CBC Labs and Abnormalities Flashcards
Pernicious Anemia/B12 Deficiency complications
Nerve damage, dementia
Macrocytic, Normochromic, High RDW Anemias
Pernicious Anemia
B12 Deficiency
Folate Deficiency
Folate Deficiency Lab Findings
Decreased: Hgb, Hct, RBC, Folate
Normal: Reticulocytes or low
Increased: MCV, RDW
Pernicious Anemia/B12 Deficiency Lab Findings
Decreased: Hgb, Hct, RBC, B12
Normal: Reticulocytes or low
Increased: MCV, RDW, MCH, MCHC
What is the gold standard test for diagnosing Macrocytic Anemia?
Hgb electrophoresis
What drugs can cause drug-induced macrocytosis?
Carbamazepine, zidovudine, valproic acid, phenytoin, alcohol
Zidovudine - HIV NRTI
What is the MCV level for Macrocytic Anemia?
MCV >96 or >102 if elderly
What causes normocytic, normochromic anemias with normal RDW?
Acute blood loss, ACD, hemolysis, volume overload (pregnancy, parenteral overhydration)
What type of anemia is seen in Anemia of Chronic Disease (ACD)?
Normocytic, normochromic anemia
What disorders/conditions are associated with Anemia of Chronic Disease?
Temporal arteritis, rheumatoid arthritis, chronic inflammation, chronic infection, renal EPO
Common lab findings in Anemia of Chronic Disease
Anemia moderate
Hgb 7-11 mg/dl
Decreased: Hgb, Hct, Serum Fe, TIBC, RBC
Normal: Serum Ferritin Normal MCV, MCHC, Saturation%, RDW
What is the MCV level for Microcytic Anemia?
MCV <80
What are the common conditions associtated with Microcytic Anemia?
Iron Deficiency Anemia (IDA)
Thalassemia
Plumbism (lead poisoning)
What causes microcytic, hypochromic anemia with a high RDW?
IDA
Plumbism
What causes microcytic, hypochromic anemia with a normal RDW?
Thalassemia
Common lab findings in Thalassemia
Increased: Possibly RBCs
Normal: RDW, RBC, Serum Fe, Saturation%, Ferritin, TIBC, MCHC (or low)
Decreased: Hgb-slightly, Hct, MCV, MCH, MCHC
Thalassemia diagnostic findings
Hgb electrophoresis: Normal
Peripheral Blood Smear:
Anisocytosis (variation in size) Poikilocytosis (variation in shape)
Target cells=stressed RBCs that did not delete nucleus
Management of Thalassemia
Transfusions
Do not supplement with iron
Refer to hematology
What type of anemia and RDW findings are seen in Iron Deficiency Anemia?
Microcytic hypochromic anemia with a high RDW
What are the common lab findings in Iron Deficiency Anemia?
Decreased: Hgb, Hct, RBC, MCV, MCH, MCHC, Serum Fe, Saturation%, Ferritin, Reticulocytes
Increased: TIBC, RDW
What is the only anemia that presents with an increased TIBC?
Iron deficiency anemia
Physiologic causes of IDA
Menstruation, pregnancy, postpartum
Pathological causes of IDA
Blood loss in GI tract
R/O colon cancer
Normal Serum Ferritin range
Normal serum ferritin: 22-322 ng/ml
What diagnostic is highly specific for IDA?
Serum Ferritin
<20 ng/ml for males
<10 ng/ml for females
IDA treatment
Supplement with iron
150-200 mg of elemental iron daily
Hct value to consider transfusions for anemia
Hct <27%
When identifying causes of macrocytic anemia, what two labs should always be ordered together?
B12 level
Folate level
What are the first tests in diagnosing anemia?
CBC, Hgb, Hct, MCV, and reticulocyte counts
Hgb/Hct values in anemia
Males: Hgb <13g/dL, Hct<38%
Females: Hgb<12g/dL, Hct<35%
Causes of low Hgb
IDA, B12 or folate deficiency, BM damage, leukemia, lymphoma, acute or chronic blood loss, RBC hemolysis, overhydration
Causes of high Hgb
Dehydration, renal problems, pulmonary disease, heart disease, PV
What are reticulocytes?
