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502 Lab Interpretation > Coagulation > Flashcards

Coagulation Flashcards

1
Q

Normal Platelet Count

A

150,000-300,000

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2
Q

How are platelets formed?

A

Platelets are formed in the bone marrow from large bone marrow cells called megakaryocytes. The dominant hormone controlling megakaryocyte development is thrombopoietin.

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3
Q

Conditions that Cause Increased Platelets

A

-Active bleeding (surgery, infection, trauma) -Polycythemia Vera -Postsplenectomy -Myeloproliferative diseases (chronic myeloid leukemia, other blood cancers)

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4
Q

Conditions that Cause Decreased Platelets

A

Disseminated Intravascular Coagulation, Thrombotic Thrombocytopenic Purpura, Heparin-Induced Thrombocytopenia, Idiopathic Thrombocytopenic Purpura, Drugs (ACEIs, Apap, Allopurinol, Anti-arrhythmics, antibiotics, diuretics, NSAIDs), EDTA-Dependent Agglutination

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5
Q

Disseminated Intravascular Coagulation

A

Systemic activation of blood coagulation, which results in generation and deposition of fibrin, leading to microvascular thrombi in various organs and contributing to multiple organ dysfunction syndrome.

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6
Q

DIC Causes

A

Always secondary to an underlying disorder, generally involving systemic inflammation. Sepsis, trauma, organ destruction, malignancy, transfusion reaction, obstetric complications, vascular abnormalities, liver failure, toxic reactions, heat stroke.

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7
Q

DIC Pathophysiology

A
  1. Tissue factor mediated thrombin generation 2. Dysfunctional anticoagulant mechanisms 3. Impaired fibrin removal, however fibrinolytic activity may be increased and contribute to bleeding 4. Inflammatory activation
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8
Q

DIC Presentation

A

Bleeding, Petechiae and ecchymosis, Thrombosis, Renal failure, Respiratory symptoms, Neurologic changes, Hypotension, Tachycardia

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9
Q

DIC Workup

A
  • Thrombocytopenia
  • Schistocytes
  • Prolonged coagulation times (PT/PTT)
  • Elevated D-dimer
  • Fibrinogen may be low
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10
Q

Thrombotic Thrombocytopenic Purpura

A

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder characterized by clotting in small blood vessels of the body (thromboses), resulting in a low platelet count.

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11
Q

TTP Signs and Symptoms

A
  • Neurologic manifestations (change in mental status, seizures, hemiplegia, paresthesias, visual disturbance, aphasia)
  • Fatigue
  • Petechiae
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12
Q

TTP Workup

A
  • Normal or elevated WBC count
  • Hemoglobin concentration 8-9 g/dL
  • Platelet count 20-50,000
  • Schistocytosis
  • PT/PTT normal
  • D-dimer and fibrinogen may be elevated
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13
Q

TTP Treatment

A

Total plasma exchange

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14
Q

Normal Prothrombin Time (Used to monitor coumadin therapy)

A

11-14 seconds

Evaluates extrinsic and common pathway

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15
Q

Prothrombin Time Increased

A

Liver disease, coumadin therapy, antibiotics, DIC, hereditary factor deficiencies (II, V, VII, X), massive blood transfusions, vitamin K deficiency.

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16
Q

Normal Partial Thromboplastin Time (Used to monitor heparin therapy)

A

26-34 seconds

Evaluates intrinsic and common clotting pathway.

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17
Q

PTT Increased

A

Deficiency in coagulation factors in the intrinsic pathway (hemophilia) except factor 13.

DIC Nonspecific inhibitor (lupus anticoagulant)

Heparin therapy, coumadin, antibiotics, aspirin

Vitamin K deficiency

Liver disease

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18
Q

Normal Fibrinogen Level

A

150-400 mg/dl

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19
Q

Fibrinogen

A

Acute phase reactant synthesized in the liver, involved in forming the clot in secondary hemostasis.

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20
Q

Fibrinogen Increased

A

Inflammatory status, smoking, pregnancy, malignancy, nephrotic syndrome.

