CBC Notes Flashcards
Study of blood
Hematology
- Plasma = 55%
- RBC = 44%
- WBC and platelets = 1%
Protein in RBC that functions to transport oxygen and carbon dioxide
Hemoglobin
Tissues responsible for producing and maturing blood cells
Hematopoetic tissues (perform Hematopoiesis)
-Spleen, lymph nodes, thymus, bone marrow, liver, the RES
T/F Only mature blood cells are released into peripheral blood
True
Hormones that stimulate hematopoiesis.
- Erythropoietin (from kidney)
- Leukopoietin
- Thrombopoietin and others
Primary regulator of erythropoiesis
Erythropoietin (EPO)
- Division take 3-5 days
- Remain in bone marrow for 1-2 days to mature before release into circulation
Life span of a RBC
- Main function of RBC
- Main components of RBC
120 days
- Transport HgB
- 90% hemoglobin and 10% water
Signs and symptoms to order a CBC
Tons
-Weakness, fatigue, apathy, lassitude, pallor, brittle nails, dyspnea, tachycardia, etc. etc.
If a chest X-ray appears to show pneumonia, why would we order a CBC?
Help check if the pneumonia is being caused by a viral, bacterial, or fungal pathogen
X-ray shows increased RPI and RTI. What are potential causes for this?
-What labs would be helpful?
SOL = Blood, Pus, Tumor, Edema
-CBC and ESR
X-ray with open growth plates shows demineralization. Is this normal?
NO!
- Open growth plates = child = anytime demineralization occurs outside of what age group/amount for the age we would normally suspect, consider it pathologic
- Need biochemical profile, metabolic panel, and CBC
What is normally reported if a CBC is requested?
- RBC
- Hemoglobin
- Hematocrit
- RBC indices
- Platelets
(may see other info)
As a general rule, women and children have _____ lab counts than males
Women/children = Lower counts compared to males
What does it imply if hematocrit is 45%?
45% of blood volume consists of RBCs while 53% consists of plasma
If hematocrit, RBC, or hemoglobin are low, it indicates what general condition?
Anemia
T/F RBC is 4.2 (normal), Hct is 25 (low), and HgB is 9 (low). Lab works shows that the patient does NOT have anemia because of normal RBC
FALSE
RBC. Hct, HgB all can be used to determine anemia if more than 1 is low or even low normal. Don’t know what specific type without getting the indices
Indice that provides information about the size of the RBC
MCV
HgB weight (HgB/RBC)= MCH
HgB concentration (HgB/Hct) = MCHC
(MCH and MCHC determine color while MCV determines size)
Patient has anemia. Indices show decreased MCV and MCH/MCHC. What do the RBCs look like?
Microcytic Hypochromic
(MC type)
Patient has anemia. Indices show normal MCV and MCH/MCHC. What do the RBCs look like?
Normocytic Normochromic
Patient has anemia. Indices show increased MCV and normal/increased MCH/MCHC. What do the RBCs look like?
Macrocytic normochromic or Hyperchromic
3 general RBC causes of anemia
1) Decreased production
2) Increased breakdown
3) Blood loss
(classified by RBC morphology = cell size)
4 pathologies that produce microcytic hypochromic anemia
Indices = low MCV and MCH/MCHC
1) IDA (MC by far)
2) Anemia of Chronic Disease (25% microcytic, 75% normocytic)
3) Thalassemia
4) Chronic Blood Loss (really an IDA)
4 pathologies that cause macrocytic normochromic anemia
Increased MCV, Normal or increased MCH/MCHC
1) Vitamin B-12 deficiency
2) Folic Acid (B-9) deficiency
3) Alcoholism
4) Liver disease
What macrocytic normochromic anemias are considered megaloblastic?
B-9 and B-12 deficiency Anemias
Alcoholism and liver disease causes nonmegaloblastic anemias
4 pathologies that cause normocytic normochromic anemia.
