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Hematology Exam I > Clinical Interpretations of Lab Exams > Flashcards

Clinical Interpretations of Lab Exams Flashcards

1
Q

What does anicoytosis mean?

Poikilocytosis?

A

Anisocytosis = size

Poikilocytosis = morphology

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2
Q

What is the normal volume of RBC?

A

80-100 fL

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3
Q

Macro vs Microcytic?

A

Macro = >100 fL

Micro = <80 fL

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4
Q

How would you classify anemia?

Etiology vs MCV

A

Etiology –> Blood loss, Impaird Production, Increased Destruction

MCV -> Microcytic, Normocytic, Macrocytic

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5
Q

What blood test would you order to investigate an anemic patient?

A

CBC

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6
Q

CBC Components:

  1. PCV
  2. RBC Indices –> MCH and MCHC
  3. RDW
  4. TLC
  5. Diff
  6. PBS
A

PCV = Packed Cell Volume

MCH = Mean Corpuscular Hemoglobin

MCHC = Mean Corpuscular Hemoglobin Concentration

RDW = Red Cell Distribution Width

TLC = Total Leukocyte Count

Diff = Differential Leukocyte Count

PBS = Peripheral Blood Smear

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7
Q

What does mean corpuscular volume help with?

A

Determining macrocytic vs microcytic anemias

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8
Q

What is the normal range of WBC count?

A

4.0 to 11.0 K/uL

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9
Q

What is the normal range of RBC count?

A

4.40 to 6.00 M/uL

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10
Q

What is the normal range of Platelet count?

A

150 to 400 K/uL

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11
Q

What should the relative percentages of Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Basophils be?

A

Neutrophils 50 to 70%

Lymphocytes 20 to 40%

Monocyte 2 to 12%

Basophil < 1%

Eosinophil < 5%

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12
Q

What is the normal range of Hemoglobin count?

A

Male –> 12 to 16 g/dL

Female –> 11 to 15 g/dL

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13
Q

***What is the normal range of MCV?***

A

80 to 100 fL

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14
Q

What is Reticulocyte Count (Retic Count) used for?

A

To assess erythropoietic activity

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15
Q

What is ESR used for?

A

A non-specific characteristic that tells you whether the disease is active or not

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16
Q

What is a Bone Marrow (BM) exam used for?

A

Used when cause of anemia is not evident

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17
Q

Reticulocyte Count

  1. Marker of
  2. Normal Range
  3. What to look for in Anemia
A
  1. Marker of effective erythropoiesis (bone marrow response to anemia)
  2. Normal range 0.5 to 1.5%
  3. % count is falsely elevated in anemia

***Must be corrected for degree of anemia***

Corrected Retic Count = (Patient Hct/45) x Retic Count

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18
Q

How are Reticulocytes detected in the blood?

A

Supravital stains - detect the thread-like RNA filaments in cytoplasm

Only remain in blood for 24 hours before becoming mature RBCs

19
Q

Microcytic Anemia (MCV < 80 fL)

What are the four types? (List in order of how common they are)

A
  1. Iron Deficiency - Most Common
  2. Anemia of Chronic Disease (ACD) - e.g. Kidney/Renal Failure
  3. Thalassemia
  4. Sideroblastic Anemia - Least Common
20
Q

What are some laboratory tests for microcytic anemias?

A

Serum Iron

TIBC (serum total iron binding capacity)

% Saturation [Serum Fe/TIBC] x 100

***Serum Ferritin –> Circulating fraction of storage iron (Single best test for iron studies)

Hb Electrophoresis (Gold standard for dx mild B-thalassemia; mild a-thalassemia is a dx of exclusion)

21
Q

Hemolytic Anemias

  1. 3 Categories
A
  1. Drug-induced
  2. Autoimmune (Most Common; F > M)

***SLE most common cause of autoimmune hemolytic anemia (AIHA(

  • 70% - Warm (IgG antibodies) type
  • 30% - Cold (IgM antibodies + Complement) type
    3. Alloimmune
  • Hemolytic Transfusion Reaction
  • Hemolytic Disease of Newborn
22
Q

Direct Coombs Test (DCT)

(i.e. Direct Antiglobulin Test (DAT))

A

Uses patient RBC (has already contacted/touched with antibody) (Cell, rather than protein)

  • Patient’s RBCs are incubated with antihuman antibodies (Coombs reagent)
  • RBCs agglutinate: antihuman antibodies form links between RBCs by binding to the human antibodies on the RBCs
23
Q

Indirect Coombs Test (ICT)

(i.e. Indirect Antiglobulin Test (IAT))

A

Uses the patient’s serum or antibody directly (protein, rather than cell)

  • Recipient’s serum is obtained, containing antibodies (Ig’s)
  • Donor’s blood sample is added to the tube with serum
  • Recipients Ig’s that target the donor’s RBCs form antibody-antigen complexes
  • Anti-human Ig’s (Coombs Antibodies) are added to the solution
  • Agglutination of RBCs occurs because human Ig’s are attached to the RBCs
24
Q

When would you use Indirect Coombs Test vs. Direct?