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21
Q

Fibrinogen Decreased

A

Liver disease, DIC, thrombolytic Rx (atenolol, cholesterol-lowering meds, corticosteroids, thrombolytics), hereditary dysfibrinogenemia, transfusion

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22
Q

Normal D-Dimer Level

A

Less than 500

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23
Q

D-Dimer

A

Represents fibrin degradation of a blood clot after fibrinolysis

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24
Q

D-Dimer Increased

A

DVT, DIC, PE, recent surgery, sepsis, malignancy

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25
Q

D-Dimer High Sensitivity/Low specificity

A

A negative result rules out PE, DVT, but a positive does not confirm the diagnosis.

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26
Q

Normal WBC

A

1-10,000/mm3

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27
Q

Normal RBC

A

3.5-5.0 million/mm3

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28
Q

Normal Hgb

A

12-17

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29
Q

HCT

A

36-52%

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30
Q

MCV

A

82-94 fl

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31
Q

MCH

A

27-31 pg

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32
Q

MCHC

A

32-35%

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33
Q

RDW

A

10-12.5%

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34
Q

RBCs Elevated

A

Dehydration, Polycythemia Vera and other bone marrow disorders, hypoxia, high altitude

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35
Q

RBCs Decreased

A

Anemias, hemolysis, hemoglobinopathies, ETOH abuse, chronic renal failure, hemorrhage, iron deficiency anemia, liver disease, megaloblastic anemia, reticulocytosis.

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36
Q

MCV (Mean Corpuscular Volume)

A

A measure of the average volume of a RBC. Helpful for characterizing anemias. High: alcohol abuse, liver disease, megaloblastic anemia, reticulocytosis, sperocytosis. Low: Anemia of chronic disease, iron deficiency anemia, sickle cell, thalassemia.

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37
Q

MCH (Mean Corpuscular Hgb)

A

The amount of Hgb per RBC. Hgb/RBC. High: alcohol abuse, liver dz, megaloblastic anemia. Low: anemia of chronic disease, iron deficiency anemia, thalassemia.

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38
Q

MCHC (Mean Corpuscular Hgb Concentration)

A

The hemoglobin concentration per red cell. Hgb/Hct. Low: Anemia of chronic disease, thalassemia. High: hemolysis, spherocytosis

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39
Q

RDW

A

Measurement of variation in RBC size and shape. Assists in differentiating iron deficiency anemia from other microcytic anemias. High in ETOH abuse, hemolytic anemia, iron deficiency anemia, megaloblastic anemia, mixed anemias, reticulocytosis.

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40
Q

Anisocytosis

A

RBCs of unequal size. Commonly found in anemia

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41
Q

Poikilocytosis

A

Abnormally shaped RBCs. Dacrocytes (teardrop), elliptocytes, codocytes (target cells), Schistocytes (helmut cells)

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42
Q

Mature WBCs

A

Neutrophils (55-70%) Lymphocytes (30-45%) Monocytes (1-10%) Eosinophils (2-5%) Basophils (0-1%)

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43
Q

Immature WBCs

A

Band forms Metamyelocyte Myelocyte Blasts

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44
Q

Hgb/Hct Increased

A

P. vera, dehydration, burns, high altitudes, smoking/COPD

45
Q

Hgb/Hct Decreased

A

Anemias, bleeding, hemoglobinopathies, DIC, bone marrow disorders.

46
Q

Platelet Count Increased

A

Myeloproliferative disorders, acute bleeding, post-splenectomy

47
Q

Platelet Count Decreased

A

ITP, TTP, HIT, Infection, ETOH, Drugs, Bone marrow disorders

48
Q

Iron Studies Normal Values

A

Fe 150-175 mcg/dl TIBC 250-460 mcgdl Ferritin Males: 16-300 ng/mL, Females: 4-161 ng/mL

49
Q

Iron Increased

A
  • Hemochromatosis
  • Multiple transfusions
  • Lead poisoning
  • Hemolytic Anemia
50
Q

