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CBC Flashcards

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1
Q

Hematopoietic stem cells reside in _____

and are able to

A

bone marrow
differentiate into all 10 cell lineages (mature blood cells)
this means they are multipotent

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2
Q

Hematopoesis (production of these cells) can increase based on

A

body symptoms (infection, cancer, etc)

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3
Q

When doing a CBC what cells are we looking at?

A

RBC
thromboycyes (which are platelets)
the phils (neutrophil, eosinophil, basophil)
monocytes

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4
Q

Anemia occurs when you do not have sufficient ____

or the ones you do have are

A

RBCs

malformed

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5
Q

If you do not have enough RBCs, then you will not have enough

A

Hg and iron

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6
Q

There are many types of anemia and the CBC is one of the main tests used to

A

diagnose anemia.

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7
Q

signs of anemia?

A

Fatigue
Light headed
Pale in the face and the eyelids! (conjunctival pallor) if you pull down eye lids and don’t see a lot of red, you can begin to speculate that maybe they are anemic
bruising

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8
Q

____ anemia is the most common

A

Iron-deficiency anemia:

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9
Q

iron deficiency anemia can be caused by

A

can be caused by blood loss, pregnancy, poor diet, gastric bypass (removing part of stomach, you have less area for absorption so they have iron deficiency anemia as well)

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10
Q

Thalassemia

A

Body produces abnormal alpha or beta chain of hemoglobin, genetic cause, more common in certain ethnic groups
Abnormality in hemoglobin chains
Primarily genetic
leads to anemia

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11
Q

avg cost for CBC

A

20$ or more at hospital (3-5x as much) but very cost efficient because you look at a lot of things

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12
Q

CBC is one of the most important medical tests and is often ordered as part of

A

a routine medical examination, in the evaluation of infection, inflammation, or neoplastic processes.

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13
Q

types of WBC

A

lymphocyte, monocyte, neutrophil, basophil, eosinophil

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14
Q

what is collectively known as the granulocytes

A

neutrophils, basophils, eosinophils

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15
Q

total WBC count that includes all WBCs together (monocyte, lymphocyte and the “three phils”) should be

A

4.5-11 *10^3 uL

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16
Q

The white blood cell, also called a ______, is responsible for

A

leukocyte

fighting off infection and disease.

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17
Q

Leukocytosis=

and is usually caused by

A 
elevated WBC count
BACTERIAL infections 
but also 
-Corticosteroids, such as Prednisone (we use this drug for asthma, joint disease, skin disease, poison ivy)
-Smokers
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18
Q

Leukopenia =

and is usually caused by

A

decreased WBC count

VIRAL infections/ parasites

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19
Q

Benign ethnic leukopenia-

A

individuals of African descent especially → complicated, but confers malaria protection
African americans tend to have lower (maybe 1000 less) total wbc count than caucasions

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20
Q

some reasons for leukopenia

A

Decreased production → bone marrow malignancy or defect, chemotherapy, nutritional deficiency ( lack of B12,folate)

Radiation treatment for cancer

Alcohol abuse, poor nutrition, gastric bypass → impaired folic acid absorption → decreased WBC production b.c you are not absorbing the vitamins you need to produce

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21
Q

The majority of mature WBCs are ____ so any increase or decrease in total WBC count is usually a reflection of

A

neutrophils ~ 60% so

a change in neutrophil count predominantly.

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22
Q

The increase/decrease in a total WBC can reflect changes in any of the WBC cells, but more commonly reflects change in

A

neutrophils

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23
Q

these terms are used interchangeably
Leukocytosis =
Leukopenia =

A

tosis= neutrophilia

penia=neutropenia (WBCs are depressed)

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24
Q

Leukocytosis AKA Granulocytosis is due to

A

an increase in the phils only

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25
Q

normally neutrophils are what percent of total WBC?

A

50-70%

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26
Q

Normal absolute neutrophil ≈

A

1.8-7.8 x 10^3/uL

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27
Q

Total WBC count x % neutrophils =

A

absolute neutrophil count

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28
Q

if you have 10,000 WBC and 65% neutrophils, what is your absolute neutrophil count?

A

10,000*.65= 6,500 absolute neutrophil count

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29
Q

2 forms of neutrophils and the difference

A

band neutrophils - immature nucleus

segmented neutrophils- mature nucleus

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30
Q

what is the left shift?

