Lab Evaluation of Hematologic Parameters

Question 1

acronym for differential blood cell count in a CBC

Answer 1

“Never Let Monkeys Eat Bananas”:
neutrophils > lymphocytes > monocytes > eosinophils > basophils

Question 2

normal hemoglobin (Hb) value for men

Answer 2

14-18 g/dL

Question 3

normal hemoglobin (Hb) value for women

Answer 3

12-16 g/dL

Question 4

hemoglobin - overview

Answer 4

*value is measured in grams per deciliter
*tells you how much of the protein hemoglobin (in grams) is in one deciliter of blood

Question 5

hematocrit (Hct) - overview

Answer 5

*value is a percentage
*tells you the volume of packed RBCs in a given volume of whole blood
*Hct is typically 3x the Hb

Question 6

mean corpuscular volume (MCV) - overview

Answer 6

tells average size of red blood cells

Question 7

mean corpuscular hemoglobin (MCH) - overview

Answer 7

*tells average WEIGHT of hemoglobin per cell
*units = picograms
*ex: 30 picograms of hemoglobin per RBC

Question 8

mean corpuscular hemoglobin concentration (MCHC) - overview

Answer 8

*tells average CONCENTRATION of hemoglobin in RBCs
*units = grams per deciliter
*ex: 35 grams of Hb per deciliter of RBCs

Question 9

red cell distribution width (RDW) - overview

Answer 9

tells us how VARIED the sizes of the red cells are

Question 10

relationship between MCV and RDW

Answer 10

*if RDW is normal, all cells are similar size (MCV is a good indicator)
*if RDW is increased, cell size is NOT known (MCV is not a good indicator)
-UNLESS the MCV is LOW

note - MCV = mean corpuscular volume; RDW = red cell distribution width

Question 11

reticulocyte count

Answer 11

*measures the percentage of reticulocytes (immature RBCs) circulating in the blood
*methylene blue stain identifies precipitated RNA in young cells
*larger than mature RBC, with less central pallor
*not part of CBC; need to order separated

Question 12

microcytosis

Answer 12

*term used when RBCs have a low MCV (smaller than normal)
*causes include:
1. iron deficiency anemia
2. anemia of chronic disease
3. hemoglobinopathies (sickle cell, thalassemias, etc)
4. copper deficiency
5. lead poisoning
*often associated with a low MCH (hypochromia: low weight of Hb in cell)

Question 13

RBC morphological abnormality: basophilic stippling

Answer 13

*punctate basophilic precipitation of undegraded RNA in RBCs
*a sign of INEFFECTIVE HEMATOPOIESIS
*seen in LEAD TOXICITY, sideroblastic anemia, and thalassemias

Question 14

RBC morphological abnormality: target cells

Answer 14

*result of redundant red cell membrane / decreased cell volume
*causes:
-hemoglobinopathies/THALASSEMIAS
-iron deficiency anemia
-drug-induced hemolytic anemia
-liver disease

Question 15

RBC morphological abnormality: schistocytes

Answer 15

*aka helmet cells
*associated with microangiopathic hemolytic anemias (DIC, TTP, HUS) or mechanical hemolysis (ex. heart valve prosthesis)

Question 16

RBC morphological abnormality: acanthocytes

Answer 16

*aka thorn cells or spur cells
*associated with LIVER DISEASE, abetalipoproteinemia, vitamin E deficiency

note - can also just be artifact

Question 17

RBC morphological abnormality: rouleaux

Answer 17

*“rolls” or stacks of coins
*RBCs abnormally adhere to each other due to increased immunoglobulin production
*associated with PLASMA CELL DYSCRASIAS (multiple myeloma, plasma cell leukemia) or infection

note - can also just be artifact

Question 18

RBC morphological abnormality: Howell Jolly bodies

Answer 18

*remnants of nuclear chromatin normally removed by the spleen
*seen in surgically (splenectomy) or functionally ASPLENIC (sickle cell) patients

Question 19

RBC morphological abnormality: spherocytes

Answer 19

*small, spherical cells with NO CENTRAL PALLOR
*associated with hereditary spherocytosis or autoimmune hemolytic anemia

Question 20

normal myeloblast range in bone marrow aspirate

Answer 20

< 5.0

[note - myeloblasts should NEVER be in the peripheral blood !]

Question 21

normal myeloblast range in a peripheral blood sample

Answer 21

0 [there should NEVER be myeloblasts in the peripheral blood {these are very immature blood cells}]

Question 22

what is included in a BASIC metabolic panel

Answer 22

sodium
potassium
chloride
CO2
BUN
creatinine
glucose
calcium

note - run on serum

Question 23

what is included in a COMPREHENSIVE metabolic panel

Answer 23

BMP [sodium, potassium, chloride, CO2, BUN, creatinine, glucose] PLUS:
total protein
albumin
AST
ALT
alkaline phosphatase
total bilirubin

Question 24

what cell is this? what is its associated pathology?

Answer 24

*acanthocyte (“spur” or “thorn” cells)
*associated with LIVER DISEASE primarily

Question 25

what cell is this? what is its associated pathology?

Answer 25

*basophilic stippling
*associated with lead toxicity, sideroblastic anemia, and thalassemias

Question 26

what cell is this? what is its associated pathology?

Answer 26

*howell jolly bodies
*associated with asplenia (splenectomy) or functional asplenia (sickle cell patients)

Question 27

what cell is this? what is its associated pathology?

Answer 27

*rouleaux
*associated with plasma cell dyscrasias (MGUS, multiple myeloma, plasma cell leukemia)

Question 28

what cell is this? what is its associated pathology?

Answer 28

*schistocytes
*associated with microangiopathic hemolytic anemias (DIC, TTP, HUS) or mechanical hemolysis (heart valve prosthesis)

Question 29

what cell is this? what is its associated pathology?

Answer 29

*spherocytes
*associated with hereditary spherocytosis

Question 30

what cell is this? what is its associated pathology?

Answer 30

*target cells
*associated with thalassemias primarily