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Diagnostics > CBC & Iron Studies > Flashcards

CBC & Iron Studies Flashcards

1
Q

Components of CBC

A

WBC, RBC, Hgb, Hct, Mean cell volume, mean cell Hgb, Mean cell Hgb concentration, Platelet count, differential

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2
Q

White Blood Cell Ranges

A

Adult: 5000-10000
Child <2: 6200-17000
Newborn: 9000-30,000 (normalizes over 2 weeks)

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3
Q

White Blood Cell Components

A 
Neutrophils: 40-85%
Lymphocytes: 10-45%
Monocytes: 3-15%
Eosinophils: 0-7%
Basophils: 0-2%
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4
Q

Granulocytes

A

Have granules in cytoplasm and mugltilobed nuclei
AKA PMNs or Polys

Neutrophils, eosinophils, basophils

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5
Q

Agranulocytes

A

Lymphocytes, Monocytes

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6
Q

Abnormal Leukocytes

A

Leukocytosis: >10,000; bacterial infection, inflammation, neoplasm, leukamoid response, glucocorticosteroid use, Left Shift

Leukopenia: <5000, viral, overwhelming bacterial infection, bone marrow failure, drug toxicity, autoimmune

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7
Q

“Left Shift”

A

Elevated WBC count due to increase in neutrophils and bands, often with reciprocal decrease in lymphocytes

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8
Q

Leukemoid Response

A

Development of early neutrophilic cells
WBC >50,000
Benign, typically resolves with condition (as opposed to Leukemia which continues to rise)

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9
Q

Neutrophilia

A

Elevated neutrophil count

Bacterial infections, leukemia, inflammation, medications (steroids, epi), stress

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10
Q

Neutropenia

A

Decreased neutrophil count

Viral infection, aplastic anemia, overwhelming bacterial infection, drugs (chemo, sulfa, thyroid, phenothiazines)

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11
Q

Lymphocytosis

A 
Elevated lymphocyte count
Viral infections (mono/hepatitis), lymphocytic leukemia
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12
Q

Lymphocytopenia

A

Decreased lymphocyte count

Corticosteroids, immunodeficiency diseases (HIV)

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13
Q

Eosinophilia

A

Elevated eosinophil count
“NAACP”
Neoplasm, Allergies, Addison disease, Collagen vascular disease, Parasites; coccidiomycosis

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14
Q

Eosinopenia

A

Decreased eosinophil count

Corticosteroids, acute stress/inflammatory conditions

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15
Q

What does elevated neutrophils mean?

A

BACTERIAL INFECTION

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16
Q

What is a diagnostic sign of mono?

A

Atypical lymphocytes on smear

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17
Q

Leukemoid reaction

A

Leukocytosis over 50,000
peripheral blood smear shows metamyelocytes and bands, rarely myeloblasts
Bone marrow shows more cells but otherwise typical
Acute leukemia bone marrow shows predominance of immature elements

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18
Q

Markedly elevated WBC (low neutrophils, high leukocytes), enlarged cervical/axillary lymph nodes, easily palpable spleen

A

Leukemia

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19
Q

Platelets

A

Normal 150,000-400,000
Crtical <50,000 or >1million
High platelets associated with clotting risk
5-10k needed to maintain vascular integrity

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20
Q

Thrombocytosis

A 
Increased platelets (>400,000)
Malignancy, polycythemia vera, postsplenectomy syndrome, drugs
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21
Q

Thrombocytopenia

A 
Decreased platelets (<100,000)
ITP more common of the 2 types
Could be associated with Leukemia, cirrhosis, DIC, anemia
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22
Q

Idiopathic Thrombocytopenia (ITP)

A

More common in kids/AIDS pts
Autoimmune phagocytosis of platelets
Gums, nose and skin bleeding, petechiae, purpura, epistaxis, menorrhagia
Treated with corticosteroids or splenectomy

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23
Q

Red Blood Cells

A 
AKA erythrocytes
Live 120 days
No nucleus or mitochondria
Production stimulated by erythopoeitin
Extracted by spleen
Range: male 4.7-6.1x10^6, female 4.2-5.4x10^6
24
Q

Main function of RBC

A

transportation of O2

25
Q

Hemoglobin (Hgb, Hb)

A

Male 14-18g/dl, female 12-16

binds and transports Oxygen

26
Q

Hematocrit (Hct)

A

Male 42-52%, female 37-47% (total blood volume made up by RBC)
approx 3x Hgb concentration
Low=anemia, high=polycythemia

27
Q

Anisocytosis

A

Varying size in RBC

Degree correlates with RBC width

28
Q

Poliocytosis

A

varying shape in RBC

29
Q

Target cells

A

Bulls eye appearance on peripheral smear suggesting thalassemia or liver disease

30
Q

Fragmented cells

A

Foreign bodies in blood

31
Q

Abnormalities causing increased RBC

A

Dehydration, COPD, polycythemia

32
Q

Abnormalities causing decreased RBC

A

Anemia (B12, Fe, folate deficient; hemolytic, cirrhosis, bone marrow failure, pregnancy)

