Clin Lab Test 2 Flashcards
What findings might you find on a CBC with Chronic Leukemia?
High WBC count
What findings might you find on a CBC with Acute Leukemia?
Low WBC count
What disease might you find Auer Rods?
Acute Myeloid Leukemia
What disease might you find Reed-Sternberg cells?
Hodgkin’s Lymphoma
How do you diagnose Hodgkin’s Lymphoma?
With a biopsy.
What tests are included in the CBC?
WBC, RBC, hemoglobin, hematocrit, Red Cell indicies (MCV, MCH, MCHC), Platelet Count, RDW, Mean Platelet Volume
List the clotting factor disorders.
Hemophilia A, B, C
vonWillebran
What factors are affected in Hemophilia A?
Factor VIII
What factors are affected in Hemophilia B?
Factor IX
What pathway do Hemophilias affect?
The intrinsic pathway - APTT
What pathway does vonWillebran affect?
Neither! It works on platelets
What tests will be abnormal in vonWillebran?
Could all be normal, but bleeding time could be long.
What is the most common bleeding disorder?
vonWillebran
What labs will be affected with Intrinsic Factor Deficiencies?
APTT will be high
What factors are affected with Intrinsic Factor Deficiencies?
8,9,11,12
What factors are affected with Extrinsic Factor Deficiencies?
7
What labs will be affected by Coumadin therapy?
PT/INR
What labs will be affected by Heparin therapy?
APTT will be high
Factor X should be decreased
An increase in RDW shows what?
Recent change, such as new disease process, treatment
What are the 4 classes of thalassemias?
A Thalassemia Trait
Hemoglobin H
B Thalassemia Minor
B Thalassemia Major
Which class of Thalassemia is heterozygous?
B Thalassemia Minor
Which class of Thalassemia is homogenous?
B Thalassemia Major
How is A Thalassemia Trait defined?
Missing 2 of 4 alpha genes
How is Hemoglobin H Thalassemia defined?
Missing 3 of 4 alpha genes
What is the definitive diagnosis for Aplastic Anemia?
Bone Marrow Biopsy
What are the causes of Aplastic Anemia?
Autoimmune disorders, Malignancy
What are signs of Hemolytic anemias?
Increased Reticulocyte count
Increased bilirubin
In what group of people will you see G6PD most often?
Black Males
What drugs trigger G6PD?
Sulfa, Bactrim, nitrofuantoin
What causes most sickle cell patients to end up in the ER?
Pain Crisis
What causes pain crisis in sickle cell patients?
Ischemia from a clot
How to you treat severe pain crisis?
Hydroxeuria - helps the body to make more hemoglobin F
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)
What is the difference between B12 deficiency and Folate deficiency?
Lack of neurological symptoms
What will the CBC look like with a patient with polycythemia vera?
High everything!
What are signs of polycythemia vera?
Itchy, dark skin, headache, vertigo
What is the treatment of polycythemia vera?
Blood letting, phlebotomy
What is the universal donor blood type?
O neg
What is the universal receiver blood type?
AB pos
What is the universal plasma donor?
AB pos
What is the universal plasma receiver?
O neg
What blood group is most common in whites?
O
What blood group is most common in blacks?
O
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
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
When should Platelets be administered?
Prophylactic in surgery patients with <50,000
Known platelet dysfunction, microvascular bleeding
When should Cryoprecipitate be administered?
Tx for factor VIII deficiency, Hemophilia A, Fibrinogen deficiencies
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
What are the most common causes of death from transfusions?
TRALI
ABO incompatibility - shouldn’t happen
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)
Anemia of Chronic Disease
Microcytic/Normocytic
NO PICA, hx of chronic disease
Labs: Ferritin > 100
Thalassemias
Microcytic
Clinically normal, pallor, splenomegaly, growth failure, bone deformities, hepatosplenomegaly, jaundice
Labs: Electrophoreisis
Lead Poisoning
Microcytic
Asymptomatic, developmental delays, SIDEROBLASTS!
Lab: finger stick followed by venous stick
Tx: Patient education!!! Chelation, hospitalization
Aplastic Anemia
Normocytic
Pancytopenia, frequent infections, easy bruising
Labs: Bone Marrow Biopsy
Tx: transfusion, bone marrow transplant
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
Autoimmune Hemolytic Anemia
Hemolytic - Normocytic
Leukemia, Lymphoma, Fatigue, angina, jaundice, splenomegaly, HAPPENS FAST!
Labs: Bilirubin up, Retic count up, SPHEROCYTES
Tx: Prednisone
Sickle Cell Anemia
Normocytic
Black Patients, recurrent pain crisis, fever, diff breathing, organ failure
Labs: Sickle cells, retic count up
Tx: pain meds
B12 deficiency
Macrocytic
Glossitis, GI probs, Neurological probs
Labs: B12 serum level, anisocytosis, poikilocytosis
Tx: B12 injections
Folate deficiency
Macrocytic
Same as B12, but no Neuro symptoms
Labs: smear - anisocytosis, poikilocytosis
Tx: oral folic acid, avoid alcohol
Alcoholic anemia
Macrocytic
Sideroblastic
Which deficiencies are microcytic?
