Exam 1 Flashcards
What makes up a CBC
WBC, RBc, Platelets
What does elevated neutrophils indicate
probably bacterial infection, possibly viral
chronic illness (malignancies, inflammation)
Medication effect
What does elevated lymphocytes indicate
Malignancies (leukemias, lymphomas)
Viral illnesses
What do elevated monocytes indicate
hematological disorders (50%) - splenectomy, ITP, polycythemia, hemolytic anemia)
Malignancies (8%) - leukemia, Hodgkins
Chronic illness (10%) - connective tissue disorders, SLE, RA Misc - sarcoidosis, liver disease, trauma, marathon running
What does elevated eosinophils indicate
Worldwide - parasitic infection
industrialized countries - allergies
hospitalized - new drug?
asthmatics - aspergillosis or Churg-Strauss syndrome?
What does increased basophils indicate
Reactive - occurs when patient has a non neoplastic condition
Neoplastic - cancer in bone
Hemoglobin
part of the cell that carries oxygen
Hematocrit
% of RBC’s to whole blood
normal H&H ratio
1:3; false normal with dehydration
what is Mean corpuscular Volume (MCV)
size of the red blood cell
Macrocytic anemia
MCV>96
B12 or Folate deficiency***
Hypothyroidism, alcohol abuse
other causes
Microcytic anemia
MCV<80 Iron deficiency ** thalassemia anemia of chronic disease lead poisoning sideroblastic anemia
Normocytic anemia
MCV normal 80-96 with low H&H
trauma, acute blood loss, hemolytic anemia, metastasis, iron, B12, or folate def
Work up for macrocytic anemia
B12, folate level
TSH if those are normal
Work up for microcytic anemia
serum iron
ferritin (protein that stores iron)
transferrin (protein that carries iron to sites)
Total Iron Binding Capacity (how many open sites - high is worse)
Work up for normocytic anemia
Look for blood loss - check stool for occult bleeding
Consider IDA, anemia of chronic disease, mixed anemia
Polycythemia (increased RBC)
- smoker, CPOD
- high altitude
- sleep apnea, CO2 intoxication
- renal disease
cancer
medication
What condition must you r/o with Polycythemia
Polycythemia Vera - JAK2 genetic testing
Serum erythropoietin (if normal retest)
if above tests are normal - consider erythropoietin secreting tumor
Thrombocytopenia (decreased platelets) - causes
ITP, DIC, Neonates, Medications (chemo, thiazides, estrogens, heparin), infections (CMV, HIV, parovirus), bone marrow problems
- order manual reading
Thrombocytosis causes
Reactive - acute blood loss, infection, IDA, post-op, hypersplenism or post splenectomy, trauma
Clonal - leukemia
Thrombocytosis - what to do next
check manual count/peripheral smear
retest if no initial cause found
if not a reactive cause refer to hematologist for clonal
What is included in a CMP (excluding BMP) - 6
Total Protein Albumin Total Bilirubin ALT AST ALK Phos
Low Total Protein
liver, renal disease, or severe malnutrition
High Total Protein
Chronic Inflammation (Hepatitis, HIV)
Albumin
nutritional status (if low will cause third spacing) If low affects medications slow to change (1/2 life is 20 days, can take up to 14 days to return to normal)
Pre - Albumin
half life is 2 days so it is better evaluates response to treatment. Not on CMP
Can be decreased due to diet, alcoholism, steroid, zinc deficiency
Hydration does not affect
Total Bilirubin - Indirect
Unconjugated, if elevated probable live problem
Bilirubin - direct
Conjugated - problem past the liver (GB or pancreas)
ALK (Alkaline Phosphatase) - increases with:
ductal cell problems
GB, Pancreas, Liver problems
Pregnancy (normal)
Bone problems (growth in children, cancer fractures)
Hypernatremia (cause and how to correct)
due to loss of water (GI, diuretics, renal disease, lungs)
Correct with fluid PO or IV 1/2 NS
Hyponatremia - what causes false lows
hyperlipidemia, hyperglycemia, hyperproteinemia
How to correct hyponatremia
IV - NS; use 3%NS with neuro symptoms
What to do if hyponatremia is not correcting with IVF
urine and serum levels of osmolarity and sodium
Hyperkalemia S &S
tented T waves, v-fib, agonal rhythm
Hypokalemia S &S
muscle cramping, heart irregularities
Hyperkalemia - causes
renal failure, trauma, DKA, ACEI, Adrenal Insufficiency
Hypokalemia - causes
volume depletion, diuretics, N/V
BUN - Low causes
over-hydration or liver disease, nutritional deficiency
BUN - High causes
renal disease, dehydration, GI bleed, post renal obstruction
Chloride
follows Sodium, if changed independently of sodium then you have a metabolic acid - base problem
What is renal dosing of meds based on
Creatinine Clearance, not GFR
Serum Creatinine - low reasons
secondary to decreased muscle mass
Serum Creatinine - high reasons
secondary to volume depletion or renal insufficiency
