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IPAP > ClinLab Review Slides > Flashcards

ClinLab Review Slides Flashcards

1
Q

What are the 3 functions of blood?

A

Transport
Regulate
Protect

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2
Q

What are the 3 physical characteristics and components of blood?

A

Plasma 55%
Packed RBCs 45%
WBCs 60% PMNs, 25%

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3
Q

What is the sequence of priority of WBC levels?

A 
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
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4
Q

What is the Erythroid / Granulocyte Ratio

What causes the ratio to increase?

A

1 : 3

Anemia

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5
Q

Define Hematopoiesis

A

Production, development, differentiation and maturation of blood cells and formed elements

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6
Q

Pluripotent stem cells produce ? capable of ?

A

Multi-potential stem cells

Differentiation into myeloid or lymphoid precursors

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7
Q

Where doe blood cell formation primarily take place in adults?

A

Flat bones

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8
Q

What are the two lines of WBC production in leukopoisis

A

Myeloid- PMNs, Baso, Eos, Mono

Lymphoid- B, T, NKC

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9
Q

Myeloid stem cells are AKA and derived from?

A

Platelets

Megakaryocytes

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10
Q

What are the three granular leukocytes?

A

Basophils
Eosinophils
Neutrophils

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11
Q

Characteristics of reticulocytes?

A

Immature, slightly larger RBCs released due to hypoxia

Contains RNA and polychomasia appearance (blue/gray color)

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12
Q

The oxygen affinity of Hgb A depends on what 3 things?

A

Temp
pH
2,3 BPG concentration

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13
Q

When hypoxia stimulates the release of Epo, what four areas does it affect?

A

BFU-E
CFU-E
Pro/Erythroblasts
Normoblasts

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14
Q

What 4 things are needed to make RBCs?

A

Fe3+
Globin
B12
Erythropoietin

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15
Q

What are the granular leukocytes?

A

Myleopoisis/granulocytopoiesis- Neutro, Eosino, Baso

Lymphocytes (Except NK) Monocytes

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16
Q

Contents and function of neutrophils?

A

Myeloperoxidase
Lysozyme
Defensins

Phagocytic, Microbicidal

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17
Q

Contents and function of Eosinophils?

A

Major Basic Protein
Histaminase

Modulator of hypersensitivity Helminth killing

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18
Q

Contents and function of Basophils?

A

Histamine

Immediate hypersensitivity

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19
Q

Contents and function of Monocytes?

A

Lysozymes

Phagocytic (macrophage)
Ag presentation (dendritic)
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20
Q

Contents and function of T Cells?

A

Perforin
Granzyme (only CD8)

CD4, CD8

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21
Q

Contents and function of B Cells?

A

None

Humoral Immunity

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22
Q

Contents and function of NKCs

A

Perforin
Granzymes

Cytotoxic

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23
Q

How do WBCs leave the blood stream?

What was this process formerly known as?

A

Emigration

Diapedesis

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24
Q

Myeloid stem cells eventually develop into ?

What inhibits/shortens the lifespan of these?

A

Megakaryocytes

Aspirin

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25
Q

CBC and ESR tests are drawn in which color tube?

What color are coagulation studies drawn in?

What color are samples that are tested for RBC membrane defects drawn in?

A

Lavender

Light blue

Green heparin

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26
Q

Define MCV

A

Mean Corpuscular Volume

Size of RBCs

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27
Q

Define MCH

A

Average weight of Hbg in RBCs

Rarely used as Dx tool

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28
Q

Define MCHC

A

Average concentration Hgb in each RBC

Indicates reflection of RBC staining intensity/degree of central pallor

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29
Q

Define Anisocytosis

Define Poikilocytosis

A

Increased variation in size of RBCs

Increased variation in shape of RBCs

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30
Q

Define Anemia

A

O2 carrying capacity of the blood is reduced due to decreased RBC, Hgb, HCT

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31
Q

Elevated or decreased reticulocyte numbers are indicative of ?

A 
Elevated= inc destruction
Decreased= hypoproliferative
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32
Q

What is the clinical use of Serum Iron

A

Measures transferrin bound to iron w/ diurnal variation

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33
Q

What is the clinical use of TIBC?

