Exam 2 - CBC Flashcards
1
Q
What is the term for the study of blood and its formed elements?
A
Hematology
2
Q
Plasma makes up what percentage of the total blood volume?
A
55% (formed elements - 45%)
3
Q
What is the breakdown of erythrocytes vs WBC/platelets in the total blood volume?
A
44% = erythrocytes, 1% = WBC/platelets (remember formed elements = 45% total)
4
Q
What protein is found in RBCs and functions to transport oxygen and carbon dioxide to and from all the body tissues?
A
Hemoglobin
5
Q
What is the purpose of platelets?
A
Prevent blood loss from hemorrhage
6
Q
Where do we see the main effect of the platelets?
A
Blood vessel wall
7
Q
What is the term for cellular formation, proliferation, differentiation, and maturation of blood cells?
A
Hematopoiesis
8
Q
What are the hematopoietic tissues and organs?
A
Spleen, lymph nodes, thymus, bone marrow, liver, reticuloendothelial system (RES)
9
Q
Are all RBCs released into peripheral blood from their original organs?
A
Only mature cells
10
Q
When does hematopoiesis begin in the fetus?
A
19th day of gestation
11
Q
Where are blood cells manufactured in normal adults/
A
Marrow of the axial skeleton
12
Q
Which hormone is responsible for stimulating the stem cells to differentiate and proliferate into RBCs?
A
Erythropoietin
13
Q
Where is erythropoietin produced?
A
Kidneys
14
Q
Where are erythrocytes, granulocytes, monocytes, and platelets produced postnatally?
A
Bone marrow
15
Q
Where are lymphocytes produced?
A
Secondary lymphoid organs: spleen, lymph nodes, intestinal lymphoid tissue, bone marrow, and thymus
16
Q
What is the lifespan of a RBC?
A
120 days
17
Q
What is the main function of a red blood cell?
A
Transport hemoglobin
18
Q
What is the ratio of hemoglobin to water of a RBC?
A
90% hemoglobin, 10% water
19
Q
When a patient is suspected of having an infection, what tests are commonly run and helpful to have done?
A
CBC and ESR
20
Q
What levels are measured with a traditional CBC?
A
Hemoglobin, hematocrit, RBC indices, WBCs, platelets
21
Q
What is the term for lower than normal RBC count? Higher?
A
Lower = anemia, Higher = polycythemia
22
Q
What is the adult male normal for RBC count?
A
4.5-6.0 million/mm(3)
23
Q
What is the adult female normal for RBC count?
A
4.0-5.5 million/mm(3)
24
Q
What is the normal child count for RBCs?
A
4.0-5.5 million/mm(3)
25
What is the normal adult male count for hemoglobin? Females?
Males = 13-18mg/dL, Females = 11-16 mg/dL
26
In general, what does a decreased hemoglobin count signify?
Decreased oxygenation of the tissues (tired, less energy)
27
What does hemoglobin do again?
Transports oxygen and CO2
28
What is the hematocrit a measurement of?
Percentage of total blood volume made up of RBCs (packed cell volume)
29
What is the adult male normal range for hematocrit? Female?
Male = 42-52%, Female - 37-47%
30
If a patient has a hematocrit of 47%, then what percentage of the total blood volume is made up of plasma?
53%
31
We can diagnose a patient with anemia if ANY of what levels are low?
RBCs, hematocrit, or hemoglobin
32
What is the usual mathematical relationship between hemoglobin and hematocrit?
HGB X 3 = HCT
33
What is the usual mathematical relationship between hematocrit and RBC count?
HCT X 11 = RBC count
34
RBC indices provide what insight?
Size (MCV), weight (MCH), hemoglobin concentration (MCHC)
35
What is MCV?
Mean corpuscular volume (average volume/size of the RBC)
36
What are the different measurement levels of MCV?
Normal = 80-100 cubic microns, Microcytic = 100
37
How do we measure MCV?
HCT divided by number of RBC
38
What is MCH?
Mean corpuscular hemoglobin (average weight of total hemoglobin)
39
What does mean corpuscular hemoglobin indicate?
Color of RBC
40
How do we measure MCH?
HGB divided by number of RBC
41
What are the different measurement levels of MCV?
Normochromic = 27-31pg, Hyperchromic = >31, Hypochromic =
42
What is another term for hyperchromic?
Polychromasia
43
What is MCHC?
Mean corpuscular hemoglobin concentration (measure of average concentration of percentage of hemoglobin within a single RBC
44
How do we measure MCHC?
Hgb/Hct
45
What are the different measurement levels of MCHC?
Normochormic = 32-36g/dL, Hypochromic = 36
46
How do we classify types of anemia?
Cell size and color (Hgb content)
47
Why is anemia important when diagnosed?
Indication of an underlying disorder
48
How does the body usually try to compensate for anemia?
Increased RBC production, heart rate, and respiration
49
What usually causes anemia?
1 decreased RBC production 2 increased breakdown of RBCs 3 blood loss
50
What type of anemias could present as microcytic hypochromic anemia (decreased MCV, MCH, and MCHC)?
Iron deficiency anemia (IDA), anemia of chronic disease (ACD), thalassemia, chronic blood loss
51
What types of things can lead to microcytic normochromic anemia?
Vitamin B12 or folic acid deficiency, alcoholism, liver disease
52
What types of anemias could present as normocytic normochromic anemia?
Anemia of chronic disease (ACD), acute blood loss, hemolytic anemia (like sickle cell), aplastic anemia
53
What is unique about the presentation of anemia of chronic disease?
75% presents as normocytic normochromic, 25% presents as microcytic
54
Iron is stored in what two forms?
Ferritin, hemosiderin
55
What protein transports iron?
Transferrin
56
What is a common cause of blood loss anemia?
