Hematology 1 Flashcards
Hgb: normal value
Hemoglobin: M) 14-18 g/dL F) 12-16 g/dL
Hgb: Interpretation
Increased: Long-term high-altitude (eg mountain) exposure or chronic hypoxia (secondary polycythemia)
* Hbg is the main component of RBC & serves as transporter of O2 & CO2 in the blood
Hct: normal value
Hematocrit: M) 42-52% F) 37-47%
Hct: Interpretation
The proportion of RBCs in 1 mL of plasma
Increased: May be 2/2 (but not limited) dehydration, congenital heart Dz, cor pulmonale, erythrocytosis, hypoxia (eg high-altitude)
Decreased: May be 2/2 (but not limited) anemia, bleeding, RBC destruction, bone marrow suppression or underproduction, infection, pregnancy
MCV: normal value
Mean corpuscular value: 80-100 fL (normocytic)
<80 fL microcytic; > 100 fL (macrocytic)
MCV: interpretation
Normocytic anemia: acute blood loss
Microcytic & hypochromic anemia: iron deficiency anemia, thalassemia
Macrocytic anemia: folate/B12 deficiency anemia, liver Dz, hypothyroidism
MCHC: normal value
Mean corpuscular Hgb concentration: Measure of the average color of the RBC in a blood sample.
Normal: 31-37 g/dL
MCHC: interpretation
Decreased in iron deficiency anemia & thalassemia
Normal in macrocytic & normocytic anemia
MCH: normal value
Mean corpuscular Hgb: Indirect measure of the average color of the RBC
Normal: 25-35 pg/cell
MCH: interpretation
Decreased value means pale or hypochromic RBCs. Decreased in iron-deficiency anemia and thalassemia. Normal w/ the macrocytic anemias.
TIBC: normal value
Total iron-binding capacity (TIBC): A measure of available transferrin that is left unbound to iron.
Normal value: 250-410 mcg/dL
TIBC: interpretation
Total iron-binding capacity (TIBC)
Elevated: iron deficiency, acute liver damage, progestrone birth control pills
Decreased: hemochromatosis, hemosiderosis
Normal: thalassemia, B12/folate deficiency anemia (bc iron levels are normal)
Serum ferritin: normal value
Serum ferritin is the stored form of iron. Stored in body tissue (eg spleen, liver, bone marrow). Most sensitive test for iron-deficiency anemia.
Normal: 20-400 ng/mL
Serum ferritin: interpretation
Markedly decreased in iron-deficiency anemia.
Normal to high in thalassemia.
* Avoid iron supplement before testing serum ferritin level.
Serum iron: normal value
Normal: 50-175 mcg/dL
Serum iron: interpretation
Decreased in iron-deficiency anemia. Normal to high in thalassemia and the macrocytic anemias. Affected by recent blood transfusions.
RDW: normal value
Red cell distribution width (RDW): A measure of the variability of the size of RBCs in a given sample.
Normal RDW-SD: 39-46 fL
Normal RDW-CV: 12-15% in adult
RDW: interpretation
Elevated in iron-deficiency anemia and thalassemia.
Reticulocyte: normal value
Retic: immature RBCs
Normal: 0.5-2.5% of total RBC count
Reticulocyte: interpretation
Elevated: When the bone marrow is stimulated into producing RBCs (eg post acute bleeding episodes, hemolysis, leukemia, EPO treatment, supplementation of iron/folate/B12 post deficiency)
Reticulocytosis: 1) definition 2) interpretation
1) >2.5% of total RBC count
2) If no reticulocytosis post acute bleeding episode, hemolysis, or after appropriate supplementation of deficient mineral (iron, folate, B12), or w/ EPO, rule out bone marrow failure by doing bone marrow biopsy.
Poikilocytosis: definition
Presence of abnormal shape RBCs (poikilocytes) in the blood. Can be seen in the peripheral smear.