A

To test mother’s who are Rh negative to see if baby is Rh positive

25
Q

What does it mean if you see an increased percentage of Neutrophils?

Lymphocytes?

A

Increased Neutrophils –> Bacterial infection

Increased Lymphocytes –> Viral infection

26
Q

Lymphoma

A

Lymphoid neoplasms arising in discrete masses

(e.g. in spleen or lymph nodes)

27
Q

Leukemia

A

Lymphoid neoplasms with involvement of the blood and bone marrow

(usually no discrete masses)

28
Q
A

Normal Lymph Node

29
Q
A

Lymph Node - Germinal Center

(Larger cells are the macrophages)

30
Q

What are used as tumor markers in lymphoma?

A

The various stages of lymphocyte differentiation

31
Q

Lymphoma

  1. Tools for Diagnosis (4)
A
  1. Hematoxylin and Eosin (H&E Stain)
  2. Immunophenotyping (identifying cell type by protein expression)

***Critical - only way to determine if coming from B- or T-cell

  • Immunohistochemistry
  • Flow Cytometry
    3. Cytogenetics/FISH (to identify chromosomal aberration)
    4. Molecular Diagnostics (PCR detect monoclonal population - neoplastic lymphoid population)
32
Q

What markers are looked for for B cells?

A

CD 19, 20, 21, 22

Occasionally light chain (lambda) globulin

33
Q

What markers are looked for for T Cells?

A

CD 2, 3, 4, 8

34
Q

What are the two methods used for immunophenotyping? (i.e. for determining if B- or T-cell origin)

A

Immunohistochemistry

and

Flow Cytometry

35
Q

What are important factors to understand as far clinical presentation?

A

Age

Location

Multiple/single site of involvement

36
Q

What does A or B mean about lymphoma stage?

What are the symptoms?

A

A = Asymptomatic

B = Sympatomatic

  • PAINLESS, Non-tender mass/lymphadenopathy
  • Fatigue
  • Malaise
  • Night Sweats (30% of patients)
  • Fever
  • Weight Loss
37
Q

What is the pattern of atypical proliferation? (i.e. diffuse, nodular, or both)

A

Diffuse

38
Q

What is the pattern of atypical proliferation? (i.e. diffuse, nodular, or both)

A

Nodular

39
Q

What are some critical considerations of cellular morphology of a lymphoma to consider as a pathologist?

A

Do all cells look similar? monomorphic

Multiple cell types? polymorphic

Size

Nucleus (irregular, regular, round)

Chromatin (clumped, vesicular, open)

Cytoplasm (abundant/scant, color)

Mature (peripheral lymphoma) vs Immature (Lymphoblasts)

40
Q

Monomorphic vs Polymorphic

A
41
Q

Lymphoma: Main Categories

  1. Precursor B-Cell Neoplasms
  2. Peripheral B-Cell Neoplasms
  3. Precursor T-Cell Neoplasms
  4. Peripheral T-Cell and NK-Cell Neoplasms
  5. Hodgkin’s Lymphoma
A
  1. Precursor B-Cell Neoplasms - Immature B-Cells
  2. Peripheral B-Cell Neoplasms - Mature B-Cells
  3. Precursor T-Cell Neoplasms - Immature T-Cells
  4. Peripheral T-Cell and NK-Cell Neoplasms - Mature T-Cells and Natural Killer Cells
  5. Hodgkin’s Lymphoma - Reed-Sternberg Cells and Variants
42
Q

What are the main predominating tumors in people under 10 years old compared to over 10 years old?

A

< 10 years old = Acute Leukemia

> 10 years old = Lymphoma

43
Q

***Know this***

Staging of Lymphoma

  1. Stage I
  2. Stage II
  3. Stage III
  4. Stage IV
  5. All stages - A vs B
A

I - Single lymph node region or extralymphatic site (IE)

II - Two or more LN regions or EL sites (IIE) on same side of diaphragm

III - LN regions or EL sites (IIIE) on both sides of diaphragm

IV - Disseminated or diffuse involvement of one or more EL sites

For all stages:

A = Asymptomatic

B = Fever, night sweats, or > 10% weight loss

Hematology Exam I (12 decks)

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