Heavy menstrual flow
57
What is the most common cause of anemia worldwide usually from GI blood loss?
Iron deficiency (IDA) (30% of world's population)
58
Acute blood loss results in what form of anemia? Chronic blood loss?
Acute = normocytic normochromic, Chronic = microcytic hypochromic (really an IDA)
59
What is the most common cause of chronic blood loss?
GI blood loss
60
What is the most important cause of IDA worldwide?
Parasitic infection caused by worms in which intestinal bleeding can lead to undetected blood loss in stool
61
What is the most common cause of IDA in post-menopausal adults over 50 years old?
GI bleeding from nonparasitic causes like gastric ulcer, duodenal ulcer, or GI cancer
62
What is the principal cause of IDA in developed countries?
Blood lost during menses in premenopausal women
63
Which gender is more likely to develop IDA in developed nations?
Females
64
What mineral is necessary for the formation of heme?
Iron
65
Chronic use of what medication can also lead to IDA?
Aspirin
66
What is the unusual sign of IDA is commonly seen?
Pica or pagophagia
67
How can severe IDA affect the tongue and nails?
Smooth tongue, brittle nails
68
Total iron binding capacity (TIBC) can be an indirect measurement of what other substance?
Amount of transferrin in blood
69
What does TIBC measure?
Extent to which iron-binding sites in the serum can be saturated
70
How do low levels of iron and ferritin affect levels of TIBC?
TIBC is increased (more protein available)
71
What are anisocytes?
RBCs of unequal size
72
What are poikilocytes?
Abnormally shaped RBCs
73
How can we differentiate ACD from IDA?
ACD has normal or decreased iron, normal to increased ferritin, and low/normal TIBC
74
How can we differentiate thalassemia from IDA?
Thalassemia has normal iron parameters although more microcytosis
75
What is another name for anemia of chronic disease?
Anemia of inflammation
76
What are the iron parameters for ACD?
Low serum iron, low TIBC*, normal/increased ferritin
77
What are examples of conditions that can lead to ACD?
Chronic infection, inflammation, cancer, liver disease, RA, chronic renal disease
78
Which is more common: ACD being microcytic hypochromic or ACD being normocytic normochromic?
Normocytic normochormic (75%)
79
What causes thalassemia?
Genetically derived
80
How does thalassemia directly cause anemia?
Reduced hemoglobin synthesis (either alpha or beta globulin chains)
81
What type of anemia is thalassemia?
Microcytic hypochromic
82
Which form of thalassemia is more common in China and Southeast Asia?
Alpha
83
Which form of thalassemia is more common the Mediterranean?
Beta
84
What is another name for thalassemia major (homozygous)?
Cooley's anemia
85
When do those with thalassemia minor (heterozygous) experience symptoms?
When under times of stress
86
Which tends to have a lower MCV: thalassemia or IDA?
Thalassemia
87
Which tends to have normal ish iron parameters: thalassemia or IDA?
Thalassemia (remember: more of a hemoglobin synthesis problem)
88
What procedure is done to differentiate between alpha and beta thalassemia?
Hemoglobin eletrophoresis
89
What is a patient MOST likely to have when a hair on end skull is seen upon X-ray?
Thalassemia
90
If hair on end skull on X-ray is present but the patient has normocytic anemia, what is the diagnosis?
Sickle cell anemia
91
What causes the hair on end appearance seen with thalassemia or sickle cell anemia?
Marked widening of the diploic space containing alternating bands of hypo intense trabeculae and hyperintense marrow
92
What X-ray changes can be seen in thalassemia patients' hands?
Lace-like trabeculae, osteopenia, thinned cortex
93
Which microcytic hypochromic anemia presents with high TIBC? Low? Normal?
```
High = IDA
Low = ACD
Normal = thalassemia
```
94
What causes the destruction/anemia seen with macrocytic normochormic anemia?
Large RBCs cannot conform to small capillaries, and they fracture and hemolyze with shortened life span
95
What occurs with the megaloblastic form of microcytic normochromic anemia?
Changes with RBC/WBC precursors: inhibition of DNA synthesis in RBC production (likely B9 or B12 deficiency)
96
Which type of anemia can be either megaloblastic or nonmegaloblastic?
Macrocytic normochromic anemia
97
What is probably the cause of nonmegaloblastic microcytic normochromic anemia?
Liver disease, alcohol
98
Strict vegetarians are likely to have which vitamin deficiency that can lead to microcytic normochromic anemia?
B12
99
What substance is produced by the gastric mucosa and is required in order for B12 to be absorbed by the small intestine?
Intrinsic Factor (IF)
100
What is the most common cause of B12 deficiency?
IF deficiency (pernicious anemia)
101
What is the second most common cause of B12 deficiency?
Lack of gastric acid necessary to separate B12 from its binding proteins
102
What is the third most common cause of B12 deficiency?
Malabsorption cause by diseases of the terminal ilium (worms, IBD, malabsorption syndromes)
103
What are signs and symptoms of B12 deficiency?
Lemon-yellow skin color, premature aging, sore tongue, GI symptoms, paresthesias, loss of vibratory sensation
104
What causes pernicious anemia?
MC genetic, maybe dietary in strict vegetarians
105
How can pernicious anemia end up causing great harm to the patient?
1/4 result in stomach cancer
106
Which can result in neurologic symptoms: B9 or B12 deficiency?
B12 (numbness, tingling, memory loss, loss of balance, loss of bladder control)
107
How does normochromic megaloblastic anemia affect MCV? Iron? Ferritin? MCH? RBCs? Hemoglobin?
Increased MCV, MCH, iron, and ferritin; Decreased RBCs and hemoglobin
108
What substances are elevated in macrocytic normochromic NONmegaloblastic anemia?
Liver enzymes, bilirubin, MCV
