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Clin Lab > Hematology 2 > Flashcards

Hematology 2 Flashcards

1
Q

Normal range of WBC

A

4.4 – 11.3 x103 cells/ L

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2
Q

two general groups of cells that make up WBC

A

Granulocytes (Neutrophils, eosinophils, basophils)

Non-granulocytes (Lymphocytes/ monocytes)

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3
Q

Phagocytic cells which derive their name for the presence of granules within cytoplasm that store lysozymes and other chemicals needed to destroy foreign cells

A

Granulocytes

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4
Q

Produced by bone marrow during bacterial infection

A

Neutrophils

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5
Q

Normal range of Neutrophils

A

PMNs 45 – 73%; bands 3 – 5%

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6
Q

↑ in “Bands” during an infection ONLY

A

a “left shift”

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7
Q

‘margination’

A

Adhere to walls of vascular endothelium

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8
Q

Causes for Elevations in Neutrophils

A

Increased production = Bacterial infections

Demargination = Trauma, acute MI, Drugs (i.e., Corticosteroids)

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9
Q

Normal range for Eosinophils and basophils

A

eosinophils: 0 – 4%; basophils: 0 – 1%

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10
Q

Eosinophils elevations are highly suggestive of

A

parasitic infections or allergic reactions

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11
Q

Increase in Basophils are due to

A

allergic and hypersensitivity reactions (release histamine= causal)
May increase for chronic inflammatory diseases and leukemias

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12
Q

Responsible for “phagocytosis” (ingestion) of substances labeled by antibodies or compliment proteins

A

Monocytes & macrophages

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13
Q

Normal range of Monocytes & macrophages

A

2 – 8%

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14
Q

Increased monocytes seen in

A

tuberculosis/ malaria/ rickettsia

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15
Q

Give specificity & memory to foreign invaders

A

Lymphocytes

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16
Q

Normal range for Lymphocytes

A

20 – 40%

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17
Q

produce antibodies

A

B lymphocytes

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18
Q

Cytotoxic through antibody & complement activation

A

T lymphocytes & Natural Killer Cells (NK cells)

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19
Q

Effects of Infections on White Blood Cells

A 
Increase in Neutrophils = Bacteria, and TB (lesser extent)
Increase in Lymphocytes = Viral
Decrease in Lymphocytes = HIV
Increase in Eosinophils = Parasites
Increase in Monocytes = TB
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20
Q

Effects of Non- infectious factors on WBCs

A

Stressors increase Neutrophils
Corticosteroids increase Neutrophils, decrease Lymphocytes
Radiation decreases Neutrophils and Lymphocytes
Allergies increase Eosinophils
Chronic infections increase Basophils

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21
Q 
GW presents with fevers and severe body wide rash following initiation of Lyrica.
 No recent travel reported
WBC’s:		     14,000 cells/uL
Neutrophils (50%); Band (3%);
Lymphocytes (22%); Monocytes (4%)
Eosinophils (20%); Basophils (1%)
Which of the following caused elevated WBCs?
Bacteria infection
Viral infection
Parasitic infection 
Rash
A

Rash

22
Q

First to adhere to vascular injury

Form weak hemostatic plug= hemostasis

A

Platelets

23
Q

Normal range of Platelets

A

150,000 – 450,000 cells/L

24
Q

Platelet count < 150,000 cells/ μL

A

Thrombocytopenia

25
Q

Hyperdestructive causes of Thrombocytopenia

A 
Drugs (e.g., heparin)
Autoimmune disease (e.g., SLE)
26
Q

Hypoproductive cause of Thrombocytopenia

A

Aplastic anemia

27
Q

Risk of bleeding from trauma

A

Platelet count < 50,000

28
Q

Risk for spontaneous bleeding

A

Platelet count < 20,000

29
Q

Platelet count > 450,000 cells/ μL

A

Thrombocytosis

30
Q

Causes of Thrombocytosis

A

stress, infection, trauma, malignancy

31
Q

platelet count > 800,000 cells/ μL

A

Thrombocythemia

Risk of clotting (i.e., ischemic stroke) and bleeding (i.e., GI)

32
Q

Mean platelet volume (MPV)(for thrombocytopenia)

A

Normal range 7 – 11 fL (varies with laboratory)

33
Q

Cause of Thrombocytopenia + High MPV

A

hyperdestructive

34
Q

Cause of Thrombocytopenia + Low MPV

A

hypoproductive

35
Q

Measure the ability of the platelet to aid in clotting

A

Platelet Function tests

36
Q

Measure time to stop bleeding following an incision

Falling out of favor (lack of sensitivity/ specificity)

A 
Bleeding time (BT)
Normal range: 2 – 9 min
37
Q

Measures the ability of platelets to aggregate after a platelet agonist is added (i.e. epinephrine)
Develop aggregation graph
Slope and curve of over time identifies platelet disorders

A

Platelet aggregation

38
Q

Uses of Coagulation studies

A

Identify deficiencies in coagulation proteins

Monitor effects of anticoagulation therapy

39
Q

Identifies deficiencies extrinsic clotting cascade & common pathways (factors II,V,VII,X)
Uses thromboplastin + Ca =promotes factor X to Xa

A 
Prothrombin time (PT)
Normal range = 10- 13 seconds
40
Q

Problem with PT

A

Clotting time dependent on thromboplastin source

Animal versus human thromboplastin differ in sensitivity

41
Q

‘PT’ test that accounts for thromboplastin sensitivity

A

International Normalized Ratio (INR)

Normal INR = 1.0 (0.9- 1.2)

42
Q

Best possible ISI

A

1 (range from 1- 3)

43
Q

Relation between thromboplastin and ISI

A

Larger the ISI, the less sensitive the thromboplastin

44
Q

PT = 10 sec (baseline); PT= 30 sec (day #3 on warfarin); ISI = 1.0
What is the INR ?

A

INR = { 30 (sec) /10 (sec) }^1.0 = 3.0

45
Q

Used in evaluating therapeutic effects of heparin

A

Antifactor Xa Assay

46
Q

Mechanism of Antifactor Xa Assay

A

Uses patient plasma + antithrombin III + factor Xa
Heparin combines with antithrombin III to inhibit factor Xa
Assay measures remaining levels of factor Xa
Levels of factor Xa consumed are proportional to amount of heparin

47
Q

Therapeutic range of Antifactor Xa Assay

A
  1. 5 – 1.0 units/mL = LMW Heparin (BID dose)

0. 35 – 0.7units/mL = UF Heparin

48
Q

Byproduct of plasmin digestion of cross-linked fibrin

A

D- dimer (< 0.5 mcg/mL)

49
Q

Uses of D- dimer

A

Helps diagnose or rule out thromboembolic event
e.g., DVT/ pulmonary embolism
Sensitive but nonspecific marker

50
Q

Conditions where D-dimer is Falsely elevated

A

Malignancy, Infection, Pregnancy, & Acute Inflammation

51
Q

23 y/o female patient presents with sudden, stabbing chest pain and SOB; Wgt= 70 kg
Medication Hx:
Oral contraceptives/ Ibuprofen prn
Proventil HFA inhaler (asthma)

D-dimer = 7.0 mcg/mL

1) What thromboembolic event do you suspect?
2) What INR would you suggest on Warfarin?
3) Would anti-factor Xa level be necessary on LMWH?

A

DVT
2-3
Yes

Clin Lab (4 decks)

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