Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Patient Care 2023 > CBC And Related Patho > Flashcards

CBC And Related Patho Flashcards

1
Q

Do you have to request a differential for a CBC

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Is fasting required for a CBC

A

No
*collection of blood should be fresh <3 hours old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where are RBC, WBC, and platelets formed

A

In the bone marrow
“The factory”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the functions of RBC, WBC, Hgb, Hematocrit, and platelets

A

RBC: carry oxygen
WBC: fight infection
Hgb: O2 carrying protein in RBC
Hematocrit: proportion of red blood cells to plasma
Platelets: cells which help with blood clotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does a differential include?

A
  1. WBC types
    *lymphocytes
    *monocytes
    *neutrophils
    *eosinophils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are granulocytes

A
  1. Neutrophils
  2. Basophils
  3. Eosinophils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is leukocytosis and leukopenia?

A

Leukocytosis: WBC elevation (think inflammation, infection)
Leukopenia: Low WBC (think autoimmune issues, chemo, bone marrow problems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the critical values of WBC

A

<2 or >40,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should you do if the WBC are high on the CBC

A

Look at the differential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should you think of if the neutrophils, lymphocytes, monocytes, and eosinophils are elevated?

A

N (immature bands/mature segs): bacterial/progenitor infection
*bands are bad
L: viral, TB
M: viral, TB
E: allergy, parasite, fungal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is another term for RBC count?

A

Erythrocyte count
*represent the # of RBC in the system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the trends of RBC relating to gender

A

W: lower RBC values
M: higher RBC values

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is anemia

A

When the value of RBC is decreased below the expected normal range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some causes of low RBC

A
  1. Hemorrhage
  2. Hemolysis (G6PD deficiency)
  3. Dietary deficiency
  4. Genetic aberrations
  5. Normal pregnancy
  6. Drug ingestion
  7. Marrow failure
  8. Chronic illness
  9. Organ failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some causes of high RBC

A
  1. High altitudes
  2. Congenital heart disease
  3. Severe COPD
  4. Polycythemia Vera
  5. Drugs
    *1,2,3 have low O2 levels therefore RBCs are stimulated to increase O2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is polycythemia Vera

A

Neoplastic condition causing uncontrolled RBC production by bone marrow (will increase RBC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What causes alteration of RBC count

A
  1. Dehydration
    *total blood volume is contracted thus RBC is more conc
  2. Over-hydration
    *conc is diluted RBC is falsely low
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does Hbg measure

A
  1. The total amount of Hgb in peripheral blood
    *should be repeated serially in patients with ongoing bleeding
    *apart of anemia eval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the trends with hbg and gender?

A

W: lower
M:higher
*levels decrease with age
*abnl values indicate pathological state same as abnl RBC r

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can interfere with Hbg

A
  1. Heavy smoking
  2. High altitudes
  3. Drugs
  4. Dehydration and over hydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the critical values of Hgb

A

<7 or >21g/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What makes the decision for a blood transfusion

A

Based on Hgb and Hct
*<7.5g/dL or Hct <24%
*if the patient is unstable dont wait to reach below 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the consequence of too little Hgb

A
  1. Strain cardiopulmonary system to compensate
    *angina, MI, CHF, stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the consequence of too high Hgb

A

Sludging from increased numbers of RBCs *Stroke, organ infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the Hct

A

% of blood volume that is RBC’s
*how conc is the blood with RBC
-Ratio of packed red blood cells to total sample size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What do Hct levels reflect

A

The Hgb and RBC values
*repeat serially in patients with ongoing bleeding
*used to help eval anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the relation between Hct and Hgb

A

Hct is approx 3x the Hgb under normal conditions
*EX: if Hgb is 14, Hct should be around 42%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the critical values of Hct

A

<21% or >65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What info does the indices provide

A

Provide information about the size, weight, and hemoglobin concentration of RBCs
*helps to classify the anemias
*RBC, Hct, Hgb are needed to calculate RBC indices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the main the RBC indices

A
  1. Mean corpuscular volume (MCV)
  2. Mean corpuscular Hemoglobin concentration (MCHC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does Mean corpuscular volume (MCV) measure

A
  1. The volume, or size of a single RBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does a low, high, or normal MCV mean

A

Low: <80 (microcytic)
High: >100 (macrocytic)
Normal: 80-100 (normocytic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

With an increased macrocytic MVC what types of anemias will be present?