Iron Decreased

A
  • Iron deficiency
  • Nephrotic syndrome
  • Hypothyroidism
  • Anemia of chronic disease
  • Chronic renal failure
  • Infections
51
Q

TIBC Increased

A

Iron deficiency anemia, acute hepatitis, pregnancy, drugs (BCPs)

52
Q

TIBC Decreased

A

Low protein states such as nephrotic syndrome and malnutrition, anemia of chronic disease, hemochromatosis

53
Q

Ferritin Increased

A
  • Hemochromatosis
  • Thalassemia
  • Multiple Blood Transfusions
  • Chronic inflammatory disorders
54
Q

Ferritin Decreased

A

Iron deficiency anemia

55
Q

Reticulocyte Count Normal Value

A

40-135,000/mcl or 1-2%

56
Q

Reticulocytes Increased

A
  • Hemolytic anemia
  • Blood loss anemia
57
Q

Reticulocytes Decreased

A
  • Iron deficiency
  • Aplastic anemia
  • Myelodysplastic Syndrome (MDS)
  • Pure red cell aplasia
  • Bone marrow suppression
58
Q

Haptoglobin (HP)

A

Transport glycoprotein synthesized by the liver that serves as a carrier for free hemoglobin. 27-139 mg/dL

59
Q

HP Decreased

A

Hemolytic anemias such as transfusion reactions TTP Drugs (methyldopa) Artificial heart valves

60
Q

Methylmalonic Acid Normal Value

A

<0.4 mcg/dL; measured in serum or urine. Serum only accurate if renal fx normal. Standard is urine, which corrects for elevated creatinine

61
Q

Methylmalonic Acid Increased

A

B12 deficiency, methylmalonic aciduria

62
Q

Vitamin B12 Decreased

A
  • Pernicious anemia
  • Vegans
  • IBS
  • Gastrectomy patients
63
Q

Vitamin B12 Normal

A

180-400 pg/ml

64
Q

Folic Acid Decreased

A

Malnutrition, excessive uptake (pregnancy), hemolytic anemia, acute leukemias, drugs (methotrexate, dilantin, ETOH)

65
Q

Direct Coombs

A

Detects antigen-antibody complexes on the RBC. Antibody is produced that coats the patient’s own cells. Positive in hemolytic anemia.

66
Q

Normal SGOT (AST)

A

5-40 iu/L

67
Q

Normal SGPT (ALT)

A

5-35 iu/L

68
Q

Normal Direct (conjugated) Bilirubin

A

0.1-0.3 mg/dl

69
Q

Normal Indirect (unconjugated) Bilirubin

A

0.2-0.7 mg/dl

70
Q

Normal Alkaline Phosphatase

A

30-115 iu/L

71
Q

Normal Total Protein

A

6.0-8.0 g/dl

72
Q

Normal Albumin

A

3.4-4.7 g/dl

73
Q

Increased AST/ALT

A
  • Hepatocellular damage
  • Fatty liver
  • Viral hepatitis
  • ETOH hepatitis
  • AST/ALT ratio often > 2:1 in ETOH hepatitis
74
Q

Increased Direct Bilirubin

A

Hepatocellular damage, obstructive jaundice, drug-induced cholestasis, primary biliary cirrhosis.

75
Q

Increased Indirect Bilirubin

A
  • Gilbert syndome
  • Hepatocellular damage
  • Hemolysis
  • Primary biliary cirrhosis
76
Q

Increased Alkaline Phosphatase

A

Hepatocellular jaundice, CBD obstruction, primary biliary cirrhosis

77
Q

Decreased Total Protein and Albumin

A

Hepatocellular jaundice, malnutrition

78
Q

Normal NA

A

135-145 meq/l

79
Q

Normal K

A

3.5-4.5 meq/l

80
Q

Normal Cl

A

98-102 meq/l

81
Q

Normal CO2

A

22-28 meq/l

82
Q

Normal BUN

A

8-20 mg/dl

83
Q

Normal Creatinine

A

0.6-1.2 mg/dl

84
Q

Normal Glucose

A

70-110 mg/dl

85
Q

Na Increased

A
  • Hyperaldosteronism
  • Dehydration from vomiting/excess sweating
  • Inadequate water intake
86
Q