IDA, Thalassemias, Lead poisoning
Which deficiencies are normocytic?
Aplastic, Hemolytic, Hemoglobinopathies
Which deficiencies are macrocytic?
B12, Folate, Alcohol
Hemophilia A is caused by a deficiency in…
Factor VIII
Hemophilia a and b is a _ linked recessive disorder and is almost always seen in _
X, men
This is a classic symptom of hemophilia A and B
Bleeding in the joints (hemarthroses)
How is Hemophilia A treated?
Infusions of factor VIII or with Desmopressin
Hemophilia B is a deficiency in _
Factor IX
Hemophilia B is also called
Christmas tree disease
How do you treat Hemophilia B?
Infusion of factor IX, (Desmopressin not helpful)
Hemophilia C is a deficiency in _
Factor XI
Hemophilia C is seen in
men and women
Hemophilia C is more mild or more severe than A or B?
mild
How do you treat Hemophilia C?
factor infusions
What lab values will help you identify a hemophilia?
prolonged APTT
Von Willebrand disease is found in…
both men and women
Von Willebrand disease is a deficiency in
VIII/vWF complex, or just vWF part
What are the signs of Von Willebrand disease?
bleeding of mucus membranes, easy bruising, menorrhagia in women, family hx
How does the vWF work?
attaching platelets to each other, making an initial platelet plug. also binds to VIII prolonging it’s half life
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
What three assays are looked at when diagnosing vW disease?
vWF:Antigen, vWF:ristocetin cofactor, Factor VIII level
How do you treat vW disease?
Desmopressin for mild, vWF/VIII concentrates, oral contraceptives for women experiencing menorrhagia
What conditions may result in thrombocytopenia?
Decreased platelet production, increased platelet consumption, sequestration of platelets in the speen
What is the definition of thrombocytopenia?
platelet count less than 150,000
At what point to patients with thrombocytopenia become symptomatic?
50,000
What are the symptoms of thrombocytopenia?
excessive bleeding with trauma, spontaneous bleeding, petechiae, petechiae, bruising
If ill with multisystem disorder, what should you consider?
viral infection, heparin-induced thrombocytopenia, liver disease, TTP, bone marrow failure, pregnancy with HELLP syndrome
If present with isolated thrombocytopenia, what should you consider?
drug-induced thrombocytopenia, ITP, gestational thrombocytopenia
How to manage asymptomatic/symptomatic patients with incidental thrombocytopenia?
Asymptomatic, repeat the platelet count in one to four weeks. Symptomatic require immediate evaluation.
What population do you usually see ITP in?
children, women with previous recent infection.
What are the symptoms of ITP?
asymptomatic, purpura, petechiae, epistaxis, oral bleeding. Non systemic.
What is the treatment for ITP?
Usually nothing. Prednisone or dexamethasone if severe.
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.
What do labs show with TTP?
low platelets, schistocytes (RBC fragments)
What is the treatment for TTP?
Plasmapheresis, corticosteroids
What do you call TTP in children?
Hemolytic Uremic Syndrome (includes renal failure, bloody diarrhea, ab pain)
How does HIT present?
Most commonly as 50% reduction in platelets, both arterial and venous thrombosis.
How do you treat DIC?
Treat underlying disease that triggered it, supportive measures, sometimes platelet or plasma transfusions.
What do DIC labs look like?
All abnormal
What are the three other non-genetic clotting component abnormalities?
Estrogen therapy, pregnancy, malignancy
What are the 4 blood flow abnormalities?
A fib, LV dysfunction, bed rest/paralysis, venous obstruction
What are the 4 contact surface abnormalities?
Atherosclerosis, vasculature injury, abnormal/mechanical heart valve, indwelling catheter
Factor VIII deficiency causes
Hemophilia A
Factor VIII increase causes
Elevated Factor VIII
What test is most reliable in evaluating a VTE pt with possible hyperhomocysteinemia?
Fasting homocystein level
Factor V Leiden resists what proteins?
Protein C and S
What is the first test to identify a pt with Factor V Leiden?
APC (or Modified APC Resistance Assay)
The homozygous form of protein C and S deficiencies (and Antithrombin deficiency) cause
spontaneous thrombosis at or before birth
Lack of response to what drug indicates Antithrombin deficiency
Heparin
What two medications are commonly used with the initial treatment of VTE?
Warfarin, LMW Heparin
Thrombophilia patients should avoid…
estrogen containing drugs
Thrombophilia patients should manage…
weight and hypertension
Thrombophilia patients should quit
smoking, high risk physical activity
How quickly to platelet counts return to normal after quitting alcohol?
1-2 weeks
DIC can occur secondarily from
sepsis, trauma, burns, malignancy.
What antibiotics can cause thrombocytopenia?
Cephalosporins, Rifanapin, Bactrim, Vancomycin
Which hypertensive med can cause thrombocytopenia?
HCTZ
If drug induced thrombocytopenia is suspected, how long should you wait before repeating the CBC after stopping the med?
1 week
What genetic finding do you find in AML/CML?
Philadelphia chromosome
What is the treatment for AML/CML?
TKIs (Tyrosine Kinase Inhibitors)
