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Heme/Genetics > Lab Med CBC > Flashcards

Lab Med CBC Flashcards

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1
Q

Components of automated CBC

A
  • Total WBC count – White Blood Cell (leukocyte)
  • Differential means automated (i.e. via machine, not manual)
  • RBC count – Red Blood Cell (erythrocyte)
  • H&H – Hemoglobin and Hematocrit
  • RBC indices (MCV, MCH, MCHC, RDW)
  • Plt count - Platelet
  • Plt indices
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2
Q

What do you NOT get in automated CBC?

A
  • the reticulocyte count

- band count and immature cell count- must specify on order (order manual differential)

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3
Q

What is the function of lymphocytes?

A

assist in building immunity and include B and T cells

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4
Q

Total WBC Breakdown on Differential

A
  1. LYMPHS – Lymphocytes
  2. MONOS – Monocytes
  3. Granulocytes = Neutrophils, Eosinophils, & Basophils
  4. POLYS – Neutrophils (segs)
  5. EOS – Eosinophils
  6. BA – Basophils
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5
Q

Define Agranulocytosis

A
  • (aka: Bone Marrow Failure) is the deficiency of granulocytes
  • pt is more susceptible to infections
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6
Q

If suspicious of blood dyscrasias you should…

A

Specify manual differential on order.

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7
Q

Total WBC count

A

Provides a count of all 5 types of WBCs:

Neutrophils, Basophils, Eosinophils, Monocytes, and Lymphocytes

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8
Q

Normal range for total WBC count

A

~ 4 – 11,000/mm3

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9
Q

Neonatal Leukocytosis

A
  • Birth – 3 days = 18 – 22 K
  • 3 – 4 days = 8 – 16 K
  • Adult levels at 6 months – in reference to neutrophils
  • During neonatal period (<1 month) segs predominate (~60%)
  • From 1 month to 4 years lymphs predominate (60%)
  • After 4 y/o returns to adult pattern (60% segs, 40% lymphs)
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10
Q

What is the most numerous WBC?

A

Neutrophil (polymorphocyte) poly

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11
Q

Neutrophil (polymorphocyte) poly characteristics

A
  • Multi-lobed nucleus (2-5 lobes) and a pale cytoplasm with an irregular outline and fine azurophilic granules
  • Has 6-10 hour lifespan
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12
Q

What is the primary cause of Neutrophilic leukocytosis?

A

-bacterial infection

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13
Q

Neutrophilic leukocytosis characteristics

A

Usually accompanied by increased band count (left shift)

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14
Q

Bandemia

A

Increased band (immature neutrophil) count

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15
Q

No elevation in neutrophils may be seen with:

A
  • Overwhelming infection (Sepsis)
  • Debilitated patients (Cancer, Autoimmune D/O)
  • Elderly and Infancy
  • ECHO viral infections are common (enteric colitis) in US most of the time asymptomatic, but more serious in infants, elderly and immune compromised
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16
Q

Non-infectious causes of Neutrophilic Leukocytosis

A
  1. Tissue destruction: burns, abscess, trauma, MI, CA, cirrhosis
  2. Metabolic toxic states: uremia, DKA, gout, last trimester of pregnancy
  3. Drugs: corticosteroids, lithium, epi, albuterol
  4. Others: lead poisoning, leukemia, demargination = extravasation – into surrounding tissue due to innate immune response. (sepsis)
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17
Q

Leukopenia (AKA Neutropenia)

A

Decline in WBC count

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18
Q

Neutropenia is primarily associated with…

A
  • overwhelming infection/septicemia,
  • hypersplenism (SLE, Mononucleosis -EBV),
  • drugs/anemias/leukemias
  • d/t bone marrow suppression or destruction
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19
Q

Monocytosis is most associated with

A

-Subacute bacterial endocarditis
-Consider leukemia
-Also, collagen diseases, sarcoidosis, ulcerative collitis, sprue
(Elevated monocyte count)

20
Q

Eosinophilia

A
  • Most commonly seen in roundworm infections d/t peroxidases, neurotoxins in granuoles
  • Asthma and allergic rhinitis (clear nose drop)
  • Chronic skin diseases, e.g., psoriasis, eczema
  • EOS have limited bacterial phagocytic ability
21
Q

Basophilia

A
  • Most common cause is chronic myelogenous leukemia
  • Also parasitic infections
  • Activated in inflammatory/hypersensitivity rxn
  • Histamine/hep/SRS-A cause vasodilation, capillary leakage, bronchoconstriction, serve as chemoattractants
22
Q

