ClinLab Review Slides Flashcards
1
Q
What are the 3 functions of blood?
A
Transport
Regulate
Protect
2
Q
What are the 3 physical characteristics and components of blood?
A
Plasma 55%
Packed RBCs 45%
WBCs 60% PMNs, 25%
3
Q
What is the sequence of priority of WBC levels?
A
Neutrophils Lymphocytes Monocytes Eosinophils Basophils
4
Q
What is the Erythroid / Granulocyte Ratio
What causes the ratio to increase?
A
1 : 3
Anemia
5
Q
Define Hematopoiesis
A
Production, development, differentiation and maturation of blood cells and formed elements
6
Q
Pluripotent stem cells produce ? capable of ?
A
Multi-potential stem cells
Differentiation into myeloid or lymphoid precursors
7
Q
Where doe blood cell formation primarily take place in adults?
A
Flat bones
8
Q
What are the two lines of WBC production in leukopoisis
A
Myeloid- PMNs, Baso, Eos, Mono
Lymphoid- B, T, NKC
9
Q
Myeloid stem cells are AKA and derived from?
A
Platelets
Megakaryocytes
10
Q
What are the three granular leukocytes?
A
Basophils
Eosinophils
Neutrophils
11
Q
Characteristics of reticulocytes?
A
Immature, slightly larger RBCs released due to hypoxia
Contains RNA and polychomasia appearance (blue/gray color)
12
Q
The oxygen affinity of Hgb A depends on what 3 things?
A
Temp
pH
2,3 BPG concentration
13
Q
When hypoxia stimulates the release of Epo, what four areas does it affect?
A
BFU-E
CFU-E
Pro/Erythroblasts
Normoblasts
14
Q
What 4 things are needed to make RBCs?
A
Fe3+
Globin
B12
Erythropoietin
15
Q
What are the granular leukocytes?
A
Myleopoisis/granulocytopoiesis- Neutro, Eosino, Baso
Lymphocytes (Except NK) Monocytes
16
Q
Contents and function of neutrophils?
A
Myeloperoxidase
Lysozyme
Defensins
Phagocytic, Microbicidal
17
Q
Contents and function of Eosinophils?
A
Major Basic Protein
Histaminase
Modulator of hypersensitivity Helminth killing
18
Q
Contents and function of Basophils?
A
Histamine
Immediate hypersensitivity
19
Q
Contents and function of Monocytes?
A
Lysozymes
Phagocytic (macrophage) Ag presentation (dendritic)
20
Q
Contents and function of T Cells?
A
Perforin
Granzyme (only CD8)
CD4, CD8
21
Q
Contents and function of B Cells?
A
None
Humoral Immunity
22
Q
Contents and function of NKCs
A
Perforin
Granzymes
Cytotoxic
23
Q
How do WBCs leave the blood stream?
What was this process formerly known as?
A
Emigration
Diapedesis
24
Q
Myeloid stem cells eventually develop into ?
What inhibits/shortens the lifespan of these?
A
Megakaryocytes
Aspirin
25
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?
Lavender
Light blue
Green heparin
26
Define MCV
Mean Corpuscular Volume
| Size of RBCs
27
Define MCH
Average weight of Hbg in RBCs
| Rarely used as Dx tool
28
Define MCHC
Average concentration Hgb in each RBC
| Indicates reflection of RBC staining intensity/degree of central pallor
29
# Define Anisocytosis
Define Poikilocytosis
Increased variation in size of RBCs
Increased variation in shape of RBCs
30
Define Anemia
O2 carrying capacity of the blood is reduced due to decreased RBC, Hgb, HCT
31
Elevated or decreased reticulocyte numbers are indicative of ?
```
Elevated= inc destruction
Decreased= hypoproliferative
```
32
What is the clinical use of Serum Iron
Measures transferrin bound to iron w/ diurnal variation
33
What is the clinical use of TIBC?
Total Iron Binding Capacity
| Measures total amount of Fe that can be bound by transferrin the plasmin or serum
34
# Define Transferrin Saturation
When is this measurement increased?
Max amount of iron that is bound in plasma or serum
Iron overload
35
What factors affect an ESR time?
Accelerates time:
Inc fibrinogen levels and globulin proteins
Anemia
Lowers time:
Abnormal RBC shape hinder rouleaux
Microcytes
36
# Define Zeta Potential
What happens when Zeta decreases?
Forces that hold RBCs apart from each other
Formation of rouleaux which increases ESR
37
What are the difference in levels of Iron Deficiency and Anemia from chronic diseases?
