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ADV DIAG > hematology > Flashcards

hematology Flashcards

1
Q

CBC and component tests report what

A

the numbers, size and shape of the various cells in the blood

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2
Q

red cells transport what

A

oxygen

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3
Q

WBC function is what

A

part of defense against unwanted intruders

e.g. bacteria and viruses

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4
Q

platelets maintain the integrity of what system

A

vascular system

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5
Q

how do platelets mainitan integrity of vascular system

A

by plugging leaks in blood vessels

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6
Q

what is the fluid component of blood called

A

plasma

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7
Q

what makes plasma

A

about 55% of blood volume

90% water

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8
Q

blood cells are produced from what

A

a precursor cell in bone marrow

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9
Q

what is hematocrit

A

percent of whole blood volume occupied by RBCs

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10
Q

hematocrit lab values

A

male 38.8 - 50%

female 34.9 - 44.5%

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11
Q

what is hemoglobin

A

protein in RBCs that carriers oxygen to blood

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12
Q

hemoglobin lab values

A

male 13.5 - 17.5 g/dl

female 12 - 15.5 g/dl

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13
Q

hemoglobin ratio to hematocrit

A

1/3

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14
Q

what are reticulocytes

A

new RBCs recently release from bone marrow

immature RBCs

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15
Q

reticulocytes test what

A

test activity of bone marrow and need for RBCs

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16
Q

how are reticulocytes reported

A

as a percent of total red cells (0.5% to 1.5%)

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17
Q

why should you look at reticulocyte count for pt with anemia

A

to determine if there is a problem originating in bone marrow

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18
Q

what will reticulocyte count look like if bone marrow is doing its job WNL

A

higher count

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19
Q

optimal range of RBC distribution width (RDW)

A

13

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20
Q

what does RBW measure

A

the consistency of the size of RBCs

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21
Q

RBW is often increased in

A
  1. pernicious anemia
  2. folic acid deficiency
  3. iron deficiency anemia
  4. hemolytic anemia
  5. transfusions
  6. sideroblastic anemia
  7. alcohol abuse
  8. hereditary anemias
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22
Q

RBW decreased when

A

barely

not going to see this a lot with primary care

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23
Q

RBC optimal values

A

male 4.7 - 5.25 million/mm3

female 4 - 4.5 million/mm3

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24
Q

RBC evaluates what

A

normal erythropoiesis (production of RBCs)

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25
Q

WBC range

A

4500 - 11,000

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26
Q

look at WBC when concerned for what

A

infection, viruses

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27
Q

what is leukocyte

A

another name for white blood cyte

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28
Q

leukocytosis

A

WBC elevated

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29
Q

leukopenia

A

WBC low

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30
Q

name the different leukocytes

A
  1. neutrophils
  2. eosinophils
  3. basophils
  4. lymphocytes
  5. monocytes
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31
Q

what are segemented nuclei or polymorphonuclear leukocytes

A

neutrophils, eosinophils, basophils

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32
Q

what are non-segmented nuclei

A

lymphocytes and monocytes

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33
Q

neutrophils are prominent in what

A

acute infection and inflammatory states

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34
Q

neutrophils increase with what

A

infection and burns

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35
Q

neutrophils decrease with what

A

b12 and folate anemia and chemotherapy

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36
Q

eosinophils are important with what

A

allergic reactions and parasitic infections and leukemias

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37
Q

basophils important with what

A

allergic response

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38
Q

basophils rise with what

A

allergies, CML, Hodgkin’s

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39
Q

what are the largest leukocytes

A

monocytes

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40
Q

what are the most abundant leukocytes

A

neutrophils

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41
Q

monocytes do what

A

important role with chronic infections and inflammation

important with fibrocytosis and production of cytokines to help stimulate other WBCs to recruit for fighting infecetion

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42
Q

where are monocytes stored

A

spleen

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43
Q

what causes increased monocytes

A

stress response, viral infection, chronic inflammatory states, mono

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44
Q

what are the different types of lymphocytes

A

B cells, T cells, neutropillar cells

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45
Q

what are the 6th type of WBC

A

newly produced polymorphonuclear leukocytes are called bands

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46
Q

what is WBC shift to left

A

when bands and PMNs appear as greater percent of WBCs

high number of immature WBC are present to fight infection/inflammation

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47
Q

where are platelets produced

A

bone marrow

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48
Q

what to platelets participate in

A

clotting

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49
Q

red cell indices

A

MCV
MCH
MCHC

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50
Q

what is mean corpuscular volume (MCV) and the range

A

average red cells size

80 - 100 fl

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51
Q

what is the most common red cell indices to look at in anemic pt

A

MCV

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52
Q

what is mean corpuscular hemoglobin (MCH) and range

A

average mass of hemoglobin per cell

27 - 33 pg (picograms)