Normal serum folate level
Normal folate level: 3.1 - 17.5 ng/mL
Normal vitamin B12 level
Normal vitamin B12: > 250 pg/mL
Normal WBC count
Normal WBC count: 5000 to 10000
Normal neuts or segs
Normal neuts or segs: 55-70%
Normal lymph
Normal lymph: 20-40%
Normal monocyte level
Normal monocyte: 2-8%
Normal eosinophils level
Normal eosinophils: 1-4%
Hgb electrophoresis test: definition
Hgb electrophoresis: the gold-std test to diagnose hemoglobinopathies such as sickle cell anemia, thalassemia
Secondary polycythemia: 1) definition and 2) indication
1) Hgb: M> 18.5%, F>16.5% Hct: M>52%, F>48%
2) Chronic smokers, Pts w/ long-term COPD, long-term residence at high altitude, or EPO Tx have higher incidence of secondary polycythemia
Acute hemorrhage: 1) definition 2) S/Sx
1) =/>15% blood loss that results in orthostatic HoTN (systolic BP drop > 20mm Hg)
2) Shock, reticulocytosis
* Correct Hgb value will not show up until 24 hrs after onset of the hemorrhage
Neutropenia: 1) definition 2) S/Sx
1) Absolute neurtophil count (ANC) < 1500/mm3
2) Frequent infections (esp. bacterial) w. fever, sore throat, oral thrush, etc.
* African Am may have a lower ANC count that is benign (normal bone marrow aspirate)
B12 deficiency: 1) S/Sx 2) Lab findings
1) Gradual onset of symmetrical peripheral neuropathy starting in the feet and/or arms. Numbness, ataxia (+ Romberg test), loss of vibration and position sense, impaired memory/dementia
2) <250 pg; peripheral smear shows macro-ovalocytes, megaloblasts, and multisegmented neuts
Hodgkin’s lymphoma: 1) definition 2) S/Sx
1) A cancer of the beta lymphocytes (B cells).
2) Night sweats, fevers, pain w/ ingestion of alcohol. Generalized pruritus w/ painless enlarged lymph nodes (neck). Anorexia and wt loss. More common in young (20-40) or older (>60) adults, white males.
Non-Hodgkin’s lymphoma: 1) definition 2) S/Sx
1) A cancer of the lymphocytes (usually B cells) and killer cells. Has poor prognosis.
2) More common in a Pt > 65 yo; night sweats, fever, wt loss, generalized lymphadenopathy (painless)
Multiple myeloma: 1) definition 2) S/Sx
1) A cancer of the plasma cells.
2) Fatigue, weakness and bone pain (usually in back or chest). Causes proteinuria w/ Bence-Jones proteins, hypercalcemia, normocytic anemia. More common in older adults.
Bence-Jones protein test: indication
Used mainly to diagnose and monitor multiple myeloma
Screening test for all anemias
CBC (Hgb/Hct)
Hgb: M) 14-18 g/dL F) 12-16 g/dL
Hct: M) 42-52% F) 37-47%
Diagnostic test for thalassemia and sickle cell anemia
Hemoglobin electrophoresis
Ferritin level low: interpretation
Iron-deficiency anemia
Normal serum ferritin: 20-400 ng/mL
Ferritin level normal to high: interpretation
Thalassemia minor/trait
Normal serum ferritin: 20-400 ng/mL
Best absorbed form of iron supplementation
Ferrous sulfate (OTC, cheapest)
Key point to teach a Pt who takes iron pill
After taking antacid, wait 4 hrs to take iron pill
Which meds does iron interact with? (three types)
Tetracycline, levothyroxine and bisphosphonates. Take iron pills 2 hrs before or after these meds.
1) Meds and 2) conditions that can lower Hgb levels and worsen anemia
1) ARBs (losartan, valsartan), ACEIs (lisinopril)
2) CKD, diabetes, chronic HF, HTN
Thrombocytopenia: 1) definition 2) S/Sx
1) Platelet count of < 150,000 /uL
2) Easy bruising, bleeding gums, spontaneous nosebleeds, hematuria
Normal platelet count
150,000 - 450,000 /uL
What to check for a easy bruising and initial lab order.
Check meds (eg ASA, NSAIDs, heparin, warfarin, SSRIs, steroids. Evaluate Pt for a possible coagulation disorder (eg Willebrand Dz, vit. C deficiency, scurvy). Initial lab order: CBC, PT, PTT.
Anemia: definition
Decreased in the Hgb/Hct value below the norm for the Pt’s age and gender.
