CBC & Iron Flashcards
1
Q
What 4 values are we looking at when ordering a CBC?
A
- WBC abnormalities
- Hemoglobin abnormalities
- Hematocrit abnormalities
- Platelet abnormalities
2
Q
4 findings for WBC abnormalities
A
- infection
- inflammation
- neoplasm/malignancy
- drug rxns
3
Q
2 findings for hemoglobin/hematocrit abnormalities
A
- anemia
- polycythemia
4
Q
2 findings with platelet abnormalities
A
- bleeding disorders
- hypercoagulable states (excessive clot formation)
5
Q
What are the 2 components of a White Blood Cell Count?
A
- WBC count (total # WBC (leukocytes)
- The Differential (% of each type of leukocyte present in the sample)
6
Q
WBC can be elevated in a certain age. How old and why?
A
Newborns (childbirth is stressful)
*will decline to normal range over 2 weeks
7
Q
What is the most predominent lab value of a WBC Differential (CBC w/diff)?
A
Neutrophils (40-85%)
8
Q
Definition: has granules in their cytoplasm and multilobed nuclei
A
granulocytes
9
Q
What is a PMN?
A
-granulocytes
“polys” (polymorphonuclear leukocytes)
10
Q
-Most common PMN –Primary job is phagocytosis of bacteria
A
Neutrophils
11
Q
Involved in allergic rxns
A
Eosinophils
12
Q
Involved in parasitic reactions and are also known as “mast cells”
A
Basophils
13
Q
A bacterial infection will have elevated what?
A
Neutrophils
14
Q
-Decrease in neutrophils
-Elevated lymphocytes (T and B cells)
What’s going on?
A
Acute viral infection
or
Chronic bacterial infection
15
Q
Capable of fighting bacteria like neutrophils do
A
Monocytes (phagocytic cells)
16
Q
Neutropenia
A
Decrease
17
Q
Neutrophilia
A
Increase
18
Q
Monocytosis
A
Increase
19
Q
Monocytopenia
A
Decrease
20
Q
Eosinophilia
A
Increase (granulocytes)
21
Q
Eosinopenia
A
Decreased
22
Q
Basophilia
A
Increase (granulocytes)
23
Q
Basopenia
A
Decrease
24
Q
The 3 granulocytes
A
- Neutrophils
- Eosinophils
- Basophils
25
The 2 nongranulocytes (agranulocytes)
- Lymphocytes (T and B cells)
| - Monocytes
26
Leukocytosis, what type of infection is happening? (most common)
What cells would be increased?
Bacterial infection
| Cytosis = increase in WBC (neutrophils)
27
Leukopenia, what type of infection is happening?
Viral infection
| Penia= decrease in WBC
28
Which autoimmune disease is related to leukopenia and relates to destruction of WBC?
HIV
29
What does a "left shift" mean?
- bacterial shift
- (leukocytosis)
- acute bacterial infection
30
baby neutrophils
bands
31
With leukocytosis and left shift, what cells decrease? What cells increase?
Lymphocytes decrease
Neutrophils increase (acute bacterial)
32
What increases w/ left shift?
neutrophils and bands
33
- Can be confused w/ leukemia initially
- Elevated WBC
- Development of early neutrophilic cells (metamyelocytes)
- Associated w/infection
- Benign (resolves after condition resolves)
Leukemoid Response
34
Which 5 things cause neutrophilia (elevated neutrophil count)
- Bacterial infections
- Leukemia
- Inflammation (RA)
- Medications
- Stress
*LIMBS*
35
Which 4 things cause neutropenia (decreased neutrophil count)
- Viral infection
- Aplastic anemia
- Overwhelming bacterial infection (the elderly)
- Drugs
36
Which 2 things cause lymphocytosis (elevated lymphocyte count)
- Viral infections (mononucleosis and viral hepatitis)
| - Lymphocytic leukemia
37
Which 2 things cause lymphocytopenia (decreased lymphocyte count)
- Corticosteroids
| - Immunodeficiency diseases (HIV)
38
Which 5 things cause eosinophilia (elevated eosinophil)
- Neoplasm (leukemia)
- Allergic rxn (drug allergies) and allergic CONDITIONS
- Addison's disease
- Collagen vascular disease (autoimmune, lupus)
- Parasites
* NAACP*
AND, in the valley = Coccidiomycosis
39
Which 3 things cause eosinopenia (decreased eosinophil count)
- Corticosteroids (opposite of Addison's disease)
- Acute stress
- Inflammatory conditions
40
Which 2 WBCs DO NOT respond to bacterial or viral infections?
- Eosinophils
| - Basophils
41
If a pt has an allergic rxn (hives), what do we give them?
Glucocorticosteroids (prednisone) for symptomatic relief
42
Increasing WBCs means what about an infection?
Worsening infection
43
Decreasing WBCs mean what about an infection?
Resolving infection
44
If WBC count is abnormal and the clinical picture is benign, what is the next step?
Check medications (may cause increases/decreases in WBC)
45
```
A 15 y/o female presents after being sent home from summer camp for malaise, fatigue, sore throat.
-Hepatomegaly
-Splenomegaly
-Increased lymphocytes
-Decreased neutrophils
What is the dx?
```
Viral infection
| mono or viral pharyngitis
46
What blood test do we get to test for mononucleosis?
