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CLIN LAB TEST > Clin Lab Test 2 > Flashcards

Clin Lab Test 2 Flashcards

1
Q

What findings might you find on a CBC with Chronic Leukemia?

A

High WBC count

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2
Q

What findings might you find on a CBC with Acute Leukemia?

A

Low WBC count

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3
Q

What disease might you find Auer Rods?

A

Acute Myeloid Leukemia

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4
Q

What disease might you find Reed-Sternberg cells?

A

Hodgkin’s Lymphoma

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5
Q

How do you diagnose Hodgkin’s Lymphoma?

A

With a biopsy.

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6
Q

What tests are included in the CBC?

A

WBC, RBC, hemoglobin, hematocrit, Red Cell indicies (MCV, MCH, MCHC), Platelet Count, RDW, Mean Platelet Volume

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7
Q

List the clotting factor disorders.

A

Hemophilia A, B, C

vonWillebran

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8
Q

What factors are affected in Hemophilia A?

A

Factor VIII

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9
Q

What factors are affected in Hemophilia B?

A

Factor IX

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10
Q

What pathway do Hemophilias affect?

A

The intrinsic pathway - APTT

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11
Q

What pathway does vonWillebran affect?

A

Neither! It works on platelets

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12
Q

What tests will be abnormal in vonWillebran?

A

Could all be normal, but bleeding time could be long.

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13
Q

What is the most common bleeding disorder?

A

vonWillebran

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14
Q

What labs will be affected with Intrinsic Factor Deficiencies?

A

APTT will be high

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15
Q

What factors are affected with Intrinsic Factor Deficiencies?

A

8,9,11,12

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16
Q

What factors are affected with Extrinsic Factor Deficiencies?

A

7

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17
Q

What labs will be affected by Coumadin therapy?

A

PT/INR

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18
Q

What labs will be affected by Heparin therapy?

A

APTT will be high

Factor X should be decreased

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19
Q

An increase in RDW shows what?

A

Recent change, such as new disease process, treatment

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20
Q

What are the 4 classes of thalassemias?

A

A Thalassemia Trait
Hemoglobin H
B Thalassemia Minor
B Thalassemia Major

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21
Q

Which class of Thalassemia is heterozygous?

A

B Thalassemia Minor

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22
Q

Which class of Thalassemia is homogenous?

A

B Thalassemia Major

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23
Q

How is A Thalassemia Trait defined?

A

Missing 2 of 4 alpha genes

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24
Q

How is Hemoglobin H Thalassemia defined?

A

Missing 3 of 4 alpha genes

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25
Q

What is the definitive diagnosis for Aplastic Anemia?

A

Bone Marrow Biopsy

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26
Q

What are the causes of Aplastic Anemia?

A

Autoimmune disorders, Malignancy

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27
Q

What are signs of Hemolytic anemias?

A

Increased Reticulocyte count

Increased bilirubin

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28
Q

In what group of people will you see G6PD most often?

A

Black Males

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29
Q

What drugs trigger G6PD?

A

Sulfa, Bactrim, nitrofuantoin

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30
Q

What causes most sickle cell patients to end up in the ER?

A

Pain Crisis

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31
Q

What causes pain crisis in sickle cell patients?

A

Ischemia from a clot

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32
Q

How to you treat severe pain crisis?

A

Hydroxeuria - helps the body to make more hemoglobin F

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33
Q

What may cause a deficiency in vitamin B12?

A

gastric bypass, intestinal resection, diet, lack of intrinsic factor, Chrone’s disease, Pernicious anemia (autoimmune against the parietal cells)

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34
Q

What is the difference between B12 deficiency and Folate deficiency?

A

Lack of neurological symptoms

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35
Q

What will the CBC look like with a patient with polycythemia vera?

A

High everything!

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36
Q

What are signs of polycythemia vera?

A

Itchy, dark skin, headache, vertigo

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37
Q

What is the treatment of polycythemia vera?

A

Blood letting, phlebotomy

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38
Q

What is the universal donor blood type?

A

O neg

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39
Q

What is the universal receiver blood type?

A

AB pos

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40
Q

What is the universal plasma donor?

A

AB pos

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41
Q

What is the universal plasma receiver?

A

O neg

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42
Q

What blood group is most common in whites?

A

O

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43
Q

What blood group is most common in blacks?

A

O

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44
Q

When should RBCs be administered?

A

Low hemoglobin ( less than 7 g/dL)
Acute blood loss
Transfusion is unnecessary with Hgb greater than 10 g/dL
Intermediate levels based on organ ischemia, potential/ongoing bleeding, intravascular status, pt risk factor for complications of low oxygenation

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45
Q

When should FFP be administered?

