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PNP: Physical Assessment > CBC and Urinalysis > Flashcards

CBC and Urinalysis Flashcards

1
Q

When to order CBC (3)

A
  1. Screening for anemia
  2. Suspected hematological disorder
  3. Toxic child
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2
Q

RBC size (3)

A
  1. Normocytic –> RBC size is normal but there is not enough of them (anemia)
  2. Microcytic –> RBC size is smaller than normal
  3. Macrocytic –> RBC size is larger than normal
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3
Q

Microcytic, Hypochromic (3)

A
  1. Many RBCs smaller than nucleus of normal lymphocytes, increased central pallor
  2. Occurs with iron deficiency, thalassemias, anemia of chronic disease.
  3. The red cells tend to be very small and have central pallor
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4
Q

MCV: Mean Corpuscle Volume (6)

A
  1. Helps you determine size of red cell
  2. Determining low of normal
  3. Age (years + 70)
  4. Only used between 2-10 years old
    - So lower limit of normal is 70
    - Upper limit of normal is 90
  5. Ex: If child is 2, lower limit is 72
  6. If child is 10, lower limit of normal is 80
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5
Q

RDW: Red Cell Distribution Width (4)

A
  1. Coefficient of variation of the red cell volume distribution
  2. How much do the red cells look like each other?
  3. When RDW is elevated, cells don’t look like each other
  4. When RDW is low or normal, ells look like each other
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6
Q

Mentzer Index (3)

A
  1. Determined by MCV/RBC
  2. Value greater than 13 suggests iron deficiency
  3. Less than 13 it suggests thalassemia.
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7
Q

Calculating Hct from Hgb

A

Hct = 3 x Hgb

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8
Q

MCH vs. MCHC

A
  1. MCH: Amount of HgB/RBC
  2. MCHC: Portion of RBC occupied by HgB
  3. CHR =Retic - He
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9
Q

Red Cell Line Shape vs. Size

A

Shape = RDW

Size = MCV

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10
Q

RBC Rule of 3’s

A
  1. Hemoglobin is 3x RBC
  2. Hematocrit is 3x Hgb
  3. The lower limit of normal for the hemoglobin is 11 + (0.1 x age in years)
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11
Q

Seventy Plus One Rule

A

70 + (age in years) is the lower limit of normal for MCV

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12
Q

RDW Levels (3)

A
  1. Normal: 11-14
  2. Thalassemia: slightly over upper limit by 1-2 points or normal
  3. Iron deficiency anemia: 14-25 (very elevated)
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13
Q

CHr (Advia) Or Retic-He (Sysmex) (4)

A
  1. This value measure the amounts of hemoglobin in reticulocyte
  2. Normal value is > 28 picogram (pg)
  3. This is a measure of iron available for producing new RBC’s
  4. Value is reduced in iron deficiency and thalassemia
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14
Q

Causes of Microcytic Anemia

A
  1. Most common: Iron deficiency and Thalassemia
  2. Less Common: Hemoglobin C disease, Hemoglobin D disease, anemia of inflammation, hereditary pyropoikilocytosis (lead poisoning)
  3. Rare: Sideroblastic anemia, Copper deficiency, Pyridoxine deficiency
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15
Q

Causes of Iron Deficiency Anemia: Decreased Absorption (6)

A
  1. Achlorhydria (production of gastric acid in the stomach is absent or low)
  2. Celiac disease
  3. Competing metal
  4. Iron deficiency
  5. Clay
  6. Starch
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16
Q

Causes of Iron Deficiency Anemia: Increased Loss (9)

A

BLEEDING

  1. GI
  2. GU (menses, hemosidinuria)
  3. Lung (pulmonary hemosiderosis)
  4. Joints (hemarthroses)
  5. Factitious
  6. Pregnancy
  7. Frequent blood donation
  8. Newborn exchange transfusion
  9. Iatrogenic
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17
Q

Differential Dx of Normocytic Anemia

A
  1. Blood Loss
  2. Decreased RBC Production
    - Ex: bone marrow isn’t working adequately
  3. Increased RBC Destruction
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18
Q