A

there is a higher predominance of immature neutrophils (bands) present on a particular CBC.

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31
Q

If you get a CBC that separates the bands and segs, in order to find absolute neutrophil you need to

A

add percentages of bands/segs and multiply it by total WBC count

ex: total WBC count= 6,000
bands -30%
segs- 3%
total= 33%

.336000= 2,000 or 210^3

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32
Q

severe neutropenia

A

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

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33
Q

3 different types of lymphocytes

A

T cells, B cells, NK (natural killer cells)

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34
Q

fxn of lymphocytes

A

form immunity against foreign proteins and pathogens
Binding sites on T cells and B cells bind to specific antigens and play a role in their destruction

NK (Natural Killer) cells are involved in the destruction of tumor and virally infected cells

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35
Q

lymphocyte vs. leukocyte

A

leukocytes are a whole bucket of WBC

whereas lymphocytes are a particular kind of WBC (B, T NK)

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36
Q

immature lymphocyte=

A

Immature lymphocyte = lymphoblast or “blasts”

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37
Q

Lymphocytosis=

usually due to

A

increased # of lymphocytes
usually due to a VIRUS (whereas with leukocytosis it is due to bacteria)

Viruses can include 
Mononucleosis (virus)
Cytomegalovirus (CMV)
Primary HIV infection (virus)
Viral Pneumonia
Measles, Mumps, Rubella
Varicella
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38
Q

lymphocytopenia =
usually due to
think about

A

decreased # of lymphocytes
bacteria/fungal sepsis
patient’s in compromised states (picture of woman who had chemo)

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39
Q

Monocyte is the precursor or/to the

fxn:

A

macrophage

help remove dead or damaged tissue by evolving into macrophages and removing cellular debris

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40
Q

eosinophils- think _____

fxn:

A

allergic response

True physiologic function remains a mystery

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41
Q

eosinophilia =

think

A

increase # of eosinophils

allergic disorder/parasite!

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42
Q

eosinopenia due to

A

acute bacterial infection

43
Q

basophils are similar in fxn to

how?

A

eosinophil –> in that involved in parasitic infections and allergy related illnesses

Basophil count probably the least used component of the CBC
Basophilic leukocytosis fairly uncommon

44
Q

Platelets are the smallest but the most ______

A

numerous of the three main blood cell types.

45
Q

fxn of platelets

A

Responsible for hemostasis and thrombosis through activation due to injury, adherence to endothelial wall of vessel, aggregation and interaction with coagulation factors
keep you from bleeding out

46
Q

Normal Platelet value

A

150-450*10^3 uL

47
Q

platelets are important in determining if a pt has a _____ disorder

When you see unexplained bleeding, bruising- first thought should be________,

if platelets are fining, then we can look at

A

coagulation disorder, such as unexplained bruising, myeloproliferative disorders, patients on chemotherapy

platelet function or the underlying pathways involved in platelet function

factors of the coagulation cascade (our favorite!)

48
Q

Reactive thrombocytosis vs. autonomic thrombocytosis

A

both are increased level of platelts
reactive= elevated platelet count that develops secondary to another disorder/issue (think post surgery)
autonomic =overproduction due to an issue in the bone marrow

49
Q

thrombocytopenia =

is usually caused by

A

decreased platelet count

  • Lab error- platelets can be clumped by preservative 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
50
Q

CBC RBC count is most useful in diagnosing

A

anemia

51
Q

normal RBC count

A

Normal:
Male: 4.6-6.0 x 10^6/uL
Female: 3.9-5.5 x 10^6/uL

52
Q

What does RBC count on a CBC?

A

total # of RBCs

53
Q

Causes for high RBC count

A

-Cigarette smoking (smokers tend to have)
Body is trying to compensate for that subtle lack of O2
-Dehydration
Because there isn’t as much volume so RBC concentration looks higher

54
Q

Polycythemia

A

abnormally high RBC count & corresponding high hemoglobin count

55
Q

Reasons for decreased RBC count

A 
Anemia
Bleeding – GI or GYN primarily
Hematopoetic failure- radiation, toxins or tumors
Poor nutrition- B6, B12, Folate, Iron
Drug induced- antibiotics, NSAIDs
56
Q

which is more common, anemic pt with high RBC or low RBC?