A

Urgent reversal of Warfarin therapy.
Correction of known coagulation factor deficiencies when specific correlates are unavailable.
Correction of microvascular bleeding with increased PT or APTT.
Antithrombin III deficiency
Tx of immunodeficiencies
Tx of TTP

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46
Q

When should Platelets be administered?

A

Prophylactic in surgery patients with <50,000

Known platelet dysfunction, microvascular bleeding

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47
Q

When should Cryoprecipitate be administered?

A

Tx for factor VIII deficiency, Hemophilia A, Fibrinogen deficiencies

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48
Q

What is TRALI?

A

Noncardiogenic form of pulmonary edema associated with blood product administration. Clinical appearance is similar to ARDS. Bilateral infiltrates on CXR.
Tx: supportive

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49
Q

What are the most common causes of death from transfusions?

A

TRALI

ABO incompatibility - shouldn’t happen

50
Q

Iron Deficiency Anemia

A

Microcytic
S/S: PICA, fatigue, wt loss, light headed/dizzy, poor diet, CKD, pale skin, SOB, jaundice, tachycardia
Labs: serum Ferritin level < 30 (46 maybe)

51
Q

Anemia of Chronic Disease

A

Microcytic/Normocytic
NO PICA, hx of chronic disease
Labs: Ferritin > 100

52
Q

Thalassemias

A

Microcytic
Clinically normal, pallor, splenomegaly, growth failure, bone deformities, hepatosplenomegaly, jaundice
Labs: Electrophoreisis

53
Q

Lead Poisoning

A

Microcytic
Asymptomatic, developmental delays, SIDEROBLASTS!
Lab: finger stick followed by venous stick
Tx: Patient education!!! Chelation, hospitalization

54
Q

Aplastic Anemia

A

Normocytic
Pancytopenia, frequent infections, easy bruising
Labs: Bone Marrow Biopsy
Tx: transfusion, bone marrow transplant

55
Q

G6PD

A

Hemolytic - Normocytic
Black men, episodes of acute hemolysis. Drugs activate it - sulfa, bactrim, nitrofuantoin.
Labs: Bilirubin up, Retic count up, Heinz bodies, bite cells
Tx: avoid triggers, self resolves

56
Q

Autoimmune Hemolytic Anemia

A

Hemolytic - Normocytic
Leukemia, Lymphoma, Fatigue, angina, jaundice, splenomegaly, HAPPENS FAST!
Labs: Bilirubin up, Retic count up, SPHEROCYTES
Tx: Prednisone

57
Q

Sickle Cell Anemia

A

Normocytic
Black Patients, recurrent pain crisis, fever, diff breathing, organ failure
Labs: Sickle cells, retic count up
Tx: pain meds

58
Q

B12 deficiency

A

Macrocytic
Glossitis, GI probs, Neurological probs
Labs: B12 serum level, anisocytosis, poikilocytosis
Tx: B12 injections

59
Q

Folate deficiency

A

Macrocytic
Same as B12, but no Neuro symptoms
Labs: smear - anisocytosis, poikilocytosis
Tx: oral folic acid, avoid alcohol

60
Q

Alcoholic anemia

A

Macrocytic

Sideroblastic

61
Q

Which deficiencies are microcytic?

A

IDA, Thalassemias, Lead poisoning

62
Q

Which deficiencies are normocytic?

A

Aplastic, Hemolytic, Hemoglobinopathies

63
Q

Which deficiencies are macrocytic?

A

B12, Folate, Alcohol

64
Q

Hemophilia A is caused by a deficiency in…

A

Factor VIII

65
Q

Hemophilia a and b is a _ linked recessive disorder and is almost always seen in _

A

X, men

66
Q

This is a classic symptom of hemophilia A and B

A

Bleeding in the joints (hemarthroses)

67
Q

How is Hemophilia A treated?

A

Infusions of factor VIII or with Desmopressin

68
Q

Hemophilia B is a deficiency in _

A

Factor IX

69
Q

Hemophilia B is also called

A

Christmas tree disease

70
Q

How do you treat Hemophilia B?

A

Infusion of factor IX, (Desmopressin not helpful)

71
Q

Hemophilia C is a deficiency in _

A

Factor XI

72
Q

Hemophilia C is seen in

A

men and women

73
Q

Hemophilia C is more mild or more severe than A or B?

A

mild

74
Q

How do you treat Hemophilia C?

A

factor infusions

75
Q

What lab values will help you identify a hemophilia?

A

prolonged APTT

76
Q

Von Willebrand disease is found in…

A

both men and women

77
Q

Von Willebrand disease is a deficiency in

A

VIII/vWF complex, or just vWF part

78
Q

What are the signs of Von Willebrand disease?

A

bleeding of mucus membranes, easy bruising, menorrhagia in women, family hx

79
Q

How does the vWF work?

A

attaching platelets to each other, making an initial platelet plug. also binds to VIII prolonging it’s half life

80
Q

What will show in labs with VW disease?