Physiological Anemia of Term Infant (3)

A
  1. Anemia in the first 2-3 months of life
  2. Not due to iron deficiency
  3. Does not respond to iron therapy
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19
Q

Physiological Anemia of Pre-Term Infant

A

Appears at 1-2 months of age and is often more severe

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20
Q

Normochromic Anemias (5)

A
  1. Hereditary Spherocytosis
  2. Hereditary Elliptocytosis
  3. G6PD deficiency
  4. Aplastic anemia
  5. Acute blood loss
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21
Q

Macrocytic Anemias (4)

A

a. Vitamin B12 deficiency
b. Folate deficiency
c. Liver Disease
d. Loss of reticulocytes (due to hemolysis)

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22
Q

Anemia Lab Values: Electrophoresis (5)

A
  1. Iron deficiency anemia: normal
  2. Thalassemia: increased HbA2 or F
  3. Chronic inflammation: normal
  4. Lead poisoning: normal
  5. Sickle Disease: HbSS
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23
Q

Anemia Lab Values: ESR (5)

A
  1. Iron deficiency anemia: normal
  2. Thalassemia: normal
  3. Chronic inflammation: increased
  4. Lead poisoning: normal
  5. Sickle Disease: low
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24
Q

Anemia Lab Values: Smear (5)

A
  1. Iron deficiency anemia: hypochromic, target cells
  2. Thalassemia: normocrhomic, microcytic
  3. Chronic inflammation: varies
  4. Lead poisoning: basophilic stippling
  5. Sickle Disease: sickle cell
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25
Q

Factors that Interfere with Normal WBC (4)

A
  1. Age- High neutrophil count during first several days of life
  2. Race - African Americans have lower WBC
  3. Minor Illness
    - Widely variable leukocyte count
    - Neutropenia is not uncommon during a viral illness
  4. Measurement Method: inherent errrors
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26
Q

Neutrophils (8)

A
  1. First line of defense against bacterial infection
  2. Major function are phagocytosis and killing microorganisms via enzymatic degredation
  3. High in first few days of life, Decrease rapidly after birth within first few days
    - On the lower side in infancy (20-30% of circulating WBC)
  4. At age 5 years old, equal neutrophils and lymphocytes
  5. At puberty, reaches 70% predominance found in adult
  6. Most abundant type of WBC
  7. Can see granules when stained
  8. Band is the immature neutrophil; Is an acute phase response; goes up with severe infection
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27
Q

Neutropenia vs. Neutrophila Shift

A

Neutropenia: shift to the right

Neutrophila: excess neutrophils; shift to the left

28
Q

Calculating ANC

A

ANC = (Neutrophils + Bands Percentage)(Total WBC Count)

Ex: What is the neutrophil count if WBC is 4,500, with 2 bands, and 10 neutrophils?
ANC= (10+2)(4,500)= (.12%)(4,500)= 540

*Make sure to make neutrophils + bands a percent!

29
Q

Neutropenia Classifications (5)

A
  1. In African Americans, 30% may have 1,000 as normal
  2. Caucasian: 1,500-8,000 normal
  3. Mild Neutropenia: 1,500-1,000
  4. Moderate Neutropenia: 1,000-500
  5. Severe Neutropenia:
30
Q

Causes of Increased Neutrophils (7)

A
  1. Physiological: newborn, stress, exercise
  2. Acute hemorrhage
  3. Acute bacterial infection
  4. Metabolic derangement - diabetes, acidosis, anoxia, burn, seizures
  5. Drugs – epinephrine, steroids, lithium
  6. Connective tissue disease – JIA, IBS
  7. Hematological disorders – cancers, hemolysis splenectomy
31
Q

Neutrophil and Lymph Evaluation (3)