Mono Spot
47
What test do we do to test for mononucleosis?
| What is a positive finding?
Peripheral Smear
| Atypical lymphocytes
48
In what type of reaction will you see metamyelocytes and bands on a peripheral blood smear, but RARELY myeloblasts (immature forms)
Leukemoid reaction
49
In what condition would you see bone marrow w/predominance of myeloblasts (immature elements)
Acute leukemia
50
Pt with splenomegaly, WBC count was elevated 2 years ago (pt didn't follow up), currently w/scattered lymph nodes and no sxs (worrisome). Peripheral smear shows increased mature lymphocytes.
What does the patient NOT have?
What is the likely dx..?
This is NOT leukemoid rxn because the WBC was elevated 2 years ago and has since increased)
Leukemia
51
What helps initiate a coagulation cascade?
Platelets (plts)
52
Integral to hemostasis
Platelets (plts)
53
If platelet count is under 50,000 (low) what are we concerned about?
Bleeding
54
If platelet count is over 1 million, what are we concerned about?
Blood clots
55
What platelet count is needed to maintain vascular integrity?
5 - 10K
56
PLT 30 - 50K
moderately increased risk of bleeding
57
PLT greater than 50K
Good, not a problem
58
PLT 10 - 30
severely increased risk of bleeding (but don't transfuse pt unless bleeding)
59
PLT <10K
severely increased risk of bleeding (transfuse)
60
Thrombocytosis
(increased or decreased PLT levels)?
What condition?
Increased PLT levels
| -Malignancy
61
Thrombocytopenia
(increased or decreased PLT levels)?
What condition?
Decreased PLT levels
| -Purpura (either idiopathic or thrombotic)
62
Common in children and AIDS patients
ITP (idiopathic thrombocytopenic purpura)
63
-Pt presents with mucosal/skin bleeding due to low platelets
-petechia, purpura, epistaxis, menorrhagia
-Low platelets
-Other blood counts and peripheral smear is normal
Dx?
ITP (idiopathic thrombocytopenic purpura)
64
Tx and Prognosis of ITP
| -What % will develop chronic ITP?
- Children get better on their own (self limited)
- Tx adults with corticosteroids and if unresponsive possible splenectomy
- 50-60% will develop chronic ITP
65
RBC life span
120 days
66
Key function of RBC
Transportation of O2
67
Reticulocyte life span
| What is it?
"baby RBC"
| 4 days
68
A decreased O2 causes the kidneys to release what?
Erythropoietin
69
What does erythropoietin do?
Triggers stem cell hematopoiesis (leads to increased erythrocyte production) and ideally increased O2.
70
A life span of RBC is 120 days, what happens at the end of its life?
Extracted by the spleen
71
Binds and transports oxygen
Hemoglobin (Hgb)
72
A measure of the total amount of hemoglobin in the blood
RBC count - Hemoglobin
73
- A measure of the % of total blood volume that is made up by RBCs.
- Is approximately 3 times that of Hgb concentration
RBC count - Hematocrit
74
If underhydrated, hematocrit high or low?
High
75
If over-hydrated, hematocrit high or low?
Low
76
RBCs can vary by 2 things.
What is anisocytosis?
What is poiliocytosis?
- Size
| - Shape
77
Anisocytosis correlates with what?
RDW (red diameter width) = size
78
Poiliocytosis suggests what?
A defect in maturation of RBC precursors (shape is affected)
79
A patient has thalasemia or liver disease. What will the cells look like on their peripheral smear?
Target cells
80
A patient has foreign bodies in blood from a heart valve and thermal injury. What will the cells look like on peripheral smear?
Fragmented
81
A patient has Sickle Cell Anemia, what will cells look like on peripheral smear?
Sickle cells
82
Increased RBC count due to what 3 things?
- Dehydration
- COPD
- Polycythemia vera (bone marrow disorder)
83
Decreased RBC count due to what?
Anemia
84
What do these cause?
- B12/Folate deficiency
- Cirrhosis
- Bone marrow failure
- Pregnancy
Anemia
85
-Dehydration
-Polycythemia Vera
-Smoking/COPD
-High altitude
Cause what?
Polycythemia/Erythrocytosis
| increased RBC/Hgb/Hct levels
86
What are the 2 types of polycythemia?
- Relative
| - Absolute
87
What are the 2 types of absolute polycythemia?
- Polycythemia Vera
| - Secondary Polycythemia
88
Artifact of concentration due to decreased plasma volume (dehydration)
- Elevated Hct
- Normal RBC mass
Relative Polycythemia
89
True increase in RBC mass
Absolute polycythemia
90
- Elevated Hct
| - Increased RBC mass
Polycythemia vera (bone marrow disorder characterized by overproduction of erythroid cells)
91
- Increased erythropoietin production
| - Tissue hypoxia is major cause (COPD/living at high altitude)
Secondary Polycythemia
92
```
Hx:
HA, dizziness, tinnitus, blurred vision, fatigue, pruritus following warm shower/bath
PE:
engorged retinal veins
-Thrombosis
-Splenomegaly
Dx?
```
Polycythemia vera
93
-Elevated Hgb/Hct
-Increased RBC mass
-Leukocytosis
-Thrombocytosis
Dx?
Tx?
- Polycythemia Vera
| - tx w/ phlebotomy