Fe deficient: in TIBC, dec Ferritin
Chronic Dz: Dec TBIC, inc Ferritin
38
Define Hemolytic Anemia
Shortened red cell survival
39
What are the three types of hereditary hemolytic anemias?
Defected RBC membranes
Enzyme defects
Hemoglobinopathies- Thalassemia syndromes
40
How is Sickle Cells characterized?
Production of HbS
| B chain abnormality, single AA substitution of Valine for Gluamic Acid
41
What is the difference between Sickle Cell Dz and Sickle Cell Trait?
```
Dz= HbSS Homozygous
Trait= HbSB Heterozygous
```
42
What are the two Alpha Thalassemias?
Hgb H Dz-severe micro/hypo BBBB
| Hydrops Fetalis- severe micro/hypo Hgb Barts (GGGG)
43
What are the two Beta Thalassemias?
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
44
What are the four causes of micro/hypo anemia?
Fe deficient
Inflammation
Thalassemia A/B
45
PTs with poikilocytosis or anisocytosis correlates to them also having a higher ?
RDW
46
Define Hemostasis
Response to hemorrhage and process to stop the bleed
47
What is the first stage of wound healing?
Hemostasis
48
What are the two parts of hemostasis?
Primary- spasm and plug formation
Secondary- clotting/coag cascade
49
# Define Platelet Adhesion
What does this step require?
Platelets attaching to non-platelet surfaces on collagen
GP1b to vWF
GP1a to Collagen
vWF
50
Define Platelet activation?
Pseudopods
| Granule release
51
# Define Platelet Aggregation
What can inhibit this step?
Platelets sticking to each other by fibrinogen bridge GP2b or GP3a
Aspirin
52
What are the 3 stages of coagulation?
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
What factors are in the intrinsic pathway?
What lab test assesses the intrinsic path?
8 9 11 12
Activated Partial Thromboplastin Time (aPTT)
54
What factors are in the Extrinsic Pathway?
What lab test assesses the Extrinsic Path?
3 7
Prothrombin TIme (PT)
55
What test is used for Coumadin therapy monitoring?
What test is used for Heparin therapy monitoring?
PT
aPPT
56
Factor 1 is called ?
Fator 2 is called ?
Fibrinogen
Prothrombin
57
Factor 8 is called ?
Factor 9 is called ?
vWF (Hemophilia A)
Christmas Factor (Hemophilia B)
58
Factor 13 is called ?
Why is this one important?
Fibrin Stabilizing factor
| Final stage of clot formation, stabilizes and cross links fibrin
59
What are the Vit K dependent Factors?
2 7 9 10
| Proteins C and S
60
What factors are screened for in a PT draw?
1 2 5 7 10
61
Define INR
Internationalized Normalized Ratio
| Normalized PT time test
62
What is the use and time Activated Clotting Time tests are done?
Fresh Whole Blood, not plasma
Bedside/OR
High dose Heparin Therapy and when aPTT results can't be used
63
If a Mixing study fails to correct = ?
If mixing corrects then it's ?
Inhibitor
Factor deficiency
64
# Define Fibrinolysis
When plasmin digests fibrin it produces ?
Mechanism that dissolves clots
Fibrin degeneration products
65
Crosslinked FDPs are AKA ?
D-Dimer= high sensitivity for clots but low specificity
66
When are D-Dimer assays used?
PE
DVT
DIC
Thrombotic stroke
67
Quantitative and Qualitative platelet disorders include ?
Quant- deficient production, abnormal distribution, increased destruction
Qual- congenital, acquired
68
What are the platelet adhesion disorders?
Bernard- dec GP1b/GPIX
| vWF- reduce Factor 8 (most common)
69
What are the platelet disorders of aggregation?
Glanzman- dec GP2b/3a
70
What is the main regulatory protein of secondary hemostasis?
Anti-thrombin
71
What is the substrate/base of A and B Ags?
H substance
72
ABO blood group system has a naturally occurring Ab that are predominantly ?
IgM
73
What tests are run on pre-transfusion PTs?
ABO
Rh
Ab screen/Cross match
74
When are whole blood transfusions indicated?
RBC Mass and Plasma volume
75
When are pRBCs indicated?
Increasing RBC mass in PTs requiring increased O2 carrying capacity
76
When are FFP transfusions indicated?
```
Coagulation deficiencies in PTs w/:
Liver Dz
DIC
Vit K deficiency
Warfarin ODs
Massive transfusions
```
77
When is CRYO transfusions indicated?
Fibrinogen replacement
| Factor 8 and vWF
78
Microbial infections after transfusions are normally due to infected ?
