increase
RBC
-mature RBC in blood
hmg
-iron containing protein found in RBC
-carriers of oxygen and CO2
Hct
-proportion of RBC %
-low- anemia
-high hct with normal hmg- dehydration
-high hct with high hmg- high altitude, pulmonary disease, polycythemia vera
-indicates dehydration
-direct relationship with hmg
-if you give IV fluids -> lower Hct (%) -> hmg unchanged?
-Hct is approx 3x hmg
indices
-MCV*: size or volume of RBC (Hct/RBC count) -> helps to classify types of anemia
-MCV- aka the quality, dense or not dense enough?
-MCH: weight of hemoglobin in the RBC (Hgb/RBC count)
-MCHC: Assesses both the size of the RBC as well as the concentration of hemoglobin (Hgb/Hct)
-MCHC assesses hypochromic (smaller and not dense), normochromic, hyperchromic
types of anemia
-normocytic
-microcytic
-macrocytic
-defined by MCV
red cell distribution weight (RDW)
-measurement of the range in the volume and size of your RBC
-the precision of the RBC
-when all the RBCs are similar -> RDW is normal
-when some RBCs are small or some large -> RDW is elevated
-“the poor mans reticulocyte count”- if reticulocytes are high RDW is high (new cells measure bigger) -> compensating for anemia
-if someone is anemic and RDW is low -> why arnt they compensating?
reticulocyte count
-immature RBC
-normally only 0.5-1.5%
-90-120 days life span of RBC
-the new amount of RBC being made
peripheral blood smear
-number, shape, and appearance
serum iron
-essential component of hmg
-lack of iron -> cant build hmg
-deficiency- diet, chronic GI bleed
components of RBC
-folic acid
-b12
-iron
shilling test
-B12 testing
-Radio labeled B12 given orally
-Urine collected 24 hrs, checked for B12 level
-8-40% should be excreted
-If less with dose of intrinsic factor then indicative of pernicious anemia
-B12 deficiency- macrocytic anemia
coomb’s test
-used to detect antibodies that act against the surface of yourRBC
-autoimmune destruction of RBCs -> hemolytic anemia
-presence of these antibodies indicates condition -> hemolytic anemia
-hemolytic anemia- blooddoes not contain enoughRBCbecause they are destroyed prematurely
-possible jaundice
anemia diff dx: Proliferation (Can’t produce!)
-Anemia of CHRONIC disease
-bone marrow not as active to produce RBC or EPO deficient
-Anemia of Chronic disease- inflammation (Rheumatoid Arthritis, lupus, chronic infections, malignancy) -> low EPO
-Renal disease- Deficient EPO
-Fanconi anemia- Inherited aplastic anemia (bone marrow issue)
-Blackfan-Diamond syndrome -> Inherited bone marrow failure
-Parvovirus- Infection causing aplastic anemia (bone marrow can be suppressed) -> temporary
-Drug or toxins
anemia diff dx: maturation (trouble assembling)
-Vitamin B12 deficiency- Perncicous anemia -> poor quality membranes
-Folate deficiency- normo or macro
-Iron deficiency- normo or micro
-Sideroblastic- Iron in the mitochondria has abnormal sequestration (Ringed)
-Lead poisoning- Inhibits heme synthesis & decreased survival of RBC
anemia diff dx: hemolysis (broken down!)
-Hemoglobinopathies- spleen kills RBCs due to poor quality RBCs
-Immune hemolytic anemia- autoimmune
-Infectious causes of hemolysis
-Membrane abnormalities
-Metabolic abnormalities
-Mechanical hemolysis- valve replacements
-Drug or toxins
-Wilson disease- Copper in RBC, cell damage -> Kayser-Fleischer rings on eyes
other anemia diff dx
-hypersplenism
-hemorrhage (disappearing act!)
microcytic dx
-MC_ iron deficiency
-normal reticulocyte:
-Sideroblastic
-Anemia of Chronic Disease
-Thalassemia- common for Mediterranean descent
-high reticulocyte: (body is trying to compensate)
-immune hemolytic
-hereditary spherocytosis- inherited RBC disorder -> loss of biconcave shape, lack central pallor
-membrane or enzyme defects
iron deficiency causes
-blood loss- MC
-menorrhagia
-diet low in iron
thalassemia
-Mutations in gene for globulin chains
-1. Decreased alpha hemoglobin chains = alpha thalassemia
-Present at birth
-typically microcytic
-Range from no symptoms to fatal - depends on if both parents passed it
-2. Decreased beta hemoglobin chains = beta thalassemia
-Produced after fetal hemoglobin is replaced with beta, 3-6 months.