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53
Q

what is mean corpuscular hemoglobin concentration (MCHC) and range

A

average hemoglobin concentration in red cell

33-36 g / dl

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54
Q

CBC uses

A
  1. part of comprehensive examination
  2. baseline test
  3. differential when serious infection is diagnosed
  4. repeated to document recovery
  5. bleeding of any kind
  6. c/o fatigue, sob, pallor; r/o anemia
  7. for female c/o increased menses
  8. pt c/o dark stools
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55
Q

is CBC sensitive and/or specific

A

sensitive

not specific for particular disease

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56
Q

h/h assess what

A

seriousness of bleeding post trauma or for other causes of bleeding

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57
Q

anemia is diagnosed with what CBC values

A

decreased H/H

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58
Q

what does CBC look like with infection or inflammation

A

WBC rises

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59
Q

what does CBC look like with bacterial infection

A

shift to left (more neutrophils)

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60
Q

what does CBC look like with infectious mononucleosis

A

percent of monocytes rise in differential

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61
Q

what can explain bleeding or bleeding tendency

A

thrombocytopenia

62
Q

what is thrombocytosis and what is the risk

A

too many platelets

may increase risk of abnormal clotting and possibly stroke

63
Q

what does CBC look like with leukemia

A

elevated WBC with abnoral distribution of the types of white cells

64
Q

Which is true if blood plasma?

a. 90% water
b. Includes platelets but no other cells
c. Includes platelets and white cells but no red cells
d. Is the liquid component of blood without fibrinogen

A

a

65
Q

name cellular components of blood

A

red cells, white cells, platelets

reticulocytes are new RBCs

66
Q

name usual white cells in blood

A

polymorphoneuclear leukocytes (PMNs or just leukocytes), lymphocytes, and monocytes - PMNs are neutrophils, basophils or eosinophils

67
Q

define blood plasma

A

liquid component of blood that includes fibrinogen

68
Q

vitamin b12 normal range

A

200 - 600 pg/ml

69
Q

folate normal range

A

2 - 20 ng/ml

70
Q

Vitamin b12 and folate are necessary for

A

red cell production, DNA synthesis and neurological function

Folic acid especially important for development of the fetus during pregnancy

71
Q

what does deficiency of vitamin b12 or folate cause

A

diminished production of red cells

72
Q

what happens to hemoglobin with b12 or folate deficiecny

A

hemoglobin synthesis is not effected

cells are jam packed full with hgb

red cells are macrocytes0 larger than normal, and hyperchromic (dense red cells)

increase in MCV, > 100

increase MCH

73
Q

pernicious anemia is caused by what

A

b12 deficiency

parietal cells in stomach do not produce intrinsic factor necessary for absorption of b12

74
Q

intrinsic factor antibody +

A

pernicious anemia

75
Q

treatment of pernicious anemia

A

injected supplementation of b12 bc cannot be absorbed in PO form

76
Q

other causes of folic acid or b12 deficiecny

A

nutrition deficiency or malabsorption syndrome

vegans, gastric bypass, celiac disease

77
Q

symptoms of b12 deficency

A 
infertility
hypothyroidism
depression
cognitive decline/ memory loss
low energy
numbness (neuro)
78
Q

who is possibly folate deficient

A

alcoholics

pregnant women

79
Q

what tests are ordered for macrocytic, hyperchromic anemia

A

folate and vitamin b 12

80
Q

b12 levels are ordered for pt with

A

memory loss, depression, and other neurologic s/s- numbness and tingling

81
Q

folate levels are ordered for pts who are

A

alcoholics or pregnant pts or pts with suspected nutritional deficiencies

82
Q

pt comes in with fatigue or memory loss or neuro symptoms, what do you order

A

CBC
b12
folate

83
Q

what is needed to converting homocysteine to methionine and methylmalonyl CoA (MMA) to succinyl CoA