Normal MCV, MCH/MCHC
1) Anemia of Chronic Disease (75% of the time, 25% microcytic)
2) Acute blood loss
3) Hemolytic Anemia (like Sickle Cell)
4) Aplastic Anemia
CBC 5 year old African American male. Any findings?
- WBC = 7.1 (N)
- RBC = 4.2 (N)
- HgB = 9 (Low)
- Hct = 25 (Low)
- MCV = 75 (low)
- MCH = 24 (Low)
- MCHC = 32-36 (low)
- Platelets = 200 (N)
Patient has Anemia based on low HgB and Hct
-Since indices show microcytic hypochromic anemia (low MCV, MCH/MCHC), the patient has either Chronic Blood Loss, IDA, Thalassemia, or ACD
IDA is most common though and nothing else indicates CBL, Thalassemia or ACD
Protein responsible for transporting iron
Transferrin
T/F Very little iron is lost in the body. Most is done by cells in the GI tract or through menses and urine
True
What is the most common cause of an IDA would wide?
GI blood loss
Acute bleeding results in ____cytic ___chromic anemia while chronic blood loss results with _____cytic ____chromic anemia
Acute = normocytic normochromic anemia
Chronic = microcytic hypochromic anemia
MC of IDA in developed countires
Blood lost during menses
-Developing = GI bleeds
Iron is necessary for the formation of what part of hemoglobin?
Heme
- Vast majority is in hemoglobin (70-95%)
- Intake and excretion for iron is 1-2 mg/day
Pica for ice seen with IDA. May disappear with correction of IDA.
Pagophagia
Protein molecule to bind iron. Measures the extent to which iron-binding sites in the serum can be saturated. Binding sites in serum are almost entirely dependent on circulating transferrin, this is really an indirect way to measure the amount of transferrin in the blood
Total Iron Binding Protein (TIBC)
Cellular appearances associated with IDA
- Target cells
- Anisocytes
- Poikilocytes
Microcytic hypochromic anemia. Normal/decreased iron, normal to increased ferritin, and TIBC is low or normal
Dx:
Anemia of chronic disease
(a.k.a. Anemia of inflammation)
(if kidney problem = Anemia of Renal Disease = ARD)
Microcytic hypochromic anemia. Normal iron parameters although more microcytosis.
Dx:
Thalassemia
Inhibition of erythripoiesis from altered iron metabolism.
Anemia of Chronic Disease
Hereditary disorder characterized by reduced synthesis of globulin chains (alpha or beta) of hemoglobin. Results in reduced hemoglobin synthesis. Microcytic hypochromic anemia type.
Alpha/Beta Thalassemia
T/F Alpha Thalassemia is seen in primarily in peope of Mediterranean origin
FALSE.
Alpha = China and SE Asia
Beta = Meditarranean
T. minor = trait is present, asymptomatic/minor s/s
T. intermedia = minor to moderate s/s
T. major = life threatening anemia with other changes
Growth failure, bone deformities, marrow expansion, widened diploic space, calcerium has a hair on end appearance, facial abnormalities, pathologic fractures, hepatosplenomegaly, jaundice, and gallstones.
What is the Dx?
Thalassemia major
a.k.a Cooley’s Anemia or Mediterranean anemia
Microcytic hypochromic anemia. Iron parameters (TIBC, iron, ferritin) are normal
Thalassemia
TIBC:
1) IDA/CBL ________
2) ACD_________
3) Thalassemia ___________
1) Increased
2) Decreased
3) Normal
Patient has low iron and low TIBC. How do we know if they have a kidney problem (ARD)?
Do a UA for BUN/Creatinine
Normal = ACD
Abnormal = ARD
Characteristic changes in the RBC and WBC precursors causing inhibition of DNA synthesis in RBC production. Likely due to B-9 or B-12 deficiency
Megaloblastic
-Macrocytic normochromic anemia
MC cause of a B12 deficiency
Low Intrinisc Factor
(Pernicious anemia)
2nd MC = lack of gastric acid necessary to separate B-12 from its binding proteins
3rd MC = malabsorption caused by disease of the terminal ilium (worms, IBD, malab)
What neurologic symptom may indicate a B12 deficiency?
