Final lab q Flashcards
Hemoglobin anomalies are divided in what two groups?
Hemoglobinopathy group D, S, E
Abnormal-quantitative anomalies- thalassemia group ( high rate of Hg F; Hb A2)
Hemolytic anemia
Lysis of RBC
It is the premature destruction of red blood cells
Anemia occurs when the bone marrow is unable to compensate for the premature destruction of RBCs
Hemophilia B
Factor IX deficiency
Prolonged aPTT
normal PT and bleeding time reduced or absent factor IX
Hemphilia A
Factor VIII deficiency
Prolonged aPTT
Normal PT and bleeding time Reduced or absent factor VIII
High WBC indicates what?
Low WBC indicates what?
High WBC–> presence of an infection
Low WBC –> immune deficiency
How is MCHC expressed?
Hypochromic -less color Hyperchromic -more color Normochromic -normal
If there is more than 10% of abnormally shaped RBCs, what is that called?
poikilocytosis
Effects of protein C/S deficiency:
pregnancy loss; strokes; DVT
In general, what is ESR help for monitoring?
Inflammatory diseases
In hemolytic anemia will the reticulocyte count be high or low?
HIgh
In what cases would the ESR be elevated?
Temporal arteritis Rheumatoid arthritis polymyalgia rheumatica
Iron deficiency
1) What is the MCV value?
2) What is the profile ordered?
Iron deficiency= MCV less than 80
Order: serum iron; ferritin(best test for anemia)
Eosinophils are elevated due to what?
allergic reaction and parasitic infections
Erythropoiesis
1) kidneys sensse hypoxia
2) Kidney increases endogenous erythropoeitin production
3) erythropoietin–> causes bone marrow to produce new red blood cells
4) Kidneys decrease erythropoeitin production as they sense increased tissue oxygenation
Ferritin Test for anemia?
Measure iron stores in the body, for a female should be between 11-122
If low, replace irons for 6 months if less than 10!
Prolongation of both aPTT and PT suggests?
Defect that lies in the common pathway
A prolonged aPTT and a
normal PT is considered to have a defect in what pathway?
Intrinsic
A prolonged PT and a normal aPTT has a defect in what pathway?
Extrinsic
Red Blood Cells- Erythrocytes - Fxn? origin? Made from?
Carry oxygen from lungs Carry CO2 back to the lungs Normally live 120 days !!! Contain hemoglobin--> needs: iron, folic acid and b12 Made in the bone marrow !
Reticulocyte count is used for what?
Test to determine bone marrow function
It measures the number of immature RBCS that are circulating
Total iron binding capacity is used for what?
TIBC/transferrin
What are acute phase reactants?
Proteins and chemical markers that rise in response to tissue injury/inflammation
They are nonspecific
Most commonly seen is the SED rate
Magaloblastic anemia
- What is the MCV value?
- What are the two causes ?
- MCV greater than 95
- Causes:
1) Vit. B12 deficiency = cyanocobalamin -pernicious anemia, - malabsorption
- diet
2) Folate deficiency -diet/meds - increased need in pregnancy
MVC normocytic
values: Macrocytic value: Microcytic value:
Normocytic= 80-100 macrocytic= greater than 100 microcytic= less than 80
Platelets testing- bleeding time
small puncture wound– observe the time to see how long it takes till the patient stops bleeding
drugs may increase bleeding times such as NSAIDS and salicylates
Production of Red blood cells:
precursor stem cells –> erthyoid–> reticulocyte–> red blood cells
What are lymphocytes? What does a rise in lymphocytes indicate?
Lymphocytes are B cells and T cells
Rise in lymphocytes= chronic bacterial infection or viral infection
What are monocytes? Cause of elevation?
Phagocytes
Live longer than neutrophils
Elevated in chronic inflam
Autoimmune diseases, TB, Syphillis
What are neutrophils bands? What do they indicate?
