CBC/CMP Flashcards
1
Q
WBC count in younger children
A
Higher than adults
2
Q
Differential (most-least)
A
Neutrophils, Lymphocytes, monocytes, eosinophils, basophils.
3
Q
Granulocytes
A
Neutrophils, Eosinophils, Basophils. Also called PMNs.
4
Q
Neutrophils
A
Bacterial infections. Immature neutrophils are called bands.
5
Q
Eosinophils
A
Allergic reactions and parasitic infections
6
Q
Basophils
A
Allergic reactions. Also called mast cells.
7
Q
Lymphocytes
A
T and B cells. Fight acute viral infections.
8
Q
Monocytes
A
Phagocytes towards bacteria.
9
Q
Leukocytosis
A
Elevated WBC. Bacterial infection, inflammation, neoplasm, leukemoid response, steroid use
10
Q
Leukopenia
A
Viral infection, over-whelming bacterial infection, bone marrow failure, drug toxicity, autoimmune disorder.
11
Q
Bacterial infection CBC
A
Leukocytosis with a left shift. Increased neutrophils with bands (immature neutrophils). Commonly seen with a decrease in lymphocytes.
12
Q
Leukemoid Response
A
Markedly elevated WBC count. Development of metamyelocytes. Often associated with infection but is benign and resolves on it’s own.
13
Q
Neutrophilia
A
Bacterial infection, leukemia, inflammation (RA, thyroiditis), medications (steroids, epi), stress, trauma, metabolic disorders (DKA, gout, eclampsia).
14
Q
Neutropenia
A
Viral infection, aplastic anemia, overwhelming bacterial infection (increased bands), drugs (chemo, sulfa, antithyroids, phenothiazines), radiation.
15
Q
Lymphocytosis
A
Viral infections, ALL, mononucleosis (atypical lymphocytes).
16
Q
Lymphocytopenia
A
Corticosteroids, immunodeficiency, leukemia, radiation, sepsis.
17
Q
Eosinophilia
A
Neoplasms (leukemia), allergic reactions/conditions, addison’s disease, collagen vascular disease, autoimmune diseases (SLE), parasites, coccidiomycosis.
18
Q
Eosinopenia
A
Corticosteroids, acute stress, inflammatory conditions
19
Q
Monocytosis
A
Chronic inflammatory disorders (ulcerative colitis), collagen vascular disease, viral infection, parasites, TB.
20
Q
Monocytopenia
A
Corticosteroids
21
Q
Basophilia
A
Myeloproliferative disease, CML.
22
Q
Basopenia
A
Acute allergic reactions, hyperthyroidism, stress.
23
Q
Increased RBC count
A
Dehydration, COPD, polycythemia vera.
24
Q
Decreased RBC count
A
Bleeding, iron deficiency, B12/folate deficiency, hemolytic anemia, cirrhosis, bone marrow failure, pregnancy.
25
MCV
Average RBC size
26
MCH
Weight of Hb in the RBC
27
MCHC
Hb concentration in the RBC
28
RDW
Measures the variation in RBC size.
29
Anisocytosis
Varied RBC sizes
30
Critical Hb/Hct levels
Consider transfusion at Hb
31
Iron deficiency anemia
Microcytic hypochromic. Usually secondary to chronic bleeding.
32
Lead Poisoning anemia
mild microcytic hypochromic with basophillic stippling.
33
Thalassemia
Microcytic anemia. Total RBC count may be normal. Target cells. Diagnosised with Hb electrophoresis.
34
Macrocytic anemias
B12 and folate deficiencies
35
Normocytic anemias
Anemia of chronic disease, renal failure, acute blood loss
36
Polycythemia
Polycythemia vera, COPD, Smoking, high altitude
37
Polycythemia vera
bone marrow disorder. Increased RBC mass, leukocytosis and thrombocytosis. HA, dizziness, tinnitus, blurred vision, fatigue, pruritis, engorged retinal vessels, thrombosis, splenomegaly. Treated with phlebotomy.
38
Platelet Critical Value
less than 50,000. Spontaneous bleeding will occur at
39
Thrombocytosis
Malignancy, polycythemia vera, post-splenectomy, drugs (estrogen).