Na Decreased

A
  • Adrenal insufficiency
  • Excess free water
  • SIADH Hyperglycemia (pseudo) Na falls 1.6 for every 100 mg/dl increase of glucose over 100
  • Volume overload (CHF, ETOH disease)
  • Drugs (NSAIDs, diuretics, SSRIs)
87
Q

K Increased

A
  • Hemolysis
  • Rhabdomyolysis
  • Renal Failure
  • Addison Disease
  • RTA Type 4
  • Drugs (ACEIs, ARBs)
88
Q

K Decreased

A
  • Poor oral intake
  • Drugs (diuretics, B agonists, insulin)
  • RTA 1 and 2
  • Hyperaldosteronism
  • Cushings Syndrome
  • Familial Periodic Paralysis
  • Diarrhea
  • Low magnesium
  • Genetic Disorders
89
Q

Cl Increased

A
  • Renal failure
  • Nephrotic syndrome
  • Dehydration
  • RTA
  • Overrx with NS
  • Drugs (acetazolamide)
90
Q

Cl Decreased

A
  • GI losses
  • Diabetic ketoacidosis
  • Excess sweating
  • SIADH
  • Hyperaldosteronism
91
Q

Increased CO2

A
  • Metabolic acidosis
  • Volume contraction
  • Compensated respiratory acidosis
92
Q

Decreased CO2

A
  • Metabolic acidosis
  • Compensated respiratory alkalosis
  • Drugs (acetazolamide)
93
Q

BUN Increased

A
  • Renal failure
  • CHF
  • Dehydration
  • Shock
  • Burns
  • Upper GI Bleed
  • Urinary tract obstruction
94
Q

BUN Decreased

A
  • Hepatic failure
  • Cachexia
95
Q

Creatinine Increased

A
  • Renal failure
  • Urinary tract obstruction
  • Nephrotoxic drugs
96
Q

Creatinine Decreased

A

Reduced muscle mass

97
Q

Glucose Increased

A
  • DM
  • Cushings Syndrome
  • Chronic Pancreatitis
  • Steroids
98
Q

Glucose Decreased

A
  • Diffuse liver disease
  • Insulinoma
  • Drugs (insulin, hypoglycemic agents)
99
Q

Normal Calcium Level

A

8.5-10.5

100
Q

Calcium Increased

A
  • Hyperparathyroidism
  • Malignancies
  • Vitamin D excess
  • Paget disease
  • Milk alkali syndrome
  • Familial hypocalcuria
  • Drugs (thiazide diuretics, lithium)
101
Q

Calcium Decreased

A
  • Hypoparathyroidism
  • Vitamin D deficiency
  • Renal insufficiency
  • Massive transfusion
  • Magnesium deficiency
  • Hypoalbuminemia (For every decrease in albumin by 1 mg/dl, calcium should be corrected up by 0.8 mg/dl)
102
Q

Normal Phosphorus Level

A

2.5-4.5

103
Q

Phosphorus Increased

A
  • Renal failure
  • Tumor lysis syndrome
  • Hypoparathyroidism
  • Sarcoid Cirrhosis
  • Drugs (Steroids, HCTZ, phosphate enemas)
104
Q

Phosphorus Decreased

A
  • Hyperparathyroidism
  • Rickets
  • Malabsorption
  • Acute pancreatitis
  • Severe hypercalcemia
  • Drugs (acetazolamide, thiazides, phosphate binding antacids)
105
Q

Magnesium Normal Level

A

1.8-3.0

106
Q

Magnesium Increased

A
  • Renal failure
  • Dehydration
  • Tissue trauma
  • Hypothyroidism
  • Drugs (lithium, magnesium salts)
107
Q

Magnesium Decreased

A
  • Chronic diarrhea
  • Alcoholism
  • TPN without replacement
  • CHF
  • Acute Pancreatitis
  • Drugs (cisplatin, albuterol, calcium salts)
108
Q
A

502 Lab Interpretation (1 decks)

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