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Spring 2022 > CBC Labs and Abnormalities > Flashcards

CBC Labs and Abnormalities Flashcards

1
Q

Pernicious Anemia/B12 Deficiency complications

A

Nerve damage, dementia

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2
Q

Macrocytic, Normochromic, High RDW Anemias

A

Pernicious Anemia
B12 Deficiency
Folate Deficiency

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3
Q

Folate Deficiency Lab Findings

A

Decreased: Hgb, Hct, RBC, Folate

Normal: Reticulocytes or low

Increased: MCV, RDW

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4
Q

Pernicious Anemia/B12 Deficiency Lab Findings

A

Decreased: Hgb, Hct, RBC, B12

Normal: Reticulocytes or low

Increased: MCV, RDW, MCH, MCHC

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5
Q

What is the gold standard test for diagnosing Macrocytic Anemia?

A

Hgb electrophoresis

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6
Q

What drugs can cause drug-induced macrocytosis?

A

Carbamazepine, zidovudine, valproic acid, phenytoin, alcohol

Zidovudine - HIV NRTI

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7
Q

What is the MCV level for Macrocytic Anemia?

A

MCV >96 or >102 if elderly

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8
Q

What causes normocytic, normochromic anemias with normal RDW?

A

Acute blood loss, ACD, hemolysis, volume overload (pregnancy, parenteral overhydration)

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9
Q

What type of anemia is seen in Anemia of Chronic Disease (ACD)?

A

Normocytic, normochromic anemia

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10
Q

What disorders/conditions are associated with Anemia of Chronic Disease?

A

Temporal arteritis, rheumatoid arthritis, chronic inflammation, chronic infection, renal EPO

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11
Q

Common lab findings in Anemia of Chronic Disease

A

Anemia moderate
Hgb 7-11 mg/dl

Decreased: Hgb, Hct, Serum Fe, TIBC, RBC

Normal: Serum Ferritin Normal MCV, MCHC, Saturation%, RDW

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12
Q

What is the MCV level for Microcytic Anemia?

A

MCV <80

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13
Q

What are the common conditions associtated with Microcytic Anemia?

A

Iron Deficiency Anemia (IDA)
Thalassemia
Plumbism (lead poisoning)

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14
Q

What causes microcytic, hypochromic anemia with a high RDW?

A

IDA

Plumbism

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15
Q

What causes microcytic, hypochromic anemia with a normal RDW?

A

Thalassemia

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16
Q

Common lab findings in Thalassemia

A

Increased: Possibly RBCs

Normal: RDW, RBC, Serum Fe, Saturation%, Ferritin, TIBC, MCHC (or low)

Decreased: Hgb-slightly, Hct, MCV, MCH, MCHC

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17
Q

Thalassemia diagnostic findings

A

Hgb electrophoresis: Normal

Peripheral Blood Smear:
Anisocytosis (variation in size) Poikilocytosis (variation in shape)
Target cells=stressed RBCs that did not delete nucleus

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18
Q

Management of Thalassemia

A

Transfusions
Do not supplement with iron
Refer to hematology

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19
Q

What type of anemia and RDW findings are seen in Iron Deficiency Anemia?

A

Microcytic hypochromic anemia with a high RDW

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20
Q

What are the common lab findings in Iron Deficiency Anemia?

A

Decreased: Hgb, Hct, RBC, MCV, MCH, MCHC, Serum Fe, Saturation%, Ferritin, Reticulocytes

Increased: TIBC, RDW

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21
Q

What is the only anemia that presents with an increased TIBC?