A

Megaloblastic anemias
1. Vitamin B12 (pernicious anemia)
2. Folate (MC cause)
Non-megaloblastic
1. Alcoholism
2. Chronic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

With an decreased microcytic MVC what types of anemias will be present?

A
  1. Iron deficiency
  2. Thalassemia
  3. Anemia of chronic disease/inflammation
  4. Sideroblastic anemia (MC cause Lead Poisoning)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does Mean corpuscular hemoglobin measure? (MCHC)

A

Measures average concentration or percentage of Hgb within a single RBC
*measure color
*how saturated the RBC is with Hgb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

With a hypochromic MCHC what types of anemias will be present?

A

1.Iron deficiency
2.Thalassemia
3. Anemia of chronic disease/inflammation
4. Sideroblastic anemia (MC cause Lead Poisoning)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does a low, normal MCHC mean

A

Low: hypochromic
*there are low values of hemoglobin
Normal: normochromic
*hemolytic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What does Red blood cell distribution width measure? (RDW)

A
  1. Indication of variation in RBC size or degree of anisocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is anisocytosis?

A

Blood condition where RBC are varying in size/volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is polikilocytosis

A

Variation in shape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the critical values of platelet counts

A

<20,000 (spontaneous hemorrhage) or >1,000,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is thrombocytopenia and thrombocytosis

A

Penia: platelet count <100,000
*easy bruising, petechiae, expistaxis, hematuria
Cytosis: platelet count >400,000
*vascular thrombosis with tissue or organ infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How is anemia classified?

A
  1. Decreased in RBC number or function
  2. Decreased in the O2 capacity of blood
    *condition not a disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are some signs of acute anemia

A

More symptomatic
1. Tachycardia
2. orthostatic changes
3. heart murmur
4. obvious blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are some signs of chronic anemia

A

Condition can be asymptomatic
1. Pallor
2. fatigue
3. jaundice/splenomegaly
4. exertional dyspnea
*Pica: appetite for non food substances like chalk and clay
*Pagophagia: ice craving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What will be present on the CBC for normocytic, normochromic anemia

A
  1. Decreased RBC count
  2. Decreased Hgb, Hct
    *normal indices MCV MCHC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the different types of normocytic, normochromic anemias

A
  1. Anemia of chronic disease
    *microcytic about 30% of the time
  2. Aplastic anemia
    *meds
  3. Renal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the causes for microcytic Anemias?

A

T: thalassemia
I: iron deficiency
C: chronic disease
S: siderblastic anemia
*Low MCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What will be present on the CBC for microcytic, hypochromic anemia

A
  1. Decreased RBC count
  2. Decreased Hgb, Hct
    *abnormal indices <MCV <MCHC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the function of cooper

A

For gut absorption of iron
*may be a deficiency in bariatric patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What will be present on the CBC for Microcytic, normochromic anemia

A
  1. Decreased RBC
  2. Decreased Hgb, HCT
    *<MCV, normal MCHC
52
Q

What is a common cause of microcytic, normochromic anemia

A

Chronic disease
*nomrocytic more common over 70% of the time

53
Q

What will be present on the CBC for macroocytic, normochromic anemia

A

High MCV
Normal MCHC

54
Q

What will cause macrocytic, normochromic anemia?

