Clin Lab Test 2 Flashcards
(120 cards)
1
Q
What findings might you find on a CBC with Chronic Leukemia?
A
High WBC count
2
Q
What findings might you find on a CBC with Acute Leukemia?
A
Low WBC count
3
Q
What disease might you find Auer Rods?
A
Acute Myeloid Leukemia
4
Q
What disease might you find Reed-Sternberg cells?
A
Hodgkin’s Lymphoma
5
Q
How do you diagnose Hodgkin’s Lymphoma?
A
With a biopsy.
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
7
Q
List the clotting factor disorders.
A
Hemophilia A, B, C
vonWillebran
8
Q
What factors are affected in Hemophilia A?
A
Factor VIII
9
Q
What factors are affected in Hemophilia B?
A
Factor IX
10
Q
What pathway do Hemophilias affect?
A
The intrinsic pathway - APTT
11
Q
What pathway does vonWillebran affect?
A
Neither! It works on platelets
12
Q
What tests will be abnormal in vonWillebran?
A
Could all be normal, but bleeding time could be long.
13
Q
What is the most common bleeding disorder?
A
vonWillebran
14
Q
What labs will be affected with Intrinsic Factor Deficiencies?
A
APTT will be high
15
Q
What factors are affected with Intrinsic Factor Deficiencies?
A
8,9,11,12
16
Q
What factors are affected with Extrinsic Factor Deficiencies?
A
7
17
Q
What labs will be affected by Coumadin therapy?
A
PT/INR
18
Q
What labs will be affected by Heparin therapy?
A
APTT will be high
Factor X should be decreased
19
Q
An increase in RDW shows what?
A
Recent change, such as new disease process, treatment
20
Q
What are the 4 classes of thalassemias?
A
A Thalassemia Trait
Hemoglobin H
B Thalassemia Minor
B Thalassemia Major
21
Q
Which class of Thalassemia is heterozygous?
A
B Thalassemia Minor
22
Q
Which class of Thalassemia is homogenous?
A
B Thalassemia Major
23
Q
How is A Thalassemia Trait defined?
A
Missing 2 of 4 alpha genes
24
Q
How is Hemoglobin H Thalassemia defined?
A
Missing 3 of 4 alpha genes
25
What is the definitive diagnosis for Aplastic Anemia?
Bone Marrow Biopsy
26
What are the causes of Aplastic Anemia?
Autoimmune disorders, Malignancy
27
What are signs of Hemolytic anemias?
Increased Reticulocyte count
| Increased bilirubin
28
In what group of people will you see G6PD most often?
Black Males
29
What drugs trigger G6PD?
Sulfa, Bactrim, nitrofuantoin
30
What causes most sickle cell patients to end up in the ER?
Pain Crisis
31
What causes pain crisis in sickle cell patients?
Ischemia from a clot
32
How to you treat severe pain crisis?
Hydroxeuria - helps the body to make more hemoglobin F
33
What may cause a deficiency in vitamin B12?
gastric bypass, intestinal resection, diet, lack of intrinsic factor, Chrone's disease, Pernicious anemia (autoimmune against the parietal cells)
34
What is the difference between B12 deficiency and Folate deficiency?
Lack of neurological symptoms
35
What will the CBC look like with a patient with polycythemia vera?
High everything!
36
What are signs of polycythemia vera?
Itchy, dark skin, headache, vertigo
37
What is the treatment of polycythemia vera?
Blood letting, phlebotomy
38
What is the universal donor blood type?
O neg
39
What is the universal receiver blood type?
AB pos
40
What is the universal plasma donor?
AB pos
41
What is the universal plasma receiver?
O neg
42
What blood group is most common in whites?
O
43
What blood group is most common in blacks?
O
44
When should RBCs be administered?
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
45
When should FFP be administered?
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
46
When should Platelets be administered?
Prophylactic in surgery patients with <50,000
| Known platelet dysfunction, microvascular bleeding
47
When should Cryoprecipitate be administered?