A

Total Iron Binding Capacity

Measures total amount of Fe that can be bound by transferrin the plasmin or serum

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34
Q

Define Transferrin Saturation

When is this measurement increased?

A

Max amount of iron that is bound in plasma or serum

Iron overload

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35
Q

What factors affect an ESR time?

A

Accelerates time:
Inc fibrinogen levels and globulin proteins
Anemia

Lowers time:
Abnormal RBC shape hinder rouleaux
Microcytes

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36
Q

Define Zeta Potential

What happens when Zeta decreases?

A

Forces that hold RBCs apart from each other

Formation of rouleaux which increases ESR

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37
Q

What are the difference in levels of Iron Deficiency and Anemia from chronic diseases?

A

Fe deficient: in TIBC, dec Ferritin

Chronic Dz: Dec TBIC, inc Ferritin

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38
Q

Define Hemolytic Anemia

A

Shortened red cell survival

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39
Q

What are the three types of hereditary hemolytic anemias?

A

Defected RBC membranes
Enzyme defects
Hemoglobinopathies- Thalassemia syndromes

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40
Q

How is Sickle Cells characterized?

A

Production of HbS

B chain abnormality, single AA substitution of Valine for Gluamic Acid

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41
Q

What is the difference between Sickle Cell Dz and Sickle Cell Trait?

A 
Dz= HbSS Homozygous
Trait= HbSB Heterozygous
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42
Q

What are the two Alpha Thalassemias?

A

Hgb H Dz-severe micro/hypo BBBB

Hydrops Fetalis- severe micro/hypo Hgb Barts (GGGG)

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43
Q

What are the two Beta Thalassemias?

A

Minor- microcytic, target cells, Inc A2, slight inc F but Pt is ASx

Major- severe microcytic anemia, schistocytes and nucleated RBCs
Inc Hgb F, Dec Hgb A

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44
Q

What are the four causes of micro/hypo anemia?

A

Fe deficient
Inflammation
Thalassemia A/B

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45
Q

PTs with poikilocytosis or anisocytosis correlates to them also having a higher ?

A

RDW

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46
Q

Define Hemostasis

A

Response to hemorrhage and process to stop the bleed

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47
Q

What is the first stage of wound healing?

A

Hemostasis

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48
Q

What are the two parts of hemostasis?

A

Primary- spasm and plug formation

Secondary- clotting/coag cascade

49
Q

Define Platelet Adhesion

What does this step require?

A

Platelets attaching to non-platelet surfaces on collagen

GP1b to vWF
GP1a to Collagen

vWF

50
Q

Define Platelet activation?

A

Pseudopods

Granule release

51
Q

Define Platelet Aggregation

What can inhibit this step?

A

Platelets sticking to each other by fibrinogen bridge GP2b or GP3a

Aspirin

52
Q

What are the 3 stages of coagulation?

A

Ex/Intrinsic leads to formatoin of Prothrombinase X-V

Prothrombinase converts 2 (prothrombin) to 2a (thrombin)

Thrombin converts fibrinogen to fibrin forming 13 cross links

53
Q

What factors are in the intrinsic pathway?

What lab test assesses the intrinsic path?

A

8 9 11 12

Activated Partial Thromboplastin Time (aPTT)

54
Q

What factors are in the Extrinsic Pathway?

What lab test assesses the Extrinsic Path?

A

3 7

Prothrombin TIme (PT)

55
Q

What test is used for Coumadin therapy monitoring?

What test is used for Heparin therapy monitoring?

A

PT

aPPT

56
Q

Factor 1 is called ?

Fator 2 is called ?

A

Fibrinogen

Prothrombin

57
Q

Factor 8 is called ?

Factor 9 is called ?

A

vWF (Hemophilia A)

Christmas Factor (Hemophilia B)

58
Q

Factor 13 is called ?

Why is this one important?

A

Fibrin Stabilizing factor

Final stage of clot formation, stabilizes and cross links fibrin

59
Q

What are the Vit K dependent Factors?

A

2 7 9 10

Proteins C and S

60
Q

What factors are screened for in a PT draw?

