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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
Q

What diagnostic is highly specific for IDA?

A

Serum Ferritin
<20 ng/ml for males
<10 ng/ml for females

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26
Q

IDA treatment

A

Supplement with iron

150-200 mg of elemental iron daily

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27
Q

Hct value to consider transfusions for anemia

A

Hct <27%

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28
Q

When identifying causes of macrocytic anemia, what two labs should always be ordered together?

A

B12 level

Folate level

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29
Q

What are the first tests in diagnosing anemia?

A

CBC, Hgb, Hct, MCV, and reticulocyte counts

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30
Q

Hgb/Hct values in anemia

A

Males: Hgb <13g/dL, Hct<38%
Females: Hgb<12g/dL, Hct<35%

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31
Q

Causes of low Hgb

A

IDA, B12 or folate deficiency, BM damage, leukemia, lymphoma, acute or chronic blood loss, RBC hemolysis, overhydration

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32
Q

Causes of high Hgb

A

Dehydration, renal problems, pulmonary disease, heart disease, PV

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33
Q

What are reticulocytes?

A

Immature RBCs

Circulate in blood for 1-3 days before maturing

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34
Q

What causes Sickle Cell Anemia?

A

Autosomal recessive disorder

HbSS: Inherits gene from both parents

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35
Q

Typical presentation of Sickle Cell Anemia

A

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
Q

Diagnostic tests for sickle cell anemia

A

CBC, hgb electrophoresis, gene studies

37
Q

Common lab findings in sickle cell anemia

A

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
Q

Screening/Prevention for SCD patients

A

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
Q

Managing acute SCD complications

A

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
Q

Continuous treatment for sickle cell disease

A

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
Q

S/S of severe acute complications of SCD crisis

A

Acute chest syndrome, acute chest pain, hypoxemia, stroke symptoms, retinopathy, pulmonary HTN, hepatomegaly, cardiomegaly, systolic murmurs

42
Q

S/S of chronic hemolytic anemia

A

Fatigue, gallstones, splenomegaly, poorly healing ulcers on tibial region, irritable, dizziness, tachycardia, SOB, pallor, jaundice, slow growth

43
Q

Folate deficiency treatment

A

Folate 1 mg PO daily x 4 months or indefinitely if cause is not identified

44
Q

B12 deficiency treatment

A

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
Q

When should anemias begin to correct with proper treatment?

A

1 week evidenced by increased reticulocyte counts

46
Q

Sickle cell anemia management

A 
Rehydration
Oxygen
Possible transfusions
Folic acid supplementation
Hydroxyurea
Diet rich in complex B vitamins and vitamin C
47
Q

G6PD Deficiency

A

Hereditary enzyme defect
Decreased ability of RBCs to deal with oxidative stresses causing an episodic hemolytic anemia
Affects African Americans, Mediterranean, and Asians

48
Q

What type of anemia is seen in G6PD deficiency?

A

Hemolytic anemia

49
Q

What causes aplastic anemia?

A

Can be idiopathic, drugs, chemical exposure, B12 deficiency, and folate deficiency

50
Q

Common lab findings in aplastic anemia

A

Sever anemia, neutropenia, thrombocytopenia

Decreased: Hgb, Hct, RBC, Reticulocyte, PLTs, neutrophils

Normal: MCV, Fe, Saturation%, Ferritin, TIBC

51
Q

4 most common causes of abnormal WBCs

A

1-Infection
2-Steroids
3-Cancer/Leukemia
4-Catastrophic events (MI, PE, Surgery)

52
Q

Leukocytosis

A

Increase in WBC >11,000

53
Q

Leukocytosis management considerations based on range

A

> 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
Q

Diagnostics for leukocytosis/leukopenia

A

WBC with differential, peripheral blood smear

55
Q

Leukopenia

A

Decrease in WBC <4000

56
Q

Causes of leukopenia

A

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
Q

Drugs that might cause leukopenia

A

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
Q

What types of WBCs are granulocytes or polymorphonuclear?

A

Neutrophils, basophils, eosinophils

59
Q

What types of WBCs are agranulocytes or mononuclear?

A

Monocytes, lymphocytes

60
Q

What are the low and high WBC values that need urgent treatment?

A

WBC <500 or >30000/mm3

61
Q

What are the lab characteristics of neutrophilia with a degenerative shift to the left?

A

Neutrophils >8000/mm3
Increase in bands with no leukocytosis
Poor prognosis

62
Q

What are the lab characteristics of neutrophilia with a regenerative shift to the left?

A

Neutrophils >8000 mm3
Increase in bands with leukocytosis
Good prognosis

63
Q

What are the lab characteristics of neutrophilia with a shift to the right?

A

Decrease in bands (immature)

Increase in segs (mature)

64
Q

What is the ratio of segmented neutrophils to bands?

A

Segs:Bands 3:1

65
Q

Neutropenia value

A

Neutrophils <1800/mm3

66
Q

Agranulocytosis

A

Marked neutropenia & leukopenia
Dangerous & often fatal
Requires reverse isolation

67
Q

What are the primary causes of increased eosinophils?

A

Allergic response

Parasitic infections

68
Q

How is eosinophilia classified?

A

Increase in eosinophils >5% or >500/mm3

69
Q

How is eosinopenia classified?

A

Decrease in eosinophils <50/mm3

70
Q

What are the primary causes of increased basophils?

A

Parasitic infection

Some allergic disorders

71
Q

How is basophilia classified?

A

Basophils >50/mm3

72
Q

How is basopenia classified?

A

Basophils <15-20/mm3 but very few is common

73
Q

How is monocytosis classified?

A

Monocytes >500/mm3 or >10% of WBCs

74
Q

What is the primary cause of increased lymphocytes?

A

Viral infections

75
Q

What are the three types of lymphocytes?

A

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
Q

How is lymphocytosis classified?

A

Lymphocytosis
Lymphocytes >4000/mm3 in adults;
>7200/mm3 in children
>9000/mm3 in infants

77
Q

How is lymphopenia classified?

A

Lymphopenia
Lymphocytes < 1000/mm3 in adults
< 2500/mm3 in children

<500 very susceptible to infection

78
Q

Monocytopenia causes

A

Aplastic anemia, steroids, AML, myelotoxic drugs

79
Q

Monocytosis causes

A

Myeloproliferative disorder (CML), TB, chronic inflammation, stress response, Cushing syndrome, sarcoidosis, viral infection

80
Q

What are the primary causes for neutrophilia?

A

Bacterial infection

Acute inflammation

81
Q

Platelets and pregnancy

A

Pregnant women may have mild to moderate (75-150) thrombocytopenia

82
Q

How is thrombocytopenia classified?

A

Platelets <150k/mm3

83
Q

Causes of thrombocytopenia

A

BM issues, PLTs dying, heparin induced, leukemia, infection, lupus

84
Q

Management of thrombocytopenia

A

Stop offending agents

Limit activity/prevent injury

Educate: No NSAIDs, ASA, ginkgo biloba

Refer to hematology

85
Q

How is thrombocytosis classified?

A

Platelets >400/450k/mm3

86
Q

Causes of thrombocytosis

A

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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