Loss of vibratory sensation
-Paresthesias
In severe cases, what psychological conditions may arise from B-9 deficiency (besides megaloblastic anemia)?
Depression and dementia
Folic acid deficiency does NOT cause neurologic damage
CBC Adult Female. What are the findings?
- WBC = 6.1 (N)
- RBC = 4 (Low)
- HgB = 8 (Low)
- MCV = 104 (High)
- MCH/MCHC = (N)
Macrocytic normochromic anemia
-MC is B-9 or B-12 deficiency anemia (Megaloblastic)
T/F Pancreatitis is a classic hallmark for megaloblastic anemia
FALSE.
Pancreatitis is associated with alcoholics or people with liver problems which both cause nonmegaloblastic macrocytic normochromic anemia
4 patholgies that cause Normocytic Normochromic Anemia
Normal MCV, MCH/MCHC
1) Anemia of Chronic Disease (Inflammation)
2) Acute Blood Loss
3) Hemolutic Anemia
4) Aplastic Anemia
Severe life threatening syndrome. Decrease production of all blood cells. Hypocellular bone marrow. Low reticulocyte count, pancytopenia, with increased EPO.
What is the Dx?
Aplastic Anemia
Anemia secondary to RBC destruction. May develop jaundice splenomegaly, and gallstones. Defects of the RBC are usually hereditary. If due to an outside factor it is usually acquired.
Hemolytic Anemia
T/F Most of RBC breakdown is extravascular and occurs within the reticuloendothelial system (RES)
True
Serious chronic hemolytic anemia. Short life expectancy. Begins in childhoold. Almost exclusive to black people. Occurs during times of physiological stress (specifically lowered oxygen tension)
Sickle Cell Anemia
X-rays may show a _________ to ________ pattern of lytic destruction in someone with sickle cell anemia.
a. k.a. Hand-Foot Syndrome
- Permative/moth eaten lytic pattern
T/F Hair on end appearance is seen in only Thalassemia
FALSE.
May be present in sickle cell disease or thalassemia
Although blood cell counts are normal in someone with sickle cell disease, what will test positive to confirm the Dx?
Sickling Test (Sickledex test of HgB electrophoresis)
CBC child. What is the Dx?
- RBC = 3.8 (Low)
- HgB = 7 (Low)
- Hct = 20 (Low)
- MCV = 85 (N)
- MCH = 29 = (N)
Normocytic normochromic anemia
- Could be sickle cell, acute blood loss, ACD, or aplastic anemia
- Need more info to DDx
CBC 70 year old female. What is the Dx?
- WBC = 3.8 (Low)
- RBC = 2.2 (low)
- HgB = 7 (low)
- Hct = 19 (low)
- MCV = 84 (N)
- MCH/MCHC = Normal
- Platelets = 79 (low)
Aplastic Anemia
- Patient is anemic (low RBC, HgB, Hct)
- Patient has normocutic normochromic anemia (AA, SCA, ABL, ACD)
- Patient has pancytopenia (low blood cells = Aplastic Anemia)
CBC 18 year old black male. What is the Dx?
- WBC = 8 (N)
- RBC = 4 (low)
- HgB = 10 (low)
- Hct = 35 (low)
- MCV = 90 (N)
- MCH/MCHC = Normal
- Platelets = Normal
Sickle Cell Anemia
- Low RBC, HgB, Hct indicate anemia
- normal MCV and MCH/MCHC indicate normocytic normochromic anemia
- Of the 4 (SSA, ABL, ACD, AA), Sickle Cell is MC in this case
X-ray finding for Sickle Cell Anemia
Lincoln Log or “H-Shaped” Vertebrae
Tx: needs hematologist
Represents an increase in erythropoiesis (increased RBC, HgB, and Hct).