Tx for factor VIII deficiency, Hemophilia A, Fibrinogen deficiencies
48
What is TRALI?
Noncardiogenic form of pulmonary edema associated with blood product administration. Clinical appearance is similar to ARDS. Bilateral infiltrates on CXR.
Tx: supportive
49
What are the most common causes of death from transfusions?
TRALI
| ABO incompatibility - shouldn't happen
50
Iron Deficiency Anemia
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
Anemia of Chronic Disease
Microcytic/Normocytic
NO PICA, hx of chronic disease
Labs: Ferritin > 100
52
Thalassemias
Microcytic
Clinically normal, pallor, splenomegaly, growth failure, bone deformities, hepatosplenomegaly, jaundice
Labs: Electrophoreisis
53
Lead Poisoning
Microcytic
Asymptomatic, developmental delays, SIDEROBLASTS!
Lab: finger stick followed by venous stick
Tx: Patient education!!! Chelation, hospitalization
54
Aplastic Anemia
Normocytic
Pancytopenia, frequent infections, easy bruising
Labs: Bone Marrow Biopsy
Tx: transfusion, bone marrow transplant
55
G6PD
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
Autoimmune Hemolytic Anemia
Hemolytic - Normocytic
Leukemia, Lymphoma, Fatigue, angina, jaundice, splenomegaly, HAPPENS FAST!
Labs: Bilirubin up, Retic count up, SPHEROCYTES
Tx: Prednisone
57
Sickle Cell Anemia
Normocytic
Black Patients, recurrent pain crisis, fever, diff breathing, organ failure
Labs: Sickle cells, retic count up
Tx: pain meds
58
B12 deficiency
Macrocytic
Glossitis, GI probs, Neurological probs
Labs: B12 serum level, anisocytosis, poikilocytosis
Tx: B12 injections
59
Folate deficiency
Macrocytic
Same as B12, but no Neuro symptoms
Labs: smear - anisocytosis, poikilocytosis
Tx: oral folic acid, avoid alcohol
60
Alcoholic anemia
Macrocytic
| Sideroblastic
61
Which deficiencies are microcytic?
IDA, Thalassemias, Lead poisoning
62
Which deficiencies are normocytic?
Aplastic, Hemolytic, Hemoglobinopathies
63
Which deficiencies are macrocytic?
B12, Folate, Alcohol
64
Hemophilia A is caused by a deficiency in...
Factor VIII
65
Hemophilia a and b is a _ linked recessive disorder and is almost always seen in _
X, men
66
This is a classic symptom of hemophilia A and B
Bleeding in the joints (hemarthroses)
67
How is Hemophilia A treated?
Infusions of factor VIII or with Desmopressin
68
Hemophilia B is a deficiency in _
Factor IX
69
Hemophilia B is also called
Christmas tree disease
70
How do you treat Hemophilia B?
Infusion of factor IX, (Desmopressin not helpful)
71
Hemophilia C is a deficiency in _
Factor XI
72
Hemophilia C is seen in
men and women
73
Hemophilia C is more mild or more severe than A or B?
mild
74
How do you treat Hemophilia C?
factor infusions
75
What lab values will help you identify a hemophilia?
prolonged APTT
76
Von Willebrand disease is found in...
both men and women
77
Von Willebrand disease is a deficiency in
VIII/vWF complex, or just vWF part
78
What are the signs of Von Willebrand disease?
bleeding of mucus membranes, easy bruising, menorrhagia in women, family hx
79
How does the vWF work?
attaching platelets to each other, making an initial platelet plug. also binds to VIII prolonging it's half life
80
What will show in labs with VW disease?
Normal CBC, PTT, PT/INR, fibrinogen. Bleeding time may be long, but isn't used often. Can test for vWF level
81
What three assays are looked at when diagnosing vW disease?
vWF:Antigen, vWF:ristocetin cofactor, Factor VIII level
82
How do you treat vW disease?