A

1 2 5 7 10

61
Q

Define INR

A

Internationalized Normalized Ratio

Normalized PT time test

62
Q

What is the use and time Activated Clotting Time tests are done?

A

Fresh Whole Blood, not plasma
Bedside/OR
High dose Heparin Therapy and when aPTT results can’t be used

63
Q

If a Mixing study fails to correct = ?

If mixing corrects then it’s ?

A

Inhibitor

Factor deficiency

64
Q

Define Fibrinolysis

When plasmin digests fibrin it produces ?

A

Mechanism that dissolves clots

Fibrin degeneration products

65
Q

Crosslinked FDPs are AKA ?

A

D-Dimer= high sensitivity for clots but low specificity

66
Q

When are D-Dimer assays used?

A

PE
DVT
DIC
Thrombotic stroke

67
Q

Quantitative and Qualitative platelet disorders include ?

A

Quant- deficient production, abnormal distribution, increased destruction

Qual- congenital, acquired

68
Q

What are the platelet adhesion disorders?

A

Bernard- dec GP1b/GPIX

vWF- reduce Factor 8 (most common)

69
Q

What are the platelet disorders of aggregation?

A

Glanzman- dec GP2b/3a

70
Q

What is the main regulatory protein of secondary hemostasis?

A

Anti-thrombin

71
Q

What is the substrate/base of A and B Ags?

A

H substance

72
Q

ABO blood group system has a naturally occurring Ab that are predominantly ?

A

IgM

73
Q

What tests are run on pre-transfusion PTs?

A

ABO
Rh
Ab screen/Cross match

74
Q

When are whole blood transfusions indicated?

A

RBC Mass and Plasma volume

75
Q

When are pRBCs indicated?

A

Increasing RBC mass in PTs requiring increased O2 carrying capacity

76
Q

When are FFP transfusions indicated?

A 
Coagulation deficiencies in PTs w/:
Liver Dz
DIC
Vit K deficiency
Warfarin ODs
Massive transfusions
77
Q

When is CRYO transfusions indicated?

A

Fibrinogen replacement

Factor 8 and vWF

78
Q

Microbial infections after transfusions are normally due to infected ?

A

Platelets

79
Q

Define Acute Hemolytic Transfusion Reactions

A

Ag/Ab reaction activating complement and coagulation systems and causes an endocrine response

80
Q

What are the most common causes of Acute Hemolytic Transfusion Reactions?

A

Clerical errors at transfusion services and at bedside

81
Q

What are the 4 most common Abs seen in Acute Hemolytic Transfusion Reactions?

A

anti-A
anti-Kell
anti-Jka
anti-Fya

82
Q

What are the S/Sxs of an Acute Hemolytic Transfusion Reaction?

A

Fever/Chills
Back/infusion site pain
HOTN/Shock
Sense of impending doom

83
Q

Define Febrile Non-Hemolytic Transfusion Reactions

A

Temp increase of 1*C or more after a transfusion with no other explanations
Cytokines before transfusion-More common in platelet transfusions
Cytokines after transfusion- more common w/ RBC transfusions

84
Q

How are Febrile Non-hemolytic Transfusion reactions diagnosed?

A

Diagnosis of elimination

85
Q

Febrile Non-hemolytic transfusion reactions are from Abs in recipients plasma reaction to ?

A

Leukocytes or platelet Ags

86
Q

Allergic Transfusion Reactions are an allergy to ?

A

Donor plasma proteins

87
Q

Anaphylactic transfusion transactions are allergic reactions to ?

A

Recipient anti-IgA

88
Q

What is the difference between Spherocytosis and Stomatocytosis

A

Spherocytosis- huge MCHC

Stomatocytosis- inc MCV, dec MCHC

89
Q

RBCs express ?

Plasma contains ?

A

Ags

Abs

90
Q

What are the three alleles of the blood system?

How does the place holder become expressed?

A

A B O recessive

Homozygous OO

91
Q

How are ABO group Ags formed?

A

Transferases add sugars to H substance- the base of A and B Ags
O- none of the H substance is converted to A or B

92
Q

What sugars are responsible for H, A and B specificity?