Polycythemia
3 Types : Vera (primary), Absolute (secondary), Relative
S/S = red face, high BP, low exercise tolerance, joint pain, splenomegaly, itchiness after a warm bath
Absolute increase in all cell types (RBC, WBC, plateles) associated with chronic myeloporliferative disorders. Hyperplastic bone marrow due to chemical or radiation exposure
Polycythemia vera (Primary)
T/F Erythrocytosis is not dependent on EPO levels
True
Increase in RBC, WBC, HgB, Hct. Associated with polycythemia vera
Panhyperplasia
What do many patients with primary polycythemia die of?
Cardiac and thrombotic disease or if they survive, they develop myelofibrosis and vascular complications.
EPO mediated. Physiologic response to the need for more RBC production due to increased need for oxygen, pulmonary disorder or increase in EPO Usually due to hypoxia.
Secondary polycythemia
-PCKD, renal carcinoma, chronic GMN, chronic liver disease, and anabolic steroids may also cause this.
What lab finding can help differentiate between primary and secondary polycythemia?
Primary = panhyperplasia (also splenomegaly)
Secondary = normal WBCs, platelets, spleen. Rest are elevated
Due to a decrease in plasma volume and the RBC mass remains unchanged. Associated with dehydration. Increased RBCs, HgB, and Hct. WBC and platelets are normal.
Relative Polycythemia
CBC 60 year old male. What is the Dx?
- RBC = 8 (high)
- HgB = 22 (high)
- Hct = 68 (high)
- MCV = 84 (N)
- MCH/MCHC = High
- Platelets = 79 (low)
Polycythemia
- Elevated RBC
- Normal dark red cells = Polychromasia
- Could look at EPO levels to DDx Primary, Secondary, Relative Polycythemia
(Low/Normal EPO = Primary = Cancer)
(High EPO = Secondary = Hypoxia)
(Normal EPO = Relative = Dehydration)
Measurement of the rate with which the RBC’s settle in saline or plasma over a specific time period. Very sensitive, but not specific.
Erythrocyte Sedimentation Rate (ESR)
-Increased plasma proteins (like fibrinogen) causes the RBCs to stack up to each other which increases their weight and descends faster causing an increased ESR
“helps to see if the body is reacting to something”
-
Stacking of the RBCs similar to a stack of coins. As they stack, they drop more rapidly.
Rouleaux formation
Which is NOT true of ESR?
a) Increases with age
b) Formula must be corrected in anemia because there are fewer cells
c) Not part of the CBC so must be ordered separately.
d) All the above are true.
d) All the above are true.
Non-specific acute phase reactant used to diagnose bacterial infections, connective tissue disorders, neoplastic disease, inflammatory disorders. Abnormal protein produced by the liver in response to tissue destruction/inflammation.
C-reactive protein (CRP)
T/F CRP indicates the presence of an acute inflammatory reaction and NOT the cause of it
True
T/F ESR is a more sensitive and rapidly responding indicator than CRP
FALSE.
CRP is more sensitive and rapidly responding than ESR
Ex: 1st 24 hours of pathology = ESR may not be elevated, but CRP will be incrased. Later, CRP maybe normal, but ESR maybe elevated
RBC cell morphology that varies in size frequently found in hemolytic anemia.
Anisocytes
Increased numbers of reticulocytes seen in B9 and B12 deficiency as well as in polycythemia.
Polychromasia
-Look at MCH and MCHC on lab
Oval shaped RBCs. Normally only small numbers are present, may be seen in IDA, and megaloblastic anemia
Ovalocytes
Teardrop cells are associated with what pathology?
Thalassemia
RBC where the HgB is found in the peripheral rim and central core. Seen with sickle cell, thalassemia, and chronic liver problems.
Target Cells
Abnormal RBC variations in the shape seen in the anemias and leukemias.
Poililocytes
RBC morpholohy where remnants of RNA are found in the RBC and cause a stippling appearance. Seen in lead poisioning, thalassemia, and hemolytic anemia
Basophilic stippling
Young immature non-nucleated RBCs. Increased with production of RBC. Decreased if bone marrow is not producing adequately.
Reticulocytes.
T/F ESR is so sensitive for infection that it is elevated in 90% of cases
True