-Range from no symptoms to transfusion dependent
-Target cells and basophilic stippling (small blue dots due to ribosomal clusters)
MC normocytic anemia
-blood loss
-normal MCV
normocytic anemia diagnosis: reticulocyte normal
-isolated anemia:
-chronic anemia disease
-Early Iron deficiency
-Early folate or B12 deficiency
-Medication effect
-If others excluded, consider:
-Red blood Cell aplasia
-Myelodysplasia
-Paroxysmal Nocturnal Hemoglobinuria
normocytic anemia diagnosis: reticulocyte increased
-means no blood loss -> probable hemolysis
-multiple cytopenia:
-myelodysplasia
-bone marrow infiltration
-aplastic anemia
macrocytic diagnosis: reticulocyte low
-B12
-Folate
-Liver disease
-Hypothyroidism
-Down Syndrome
-Medication effect
-Myelodysplasia
-low B12 + folate -> confirms deficiency
macrocytic diagnosis: reticulocyte high
-hemolysis
-blood loss
-hypo-regenerative
hemolytic anemia: intrinsic
-1. hemoglobinopathies- sickle cell or thalassemia
-2. membranopathies- hereditary spherocytosis or hereditary elliptocytosis
-3. enzymopathy: G6PD -> oxidative stress or “Heinz Bodies”
hemolytic anemia: extrinsic
-Immune Hemolytic
-Microangiopathic Hemolytic- Small blood vessels shearing RBC or Schistocytes
-Malaria
-Blood Transfusion Reaction
-Fetal Rh Compatibility
erthrocytosis
-Hemoglobin elevated
-Myeloproliferative neoplasm - Polycythemia vera
-Reactive erythrocytosis
-Spurious erythrocytosis- just dehydration
-Secondary polycythemia:
-Smoking
-High altitude
-Lung disease / fibrosis
-Renal Cell Carcinoma (elevated EPO)
-Cerebellar hemangioblastoma (elevated EPO)
myeloid vs lymphoid
-myeloid stem cell -> RBC or Platelets or grandulocytes
-lymphoid stem cells -> lymphoblast -> B lymphocyte (memory) or T lymphocyte or NKC
immature neutrophils
-left shift- surge of banded neutrophils (immature neutrophils) -> major infection
-platelets cant be immature
differential count: neutrophil
-40-70%
-> 70% left shift -> bacterial infection
-Low in bone marrow depression like chemo or radiation
-Low with typhoid, measles & rubella, systemic lupus erythematosus
-High in ACUTE INFECTIONS! Immature bands.
-Left shift (rise in bands during bacterial infection)
-If very low, consider patient on isolation (chemotherapy)- immature neutrophils stop being produced -> low immunity
differential count: lymphocytes
-20-25%
-Low in heart failure, renal failure and corticosteroid therapy
-High in tuberculosis, syphilis, pertussis, autoimmune disease and ulcerative colitis
differential count: monocytes
-2-10%
-high in bacterial infections
-can also be high in viral
differential count: eosinophils
-1-6%
-allergies
-Low values seen in: high stress, trauma, surgery and Cushing’s syndrome (cortisol)
-High in parasitic infections, skin diseases and allergies
differential count: basophils
-0-2%
-allergic reactions
-Low in hyperthyroidism, pregnancy and ovulation
-Hypersensitive conditions like ulcerative colitis, histamines
neoplastic proliferation: lymphoid
-B-cell neoplasms (memory):
-Bone marrow to lymph nodes to circulation
-Antibody production
-T & NK cell neoplasms:
-Stem to thymus to circulation
-Cellular immunity
-Hodgkin lymphoma - know diff between hodgkin and non-hodgkin
neoplastic proliferation: myeloid neoplasms
-acute myeloid leukemia
-myeloproliferative neoplasms
platelets
-Small fragments from megakaryocyte
-Forms the plug of the clot
-Aspirin can inhibit & hypothermia
-cant be immature
bleeding disorders: hemophilia A
-Deficiency of factor VIII
-Profuse hemorrhage
-Classic hemophilia
-Increased PTT
bleeding disorders: hemophilia B
-Christmas Disease
-Deficiency of factor IX
-Increased PTT
bleeding disorders: Von Willebrands disease
-Decreased von willebrand’s factor
-MC clotting disorder
-Increased bleeding time
bleeding disorders: thrombcytopenia
-Low platelet count
-Petechiae
-Causes:
-Immune, Drugs (Heparin), post viral, transfusion reaction, sepsis
bleeding time
-How long to stop bleeding
-Platelet function
-Finger prick, blotted till bleeding stopped and timed
-1-3 minutes
clotting time
-Time for blood outside body to clot
-Test tube clot formation timed
-8-15 minutes
prothrombin time (PT)
-PT can vary based on lab -> INR is the normalized calculation for the variability
-PTT never varies
-PT - extrinsic
-efficacy of the extrinsic pathway and the common pathway
-Factors II, V, VII and X
-Significant inter-laboratory variability
-9.5- 13.5 seconds
-Increased in warfarin use, liver disease, Vit K deficiency, disseminated intravascular coagulation, massive blood transfusion, hypothermia
-international normalized ratio (INR): created to offset lab variability -> 1-1.3
platelet count
-Number in the blood
-150,000- 350,000
-Decreased in some viral infections, drug reactions
-Increased in high altitude, strenuous exercise
partial thromboplastin time (PTT)
-Efficacy of intrinisc and common pathway!
-Factors I, II, V, VlII, IX, X, XI and XII -> you need to know this
-Normal 60-70 seconds