40
Thrombocytopenia
ITP, TTP, leukemia, cirrhosis, DIC, anemia (hemolytic, pernicious)
41
Idiopathic Thrombocytopenia Purpura
Autoimmune disorder commonly seen in children. Mucosal/skin bleeding, petechia, purpura. Usually self limited, can treat adulst with corticosteroids. Possible splenectomy
42
BUN Critical value
Greater than 100
43
BUN measures
(Blood Urea Nitrogen) Liver and kidney function. Urea is formed in the liver as a byproduct of protein metabolism then excreted by the kidneys.
44
Azotemia
Retention of nitrogenous waste. Increased BUN and creatinine.
45
Increased BUN
Renal disease, excess protein intake, GI bleed, dehydration.
46
Decreased BUN
Over hydration and primary liver disease
47
Hepatorenal Syndrome and BUN
BUN may be normal because not as much is being produced but less is being excreted.
48
Creatinine (Cr) Critical Value
Greater than 4
49
Creatinine physiology
Product of creatine phosphate which is used in skeletal muscle contraction. Levels increased throughout the day and after high protein meals. Levels are related to muscle mass.
50
Creatinine measures
Directly proportional to kidney function. Approximation of GFR. Serum concentrations tend to rise late so not a good real time estimate.
51
BUN/Creatinine Ratio Measures
Kidney and Liver function. Increased ratio= decreased RBF.
52
Increased BUN/Creatinine ratio
Prerenal azotemia (renal hypoperfusion), GI bleed, High protein diet, sepsis, hypermetabolic state, ileal conduit, drugs.
53
BUN/Cr of >30
GI bleed
54
Decreased BUN/Creatinine Ratio
Malnutrition, low protein diet, ketoacidosis, hemodialysis, SIADH, drugs.
55
Acute Kidney Injury Creatinine levels
Serum creatinine > 0.5 or an increase > 50%
56
BUN/Cr > 20/1
Prerenal azotemia
57
Prerenal Azotemia Causes
Hypovolemia, shock, burns, dehydration, CHF, MI, GI bleed, excessive protein intake, tube feeding, sepsis, excessive protein catabolism (starvation).
58
BUN/Cr of 10/1
Intrinsic Azotemia
59
Normal BUN/Cr ratio
6-25
60
Intrinsic Azotemia
Acute tubular necrosis, nephrotoxins (NSAIDs, aminoglycosides, contrast, vancomycin), Glomerularnephritis, Vascular diseases (polyarteritis nodosa).
61
Post renal azotemia
BUN/Cr ratio is variable. Blood clot, stones, sickle cell, prostatic hypertrophy, malignancy, neuropathic bladder, urethral stricture.
62
Chloride Critical Value
Less than 80 and more than 115.
63
Chloride functions
Extracellular anion that maintains electrical neutrality, water balance, buffer (as CO2 increases Cl shifts into cells), part of the anion gap.
64
Total Protein
Albumin+Globulin+prealbumin. Most significan component of osmotic pressure in the vasculature.
65
Albumin Functions
Maintains colloidal pressure (60% of total protein), transports important blood constituents.
66
Albumin Measures
Hepatic function (formed in liver with half life of 12-18 days) and is a measure of nutritional status.
67
Decreased Albumin
Burns, Post-op, malnourishment, liver disease, third spacing (lost in extravasculature), protein losing enteropathies (crohns or celiac), protein-losing nephropathies (nephrotic syndrome).
68
Increased Albumin
Dehydration
69
Prealbumin Measures
Early indicator of nutritional status (3 day half life), negative acute phase reactant (inverse relationship with CRP).
70
Globulins Physiology
Made in the bone marrow and lymph tissue. Building blocks for antibodies, acute phase reactants and transporters.
71
Normal/Elevated Globulin with low albumin
Collagen vascular disease or chronic liver disease.
72
Normal Albumin/Globulin Ratio
Usually exceeds 1
73
Serum Protein Electrophoresis
Seperates serum proteins based on electrical charge.
74
Multiple Myeloma
M-spike in beta or gammaglobulin. Bence-jones protein in the urine. Cancer of the plasma cells.
75
Calcium Critical Value
Less than 6 or more than 13
76
Calcium Physiology
Absorbed through the GI tract (vitamin D) then stored in the bone and excreted by the kidney. Total calcium= Free/ionized calcium + bound clacium (albumin). Dependent on PTH and vitamin D levels.
