CBC rev Flashcards
Transports blood cells & other substances throughout the body
Plasma
–Transports oxygen throughout body (utilizing hemoglobin)
Red Blood Cells (RBC)
–Helps protect the body from infection and regulate the immune cells
White Blood Cells
–Involved in coagulation
Platelets
- What is the production of RBC called?
- What hormone is involved? Produced where?
Erythropoiesis
Erythropoietin / Kidneys
- Where does the cellular production of RBCs occur?
- How long does it take for RBCs to form stem cells?
- Life span of a RBC?
- Bone marrow
- 7 days
- 120 days
What are the 2 bone marrow abnormalities?
- BM replaced by tumor cells –> leads to abnormal blood counts (such as lymphoma infiltration)
- BM damaged by chemicals (benzene, abx) –> leads to aplastic anemia
What are reticulocytes and how long does they take to mature in the circultion?
Youngest circulating RBCs (larger than other RBC)
1 day
An increased retic count is associated with an increase in which 2 lab values?
- Why?
MCV (mean cell volume) and RDW (red cell distribution width)
- d/t the retics being larger in size
A RBC lifespan is 90-120 days
- What 4 things can shorten the lifespan? (RBC destruction)
- Uremic toxins
- ↑ blood glucose
- Inflammatory cytokines
- Infections
Protein in RBC that carries oxygen
Hemoglobin
Percent of whole blood made up of RBCs
Hematocrit
4 Components of RBC indices
-
MCV (mean cell volume)
- Macrocytosis
- Microcytosis
- Normocytic
- MCH (mean cell hemoglobin / wt of hgb in RBC)
- MCHC (mean cell hgb concentration)
- RDW (red cell distribution width / range of cell sizes)
How are “normal” ranges for CBC components based?
Blood samples obtained from white men (20-60 yrs old) who are NOT taking meds.
What 3 things are seen on peripheral smear?
-
Abnormal size: anisocytosis
- Correlates w/ RDW
- Ex: microcytosis & macrocytosis
-
Abnormal shape: poikilocytosis
- Defect in precursor cells
-
Abnormal color:
- hypochromasia (pale d/t less hgb)
- hyperchromasia (dark d/t dehydration or spherocytes)
- polychromasia (blue stained d/t early release from BM)
Which cell on peripheral smear?
- Hemoglobinopathy
- Thalassemia
- Liver disease
Target cells
(bull’s eye appearance)
Which abnormality on Peripheral Smear?
- Blue granules
- Ribosomal precipitates
- Thalassemia
- ETOH abuse
- Lead/Heavy metal poisoning
Basophilic stippling
Which abnormality on Peripheral Smear?
- Crescent-shaped RBCs
Sickle Cells
(sickle cell anemia)
Which abnormality on Peripheral Smear?
- Multiple Myeloma
Rouleaux formation
(RBCs stack on each other like coins)
Which abnormality of Peripheral Smear?
- Schistocytes
- Helmet cells
- Vascular FB (mechanical heart valve)
- Disseminated intravascular coag
- Thrombotic Thrombocytopenic Purpura
Fragmented Cells
Which abnormality on Peripheral Smear?
- Hgb precipitate on surface of RBC skeleton
- Seen w/ crystal violet stain
- G6PD deficiency
- Autoimmune hemolytic anemia
- Thalassemia
Heinz Bodies
Which abnormality on Peripheral Smear?
- Semicircular portions removed from cell margin
- Caused by removal of hemoglobin precipitate by _____.
Bite Cells
Bite Cells on a peripheral smear are associated w/ which 2 conditions?
- G6PD deficiency
- Hemolytic Anemia
Which abnormality on Peripheral Smear?
- Small, round remnants of nuclear DNA inside cell
Howell-Jolly Bodies
Howell-Jolly Bodies (small round remnants of nuclear DNA inside cell) are associated with what 4 things?
