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Final lab q Flashcards

1
Q

Hemoglobin anomalies are divided in what two groups?

A

Hemoglobinopathy group D, S, E

Abnormal-quantitative anomalies- thalassemia group ( high rate of Hg F; Hb A2)

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2
Q

Hemolytic anemia

A

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

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3
Q

Hemophilia B

A

Factor IX deficiency
Prolonged aPTT
normal PT and bleeding time reduced or absent factor IX

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4
Q

Hemphilia A

A

Factor VIII deficiency
Prolonged aPTT
Normal PT and bleeding time Reduced or absent factor VIII

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5
Q

High WBC indicates what?

Low WBC indicates what?

A

High WBC–> presence of an infection

Low WBC –> immune deficiency

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6
Q

How is MCHC expressed?

A

Hypochromic -less color Hyperchromic -more color Normochromic -normal

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7
Q

If there is more than 10% of abnormally shaped RBCs, what is that called?

A

poikilocytosis

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8
Q

Effects of protein C/S deficiency:

A

pregnancy loss; strokes; DVT

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9
Q

In general, what is ESR help for monitoring?

A

Inflammatory diseases

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10
Q

In hemolytic anemia will the reticulocyte count be high or low?

A

HIgh

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11
Q

In what cases would the ESR be elevated?

A

Temporal arteritis Rheumatoid arthritis polymyalgia rheumatica

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12
Q

Iron deficiency

1) What is the MCV value?
2) What is the profile ordered?

A

Iron deficiency= MCV less than 80

Order: serum iron; ferritin(best test for anemia)

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13
Q

Eosinophils are elevated due to what?

A

allergic reaction and parasitic infections

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14
Q

Erythropoiesis

A

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

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15
Q

Ferritin Test for anemia?

A

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!

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16
Q

Prolongation of both aPTT and PT suggests?

A

Defect that lies in the common pathway

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17
Q

A prolonged aPTT and a

normal PT is considered to have a defect in what pathway?

A

Intrinsic

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18
Q

A prolonged PT and a normal aPTT has a defect in what pathway?

A

Extrinsic

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19
Q

Red Blood Cells- Erythrocytes - Fxn? origin? Made from?

A 
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 !
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20
Q

Reticulocyte count is used for what?

A

Test to determine bone marrow function

It measures the number of immature RBCS that are circulating

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21
Q

Total iron binding capacity is used for what?

A

TIBC/transferrin

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22
Q

What are acute phase reactants?

A

Proteins and chemical markers that rise in response to tissue injury/inflammation
They are nonspecific
Most commonly seen is the SED rate

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23
Q

Magaloblastic anemia

  • What is the MCV value?
  • What are the two causes ?
A
  • MCV greater than 95
  • Causes:
    1) Vit. B12 deficiency = cyanocobalamin -pernicious anemia,
  • malabsorption
  • diet
    2) Folate deficiency -diet/meds
  • increased need in pregnancy
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24
Q

MVC normocytic

values: Macrocytic value: Microcytic value:

A

Normocytic= 80-100 macrocytic= greater than 100 microcytic= less than 80

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25
Q

Platelets testing- bleeding time

A

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

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26
Q

Production of Red blood cells:

A

precursor stem cells –> erthyoid–> reticulocyte–> red blood cells

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27
Q

What are lymphocytes? What does a rise in lymphocytes indicate?

A

Lymphocytes are B cells and T cells

Rise in lymphocytes= chronic bacterial infection or viral infection

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28
Q

What are monocytes? Cause of elevation?

A

Phagocytes
Live longer than neutrophils
Elevated in chronic inflam
Autoimmune diseases, TB, Syphillis

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29
Q

What are neutrophils bands? What do they indicate?

A

Neutrophil bands= immature cells

Usually high bands = bacterial infections

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30
Q

What are platelets?

A

Non nucleated, disc shaped cells Derived from bone marrow

Platelets activated when endothelium is damaged

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31
Q

What are reticulocytes?

A

young red blood cells from the bone marrow

Retic count –> best indicator of how the bone marrow is doing

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32
Q

What are thalassemias? Caused by what?

A

Hereditary anemias–> caused by genetically transmitted abnormalities
Caused by decreased or absent synthesis of Alpha or beta globin chains

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33
Q

What are the 2 tests for hemostasis/coagulation?

A

PT: prothrombin time ; monitored with coumadin
aPTT: partial thromboplastin time ; monitored with heparin

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34
Q

What are the 2 things you can determine from the CBC?

A

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

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35
Q

What are the causes of hemolytic anemia ?