A

Normal CBC, PTT, PT/INR, fibrinogen. Bleeding time may be long, but isn’t used often. Can test for vWF level

81
Q

What three assays are looked at when diagnosing vW disease?

A

vWF:Antigen, vWF:ristocetin cofactor, Factor VIII level

82
Q

How do you treat vW disease?

A

Desmopressin for mild, vWF/VIII concentrates, oral contraceptives for women experiencing menorrhagia

83
Q

What conditions may result in thrombocytopenia?

A

Decreased platelet production, increased platelet consumption, sequestration of platelets in the speen

84
Q

What is the definition of thrombocytopenia?

A

platelet count less than 150,000

85
Q

At what point to patients with thrombocytopenia become symptomatic?

A

50,000

86
Q

What are the symptoms of thrombocytopenia?

A

excessive bleeding with trauma, spontaneous bleeding, petechiae, petechiae, bruising

87
Q

If ill with multisystem disorder, what should you consider?

A

viral infection, heparin-induced thrombocytopenia, liver disease, TTP, bone marrow failure, pregnancy with HELLP syndrome

88
Q

If present with isolated thrombocytopenia, what should you consider?

A

drug-induced thrombocytopenia, ITP, gestational thrombocytopenia

89
Q

How to manage asymptomatic/symptomatic patients with incidental thrombocytopenia?

A

Asymptomatic, repeat the platelet count in one to four weeks. Symptomatic require immediate evaluation.

90
Q

What population do you usually see ITP in?

A

children, women with previous recent infection.

91
Q

What are the symptoms of ITP?

A

asymptomatic, purpura, petechiae, epistaxis, oral bleeding. Non systemic.

92
Q

What is the treatment for ITP?

A

Usually nothing. Prednisone or dexamethasone if severe.

93
Q

What population do you see TTP in?

A

adult women present with serious illness that includes fever, CNS symptoms, renal abnormalities plus purpura, epistaxis, oral bleeding.

94
Q

What do labs show with TTP?

A

low platelets, schistocytes (RBC fragments)

95
Q

What is the treatment for TTP?

A

Plasmapheresis, corticosteroids

96
Q

What do you call TTP in children?

A

Hemolytic Uremic Syndrome (includes renal failure, bloody diarrhea, ab pain)

97
Q

How does HIT present?

A

Most commonly as 50% reduction in platelets, both arterial and venous thrombosis.

98
Q

How do you treat DIC?

A

Treat underlying disease that triggered it, supportive measures, sometimes platelet or plasma transfusions.

99
Q

What do DIC labs look like?

A

All abnormal

100
Q

What are the three other non-genetic clotting component abnormalities?

A

Estrogen therapy, pregnancy, malignancy

101
Q

What are the 4 blood flow abnormalities?

A

A fib, LV dysfunction, bed rest/paralysis, venous obstruction

102
Q

What are the 4 contact surface abnormalities?

A

Atherosclerosis, vasculature injury, abnormal/mechanical heart valve, indwelling catheter

103
Q

Factor VIII deficiency causes

A

Hemophilia A

104
Q

Factor VIII increase causes

A

Elevated Factor VIII

105
Q

What test is most reliable in evaluating a VTE pt with possible hyperhomocysteinemia?

A

Fasting homocystein level

106
Q

Factor V Leiden resists what proteins?

A

Protein C and S

107
Q

What is the first test to identify a pt with Factor V Leiden?

A

APC (or Modified APC Resistance Assay)

108
Q

The homozygous form of protein C and S deficiencies (and Antithrombin deficiency) cause

A

spontaneous thrombosis at or before birth

109
Q

Lack of response to what drug indicates Antithrombin deficiency

A

Heparin

110
Q

What two medications are commonly used with the initial treatment of VTE?

A

Warfarin, LMW Heparin

111
Q

Thrombophilia patients should avoid…

A

estrogen containing drugs

112
Q

Thrombophilia patients should manage…

A

weight and hypertension

113
Q

Thrombophilia patients should quit

A

smoking, high risk physical activity

114
Q

How quickly to platelet counts return to normal after quitting alcohol?

A

1-2 weeks

115
Q

DIC can occur secondarily from

A

sepsis, trauma, burns, malignancy.

116
Q

What antibiotics can cause thrombocytopenia?

A

Cephalosporins, Rifanapin, Bactrim, Vancomycin

117
Q

Which hypertensive med can cause thrombocytopenia?

A

HCTZ

118
Q

If drug induced thrombocytopenia is suspected, how long should you wait before repeating the CBC after stopping the med?

A

1 week

119
Q

What genetic finding do you find in AML/CML?

A

Philadelphia chromosome

120
Q

What is the treatment for AML/CML?

A

TKIs (Tyrosine Kinase Inhibitors)

CLIN LAB TEST (1 decks)

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