A

low

57
Q

CBC- Hemoglobin -HGB normal values

analogy

A

Normal value: Males- 13.6-17.2 g/dL
Females- 12.0-15.0 g/dL

Hemoglobin = The total amount of spaghetti present on all the plates combined.

58
Q

fxn of hemoglobin

A

Function of hemoglobin is to carry oxygen

Within the globulin chains is heme, which contains iron → important in oxygen and CO2 transport

59
Q

Reasons for increased HGB

A

Tobacco use and advanced COPD
Trying to compensate for hypoxic state
Alcohol abuse
Dehydration (false elevation)

60
Q

reasons for decreased HGB

A
  • Acute blood loss anemia - Where is this person bleeding from? (Colon- in older person, colon CA until proven otherwise!!)
  • Malnutrition- Poor intake or absorption of B12, Iron, Folate
  • Renal failure- EPO produced in kidneys
  • Disorders of hemoglobin structure (thalassemia, sickle cell anemia)
61
Q

to check and see if someone may have low HGB check

A 
palpebral conjunctiva for pallor 
if white (not red) then you are decreased in HGB
62
Q

CBC Hematocrit values

A

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

63
Q

Hematocrit =
how is it done?
analogy

A

percentage of whole blood that is made up of RBCs
Also called Packed Cell Volume (PCV)
centrifuge /but usually done with automated analyzer

Hematocrit = If you take all your red plates and spaghetti and throw it in a trash can filled with water. Assume that there is no room between plates and they are tightly packed. What percentage of trash can is filled by those plates with spaghetti on them?

64
Q

anything that decreases your hemoglobin will decrease your

A

hematocrit-so if pt has low hematocrit it is for the same reasons he’d have low HGB

65
Q

Red Blood cell indices consists of

A 
MCV = Mean Corpuscular Volume
MCHC = Mean Corpuscular Hemoglobin Concentration
MCH = Mean Corpuscular Hemoglobin
RDW = Red Blood Cell Distribution Width
66
Q

The Red Blood cell indices gives a lot of info about

RBC count analogy

A

the types and causes of anemia

RBC count = The total number of red plates present.

67
Q

The MCV, MCHC and MCH are calculated mathematically and automatically using

A

the RBC, Hgb and Hct values

68
Q

RDW refers to the

higher RDW=

analogy

A

RBC distribution width–> 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

Higher RDW = larger variation in RBC volume
normal RDW= all RBCs are basically the same size

bigger dinner plates/vs. appetizer size plates

69
Q

The RDW appears to be the earliest manifestation of ____________
however, RDW is not truly diagnostic of any one disease really and is considered to be _______ than other RBC indices

A

iron deficiency anemia and is frequently increased in nutritional-linked anemias

“less important”

70
Q

If you see incrase in RDW, start thinking

A

iron deficiency in pt

71
Q

Anisocytosis

A

cells of varying size

72
Q

CBC: mean corpuscular volume = MCV

analogy

A

the average volume of the RBC by dividing the Hct/Hgb

MCV = What is the average volume of all the red plates combined?

73
Q

MCV classifies RBCs into 3 categories

A

Microcytic: decreased MCV
Normocytic : normal MCV
Macrocytic : increased MCV

74
Q

MCH=

analogy

A

mean corpuscular HGB
Measures the average WEIGHT of hemoglobin within the RBC by dividing the Hgb/RBC

MCH = What is the average weight of the spaghetti on all these red plates?

75
Q

MCH Rises or falls with rise and fall of

A

MCV (more volume = more Hgb)

76
Q

MCHC=

analogy

A

Mean corpuscular hemoglobin concentration
Measures the proportion of each RBC that is taken up by hemoglobin

MCHC = Based on the size of your plate, what is the percentage of the plate taken up by the spaghetti?

77
Q

_____ is responsible for giving blood its characteristic red color so increased hemoglobin
so therefore increased HGB= increased…..