A

Hereditary– Sickle cell anemia; Hereditary sphereocytosis, G6PD
Acquired-medics, DIC, hemolytic uremia syndrome

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36
Q

eshsathaarne 5th%e) components of blood?

A

Plasma-55%
RBC-45%
WBC/Platelets- less than 1%

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37
Q

What are the components of the RBC count?

A 
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)
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38
Q

What are the granulocytes?

A

Eosinophils

Basophils Neutrophils

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39
Q

What are the non- granulocytes?

A

Lymphocytes and monocytes

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40
Q

What are the normal hemoglobin levels in males and female:

A

Male: 13.6-17.2 Females: 12-15

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41
Q

What are the normal Hgbs in an adult?

A

Hb F
Hb A2
HbA
Absent:HbC,D,E,H,S

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42
Q

What are the normal

reticulocyte counts and abnormal?

A
  • 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
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43
Q

What are the % of each type of WBC intheWBC differential?

A

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%

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44
Q

What are the panic Hemoglobin values ?

A

PANIC LEVEL: less than 5 or greater than 20 !!!!!

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45
Q

What are the symptoms of vit. B12 deficiency ?

A

Neuro complaints Neuropathy in the legs

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46
Q

What are the two types of CBCs that can be ordered?

A

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

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47
Q

What can a decrease in

Hematocrit and hemoglobin indicate?

A

Allows you to diagnose anemia! Does not tell you cause though

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48
Q

What can a high reticulocyute count indicate?

A

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

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49
Q

What can cause a decrease in the hemoglobin levels?

A

Iron def. anemia thalassemia liver disease hyperthyrodism

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50
Q

What can cause a decrease inthe reticulocyte count?

A

aplastic anemia, myxedema, radiation therapy, iron def. anemia,

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51
Q

What can cause an increase in

reticulocyte count?

A

hemolytic anemia chronic hemorrhage sphereocytosis malaria

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52
Q

What can cause an increase in the hemoglobin levels?

A

COPD polycythemia vera CHF

smokers

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53
Q

What causes an increase in

erythropoietin levels ? a decrease?

A

Increase–> COPD, pregnancy, sickle cell

Decrease –> chronic renal failure

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54
Q

What causes can increase in PT? Decrease in PT?

A

Increased with:
Some Factor deficiencies- Hemophilias (I,II,V, VII, X)
Alcoholism
Cirrhosis
Vitamin K deficiency
Coumadin (Warfarin)
Decreased with: Deep vein thrombosis Myeloma

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55
Q

What could decreased RBC count indicate?

A

anemia

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56
Q

What could increased RBC count indicate?

A

Polycythemia vera–> elevated RBC, face is flushed, excessive itching

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57
Q

What does a atypical

lymphocyte indicate?

A

“Reactive lymphocyte” = “Downey cell” Suggests–> Mono

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58
Q

What happens if a pt is Rh - and is transfused with Rh+ blood??

A

Fever, anaphylaxis, severe hemolysis

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59
Q

What effect will a diet high in Vit k have on PT time?

A

It will shorten the PT time

60
Q

What do we need for adequate hemostasis?

A

Platelets: proper number and fxn

Humoral coagulation factors: intrinsic and extrinsic pathway

61
Q

What do protein C and S do?

A

Help prevent blood clots

62
Q

What does the CBC stand for?

A

Complete blood count

63
Q

What does Rh- mean

A

antigen is absent

64
Q

What does Rh+ mean

A

antigen is present

65
Q

What does EDTA stand for? What is it?

A

It is an anticoagulant in the tubes for a CBC

Stands for: Ethylenediaminetetraacetic acid

66
Q

What does destruction of hemoglobbin produce?

A

Heinz Bodies!!!

67
Q

What does an elevated ESR indicate?

A

inflammatory response –> makes RBCs heavier and more likely to fall rapidly when placed in a special vertical tube, rouleaux formation

68
Q

What does a Hgb electrophoresis tell us?

A

Quantifies normal and abnormal forms of Hgb;

69
Q

What is being looked at in

the CBC? ( 3 things)

A

Red blood cells, white blood cells, platelets

70
Q

Whatis critically low platelets? Critically high ?

A

critically Low: less than 30, 000 critically High: greater than 100,000

71
Q

Whatis erythropoietin?

A

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

72
Q

What is factor V leiden?

A

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

73
Q

Whatis hemolytic

anemia?

A

RBCs are lysing very rapidly –> causes buildup of bilirubin –> enlargement of liver and spleen –> Jaundice

74
Q

Whatis leukemia?

A

Uncontrolled production of leukocytes Defects in bone marrow

Smears show immature and abnormal cells WBC count can be greater than 100,000

75
Q

Whatis leukocytosis? What does it indicate? Causes?

