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Clin Lab Med Flashcards

1
Q

Hgb normal range

A

13.5-17.5

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2
Q

Hematocrit normal range

A

38.8-50%

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3
Q

WBC normal range

A

4.2-10.2

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4
Q

Platelet normal range

A

150-355

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5
Q

UFH

Given IV

A

Good if someone just had surgery

Only one approved for Pregnancy

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6
Q

UFH

Labs to order

A

Baseline: aPTT, PT/INR, CBC

Monitor: aPTT or Factor 10a

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7
Q

Intrinsic pathway

A

PTT

Heparin monitoring

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8
Q

Extrinsic pathway

A

PT

Warfarin monitoring

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9
Q

LMWH/Lovenox

Given SubQ

A

Does not work as well in obese pt bc it will not distribute through fat

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10
Q

LMWH/Lovenox

Labs to order

A

Baseline: aPTT, PT/INR, CBC, Creatinine

do not need monitoring labs, if anything: 10a activity

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11
Q

Warfarin/Coumadin

SubQ

A

Takes time to build up, need bridging medication

Cheap

Approved with kidney dysfunction!

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12
Q

If you have kidney dysfx, which anticoag do you use?

A

Warfarin/Coumadin

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13
Q

If you have DVT or PT and an underlying CA, which anticoag is recommended?

A

LMWH/Lovenox

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14
Q

If you have DVT or PE and NO underlying CA, which anticoag do you use?

A

any of the DOAC

Direct thrombin inh OR
Direct 10a Inhib (Xarelto and Eliquis)

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15
Q

Warfarin/Coumadin

Labs to order

A

Baseline: aPTT, PT/INR, CBC, Creatinine, LFTs (the most labs)

monitor: PT/INR

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16
Q

Which drug requires the most lab testing?

A

Warfarin/Coumadin

Baseline (5): aPTT, PT/INR, CBC, Creatinine, LFTs

Monitor: PT/INR

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17
Q

Labs to order with DOACs

A

only Baseline: PT/INR, CBC, Creatinine

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18
Q

Need 5-10 d of IV anticoag before starting Pradaxa or Edoxoban, but can do these other two without any pre-med

A

Xarelto and Eliquis

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19
Q

What do you use as a bridge when starting Warfarin (Coumadin)?

A

UFH or LMWH must be given in overlap for at least 5 d or until INR is good for 24 hr or 2 consec days

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20
Q

Reversal agent for UFH and LMWH

A

Protamine

PER977*

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21
Q

Reversal agent for Warfarin/Coumadin

A

Vitamin K

4Factor-PCC (new and expensive)

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22
Q

Reversal agent for Pradaxa

A

Idarucizumab (praxbind)

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23
Q

Reversal agent for Xarelto

A

supportive care

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24
Q

Reversal agent for Eliquis and Edoxoban

A

Andexanet (new and expensive)