A

B12 cofactor

84
Q

when b12 is not available, what levels increase

A

MMA and homocysteine

85
Q

what are the best indicators of b12 deficiency

A

MMA- methionine and methylmalonyl CoA

bc b12 is only coenzyme required in this pathway

86
Q

what are indirect measures of bone marrow

A

ferritin, iron level, and total iron binding capacity

necessary for production of hgb

87
Q

what happens to RBC without sufficient iron

A

microcytic red cells that are hypochromic

MCV and MCH low

MCV < 80

88
Q

what is frequently associated with iron deficiency anemia

A

chronic GI blood loss

89
Q

is serum ferritin needed when blood loss is documented with stool occult blood tests or site of bleeding is identified

A

not necessary when you know where bleeding source is

90
Q

when to order ferritin/iron, iron binding capacity labs

A

microcytic anemia (low h/h, MCV < 80, microcytic

91
Q

what do labs look like with iron deficiency anemia

A 
ferritin low
iron low
TIBC normal or high
transferrin sat. low
RDW normal or high
RBC count low
92
Q

ferritin normal values

A

30–300 ng/mL (=μg/L) for males

6–115 ng/mL (=μg/L) for females

93
Q

mild to moderate iron def anemia

A

Hgb > 10; Ferritin > 15

94
Q

severe iron def anemia

A

hgb < 10, ferritin < 15

95
Q

aside from iron def anemia, what can low ferritin indicate

A
  1. hypothyroidism
  2. vit C deficiency
  3. celiac disease
96
Q

increased ferritin occurs when

A

inflammatory and neoplastic disorders

eg hepatitis, some tumors, acute leukemia, Hodgkin lymphoma, GI tract tumors

97
Q

what is first step in evaluation of normocytic anemia

A

assess clinical hx

Does pt have some dx that would cause anemia of chronic disease?

ie renal insuff, thyroid disease, or other endocrine disease

98
Q

what should you check to look for early iron deficiency or combined nutritional deficiecny

A

iron studies

folate/vit b12 levels

99
Q

what to do if reticulocyte count is increased

A

do hgb electrophoresis to look for hemoglobinopathy, screen for g6pd defieicny, and direct anticoagulation tst

100
Q

what to consider if reticulocyte is low

A

anemia of chronic disease

chronic renal insuff

thyroid disease

marrow damage

101
Q

if cause of normocytic anemia is not apparent what should be done

A

bone marrow aspirate and bx

102
Q

define pernicious anemia

A

B12 deficiency anemia caused by a lack of intrinsic factor production by the gastric parietal cells - intrinsic factor is necessary for the absorption of B12 in the distal ileum

103
Q

What would be your concern when an older patient has iron deficiency anemia?

A

GIB or CA

104
Q

what labs are included in assessment of clotting

A
  1. partial thromboplastin time, PTT
  2. prothrombin time, PT
  3. international normalized ratio, INR
  4. d-dimer
105
Q

what is partial thromboplastin time, PTT

A

measure of adequacy of intrinsic or coagulation pathway

106
Q

what do PT and INR measure

A

activity of extrinsic pathway and vitamin K dependent clotting factors

107
Q

is PT or INR more reliable

A

INR

108
Q

units of measurement for PTT, PT, INR

A

PTT and PT reported in units

INR has no units

109
Q

d-dimer is what

A

breakdown product of fibrin

110
Q

when is d-dimer elevated

A

when clots are lysed either as part of body’s own repair mechanisms or by injected fibrinolytics

111
Q

how is d-dimer measured

A

ng/ml or micrograms/L

112
Q

when is d-dimer used

A

when there is concern for PE or blood clot (DVT)

to assess treatment of PE or DVT

assess possibility of disseminated intravascular coagulopathy

113
Q

can d-dimer be used for diagnosis

A

no, it supports diagnosis

cannot actually diagnose

114
Q

what should d-dimer look like after receiving treatment

A

decreased as the clot should have decreased in size

if it remains elevated then there is a high likelihood of recurrence and anticoagulation is continued