A
  1. Shift to the left: an increase in the number of immature neutrophils (bands and metamyelcote >5% bands)
  2. Absolute lymphocytosis
    - Physiologic → 2 months-4 years
    - Increased in Pertussis, TB, Mononucleosis, CMV, Measles, Adenovirus, Syphilis
  3. Lymphopenia
32
Q

Lymphocytes (3)

A

T and B cells

  1. Coordinate/execute immune response via release of inflammatory cytokines
  2. Bone marrow/thymus are primary lymphoid organs
  3. Secondary organ is spleen
33
Q

Lymphocytosis (with causes) vs. Lymphopenia

A

Lymphopenia: less than 1,000

Lymphocytosis: over 5,000

  • Response to acute viral infections
  • Chronic infectious states such as TB, Syphillis
  • Also seen in ALL, Non Hodgkin’s Lymphoma
34
Q

Leukocytes (5)

A
  1. Large cells with blue-gray cytoplasm
  2. Reniform (kidney) shaped (i.e. folded nuclei)
  3. Efficient at digestion of fungi and microbacteria
  4. Return of Monocytes precedes return of neutrophils by 1-2 days
  5. May see some monocytosis when child is recovering from an infection
35
Q

Basophils (6)

A
  1. Contain large cytoplasmic granules and sulfated acidic proteins
  2. Express IgE receptors
  3. Main function is allergy
    - Type I allergic reaction – elevated IgE and histamine release
  4. Release histamine when stimulated
  5. Above 150u/L = basophilia which is associated with hypersensitivity reactions
  6. Basophilia may also be due to viral infections (Varicella, Flu, TB)
36
Q

Eosinophils (5)

A
  1. Bilobed nucleus with a red granulocyte filled cytoplasm
  2. Fight parasites
  3. Control Allergic Reactions
  4. Eosinophilia (over 500 cells/mm) is usually seen when Eosinophils make up more than 10% of WBC’s
  5. Hypereosinophilia persisting for months can cause tissue damage
37
Q

Causes of Eosinophilia (5)

A 
Neoplasm
Addison's Disease
Asthma/Allergy
Collagen Vascular (autoimmune) disease
Parasites
38
Q

Platelet Line (3)

A
  1. Life span of platelets is 8-9 days
  2. One third are sequestered in the spleen
  3. Normal count is 150,000-450,000
39
Q

Pseudothrombocytopenia (3)

A
  1. Articifially low count due to clumping
  2. Suspect if there is a low platelet count and patient is well
  3. Clumps of platelets on a blood film from EDTA specimen; generally from EDTA preservative from purple-top tubes
40
Q

Platelet Levels and Bleeding (5)

A
  1. Over 100,000 - no bleeding
  2. 50,000-100,000 - mild bleeding with trauma
  3. 20,000-50,000 - mild cutaneous bleeding
  4. 5,000-20,000 - moderate cutaneous and mucosal bleeding
  5. less than 5,000 - potentially severe CNS bleeding
41
Q

MPV (4)

A

MPV is Platelet Size

  1. Normal: 7-10
  2. Giant: >13
    - Due to Inherited Syndrome
  3. Decreased:
42
Q

Thrombocytosis

A

acute phase reactant; platelet count >450,000/mm3

43
Q

Chediak Higashi Syndrome

A

WBC morphology

Giant azurophillic granules in lymphocytes

44
Q

Dohle Bodies

A

WBC; Bluish cytoplasmic inclusions in neutrophils in bacterial infections, burns, myelodysplasia, pregnancy

45
Q

In utero hemoglobin (HbF) chains

A
  1. Two alpha globin chains

2. Two gamma globin chains

46
Q

Hemoglobin A (HbA) chains

A
  1. Two alpha chains

2. Two beta chains

47
Q

Hemoglobin A2 chains

A
  1. Two alpha chains

2. Two delta chains

48
Q

Reasons for Ordering Reticulocyte Count (6)

A
  1. Normocytic anemia
  2. Acute blood loss (usually doubling of reticulocyte count in first 24 hours)
  3. Problems with bone marrow
  4. Response to anemia therapy
  5. Infections
    - Parvovirus causes aplasia of bone marrow sinc there is no new RBC production for 7 days
  6. Drugs causing hemolysis or bone marrow aplasia
49
Q