A

Elevated white count Greater than 11,000 Indicates–infection
Causes: infection, sepsis, abscess, cancer, stress

76
Q

Whatis leukopenia?

A

Decreased white count
Less than 5,000
Causes can be: viral infections, bone marrow suppression, medications, anemia, malaria and chemotherapy

77
Q

What is a sign of folate deficiency ?

A

Spina bifida

78
Q

What is a qualitative testing for platelets?

A

Aggregation using epi

Principle of platelet aggregometer

79
Q

What is another name for the WBC count?

A

Leukocyte count

80
Q

What is another name for neutrophils?

A

PMN: polymorphonuclear neutrophils

81
Q

What is another name for monocytes?

A

monomorphonuclear

82
Q

What is anisocytosis? What are the two types?

A

abnormal variations in the size of RBCs
Macrocyte= larger than 9 microns [liver disease]
Microcyte=smaller than 6 micron [anemias]

83
Q

What if a left shift?

A

Left shift means bandemia= high levels of bands–> high levels of immature neutrophils
Indication: Bacterial infection

84
Q

What has a greater affinity for Hgb?

A

Carbon monoxide has a greater affinity for RBCs then oxygen

85
Q

What happens if a pt is Rh - and is transfused with Rh+ blood??

A

Fever, anaphylaxis, severe hemolysis

86
Q

What effect will a diet high in Vit k have on PT time?

A

It will shorten the PT time

87
Q

What is the PT-prothrombin time? Normal and Panic values?

A

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````

88
Q

What is the profile ordered for hemolytic anemia?

A

CBC
Retic count
Tests to determine problem: Peripheral blood smear
LDH
Coombs test
Urobilinogen in urine Haptoglobin decreased ( released in response to RBC lysing)

89
Q

What is the profile of someone who has iron deficiency?

A

Hemoglobin - low Hematocrit -low Microcytic -low Hypochromic -low Iron -low
Ferritin -low
TIBC -HIGH

90
Q

What is the partial thromboplastin time test? ( aPTT)

A 
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
91
Q

What is the normal WBC reference level?

A

5,000-10,000/mm –> we call it between 5-10

92
Q

What is the normal RBC count in males? Females?

A

Male: 4.5-6.2 Females: 4.0-5.5

[ X10^9]

93
Q

What is the normal Hgb in neonates?

A

Hb F

94
Q

What is the normal concentration of platelets?

A

150,000-400,000

95
Q

What is the mean corpuscular

volume (MCV)?

A

Measures the average size and volume of the RBC
Normal is 80-100
Indicated the amount of volume occupied by a single erythrocyte

96
Q

Whatis the mean corpuscular

hemoglobbin ( MCH)?

A

Average weight if the Hgb per RBC

decreased MCH–> in Iron def. anemia increased MCH –> macrocytic anemia, tabacco users

97
Q

Whatis the MCHC?

A

Mean corpuscular hgb concentration

98
Q

What is the main functon of

Hemoglobin?

A

Carry oxygen away from lungs and carry CO2 to the lungs

99
Q

What is the International

Normalized Ratio?

A

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

100
Q

What is the hematocrit? What is the ratio of hematocrit to hemoglobin?

A

Hematocrit= packed cell volume (PVC) or erythrocyte volume fraction (EVF)
Hematocrit is 3X more than hemoglobin

101
Q

What is the Erythrocyte

sedimentation rate?

A

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

102
Q

What is the chief function of red

marrow? Who has the most?

A

Fxn of red marrow= production of erythrocytes, leukocytes and platelets
Children have the most

103
Q

What is RhIG Rhogam ?

A

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

104
Q

What is protein S?

A

Co-factor for protein C

ratio of protein C to protein S may ID carrier of congential protein C def.

105
Q

What is protein C?

A

Vit K dependent protein that prevents intravascular thrombi
It is autosomal dominant
Protein C’s activity is enhanced by protein S

106
Q

What is protein C?

A

Vit K dependent protein that prevents intravascular thrombi
It is autosomal dominant
Protein C’s activity is enhanced by protein S

107
Q

Whatis poikilocytosis?

A

Variation in the shape of RBCs

Poikilocytosis –> causes an increase in the RDW

108
Q

What is platelet formation essential for?

A 
esential for blood clotting:
Homeostatis plug Vasocontrictors
Clot retraction
tissue repair
regulate local inflammation
109
Q

Whatis leukopenia?

A

Decreased white count
Less than 5,000
Causes can be: viral infections, bone marrow suppression, medications, anemia, malaria and chemotherapy

110
Q

What does Rh+ mean

A

antigen is present

111
Q

What does EDTA stand for? What is it?