A

Vitamin B12 or folic acid deficiency

55
Q

What are some causes of decreased bone marrow production of RBC

A
  1. Infiltration process
    *myeloma, leukemia, bone marrow metastases
  2. Aplastic anemia
  3. Decreased materials for RBC production
    *iron, folate, b12
56
Q

What is aplastic anemia

A
  1. Loss of hematopoietic cells leading to pancytopenia
    *decrease in ALL blood cell types
    *hematopoietic failure
57
Q

Infiltration process and aplastic anemia causes low levels of what

A
  1. WBC and platelets, RBC
58
Q

What is the cause of aplastic anemia

A
  1. Drugs
    *chemo, RA, radiation
  2. Viruses
  3. Autoimmune
59
Q

For normocytic anemia what is normal, elevated, or decreased

A

Decreased: RBC
Normal: indices

60
Q

What is the confirmatory test for aplastic anemia

A

Bone marrow biopsy
*will report hypoactive bone marrow
*myeloid cells are decreased (pancytopenia)

61
Q

What is the treatment for aplastic anemia

A
  1. Removing the offending drug
    *MC cause of death is from bleeding and infection
    *bc there are no WBC or platelets
62
Q

What represents iron stores

A

Ferritin
*if ferritin is normal or elevated with microcytic anemia iron deficiency is not the problem

63
Q

What are the different categories of Anemia of chronic disease (ACD)

A
  1. Anemia of inflammation
  2. Anemia of organ failure
  3. Anemia of older adults
64
Q

How is anemia of inflammation mediated

A

Through hepcidin

65
Q

What is hepcidin

A

Acute phase protein that is (triggered with stress, inflammation, infection) a key regulator of iron metabolism

66
Q

What will happen if there is an increase in hepcidin levels

A

Will block the iron absorption from the gut and release iron from marrow
*will be unable to use iron stores as a result of inflammation
*ferritin is normal to elevated
*low serum iron

67
Q

What are the serum levels in anemia of organ failure?

A

Serum iron normal
*erythropoietin is reduced

68
Q

Why is erythropoiesis impaired (organ failure)

A

Due to decrease in both EPO production from diseased kidneys and marrow responsiveness to EPO from inflammatory aspect

69
Q

Why is iron needed

A

Hemoglobin production and function

70
Q

What happens when there is little iron

A

Pale (hypochromic)
Small (microcytic)

71
Q

Why does IDA happen in children and adults

A

C: poor diet
A: blood loss

72
Q

What is thalessmias

A
  1. Microcytic anemia
    *due to decreased amounts of Hgb
    *will be normal or increased iron levels
    *wont respond to iron treatment
73
Q

What causes a thalassemias

A
  1. Reduction in production of alpha (major) or beta chain (minor)
    *the more deletion the more serious the disease
    *normal Hgb has 4 alpha and 4 beta
74
Q

What are target cells?

A

RBC look like a target sign with a dark spot in their pale centers
*thalassemias

75
Q

What is the key test for diagnosis of thalassemias

A

Hgb electrophoresis

76
Q

What are trait thalassemias

A

Laboratory feature without significant clinical impact
*little or no anemias with strongly low MVC

77
Q

What are intermedia thalassemias

A

There is an occasional RBC transfusion requirement

78
Q

What are major thalassemias

A

The disorder is life-threatening and the patient is transfusion dependent
*many die from an overload of RBC transfusion

79
Q

How to calculate the mentzer index

A

Mean corpuscular volume (MCV) / total RBC
*>13 IDA
*<13 thalassemia

80
Q

What is the cause of siderolastic anemia

A

Acquired or congenital/inherited
*myelodysplasia
chronic alcoholism
****lead poisoning Mc causes

81
Q

What is the pathology behind sideroblastic anemia

A

Condition will reduce the Hgb synthesis causing iron accumulation in the mitochondria
*x-linked condition

82
Q

How can lack of raw material lead to decreased bone marrow production

A
  1. Inadequate levels of folate and B12 result in improper formation and early release of prematurely large RBC (macrocytic)
  2. There will also be an alteration of DNA synthesis in WBCs
    *will be PMN white cells
    *will be hypersegmented neutrophils with 5-6 lobes
83
Q

What are the lab findings of sideroblastic anemia?