A 
H= Fucose 
A= Actylgalactosamine
B= Galactose
93
Q

Define Natural Sensitization

A

Abs formed after exposure to environmental agents w/ A and B like Ags

94
Q

Define Forward/Direct grouping

Define Reverse Typing

A

PT RBCs mixed w/ reagent typing serum to ID red cell Ags (reaction w/ PT cells)

PTs plasma is mixes w/ reagent typing cells to ID red cell Abs (reaction w/ PT serum)

95
Q

What Ags make up the Rh system?

A

D C E c e Ags

96
Q

How do Rh Abs form?

A

Can’t develop without immune sensitization from exposure to foreign RBC Ags

97
Q

What tests are performed to detect Abs on RBCs?

A

Anti-human Globulin

Coombs reagent

98
Q

Define Indirect Antiglobulin Test

When is it perfromed?

A

Coating RBCs w/ Abs from PT/recipient and tested w/ AHG sera

Screening for unexpected Abs in PTs serum (maternal serum during pregnancy, PT prior to transfusion)

99
Q

What type of tube specimen is used for Patient Pre-Transfusion/Compatibility Testing

What does this test compose of?

A

EDTA Lavender/Pink top

ABO, Rh and Ab screening

100
Q

How is incompatibility between donor and recipient blood samples shown?

A

Agglutination of donor RBCs in recipient serum

101
Q

What part of the transfusion is as important as having a safe product to transfuse?

A

Proper collection of PTs specimen

Proper completion of transfusion request paperwork

102
Q

What is the most important step in the safe admin of blood products?

What are most ABO mismatches due to?

A

Correct ID of donor unit and recipient

Wrong tube/wrong blood because of label issues

103
Q

Define Minor Crossmatch

What result does not require further testing?

A

PT serum with donor cell and immediately centrifuging , absence of agglutination= compatible

No Abs are detected and no record of Abs, immediate spin cross match is sufficient

104
Q

Define Major Crossmatch

A

If AB is present or detected during Ab screening

3 steps- spin, incubation @ 37*C and indirect agglutination test

105
Q

When is the Type and Screen method used for PTs blood?

A

Surgical cases when blood use is infrequent but possible

ABO, Rh and unexpected Abs are screened for

106
Q

What type of blood work is ordered for surgical cases when blood usage is probable or when transfusion si required?

A

Type and Cross

ABO, Rh and unexpected Abs are screened

107
Q

What are the preferred forms of pRBCs to be given to each blood group?

A

AB- AB or A or B or O
A- A or O
B- B or O
O- O

108
Q

What type of pRBC is the universal donor?

Who are the universal recipients?

A

O Neg

AB

109
Q

What is the exception for Rh transfusions?

A

pRBC neg should go to PTs w/ Rh neg

Rh pos can get either Rh pos or neg

110
Q

Who gets FFP transfuions?

Who can receive plasma from AB blood types?

A

ABO compatible but w/ Rh disregarded

Any type of PT

111
Q

Define Whole Blood

A

One unit of unprocessed donated blood that contains one unit of plasma and RBCs not usually found in MTFs and used in field emergencies

112
Q

What temp is Whole Blood stored at?

What Factors are temp liable?

A

1-6*C

5 and 8 decreased after 7 days

113
Q

When is the use of whole blood indicated?

A

Fresh/less than 24hrs since drawn can be utilized in emergent situations when PT has lost blood volume

114
Q

Define pRBC

A

RBCs
Optisol
Plasma

115
Q

pRBCs do NOT provide what components?

What temp are they stored at and what is their shelf life?

A

Platelets, Neutrophils, coag factors

1-6*C x 62ks

116
Q

What is the indication to use pRBCs?

A

Sx anemia not treatable w/ specific therapies (Fe, B12, B9)

117
Q

Define Washed RBCs

What is their shelf life?

A

RBCs washed w/ saline to remove plasma but should not be considered leukoreduced

Must be used in 24hrs

118
Q

What is the indication for using washed RBCs?

A

Repeated hypersensitivity reactions to blood/components despite prophylaxis

119
Q

Stopped on

A

Slide 10

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