Immature RBCs
Circulate in blood for 1-3 days before maturing
What causes Sickle Cell Anemia?
Autosomal recessive disorder
HbSS: Inherits gene from both parents
Typical presentation of Sickle Cell Anemia
Chronic anemia due to hemolysis
Onset usually first year of life
Dactylitis usually first symptom (Hand-foot syndrome)
Acute episodes of painful vaso-occlusive crises
Low grade fever, splenomegaly, extreme pain and exacerbations
Diagnostic tests for sickle cell anemia
CBC, hgb electrophoresis, gene studies
Common lab findings in sickle cell anemia
HgbS comprises 85-98% of Hgb
Decreased: Hct (20-30), Hgb 6-11
Normal: MCV
Increased: Reticulocyte, Bilirubin, Leukocytosis, Liver enzymes
Nucleated RBCs present
Screening/Prevention for SCD patients
Infection:
Pneumococcal vaccines
Prophylactic oral PCN daily until 5yo
Vascular complications:Stroke-annual transcranial u/s starting at 2yo until 16+yo
Renal complications:
Proteinuria-annual spot urine testing with nephrology referral if indicated
Ischemic retinopathy - annual ophthalmologic exam starting at 10yo
Managing acute SCD complications
Vaso-occlusive crisis: If complicated by aplastic crisis, neuro/pulmonary/abd s/s, septic—>Send to ED
STAT pain management
Mild: NSAIDs, Severe: Opioids
Acute Chest Syndrome: Cough/SOB with lung infiltrates, fever; Emergency, need ABT
Infection risk with impaired/lack of spleen function. Empiric ABT for T>101F or s/s of infection
Liver/Gallbladder issues: Cholelithiasis, cholecystitis. Tx same as non-SCD patients
Continuous treatment for sickle cell disease
Hydroxyurea: Increases fetal Hgb (HgbF - immune to sickling). Tx adults if frequent crises; Offer children tx at 9+mos to reduce complication risk
Chronic Transfusions: Improve anemia, reduces complications; need frequent IV access, r/f transfusion reactions or iron overload;
Requires management by SCD specialist
S/S of severe acute complications of SCD crisis
Acute chest syndrome, acute chest pain, hypoxemia, stroke symptoms, retinopathy, pulmonary HTN, hepatomegaly, cardiomegaly, systolic murmurs
S/S of chronic hemolytic anemia
Fatigue, gallstones, splenomegaly, poorly healing ulcers on tibial region, irritable, dizziness, tachycardia, SOB, pallor, jaundice, slow growth
Folate deficiency treatment
Folate 1 mg PO daily x 4 months or indefinitely if cause is not identified
B12 deficiency treatment
Cyanocobabamin 800-1000 mcg IM qd for 1-2 weeks, then 100-1000 mcg weekly until H/H stabilizes; continue 100-1000ug IM q mo. for life
When should anemias begin to correct with proper treatment?
1 week evidenced by increased reticulocyte counts
Sickle cell anemia management
Rehydration Oxygen Possible transfusions Folic acid supplementation Hydroxyurea Diet rich in complex B vitamins and vitamin C
G6PD Deficiency
Hereditary enzyme defect
Decreased ability of RBCs to deal with oxidative stresses causing an episodic hemolytic anemia
Affects African Americans, Mediterranean, and Asians
What type of anemia is seen in G6PD deficiency?
Hemolytic anemia
What causes aplastic anemia?