A
  1. Basophilic stippling on smear (lead poisoning)
  2. Bone marrow will have “ringed” sideroblastic seen with Prussian blue stain
  3. Resembles anemia of chronic disease except iron levels elevated
84
Q

What causes megaloblastic anemias

A
  1. Abnormalities in DNA synthesis (hypersegmented neutrophils occur)
    *vitamin b 12 deficiency
    *folate deficiency
    *antimtabolite drugs
85
Q

What are the causes of nonmegaloblastic anemias?

A

There will be no hypersegmented neutrophils
1. Alcohol abuse
2. Liver disease
3. Hyperthyroidism
4. Myelodysplastic syndrome

86
Q

Why is vitamin B12 needed

A

For the conversion of inactive form of folate to active
*will help with the formation and function of RBC

87
Q

What would happen to the RBC if there is a B12 or folate deficiency

A

RBC become large (megaloblastic cells)

88
Q

What is needed that is in the stomach that helps with vitamin B12 absorption

A

Parietal cells will secrete a protein called intrinsic factor (IF)
*IF binds to B12 which allow it to be absorbed in the terminal ileum

89
Q

What can a vitamin B12 deficiency also cause

A
  1. Neurological symptoms
    *folate will not have neurological symptoms
90
Q

How will a B12 deficiency present

A
  1. Tingling/paresthesia or burning feelings on the skin
  2. A tongue that is red, shiny, and sore = glossitis
  3. Feeling tired and weak
  4. Problems with memory
91
Q

What are produced against parietal cells

A

Autoantibodies

92
Q

What leads to a reduction of B12 absorption (pernicious anemia)

A

Loss of intrinsic factor
*automimmune gastritis

93
Q

What is the most common cause of B12 deficiency

A

Pernicious anemia
*associated with gastric cancer

94
Q

How can pernicious anemia be diagnosed

A

Labs
*showing IF antibody and anti parietal cell antibody
**Schilling test is rarely performed, antibody testing and rapid radioimmunoassys have replaced schilling

95
Q

Why is folic acid needed?

A
  1. To help with normal function of RBC and WBCs
96
Q

What is the most common cause of Macrocytic anemia?

A

Folic acid deficiency

97
Q

How to determine if there is a folate or a vitamin B12 def

A

Order methymalonic acid (MMA) *test of choice
*elevated MMA indicated B12 def
*folate will be normal

98
Q

What are elevated Homocysteine levels associated with? (HCY)

A

Vitamin B12 of folate def

99
Q

What are the different types of things that can result in anemia? (Loss of RBC)

A
  1. Bleeding
  2. Destruction (hemolysis)
    *external (extracorpuscular) factors: acquired defect
    *Internal (intracorpuscular) factors : problems with RBC itself, hereditary defect
100
Q

A cause of hemolytic anemia would lead to increased production of what?

A

Bilirubin
*when RBC break down unconjugated (indirect) bilirubin forms in the circulation
*indirect bilirubin is elevated in hemolysis

101
Q

What are the causes of extracorpuscular hemolysis

A
  1. Hyperactive spleen
    *inappropriately destroys and removes RBC
  2. Immune hemolytic anemia
  3. Infection
  4. Toxins
  5. Hemolytic syndrome
102
Q

How will a patient present with hemolysis

A
  1. Rapid onset of pallor
  2. Normocytic/normochromic anemia
  3. Jaundice
  4. May have a history of pigmented (bilirubin) gallstones
  5. Splenomegaly
103
Q

What are some findings of hemolysis or hemolytic anemia

A
  1. Indirect bilirubin levels will be elevated
  2. Jaundice will occur
  3. Elevated lactic acid dehydrogenase (LDH)
  4. Increased retic count (reticulocytosis)
    *bone morrow factory starts pumping out immature RBC
104
Q