Neutrophil bands= immature cells
Usually high bands = bacterial infections
What are platelets?
Non nucleated, disc shaped cells Derived from bone marrow
Platelets activated when endothelium is damaged
What are reticulocytes?
young red blood cells from the bone marrow
Retic count –> best indicator of how the bone marrow is doing
What are thalassemias? Caused by what?
Hereditary anemias–> caused by genetically transmitted abnormalities
Caused by decreased or absent synthesis of Alpha or beta globin chains
What are the 2 tests for hemostasis/coagulation?
PT: prothrombin time ; monitored with coumadin
aPTT: partial thromboplastin time ; monitored with heparin
What are the 2 things you can determine from the CBC?
Enumerization- number/how many Characterization- shape
Why: Both of those factors leads to disease, if number is too low or is the shape is abnormal = DISEASE
What are the causes of hemolytic anemia ?
Hereditary– Sickle cell anemia; Hereditary sphereocytosis, G6PD
Acquired-medics, DIC, hemolytic uremia syndrome
eshsathaarne 5th%e) components of blood?
Plasma-55%
RBC-45%
WBC/Platelets- less than 1%
What are the components of the RBC count?
Hemoglobin (Hg or Hgb) Hematocrit (Hct or "the crit") Red cell size distribution width (RDW) Reticulocyte Count Red blood cell -indices Erythrocyte Sedimentation Rate (ESR)
What are the granulocytes?
Eosinophils
Basophils Neutrophils
What are the non- granulocytes?
Lymphocytes and monocytes
What are the normal hemoglobin levels in males and female:
Male: 13.6-17.2 Females: 12-15
What are the normal Hgbs in an adult?
Hb F
Hb A2
HbA
Absent:HbC,D,E,H,S
What are the normal
reticulocyte counts and abnormal?
- 0.5% to 1.5% of the total numbers of red blood cells in men
- -0.5% to 2.5% in women
- -If less than 0.5%–> bone marrow is not working properly
What are the % of each type of WBC intheWBC differential?
Lymphocytes: 20–40% Neutrophils: mature-50-70% and immature: less than 5% ( bands) Eosinophils: less than 5% Basophils: less than 2% Monocytes less than 7%
What are the panic Hemoglobin values ?
PANIC LEVEL: less than 5 or greater than 20 !!!!!
What are the symptoms of vit. B12 deficiency ?
Neuro complaints Neuropathy in the legs
What are the two types of CBCs that can be ordered?
1) CBC: WBC, RBC, Hb, Hct, RBC indices, RDW, Mean platelet volume
2) CBC with differential –> this includes the number of each WBC: Neutrophils, lymphocytes, monocytes, esosinophils, basophils
What can a decrease in
Hematocrit and hemoglobin indicate?
Allows you to diagnose anemia! Does not tell you cause though
What can a high reticulocyute count indicate?
That the bone marrow is responding to the need for increased RB production
Person who recently donated blood–> high retic. count
Women after menses–> high retic. count
What can cause a decrease in the hemoglobin levels?
Iron def. anemia thalassemia liver disease hyperthyrodism
What can cause a decrease inthe reticulocyte count?
aplastic anemia, myxedema, radiation therapy, iron def. anemia,
What can cause an increase in
reticulocyte count?
hemolytic anemia chronic hemorrhage sphereocytosis malaria
What can cause an increase in the hemoglobin levels?
COPD polycythemia vera CHF
smokers
What causes an increase in
erythropoietin levels ? a decrease?
Increase–> COPD, pregnancy, sickle cell
Decrease –> chronic renal failure
What causes can increase in PT? Decrease in PT?
Increased with:
Some Factor deficiencies- Hemophilias (I,II,V, VII, X)
Alcoholism
Cirrhosis
Vitamin K deficiency
Coumadin (Warfarin)
Decreased with: Deep vein thrombosis Myeloma
What could decreased RBC count indicate?
anemia
What could increased RBC count indicate?