115
Q

is d-dimer used for rule in or rule outs

A

good for ruling out clotting as cause of symptom

116
Q

other times d-dimer is positive

A
  1. sickle cell
  2. pregnancy
  3. some malignancies
  4. post op
  5. when rheumatoid factor is elevated
117
Q

how do false positives affect diagnostic value of d-dimer

A

limits the diagnostic value

118
Q

PTT is used to follow what

A

pt’s coagulation on heparin

not need for low molecular wt heparin, just baseline in this form of treatment

119
Q

INR is used to assess what

A

pt’s response to warfarin

120
Q

how is ventilation/perfusion scan performed

A

nuclear study

  1. radioactive marker injected
  2. circulates in vascular system
  3. scan done
    THEN
  4. pt breaths in radioactive substance
  5. another scan performed
121
Q

what does v/q scan look for

A

concern for PE

looks for mismatch between inhaled scan and vascular scan (inspired radioactivity but no perfusion activity)

122
Q

how is spiral CT (helical CT or multidetector CT) performed

A

cuts are made at 2 mm intervals, normally cuts are 5 or more mm

123
Q

what is spiral CT used for

A

quick way to visualize the pulmonary arteries where embolus may be lodged

124
Q

what is gold standard for PE diagnosis

A

spiral CT (helical CT or multidetector CT)

125
Q

When is D-dimer formed?

A

when fibrin in clots break down

126
Q

which vitamin is necessary for coagulation factors assessed by INR?

A

vitamin K

127
Q

what characteristics are different with sickle cells

A

sickle shapes of red cells as result of abnormal conformation of hemoglobin

cells sickle when oxygen concentration is reduced

sickle cells are stiffer than normal cells

RDW is increased d/t variation in width of red cells

128
Q

abbreviation for abnormal hemoglobin

A

HbgS

129
Q

normal hemoglobin abbreviation

A

HgbA

130
Q

what is happening with sickle cells?

A

When cells become stiffer than normal cells and cause microvascular obstructions and occlusions and get clots and lots of ischemia and pain and organ necrosis and ill

131
Q

sickle cell trait occurs in people who are what

A

heterozygous

have normal gene and abnormal gene for hemoglobin

132
Q

do pts with sickle cell trait show symptoms

A

no, usually asymptomatic

133
Q

homozygous for sickle cell gene means what

A

100% cells are effected

subject to severe symptoms

greater risk for thromboembolism

134
Q

sickle cell tests are used for what

A
  1. screening
  2. diagnosing

sickle cell trait and sickle cell disease

  1. genetic counseling
135
Q

what ethnic origins are most affected with sickle cell

A

African americans

mediterraneans

sub-suhara africans

Asians

BC of adaptation from Malaria

136
Q

what kind of testing is needed for pts who have symptoms of repeated microvascular events

A

sickle cell test

pts are at risk of having sickle cell trait

137
Q

how to diagnose sickle cell

A

hemoglobin electrophoresis for definitive diagnosis

138
Q

What do red blood cells look like with iron deficiency anemia?

A

hypochromic, microcytic

139
Q

What does leukocytosis with left shift look like

A

WBC elevated and abnormally high number of bands

140
Q

What is mean corpuscular volume, MCV

A

measure of average size ore red cells

141
Q

what is blood typing

A

assessment of different antigens and antibodies in the blood

142
Q

what is cross matching

A

identification of blood and blood products to transfuse into pt

143
Q

what happens if cross matching is not done properly

A

pt may have mild reaction to blood transfusion or may have serious reaction and die

144
Q

what requires blood type and cross match

A

transfusions of whole blood or any of components of blood- red cells, platelets, plasma

145
Q

what are antigens on red cells referred to

A

A or B depending on which antigen is present

146
Q

blood type A- antigens and antibodies

A

antigens on RBC- A
can donate blood to A, AB
can receive blood from O and A
antibodies to B antigen

147
Q

blood type B- antigens and antibodies

A

antigens on RBC- B
can donate blood to B, AB
can receive blood from B, O
antibodies to A antigen

148
Q

blood type AB

A

antigens on RBC- A and B
can donate blood to AB
antibodies to none
can receive blood from AB, O

149
Q

blood type O

A

antigens on RBC- none
can donate blood to A, B, AB, O
antibodies to A antigen and B antigen
can receive blood from O

150
Q

what is Rh

A

another antigen on red cell surface

stands for Rhesus antigen

if present, blood is Rh positive and if negative blood is Rh negative

151
Q

Define the ABO blood typing group

A

Red cells have on their surface either antigen A , B or neither in which case their blood is type O

152
Q

Which antibodies are in the plasma of each ABO blood type?

A

Type A blood has type B antibodies in the plasma. Type B has type A antibodies. Type AB has neither antibody and type O has both A and B antibodies in the plasma.

ADV DIAG (23 decks)

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