Right shift vs. left shift

A

Right shift = increase in the percentage of lymphocytes

Left shift = increase in band count

23
Q

Lymphocytosis

A
  • Most common cause is viral infection
  • NL to decreased WBC count d/t decrease in segs; however, relative since total lymph numbers remain constant
  • Real lymphocytosis d/t pertussis, mono (atypical), lymphocytic leukemia, adenovirus
24
Q

The RBC count measures…

A
  • circulating RBCs

- indirect measure of hemoglobin (Hgb) – Due to RBC being carrier for Hgb

25
Q

Reticulocyte is increased in…

A

-Hemolytic anemia
–Acute/chronic bleed
–After treatment with B12/folate/iron

26
Q

Hgb - Hemoglobin

A

Carried by the RBC – binds to O2 and Fe for transport

27
Q

Hgb males vs. females

A

Anemia <13 gms/dl (males), <12 gms/dl (females) d/t body habitus & volume

28
Q

HCT – Hematocrit

A
  • Ratio of Volume of RBCs to the total volume of blood
  • Another, indirect measure of Hgb
  • Roughly 3x the Hgb value
  • Each 1 unit of red cells (packed or whole) = Hgb 1 gm/dl and the HCT 3%
29
Q

Calculating HCT

A

RBC count X MCV = HCT

Red Blood Cell count X Mean Corpuscular Volume is equal to Hematocrit

30
Q

RBC Indices

A
  • MCV – Mean Corpuscular Volume (size) = MICRO/NORMO/MACRO-cytic
  • MCH – Mean Corpuscular Hemaglobin (mass/wt)
  • MCHC – Mean Corpuscular Hemoglobin Concentration

–All 3 MCV, MCH and MCHC are used to further differentiate a type of anemia

31
Q

Divide HGB by HCT

A

Determines amount of HGB to volume of cells

32
Q

Plts – Platelets

A

(aka Thrombocyte)

Major clotting blood cell

33
Q

Causes for increase in Plt count

A

~25% of increase d/t malignancy

  • Polycythemia vera
  • Splenectomy
34
Q

Pancytopenia

A

Decrease of WBC, RBC and Plt counts

35
Q

Etiology of pancytopenia

A
  • toxins
  • drugs
  • infection
  • myelodysplasia
  • malignancy
  • radiation
  • vitamin B12/folate deficiency
  • SLE (systemic lupus erythematosus
  • congenital causes
36
Q

Initial Anemia Lab Orders (4)

A

CBC
MCV
Blood Smear –(aka) peripheral smear
Reticulocyte Count

37
Q

What is a peripheral smear?

A
  • ID of every cell type present (looking for anything that is not common or normally present)
  • ID of Cell stage within the hemopoiesis cell line (certain cell stages are present in greater number with certain diseases/blood dyscrasias)
38
Q

Secondary Anemia Labs (5)

A
  • Iron Lab Studies
  • Hemoglobin electrophoresis – definitive diagnosis to confirm suspicion of thalassemia
  • Hemolysis lab studies
  • DIC Panel
  • Bone Marrow Studies
39
Q

Iron Lab Studies (9)

A
  • Serum Iron level
  • TIBC – total Iron binding capacity
  • % saturation
  • Ferritin level
  • Serum folate
  • Serum B12
  • TSH – thyroid stimulating hormone
  • Soluble transferrin receptor
  • Serum Erythropoietin
40
Q

Hemolysis

A

RBC is unable to maintain its intact structure

–> passage through circulation and reticuloendothelial system

41
Q

Hemolysis Lab Studies (4)

A
  1. LDH- lactase dehydrogenase
  2. Unconjugated Bilirubin- picks up hemolysis disease if haptoglobin is not decreased
  3. Haptoglobin- decreased with hemolytic anemia
  4. Coombs’ Test
42
Q

Positive Coombs test

A
  • Indicative of Ab presence on the RBC

- Causing an immune response hemolysis of RBCs and rejection reaction

43
Q

Negative Coombs test

A
  • Indicative of no Ab presence on the RBC

- Hemolysis cause is from inherited or congenital blood dyscrasia

44
Q

DIC panel

A
  1. D-dimer – fibrin degradation product (elevated)
  2. Plasma Fibrinogen (decrease)
  3. Platelet Count (decrease)
  4. PT (increase)
  5. PTT (increase)
  6. Blood smear
  7. Soluble fibrin monomer complex (increased with ongoing fibrinolysis)
45
Q

Bone Marrow Aspirate/Biopsy

A

Aspirate is fluid (slide smear) vs. Biopsy is tissue (frozen section slides)

46
Q

M/E Ratio (Myeloid/nucleated Erythroid cells) in bone marrow

A
  • Normal adult varies from 1.2:1 to 5:1
  • An increased M/E ratio (6:1) may be seen in infection, CML, or erythroid hyperplasia – increase in the reproduction rate of cells.

Heme/Genetics (15 decks)

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