Polycythemia vera–> elevated RBC, face is flushed, excessive itching
What does a atypical
lymphocyte indicate?
“Reactive lymphocyte” = “Downey cell” Suggests–> Mono
What happens if a pt is Rh - and is transfused with Rh+ blood??
Fever, anaphylaxis, severe hemolysis
What effect will a diet high in Vit k have on PT time?
It will shorten the PT time
What do we need for adequate hemostasis?
Platelets: proper number and fxn
Humoral coagulation factors: intrinsic and extrinsic pathway
What do protein C and S do?
Help prevent blood clots
What does the CBC stand for?
Complete blood count
What does Rh- mean
antigen is absent
What does Rh+ mean
antigen is present
What does EDTA stand for? What is it?
It is an anticoagulant in the tubes for a CBC
Stands for: Ethylenediaminetetraacetic acid
What does destruction of hemoglobbin produce?
Heinz Bodies!!!
What does an elevated ESR indicate?
inflammatory response –> makes RBCs heavier and more likely to fall rapidly when placed in a special vertical tube, rouleaux formation
What does a Hgb electrophoresis tell us?
Quantifies normal and abnormal forms of Hgb;
What is being looked at in
the CBC? ( 3 things)
Red blood cells, white blood cells, platelets
Whatis critically low platelets? Critically high ?
critically Low: less than 30, 000 critically High: greater than 100,000
Whatis erythropoietin?
glycoprotein that is produced by the kidneys (renal cortex) in response to renal hypoxia – > stimulates the formation and development of new erythrocytes in bone marrow
What is factor V leiden?
Abnormal form of gene for factor V Inherited defect in factor X –> leading to hypercoagulability
Factor V activity levels in patients with Factor X leiden are NORMAL
Whatis hemolytic
anemia?
RBCs are lysing very rapidly –> causes buildup of bilirubin –> enlargement of liver and spleen –> Jaundice
Whatis leukemia?
Uncontrolled production of leukocytes Defects in bone marrow
Smears show immature and abnormal cells WBC count can be greater than 100,000
Whatis leukocytosis? What does it indicate? Causes?
Elevated white count Greater than 11,000 Indicates–infection
Causes: infection, sepsis, abscess, cancer, stress
Whatis leukopenia?
Decreased white count
Less than 5,000
Causes can be: viral infections, bone marrow suppression, medications, anemia, malaria and chemotherapy
What is a sign of folate deficiency ?
Spina bifida
What is a qualitative testing for platelets?
Aggregation using epi
Principle of platelet aggregometer
What is another name for the WBC count?
Leukocyte count
What is another name for neutrophils?
PMN: polymorphonuclear neutrophils
What is another name for monocytes?
monomorphonuclear
What is anisocytosis? What are the two types?
abnormal variations in the size of RBCs
Macrocyte= larger than 9 microns [liver disease]
Microcyte=smaller than 6 micron [anemias]
What if a left shift?
Left shift means bandemia= high levels of bands–> high levels of immature neutrophils
Indication: Bacterial infection
What has a greater affinity for Hgb?
Carbon monoxide has a greater affinity for RBCs then oxygen
What happens if a pt is Rh - and is transfused with Rh+ blood??
Fever, anaphylaxis, severe hemolysis
What effect will a diet high in Vit k have on PT time?
It will shorten the PT time
What is the PT-prothrombin time? Normal and Panic values?
Vit. K dependent
During Clotting prothrombin is converted to thrombin
Part of the extrinsic pathway PANIC: greater than 40
adults should be 10-15 secs newborn: less than 17
child: 11-14````
What is the profile ordered for hemolytic anemia?
CBC
Retic count
Tests to determine problem: Peripheral blood smear
LDH
Coombs test
Urobilinogen in urine Haptoglobin decreased ( released in response to RBC lysing)
What is the profile of someone who has iron deficiency?