Can be idiopathic, drugs, chemical exposure, B12 deficiency, and folate deficiency
Common lab findings in aplastic anemia
Sever anemia, neutropenia, thrombocytopenia
Decreased: Hgb, Hct, RBC, Reticulocyte, PLTs, neutrophils
Normal: MCV, Fe, Saturation%, Ferritin, TIBC
4 most common causes of abnormal WBCs
1-Infection
2-Steroids
3-Cancer/Leukemia
4-Catastrophic events (MI, PE, Surgery)
Leukocytosis
Increase in WBC >11,000
Leukocytosis management considerations based on range
> 100k = Send to ER
20,000 + symptoms = urgent, need tx
15,000-20,000 without great symptoms: May monitor, repeat, trend (depends on type of elevations)
Diagnostics for leukocytosis/leukopenia
WBC with differential, peripheral blood smear
Leukopenia
Decrease in WBC <4000
Causes of leukopenia
Bone marrow deficiency/failure, chemotherapeutics, autoimmune disorders (lupus), liver/spleen disease, radiations, mononucleosis, cancers of BM, very severe bacterial infections (sepsis), severe emotional or physical stress, ethnic/genetic trait
Drugs that might cause leukopenia
Antibiotics, anticonvulsants, antithyroid, captopril, chemotherapy, chlorpromazine, clozapine, diuretics, H-2 agonists, sulfonamides, quinidine (tx Afib/flutter, anti-parasite, brand Nuedexta), terbinafine, ticlopidine (blood thinner)
What types of WBCs are granulocytes or polymorphonuclear?
Neutrophils, basophils, eosinophils
What types of WBCs are agranulocytes or mononuclear?
Monocytes, lymphocytes
What are the low and high WBC values that need urgent treatment?
WBC <500 or >30000/mm3
What are the lab characteristics of neutrophilia with a degenerative shift to the left?
Neutrophils >8000/mm3
Increase in bands with no leukocytosis
Poor prognosis
What are the lab characteristics of neutrophilia with a regenerative shift to the left?
Neutrophils >8000 mm3
Increase in bands with leukocytosis
Good prognosis
What are the lab characteristics of neutrophilia with a shift to the right?
Decrease in bands (immature)
Increase in segs (mature)
What is the ratio of segmented neutrophils to bands?
Segs:Bands 3:1
Neutropenia value
Neutrophils <1800/mm3
Agranulocytosis
Marked neutropenia & leukopenia
Dangerous & often fatal
Requires reverse isolation
What are the primary causes of increased eosinophils?
Allergic response
Parasitic infections
How is eosinophilia classified?
Increase in eosinophils >5% or >500/mm3
How is eosinopenia classified?
Decrease in eosinophils <50/mm3
What are the primary causes of increased basophils?
Parasitic infection
Some allergic disorders
How is basophilia classified?
Basophils >50/mm3
How is basopenia classified?
Basophils <15-20/mm3 but very few is common
How is monocytosis classified?
Monocytes >500/mm3 or >10% of WBCs
What is the primary cause of increased lymphocytes?
Viral infections
What are the three types of lymphocytes?
T cells, B cells, NK cells
Helper T cells: help other cells mature and activate and function (cytokine production) Cytotoxic T cells: destroy Memory T cells: remember antigens Plasma B cells: antibodies Memory B cell: remember past infections NK cells: similar to cytotoxic T cells
How is lymphocytosis classified?
Lymphocytosis
Lymphocytes >4000/mm3 in adults;
>7200/mm3 in children
>9000/mm3 in infants
How is lymphopenia classified?
Lymphopenia
Lymphocytes < 1000/mm3 in adults
< 2500/mm3 in children
<500 very susceptible to infection
Monocytopenia causes
Aplastic anemia, steroids, AML, myelotoxic drugs
Monocytosis causes
Myeloproliferative disorder (CML), TB, chronic inflammation, stress response, Cushing syndrome, sarcoidosis, viral infection
What are the primary causes for neutrophilia?
Bacterial infection
Acute inflammation
Platelets and pregnancy
Pregnant women may have mild to moderate (75-150) thrombocytopenia
How is thrombocytopenia classified?
Platelets <150k/mm3
Causes of thrombocytopenia
BM issues, PLTs dying, heparin induced, leukemia, infection, lupus
Management of thrombocytopenia
Stop offending agents
Limit activity/prevent injury
Educate: No NSAIDs, ASA, ginkgo biloba
Refer to hematology
How is thrombocytosis classified?
Platelets >400/450k/mm3
Causes of thrombocytosis
May be myeloid malignancy (primary thrombocytosis [PT]) or a secondary process related to various clinical conditions including IDA, surgical asplenia, infection, chronic inflammation, hemolysis, tissue damage, and non-myeloid malignancy (reactive thrombocytosis [RT]).