What are the special tests to detect hemolytic anemia

A
  1. Erythrocyte fragility
    *detects hereditary spehrocytosis
  2. Hemoglobin electrophoresis
    *SCA, thalassemia
105
Q

What underlying problem can cause the production of defective RBC

A
  1. Membrane of RBC (Spherocytosis)
  2. Hemoglobin (sickle, cell)
  3. Metabolic enzyme
    ***function is altered, leads to anemia and inadequate oxygen delivery
106
Q

What is sickle cell disorder

A

Autosomal recessive disorder
*mutation in beta chain of hemoglobin
*deoxygenation will cause a sickle shape
*Hgbs instead of Hgb A

107
Q

What is sickle cell trait

A

Heterozygous Hgb AS
*asymptomatic MC

108
Q

What is the most severe form of sickle cell

A

Homozygous Hgb SS
*both beta chains are affected
*inherit two copies of the sickle cell gene one from each parent

109
Q

What is sickle cell presentation in a patient

A
  1. Healthy infant until around 6 months
    *fever
    *dactylitis
    *splenomegaly then regresses around 4 and no palpable
110
Q

Why does the spleen regress in size around 4 (sickle cell)

A

Bc of organ occlusion, the spleen is not getting proper blood supply

111
Q

What is acute chest syndrome (sickle cell)

A
  1. Sickling in blood vessels deprive lungs of oxygen
    *lung tissue is damaged and cannot exchange
    *chest pain and tachycardia
112
Q

What is aplastic crisis (sickle cell)

A
  1. Causes bone marrow to stop producing new RBC for a while
    *from parvovirus B19
    *will have slapped check syndrome
113
Q

Main sickle cell management

A

Vaccinations SHIN
S: strep pneumonia
HI: Haemophilus influenza
N: neisseria meningitis

*stem cell transplant is only cure for SCD

114
Q

What is hereditary spherocytosis

A
  1. Autosomal dominant
    *there is an issue with the RBC membrane not as malleable which causes them to get stuck in the spleen and destroyed
    *splenomegaly is common
115
Q

What is the hallmark of hereditary spherocytosis

A
  1. Microspherocytes or spherocytes
    *round RBC lacking central clearing
    *increase MCHC (hyperchromic, microcytic anemia)
116
Q

What tests will be + or - (hereditary spherocytosis)

A
  1. Osmotic fragility test +
    *indicated cells easily lyse
  2. High RDW
  3. Coombs test -
    *indicates not an autoimmune process
117
Q

What is the treatment of hereditary spherocytosis

A

Splenectomy
*folate replacement

118
Q

What is pyruvate kinase and the def

A
  1. An enzyme that helps cells turn sugar into energy
    *RBC lack mitochondria so the rely on glycolysis for energy
  2. Deficiency can lead to a deficiency in energy and to premature RBC destruction
119
Q

Absence of pyruvate kinase can lead to what?

A

Damage and death to RBC causing anemia

120
Q

What is Glucose-6-phosphate dehydrogenase deficiency(G6PD Deficiency)

A

Genetic disorder X-linked recessive (males)
*defect in enzyme glucose 6 phosphate dehydrogenase causes RBC to break down prematurely

121
Q

What is G6PD involved with

A

Protecting the RBC against oxidative stress
*oxidative stress is when there is an imbalance of production of free radicals and the ability of the body to counteract or detoxify their harmful effects

122
Q

What does oxidative stress oxidize hemoglobin into

A

Methomeglobin (does not carry oxygen well)
*causes RBC membrane damage (so anemia)

123
Q

Why dos hemolysis occur (G6PD def)

A

In response to infection, drugs, or fava beans

124
Q

What is the presentation of G6PD def

A
  1. Asymptomatic until oxidative stress
  2. Will be self limiting
    *lasts 8-14 days due to compensatory response to produce new RBC with high levels of G6PD
125
Q

People with G6PD def have protection against what

A

Malaria
*more difficult for parasite to invade RBC

Clinical Patient Care 2023 (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions