ClinLab Review Slides Flashcards
What are the 3 functions of blood?
Transport
Regulate
Protect
What are the 3 physical characteristics and components of blood?
Plasma 55%
Packed RBCs 45%
WBCs 60% PMNs, 25%
What is the sequence of priority of WBC levels?
Neutrophils Lymphocytes Monocytes Eosinophils Basophils
What is the Erythroid / Granulocyte Ratio
What causes the ratio to increase?
1 : 3
Anemia
Define Hematopoiesis
Production, development, differentiation and maturation of blood cells and formed elements
Pluripotent stem cells produce ? capable of ?
Multi-potential stem cells
Differentiation into myeloid or lymphoid precursors
Where doe blood cell formation primarily take place in adults?
Flat bones
What are the two lines of WBC production in leukopoisis
Myeloid- PMNs, Baso, Eos, Mono
Lymphoid- B, T, NKC
Myeloid stem cells are AKA and derived from?
Platelets
Megakaryocytes
What are the three granular leukocytes?
Basophils
Eosinophils
Neutrophils
Characteristics of reticulocytes?
Immature, slightly larger RBCs released due to hypoxia
Contains RNA and polychomasia appearance (blue/gray color)
The oxygen affinity of Hgb A depends on what 3 things?
Temp
pH
2,3 BPG concentration
When hypoxia stimulates the release of Epo, what four areas does it affect?
BFU-E
CFU-E
Pro/Erythroblasts
Normoblasts
What 4 things are needed to make RBCs?
Fe3+
Globin
B12
Erythropoietin
What are the granular leukocytes?
Myleopoisis/granulocytopoiesis- Neutro, Eosino, Baso
Lymphocytes (Except NK) Monocytes
Contents and function of neutrophils?
Myeloperoxidase
Lysozyme
Defensins
Phagocytic, Microbicidal
Contents and function of Eosinophils?
Major Basic Protein
Histaminase
Modulator of hypersensitivity Helminth killing
Contents and function of Basophils?
Histamine
Immediate hypersensitivity
Contents and function of Monocytes?
Lysozymes
Phagocytic (macrophage) Ag presentation (dendritic)
Contents and function of T Cells?
Perforin
Granzyme (only CD8)
CD4, CD8
Contents and function of B Cells?
None
Humoral Immunity
Contents and function of NKCs
Perforin
Granzymes
Cytotoxic
How do WBCs leave the blood stream?
What was this process formerly known as?
Emigration
Diapedesis
Myeloid stem cells eventually develop into ?
What inhibits/shortens the lifespan of these?
Megakaryocytes
Aspirin
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
Define MCV
Mean Corpuscular Volume
Size of RBCs
Define MCH
Average weight of Hbg in RBCs
Rarely used as Dx tool
Define MCHC
Average concentration Hgb in each RBC
Indicates reflection of RBC staining intensity/degree of central pallor
Define Anisocytosis
Define Poikilocytosis
Increased variation in size of RBCs
Increased variation in shape of RBCs
Define Anemia
O2 carrying capacity of the blood is reduced due to decreased RBC, Hgb, HCT
Elevated or decreased reticulocyte numbers are indicative of ?
Elevated= inc destruction Decreased= hypoproliferative
What is the clinical use of Serum Iron
Measures transferrin bound to iron w/ diurnal variation
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
Define Transferrin Saturation
When is this measurement increased?
Max amount of iron that is bound in plasma or serum
Iron overload
What factors affect an ESR time?
Accelerates time:
Inc fibrinogen levels and globulin proteins
Anemia
Lowers time:
Abnormal RBC shape hinder rouleaux
Microcytes
Define Zeta Potential
What happens when Zeta decreases?
Forces that hold RBCs apart from each other
Formation of rouleaux which increases ESR
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
Define Hemolytic Anemia
Shortened red cell survival
What are the three types of hereditary hemolytic anemias?
Defected RBC membranes
Enzyme defects
Hemoglobinopathies- Thalassemia syndromes
How is Sickle Cells characterized?
Production of HbS
B chain abnormality, single AA substitution of Valine for Gluamic Acid
What is the difference between Sickle Cell Dz and Sickle Cell Trait?
Dz= HbSS Homozygous Trait= HbSB Heterozygous
What are the two Alpha Thalassemias?
Hgb H Dz-severe micro/hypo BBBB
Hydrops Fetalis- severe micro/hypo Hgb Barts (GGGG)
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
What are the four causes of micro/hypo anemia?
Fe deficient
Inflammation
Thalassemia A/B
PTs with poikilocytosis or anisocytosis correlates to them also having a higher ?
RDW
Define Hemostasis
Response to hemorrhage and process to stop the bleed
What is the first stage of wound healing?
Hemostasis
What are the two parts of hemostasis?
Primary- spasm and plug formation
Secondary- clotting/coag cascade
Define Platelet Adhesion
What does this step require?
Platelets attaching to non-platelet surfaces on collagen
GP1b to vWF
GP1a to Collagen
vWF
Define Platelet activation?
Pseudopods
Granule release
Define Platelet Aggregation
What can inhibit this step?
Platelets sticking to each other by fibrinogen bridge GP2b or GP3a
Aspirin
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
What factors are in the intrinsic pathway?
What lab test assesses the intrinsic path?
8 9 11 12
Activated Partial Thromboplastin Time (aPTT)
What factors are in the Extrinsic Pathway?
What lab test assesses the Extrinsic Path?
3 7
Prothrombin TIme (PT)
What test is used for Coumadin therapy monitoring?
What test is used for Heparin therapy monitoring?
PT
aPPT
Factor 1 is called ?
Fator 2 is called ?
Fibrinogen
Prothrombin
Factor 8 is called ?
Factor 9 is called ?
vWF (Hemophilia A)
Christmas Factor (Hemophilia B)
Factor 13 is called ?
Why is this one important?
Fibrin Stabilizing factor
Final stage of clot formation, stabilizes and cross links fibrin
What are the Vit K dependent Factors?
2 7 9 10
Proteins C and S
What factors are screened for in a PT draw?
1 2 5 7 10
Define INR
Internationalized Normalized Ratio
Normalized PT time test
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
If a Mixing study fails to correct = ?
If mixing corrects then it’s ?
Inhibitor
Factor deficiency
Define Fibrinolysis
When plasmin digests fibrin it produces ?
Mechanism that dissolves clots
Fibrin degeneration products
Crosslinked FDPs are AKA ?
D-Dimer= high sensitivity for clots but low specificity
When are D-Dimer assays used?
PE
DVT
DIC
Thrombotic stroke
Quantitative and Qualitative platelet disorders include ?
Quant- deficient production, abnormal distribution, increased destruction
Qual- congenital, acquired
What are the platelet adhesion disorders?
Bernard- dec GP1b/GPIX
vWF- reduce Factor 8 (most common)
What are the platelet disorders of aggregation?
Glanzman- dec GP2b/3a
What is the main regulatory protein of secondary hemostasis?
Anti-thrombin
What is the substrate/base of A and B Ags?
H substance
ABO blood group system has a naturally occurring Ab that are predominantly ?
IgM
What tests are run on pre-transfusion PTs?
ABO
Rh
Ab screen/Cross match
When are whole blood transfusions indicated?
RBC Mass and Plasma volume
When are pRBCs indicated?
Increasing RBC mass in PTs requiring increased O2 carrying capacity
When are FFP transfusions indicated?
Coagulation deficiencies in PTs w/: Liver Dz DIC Vit K deficiency Warfarin ODs Massive transfusions
When is CRYO transfusions indicated?
Fibrinogen replacement
Factor 8 and vWF
Microbial infections after transfusions are normally due to infected ?
Platelets
Define Acute Hemolytic Transfusion Reactions
Ag/Ab reaction activating complement and coagulation systems and causes an endocrine response
What are the most common causes of Acute Hemolytic Transfusion Reactions?
Clerical errors at transfusion services and at bedside
What are the 4 most common Abs seen in Acute Hemolytic Transfusion Reactions?
anti-A
anti-Kell
anti-Jka
anti-Fya
What are the S/Sxs of an Acute Hemolytic Transfusion Reaction?
Fever/Chills
Back/infusion site pain
HOTN/Shock
Sense of impending doom
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
How are Febrile Non-hemolytic Transfusion reactions diagnosed?
Diagnosis of elimination
Febrile Non-hemolytic transfusion reactions are from Abs in recipients plasma reaction to ?
Leukocytes or platelet Ags
Allergic Transfusion Reactions are an allergy to ?
Donor plasma proteins
Anaphylactic transfusion transactions are allergic reactions to ?
Recipient anti-IgA
What is the difference between Spherocytosis and Stomatocytosis
Spherocytosis- huge MCHC
Stomatocytosis- inc MCV, dec MCHC
RBCs express ?
Plasma contains ?
Ags
Abs
What are the three alleles of the blood system?
How does the place holder become expressed?
A B O recessive
Homozygous OO
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
What sugars are responsible for H, A and B specificity?
H= Fucose A= Actylgalactosamine B= Galactose
Define Natural Sensitization
Abs formed after exposure to environmental agents w/ A and B like Ags
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)
What Ags make up the Rh system?
D C E c e Ags
How do Rh Abs form?
Can’t develop without immune sensitization from exposure to foreign RBC Ags
What tests are performed to detect Abs on RBCs?
Anti-human Globulin
Coombs reagent
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)
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
How is incompatibility between donor and recipient blood samples shown?
Agglutination of donor RBCs in recipient serum
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
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
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
Define Major Crossmatch
If AB is present or detected during Ab screening
3 steps- spin, incubation @ 37*C and indirect agglutination test
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
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
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
What type of pRBC is the universal donor?
Who are the universal recipients?
O Neg
AB
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
Who gets FFP transfuions?
Who can receive plasma from AB blood types?
ABO compatible but w/ Rh disregarded
Any type of PT
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
What temp is Whole Blood stored at?
What Factors are temp liable?
1-6*C
5 and 8 decreased after 7 days
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
Define pRBC
RBCs
Optisol
Plasma
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
What is the indication to use pRBCs?
Sx anemia not treatable w/ specific therapies (Fe, B12, B9)
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
What is the indication for using washed RBCs?
Repeated hypersensitivity reactions to blood/components despite prophylaxis
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