A

Iron deficiency anemia

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22
Q

Physiologic causes of IDA

A

Menstruation, pregnancy, postpartum

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23
Q

Pathological causes of IDA

A

Blood loss in GI tract

R/O colon cancer

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24
Q

Normal Serum Ferritin range

A

Normal serum ferritin: 22-322 ng/ml

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25
What diagnostic is highly specific for IDA?
Serum Ferritin <20 ng/ml for males <10 ng/ml for females
26
IDA treatment
Supplement with iron | 150-200 mg of elemental iron daily
27
Hct value to consider transfusions for anemia
Hct <27%
28
When identifying causes of macrocytic anemia, what two labs should always be ordered together?
B12 level | Folate level
29
What are the first tests in diagnosing anemia?
CBC, Hgb, Hct, MCV, and reticulocyte counts
30
Hgb/Hct values in anemia
Males: Hgb <13g/dL, Hct<38% Females: Hgb<12g/dL, Hct<35%
31
Causes of low Hgb
IDA, B12 or folate deficiency, BM damage, leukemia, lymphoma, acute or chronic blood loss, RBC hemolysis, overhydration
32
Causes of high Hgb
Dehydration, renal problems, pulmonary disease, heart disease, PV
33
What are reticulocytes?
Immature RBCs | Circulate in blood for 1-3 days before maturing
34
What causes Sickle Cell Anemia?
Autosomal recessive disorder | HbSS: Inherits gene from both parents
35
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
36
Diagnostic tests for sickle cell anemia
CBC, hgb electrophoresis, gene studies
37
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
38
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
39
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
40
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
41
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
42
S/S of chronic hemolytic anemia
Fatigue, gallstones, splenomegaly, poorly healing ulcers on tibial region, irritable, dizziness, tachycardia, SOB, pallor, jaundice, slow growth
43
Folate deficiency treatment
Folate 1 mg PO daily x 4 months or indefinitely if cause is not identified
44
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
45
When should anemias begin to correct with proper treatment?
1 week evidenced by increased reticulocyte counts
46
Sickle cell anemia management
``` Rehydration Oxygen Possible transfusions Folic acid supplementation Hydroxyurea Diet rich in complex B vitamins and vitamin C ```
47
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
48
What type of anemia is seen in G6PD deficiency?
Hemolytic anemia
49
What causes aplastic anemia?
Can be idiopathic, drugs, chemical exposure, B12 deficiency, and folate deficiency
50
Common lab findings in aplastic anemia
Sever anemia, neutropenia, thrombocytopenia Decreased: Hgb, Hct, RBC, Reticulocyte, PLTs, neutrophils Normal: MCV, Fe, Saturation%, Ferritin, TIBC
51
4 most common causes of abnormal WBCs
1-Infection 2-Steroids 3-Cancer/Leukemia 4-Catastrophic events (MI, PE, Surgery)
52
Leukocytosis
Increase in WBC >11,000
53
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)
54
Diagnostics for leukocytosis/leukopenia
WBC with differential, peripheral blood smear
55
Leukopenia
Decrease in WBC <4000
56
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
57
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)
58
What types of WBCs are granulocytes or polymorphonuclear?
Neutrophils, basophils, eosinophils
59
What types of WBCs are agranulocytes or mononuclear?
Monocytes, lymphocytes
60
What are the low and high WBC values that need urgent treatment?
WBC <500 or >30000/mm3
61
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
62
What are the lab characteristics of neutrophilia with a regenerative shift to the left?
Neutrophils >8000 mm3 Increase in bands with leukocytosis Good prognosis
63
What are the lab characteristics of neutrophilia with a shift to the right?
Decrease in bands (immature) | Increase in segs (mature)
64
What is the ratio of segmented neutrophils to bands?
Segs:Bands 3:1
65
Neutropenia value
Neutrophils <1800/mm3
66
Agranulocytosis
Marked neutropenia & leukopenia Dangerous & often fatal Requires reverse isolation
67
What are the primary causes of increased eosinophils?
Allergic response | Parasitic infections
68
How is eosinophilia classified?
Increase in eosinophils >5% or >500/mm3
69
How is eosinopenia classified?
Decrease in eosinophils <50/mm3
70
What are the primary causes of increased basophils?
Parasitic infection | Some allergic disorders
71
How is basophilia classified?
Basophils >50/mm3
72
How is basopenia classified?
Basophils <15-20/mm3 but very few is common
73
How is monocytosis classified?
Monocytes >500/mm3 or >10% of WBCs
74
What is the primary cause of increased lymphocytes?
Viral infections
75
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 ```
76
How is lymphocytosis classified?
Lymphocytosis Lymphocytes >4000/mm3 in adults; >7200/mm3 in children >9000/mm3 in infants
77
How is lymphopenia classified?
Lymphopenia Lymphocytes < 1000/mm3 in adults < 2500/mm3 in children <500 very susceptible to infection
78
Monocytopenia causes
Aplastic anemia, steroids, AML, myelotoxic drugs
79
Monocytosis causes
Myeloproliferative disorder (CML), TB, chronic inflammation, stress response, Cushing syndrome, sarcoidosis, viral infection
80
What are the primary causes for neutrophilia?
Bacterial infection | Acute inflammation
81
Platelets and pregnancy
Pregnant women may have mild to moderate (75-150) thrombocytopenia
82
How is thrombocytopenia classified?
Platelets <150k/mm3
83
Causes of thrombocytopenia
BM issues, PLTs dying, heparin induced, leukemia, infection, lupus
84
Management of thrombocytopenia
Stop offending agents Limit activity/prevent injury Educate: No NSAIDs, ASA, ginkgo biloba Refer to hematology
85
How is thrombocytosis classified?
Platelets >400/450k/mm3
86
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]).

Spring 2022 (14 decks)

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