33
Q

Polycythemia/Eryhtrocytosis

A

Increased RBC &Hgb/Hct levels

Dehydrationm polycythemia vera, COPD, high altitude

34
Q

Categories of Polycythemia

A

Relative>artifact of concentration, due to decreased plasma volume/dehydration

Absolute>TRUE increase in RBC mass; polycythemia vera, secondary polycythemia

35
Q

Polycythemia Vera

A

Bone marrow disorder-overproduction of erythroid cells
Elevated Hgb/Hct
increased RBC mass (differentiates between relative/absolute)

Dizziness, pruriti following warm shower/bath, blurred vision, engorged retinal veins, thrombosis, splenomegaly

Treated with phlebotomy

36
Q

What is most common hematologic disorder in US?

A

Anemia

37
Q

Anemia

A

Abnormal RBC size and shape
Low Hgb
Spoon nails (Koilonychia) &desire to eat weird things/dirt (Pica)

Causes: Reduced production of RBC, Increased destruction of RBC, loss of RBC

Hemoglobin: <12 females, <14 males

38
Q

RBC Indicies of anemia

A

MCV, MCH, MCHC, RDW

39
Q

Mean Cell Volume (MCV)

A

Measure of avg RBC size
>100-macrocytic (large)
80-99 normocytic
<80 microcytic

40
Q

Mean Cell Hgb (MCH)

A

Weight of Hgb in RBC
>31 Hyper-chromic (bright color)
27-31 normochromic
<27 hypo chromic (pale color)

41
Q

Mean Cell Hgb Concentration (MCHC)

A

Hgb concentration

42
Q

RBC Width (RDW)

A

Measure of variation in RBC size

43
Q

Iron deficient Anemia

A

Microcytic, hypochromic
secondary to chronic blood loss (GI bleed, menstruation)

Results from decrease in serum iron

Decreased production of Hgb

Low serum Fe, transferritin sat, ferritin
High TIBC

44
Q

Lead Poisoning

A

Microcytic hypo chromic with basophilic stippling on smear

45
Q

Thalassemia

A

Hereditary disorder-reduced synthesis of global chains
Minor more common than major-RBC small but normal or elevated count
Smear may have target cells and basophilic stippling

Hemoglobin electrophoresis for diagnosis

46
Q

Normocytic Anemia

A

Normal MCV/normal sized RBC

Anemia of chronic disease (autoimmune, malignancy), renal failure, acute blood loss

47
Q

Microcytic anemia

A

High MCV, big RBC
Vitamin B12 or folate deficiency

Macrocytosis can be caused by alcohol consumption as well

48
Q

Megaloblastic anemia

A

B12/folate deficiency causes inhibition of DNA synthesis during RBC production>cell growth without division (large immature/dysfunction RBC)

49
Q

Pernicious anemia

A

autoimmune destruction of gastric parietal cells>low intrinsic factor>low absorption of B12
Can lead to megaloblastic anemia

50
Q

Iron studies

A

Serum iron, total iron binding capacity, transferring, transferrin saturation, ferritin

70% of body’s iron in hemoglobin, 30% stored as ferritin &hemosiderin

Supplied in diet, 10% of ingested iron absorbed

iron bound to transferrin and carried in bone marrow

51
Q

Serum Iron

A

measurement of quantity of iron bound to transferrin

52
Q

Total Iron Binding Capacity (TIBC)

A

measurement of all proteins available for binding mobile iron
Indirect measurement of transferrin
Increased in 70% of pts with iron deficiency

53
Q

Transferrin

A

Negative acute-phase reactant protein
Decreases in acute inflammatory reactions and chronic illnesses/liver diseases

Produced in liver

54
Q

Transferrin saturation

A

% of transferring and other mobile iron-binding proteins saturated with iron

serum ironx100%/TIBC

<15% in pts with iron deficiency

Increased with hemolytic, megaloblastic and sideroblastic anemia, hemochromatosis

55
Q

Best iron test for hemochromatosis?

A

Transferrin saturation

56
Q

Hemochromatosis

A

Excess iron deposited in liver, heart &other organs, causes severe organ dysfunction

Primary-genetic
Secondary (acquired)-repeating blood transfusion

Low TIBC
High Fe, transferritin sat. ferritin, LFTs

57
Q

Ferritin

A

Marker of iron storage

MOST SENSITIVE TEST FOR IRON DEFICIENCY

low ferritin=decreased iron storage

Acute-phase reactant, elevated with inflammation &infection when no iron stores exist

Diagnostics (7 decks)

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