A

Iron is responsible for giving blood its characteristic red color so increased hemoglobin = increased iron = increased red color of RBC

78
Q

MCHC Mean corpuscular hemoglobin concentration: deals with color of RBCS
categories:

A

Hypochromic RBCs- decreased concentration of hemoglobin (↓ MCH or MCHC)

Normochromic RBCs- normal concentration of hemoglobin (Normal MCH/MCHC)

Hyperchromic RBCs- increased concentration of hemoglobin (↑MCH or MCHC)

79
Q

types of anemia

Normochromic normocytic anemia

A

= means you’ve just lost some of the red blood cells but they are normally shaped RBCs with normal hemoglobin

80
Q

types of anemia

Microcytic hypochromic anemia=

A

means that less hemoglobin and smaller cells

81
Q

types of anemia

Macrocytic normochromic–

A

bigger cells but maybe not as many

82
Q

what is the most frequently encountered anemia and what does it reflect?

A

normocytic

decreased RBC production or increased RBC destruction

83
Q

why is it called normocytic anemia?

A

cells are normal–we just don’t have enough of them (not producing, or we’re destroying)

84
Q

in normocytic anemia _____ is decreased, but ____ is normal

A

the Hgb/Hct decreased, but MCV normal

85
Q

normocytic anemia can happen due to

A

Acute blood loss
Ex: had a BM and major blood loss
-Anemia of chronic disease (≈75% of time)

86
Q

In Microcytic Anemia MCV is

A

decreased (cells are smaller–volume is smaller)

87
Q

most common cause of microcytic anemia?

A

iron deficiency anemia

Alpha thalassemia & beta thalassemia

88
Q

macrocytic anemia, MCV Is

causes

A

increased
alcohol abuse, liver disease
B12 or folate deficiency

89
Q

which is LESS common microcytic or macrocytic?

A

macro

90
Q

reticulocyte count test
what is a reticulocyte
why would you do this test
is it part of the CBC?

A

immature RBC (immature red blood cells that are visible due to the presence of ribosomal RNA that turns blue when stained)

if CBC seems abnormal (follow up test)

not part of CBC

91
Q

avg life span of RBC

important for what test (not on CBC)

A

100-120 days
HBG A1C
it is an average of blood sugars of the last 3mos–because it follows RBCs around for their whole life span (100 days or so)

92
Q

In cases of severe anemia, reticulocytes are

A

prematurely released into circulation, resulting in a higher than normal reticulocyte count

93
Q

what does an increased reticulocyte count mean?

A

Hemolysis or Hemolytic anemia
Acute blood loss
Represents recent or ongoing immature RBC production and activity

94
Q

what does a decreased reticulocyte count mean?

what could cause this?

A
  • Vitamin deficiency anemia
  • Iron deficiency anemia
  • Bone marrow failure
  • Decreased EPO production (renal disease/failure)
95
Q

what are some common hemoglobin variations/types?

A

Hemoglobin A: composed of two alpha and two beta chains

Hemoglobin A2: composed of two alpha and two delta chains

Hemoglobin F: two alpha and two gamma chains
F stands for fetal
See this hemoglobin in fetus and very young infants
Represents decreases in RBC production

96
Q

variant forms of HGB result from differences in

A

B chains

97
Q

adult HGB vs. fetal HGB

A

Adult Hemoglobin= two alpha and two beta globin chains

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

98
Q

In adults what percent do we have of
HBA
HB A2
HB F

A

A -95%
A2- 2-3.5%
F- less than 2%

99
Q

In children what percent do they have of HGB F as a newborn? then what?

A

50-80%, they lose it as time goes by

100
Q

HGB electrophoresis tests for

A

Hemoglobinopathies–to which there are many

101
Q

Examples of Hemoglobinopathies (that get tested for in Hemoglobin electrophoresis)

A

Alpha Thalassemia- impaired production of alpha chains
—-Alpha chains are a bit abnormal
Beta Thalassemia- impaired or very reduced beta hemoglobin chains; common in Mediterranean, Asian, African descent
These people may have appearance of anemia if they come in to see dr.
Hemoglobin S- Sickle cell trait or disease
Hemoglobin C- mild anemia
Hemoglobin E- mild anemia, common in Asian descent

102
Q

When would you conduct a HGB electrophoresis test?

A

Following an abnormal CBC or finding of anemia

Family studies, i.e. family history of thalassemia trait or disease, sickle cell trait or disease

103
Q

If on a HGB electrophoresis you see a predominance o hemoglobin S the pt probably has

A

probably sickle cell or sickle cell trait

Clinical Science (2 decks)

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