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ECOS 3 Midterm > Lab Medicine Basics > Flashcards

Lab Medicine Basics Flashcards

1
Q

When would WBC be elevated?

A

Increased in:
Infections
Inflammatory diseases
Autoimmune Systemic disease: SLE, RA
Leukemia
Emotional, physical stress (“demargination”)

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2
Q

When would WBC be depressed?

A

Low in:
Bone Marrow failure: Sepsis., malignancies
Collagen Vascular Disease
Medications- antimetabolites, barbiturates, anticonvulsants, antithyroid

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3
Q

When would Hemoglobin be increased? (6)

A

Increased in:
Severe dehydration
COPD
Polycythemia, Erythrocytosis
Shock
CHF
High altitude

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4
Q

When would Hemoglobin be decreased? (6)

A

Decreased in:
Hemolytic reactions
Acute or Chronic blood loss
Pregnancy
Leukemia
Drugs
Hyperthyroidism, severe

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5
Q

Hematocrit usually follows Hemoglobin - examples?

A

Hemoglobin will typically be = hematocrit/3.

Ex: Hb 11, Hct 33

Ex: HB 5, Hct 15

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6
Q

When would platelets be increased? (4)

A

Increased in:
Essential Thrombocytosis
Myeproliferative states
Hemolysis
Acute inflammatory states as an acute phase reactant

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7
Q

When would platelets be decreased? (6)

A

Decreased in:
ITP
HIT
Aplastic anemia
Uremia
Hypersplenism
Bone Marrow Failure related to infection: sepsis

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8
Q

Low platelets signs and symptoms?

A

Easy bruising
Epistaxis
Hematuria
menorrhagia

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9
Q

Basic Metabolic Panel: Sodium is high

why?

A

Hypernatremia: Dehydration (loss of water), Cushings syndrome, Hyperaldosteronism, Advanced age, Pregnancy

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10
Q

Basic Metabolic Panel: Sodium is low

why?

A

Hyponatremia: diarrhea, vomiting, HF, Liver Failure (dilutional), SIADH

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11
Q

Basic Metabolic Panel: Potassium is low

A

Low: vomiting, diarrhea, metabolic alkalosis, diuretics, Decreased intake, renal dysfunction

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12
Q

Basic Metabolic Panel: Potassium is high

why?

A

High: AKI, CKD, Metabolic Acidosis, Drugs like ACEI and ARBS

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13
Q

Basic Metabolic Panel: Chloride is low

why?

A

Low: vomiting, excess sweating, SIADH, mineralocorticoid excess

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14
Q

Basic Metabolic Panel: Chloride is high

why?

A

High: diarrhea, ATN, mineralocorticoid deficiency, drugs

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15
Q

Basic Metabolic Panel: BUN is high

why?

A

High: Acute GN, PCKD, GI bleeding (breakdown of hemoglobin in gut), chronic nephritis, CKD

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16
Q

Basic Metabolic Panel: BUN is low

why?

A

Low: malnutrition, malabsorption, nephrotic syndrome, overhydration

17
Q

Basic Metabolic Panel: CR is low

why?

A

Low creatinine: Muscle wasting

18
Q

Basic Metabolic Panel: CR is high

why?

A

creatinine High: Renal dysfunction, Shock, dehydration, HF, increased body mass

19
Q

Anion gap

A

Anion Gap refers to concentration of unmeasured anions in blood such as protein, phosphate, sulphate, organic acids

AG = Na – (Cl + HCO3). Usual normal range
Can use serum BMP to estimate.

20
Q

What causes increased anion gap?

A

Increased: uremia, lactic acidosis, ketoacidosis, DKA, Rhabo, alcohol abuse, Drugs

*mnemonic* GOLD MARK.

Glycols (ethylene and propylene), Oxoproline, L-lactate, D-lactate, Methanol, Aspirin, Renal failure, and Ketoacidosis

21
Q

What causes decreased anion gap?

A

Low: cirrhosis, nephrotic syndrome, hemorrhage, lithium intoxication

22
Q

Serum iron test

A

Iron can be measured in serum (preferred) or plasma. The test measures circulating iron, most of which is bound to the transport protein transferrin.

23
Q

If Serum iron is low, why?

A

in iron deficiency as well as in anemia of chronic disease/anemia of inflammation (ACD/AI).

By itself, low serum iron is not diagnostic of any condition but must be evaluated in light of other tests such as transferrin saturation and ferritin.

24
Q

Serum transferrin

A

Transferrin is a circulating transport protein for iron.

25
Q

Why would serum transferrin be increased? decreased?

A

increased in iron deficiency

decreased in ACD

26
Q

Transferrin saturation – Transferrin saturation (TSAT)

A

TSAT is the ratio of serum iron to TIBC: (serum iron ÷ TIBC x 100).

27
Q

In iron deficiency, Fe is high/low?
TIBC is increased/decreased?
transferrin saturation is high/low?

A

In iron deficiency, iron is reduced and TIBC is increased, resulting in a lower transferrin saturation.
•Normal values are in the range of 25 to 45 percent

28
Q

Serum ferritin

A

Ferritin is a circulating iron storage protein that is increased in proportion to body iron stores.

A very low ferritin level is diagnostic of iron deficiency

29
Q

High TSH, Low free T4 and T3 = dx?

A

Hypothyroidism

The TSH is trying to stimulate more hormone production, but it is not working!
If there were more hormone in the system, there would be feedback to the anterior pituitary saying, “We’re good, no need to put out more stimulating hormone!”

30
Q

A 65-year-old woman with worsening dyspnea on exertion, fatigue, dizziness, and palpitations. She is found to have conjunctival pallor and guiacpositive stools.

DDx?

A

Unstable angina
Congestive Heart Failure
Hypothyroidism
Atrial fibrillation
Anemia

31
Q

A 65-year-old woman with worsening dyspnea on exertion, fatigue, dizziness, and palpitations. She is found to have conjunctival pallor and guiacpositive stools.

How would we work this patient up?

A
  • CBC -anemia
  • ECG - A-fib, CHF, New onset unstable angina
  • Cardiac enzymes - unstable angina
  • BNP (Brain natureticpeptide)/CXR - CHF, pulmdisease
  • PT & PTT- coagulation
32
Q

How to evaluate cell appearance?

A

Peripheral smear

33
Q

How to determine the type of anemia?

A

Iron studies, VitB-12, folic acid levels

34
Q

How to investigate the source of GI blood loss?

A

GI consult for possible EGD and colonoscopy

35
Q

Weight loss, lymphadenopathy, and coagulopathy may be an indication of non-gastrointestinal malignancies, such as…?

A

leukemias or lymphomas

36
Q

Younger patients with anemia, consider…

A

sickle cell disease, thalassemias, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and other inherited causes of anemia

37
Q

presence of epigastric and LUQ abdominal pain, along with long-term use of NSAID’s, raises a flag for …?

A

testing to rule out a bleeding ulcer

38
Q

most common cause of anemia in elderly?

micro-/normo-/macrocytic?

A

anemia of chronic inflammation

usually microcytic-normocytic

39
Q

All anemias presenting with hemodynamic instability can improve with…

A

RBC transfusions

ECOS 3 Midterm (14 decks)

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