Hemoglobin - low Hematocrit -low Microcytic -low Hypochromic -low Iron -low
Ferritin -low
TIBC -HIGH
What is the partial thromboplastin time test? ( aPTT)
Measures intrinsic pathway used to monitor heperarin Normal: 20-36 seconds Panic: greater than 70 Heparin--> prolongs the PTT time aPTT increased with factor deficiencies: I, II, V, VIII, IX, X, XI, XII
What is the normal WBC reference level?
5,000-10,000/mm –> we call it between 5-10
What is the normal RBC count in males? Females?
Male: 4.5-6.2 Females: 4.0-5.5
[ X10^9]
What is the normal Hgb in neonates?
Hb F
What is the normal concentration of platelets?
150,000-400,000
What is the mean corpuscular
volume (MCV)?
Measures the average size and volume of the RBC
Normal is 80-100
Indicated the amount of volume occupied by a single erythrocyte
Whatis the mean corpuscular
hemoglobbin ( MCH)?
Average weight if the Hgb per RBC
decreased MCH–> in Iron def. anemia increased MCH –> macrocytic anemia, tabacco users
Whatis the MCHC?
Mean corpuscular hgb concentration
What is the main functon of
Hemoglobin?
Carry oxygen away from lungs and carry CO2 to the lungs
What is the International
Normalized Ratio?
INR; it is retrieved from the PT; should be 1
2 - 3 for management of DVT, prevention of systemic embolism and mitral or aortic prosthetic tissue valves
2.5 - 3.5 for post MI, mechanical heart valves, recurrent systemic embolism
What is the hematocrit? What is the ratio of hematocrit to hemoglobin?
Hematocrit= packed cell volume (PVC) or erythrocyte volume fraction (EVF)
Hematocrit is 3X more than hemoglobin
What is the Erythrocyte
sedimentation rate?
If ESR is higher than your age= problem
ESR= rate at which erythrocytes settle out of anticoagulated blood in one hour
Reflect the acute phase reaction in inflammation and infection
Normally cells settle slowly
ESR= lacks sensitivity and specificity
What is the chief function of red
marrow? Who has the most?
Fxn of red marrow= production of erythrocytes, leukocytes and platelets
Children have the most
What is RhIG Rhogam ?
It is a concentrated solution of IgG derived from human plasma cells
Sensitization: pregnancy, abortions, blood transfusions.
Given to women who is Rh- so that the body doesnt consider the fetus as foreign
What is protein S?
Co-factor for protein C
ratio of protein C to protein S may ID carrier of congential protein C def.
What is protein C?
Vit K dependent protein that prevents intravascular thrombi
It is autosomal dominant
Protein C’s activity is enhanced by protein S
What is protein C?
Vit K dependent protein that prevents intravascular thrombi
It is autosomal dominant
Protein C’s activity is enhanced by protein S
Whatis poikilocytosis?
Variation in the shape of RBCs
Poikilocytosis –> causes an increase in the RDW
What is platelet formation essential for?
esential for blood clotting: Homeostatis plug Vasocontrictors Clot retraction tissue repair regulate local inflammation
Whatis leukopenia?
Decreased white count
Less than 5,000
Causes can be: viral infections, bone marrow suppression, medications, anemia, malaria and chemotherapy
What does Rh+ mean
antigen is present
What does EDTA stand for? What is it?
It is an anticoagulant in the tubes for a CBC
Stands for: Ethylenediaminetetraacetic acid
What does destruction of hemoglobbin produce?
Heinz Bodies!!!
Whatis leukocytosis? What does it indicate? Causes?
Elevated white count Greater than 11,000 Indicates–infection
Causes: infection, sepsis, abscess, cancer, stress
Whatis leukemia?
Uncontrolled production of leukocytes Defects in bone marrow
Smears show immature and abnormal cells WBC count can be greater than 100,000
Whatis hemolytic
anemia?