Desmopressin for mild, vWF/VIII concentrates, oral contraceptives for women experiencing menorrhagia
83
What conditions may result in thrombocytopenia?
Decreased platelet production, increased platelet consumption, sequestration of platelets in the speen
84
What is the definition of thrombocytopenia?
platelet count less than 150,000
85
At what point to patients with thrombocytopenia become symptomatic?
50,000
86
What are the symptoms of thrombocytopenia?
excessive bleeding with trauma, spontaneous bleeding, petechiae, petechiae, bruising
87
If ill with multisystem disorder, what should you consider?
viral infection, heparin-induced thrombocytopenia, liver disease, TTP, bone marrow failure, pregnancy with HELLP syndrome
88
If present with isolated thrombocytopenia, what should you consider?
drug-induced thrombocytopenia, ITP, gestational thrombocytopenia
89
How to manage asymptomatic/symptomatic patients with incidental thrombocytopenia?
Asymptomatic, repeat the platelet count in one to four weeks. Symptomatic require immediate evaluation.
90
What population do you usually see ITP in?
children, women with previous recent infection.
91
What are the symptoms of ITP?
asymptomatic, purpura, petechiae, epistaxis, oral bleeding. Non systemic.
92
What is the treatment for ITP?
Usually nothing. Prednisone or dexamethasone if severe.
93
What population do you see TTP in?
adult women present with serious illness that includes fever, CNS symptoms, renal abnormalities plus purpura, epistaxis, oral bleeding.
94
What do labs show with TTP?
low platelets, schistocytes (RBC fragments)
95
What is the treatment for TTP?
Plasmapheresis, corticosteroids
96
What do you call TTP in children?
Hemolytic Uremic Syndrome (includes renal failure, bloody diarrhea, ab pain)
97
How does HIT present?
Most commonly as 50% reduction in platelets, both arterial and venous thrombosis.
98
How do you treat DIC?
Treat underlying disease that triggered it, supportive measures, sometimes platelet or plasma transfusions.
99
What do DIC labs look like?
All abnormal
100
What are the three other non-genetic clotting component abnormalities?
Estrogen therapy, pregnancy, malignancy
101
What are the 4 blood flow abnormalities?
A fib, LV dysfunction, bed rest/paralysis, venous obstruction
102
What are the 4 contact surface abnormalities?
Atherosclerosis, vasculature injury, abnormal/mechanical heart valve, indwelling catheter
103
Factor VIII deficiency causes
Hemophilia A
104
Factor VIII increase causes
Elevated Factor VIII
105
What test is most reliable in evaluating a VTE pt with possible hyperhomocysteinemia?
Fasting homocystein level
106
Factor V Leiden resists what proteins?
Protein C and S
107
What is the first test to identify a pt with Factor V Leiden?
APC (or Modified APC Resistance Assay)
108
The homozygous form of protein C and S deficiencies (and Antithrombin deficiency) cause
spontaneous thrombosis at or before birth
109
Lack of response to what drug indicates Antithrombin deficiency
Heparin
110
What two medications are commonly used with the initial treatment of VTE?
Warfarin, LMW Heparin
111
Thrombophilia patients should avoid...
estrogen containing drugs
112
Thrombophilia patients should manage...
weight and hypertension
113
Thrombophilia patients should quit
smoking, high risk physical activity
114
How quickly to platelet counts return to normal after quitting alcohol?
1-2 weeks
115
DIC can occur secondarily from
sepsis, trauma, burns, malignancy.
116
What antibiotics can cause thrombocytopenia?
Cephalosporins, Rifanapin, Bactrim, Vancomycin
117
Which hypertensive med can cause thrombocytopenia?
HCTZ
118
If drug induced thrombocytopenia is suspected, how long should you wait before repeating the CBC after stopping the med?
1 week
119
What genetic finding do you find in AML/CML?
Philadelphia chromosome
120
What is the treatment for AML/CML?
TKIs (Tyrosine Kinase Inhibitors)