- Sickle Cell Anemia
- Hemolytic Anemia
- Megaloblastic Anemia
- S/P splenectomy
Which abnormality on Peripheral Smear?
- Remnants of cells indicating abnormally fragile lymphocytes
Smudge Cells
Smudge Cells (remnants of cells indicating abnormally fragile lymphocytes) are associated w/ which condition?
Chronic Lymphocytic Leukemia (CLL)
Which abnormality on a Peripheral Smear?
- Immature cells
- ALWAYS abnormal
- Suggests a malignant hematologic disorder
Blasts
(Lymphoblasts, Myeloblasts)
Anemia is not a diagnosis, it is a _____.
Symptom
4 main causes of anemia
- Blood loss #1
- Destruction of blood
- Substrate deficiency
- Insufficient bone marrow
What does anemia lead to?
Deoxygenation of tissue –> organs suffer from hypoxia
Name a few sxs of anemia
- fatigue
- weakness
- dizziness
- SOB
- CP
- Postural Hypotension*
- Pallor*
- Palpitations (heart beat in ears)
- Long term: Koilonychia (flattened nails)
Reticulocytosis = elevated retic count w/ anemia, what is the cause? (2)
Hemolysis or Blood loss
Anemia w/ normal retic count (or slightly elevated), what is the cause? (2)
- Substrate problem (iron or B12 deficiency)
- Maturation problem (myelodysplastic syndrome)
How is a “corrected retic count” calculated?
- What is a normal vs abnormal response?
Retic count is % of RBCs
WITH anemia, count must be corrected to extent of anemia.
Corrected = retic % X (pt hematocrit / normal hematocrit of 45)
- >3 = normal response
- <2 = inadequate response
How do you know if the anemia is compensated? (Clinical Pearl)
Add retic count + hemoglobin
If they equal or come close to 15, anemia is compensated.
Ex: Hgb of 8.2 + retic of 6.4 = 14.6 (bone marrow is compensating)
Which component of the iron study?
- Amount of iron in the blood (quantity of iron bound to transferrin)
- 70% of body’s iron found in the hemoglobin of RBCs
Serum Iron (Fe)
Which component of the iron study?
- Amount of stored iron
- 30% of body’s iron is stored as ferritin & hemosiderin
Ferritin
Which component of the iron study?
•The potential space available on a RBC for Fe to bind
Total Iron Binding Capacity (TIBC)
Which component of the iron study?
•Protein that binds iron in the plasma and carries it to the bone marrow to be incorporated into hemoglobin
Transferrin
Which component of the iron study?
•Amount of protein (transferrin) available for binding mobile iron
Transferrin Saturation
Which component of iron study?
- Marker of iron storage
- Can be most sensitive test to detect iron deficiency
Ferritin
- A decreased iron storage = iron deficiency will cause which value to be high/low?
- Iron excess (hemochromatosis), hemolytic anemia, megaloblastic anemia will cause which value to be high/low?
- ↓ ferritin = dec. storage
- ↑ ferritin = Iron excess
Which iron study?
(Acute Phase reactant)
–May be elevated with inflammation & infection when no iron stores issue exists
–May be falsely normal with iron deficiency anemia (if there is coexistent inflammation/infection)
Ferritin
Which iron study?
(Negative Acute Phase Reactant)
–Can decrease in various acute inflammatory reactions
–May also be decreased with chronic illness & liver disease (transferrin produced in liver)
Transferrin
- How is the % of transferrin & other mobile iron-binding proteins saturated w/ iron calculated?
- What is a normal value range?
- What is an abnormal value and what does it mean?
- Transferrin sat % = (serum iron level X 100) / (TIBC)
- 20-50%
- <15% if they have iron deficiency
What is the best iron test for hemochromatosis?
Transferrin
Besides hemochromatosis, what other 3 conditions will have an increased transferrin saturation?
- Hemolytic anemia
- Megaloblastic anemia
- Sideroblastic anemia