RBCs are lysing very rapidly –> causes buildup of bilirubin –> enlargement of liver and spleen –> Jaundice
What is factor V leiden?
Abnormal form of gene for factor V Inherited defect in factor X –> leading to hypercoagulability
Factor V activity levels in patients with Factor X leiden are NORMAL
Whatis erythropoietin?
glycoprotein that is produced by the kidneys (renal cortex) in response to renal hypoxia – > stimulates the formation and development of new erythrocytes in bone marrow
Whatis critically low platelets? Critically high ?
critically Low: less than 30, 000 critically High: greater than 100,000
What is being looked at in
the CBC? ( 3 things)
Red blood cells, white blood cells, platelets
What does the CBC stand for?
Complete blood count
What do protein C and S do?
Help prevent blood clots
What do we need for adequate hemostasis?
Platelets: proper number and fxn
Humoral coagulation factors: intrinsic and extrinsic pathway
Who should you check lead levels on?
Children who live in old houses, contruction material, or have envt exposure
Who would you order a CBC for?
Routine Che ck ups Suspect infections Bleeding issues Concerns about anemia--fatigue and dyspnea
Why do you do the CBC last?
Always do the CBC last –> because it contains an anticoagulant called: EDTA
Shake the tube after drawing blood to disperse the anticoagulant
Who needs to be blood typed?
Rh– pregnant women
Type and screen - risk of transfusion [needs the blood right away ]
Type and cross- trauma,surgery, anemia [hold the blood]
Who needs the carboxyhemoglobin test?
Firefighters fire victims mechanics
Who needs coagulation studies?
Bleeders: critically ill; people on anticoagulants; unexplained bruising or bleeding
Clotters: DVT or PE
Who is the universal recipient ?
Type AB Rh+
Who is the universal donor?
Type 0 Rh-
Where are white blood cells made?
In the bone marrow; they move inside and outside of blood vessels
When should you check lead levels in children?
If they eat old paint, have GI symptoms or changes in mental status
Screen between ages 1-6 ! Levels should be less than 10, if the levels are higher than 20–> they need to be hospitalized
When is RDW usually measured ? (red blood cell distribution width)
only in the case of anemias
When is MCHC decreased? Increased?
MCHC decreased –> in thalasemia, iron def. anemia
MCHC increased –> in hemolyusis, sphereocytosis
When is an essential time to check for platelets?
Before surgery
What would you order for a megaloblastic anemic pt?
1) CBC with differential 2) vit b12
3) folate levels
What symptoms suggest Von Willebrand Disease ?
Bleeding gums, recurrent nose bleeds,
cannot stop bleeding after giving birth
most common inherited bleeding disorder
What should you order for Von WIllebrand disease?
PTT/PT- normal
Bleeding time - prolonged VWF antigen- decreased Ristocetin factor- decreased
What medications can cause a reaction in patients with G6PD deficiency?
What medications can cause a reaction in patients with G6PD deficiency?
What is transferrin?
blood protein that binds and transports iron
in anemia, transferrin looks for more iron to bind
What is thrombosis?
formation of blood clot in a vessel which obstructs blood flow
What is thrombocytosis? Causes?
High platelet count greater than 400,000
Causes: infection inflammation multiple myeloma polycythemia vera oral contraceptives IDA
high altitudes RA
What is thrombocytopenia? Causes?
Low platelet count Less than 150,000
Due to: anemia-megaloblastic autoimmune metastatic cancer hemolytic diease of the newborn leukemia
malaria
Drugs
What is the test used to diagnose sickle cell ? What is present in Pts with sickle cell anemia?
Electrophoresis
Hb S is present in patients with sickle cell
What is the term for abnormally shaped RBCs?
Poikilocytes
What is the red blood cell size distribution width ( RDW)
It is a measure of degree of anisocytosis;
** all RBCs have some degree of variations
Normal red blood cell size is 6-8 microns