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25
Left side of wishbone
WBC
26
Top of wishbone
Hgb
27
Bottom of wishbone
Hct
28
Right side of wishbone
Platelets
29
Leukopenia
<5k
30
Leukocytosis
>10k
31
Eisinophiils
allergic rxn and Parasites
32
Basophils
least common granulocyte | allergic rxn
33
Eisonophils do NOT respond to
Viral or Bacterial infection
34
Eisinophilia (high)
Fungal infection Allergic rxn Parasites
35
Basopenia (low)
Acute allergic rxn
36
Lymphocytes
T and B cells | fight acute Viral infection
37
Lymphocytosis
Viral infection | Mono or Hepatitis
38
Monocytosis
Severe infections
39
Normal platelet count
150-355
40
Polycythemia Vera
chronic myeloproliferative neoplasm prolif of myeloid cells and elevated RBC mass JAK2 mutation in setting of thrombocytosis: more at risk of developing clots or underlying CA
41
Platelet disorders (4)
Platelet dysfx Splenic sequestration Increased destruction Impaired production
42
Splenic sequestration
spleen eating up platelets | vascular congestion- liver cirrhosis
43
Increased Destruction
Immune thrombocytopenia Disseminated Intravasc Coag Heparin ind thrombocytopenia Thrombotic microangiopathy
44
Disseminated Intravascular Coagulation
clotting and bleeding at same time hard to treat seen in pts who are very sick (septic)
45
Hepatin induced thrombocytopenia (low)
platelet activation -> increased risk thrombosis -> leading to thrombocytopenia and prothrombic state
46
Thrombotic microangiopathy (TTP or HUS)
both types: condition d/t incorporation of platelets into microvasc Result: mechanical shearing of RBC as they pass thru platelet rich microthrombi
47
Thrombotic microangiopathy easy definition
fragmentation of RBC bc they are passing through small vessels with a bunch of little thrombi in the way
48
TTP (T.T.Purpura)
Medical emergency! Auto antibodies against ADAMST-13 acquired or inherited messed up gene Result: microthrombi form thru-out body
49
5 characteristics of TTP
Purpura Pentad - Mircoangio hemolytic anemia - Thrombocytopenia - Acute Kidney Injury - Neuro deficits - Fever
50
sx of TTPurpura
petechaie, pallor, jaundice
51
HUS- Hemolytic Uremic Syndrome
AKA Shiga-toxin mediated HUS
52
HUS hemolytic uremic syndrome
predominant in children
53
HUS hemolytic uremic syndrome
Etio: shigatoxin producing E.Coli 0157 CHILD w/recent diarrhea and thrombocytopenia (RED FLAG)
54
Triad of HUS-hemolytic uremic syndrome
- Mircoangio hemolytic anemia - Thrombocytopenia - Acute Kidney Injury
55
Tx for both types of thrombotic microangiopathy (TTP and HUS)
Plasma Exchange and | Supportive care
56
Lab findings for Microangio Hemolytic Anemia
Schistocytes | Thrombocytopenia
57
MTHFR gene
part of hypercoag panel | associated with miscarriages and clots
58
Eliquis brand name
Apixiban
59
Xarelto brand name
Rivaroxaban
60
Hyperglycemia | high glucose
``` IV Dextrose infusion Stress Endocrine disorders -Cushings -Acromegaly ```
61
Hypoglycemia
Addison's Dz (diminished cortisol)
62
Urea is made in the
Liver BUT, excreted by kidneys
63
Creatinine tells us only about the
KIDNEYS bc it is excreted by kidneys
64
Creatinine relationship with GFR
INVERSE | so Cr goes up, GFR goes down
65
What makes BUN/Cr Ratio so special?
determine CAUSE of Acute Kidney Injury
66
BUN of a PRE-Renal cause of AKI
>20:1 BUN/Cr
67
Pre-renal cause of AKI
Perfusion issue Hypovolemia- dehydration or hemorrhage CHF Change in vascular resistance (Renal artery stenosis)
68
Intrinsic cause of AKI
Filtration issue Acute tubular necrosis (IV contrast!!)
69
Post-renal cause of AKI
Excretion issue Stone, Bladder outlet obstruction, BPH, Urethral stricture
70
Changes in Cl generally accompany
change in Na and Bicarb
71
Bicarb is regulated by
Kidneys
72
Total protein=
Albumin + Globulin
73
Total protein used to tell us about:
Liver dz, edematous state, protein losing conditions, nutrition, immune dz, and CA!!
74
Labs to measure Synthetic function of the liver (what it can make)
Albumin Platelet count PT/INR
75
Albumin function:
Maintain Osmotic Pressure (among many others)
76
Elevated Total Protein with increased GLOBULIN
Consider Multiple Myeloma M spike and Bence Jones Proteins
77
Liver tests
AST ALT ALP BILI
78
Transaminases of Liver tests
AST ans ALT | ending in T
79
Liver tests reflect injury/dz to the Hepatobiliary system, which includes:
Liver Gallbladder Bile Ducts
80
AST is found in
liver, kidney, brain, cardiac and skeletal muscle | injury to these tissues= release of AST into bloodstream
81
Which is more specific to the liver, AST or ALT
ALT
82
ALP is found in
Liver Biliary Tract BONE
83
Rltnshp b/w Ca and Phosphorus
INVERSE Ca goes up, Phosphorus goes down
84
Cause of HypoCa2+ not enough Ca
Hypo-albumin Hypo-Mg Hypo-Parathyroid Renal failure
85
Causes of HyperCa2+ too much Ca2+
Hyperparathyroid | Malignancy
86
decrease in excitability | muscle weakness
HYPER ca2+
87
increase in excitability | tetany
HYPO ca2+
88
Signs of HYPERca2+
kidney stone | constipation
89
Signs of HYPOca2+
Chvosek's sign | Trousseau's sign
90
EKG of HYPERca2+
short QT interval
91
EKG of HYPOca2+
long QT interval
92
Free (ionized) Ca
physiologically active
93
Citrate is added to blood why
to chelate with Calcium and prevent clotting
94
In pts with decreased Albumin
must correct the total serum Calcium
95
Calcitonin
stimulates Ca deposit in bone (lowers serum levels)
96
PTH
stimulates Ca release from bone (increases serum levels)
97
90% of increase in Calcium is d/t:
``` Primary Hyperparathyroid (PTH) Malignancy ```
98
presentation of TOO MUCH Calcium
muscle weakness, loss of tone, stupor, coma SHORT QT interval on EKG
99
presentation of NOT ENOUGH Calcium
hyperexcitable, tetany, Chvostek's sign, Trousseau's sign LONG QT interval on EKG
100
Cellular shift with Insulin or Refeeding syndrome can cause:
Hypophosphorus levels
101
Magnesium is tied to what:
Calcium (Ca) and Potassium (K)
102
Low Mg
inhibits PTH action (decreases Ca) | impairs kidney's ability to conserve potassium (decreases K)
103
Low Mg sx will be similar to:
Low Ca sx
104
Torsades de pointes
Cardiac arrhythmia associated with Hypomagnesia

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