Platelets
79
Define Acute Hemolytic Transfusion Reactions
Ag/Ab reaction activating complement and coagulation systems and causes an endocrine response
80
What are the most common causes of Acute Hemolytic Transfusion Reactions?
Clerical errors at transfusion services and at bedside
81
What are the 4 most common Abs seen in Acute Hemolytic Transfusion Reactions?
anti-A
anti-Kell
anti-Jka
anti-Fya
82
What are the S/Sxs of an Acute Hemolytic Transfusion Reaction?
Fever/Chills
Back/infusion site pain
HOTN/Shock
Sense of impending doom
83
Define Febrile Non-Hemolytic Transfusion Reactions
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
How are Febrile Non-hemolytic Transfusion reactions diagnosed?
Diagnosis of elimination
85
Febrile Non-hemolytic transfusion reactions are from Abs in recipients plasma reaction to ?
Leukocytes or platelet Ags
86
Allergic Transfusion Reactions are an allergy to ?
Donor plasma proteins
87
Anaphylactic transfusion transactions are allergic reactions to ?
Recipient anti-IgA
88
What is the difference between Spherocytosis and Stomatocytosis
Spherocytosis- huge MCHC
| Stomatocytosis- inc MCV, dec MCHC
89
RBCs express ?
| Plasma contains ?
Ags
| Abs
90
What are the three alleles of the blood system?
How does the place holder become expressed?
A B O recessive
Homozygous OO
91
How are ABO group Ags formed?
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
What sugars are responsible for H, A and B specificity?
```
H= Fucose
A= Actylgalactosamine
B= Galactose
```
93
Define Natural Sensitization
Abs formed after exposure to environmental agents w/ A and B like Ags
94
# Define Forward/Direct grouping
Define Reverse Typing
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
What Ags make up the Rh system?
D C E c e Ags
96
How do Rh Abs form?
Can't develop without immune sensitization from exposure to foreign RBC Ags
97
What tests are performed to detect Abs on RBCs?
Anti-human Globulin
| Coombs reagent
98
# Define Indirect Antiglobulin Test
When is it perfromed?
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
What type of tube specimen is used for Patient Pre-Transfusion/Compatibility Testing
What does this test compose of?
EDTA Lavender/Pink top
ABO, Rh and Ab screening
100
How is incompatibility between donor and recipient blood samples shown?
Agglutination of donor RBCs in recipient serum
101
What part of the transfusion is as important as having a safe product to transfuse?
Proper collection of PTs specimen
| Proper completion of transfusion request paperwork
102
What is the most important step in the safe admin of blood products?
What are most ABO mismatches due to?
Correct ID of donor unit and recipient
Wrong tube/wrong blood because of label issues
103
# Define Minor Crossmatch
What result does not require further testing?
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
Define Major Crossmatch
If AB is present or detected during Ab screening
| 3 steps- spin, incubation @ 37*C and indirect agglutination test
105
When is the Type and Screen method used for PTs blood?
Surgical cases when blood use is infrequent but possible
| ABO, Rh and unexpected Abs are screened for
106
What type of blood work is ordered for surgical cases when blood usage is probable or when transfusion si required?
Type and Cross
| ABO, Rh and unexpected Abs are screened
107
What are the preferred forms of pRBCs to be given to each blood group?
AB- AB or A or B or O
A- A or O
B- B or O
O- O
108
What type of pRBC is the universal donor?
Who are the universal recipients?
O Neg
AB
109
What is the exception for Rh transfusions?
pRBC neg should go to PTs w/ Rh neg
| Rh pos can get either Rh pos or neg
110
Who gets FFP transfuions?
Who can receive plasma from AB blood types?
ABO compatible but w/ Rh disregarded
Any type of PT
111
Define Whole Blood
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
What temp is Whole Blood stored at?
What Factors are temp liable?
1-6*C
5 and 8 decreased after 7 days
113
When is the use of whole blood indicated?
Fresh/less than 24hrs since drawn can be utilized in emergent situations when PT has lost blood volume
114
Define pRBC
RBCs
Optisol
Plasma
115
pRBCs do NOT provide what components?
What temp are they stored at and what is their shelf life?
Platelets, Neutrophils, coag factors
1-6*C x 62ks
116
What is the indication to use pRBCs?
Sx anemia not treatable w/ specific therapies (Fe, B12, B9)
117
# Define Washed RBCs
What is their shelf life?
RBCs washed w/ saline to remove plasma but should not be considered leukoreduced
Must be used in 24hrs
118
What is the indication for using washed RBCs?
Repeated hypersensitivity reactions to blood/components despite prophylaxis
119
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