A

It is an anticoagulant in the tubes for a CBC

Stands for: Ethylenediaminetetraacetic acid

112
Q

What does destruction of hemoglobbin produce?

A

Heinz Bodies!!!

113
Q

Whatis leukocytosis? What does it indicate? Causes?

A

Elevated white count Greater than 11,000 Indicates–infection
Causes: infection, sepsis, abscess, cancer, stress

114
Q

Whatis leukemia?

A

Uncontrolled production of leukocytes Defects in bone marrow

Smears show immature and abnormal cells WBC count can be greater than 100,000

115
Q

Whatis hemolytic

anemia?

A

RBCs are lysing very rapidly –> causes buildup of bilirubin –> enlargement of liver and spleen –> Jaundice

116
Q

What is factor V leiden?

A

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

117
Q

Whatis erythropoietin?

A

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

118
Q

Whatis critically low platelets? Critically high ?

A

critically Low: less than 30, 000 critically High: greater than 100,000

119
Q

What is being looked at in

the CBC? ( 3 things)

A

Red blood cells, white blood cells, platelets

120
Q

What does the CBC stand for?

A

Complete blood count

121
Q

What do protein C and S do?

A

Help prevent blood clots

122
Q

What do we need for adequate hemostasis?

A

Platelets: proper number and fxn

Humoral coagulation factors: intrinsic and extrinsic pathway

123
Q

Who should you check lead levels on?

A

Children who live in old houses, contruction material, or have envt exposure

124
Q

Who would you order a CBC for?

A 
Routine Che
ck ups
Suspect infections
Bleeding issues
Concerns about anemia--fatigue and dyspnea
125
Q

Why do you do the CBC last?

A

Always do the CBC last –> because it contains an anticoagulant called: EDTA
Shake the tube after drawing blood to disperse the anticoagulant

126
Q

Who needs to be blood typed?

A

Rh– pregnant women
Type and screen - risk of transfusion [needs the blood right away ]
Type and cross- trauma,surgery, anemia [hold the blood]

127
Q

Who needs the carboxyhemoglobin test?

A

Firefighters fire victims mechanics

128
Q

Who needs coagulation studies?

A

Bleeders: critically ill; people on anticoagulants; unexplained bruising or bleeding
Clotters: DVT or PE

129
Q

Who is the universal recipient ?

A

Type AB Rh+

130
Q

Who is the universal donor?

A

Type 0 Rh-

131
Q

Where are white blood cells made?

A

In the bone marrow; they move inside and outside of blood vessels

132
Q

When should you check lead levels in children?

A

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

133
Q

When is RDW usually measured ? (red blood cell distribution width)

A

only in the case of anemias

134
Q

When is MCHC decreased? Increased?

A

MCHC decreased –> in thalasemia, iron def. anemia

MCHC increased –> in hemolyusis, sphereocytosis

135
Q

When is an essential time to check for platelets?

A

Before surgery

136
Q

What would you order for a megaloblastic anemic pt?

A

1) CBC with differential 2) vit b12

3) folate levels

137
Q

What symptoms suggest Von Willebrand Disease ?

A

Bleeding gums, recurrent nose bleeds,
cannot stop bleeding after giving birth
most common inherited bleeding disorder

138
Q

What should you order for Von WIllebrand disease?

A

PTT/PT- normal

Bleeding time - prolonged VWF antigen- decreased Ristocetin factor- decreased

139
Q

What medications can cause a reaction in patients with G6PD deficiency?

A

What medications can cause a reaction in patients with G6PD deficiency?

140
Q

What is transferrin?

A

blood protein that binds and transports iron

in anemia, transferrin looks for more iron to bind

141
Q

What is thrombosis?

A

formation of blood clot in a vessel which obstructs blood flow

142
Q

What is thrombocytosis? Causes?

A

High platelet count greater than 400,000
Causes: infection inflammation multiple myeloma polycythemia vera oral contraceptives IDA
high altitudes RA

143
Q

What is thrombocytopenia? Causes?

A

Low platelet count Less than 150,000
Due to: anemia-megaloblastic autoimmune metastatic cancer hemolytic diease of the newborn leukemia
malaria
Drugs

144
Q

What is the test used to diagnose sickle cell ? What is present in Pts with sickle cell anemia?

A

Electrophoresis

Hb S is present in patients with sickle cell

145
Q

What is the term for abnormally shaped RBCs?

A

Poikilocytes

146
Q

What is the red blood cell size distribution width ( RDW)

A

It is a measure of degree of anisocytosis;
** all RBCs have some degree of variations
Normal red blood cell size is 6-8 microns

UA (13 decks)

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