Reticulocyte Production Index (6)

A
  1. Corrects the reticulocyte count for the degree of anemia
  2. Evaluates whether the bone marrow’s response is appropriate
  3. Percentage; number of reticulocytes as a percentage of the RBCs
  4. With anemia, the patient’s red blood cells are depleted, creating an enormously elevated reticulocyte count
  5. Reticulocyte production should increase in response to any loss of RBCs
  6. Increase within 2-3 days of hemorrhage; will peak in 6-10 days
50
Q

Two ways to calculate RPI

A
  1. RPI = (reticulocyte count x patient’s hemoglobin)/(normal hemoglobin x 5)
  2. RPI = (Hematocrit/Normal Hematocrit)
51
Q

RPI Percentages (3)

A
  1. RPI >3: Increased production of reticulocytes suggesting either hemolysis or blood loss
  2. RPI
52
Q

Lab signs of hemolysis

A
  1. Increased lactate dehydrogenase (LDH)
  2. Increased unconjugated bilirubin
  3. Decreased serum haptoglobin
  4. RBC indices demonstrate an increase in MCHC
53
Q

Normal urine pH

A

4.5-8.5

54
Q

Alkaline urine with causes (4)

A

> 7.0

  1. Bacteriuria (UTI)
  2. Renal failure
  3. Presence of antibiotics, sodium bicarbonate
  4. Diet high in vegetables, citrus fruits and dairy products
55
Q

Nitrite and Leukocyte Esterase Dipstick (3)

A
  1. Negative nitrite result does not rule out UTI (poor sensitivity)
  2. Positive result is likely true-positive
    * High specificity
  3. Leukocyte esterase
    * More sensitive (positive in disease) indicator of infection than nitrates
    * Better when tested using catheterized, rather than a bagged specimen
56
Q

Urine Dipstick: Glucose/Bilirubin (3)

A
  1. Urine should not contain glucose
  2. False positive can occur with ascorbic acid
  3. Most common reason for positive bilirubin is old or poorly sealed dipsticks
57
Q

Urine Dipstick: Protein Levels (5)

A

Measures Albumin

  1. Trace (about 15mg/dL)
  2. 1+ = about 30mg/dL
  3. 2+ = about 100mg/dL
  4. 3+ = about 300mg/dL
  5. 4+ = 2,000 mg/dL or greater
58
Q

Dipstick Interpretation with Proteinuria (2)

A
  1. If the urine sample as specific gravity of less than or equal to 1.015, then 1+ is considered positive
    * If urine is dilute, then 1+ is positive
  2. If the urine specimen has a specific gravity of greater than or equal to 1.015, then greater than or equal to 2+ is positive
    * If urine is concentrated, then 2+ is positive
59
Q

Urine Protein/Creatinine Ratio

A

Normal ratio is

60
Q

Urine Albumin/Creatinine Ratio (3)

A
  1. Normal albumin secretion is less than 20 mg/d
  2. 30-300 mg/d is abnormal and not detected by dipstick = microalbuminuria
  3. Ratio of > .03 mg of albumin per milligram of albumin is abnormal
61
Q

Normal range of urine specific gravity

A

1.005-1.030

62
Q

Asymptomatic Microscopic Hematuria

A

In cases of asymptomatic microscopic hematuria, do a spot urine to determine ratio of calcium to creatinine
*Most common cause is hypercalcuria

63
Q

Ferritin

A

Measure of iron levels and is an acute phase reactant

*Can be high with inflammation and infection

64
Q

When is FEP elevated? (3)

A

Lead poisoning
Chronic disease
Iron deficiency

65
Q

Causes for acidic urine (6)

A

Less than 7

  1. Acidosis
  2. Presence of certain drugs
  3. Out of control DM
  4. Starvation
  5. Diarrhea
  6. High-protein diet

PNP: Physical Assessment (21 decks)

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