77
Calcium monitoring
Renal failure, hyperparathyroidism, malignancies.
78
Hypercalcemia
Hyperparathyroidsim, Malignancy (mets to the bone), chronic renal failure, excess vitamin D, granulomatous infections (sardoidosis, TB).
79
Hypercalcemia Presentation
Muscle weakness, lethargy, coma, HTN, EKG abnormalities, polyuria, polydyspia, kidney stones, anorexia, N/V, constipation.
80
Hypocalcemia
Hypoalbuminemia, large blood transfusion (citrate additives), intestinal malabsorption, renal failure, rhabdolomyolysis, alkalosis, acute pancreatitis, Hypomagnesium.
81
Hypocalcemia Presentation
Parasthesias, muscle cramps, hyperreactive reflexes, carpopedal spasms. Tetany: chvostek's and trousseau's signs.
82
Chvostek's Sign
Tapping the facial nerve against the jawbone results in the contraction of the facial muscles.
83
Trousseau's Sign
Occluding the brachial artery for 3 minutes with a BP cuff induced carpal spasms.
84
Magnesium Critical Values
Less than 0.5 or more than 3.
85
Magnesium physiology
Intracellular. Bound to ATP. Tied closely to calcium and potassium levels to maintain intracellular charge. Regulated by the kidneys along with calcium.
86
Loop diuretics and magnesium
Decreased magnesium reabsorption
87
Hypomagnesium
Malnutrition, malabsorption, alcoholism, diarrhea, treatment of DKA, CHF, Hypocalcemia, Hypokalemia, toxemia of pregnancy.
88
Hypomagnesium Presentation
Hyperactive reflexes, paresthesias, muscle weakness, tremors, tetany, prolonged PR and QT intervals with QRS widening.
89
Hypermagnesium
Renal insufficiency, addison's disease, hypothyroidism, ingestion of excess magnesium.
90
Hypermagnesium presentation
Hyporeflexemia, muscle weakness, confusion, hypotension, arrhythmias.
91
Phosphate critical value
less than one
92
Phosphate Physiology
Mostly intracellular. Combined with calcium in the bone. Absorbed in the small bowel. Levels are determined by calcium metabolism, PTH and renal excretion. Usually excretion=dietary intake. Inverse relationship with calcium.
93
Increased Phosphate
TPN, treatment of DKA, ETOH withdrawal, hypoparathyroidism.
94
Decreased Phosphate
Hyperparathyroidism, renal failure, increased dietary intake, acromegaly.
95
Alkaline Phosphatase (ALP) physiology
Found in the liver (kupffer cells), biliary tract and bone. ALP is released in the bile. New bone growth increases ALP levels.
96
Increased ALP
Extra/intrahepatic obstructive biliary disease, cirrhosis, osteoblastic mets, paget disease, RA, hyperparathyroidism. Small increases are caused by hepatic tumor, hepatotoxic drugs, hepatitis, mets to the liver.
97
Alanine Aminotransferase (ALT) Physiology
Found mainly in the liver with smaller amounts in the kidneys, heart and skeletal muscle. Injury/disease=release of ALT.
98
Elevated ALT
Hepatocellular disease
99
AST/ALT ratios
less that 1=hepatocellular disease
| Greater than 1= viral hepatitis
100
Aspartate Aminotransferase (AST) Physiology
Exists within liver cells. Hepatocellular injury causes release of AST in proportion to the number of cells damaged. Elevation usually occurs within 8 hours of the injury, peak at 24-36 and return to normal within 3-7 days.
101
Increased AST
Acute hepatitis (20x), Acute extrahepatic obstruction (10x), Cirrhosis.
102
Bilirubin Critical Value
Greater than 12
103
Bilirubin Physiology
Produced from the breakdown of RBC. Heme is transformed into unconjugated bilirubin (70-85%) and is then conjugated in the liver and excreted into the bile ducts.
104
Jaundice
total bilirubin > 2.5
105
Physiologic Jaundice of the newborn
1-12
106
Elevated Unconjugated (indirect) bilirubin
Hepatocellular dysfunction. Hepatitis, RBC hemolysis.
107
Elevated conjugated (direct) bilirubin
Gallstones or tumor.
